OCTOBER 16-18, 2019



October 16-18, 2019 | Boston, MA

Designing for Digital Health Inclusion

By: Lisa Gualtieri, PhD, ScM

Grrrr. grrrr… the sound of happiness! Last night I set my new coffee maker’s timer to go off this morning. Fresh coffee was the reward for my strong digital literacy skills – and persistence. But, rather than discussing the health benefits of coffee, let’s examine the impact of low digital literacy skills in older adults, one of the populations who can benefit most from digital health innovations.


I became aware of this issue in my research on wearable activity trackers and older adults. We recruited people aged 50-75 who owned a smartphone, gave them a tracker, and provided assistance, as needed, to help them set up the trackers and feel comfortable with their use. While the goals of our studies were not centered around digital literacy, this became an emergent goal when we learned that participant need for help was more extensive than anticipated.


One major barrier to successful tracker use was that some participants owned older generation smartphones or had pay-as-you-go smartphone plans that prevented them from downloading apps. Another barrier was that some participants had never downloaded an app themselves. We realized that, with the growing penetration of smartphones, it is important to not make assumptions that owning a smartphone equates to being able to fully utilize it.


Another barrier we discovered was in app design. The trackers we distributed had an associated app, and, once downloaded, we found many features that were difficult for some older adults to understand or use, or that were unintentionally discouraging. An example of a discouraging app feature was the scrolling list to enter one’s date of birth, which some participants said made them feel old since they had to start at the current year and scroll past so many years. Another discouraging feature was the daily step goal. The default for most trackers is set at 10,000 steps, which is more than what many older adults can manage, yet some participants didn’t know it could be changed nor was there guidance for a more manageable initial step goal. Yet another example was when participants reached the message “sync with Bluetooth” and were perplexed by what that meant.


Along with the need for digital literacy skills, we also learned that many older adults were excited about the use of trackers but had not purchased one themselves. While cost and choice confusion were barriers, the way trackers are marketed – to younger, healthier, spandex-clad individuals – was a deterrent. Furthermore, some older adults found that their health inadvertently affected their tracker use. For instance, being overweight meant the band did not fit, or the material of the band caused the sweat from menopause to give them a rash.


Older adults in our studies were excited to adopt and use trackers with our high-touch approach to assistance. Successful engagement was high; participants reported that trackers provided a visual reminder of their commitment to increase their physical activity levels. Furthermore, they reported that small changes in daily routine, such as using the stairs instead of the elevator, were easier to commit to.


In 2017, more than 318,000 mHealth apps were available to download and more than 113 million wearable activity trackers were shipped worldwide. Yet these consumer health technologies are largely designed for highly digitally literate people.


We need to identify and remove these barriers for existing digital health technologies. Better yet, let’s design for successful initial use by older adults – which will lead to technology that’s easier for everyone to set up and use. As Dr. Joe Kvedar, Vice President of Connected Health, Partners HealthCare, says, you have one shot at success. Why lose people, especially ones who may benefit from digital health innovations? No matter how a person learns about and decides to use a digital health technology, the focus should be on taking positive steps toward being healthier, not feeling discouraged because of an inability to decipher “sync with Bluetooth”. We’ve all had experiences like mine, where I was pleasantly surprised that I woke to the sound of grinding coffee beans; let’s design technologies to be easier to use so that more people can be successfully reached.


Lisa will be moderating a panel session, Designing for Equity, at the 10th Annual Connected Health Conference.


Lisa Gualtieri, PhD, ScM, is Assistant Professor at Tufts University School of Medicine, Department of Public Health and Community Medicine, where she directs the Certificate in Digital Health Communication. Lisa is Founder of RecycleHealth, a non-profit that collects wearable activity trackers and provides them to underserved populations. Lisa is on Twitter as @lisagualtieri.




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