Challenges of using healthcare wearable technology

Usability issues that curb adoption

The digital divide -- the gap between those with access to technology and the digital literacy to use it -- is a common barrier to healthcare technology utilization. The barrier extends to healthcare wearable devices, with one survey showing that one in five patients finds using their devices challenging.

The survey, conducted in January 2022, polled 450 U.S. patients who used medically prescribed wearable devices. Though a majority of survey respondents (86%) said that wearable devices improved their health and quality of life, 20% said that their wearable device was hard to use.

Further, most patients (87%) who used wearable devices that required manual data entry had recorded inaccurate data at some point. When asked why the data recording was incorrect, 54% said the instructions on inputting data were unclear, 31% said the device interface was confusing and 15% said the device malfunctioned. More than half of the patients (65%) said they had to contact their doctor's office to correct the issue.

These challenges can adversely affect wearable device adoption. A review of 20 studies published in 2022 noted that wearable device users might become frustrated by perceived inaccuracies and even stop using them. Overcoming the barriers to use, particularly by improving device accuracy, will be critical to ongoing engagement with healthcare wearable technology.

Widening existing healthcare disparities

The digital divide and other social determinants of health that prevent underserved and vulnerable communities from using healthcare wearable technology could significantly widen healthcare inequities.

For instance, research published in 2023 shows that though 42% of Americans with or at risk of cardiovascular disease (CVD) use healthcare wearable technology, those at higher risk of developing the disease are less likely to use the tools. For the study, researchers examined 16,092 adults, of whom 10,660 had CVD or were at risk of CVD between 2017 and 2020.

They found that among individuals with or at risk of CVD, those with obesity and hypertension and those who smoked cigarettes reported lower use of smart devices to track health goals. Older people and men were also less likely to own a smart device or use it to improve their health, even though they were more likely to develop CVD.

This highlights the risk that certain populations could get left behind as wearable technology becomes increasingly integrated into healthcare.

Another 2023 study that evaluated 933 CVD patients found that Hispanic and Black patients are less likely to use healthcare wearables compared with their white peers.

Pediatric populations face similar gaps in wearable technology adoption. A study published in 2023 revealed that pediatric patients from racial and ethnic minority groups wore wearable devices for a significantly shorter period than white patients. The study assessed patients' willingness to use wearable devices and related health research among 10,414 pediatric patients. Though the median device wear time was 400.7 hours across the patient population, the median for Black patients fell below 300 hours.

The gaps in wearable device adoption and use could stem from device development. An article published in 2022 highlighted biases in wearable devices and sensors resulting from a lack of diverse study populations. The article stated that a 2022 demographic analysis of studies that included participants using their own wearable devices found preferential enrollment of white participants compared with participants from minority groups.

The lack of diversity in studies can result in wearable devices unsuited to different skin types. Research published in 2021 underscored that consumer-facing healthcare wearable technology, such as Apple Watches and Fitbits, use photoplethysmographic (PPG) green light signaling, which might not work as well on dark-skinned people. The researchers explained that blood readily absorbs green light, which enables the device to measure the volume of blood present and the user's heart rate. But skin tone affects light absorption, which could result in inaccurate measurements for people with darker skin tones.

Further, researchers have found that data collected from arterial blood oxygen readings and pulse oximeters differed for Black and white patients, prompting the FDA to release a draft guidance to improve the performance and accuracy of pulse oximeters.

Potential for negative impacts on health

While most healthcare stakeholders believe healthcare wearable technology improves health, research has noted some downsides that could have an adverse effect on health.

A study published in 2024 revealed that wearable device use is associated with pathologic symptom monitoring and excessive preoccupation with symptoms among patients with heart disease. The study included 172 patients with atrial fibrillation (AFib) receiving treatment between Dec. 1, 2022, and Feb. 27, 2023. Of the patient population, 83 used a healthcare wearable device.

The researchers found that 15% of wearable device users felt anxious, scared or concerned in response to wearable alerts for high and low heart rates, and 20% said they always contacted their doctors in response to irregular rhythm notifications. Additionally, 45% of users reported checking their heart rate or performing an electrocardiogram (ECG) daily, and 19% reported using heart rate and rhythm monitoring features in response to cardiac symptoms.

Not only that, but healthcare service use to treat AFiB was significantly greater among wearable users than non-users.

Healthcare providers have also voiced concerns regarding the integration of wearable technology data into care. While most healthcare consumers believe incorporating this data would encourage them to make healthier choices, healthcare providers worry that it would create distance between providers and patients.

In a series of qualitative interviews in 2020, providers stated that wearable technology allows them to gain healthcare information from sources other than the patient directly, creating distance in the critical provider-patient relationship, which "has implications on responsibility and accountability for information collected and the subsequent decisions and actions taken, or missed."

Further, providers noted that the wide availability of data to a range of individuals and entities, including device companies and family members, "may disrupt the traditional hierarchy of specialist information processing through health care professionals" and provide information to healthcare consumers out of context.

Data privacy and security risks

Data privacy and security are some of the most pervasive concerns regarding healthcare wearable technology adoption and use.

A 2022 survey shows that 40% of 2,005 healthcare consumers are worried about data security regarding their wearable devices. Similarly, in a 2023 survey of 876 U.S. healthcare consumers, 82 respondents said they did not want to share healthcare wearable device data with their physician. Of these respondents, 63% said they wanted to keep the data to themselves for privacy reasons, and 41% said they were worried about potential data breaches.

Healthcare consumers have cause to be concerned. In 2021, 61 million fitness tracker records from both Apple and Fitbit were exposed online in a wearable device data breach. The data breach occurred at GetHealth, a New York-based health and wellness company that allows users to unify their wearable device, medical device and app data. The database was not password-protected, and the information was identifiable. Fitbit was listed in over 2,700 records, and Apple's HealthKit was mentioned over 17,000 times.

Further, it is unclear how HIPAA applies to healthcare wearable technology. Researchers from the University of Texas at Austin laid out some of the loopholes in wearable device data privacy in a 2024 research article. They noted that wearable health monitoring devices not only fall outside of FDA oversight, but the data generated by devices for commercial use are also not covered under HIPAA regulations, which could "raise privacy risks and potentially infringe upon individuals' privacy rights."

As healthcare wearable technology adoption continues, healthcare providers and consumers must address these challenges to capture the diverse benefits that these technologies can offer.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.