Benefits of digital fitness trackers don’t trickle down to low-income people
“The people who need this material the most are the least likely to receive it.”
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Technologies such as smartwatches, mobile apps, and websites have been touted as an accessible and effective way for people to monitor and increase their physical activity and improve their health. But new analysis has found that this is only really true for people of high socioeconomic status. As in many other areas of health care, the poorest people seem to see little or no benefit from these digital interventions.
“Even though people may have the same access to these interventions, we still see this pernicious law of reverse care – the people who need it most are the least likely to receive them effectively,” said Mark Kelson, who studying health statistics at the University of Exeter in the UK
Kelson and his colleagues analyzed data from 19 different studies conducted around the world between 1990 and 2020 that looked at digital interventions designed to help increase physical activity and improve health. They then compared how the interventions affected people of higher and lower socioeconomic status, and found what Kelson calls one of the clearest and strongest results he has ever seen in his career. For those of high socioeconomic status, there was a moderate positive effect – those who received the interventions increased their physical activity by approximately 1,500 to 2,500 steps per day compared to those who did not receive the interventions. ‘interventions. But there was virtually no effect in people of lower socioeconomic status. The results were published this month in the International Journal of Behavioral Nutrition and Physical Activity.
This is the kind of result that “sows fear in the hearts of behavioral interventionists,” Kelson said, as health needs are much greater in economically disadvantaged groups – the poorest people tend to be. less active and have more health problems than the richest. . So, in this case, those who need help the most are those who get the least benefit, while those who need it least are stimulated the most. “Everyone wants to increase physical activity to improve public health,” he said. “But even with the best of intentions, we might end up increasing health disparities. We really need to be careful of the socio-economic divide.”
The study did not examine why people of lower socioeconomic status with the same access to an intervention like a step counter and an associated fitness app would achieve fewer benefits. But Kelson assumes that there are probably a few overlapping reasons for the disparity. Poorer people tend to have less free time for leisure activities, which is the category of physical activity associated with the greatest number of health benefits, so they have less ability to enjoy the benefits. digital exercise-focused interventions. And people of lower socioeconomic status also tend to be less familiar with the use of digital technologies involved in these interventions, which affects how they engage with them, the researchers wrote in the article.
The first step in overcoming this digital divide is for researchers to recognize it and then explore it more systematically in their studies, Kelson said. But they should also think about how they design their interventions and look for ways to make technology more accessible and useful to the poorest people.
Lucy Yardley, a health psychologist at the University of Bristol, said a more person-centered approach to designing digital health interventions can help reduce disparities in outcomes between socio-economic classes. This means that public health experts must work hard to understand the barriers their subjects face and constantly revise the intervention until those barriers disappear.
These adjustments can be as simple as changing the language used. Most digital fitness interventions are written for an average reading level of college graduates, for example, which can make them more difficult for people with less literacy. Or they may lack clear definitions of terms. In a project to increase physical activity in people with diabetes who had lower health literacy levels, Yardley found that many misunderstood what counted as “moderate intensity” exercise and grasped much higher activity levels in the planner, and thus getting bad advice as a result.
Other adjustments may involve facing barriers of time, money or location, Yardley said. Instead of suggesting a long walk in a park that might not be accessible, the researchers might come up with simple exercises that people can do at home in front of the television, with a few cans. “You have to start with the person in their context, understand their needs and motivations, and build the response around that,” Yardley said.
Kelson said removing socio-economic barriers will also benefit researchers who design and study the interventions. When some study subjects do not get any benefit, averaging the result over all participants ends up reducing the effect you would see under ideal conditions.
“We need to come up with something that is accessible to a large group of people, but a different set than most activity interventions are aimed at,” Yardley said.
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