Sociodemographic and health-related factors are associated with long-term use of digital health devices, according to a study published in npj Digital Medicine.

Researchers followed a cohort within the long-running and ongoing Framingham Heart Study that used three digital components: a smartphone app, a blood pressure cuff and a smartwatch. 

Participants received app-based surveys at enrollment and every three months. Step count and heart rate data were collected daily from the smartwatch, while blood pressure measurements were taken weekly. During in-person exams, researchers collected sociodemographic information as well as data about health status and behaviors.

The study found that older age (55 years and above) was associated with higher use of each device over the yearlong follow-up period. Women and participants with higher levels of education were more likely to complete the app surveys. Higher scores for depressive symptoms and lower-than-excellent self-rated health were linked to lower smartwatch use. 

"These results help to identify subgroups that may benefit from additional support to maintain long-term use of digital devices in future clinical studies and population-based remote monitoring for clinical purposes," the researchers wrote. "For example, with this knowledge, researchers and clinicians can begin to understand the barriers to adherence and formulate strategies to assist and motivate persons with higher depressive symptoms and lower self-rated health status to maintain engagement and avoid attrition."

THE LARGER TREND

Since the cohort was nested within the larger Framingham Heart Study, the authors said they were able to investigate a number of factors that could have impacted long-term device use. Other strengths of the research include the long follow-up period, a larger focus beyond specific chronic conditions, and no financial incentives to enroll patients. 

However, the researchers found some limitations to the study. The cohort's participants owned smartphones, and many were white, educated, reported excellent health and lived in the New England region. Findings from this group may not be generalizable to more diverse samples.

Digital health tools are valuable for tracking study participants or remotely monitoring patients, and the study's authors said their analysis could provide insight into which populations may need extra support.

"Digital health technologies provide opportunities to transform the delivery of clinical care and optimize clinical research. The transformation of healthcare has been accelerated during the COVID pandemic as patients increasingly wish to utilize remote or telemedicine tools," they wrote. "To realize the benefits of digital technologies, strategies to address the challenges with user attrition and long-term engagement need to be developed."