“The people who need this stuff the most get it the least.”
November 28, 2021, 1:06 pm
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Technologies such as smartwatches, mobile apps and websites have been touted as accessible and effective ways for people to monitor and increase their physical activity and improve their health. But a new analysis has shown that this really only applies to people with a high socio-economic status. As in so many other areas of health care, poorer people seem to see little to no benefit from these digital interventions.
“Even though people have equal access to these interventions, we still see this pernicious inverse law of care – the people who need this stuff most will get it the least effectively,” said Mark Kelson, who studies health statistics at the University of Exeter in Great Britain
Kelson and his colleagues analyzed the data from 19 different studies conducted worldwide 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 describes as one of the clearest and most robust results he has ever seen in his career. For people of high socioeconomic status, there was a moderate positive effect – those who received the interventions increased their physical activity by around 1,500 to 2,500 steps per day compared to those who received no interventions. However, there was practically no effect in people of lower socio-economic status. The results were published this month in the International Journal of Behavioral Nutrition and Physical Activity.
The Fitbit Sense Health Smartwatch can be seen at the Fitbit booth at the IFA 2020 Special Edition trade fair for consumer electronics and household appliances on September 3, 2020 in Berlin.
This is the kind of result that “behavioral interventionists fear to the heart,” Kelson said, because health needs are much greater in economically disadvantaged groups – poorer people tend to be less active and have more health problems than richer ones. In this case, the people who need help most benefit the least, while those who need it least receive more support. “Everyone is interested in increasing physical activity to improve public health,” he said. “But even with the best of intentions, we could end up widening health inequalities. We really need to watch out for the socio-economic divide.”
The study did not investigate why people with a lower socioeconomic status would benefit less with the same access to an intervention such as a pedometer and a related fitness app. However, Kelson speculates that there are likely some overlapping reasons for the inequality. Poorer people tend to have less free time for recreational activities, which is the category of physical activity associated with the most health benefits, leaving them fewer opportunities to use digital interventions with an emphasis on exercise. And people with a lower socioeconomic status are also typically less familiar with the use of the digital technologies used in these interventions, which affects how well they deal with them, the researchers write in the paper.
The first step in bridging this digital divide is for researchers to acknowledge it and then examine it more systematically in their studies, Kelson said. But they should also consider how to shape their interventions and look for ways to make technology more accessible and useful to poorer people.
Lucy Yardley, a health psychologist at the University of Bristol, said a more person-based approach to designing digital health interventions could help narrow the disparities in outcomes between socio-economic strata. This means that public health professionals must work hard to understand what obstacles their subjects encounter and constantly revise the intervention until those obstacles are removed.
These tweaks can be as simple as changing the language used. For example, most digital fitness interventions are written for an average graduate reading level, which can make it harder for people with lower reading and writing skills to engage with. Or there are no clear definitions of terms. In a project aimed at increasing the physical activity of people with diabetes with lower health literacy, Yardley found that many people had misunderstood what was considered “moderate intensity” exercise and put a lot more activity into the planner and so the consequence is wrong advice.
Other tweaks can include dealing with time, money, or location barriers, Yardley said. Instead of suggesting a long walk in a potentially inaccessible park, researchers could offer simple exercises that people can do at home in front of the TV with a few cans of food. “You need to start with the person in their context, understand their needs and motivations, and base the intervention on them,” said Yardley.
Kelson said removing socio-economic barriers will also benefit the researchers who design and study the interventions. If some study participants do not get benefit, then averaging the result across all participants will ultimately reduce 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 different from what most activity interventions are aimed at,” said Yardley.
Inside Science is an editorially independent, nonprofit print, electronics, and video journalism news service owned and operated by the American Institute of Physics.
