COVID-19 Pandemic Increased Interest, Exposed Design Biases of Wearables in Vulnerable Populations

The COVID-19 pandemic boosted interest in wearing mobile health wearable devices among low-income Hispanic and Latino adults living in the US, but simultaneously exposed design biases of the technologies, according to research published in the Journal of Medical Internet Research.¹

The COVID-19 pandemic spurred a focus on personal health, particularly for vulnerable populations at greater risks of severe infection. However, these communities often faced barriers such as a lack of infrastructure and mistrust in the medical system that blocked access to essential care. As a result, many turned to wearable devices—which offer community members the ability to self-manage health data and reduce reliance on traditional health care providers—as a solution.

But despite their potential benefits, several challenges hinder widespread adoption of wearables among these vulnerable communities, as they are typically designed with predominantly White, affluent, populations in mind.

“Current designers do not consider the needs of low-income people of color regarding usability, accessibility, and affordability,” said Stefany Cruz, lead investigator from Northwestern University, in a news release.² “If this trend continues, it will worsen digital and health inequities…We need to build devices that are more inclusive, and the design process should consider the context and culture of individuals from marginalized communities.”

To understand the health disparities associated with wearables, investigators took a 3-pronged approach to conducting the current study. They aimed to understand how members of low-socioeconomic status (SES) communities perceive wearable devices, identify the barriers and facilitators toward adoption, and recommend design requirements to enable equitable access and accommodate for the needs of low-SES communities.

Investigators recruited 19 adults from low-SES communities in Los Angeles and Chicago who completed 2 separate rounds of interviewing between December 2021 and March 2022.

The first round of interviews addressed participants’ general needs and expectations for wearables, and the second round focused on participants’ views of wearables, their opinions on the general health and well-being of people in their neighborhood, the impact of COVID-19, and the types of health information considered by participants to be useful.

After analyzing 21 hours of interview footage, investigators gleaned common themes associated with participants’ post-pandemic attitudes toward wearables.

READ MORE: CGM Education Needed to Promote Equitable Diabetes Care

Seven participants who experienced lingering effects from COVID-19 reported having a newfound interest in how self-managing health data, such as monitoring oxygen levels, could be beneficial to their condition. Further, participants highlighted a critical lack of health care resources and infrastructure in their communities, especially during the COVID-19 pandemic, that led them to consider using wearables as practical alternatives to seeing providers in person.

All participants—even those that had access to health care resources like small clinics in their communities—reported that a lack of health care coverage was another stressor to accessing care. High medical expenses, coupled with a distrust of the health system, made “seeking medical help unfeasible,” according to 1 participant, increasing interest in self-management via wearables.

When asked about design recommendations, participants emphasized the need for developers to focus on durability, autonomy, and affordability, to meet the needs of their communities. Durability was a major concern because “most of the population…tend to work in more physically demanding environments,” and therefore need their tech to last. Data privacy was also a concern, with participants expressing uncertainty about where their health information was being sent. Finally, affordability was paramount due to the community’s low-income status.

Although participants expressed strong interest in using wearable devices, investigators noted how the needs of members of low-income SES communities are often excluded from their design, citing past research showing that patients who identified as Black were 3 times more likely to be incorrectly classified as having pulse oximeter readings than White counterparts.³

What’s more, according to the CDC, non-Hispanic Black or African American people and Hispanic people were about twice as likely to need to stay in the hospital due to COVID-19 infection than non-Hispanic White people early in the pandemic.⁴

This data becomes especially concerning, investigators noted, when considering how low-SES communities are already disproportionately impacted by inadequate health care access.

“During COVID-19, my community suffered a lot,” Cruz said.² “Some people have been able to brush it off and move on, but some of us are still scarred. We lost family members that probably would still be alive if they weren’t infected. Many people have long-COVID symptoms, which wearables also could help monitor. As these technologies get better at sensing vital signals, they also should become more inclusive.”

Investigators recommended 2 solutions to promote equitable access to wearables: develop new embedded electronic sensors in wearables and clinical tools that do not perpetuate racial disparities; and ensure that the algorithms deployed for signal processing and machine learning do not perpetuate bias.

“The insights from this study serve as a first step for researchers and technology companies in the domain of wearable technology to develop tools that account for the contextual and cultural perspectives of low-SES communities to help democratize the utility of wearable devices,” concluded investigators.

READ MORE: Public Health Resource Center

References

1. Cruz S, Lu C, Ulloa M, Redding A, Hester J, Jacobs M. Perceptions of wearable health tools post the COVID-19 emergency in low-income Latin communities: Qualitative study. JMIR Publications. 2024;12:e50826. doi: 10.2196/50826

2. COVID-19 pandemic changed attitudes toward wearables. EurekAlert. News release. May 8, 2024. Accessed May 8, 2024. https://www.eurekalert.org/news-releases/1043861

3. Sjoding MW, Dickson RP, Iwashyna TJ, Gay SE, Valley TS. Racial bias in pulse oximetry measurement [published correction appears in N Engl J Med 2021 Dec 23;385(26):2496]. N Engl J Med. 2020;383(25):2477-2478. doi:10.1056/NEJMc2029240

4. Robertson MM, Shamsunder MG, Brazier E, et al. Racial/ethnic disparities in exposure, disease susceptibility, and clinical outcomes during COVID-19 pandemic in national cohort of adults, United States. Emerg Infect Dis. 2022;28(11):2171-2180. doi:10.3201/eid2811.220072