The digital drug delivery ecosystem is set to continue expanding beyond fitness apps and connected drug delivery devices. Wearable technology for the monitoring of digital biomarkers will play a key role in this expansion and will set the direction for the future of digital health. Wearables can complement established treatment options and provide data and insights into patients’ wellbeing.
How close are we from seeing this vision materialise? What are the obstacles digital ecosystem developers must overcome in order to make body-worn sensors a valuable tool for patients and healthcare professionals?
Current evidence suggests that the use of wearable sensors achieves low long-term engagement among users. A report by Ledger and McCaffrey indicates that approximately a third of users discontinue the use of their wearable device approximately six months after initiation.
The use of monitoring devices, albeit very established, is often not easily accepted by patients. To better explain this point I will refer to the monitoring of diabetes. Diabetes patients monitor frequently their blood glucose levels and have been doing so for many years as blood glucose monitors for POC testing have been available for many years. In particular, diabetes patients belong to a segment that is being showered by data from the first day of diagnosis since, in theory, they monitor their condition very often. One would have thought that if you have the means (blood glucose meters) and a reasonably well-defined marker (glucose), keeping the disease under control would be a reasonable expectation. The answer is no. A few years back, O’Kane M et alshowed in a study that the efficacy of self-monitoring of blood glucose in patients with newly diagnosed type 2 diabetes is not high.
Why do patients fail to engage with such monitoring tools which are designed to help the management of their condition and even empower them to take things into their own hands? A recent study that assessed several tools designed to encourage medication adherence in older adults – a major area of focus for mHealth developers – found that the most common descriptors participants used to describe their experience with the devices were “frustrating” and “challenging” (Grindrod AK and Li M, Gates).
What needs to be done?
Unless wearables for digital biomarkers are used consistently for the indicated period of time, it is unlikely that they will make any impact on the management of disease. Wearable designers and manufacturers should not underestimate that patients share little common ground with typical users of fitness apps and fitness wearables. It’s likely that patients won’t want to be reminded of their condition; they may not want to engage with the treatment of their disease. Wearable device developers will need to dig deep and understand the attitudinal and behavioural fingerprint of their intended users. Only then will they stand a chance of developing meaningful devices which will be accepted by the intended users.
For any medical device – or even a consumer product – to succeed, it has to offer improved user experience. Monitoring of digital biomarkers will only succeed if patients stop considering the monitoring process extra work. In a recent conference, Mark Lightowler, ex-Novartis and now CEO at Phorix, interestingly described how wearables should become “invisibles” to stand a chance of high and sustainable levels of adoption.
Wearable monitoring device developers must not only come up with user-friendly devices and apps but also solutions that are self-reinforcing and enjoyable to use. This might be accomplished with the use of incentives, gamification and the integration of social networks to promote the added value of wearables among peers or family members. In addition, the digital ecosystem will have to be designed in harmony with intended users and stakeholders to encourage habit formation among patients, stimulate social motivation and provide a way of reinforcing goals.
 Ledger, D.; McCaffrey, D. Inside wearables: How the science of human behavior change offers the secret to long-term engagement. Endeavour Partners LLC; 2014 Jan. http:// endeavourpartners.net/assets/Wearables-and-the-Science-of-Human-Behavior-Change-EP4.pdf
 O’Kane MJ, Bunting B, Copeland M, Coates VE. Efficacy of self-monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): Randomised controlled trial. BMJ. 2008; 336:1174–1177. [PubMed: 18420662]
 Grindrod AK, Li M, Gates A. Evaluating user perceptions of mobile medication management applications with older adults: A usability study. JMIR Mhealth Uhealth. 2014; 2:e11. [PubMed: 25099993]