Experiences of Wearable Technology by Persons with Knee Osteoarthritis Participating in a Physical Activity Counselling Intervention: A Qualitative Study Using a Relational Ethics Lens (Preprint)

BACKGROUND Current evidence indicates physical activity wearables could support persons with knee osteoarthritis (OA) to be more physically active. Recent evidence also identifies, however, some persons with arthritis experience guilt or worry while using a wearable if they are not as active as they feel they should be. Questions remain around how persons with knee OA experience benefits or downsides in using a wearable in their everyday lives. Better understanding is needed if wearables are to be incorporated in arthritis self-management in ways that are ethically aware. OBJECTIVE Using an ethics lens, describe a range of experiences from persons with knee OA who used a wearable during a physical activity counselling intervention study. METHODS This is a secondary analysis of qualitative interviews (60-90 mins) nested within a randomized controlled trial (RCT). Guided by phenomenography, we explored the experiences of persons with knee OA, following participation in a physical activity counselling intervention. The intervention consisted of a 1.5-hour education session about physical activity, using a Fitbit Flex, and receiving 4 biweekly phone calls for activity counselling with a study physiotherapist (PT) in an 8-week period. All PTs were trained in the Brief Action Planning approach, whereby they guided participants to identify activity goals, develop an action plan, and identify barriers and solutions. Benefits or downsides experienced in participants’ relationships with themselves or the study PT when using the wearable were identified using a relational ethics lens. RESULTS Interviews with 21 participants (12 females, 9 males) aged 40-82 years were analyzed. Education ranged from high school graduate (n=4) to bachelor’s degree or above (n=11). Three categories of description were identified: 1) Participants experienced their wearable as a motivating or nagging influence to be more active, depending on how freely they were able to make autonomous choices about physical activity in their everyday lives; 2) Some participants felt a sense of accomplishment from seeing progress in their wearable data, which fuelled motivation. One participant experienced negative emotions (e.g., self-blame) if his wearable data indicated physical activity goals were not met; 3) For some participants, sharing wearable data helped to build mutual trust in their relationship with the study PT. They also expressed, however, there was potential for sharing wearable data to undermine this trust, particularly if this data was inaccurate. CONCLUSIONS To our knowledge, this is the first qualitative study that uses a relational ethics lens to explore how persons with arthritis experienced changes in their relationship with a health professional when using a wearable during research participation. Findings also provide an early glimpse into positive and negative emotional impacts of using a wearable that can be experienced by participants with knee OA when participating in an RCT to support physical activity.