The chronic disease burden is continuing to rise – with record numbers being diagnosed with conditions including cardiovascular disease, diabetes, cancer, chronic respiratory disease and mental illness. In developed countries, chronic diseases are often the most expensive health conditions to treat and they account for more than 60% of deaths worldwide. An increase in physical activity has been identified by the World Health Organisation as a way to help reduce the global chronic disease burden. There may be an opportunity to use wearable activity trackers to encourage an improvement in people’s health-related behaviours.
A behavioural change approach could reduce the disease burden through preventative strategies. With the rising popularity of wearable health tech, these devices could be used as part of intervention strategies to increase physical activity levels and encourage improvements in other positive behaviours by encouraging people to develop healthier lifestyle habits.
However, current evidence on effectiveness of wearables for bringing about behavioural change is inconclusive. Some insurers who have promoted the use of wearables among their policyholders have reported evidence that supports the use of wearables for behavioural change. They found that incentives can improve health engagement and reduce healthcare costs. For example, one insurer reported a decrease in medical costs for chronic diseases in those aged over 50 who engaged with physical activity trackers, and another insurer found a decrease in sickness absence in the workplace for those engaging with wearable health technology.
Nevertheless, the peer-reviewed research on the effectiveness of incentive-based wearables programs is less conclusive. A recent meta-analysis identified 16 high-quality randomised controlled trials that assessed the effects of using wearable biosensors on clinical outcomes. The study found no statistically significant impact of remote patient monitoring on BMI, weight, waist circumference, body fat percentage or blood pressure. Also, only 3 of the 16 peer reviewed studies were for 12 months or longer, pointing to a current lack of longitudinal research in this area. An increase in long-term research in this field could therefore help to improve the scientific understanding of the potential roles for wearable health tech to be used for incentivising sustained positive changes in health-related behaviours.
In the absence of further detailed long-term research in this area, one possible explanation for these inconclusive findings to date can be found by drawing on motivational theories of behaviour that look at the most effective ways to encourage sustained behavioural change.
One popular motivational theory, self-determination theory, suggests that extrinsic motivators aren’t effective at bringing about long-term sustained changes in behaviour. Extrinsic motivators are external rewards such as money and other rewards.
This theory suggests that extrinsic motivators aren’t likely to be effective at bringing about long-term sustained changes in behaviour. This may be problematic for those who want to use wearables to incentivise improvements in lifestyle habits. Currently companion apps with physical activity trackers appeal predominately to extrinsic motivation through the use of tools such as leaderboards and digital rewards. Moreover, some insurers are also giving extrinsic rewards such as discounted premiums and free gifts to those policyholders who reach specified activity goals such as walking a certain number of steps each day.
Fortunately, the other side of self-determination theory focuses on the intrinsically motivating stimuli and it suggests that these may be more effective in bringing about long-term sustained changes in behaviour. Intrinsic motivators explain the virtues of the underlying behavioural change and tailor lifestyle changes to the individual. An example of this would be the use of a health coach or personalised health coaching app to explain to an individual why they should try to change their behaviour and to help them set and attain realistic goals that enable them to incrementally improve their lifestyle choices.
There may therefore be an opportunity to use internally motivating strategies that educate people about the health virtues of making lifestyle improvements. For example, health coaching apps could explain that increased physical activity brings benefits such as weight loss, improved fitness and reduced risk of chronic diseases. This could be used in conjunction with personalised goal setting that helps an individual to set realistic activity targets based on their own level of fitness.
Moving away from physical activity, another example is the use of health technology to help those with diabetes to more tightly control their blood sugar levels. An intrinsically motivating strategy would educate and coach those with diabetes about how to use the technology on offer to achieve better blood sugar control and explain how doing this could reduce the risk of developing health complications. A more technologically advanced example is the use of virtual reality to drive health improvements. Use of virtual reality to simulate real-life situations has shown promise in reducing anxiety disorders and other conditions such as eating disorders and schizophrenia. With further developments in augmented reality on the horizon, this could allow educational opportunities in real-time that dynamically guide users towards positive lifestyle changes that help to facilitate improvements in a person’s mental or physical health by making small incremental changes in their day-to-day behaviour.
To successfully integrate wearable health tech into society in a way that could help to reduce the disease burden, collaboration with a wide range of stakeholders is likely to be needed. This includes healthcare providers, insurers, IT developers and policymakers. Together these stakeholders could help to build an ecosystem that intrinsically motivates people to improve their lifestyle habits by supporting them through incremental health and lifestyle changes.
Actuaries could play a pivotal role in the use of wearable technology to improve health. They could help to implement a data driven approach to the use of this technology by using statistical and machine learning techniques to analyse the data from wearables. Algorithms could be developed to identify correlations between individual attributes and positive health-related outcomes. These algorithms could then be used to identify related attributes in the target population along with those motivational and learning techniques that have the highest probability of being effective in helping an individual to achieve a long-term sustained improvement in their health. If applied across the population, these personalised intervention strategies could thereby be used to help reduce society’s overall chronic disease burden.
lisa balboa 