Wearable device adoption and its role in healthcare management: A cross-sectional study

INTRODUCTION

In the contemporary era, technology firms are shaping a future filled with wearable electronic devices that not only provide entertainment to consumers but also serve as guides to healthier living while helping them save money. These tech firms, particularly in the healthcare and wellness sector, have spurred the development of various wearable devices designed to cater to individuals’ health needs. These wearables are small devices that can be worn on different parts of the body, monitoring a range of physical and behavioral parameters, including physiological and biochemical aspects, in daily activities.^[1] Examples of such wearable devices include smartwatches, smart glasses, smart wristbands, smart gloves, smart jewelry, smart rings, smart belts, and smart bracelets, among others.^[2] These wearable products provide innovative solutions for addressing various healthcare issues consumers may face. These wearable devices can be categorized into three main divisions based on their roles in the healthcare industry: disease prevention and health protection, patient management, and disease management.^[3] The digitalization of wearable technologies is increasingly significant, often in conjunction with smartphones.^[4] Smartphones are the preferred choice for health-conscious consumers as they enable active monitoring of health issues while also offering computing and storage capabilities and seamless connectivity.^[5]

In today’s context, wearable devices are more affordable and sophisticated, accompanied by improved data quality in their associated applications, making them an integral part of the consumer health ecosystem. Studies have demonstrated the significant role of wearable technologies in advancing precision medicine and improving the health status of consumers in relation to clinical parameters.^[6] Additionally, they have played a pivotal role in the development of connected healthcare.^[6,7] While several studies in Saudi Arabia have examined wearable device adoption among residents, healthcare professionals, patients, and Hajj pilgrims, little is known about how expatriate populations, especially Indian expatriates, who form one of the largest migrant communities, perceive and use these technologies. Cultural, occupational, and socioeconomic differences may influence their awareness and adoption patterns.^[2,5,8,9] Therefore, this study aims to explore wearable device use specifically among Indian expatriates in Saudi Arabia, addressing a population group not well represented in previous research.

MATERIAL AND METHODS

The present study utilizes a cross-sectional design to assess the usage of wearable devices in managing personal healthcare among male expatriates residing in Saudi Arabia. This study received ethical approval under the reference number SEUREC-4427 from the Research Ethics Committee at Saudi Electronic University in Riyadh, Saudi Arabia. Data collection was conducted among male expatriates using two social media platforms, specifically Facebook and WhatsApp. An online survey was conducted among Indian expatriates in Saudi Arabia using social media groups between March and June 2023, after the main COVID-19 restrictions were lifted. Leveraging the presence of Indian associations, organizations, and communities on these platforms facilitated access to the desired target audience in Saudi Arabia. The questionnaire aimed to gather information regarding the study’s objectives, estimated completion time, and the researcher’s contact information. The questionnaire was prepared in English language. Following the distribution of electronic invitations for participation, reminder emails were sent to enhance the response rate. All data received was securely stored on system servers, accessible exclusively by the primary researcher. Each participant was assigned a unique identifier to safeguard their anonymity and maintain data confidentiality. Participants were provided with clear information about the study’s purpose and were assured of the confidentiality of their data. Informed consent was obtained from participants, with the option to withdraw at any point. The study adhered to the ethical principles outlined in the Declaration of Helsinki. Responses were recorded, verified, and analyzed using SPSS software. Descriptive analysis was conducted to examine the distribution, frequencies, and percentages of variables. It’s important to note that this study exclusively included male expatriates utilizing wearable devices and employed in various government and private sectors in Saudi Arabia. Additionally, only male participants aged 18 years or older were included in the study. Female expatriates were not included because they represent a smaller proportion of the Indian expatriate population in Saudi Arabia and were less accessible for recruitment through online community groups during the pilot phase. This decision was made to maintain sample homogeneity and the feasibility of data collection, rather than to imply any gender-related exclusion. Although the use of Facebook and WhatsApp facilitated efficient access to the target population, it is important to acknowledge that this approach may have introduced a self-selection bias. Participation was voluntary, and individuals active on these social media platforms were more likely to engage in the survey. According to official estimates, there are approximately 2.5 million Indian expatriates residing in Saudi Arabia; however, the exact number of those eligible and exposed to the survey invitation could not be determined. Consequently, a precise response rate and non-responder analysis could not be calculated, which may limit the generalizability of the findings. Participants from countries other than India were also excluded.

The sample size was calculated using a single proportion formula, assuming 80% expected awareness and use of wearable health devices among Indian expatriates, based on earlier studies in similar populations. With a 5% margin of error, 95% confidence level, and an additional 10% allowance for possible non-responses, the target sample size was 350. In total, 320 valid responses were received, giving an effective response rate of approximately 91%. The questionnaire was adapted from previously published studies on wearable health technology and digital health behavior. Five experts in digital health reviewed the questions for clarity, relevance, and content validity. A pilot test was conducted with 30 Indian expatriates in Saudi Arabia over 2 weeks to check understanding, consistency, and time to complete the survey. Based on feedback, minor revisions were made to improve clarity. The final questionnaire showed good internal consistency, with Cronbach’s alpha values ranging from 0.78 to 0.89 across main sections. The questionnaire comprises seven sections, covering demographic information, details about the type of wearable devices, their applications, challenges associated with wearable devices, features of these devices, their role in healthcare management, and their contribution to health improvement. To measure the outcomes in each domain, dichotomous variables and Likert-type scales were employed where relevant.

RESULTS

Wearable electronic devices owned and their applications

In the present study, it was observed that a significant majority of the participants owned fitness tracker devices (85.9%), with smart health watches following closely behind (77.5%). Additionally, a notable proportion of expatriates also used smart jewelry (14.4%) and smart glasses (12.2%). Figure 1 provides a visual representation of the wearable devices owned by the expatriates. In terms of the applications of these wearable devices, many participants were found to be using diet apps (94.1%) and fitness apps (100%). The least commonly reported application was glycemia wearables, which were used by only 16.6% of the expatriates. The usage of wearable device applications has been summarized in Table 2.

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Figure 1:

Participants owned wearable devices. ECG: Electrocardiogram.

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Table 2: The use of wearable devices applications.

No.	Use of wearable devices applications	Yes		No		Not applicable
		N	%	N	%	N	%
1	Diet app	301	94.1	19	5.9	0	0
2	Informative app	166	51.9	59	18.4	95	29.7
3	Fitness app	320	100	0	0	0	0
4	Monitoring app	97	30.3	98	30.6	125	39.1
5	Therapy app	57	17.8	92	28.7	171	53.4
6	Self-check app	133	41.6	63	19.7	124	38.8
7	Services app	112	35.0	154	48.1	54	16.9
8	Fitness wearable	301	94.1	19	5.9	0	0
9	Weight wearable	256	80.0	64	20.0	0	0
10	Blood pressure wearable	208	65.0	45	14.1	0	0
11	Glycemia wearable	53	16.6	97	30.3	170	53.1
12	Sleep wearable	202	63.1	64	20.0	54	16.9
13	Other	44	13.8	86	26.9	190	59.4

Wearable electronic device features and challenges

The key characteristics of the wearable devices examined in this study were found to be highly favorable among expatriates, with 100% of the devices being described as lightweight and easy to use. Additionally, a substantial majority, exceeding 90%, indicated that the devices offered features such as time and date display, message alerts, good battery life, and water resistance. Figure 2 provides a visual representation of these important device features. In terms of challenges associated with wearable devices, the study identified that the most prevalent issues were of a technical nature, accounting for 64.4% of the challenges reported. Moreover, challenges related to accuracy and reliability (34.1%) and the integration of data with laptops and smartphones (37.8%) were also noted, albeit at a somewhat lower percentage. These challenges have been detailed in Table 3.

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Figure 2:

Important features of wearable devices.

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Table 3: Wearable devices challenges.

No.	Wearable devices challenges	Yes		No		Not applicable
		N	%	N	%	N	%
1	Technical	206	64.4%	114	35.6	0	0
2	Confidentiality and privacy of data	133	41.6	82	25.6	105	32.8
3	Accuracy and reliability challenges	109	34.1	128	40.0	83	25.9
4	Integration of data with laptops and smartphones	121	37.8	180	56.3	19	5.9
5	Other	79	24.7	60	18.8	181	56.6

Wearable electronic devices in the management of healthcare

Expatriates actively engaged in healthcare management consistently reported using fitness trackers (94.1%) and smart health watches (100%) always and often. However, it’s worth noting that approximately 80% of expatriates never use biosensors, smart glasses, and smart jewelry for this purpose. The usage of wearable devices in healthcare management has been summarized in Table 4. Following the adoption of various wearable devices, expatriates reported significant improvements in their health, with 52.8% describing it as “very good” and 35.3% as “good.” This positive change has been depicted in Figure 3.

Table 4: Wearable devices in the management of healthcare.

No.	Wearable devices	Never		Rarely		Sometimes		Often		Always
		N	%	N	%	N	%	N	%	N	%
1	Fitness trackers	19	5.9	0	0	0	0	89	27.8	212	66.3
2	Smart health watches	0	0	0	0	104	32.5	103	32.2	113	35.3
3	Wearable ECG monitor	184	57.5	0	0	0	0	59	18.4	77	24.1
4	Wearable blood pressure	130	40.6	0	0	13	4.1	84	26.3	93	29.1
5	Biosensors	270	84.4	3	0.9	19	5.9	6	1.9	22	6.9
6	Smart glasses	265	82.8	0	0	19	5.9	0	0	36	11.3
7	Smart jewelry	255	79.7	0	0	19	5.9	24	7.5	22	6.9

ECG: Electrocardiogram

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Figure 3:

Participants health before and after the use of wearable devices.

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DISCUSSION

In the present day, wearable devices have found applications in the medical sector for monitoring individuals and aiding in diagnosis. This empowers individuals to actively engage in their healthcare and attain better control over their lives. In the present study, a substantial proportion of Indian expatriates exhibited ownership of various wearable devices, with fitness trackers being the most prevalent (85.9%), closely followed by smart health watches (77.5%). Our study’s outcomes align with the comparable findings, which reported that participants exhibited the highest ownership rate and expressed the greatest interest in fitness trackers.^[10] Furthermore, a noteworthy percentage of expatriates reported the use of smart jewelry (14.4%) and smart glasses (12.2%), demonstrating a diverse array of wearable technology adoption within the study sample [Figure 1]. A similar study indicated that a significant portion of both patients and healthcare professionals are also incorporating smart glasses into the healthcare system.^[11-13] Regarding the applications of these wearable devices, it was evident that a significant number of participants leveraged these technologies for health and wellness purposes. A vast majority employed diet apps (94.1%) and fitness apps (100%) to assist in managing their health. Our study findings are consistent with a similar study, which reported that diet apps, such as nutrition-information apps, can be effective in addressing what consumers perceive as personal barriers when it comes to making healthier food choices and engaging in exercise behaviors.^[14,15] However, glycemia wearables were the least utilized, with only 16.6% of the expatriates incorporating them into their health management routines [Table 2]. The outcomes derived from the use of glycemia wearable devices align with comparable findings documented among well-informed consumers and individuals with diabetes.^[16,17] These findings underscore the popularity and practicality of fitness-related applications, which align with the broader trends in the use of wearable technology for health monitoring and fitness management.^[18] The low adoption of glycemia wearables could be indicative of specific challenges or limitations associated with this type of device.^[19] Further investigation may be warranted to explore the factors contributing to this lower adoption rate and whether improvements in technology or awareness could increase its utilization among the expatriate population.

The core attributes of the wearable devices scrutinized in this study garnered overwhelmingly positive feedback from the expatriate population. Specifically, 100% of the participants regarded these devices as lightweight and user-friendly. Furthermore, a substantial majority, exceeding 90%, endorsed the presence of various features such as time and date display, message alerts, extended battery life, and water resistance [Figure 2]. These findings collectively underscore the appeal and practicality of wearable devices in the eyes of the expatriates. Our results are consistent with those presented in earlier studies that described the lightweight nature and other flexible features of wearable devices.^[20,21] In assessing the challenges associated with wearable devices, it became apparent that technical issues constituted the most prevalent hindrance, as reported by 64.4% of the participants. This observation aligns with existing literature, highlighting the importance of addressing technical challenges to enhance the overall user experience.^[22] Moreover, challenges related to accuracy and reliability (34.1%) and the integration of data with laptops and smartphones (37.8%) were also identified, although they were reported at a slightly lower percentage [Table 3]. Addressing these technical challenges should be a priority for manufacturers and developers in the wearable device industry.^[16,23] Improvements in the accuracy, reliability, and seamless integration of data could significantly enhance the utility and user satisfaction with these devices, especially in the healthcare management context.

Indian expatriates who actively participated in healthcare management consistently favored the use of fitness trackers (94.1%) and smart health watches (100%), relying on these devices frequently to monitor and enhance their well-being. This suggests that our study results align with those previously reported regarding the utilization of fitness trackers and smartwatches.^[24,25] Notably, the adoption of biosensors, smart glasses, and smart jewelry for healthcare management was considerably lower, with approximately 80% of expatriates reporting that they had never used these particular devices for this purpose [Table 4]. The potential limitations of limited usage of these devices might be attributed to their high cost, limited lifespan, and low stability levels.^[26] The marked improvements in health reported by expatriates following the incorporation of various wearable devices are a significant finding. With 52.8% of participants characterizing their health as “very good” and 35.3% as “good” after embracing these technologies, it is evident that wearable devices have the potential to positively impact individuals’ health and well-being [Figure 3]. The outcomes align with similar research, demonstrating that these smart devices not only aid individuals in leading healthier lives but also continuously gather health data for diagnosing and treating diseases. They actively record physiological measurements and monitor metabolic conditions.^[2,27] These results underscore the significance of fitness trackers and smart health watches as effective instruments for improving healthcare management within the Indian expatriate community.

The current study does have certain limitations worth acknowledging. Firstly, it primarily focuses on male expatriates, potentially restricting the applicability of the findings to a more diverse gender population. The study acknowledges that excluding female expatriates may have introduced gender-related selection bias and limited the generalizability of the findings. Future studies should aim to include both male and female participants to capture more comprehensive insights into wearable device usage among Indian expatriates in Saudi Arabia. Secondly, the study relies on data collected through self-reported perceptions related to the utilization of wearable devices, which may not always yield completely accurate results. Furthermore, the recruitment strategy relied exclusively on social media platforms, such as Facebook and WhatsApp, which may have introduced self-selection bias. Only individuals with internet access and active social media participation were reached, and the absence of a defined sampling frame precluded the calculation of a response rate and non-responder analysis. These factors may limit the external validity of the findings, and therefore, caution should be exercised when generalizing the results to all Indian expatriates in Saudi Arabia. Notwithstanding these acknowledged limitations, the research provides valuable insights into the significance of wearable devices in healthcare management within the Indian male expatriate community in Saudi Arabia. These findings serve as a foundation for further exploration and understanding of the role of wearable technology in healthcare, with the potential for broader applications and implications. Moreover, the findings of this study can assist policymakers and healthcare providers in designing culturally sensitive digital health interventions tailored to expatriate communities.

CONCLUSION

The research showed that a significant proportion of the expatriate population owned and were interested in fitness trackers and smart health watches. These devices found widespread use, primarily for health and wellness purposes, with a high reliance on diet and fitness apps to manage health. The study highlighted that wearable devices were well-received, with participants finding them lightweight and user-friendly. They appreciated features such as time and date display, message alerts, extended battery life, and water resistance. Technical issues, accuracy, and data integration challenges emerged as common hindrances, indicating the need for further technological advancements and improvements. It was also observed that fitness trackers and smart health watches played a pivotal role in enhancing the well-being of Indian expatriates. In summary, wearable devices have become valuable tools for healthcare management among Indian expatriates.