July 14, 2022 | Consumers frequently express a mixed bag of sentiments about fitness wearables and body-monitoring devices flooding the market. While personally consumers have concerns related to privacy, safety, and the user interface—as well as trustworthiness of device readouts—they also appear quite willing to give them a shot. Diagnostics World News recently surveyed a handful of users of wearables and body-monitoring devices to get firsthand feedback on the data, the user experience, and their concerns.
Volunteer device testers were easy to find. “We love information,” points out Asimina Kiourti, associate professor of electrical and computer engineering at The Ohio State University (OSU) who leads a wearable and implantable technologies group. Kiourti served as an expert commentator on the user feedback received. Our eager users weighed in on Withings Body Cardio smart scale, Withings Sleep Tracking Mat, Apple Watch, and Fitbit.
While consumer health-tracking devices aren’t overtly marketed as diagnostic tools, Kiourti says, they can be perceived as such because they track metrics such as blood oxygen saturation and body fat that used to require a visit to the doctor or a specialized device. None of the products under discussion here, she says, are designed to provide reliable and actionable clinical information, but creation of medical-grade products with an impact on healthcare does appear to be the “ultimate goal” of hundreds of companies in the space, Kiourti adds.
The Apple Watch reached that goalpost four years ago when its electrocardiogram feature was cleared by the U.S. Food and Drug Administration (FDA) with a nod from the American Heart Association, but it is an inherently difficult proposition to produce a consumer-facing, FDA-caliber device that interfaces with biological tissues that change within the course of a day. It would also need to accurately monitor the vital signs of potential users irrespective of their age, sex, and body mass index—and, in this emerging age of personalized medicine, might well be expected to be customizable to the needs and preferences of individual users, says Kiourti. “It shouldn’t be one device fits all.”
Without an FDA stamp of approval, what drives consumers to purchase these types of fitness and monitoring devices and how much are they willing to spend? Familiarity does seem to breed contentment for devices even when they’re used purely for purposes of wellness and fun, Kiourti notes. Many people who were merely intrigued when the first smartwatch came out, for example, now can’t imagine jogging without one.
At least one surveyed Fitbit user happily paid in full for her long-favorite device (the latest models retail for $100 to $300), and said it was “totally worth the cost” and she’d buy it again.
Other market factors are driving down prices in hopes of increasing adoption. While the accuracy of sensor technology presumably improves with subsequent iterations of the technology, Kiourti says, prices ratchet down as well. Insurance coverage for some out-of-pocket costs, and recommended use by a physician, would also bump up utilization rates.
Insurance companies seem to be on board. Aetna has a program where members can enroll in certain plans that over time may cover the full cost (a few hundred dollars) of an Apple Watch. These types of programs, though, can suggest that the devices are more powerful and medically relevant than they are.
Consumer loyalty isn’t as established for other types of devices. A user of the Body Cardio smart scale, who had the device provided to him for testing free of charge, said his motivation for use would be his family history of heart disease. He was particularly interested in the vascular age parameter and breakdown of specific fat, muscle, bone, and water percentages.
But while this same user loved having the device, he was unsure if he’d be willing to fork over $150 to buy one out of his own pocket any time soon. “It’s a one-time cost, so that helps, but of course as a bathroom scale goes, it’s expensive. Certainly, if health insurance covered, I’d jump at it. If a doctor recommended it, I could much more easily justify it as a health expense rather than a novelty gadget.”
Problematic User Interface
Instructions for use on the devices in question were deemed adequate by the individuals surveyed, but a pleasant experience with a product goes beyond just clear instructions. For some demographics—notably elderly individuals—a poor or complex user experience can stand in the way of using a product at all, Kiourti says.
The surveyed individuals here—all fairly tech savvy—reported multiple problems related to the user interface, which Kiourti says should be among the easiest problems to remedy.
Among the comments offered about the smart scale were that the default measurements in the associated app were all in the metric system rather than the old imperial system and, unintuitively, changes to user profiles had to be done from the dashboard. Further, an “unusual number of readings” was required before readouts were available for individual members of the family. One user’s wife never did get her vascular age after many tries.
It was disappointing and surprising, this user said, that he had to set up a profile to obtain anything beyond simple weight, and he couldn’t link the smart scale to his Apple Watch. “The app had the ability and wanted to take an initial HR [heart rate] reading using the rear camera on my phone, which just felt odd as I’m wearing a connected device that is already reading my HR ... which the [Withings] Health Mate app has a placeholder for.”
As the Body Cardio smart scale had been passed to him from another household, an additional issue was that his wife’s weight was so close to that of a prior user that she initially had trouble getting her own readings. “Probably in most families, the weights are all sufficiently distinct that this is not an issue, but I could imagine that relying on the weight to identify the user could lead to some issues, and some other mechanism to identify the user may be necessary.”
Syncing issues were cited by users of the smart scale as well as the activity tracker. “I found it a little confusing/time consuming to download the app on my phone, enter more information, and then wait for my readings from the scale to sync with the app,” said a Body Cardio user. “I would prefer to do everything through the scale.” The user of a two-year-old Fitbit Versa 2 noted that the device will sometimes not sync to her phone, disabling some of its capabilities.
An active, 32-year-old Apple Watch Series 3 user reported that the HR sensor didn’t work correctly during his workouts. “It was delayed or something. I would be out of breath, and [the watch was] showing only 120 [beats per minute or BPM] and I had to go into the heart rate application to force update the actual BPM manually so it would be reflected accurately during my active workout session being recorded.”
Kiourti, who has a newer model Apple Watch (Series 6), says she hasn’t experienced any issues with the user interface. “They are good gadgets now, but you should definitely not rely on [their recordings].”
Consumers overall have far more experience with smartwatches and fitness trackers than they do with smart scales and sleep mats. And the user experience challenges for these types of devices are predictably a bit more complex as well. Sleep tracking startup Zeo, one of the early pioneers, closed a decade ago, in part because people thought the headband felt a bit awkward.
The Withings sleep mat design, while more comfortable than a headband, lacks the portability of a wearable. “I traveled quite a bit in the three to four weeks that I had the device and did not take it with me, so my data wasn’t consistent,” said one user. “Also, there were a couple of times that I moved from my bed to another bed (quieter room) and I received a poor sleep score on those occasions.” Similarly, if she would be reading or watching television in bed before going to sleep, the mat tracked that it took her a long time to “go to sleep,” artificially lowering her score.
“I think I prefer my sleep monitor device that is on my watch as it tracks me wherever I sleep,” this user concluded. She was also displeased that other apps and data collection networks—requiring the disclosure of personal information, which she was unwilling to do—were necessary to get the full benefits of the device. “It felt like an upselling feature.”
Sleep monitoring devices with “seamless performance” are ones where users don’t have to think about them at all, Kiourti says. A smartwatch wouldn’t necessarily do any better, she adds, because it, too, is “not 100% accurate.” She attests to her own excitement when she first tried a sleep-monitoring device. Unfortunately for her, “the data was all over the place,” she says. “I was pregnant at the time and getting up a lot at night to go to the bathroom and my watch wouldn’t capture this.”
Given the huge number of companies in the wearables business, each using different algorithms, Kiourti’s advice to consumers is to read the reviews and look at how they’re rated on average before purchasing.
Interestingly, privacy was one of the bigger concerns expressed by survey respondents, notably an otherwise enthusiastic smart scale user. “I am wary of personal information sharing and collection for purposes that are not clear to me,” he said. “I don’t recall exactly what was necessary in setup, but I do know that I needed to enter an email address and confirm receipt of an email to start with the app. I’m unsurprised that the app, though not asking to speak with my Apple Watch, did ask for communication with the Apple Health ecosystem... and linked up with my Wi-Fi. I also used an email address that is not my main one, and that was a good decision as I see that I was automatically opted in to receive all promotional offers.
“Bottom line,” he continued, “a regular bathroom scale simply tells me my weight and I have no privacy concerns whatsoever, whereas a device that communicates with my phone and collects personal information, is linked to an email address, etc., significantly raises the bar for the privacy-conscious. Before purchasing the scale, this is something I may put some more thought into, and I think if Withings takes this seriously, there would be more room for the scale to be a bit ‘dumb’—providing all the same information, but keeping it walled off in the scale or with more guarantees that it does not go beyond your phone without consent.”
Privacy concerns are valid, says Kiourti, noting that hacking remains a risk despite security measures. This is not because of the shortwave communication (i.e., Bluetooth) happening between the device and smartphone but the Wi-Fi network to which the smartphone—containing all manner of personal information—is tied.
“It’s good to be cautious,” she adds, although she isn’t aware of any instances where people have lost data from using a wearable or body-monitoring device. The reality is that “sharing information on your phone makes you more vulnerable,” and people have varying degrees of comfort with that reality.
All users valued data privacy, but how much did they truly value their data? These wellness gadgets provide information consumers wouldn’t have otherwise, says Kiourti—both good and bad. First-time use comes with a degree of hesitancy or nervousness (e.g., worry the device would “find a potential health problem”). But once that bridge is crossed, the question remains whether the devices earn user loyalty.
“It helps me stay more active, stand up more, and get extra steps in during the day,” said one respondent regarding the Apple Watch, in addition to being a convenient way to control his music and workout time. Another Apple Watch user’s interest is driven not by staying on top of his current state of health but, “more so encouraging healthy habits.”
A Fitbit user was likewise enthusiastic, saying “I like getting texts and reminders on my watch and seeing how many steps I have for the day... It has been a great device. The app even tracks your sleep, which is something the Apple Watch didn’t even do for a while. You can also track your monthly [menstrual] cycle and make notes within the app. I always recommend Fitbit.”
For the other devices, data consistency actually made long-term use less likely.
One Body Cardio user remarked, “If the readings are more or less stable, there would be little reason to make it part of my daily routine,” and another said, “I don’t think that I would consistently use the scale unless I was actively trying to lose weight or had heart health concerns.”
For the most part, the design of these products (e.g., appearance and comfort) received high marks. One Apple Watch user with a small wrist was displeased with the size of the digital screen although he “got used to it a bit over time” and looks forward to newer technology that “looks like classic watches with the same Apple Watch functionality.”
Design features—including something as seemingly insignificant as color—are in fact quite meaningful to end users, as Kiourti says she has come to learn during device development projects at OSU. At the end of the day, it takes a team of engineers, designers, and software developers to create a product that hits all the sweet spots with consumers.
Although not an issue that arose in this small-sample user experience survey, the safety of wearable and body-monitoring wellness devices has been an ongoing concern, particularly the potential impact of wireless signals on a growing fetus or sleeping infant. Some people are cautious about not putting their smartphone next to their head to avoid the emitted radiation, she notes, and by extension would be concerned about a Wi-Fi wearable affixed to their body for a prolonged period.
To reach the market, all these wireless products must first meet safety guidelines and standards, says Kiourti. In the United States, the Federal Communications Commission evaluates the effects of wireless emissions on the quality of the human environment, while several organizations (including the American National Standards Institute and the Institute of Electrical and Electronics Engineers) issue recommendations for human exposure to electromagnetic fields.