TABLE 3

Barriers in the use of wearables and apps in chronic obstructive pulmonary disease (COPD) self-management

Variable technology useIn our sample, there was varied use of technology by patients, from avid users to people who used minimal technology. Although most participants used cellphones and apps in their daily life, there were some who preferred using their phones as little as possible and only carried them for emergencies
Interviewer: Do you have a cell phone?
P41: I do but I'm not good at it. I only use it for emergency purposes and there's all these little pictures on there that I don't care about. It keeps doing things I don't want it to do so I just carry it with me for emergency purposes
Wearable designParticipants had specific desires for the design of the wearable device. They wanted it to be stylish and would prefer options of styles and sizes. They did not want to stick out while wearing it as they did not want to be identified as having a medical condition requiring a monitoring device
P17 Well, I guess the watch part of it would be okay. Everybody wears them, so it's not like it would be too distinguished or to stick out too much… as long as, yeah, as everybody would just look at it as being normal so you wouldn't stick out in a crowd or nothing. That's another thing. You don't want to stick out in a crowd
Accuracy and technical issues of wearableParticipants were concerned about how accurate the device would be and did not want to use something that was inaccurate or had technical problems. Error messages and meaningless flashing or beeping was an area of concern. Some mentioned that they had given up their Fitbits or smartwatches due to technical issues and inaccurate data
P2: But, I have the latest Fitbit and it really is quite inaccurate. If you are aware, I drive a motorcycle, if I go on the bike for half an hour it says I've climbed like 50 flights of stairs. It misses things like, stairs, my office, where I am sitting right now I am up and down the stairs all day. I would estimate I am up and down the stairs 8–10 times and it typically shows 4–5. And sleep, they try their best to give you your sleep, and that is something I'm really interested in, I'll give you an example, they disregard periods that could be sleep. If you sit still for 2 h enough it might say you were napping. If I wake up from sleep after 45 min after a disturbance, the next day when I look at my sleep, it threw away that 45 min
“Prisoner of the numbers”Participants also were concerned about being a “prisoner of the numbers”, where they would feel they would need to keep checking the device to know how they were doing, and the device would dominate their lives. Small changes in oxygen saturation are common, and they did not want to be constantly checking their watch and worrying if their oxygen saturation dropped a little more than average
P41: I've asked here and my doctor about getting one of the little oximeters and they all advise against it because then you become a prisoner of the numbers. I see people here who have an oximeter and they are a prisoner of the numbers. “Oh it shouldn't have gone down 2 it should only have gone down 1, maybe it will go back up by 3 tomorrow”
CostParticipants were concerned about the cost of the device as many were on a fixed income. Specifically, they acknowledged concerns about costs of medications or inability to afford a device like a Fitbit
P38: Maybe also some of the LG watches can be offered on a prescription basis. I notice that they're 3–4–5 hundred dollars and that's very expensive. For someone with a COPD condition to say that they want to buy one to monitor themselves, if a doctor was to say that this is something that is necessary and provide a subsidy that would be a lot easier