Project: The Domestic Health Index
White Paper Created for Project
The following white paper was created through support from the Robert Wood Johnson Foundation.
The proliferation of wearable technology presents an unprecedented opportunity both to measure population health in new ways and to make it more culturally salient. We envisioned what we called a “domestic health index,” or DHI, as both a promotional tool and as a valuable dataset in its own right. Over the past two years, we have consulted experts and learned more about the rapidly evolving digital health space.
As part of this exploration, we conducted a scan of the use of wearable devices and mHealth (mobile health) apps in research, with a focus on work that would inform our planning for a DHI. Conclusions include:
Over the decade since wearable activity trackers were introduced to the market, health researchers have begun to incorporate these devices into their work. Validation research has been a priority and will remain an ongoing need as devices are upgraded and as new functionalities (e.g. measurement of sleep stages or stress) are added.
As the use of wearable devices in research has expanded, new digital platforms have emerged to support this research. These platforms offer tools for remote enrollment, consent, and management of study participants and for the collection and integration of streams of data from wearable devices and mHealth apps. The availability of these digital tools make a DHI far more feasible.
Although research using wearables has expanded, very few academic researchers are using this technology for population health surveillance. A primary challenge to such use is the fact that users of wearable technology and mHealth apps are not representative of the overall population.
Next, we engaged a series of issues that bear more specifically on the design of a DHI, including what health indicators to include, how participants might be recruited and retained, and – ultimately – how this initiative might be sustained. Conclusions include:
In order to be included in the DHI, health indicators require valid and reliable measurement via wearable devices and a robust relationship to health outcomes. In the near term, step counts, minutes of moderate to vigorous physical activity, and total sleep time are most likely to meet these criteria.
Because wearable device users are not representative of the U.S. population, in the near term the best way to get a representative sample is to recruit and send devices to study participants.
Privacy and data security remain a significant public concern. Privacy experts caution that technological development has outstripped the existing legal framework. As long as the DHI is implemented within an academic environment, IRB regulations should ensure participant privacy. Transparency about study design and IRB protections is essential, as privacy concerns could deter participation in DHI.
Resources will be needed to support participant recruitment, distribution of devices, storage and processing of the resulting data, and communication efforts. To aid in identification of stakeholders who might be willing to support this work, we discuss several use cases for the DHI. In the final section of this report, we recommend specific near-term steps for the development of a DHI.