“People who need these things the most are less likely to receive them.”
This is an Inside Science story.
Technologies such as smart watches, mobile applications, and websites have been promoted as an accessible and effective way for people to monitor and increase their physical activity and improve their health. But a new analysis has found that this is only really true for people of higher socioeconomic status. As with many other areas of healthcare, the poor seem to see little benefit from these digital interventions.
Mark Kelson, who studies health statistics at the University of Exeter in the UK, said:
Kelson and colleagues analyzed data from 19 different studies conducted around the world between 1990 and 2020 that looked at digital interventions aimed at helping increase physical activity and improve health. Then they compared how the interventions affected people of higher and lower socioeconomic status, and found what Kelson calls one of the clearest and strongest outcomes he’s seen in his career. For those with high socioeconomic status, there was a moderate positive effect—those who received the interventions increased their physical activity by about 1,500 to 2,500 steps per day compared to those who did not receive the interventions. But there was virtually no effect among those of low socioeconomic status. The results were published this month in the International Journal of Behavioral Nutrition and Physical Activity.
This is the kind of outcome, Kelson said, that “raises fear in the heart of behavioral interventionists,” because health needs are much greater in economically disadvantaged groups — poorer people tend to be less active and have more health problems than the richest. . So in this case, the people who need help the most are the ones who get the least benefit, while those who need it least get the most reinforcement. “Everyone is keen to increase physical activity to improve overall health,” he said. “But even with the best intentions, we may end up increasing health inequality. We really need to pay attention to the social and economic gap.”
The study did not examine why people of lower socioeconomic status with the same access to an intervention such as a pedometer and an associated fitness app would have a lower benefit. But Kelson speculates that there are several overlapping causes for this disparity. Poorer people tend to spend less free time on recreational activity, the category of physical activity associated with the most health benefits, so they have less ability to benefit from digital interventions focused on exercise. The researchers wrote in the paper that people of lower socioeconomic status also tend to be less familiar with the use of digital technologies involved in these interventions, which affects how well they interact with them.
The first step in overcoming this digital divide, Kelson said, is for researchers to recognize it, and then explore it more systematically in their studies. But they must also think about how to design their interventions and look for ways to make technology more accessible and beneficial for the poor.
Lucy Yardley, a health psychologist at the University of Bristol, said a person-based approach to designing digital health interventions could help reduce disparities in outcomes between socioeconomic classes. This means that public health experts must go to great lengths to understand the barriers their subjects face, and constantly review the intervention until those barriers disappear.
These modifications can be as simple as changing the language used. Most digital fitness interventions are written for the intermediate reading level of college graduates, for example, which can make it more difficult for people with lower levels of literacy to work with them. Or they may lack clear definitions of terms. In a project aimed at increasing physical activity among diabetic patients with lower levels of health literacy, Yardley found that many had misunderstood what was considered ‘moderate-intensity’ exercise and were introducing much higher levels of activity into the chart, thus obtaining as a result advice False.
Yardley said other modifications could include dealing with barriers of time, money or location. Instead of suggesting a long walk in a park that might not be available, the researchers could offer simple exercises that people can do at home in front of the TV, with two boxes of food. “You have to start with the person in their context, understand their needs and motivations, and build the intervention around that,” Yardley said.
Addressing social and economic barriers will also benefit researchers in designing and studying interventions, Kelson said. When some study subjects get no benefit, averaging the score across all participants ends up underestimating the effect you would see under ideal conditions.
“We need to devise something that is accessible to a large group of people, but a different group than the one that meets most activity interventions,” Yardley said.
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