Wearable Technology As A Facilitator of Behaviour Change

ACE 3090
PROJECT AND DISSERTATION

Wearable technology and its potential opportunities as a
facilitator of health related behavioural change, an
experiential perspective.
Authors Name: Joshua Richard Hirst
Student Number: 130583802
Degree: BSc Food Marketing & Nutrition, School of Agriculture Food and Rural
Development
Project Supervisor: Dr. Sharron Kuznesof
Abstract
Background: Unhealthy habits amongst the British population is a major contributor to
health related diseases. Astonishingly most of these health related diseases are easily
preventable, health related behaviour change is a way to achieve this. Through intervention
studies and theoretical modelling, behaviour change in individuals is something very
achievable and can possibly be applied to a population. Wellness wearables has been used
as a tool in many health related behaviour intervention studies to see whether they can have
a significant impact on altering behaviour in individuals.
Aims and Objectives: To investigate the use of wellness wearable technology through an
experiential perspective on individuals and identifying common areas which may provide
information to show how wearable technology can facilitate health related behaviour change
by comparison against the trans-theoretical model of behaviour change
Results: Participants did identify certain barriers that exist preventing adoption of wearables
and this can impact how effective wearables may be as a facilitator for a population. As a
facilitator of health related behaviour change, participant responses and results showed
positive experiences using wellness wearables. Participants experiences also showed
agreement against the trans-theoretical model and showed that wearables had an impact on
progression through the stages of change using the key constructs of behaviour change
theory such as self-efficacy and decisional balance as predictors. Barriers identified by
participants were also overcome through their experiences with wearables to show the
power that wearables can have against barriers to health related behaviour change.
Conclusion: Despite some problems with adoption of technology, the level of acceptance is
expected to increase over time making wearables potentially an even more effective tool for
behaviour change. Overall wellness wearables had an extremely positive impact on health
related behaviour change in the participants, however due to the small sample size further
research is needed to quantify results and see whether wellness wearables can have a
significant impact on a population level. That said, wearables were able to provide motivation
and facilitate behaviour change through aiding discipline to form a new behaviour or long
enough to form a new habit. It provides a platform for which individuals can use to motivate
and discipline them through the hardest stages of behaviour change which is the beginning.
Therefore wellness wearables has the potential to help facilitate healthier behaviours and
create better habits and should be utilised when possible to help improve society at a
relatively low cost.
Table of Contents
Abstract.1
Table of Figures.......4
Table of Tables.....4
Table of Appendices..4
1 Introduction .5
1.1 Stages of Change (trans-theoretical model) 5
1.2 Processes of change..6
1.3 Key Constructs in Behaviour Change theory..7
1.3.1 Self-Efficacy
1.3.2 Decisional Balance
1.4 Behaviour change theory in practice9
1.5 Acceptance of technology..10
1.6 Uses of technology in health related behavioural change.11
1.7 Future of wearable technology and health related behaviour change14
2 Aims and Objectives.15

3 Methodology.....16
3.1 Qualitative Research.16
3.2 Participants..16
3.3 Procedure....17
3.3.1 Analysis Procedure
3.3.2 Thematic Analysis Procedure
3.4 Limitations...19
3.5 Ethics...19
4 Results...20
4.1 Themes.20
4.2 Barriers to health related behaviour change..21
4.2.1 Time and lifestyle constraints
4.2.2 Perception of barriers
4.2.3 Mental barriers
4.2.4 Lack of Knowledge and awareness
4.3 Perception of smart wearable technology..23
4.3.1 Unfamiliarity of technology
4.3.2 Obsessive behaviour
4.3.3 Attitudes towards new technology
4.4 Barriers and facilitators of wearable technology use.25
4.4.1 Rewarding
4.4.2 Ease of use
4.4.3 Financial Cost
4.4.4 Attitudes towards technology
4.5 Wearable technology experiential links with the stages of change in behaviour
change theory (trans-theoretical model) 27
4.5.1 Contemplation
4.5.2 Preparation
4.5.3 Maintenance
4.6 Wearable technology experiential links with the core constructs in behaviour
change theory (trans-theoretical model) 29
4.6.1 Self-Efficacy
4.7 Wearable technology as a facilitator of health related behaviour change.30
4.7.1 Progress logging and recognition
4.7.2 Momentum of behaviour change and increased awareness
4.7.3 Goal setting
5 Discussion...31
5.1 Overcoming Barriers towards health related behaviour change with applications
of wearable technology. 31
5.1.2 Mental Barriers
5.1.3 Overcoming wearable technology use barriers
5.2 Wearable technology and the trans-theoretical model of behaviour change
theory..35
5.2.1 Progression through the stages of change
5.2.3 Self-Efficacy
6 Conclusion....39
6.1 Potential opportunities for wellness wearable technology use for health related
behaviour change..39
7 Acknowledgements...41
8 Bibliography..42
Table of Figures
Figure 1: visual representation of the stages of change first proposed by DiClemente and
Hughes..7
Figure 2: visual representation of the diffusion of innovation theory. .11
Table of Tables
Table 1: table with information and practical examples on the processes of change8
Table 2: various popular wellness wearable devices and their functions and measures..13
Table 3: table of participants interviewed in the study..18
Table 4: table of themes derived from thematic analysis of interview transcripts22
Table of Appendices
Appendix A: Interview Briefing Statement information sheet46
Appendix B: Consent Form..47
Appendix C: Interview Questions.48
Appendix D: Newcastle University Ethics Approval49
1 Introduction
Changing a behaviour is something that everyone in the world will have gone through at
some point in their life and if not then they are likely to have contemplated it. Positive healthy
behavioural changes can be very beneficial proposed by James O. Prochaska and Carlo Di
Clemente in 1977 provided a framework and provides a justification for why it is necessary to
understand how we can facilitate healthy behavioural changes. Unfortunately changing an
unhealthy behaviour is not a simple task. In order to facilitate behavioural change,
researchers first have to understand the process of how a behavioural change occurs in
people. The idea being that once that is understood, it can be used to facilitate such
changes. The trans-theoretical model (TTM) or sequence of stages in which behaviour
change could be understood.
1.1 Stages of Change (trans-theoretical model)

The trans-theoretical model breaks down behavioural change into stages of change (see
figure 1.1), these stages are as follows pre-contemplation, contemplation, preparation, action
and maintenance (DiClemente and Hughes, 1990).The model follows the idea that at any
current stage they are only able to progress to the next stage due to certain actions and
decisions (Prochaska and DiClemente, 1982). Terms used to describe the negative and
positive behaviours are problem behaviour and desired behaviour. For every behavioural
change, people will differ due to various factors, some may spend longer in preparation than
others, and some may find it difficult to progress past contemplation. The steps are briefly
described as follows; pre-contemplation being a stage where the subject has no intention of
changing behaviour, contemplation being a stage where the subject has intention to change
behaviour in the near future, preparation being a stage where the subject has made steps in
order to initiate a change in behaviour, action being a stage where the subject has changed
their behaviour for a prolonged period of time (up to 6 months) although the time frame can
differ and is subjective, finally maintenance being a stage where the subject has made
changes to behaviour and is working on preventing relapse into their problem behaviour
(DiClemente and Hughes, 1990). There is debate whether a final stage exists in the stages
of change known as termination where the subject has 100% self-efficacy and are extremely
unlikely to relapse into their problem behaviour.
Figure 1: visual representation of the stages of change first proposed by DiClemente and
Hughes
1.2 Processes of change

In order for individuals to advance to further stages of change, there are process and
mechanisms which have been theorised to play a role in helping progression across stages
of change. These processes are as follows; Consciousness Raising, Dramatic Relief and
Environmental Re-evaluation which are proposed to be involved in progress from precontemplation to contemplation. Self-Re-evaluation, Social Liberation and Self-Liberation
involved with progress from Preparation to Action. Counter Conditioning, Helping
Relationships, Reinforcement Management, and Stimulus Control Involved with
maintenance of desired behaviour (Prochaska and DiClemente, 1982, Velloza et al., 2015).
All these processes of change are briefly explained in table 1.1. Understanding the
processes of change will allow consideration of the mechanisms in which a behavioural
change occurs and identify key elements which will be beneficial in promoting a healthy
behaviour change (Prochaska et al., 1991) (Velloza et al., 2015).
Table 1: table with information and practical examples on the processes of change
(Prochaska J.O. et al, 2015) (Velloza et al., 2015)
Processes of Change
Consciousness Raising
Dramatic Relief
Environmental Reevaluation
Self Re-evaluation
Social Liberation
Self Liberation
Counter Conditioning
Helping Relationships
Reinforcement Management
Stimulus Control
Explanation
The simple process of
obtaining facts and increasing
knowledge and awareness
Both positive and negative
emotional feedback on
current or new behaviour
Process in Practice
Education about risks
and benefits of
behaviours
Seeing a problem
behaviours negative
consequences which
has created fear and
anxiety (negative
emotions)
Assessment of how ones
Seeing how a negative
behaviour affects the social
behaviour is affecting
environment
others close to you, i.e.
smoking and its effect on
your children
Personal assessment and
Accepting that behaviour
realising what one could be
change is necessary and
like adopting a new behaviour picturing the benefits of
changing such behaviour
change
Public external support and
Having public areas
opportunities or alternatives
which promote the
that can aid behaviour
behaviour change. I.e.
change
smoke free zones,
healthier restaurants
The personal belief that they
Creating a commitment
are capable of change and
to oneself to enhance
committing to change using
willpower such as a goal,
willpower
resolution or contract.
The process of replacing a
Using alternatives such
problem behaviour with an
as nicotine patches
alternative behaviour
instead of smoking.
Relationships that one may
Family and friends
have to support the behaviour encouragement to
change
change and praise for
change.
The use of punishment or
Having cheat meals for
reward to maintain a
eating well throughout
behaviour.
the week or the opposite
Control of the stimuli that may Removing all unhealthy
provoke relapse back into a
food from household to
problem behaviour
help maintain a healthy
diet
1.3 Key Constructs in Behaviour Change theory

There are two key constructs in behaviour change theory and they both are theories which
are used widely in the literature when attempting to predict behaviour. These constructs are
decisional balance and self-efficacy. Understanding these constructs gives a view into what
is happening during behaviour change and has been shown to be powerful constructs in
behaviour change theory.
1.3.1 Self-Efficacy
Banduras self-efficacy theory refers to the belief in ones ability to perform a task or in this
case to maintain a new behaviour (Bandura, 1978). The general consensus amongst the
literature is that increased self-efficacy in the presence of stimuli that may trigger relapse will
lead to less risk of relapse back into a problem behaviour (Prochaska J.O. et al, 2015). Selfefficacy theory has also been used to predict behaviour change, as it reflects an individuals
confidence in a new behaviour in can effectively predict whether the individual will adopt a
new behaviour (Bandura, 1978).

Decisional balance is a construct which enables conceptualisation of the decision making
process. First proposed by Janis and Mann (1977) as a decisional balance which weighs up
the pros and cons. This construct has become key in behaviour change theory and the
trans-theoretical model. Whenever the pros outweigh the cons on the balance sheet that
individual will commit to the behaviour or maintain the behaviour. However lots of factors
through the stages of change will affect the decisional balance and this is how the construct
helps predicts behavioural outcomes in practice (Prochaska J.O. et al, 2015). Whenever
individuals have made a change, the problem behaviour could appear as having more pros
to the individual and this is an example of how the decisional balance can shift and cause
relapse (Velicer et al., 1985). Understanding this construct can help anticipate behavioural
outcomes and therefore facilitate change and prevent relapse.
1.4 Behaviour change theory in practice

Human behaviour in reality most likely isnt as simple as it sounds however the TTM serves
a very good base model. When observing human behaviour change it is evident that ideas
from the trans-theoretical model show through. In certain cases individuals are seen to
progress through the different stages, using different processes of change as they progress.
Thus showing how powerful this model of behaviour change is in practice.
In practice, one of the most important concepts is the decisional balance in the TTM. The
intuitive idea that an individual will only do something if the benefits outweigh the
consequences. Velicer et al., (1985) showed how powerful a simple decisional balance
sheet is in human decision making where participants who were not taking action on a new
behaviour heavily exaggerated the cons for said behaviour. This idea also applies to
situations where an individual is preventing themselves from relapse, as in this case they are
trying to keep the decisional balance tilted towards the pros and thus maintaining the
behaviour (Velicer et al., 1990). This may not always be the case as Dijkstra and Borland,
(2003) and Yalnkaya-Alkar and Karanci, (2007) stated that once a behaviour has been
changed, automatically an individual will perceive the pros of the old problem behaviour as
being more appealing than before. This helps explain why relapses occur so often which is
very well conceptualized by the TTM model (Dijkstra and Borland, 2003). When observing
individuals changing behaviour, studies found that as people progress through stages of
change, the pros for their problem behavior decreases, prompting them to change behaviour
(Prochaska et al., 1991). This kind of evidence points out how significant the decisional
balance concept is in helping to explain human behaviour.
Self-efficacy is another valuable tool in the TTM as it very logical and can be seen in
individuals and in research. Self-efficacy in individuals have been shown as an indicator in
the success of that individual committing and maintain a behavioral change (Velicer et al.,
1990). In a practical sense there is a clear link between self-efficacy and decisional balance,
believing in oneself to perform a behaviour can be seen as an added pro to the changed
behaviour, thus helping to prevent any further relapse (Velicer et al., 1985).
The TTM model has also been shown to have positive effects in regards to interventions
where the aim is to change problem behaviour by utilising the tools to help individuals
progress as well as educating them on the model. Koyun and Erolu, (2016) utlised the
processes of change in their study in order to help participants stop smoking resulting in a
21% increase in quitters in the group with TTM counselling in comparison to the control.
These results have been replicated as well showing that the TTM model is an appropriate
model to apply to individuals (Bridle et al., 2005).
1.5 Acceptance of technology

Technology is an ever growing area in todays society. Acceptance of technology can be
limited if people are not ready for such drastic changes. For example, people today are
completely comfortable with sharing all their personal information and current whereabouts
to the entire world on social media. However if you proposed this idea to people 30 years
ago, the acceptance would be relatively low. We know that within a given population there
will be different groups of people with their own views towards technology. The innovators,
early adopters, early majority, late majority and the laggards according to the diffusion of
innovation theory (see figure 1.2) (Sorensen K., 2013).
Figure 2: visual representation of the diffusion of innovation theory.

Consumers of technology will not accept every new product that comes to market and there
are underlying reasons for this. Kozica et al., (2016) found that technologies that are
complex for consumers to understand, are less likely to be accepted. That is the case
despite the technology having a great potential benefit to the consumer. So being able to
convey to the consumer the functions of the technology clearly may increase consumers
acceptability. Consumers will have perceptions of new technologies due to its unfamiliarity,
therefore more information needs to be provided to the consumers in order to change their
perceptions (Ponce et al., 2016).
Ease of use of the technology is a common stated factor in the literature related to the
acceptance of technology (Ponce et al., 2016). However Chen and Lu, (2016) found that
ease of use had a very weak effect on using intentions of consumers. Whilst the strongest
factor was perceived usefulness of the technology. This implies that consumers are more
likely to accept a technology and overcome complicated interfaces if they see the technology
as beneficial to them. Therefore if a product were actually useful to the consumer and these
messages were portrayed efficiently, they would have higher usage intentions (Chen and Lu,
2016).
10
1.6 Uses of technology in health related behavioural change

Since the tech boom from 1997, technology has quickly become a fundamental part of
peoples everyday lives. Whether this is a positive or negative thing is up for debate however
optimists see the reliance on technology as a medium for creating behaviour change in
individuals. The applications of technology are extremely varied and include social media,
apps and wearable technology. Growing in popularity is the use of wearable technology and
life-logging technology due to its convenience for users as it requires little conscious action
(Nishiyama et al., 2015).
There are various types of wellness wearable devices in the market due to their rise in
popularity and their functions can differ depending on what the consumer wants (see table
1.2). However their major function is always some form of data logging which include
walking steps, sleeping patterns, heartrate, perspiration and more. The majority of these
devices are also smart meaning they have the capability of syncing with smartphones
increasing functionality. Most wearable devices available for the public today are in the
health and fitness sector. However other sectors such as commercial are growing in
wearable technology use to help monitor stock and track movement of product. Wellness
wearable devices have been shown to be effective in increasing physical activity in
participants and has led to further progress in other health related behaviour changes
(Rosenkranz et al., 2015). It is reasonable to hypothesise that other data logging devices will
have similar effects to the results shown by step tracking as life-logging has shown to
increase awareness of an individuals behaviour and thus aiding behaviour change
(Nishiyama et al., 2015).
11
Table 2: various popular wellness wearable devices and their functions and measures
Wellness Wearable Device
Wellness Wearable
Function and Measures
Device Make and Model

Fitbit Alta
-Fitness tracking, calories,

steps, time, distance
- Vibration reminders to
move, sleep tracking with
silent alarm.
Apple Watch
- Stand, exercise and move

tracking.
- Reminders for when to be
more active.
- Fitness tracking, calories,
steps, time, distance, pace.
Jawbone Up3

steps, time, distance,
heartrate
- Reminders for exercise
schedules and goals.
- Sleep tracking
- Personal coach workouts
-Fitness tracking, calories,
heartrate
schedules and staying active
- Sleep tracking
Polar A360
Microsoft Band 2
Moov Now
Misfit Shine 2

heartrate, lung capacity (VO2
max)
- Sleep and GPS tracking
- Voice commands
- 3D Fitness tracking,
calories, steps, time,
distance.
- Personal coach tips to
improve form and motivation
through earphones
steps, time, distance
- Reminders to stay active
- Sleep tracking
12
Health related behaviour change comes with its limitations and challenges. The most
obvious challenge when thinking about health related behaviour change on a population
level is the cost. With weight loss programmes and healthy eating campaigns being very
common in first world countries with an obesity problem, a major problem is cost
effectiveness and engaging those most in need of change; the socioeconomically
disadvantaged (Byrne et al., 2006). Today technology has come is able to provide us with
products at a relatively low cost. Being able to connect to the internet through a smartphone
for example, linked with wearable technology opens up a wealth of tools and information.
Web based intervention schemes are becoming more popular due to their wide outreach and
relatively low cost. Significant positive health impacts have also been shown by these
intervention schemes (Portnoy et al., 2008)
Another challenge in behaviour change is to get a population to collectively change negative
behaviours. People are unique, with different morals, motivations and perceptions. However
wearable technology and its functions has the potential to play a positive role in health
related behavioural change. The ability for wearable technology to provide programmes
tailored to individuals, and track progress for that certain individual means that it is not a one
size fits all, and thus it is able to be used effectively with individuals. Apps that track progress
from wearable technologies can be used to evaluate progress and update automatically,
setting reminders and goals. This allows users to be connected with intervention schemes
keeping them involved in continuing to change a problem behaviour.
Web based platforms are also seen as a community as a number of users will be going
through a similar process. Social support has been seen to have a positive effect on wellbeing through the mechanism of social support as motivation (Steinfield et al., 2008).
Technology has allowed people to get connected without being together in the same room,
potentially leading to stronger behaviour changes. Not only can wearable technology track
and update your progress, sharing your progress with others and receiving reassurance can
increase self-efficacy and thus help maintain the behavioural change on a large scale if the
technology infrastructure is available (Steinfield et al., 2008) (Jane et al., 2015). When
considering the most challenging stages to progress to in the trans-theoretical model is to
action, Rosenkranz et al., (2015) showed data supporting that self-efficacy was significant in
the likelihood of an individual progressing, as level of self-efficacy was measured in
participants at different stages of change and they increased accordingly.
13
1.7 Future of wearable technology and health related behaviour change

With advancements in technology, the capability for intervention schemes to reach entire
populations can make an extremely significant impact (Maher et al., 2016). Many wearable
technologies have capabilities to be synced with social media platforms for a number of
different uses such as connecting communities with similar interests, sharing each others
progress, giving an expert access to data so they are able to conduct an evaluation. With the
ever changing landscape of how people interact in the world through technology, traditional
methods of interventions for behavioural change may be at risk of becoming less effective
(Jacobs and Graham, 2016). Some people are also more willing to rely on virtual sources for
information and interventions which can help target those that are not willing to look for help
elsewhere (Maher et al., 2016). This means technology would need to be utilised in order to
provide interventions in order to aid behavioural change especially with the number of total
users always increasing. Jacobs and Graham, (2016) also concluded a very relevant point
that evaluation methods of interventions can become cost effective with the help of mobile
health apps with wearable technology which can automatically track progress and
performance. Therefore being able to be used for assessing the effectiveness of
interventions.
14
2 Aims and Objectives

The reasoning behind this report stems from the need for further understanding on how
wearable technology and its applications can affect behavioural change in individuals. What
we could potentially deduce is a way in which wearable technology can accelerate a positive
healthy behavioural change in individuals and also maintain it.
In this report the focus will be put on key stages of change which have notably been difficult
to progress to. These stage changes are from contemplation to preparation and once a
desired behaviour is achieved another challenging stage is the maintenance. Therefore we
will be identifying key elements which help initiate a change of behaviour and eventually
maintain them. The UK invest heavily on ways to educate the population about risks and
benefits of certain behaviours in an attempt to improve health. This in turn to reduce costs on
healthcare and improve quality of life. So identifying ways for the population to adopt
behavioural changes can become very beneficial.
The key constructs that are linked with the trans-theoretical model of behaviour change and
are most significant to the stages of change we will be discussing are decisional balance and
self-efficacy. Decisional balance being the proposed mechanism which suggests that in an
individual there is a balance of benefits and drawbacks, and once the benefits outweigh the
drawbacks, an individual will take action. Decisional balance also suggests that the balance
must remain tilted in favour of the benefits in order for the individual to maintain this
behaviour. Self-efficacy is also an important construct in these stages of change as it is
suggested that an individual will have to require a certain amount of belief in oneself to take
action and be able to maintain a new desired behaviour.
Therefore the aim of this report is to investigate the use of wellness wearable technology
and its applications in individuals and their experiences using them. While attempting to
identify common areas which may provide information to show how wearables can facilitate
health related behavioural change by comparing the experiences against the transtheoretical model of behaviour change.
15
3 Methodology
3.1 Qualitative Research
Behaviour change is not fully understood as an exact science, it is based around theories of
how behaviours change in individuals. Because of the complexity of the concept it is very
difficult to quantify results into valid, reliable conclusions. Sofaer, (1999) stated that
qualitative research is valuable in providing rich descriptions of complex phenomena, such
as the behavioural change mechanisms in humans. Due to these considerations qualitative
research has been the chosen methodology for this report.
In depth interviews was the chosen data generation technique as it is possible to obtain
detailed information from individuals on their behavioural change process in past and
present, and provide rich understanding of ideas, attitudes, perceptions and experiences
(Chase et al., 2016). This is not to say that quantitative research methods wont be
applicable to this study, as there is a possibility for both qualitative and quantitative research
methods to complement each other, and with this study further quantitative research may be
able to add significant insight to the behavioural change phenomena as well as validate
certain aspects (Sofaer, 1999)
3.2 Participants
Participants of this study were recruited using a convenience sampling method. There was a
single sampling criteria during this process which was that participants must have used
wellness wearable devices either currently or in the past. There were little other factors that
would cause any bias in the sampling method. Both men and women at various ages were
included in the sampling and they were not informed about the specific objectives of the
interviews until after the interview where they were to be debriefed. This method of sampling
was chosen as the interviews were looking to interview everyday people are their
experiences with wellness wearable technology. The total number of participants used in this
study as 13 (see table 3.1).
16
Table 3: table of participants interviewed in the study

Participant
Age
Sex
Wearable Experience
21
Female
Smartphone apps, Polar wearable
22
Male
Smartphone apps, Fitbit
23
Male
24
Male
Smartphone apps, Pedometer
21
Female
Smartphone apps, Pedometer

Polar wearable
21
Male
Polar wearable
32
Female
Fitbit
27
Female
29
Female
Smartphone apps, Smartwatch

apps, Apple watch
10
40
Female
Fitbit
11
43
Male
Fitbit
12
62
Male
13
34
Male
Smartphone apps, Jawbone
3.3 Procedure
After agreeing to partake in an interview, an interview date was arranged. At the interview
participants were given an information sheet (see Appendix A) outlining objectives of the
study and explaining that they have a right to withdraw their data at any time. Participants
were then asked to sign a consent form (see appendix B) and was made aware that the
interview was being recorded. Preliminary casual conversation preceded the recorded
interview in order to make the participant feel more comfortable with the interview process.
Initial interview questions (see Appendix C) were then given whilst also adding further
questions if a topic were to be brought up by the interviewer. Questions were not aimed to
be directing in any way but rather open for the participant to elaborate how they feel is
necessary in an attempt to reduce bias by the interviewer.
17
The initial interview questions asked during the interview were derived from the literature
relating to wellness wearable devices and the trans-theoretical model of behaviour change
(Velicer et al., 1985, Velloza et al., 2015, DiClemente and Hughes, 1990, Ten Hacken and
De Greef, 2008). First group of questions attempted to identify the stages of change of the
participants. Following on from these were questions to try and identify elements of selfefficacy and decisional balance throughout the behaviour change process of the individual.
Finally further questions referred to the use of wearable devices and how the individuals
experiences were of the effect it could have had on their behaviour change.
All interview audio recordings were then transcribed and analysed using a coding framework
to derive major themes, this framework is explained further in section 3.3.1.
Analysis of the themes developed from the data were then used to discuss the common
uses of wearable technology by the participants and the possible opportunities and
consequences of this. Ultimately referring back to what role wearable technology plays as a
facilitator of health related behaviour change.
3.3.1 Analysis Framework

The analysis framework for the data collected was conducted using grounded theory
techniques to identify themes and ideas developed from the data itself (Kozica et al., 2016).
This involved cycles of coding transcripts of the data collected. The first cycle involved
coding into codes developed prior to the analysis. The second cycle of coding involved using
open coding techniques which allowed codes to develop from the data itself from ideas and
themes that the data generated (Braun and Clarke, 2006). The third cycle of coding looked
for any areas which are relevant when referring to the trans-theoretical model of behaviour
change. Most common themes are then developed from these codes and broken up into
major and minor themes (Browne et al., 2016)(Braun and Clark, 2006). Finally these themes
were categorised as closely as possible to be discussed further.
3.3.2 Thematic Analysis Procedure

Thematic analysis of the interview data attempts to identify common themes and concepts
that occur numerous times throughout the interviews. The categorised themes extracted
from the transcripts enable links to be found between common reoccurring themes and find
significant data within a large qualitative dataset (Braun and Clarke, 2006). This systematic
process is aimed to help reduce any bias in the analysis of the data and avoid selective use
of specific points of the data.
18
3.4 Limitations
There are many obvious limitations to this study. Firstly using purely qualitative data means
that this report cannot be fully conclusive. This is due to wide breadth of information given by
participants and because qualitative analysis is subjective while quantitative measure may
offer more objectivity (Chase et al., 2016). Further quantitative analysis of follow up
quantitative studies may be able to produce data which can then be analysed to provide
tangible numerical data. Furthermore this study being a qualitative study with limited
resources only allowed for a small sample size in one geographical area so it may not be a
good representation of the population. The focus on experiences from participants who have
had experience using wearables in a single geographical area may also have some bias
against the socioeconomically disadvantaged. The analysis of the results although it
followed an analysis framework, is still conducted in an subjective manner which could be
open to bias, as each interviewers interpretation of qualitative data can be different (Chase
et al., 2016). In depth interviews that were used could also have caused bias in the data as
participants may sometimes feel as though they are required to give a certain answer even if
it is not there true experiences. In both these cases, being a novice researcher conducting
qualitative research and analysis could prove to have its own limitations. Due to
inexperience, the researcher could possibly have asked questions which were more leading
than intended in the interviews leading to biased answers. During data analysis inexperience
could cause the researcher to deduce themes which may not be significant and misinterpret
the data.
3.5 Ethics
All ethical issues have been considered before conducting this study, and action has
been taken where possible to satisfy these issues. Ethical approval was applied for
before any interviews were conducted. All participants were asked if they were able
to come in for interviews, and were asked to fill a consent form stating that they are
willing to be interviewed. All participants were also debriefed on the aim of the
interview after the interview and told that they had the right to withdraw their
information from the study at any point.
19
4 Results
Analysis of 13 in depth interviews with random participants explores various aspects of
smart wearable technology in an attempt to uncover what kind of experiences have been
had by individuals in relation to a health related behavioural change. This will allow us to
identify key areas in which wellness wearable technology has been positive in promoting
health related behaviour change but also help identify current problems as well. The analysis
has uncovered major themes each with their own sub themes which will be discussed
further. To assess wearables potential opportunities and consequences in health behaviour
change, the results start by analysing barriers to health related behaviour change in an
attempt to uncover reasons people may struggle to progress in changing a problem
behaviour. We also discuss what perceptions there are of wearable technology and how this
may affect the adoption of wearables and thus barriers for usage. Through analysing the
experiences individuals have had with wellness wearables and behaviour change, we can
then link their experiences to the chosen behaviour change theory (trans-theoretical model)
to try and explain how wearable technology has affected the behavioural change process.
Finally the analysis can come together to see whether wearables can possibly be an
effective tool and facilitator for health related behaviour changes.
4.1 Themes
Many of these themes that have been deduced from the analysis shown in table 1.1 come
from codes that have been gathered, and categorised into sub themes and themes. These
will be analysed further using quotes direct from interview transcripts.
20
Table 4: table of themes derived from thematic analysis of interview transcripts

Theme: Barriers to health related behaviour change
Subthemes;
- Time/lifestyle constraints
- Perception of barriers
- Mental barriers
- Lack of Knowledge/awareness
Theme: Perception of smart wearable technology
Subthemes;
- Unfamiliarity of technology
- Obsessive behaviour towards wearable technology
Theme: Barrier and facilitators of wearable technology use
- Rewarding
- Ease of use
- Financial Cost
Theme: Wearable technology experiential links with the stages of change in
behaviour change theory (trans-theoretical model)
Subthemes;
- Contemplation
- Preparation
- Maintenance
Theme: Wearable technology experiential links with the core constructs in
- Decisional Balance
- Self-Efficacy
Theme: Wearable technology as a facilitator of health related behaviour change
- Progress logging and recognition
- Momentum of behaviour change
- Increasing awareness
- Goal setting motivation
4.2 Barriers to health related behaviour change

Barriers to health related behaviour change were present in all participant although they
were greatly varied. Subthemes include lifestyle and time constraints, and how they felt that
they didn't have time to commit to changing a behaviour, the perception of these barriers
and lack of knowledge and awareness of the health related behaviour change. The need for
accessibility to information and awareness has been identified as a key area as a lot of
barriers had to do with the lack of knowledge on a subject or the lack of information on how
to change problem behaviours effectively. So barriers to health related behaviour changes
include internal as well as external barriers.
21

Time and lifestyle constraints were one of the main subthemes that were derived from
barriers to health related behaviour change as many participants saw this as a large enough
barrier to prevent them from changing behaviour. Participants made it very clear that they
felt they were more likely initiate a new behaviour if they were given more free time in their
daily lives:
I think there is a stage where you think you just cant be bothered, especially when
youre in university a lot more, and you had less time Participant 5
4.2.2 Perception of barriers

Time and lifestyle constraints led to another theme common in several interviews where
participants that suggests time and lifestyle constraints are more perceived than real.
Participants showed they were able to change behaviour even with the same constraints
they had when they originally thought they would not be able to change. This could be that
the constraints are perceived as larger barriers then they might actually be, by
overestimating the effort/time needed to commit to changing behaviour:
When I first started work I felt like I really didnt have time to eat healthy, so I didnt
think I had time to eat fruits and vegetables anymore, but I have made time now to
allow me to start eating more fruit and veg Participant 1
4.2.3 Mental barriers

Further barriers derived from participants included the mental challenges of changing
behaviour. When changing a behaviour is a conscious task, it is possible for it to be seen as
more of a task rather than a natural behaviour. Thus possibly making it mentally challenging
for individuals to find motivation to consciously change their behaviour. This subtheme was
present in over half of the interviews suggesting that as a barrier to behavioural change it is
very significant:
I wasnt physically tired after university last year, but I just felt lazy and I didnt want
to have to go do anything I didnt have to. But now I love it, I do it without thinking and
going to exercise has become something I have to do nearly every day Participant
6
22
4.2.4 Lack of Knowledge and awareness

Lastly the lack of knowledge and awareness on a particular health related behaviour change
was shown to be a major barrier in nearly half of the participants. This was a much larger
barrier than anticipated as information is quite readily available to the public however there
seems to be something preventing individuals looking for or receiving the correct
information. An explanation for this by a participant highlighted the prevalence of
contradictory information making it very unclear for people to understand:
Theres always some new health craze and new diet or exercise regime its
ridiculous, so Ive kind of given up Participant 7
There is evidence to suggest that there is a lot of information out there however the public
are not able to understand or implement it for whatever reason, making it a barrier for many
people looking to change behaviour as information is a key part in preparation for a
behaviour change:
I just dont know what Im doing really, and I dont understand the stuff that I read
online and see on the news. Maybe if I had some more direction it would make it
easier, like a trainer or nutritionist to help but thats not really an option because its
far too expensive Participant 7
4.3 Perception of smart wearable technology

Throughout this study, it was important to uncover how individuals felt about using wearable
technology and their perceptions of wearable technology. Because ultimately, it has a
significant effect on how effective wearables will be in the long run. If peoples perceptions
were very negative on certain elements, it will make it less likely for individuals to use it as a
tool, and in turn less likely for them to change their behaviours accordingly. The interviews
looked into both perceptions of wearable technology before and after use as it is just as
important to see what perceptions people had after use that may have led them to continue
using the technology or not.
23
4.3.1 Unfamiliarity of technology

Unfamiliarity of technology was more prominent in older participants, there was a lot of
scepticism around the use and effectiveness of smart wearable technology, resulting in the
decreased likelihood of adopting wearable technology. A plausible reason for this response
is that those participants may not be as exposed to smart technology such as smartphones
as much as other younger participants.
If this barrier was overcome however, perceptions of wearable technology after use in all
participants were positive even when previous perceptions were negative, suggesting that
informed perceptions after use overcome preconceived negative perceptions:
I was very sceptical of it at first, about how it worked and everything, but once I tried
I realized it was mega simple. Not having to do anything and it do all the work for you
is great, it is motivating actually seeing what youve done and how much youve
Participant 10
4.3.2 Obsessive behaviour

A third of the participant expressed views on the use of pedometers prior to their own use
about concerns that it may lead to obsessive behaviour. This is a concern which is very
talked about amongst reviews of such products and apps and it shows a negative public
perception of wearable technology. Although users may not become obsessive of the
products, the negative public perceptions could lead to people being less likely to adopt
wearable technology:
I did worry about being over obsessed about it because I didn't want to go crazy
thinking about needing to walk more steps, but I guess its not too bad now because I
use it within reason Participant 9
4.3.3 Attitudes towards new technology

A negative perception is seen in the older group of interviewees and will have a direct effect
on whether they are able to use wearable technology:
I dont use much technology in general but this stuff is way over my head, its just
too high tech for me, it just seems very unnatural to be so aware about how many
steps you walk in a day Participant 11
24
On the other end of the spectrum, some interviewees took to pedometers and new
technology very well and had no negative perceptions towards them prior to this. But actually
perceived them as being a new attractive gadget or nifty as quoted. This highlights that not
all perceptions are negative towards wearable technology, but it has more to do with the
individuals perception due to their personal experience with technology. Some individuals
were more attracted to a product which shows off its complicated technology whilst others
may not and be put off by this:
I didnt have a problem taking to pedometers, I thought they were really nifty and
easy to use Participant 1
The attitude towards new technology is classically conceptualised by the technology
adoption cycle, as some of the population are much more acceptance and hence the early
adopters and majority.
4.4 Barriers and facilitators of wearable technology use

Like how many perceptions can be both barriers and facilitators to wearable technology use,
there is much more that goes into peoples decision to start using wearable technology.
Likewise there are many factors, internal and external that may prevent people from
adopting wearable technology. Results from the interviews were able to identify reasons why
participants were more or less likely to use wearables and how this is applicable with a wider
population.
4.4.1 Rewarding
Whenever changing a behaviour requires effort and doing something challenging it is nice to
be rewarded for it and this is what all but one participant agreed on. The rewarding feeling
from seeing exercised logged by wearables was able to facilitate participants to do further
activity which then has a roll on effect. Bandura, (1978) emphasised the importance of
experiencing achievements and rewards in order to increase self-efficacy for behaviour
change:
It made me feel like the hard work I was doing by walking more was being
appreciated and recognized by the app which is a funny feeling- Participant 9
25
4.4.2 Ease of use

The initial adoption of wearable technology is as important if not more as the continued use
and what was found was that most participants started using the technology almost
unintentionally. It was pointed out that this was down to the technology being very easy to
understand and not having to consciously perform any task but rather have the technology
do all the work automatically. The ease of use has to be one of the most powerful facilitators
for initiating wearable technology use and a similar argument can be given for it also being a
facilitator for continued use:
I have looked at my phone before which counted my steps, I thought that was
interesting to see how much I walked in the day. I guess I started using it because it
was so easy to understand, I didnt have to do anything, and it just counted my steps
for me and showed me my exercise Participant 12
4.4.3 Financial Cost

Cost is always a major factor in every decision in human behaviour and it is no different in
wearable technology use. The real world is much more likely to adopt cost-effective methods
for health related behaviour change (Jane et al., 2015). The fact that there was no added
cost to start using wearable technology for most participants was a major facilitator:
I do use it because it came with my phone and its free so why not Participant 6
To further reiterate the importance of cost as a barrier and facilitator, there were participants
who stopped using wearables purely down to there being an added cost, emphasising how
much of an effect cost can have as a barrier and facilitator to wearable technology use:
I used an app which logged how many reps you did, what weights you did at the
gym. I stopped because I had to pay for it after a while - Participant 3
4.4.4 Attitudes towards technology

There seems to be certain participants with internal barriers to wearable technology use due
to preconceived negative attitudes. The belief that wearable technologys function isnt
capable of aiding in behaviour change has preventing individuals from adopting wearables.
All but one participants were able to overcome this preconceived attitude however as the
facilitators were more powerful leading to adoption of wearables:
I dont believe that a machine can give me motivation to change behaviour, I think
its up to me personally - Participant 11
26
4.5 Wearable technology experiential links with the stages of change in

The stages of change is a part of the trans-theoretical model of behaviour change which has
been used in this report and in the series of interviews to identify different stages of
behavioural change in participants. Participants responses have been analysed in a way that
incorporates the trans-theoretical model, and their experiences can be linked and explained
by the trans-theoretical model. The stages of change that were most talked about during the
interview process was the stage change from contemplation/preparation to action and also
from action to maintenance, and related to maintenance there was also the prevention of
relapse. The analysis will help determine how wearables affects participants in their stages
of change which can then be explored and discussed further.
4.5.1 Contemplation
It is common for the contemplation stage to take very long time to progress past and
sometimes requires some form of trigger. We know from the literature that contemplation
can be a stage that individuals find themselves in for long periods of time. The use of
wearables has assisted a number of the participants to take action by tracking progress and
has increased their confidence to take action:
For a long time I was thinking about putting on weight and size, but I always put it
off. What triggered it was when I went on holiday, and I weighed myself before and
after, losing that much weight triggered me to actually put on weight and make a
change. Seeing my weight tracked on my phone was very motivating and I think it
mustve helped me start and also keep me going Participant 3
The key barrier of the lack of information and knowledge on changing a behaviour which had
some participants stuck in contemplation for some time was able to be overcome with the
use of wearables. Four participants highlighted how having a starting point from using
wearables was fundamental in their behavioural change progression, some of these
participants even had an easier time adopting other positive health related behaviours
because of this:
Before starting exercise, I did think about it for a long time, my step counting just
gave me a good platform to start. I have also used the app a lot more, which has
linked to my food and the same thing has happened with being able to control my
food Participant 8
27
4.5.2 Preparation
During interviews where participants were looking to adopt a new behaviour, for preparation
there was a consensus that some form of activity tracker was needed before starting the
new behaviour. The key idea that participants emphasised was the motivation wearables
gave them to take action and also maintain. Participant who were currently in the
maintenance stage of their behaviour also had similar responses:
I would like to start running and thats taking me a while to get into to be honest. I
would definitely use a step counter for that though, or maybe something better like a
heartrate tracker. Because again itll recognize my exercise and remind me of how
much I did, and also how much I should do Participant 8
4.5.3 Maintenance
In maintaining a behaviour, it is common for relapses to occur due to external stimuli. As
wearables are seen to be useful in helping maintain a behaviour, there is a possibility that it
may be reducing the likelihood of relapse in some way. In preventing relapse another
common response from participants was that tracking progress made it easier to maintain
due to seeing previous achievements and trying to match them.
To prevent relapse I guess tracking my progress made me continue. Seeing what I
did the day before motivated me to do the same or better today Participant 13
The function that wearable technology provides with being able to track activity and progress
allows users to be reminded on the level of activity that they should be doing. This idea of
being consciously more aware of ones activity level was motivation for many participants.
Judging from the experiences of the participant, being aware of when they are at risk of
relapse gives them the motivation to prevent relapse:
I do now consciously think about walking, even if I dont track it, when I dont walk a
lot in a day and I can see that on my tracker I dont feel very good about it so I try to
avoid it as much as possible Participant 13
28
4.6 Wearable technology experiential links with the core constructs in

4.6.1 Self-Efficacy
Self-efficacy is another key construct in behaviour change theory, which explores the idea
that people are more likely to perform a task and change a behaviour the more they believe
in their own ability to achieve whatever behaviour they are looking to do. Understanding this
construct in an experiential perspective will allow applications of wearable technology to
increase self-efficacy and possibly promote health related behaviour change in individuals.
When embarking on a new behaviour change it was apparent that many participants had
little faith in their own ability to change. This perception may have been a big barrier in
preventing the individual from ever even trying to change. As Velicer et al., (1990) stated,
we know that self-efficacy measures can predict a lasting change in behaviour, and is seen
as an important construct in behaviour change (Bandura, 1978). Three participants talked
about how wearables had increased their belief in their own ability by making them realise
that they are doing exercise as it is automatically recorded:
I have been trying to exercise more for a long time, but Im starting to believe maybe
Im not built for exercise to be honest. Ive only started using it recently, but seeing
how many steps I can do a day makes me feel really good, and Ive started to do a lot
more steps now because of it Participant 10

Decisional balance is a key construct in behaviour change theory which helps to
conceptualise the phenomenon of decision making in people. In the series of interviews,
responses showed aspects of this construct and showed outcomes which were predicted by
the decisional balance sheet. Understanding this construct and how it works in participants
experiential perspective can then lead to understanding how wearable technology can tilt the
decisional balance to favour a health related behaviour change.
As we previously discovered, one of the largest barriers to the decisional balance is cost.
The removal of that barrier has resulted in tilting the decisional balance towards changing
behaviour. Participants would weigh up the pros and cons before committing to change and
with costs removed, the participants did suggest that they were more likely to change their
behaviour. Quite simply, making the behaviour change cost as little as possible can tilt the
decisional balance of more people to promote health related behaviour change:
The gym was free which was helpful, because I wouldnt have gone if I were to have
to pay for a membership - Participant 4
29
A lot of decisions are made by people every day, and pros and cons are weighed up against
each other constantly. The cons can sometimes outweigh the pros which in the mind of the
individual makes the task not worth doing. What would benefit health related behaviour
change, would be a way to reduce the cons as much as possible and emphasise the pros.
Wearables has been seen to do this in the majority of participants. Relating to the selfefficacy construct,
Koyun and Erolu's (2016) study showed that increased self-efficacy resulted in greater pros
for behaviour change. Tracking activity has made the con of added activity such as walking
to the gym, become a pro as walking more to achieve a step count goal:
Its quite a long way to the gym, I want to get exercise in but I just cant be bothered
to walk so far and be tired before I even get there. If I get into the swing of things Im
okay, but the thought of being tired, or when its cold, it does hold me back
Participant 5
4.7 Wearable technology as a facilitator of health related behaviour change

Ultimately, all the interviews conducted were aimed to uncover the experiences of people
with wearable technology and see what affect it had on health related behaviour change.
Wearable step counters aims to help facilitate increasing exercise in.
4.7.1 Progress logging and recognition

Overcoming barriers is a key part of deciding to initiate a new behaviour. With the help of
wearable technology, participants agreed that progress tracking was able to provide a form
of recognition and help with motivation. This information being recorded increases an
individuals self-efficacy as they are able to see exactly how much they are doing and having
more exercise tracked becomes a pro for doing more exercise. This positive mentality
towards behaviour change is what is needed to initiate and maintain a new behaviour.
Wearable technology providing progress logging provides this and is seen to be an
extremely effective facilitator for enhancing behaviour change (Nishiyama et al., 2015). Not
only can it affect a certain behaviour directly, but many participants found that once they
started on a path of increased exercise they saw other health related behaviour changes
start to happen:
It made me feel like the hard work I was doing by walking more was being
appreciated and recognized by the app which is a funny feeling Participant 8
30
4.7.2 Momentum of behaviour change and increased awareness

Participants were very enthusiastic about how step counters initiate and helps maintain a
current behaviour, but also that it could indirectly lead to other health related behaviour
changes. This could possibly be linked to the self-efficacy construct as the participant
believes that they are able to change their behaviour and live a healthier lifestyle. Lack of
motivation was also a key theme that was brought up in a lot of responses and two thirds of
participants outlined that the step counter was directly motivating them to at least match
previous days activity. This is a very powerful result of using wearables in a lot of
participants and seems to be very beneficial in maintenance of increasing exercise
behaviour:
When I saw how much I walked I was motivated to walk the same amount again and
not eat badly. I think it made me more aware and I wanted to walk more even though I
wasnt intending on it Participant 12
4.7.3 Goal setting

Lastly also related for motivation, goals were a very common theme brought up by nearly all
participants when asked about motivation tools. Many participants although never used
goals as a motivation tool before the use of step counters, found that achieving goals
became a strong motivational tool to maintain their behaviour. Five participants stated how
even a small goal will give satisfaction, this can therefore increase self-efficacy and lead to
positive behaviour change:
Achieving goals is extremely satisfying I think, thats what keeps me going, however
small the goal may be - Participant 11
31
5 Discussion
Wearable technology being in its infancy and constantly improving and innovating rapidly, it
is hard to imagine that its acceptance will not increase over time. This gives wearable
technology a huge opportunity as more people will be using wearable devices. The aim of
this report was to identify potential opportunities for wellness wearable technology as a
facilitator for health related behaviour change, taking into account concerns expressed by
people who have experienced using wearable devices in the past and present.
5.1 Overcoming Barriers towards health related behaviour change with

applications of wearable technology.
The most common and expected barrier to health related behaviour change was time and
lifestyle constraints. There isnt particularly much that wearable technology can do to reduce
constraints in peoples daily lives however there is a potential for wearable technology to
help motivate users or allow them to be more productive with their time in order to facilitate
health related behaviour change. People in the UK have on average two hours and 45
minutes a day of free time, however this time is taking into account reduction of free time by
a constant need to be connected to work and other commitments by email and smartphones
(Khaleeli, 2013). The belief that there isnt time for exercise is a false belief in many of
participants as shown by the responses. Even though before these participants changed
behaviour they believed that they did not have the free time to commit to changing
behaviour, once committed they realise they are able to change behaviour even with the
same time and lifestyle constraints they had previously.
This concern of having too little time to commit to changing behaviour i.e. increasing daily
steps, may be a concern that is exaggerated as all participants were able to find time to
increase their daily steps with little problems with time constraints. It is plausible that
peoples perception of how well their time is used is possibly quite exaggerated to
accommodate the belief that they dont have enough time. A British survey found that people
greatly underestimated the time spent watching television in a month by as much as 20
hours, similar underestimations also come from time spent online (Chalabi, 2013). This could
explain why participants felt that they had little time to commit to any changes. But as they
have changed, they have been able to use their time more effectively to accommodate a
new changed behaviour.
32
So what role does wearable technology play as a facilitator of health related behaviour
change to overcome time and lifestyle constraints? One of the benefits of wearable
technology that was common in responses by the participants were how easy wellness
wearables were to use and how it doesnt take any effort as it is all automatic. This is a
feature of wearables which has been noticed by users which allows them to fit wearables
into their lives relatively easily. A lot of participants starting to walk more unintentionally, this
shows how effective wellness wearables can be as a facilitator in behaviour change.
Participants who at the time were not even at a stage of contemplation progressed to action
unconsciously. Participants explained what they felt pushed them to change, an emphasis
on wearables effortless data tracking function was shown in participant responses. Wellness
wearables ability to automatically record data has been shown to be effective as a facilitator
for behaviour change and overcoming participants time and lifestyle constraints and
concerns.
5.1.2 Mental Barriers

Participants emphasised how many of the challenges that they faced were not physical
barriers but rather mental barriers, such as laziness. When a conscious act is needed to
actively try and change behaviour, participants suggested this to be much more mentally
challenging to commit to compared to a performing a habit or old behaviour. Participants
emphasised that motivation was needed in order to consciously try and change behaviour.
Perceiving the behaviour change as a task seems to result in a greater challenge, but when
something has become a natural behaviour, the task is performed without any mental
challenges and requires less conscious thought to perform. The youngest part of our brain,
the prefrontal cortex is responsible for a lot of our conscious thought and actions,
unfortunately it is also the first part of the brain to go offline during times of stress and
fatigue. When this happens it becomes very easy to perform old habits which do not require
activity from the prefrontal cortex possibly explaining why participants feel old behaviour is
less of a mental challenge to perform (Brewer et al., 2013). Overcoming this barrier will
require the new behaviour becoming a habit and in turn will make performing the behaviour
less mentally taxing for the individual. However achieving this isnt quite so simple,
motivation and discipline is needed in order to maintain a new behaviour, and turn the new
behaviour into a habit.
Lack of motivation and discipline is a massive barrier for most participants trying to commit
to a new behaviour. Low motivation in individuals has been seen to be a major contributor to
sedentary behaviour (Cavalheri et al., 2016). Unless they are able to find a way to motivate
themselves, new behaviours are not maintained for very long. A lot of participants mentioned
33
that they need some form of incentive, this has been shown to be an extremely effective tool
in promoting behaviour change (Jeffrey et al., 2016).
As we have seen in the results goal setting was a popular form of motivation, even for those
participants who were not used to goal setting in other aspects of their daily lives. So the
automatic goals set by wellness wearables is an aspect that has enabled individuals to
overcome mental barriers and find motivation to facilitate behaviour change. Having goals
set for individuals has been shown to have very positive results, Moy et al., (2015) found that
their intervention group who were given daily steps goals averaged significantly more steps
a day compared to the controlled group who were not given daily steps goals.
Reasons for why goal setting by wearables is an effective tool in motivation differs between
individuals. One group of participants were motivated as achieving the goal set out to them
gave a feeling of satisfaction and accomplishment. This feeling of satisfaction is a form of
incentive, as previously mentioned incentives have been shown to be an effective tool in
facilitating behaviour change. Another group of participants were not as motivated by
accomplishing goals however they felt that they were still incentivised to achieve the goal
set. These participants were less likely to achieve the goals set for them, however admittedly
they did find themselves walking more than they felt they have been in the past. An
explanation for this phenomenon is that these were the participants who were less aware
about changing behaviour than others. They admitted to be lacking in knowledge of certain
areas of the new behaviours due to lack of clear information. This has also been seen in a
separate study Sebastio et al., (2015) showed in older women, public information on
increasing physical activity was not being perceived in an effective way and should be
modified as the current information is not resulting in increased physical activity. What the
goal setting has seemed to have done was to provide these particular individuals with a
benchmark, a clear target which is easy to understand in which they know they should be
reaching if they were to want to change their behaviour. This set goal had become an anchor
for the participants, in human behaviour anchoring is seen where people rely heavily on a
single piece of information which effects their decision making. In this case individuals were
more likely to achieve steps closer to the goal or anchor provided (Sapadin L., 2013).
Understanding and being aware of what they need to do to change their behaviour to
exercise more resulted the participants in this study being more likely to exercise more as
they achieved steps closer to the goals set for them. Wellness wearables in as a facilitator
for health related behaviour change is able to increase an individuals awareness by goal
setting and tracking data, which has been shown through participants experiences to have a
positive effect in facilitating change.
34
5.1.3 Overcoming wearable technology use barriers

Barriers and concerns for wearable technology use in this study were present in all
participants in one way or form. There still seems to be a generation which are still not yet
accustomed to innovative technology, and this makes adoption of new technologies more
challenging. Any new technology has the perception of being complicated and high tech to
these participants even though this may not be the case. Aldhaban et al., (2015) showed
that adoption of technology varied greatly between different sociodemographic areas and
cultures due to varying attitudes towards technology. Understanding the reasons behind
these barriers and concerns is important to see how they affect wellness wearables
capability to facilitate health related behaviour changes. This will allow important steps to be
made to find ways to combat these barriers and concerns to allow wellness wearables to
facilitate health related behaviour change as much as possible.
Because there is evidence that shows functions of wellness wearables are beneficial in
increasing exercise and other health related behaviours in users through progress logging,
goal setting, step counting etc. (Tudor-Locke et al., 2004). Increasing the adoption of
wearable technology by lowering barriers briefly discussed in the results should help in
facilitating health related behaviour change on a population scale. We know that there are
individuals who are not as accepting to innovation which figure 1.2 identifies as the late
majority of laggards. This is because wellness wearable technology is still in its infancy,
naturally over time wearables will diffuse and become more accepted as the innovation
diffusion theory suggests. However this does not mean that nothing can be done to make
wearables more appealing and increase wearable adoption. Many participants expressed
their concerns over the unfamiliarity with wearable technology and this has prevented them
from adopting the technology in the past. This is a major theme in older participants and is a
well-known issue with technology adoption. Major concerns about unfamiliarity of wearable
technology comes from a lack of understanding. Increasing the understanding of
technologies such as pedometers have been shown to have a positive effect on increasing
adoption and compliance of pedometer use in sedentary patients (Ten Hacken and De
Greef, 2008).
35
Users expressed that wellness wearables were not as convenient as pieces of technology
that have accelerometers already built in such as a smartphone and this was a significant
barrier in adoption. Increased perceived convenience of a product seemed to have a higher
adoption effect in all participants as only few would go out to buy a wearable device to track
their exercise, while most were willing to try using accelerometers already built into their
smartphones. As shown in the results, expectedly cost and convenience was a major factor
in determining whether participants were to start using wellness technology. Being free
made it very easily accepted by all of the participants who were interviewed. So there is
reason to believe that people are willing to try when there is little cost. Evidence from other
studies also show the importance for tools such as pedometers to be a relatively low cost if
not free and also simple to use and understand (Craig et al., 2007). Wellness wearable
technology has now been incorporated into other technologies such as watches and phones,
this has been shown to increase usage of wellness technology which is positive for health
related behaviour change. However because participants were more likely to adopt wellness
technology in a convenient form such as built into a watch or smartphone, shows that its
potential benefit does not overcome the barrier of inconvenience to purchase a separate
product. Therefore incorporating wellness wearable technology with other technologies such
as smart watches may prove to be a significant way to increase usage. Which in turn will
further facilitate health related behaviour changes in the population.
5.2 Wearable technology and the trans-theoretical model of behaviour change

theory
Throughout this study there have been many ways in which wellness wearables have had an
effect on behaviour change, and these effects can be explained and related back to the
trans-theoretical model. We know that physical activity behaviour change is consistent with
predictions from the trans-theoretical model (Wilson et al., 2016). Using the trans-theoretical
model will allow increased understanding what is happening in the mind of the individual that
causes a change in behaviour. This is extremely valuable as it will help identify ways in
which wellness wearables can facilitate health related behaviour change.
5.2.1 Progression through the stages of change

Progressing through the stages of change is a conceptualisation of how individuals go about
changing their behaviours. This study attempts to understand how wearables could play a
role in aiding the progression through these stages of change. Particular focus was put on
what roles wellness wearables had in initiating a new behaviour, progressing from
contemplation to preparation and action, and also maintenance of a new behaviour.
36
Firstly a massive positive outcome from the use of wellness wearables was how they were
able to facilitate a positive health related behaviour change in increasing exercise in most
participants in this study. This also included participants who were not consciously aiming to
change their behaviour. As previously mentioned the ease of use and relatively low cost
allowed people to adopt using pedometers on their smartphones which also led to further
adoption of wearable devices. Relating back to the stages of change, this not only helped
individuals in contemplation to progress and take action, but surprisingly also helped
individuals in precontemplation to take action towards a health related behaviour change.
The attributes that many wellness wearable devices have such that they are easy to
understand and relatively cheap is an important factor in the eyes of the participants. This
likelihood of adoption gives wellness wearables an opportunity to facilitate a positive
behaviour change.
Separate attributes and functions of wellness wearables such as being able to track
progress and data effortlessly has become an incentive for the participants to continue using
wearables. This is an important aspect of wearables as to maintain a behaviour is just as
challenging as starting a new behaviour. Progressing to the maintenance stage in the transtheoretical model requires motivation and discipline. Wellness wearables has been seen to
provide this according to the respondents answers and successes. The ability for wearable
devices to monitor and individualise its goals and functions has a positive reception from
most of the participants and this is supported by studies that show that individualised
programs show significant improvements when compared to a general program (Jeffrey et
al., 2016). All these factors will have its own effect on how well wellness wearables facilitates
health related behaviour change, what is agreed by the majority of participants is that
wearables provides a form of motivation and helps keeping disciplined to changing
behaviour. Maintain this motivation and discipline is shown to be a key part in forming new
behaviours and eventually habits. Studies have shown that to form a new behaviour and
habit, on average it requires motivation and discipline for 66 days (Keller G., 2013). For
wearables to be able to provide this motivation and aid in discipline, it has to be seen as an
extremely powerful tool in facilitating behaviour change.
37

Decisional balance is a construct in behaviour change theory to help predict peoples
decisions in behaviour change. When discussing how wellness wearable technology is
related to this construct, this report has found ways in which wearables have interacted with
the decisional balance construct by altering pros and cons accordingly. We know from
quantitative reports that those individuals in the action stage of change had significantly
lower cons when measuring decisional balance, compared to those individuals in
contemplation and preparation (Wilson et al., 2016).
This is important to note as affecting the decisional balance can lead individuals to make
decisions that they may not have made without the interference by wellness wearable
technology; such as exaggerating the benefits of exercise and thus overcoming the cons
leading to action.
Quite simply there are two ways that wellness wearables can alter the decisional balance to
facilitate behaviour change, either reducing the cons (barriers) or increase the pros
(benefits). When interviewing participants, questions were prompted to uncover what made
them decide to initiate a new behaviour, and what tilted their decisional balance towards
favouring the benefits over the barriers. These reasons included aging and being more
aware of health benefits of exercising, realising benefits were much greater than once
thought or alternatively realises barriers were not as great as once thought. The most
effective way that wearables tilted the decisional balance was by increasing awareness on
the behaviour change, in most cases, exercise. Knowing how many steps are being done a
day made people more aware of their physical activity, and this awareness leads them
seeing it as a benefit. Similar applications could be said for calorie tracking, activity tracking
and heartrate tracking, all of which increases awareness. Having data such as steps
physically recorded by devices also seemed to have slightly increased the benefits of
walking as there was an incentive to reach a set goal, this goal setting and incentives as
previously mentioned is an effective motivator and this is consistent with the decisional
balance construct (Moy et al., 2015).
Wellness wearables are also seen as a tool by participants to be an effective logging tool
which is extremely easy to adopt and use. The constant logging of physical activity
information has also been seen to be an effective motivator for participants (Ten Hacken and
De Greef, 2008). This could be explained in terms of the decisional balance construct as a
form of reducing barriers. The greatest barriers for increasing physical activity expressed by
participants were laziness, time constraints and lack of motivation. The logging of
information when an individual is walking may provide a rewarding sensation when they see
38
that the exercise is recorded. The realisation that being lazy, and having not time is not such
a big barrier as they have been performing physical activity as shown by the data log is
mentally stimulating and can give motivation to further progress as the decisional balance
tilts in favour of the benefits. Tilting the decisional balance is an effective method to induce a
behaviour change and wellness wearables is able to achieve this to facilitate health related
behaviour change.
5.2.3 Self-Efficacy
Self-efficacy is the construct which has been shown to be very consistent in predicting
behaviour change in individuals. As higher scores of self-efficacy come from those
individuals further along in the stages of change (Bandura, 1978). Understanding how
wearable technology can affect self-efficacy can therefore help better understand how
wearable technology can positively affect behaviour change.
The fundamental function of wearables is to log data, and its this data logging which has
been seen from participant responses to have a massive effect on their self-efficacy. Visually
seeing what they have achieved and rewarding them for what they have achieved through
recognition built confidence in many of the participants. Most participants agreed that they
felt as though they could improve further because of each achievement, helping maintain
behaviour. Being aware of what they have achieved as their achievements are saved is a
form of increasing self-efficacy (Moy et al., 2015). Now this effect on self-efficacy from
progress logging is limited as it is highly likely that not everyone will have the same cognitive
processing of efficacy information and therefore reacting differently to these achievements
(Bandura, 1978). For these participants there may be need different motivations in order to
promote behaviour change.
Performing preparatory behaviours has been shown to have a positive effect in increasing
physical activity in individuals with low self-efficacy, and as they may not be as motivated by
achievements and incentives. Having preparations for performing behaviours and tasks by
wearable devices which have been individualised, have showed to have significant benefits
for individuals with low self-efficacy (Barz et al., 2016). Wearable devices being able to
provide a form of preparation to assist in behaviour change can result in increased
preparatory behaviour, effective in low self-efficacy individuals (Barz et al., 2016). With the
possibility of increasing self-efficacy as the individual progresses to the maintenance stage.
This preparatory function can be utilised by individuals to facilitate health related behaviour
change in those that may not be as motivated by reward incentives. This shows how
wellness wearables are very versatile in facilitating behaviour change.
39
6 Conclusion
6.1 Potential opportunities for wellness wearable technology use for health
related behaviour change
This study used interviews to try and gain an experiential perspective of wellness wearable
technology and their benefits and problems. With this, opportunities and major concerns
relating to health related behaviour change have been deduced to explore where the future
could lie in wellness wearable technology and how this will effect health related behaviour
change in the population, most importantly how wellness wearables can facilitate health
related behaviour change.
From all of the participants, responses for wearables technologys features have been very
positive, both for those who were sceptical before use and those who were early adopters.
However the enthusiasm over using a separate wearable device was much less popular
than those devices such as accelerometers built into phones due to added inconvenience.
However as discussed, with the growing popularity for smartwatches, this gives wellness
wearable devices an excellent platform to be exposed to the consumer by incorporation with
other technologies to increase convenience which could potentially increase adoption to
facilitate health related behaviour change. A versatile wellness wearable device with a wide
range of functions such as heart rate monitoring and sleep monitoring may show to have
more possible benefits in the eyes of the consumer thus outweighing the costs to increase
adoption however further quantitative research should be done in order to see the
acceptance of these wearables given the costs.
Use of wellness wearable devices have shown a positive outcome in initiating health related
behaviour changes by creating motivation and facilitating discipline in individuals which is an
important area to consider for maintenance of health related behaviour as well. Wellness
wearables ability to provide motivation can prove to be a significant factor in facilitating users
to maintain behaviours long enough for them to become habits. This along with various other
functions effective in facilitating health related change presents an opportunity for wellness
wearables to utilise in order to achieve a population with positive health related behaviours.
This is the ultimate goal for health related behaviour change, as creating better population
habits will lead to added benefits for society and less strain on the healthcare system by
tackling the obesity problem in the UK and as a whole have a healthier and happier
population.
40
7 Acknowledgements
Firstly I would like to thank my supervisor Dr. Sharron Kuznesof for her advice and guidance
through conducting this study and completing this report.
I would also like to thank the participants who kindly gave up their time to participate and
provide me with the valuable data for my project.
I would like to thank Frosty Berry who provided me with the financial support I needed to
complete this report, and the resources to purchase food for all the late nights spent
completing this project.
Lastly I would like to thank the Architecture School for providing me with a quiet environment
to conduct my study and complete writing this report and all my peers who were there to give
me moral support.
41
8 Bibliography
ALDHABAN, F., DAIM, T. U. & HARMON, R. Exploring the adoption and use of the
smartphone technology in emerging regions: A literature review and hypotheses
development. Management of Engineering and Technology (PICMET), 2015
Portland International Conference on, 2-6 Aug. 2015 2015. 2355-2370.
BANDURA, A. 1978. Self-efficacy: Toward a unifying theory of behavioral change. Advances
in Behaviour Research and Therapy, 1, 139-161.
BARZ, M., LANGE, D., PARSCHAU, L., LONSDALE, C., KNOLL, N. & SCHWARZER, R.
2016. Self-efficacy, planning, and preparatory behaviours as joint predictors of
physical activity: A conditional process analysis. Psychology and Health, 31, 65-78.
BRAUN, V. & CLARKE, V. 2006. Using thematic analysis in psychology. Qualitative
Research in Psychology, 3, 77-101.
BREWER, J. A., DAVIS, J. H. & GOLDSTEIN, J. 2013. Why Is It So Hard to Pay Attention,
or Is It? Mindfulness, the Factors of Awakening and Reward-Based Learning.
Mindfulness, 4, 75-80.
BRIDLE, C., RIEMSMA, R. P., PATTENDEN, J., SOWDEN, A. J., MATHER, L., WATT, I. S.
& WALKER, A. 2005. Systematic review of the effectiveness of health behavior
interventions based on the transtheoretical model. Psychology & Health, 20, 283301.
BROWNE, T., PRIESTER, M. A., CLONE, S., IACHINI, A., DEHART, D. & HOCK, R. 2016.
Barriers and Facilitators to Substance Use Treatment in the Rural South: A
Qualitative Study. Journal of Rural Health, 32, 92-101.
BYRNE, N. M., MEERKIN, J. D., LAUKKANEN, R., ROSS, R., FOGELHOLM, M. & HILLS,
A. P. 2006. Weight Loss Strategies for Obese Adults: Personalized Weight
Management Program vs. Standard Care. Obesity, 14, 1777-1788.
CAVALHERI, V., STRAKER, L., GUCCIARDI, D. F., GARDINER, P. A. & HILL, K. 2016.
Changing physical activity and sedentary behaviour in people with COPD.
Respirology, 21, 419-426.
CHASE, L. D., TEEL, T. L., THORNTON-CHASE, M. R. & MANFREDO, M. J. 2016. A
Comparison of Quantitative and Qualitative Methods to Measure Wildlife Value
Orientations Among Diverse Audiences: A Case Study of Latinos in the American
Southwest. Society & Natural Resources, 29, 572-587.
Chalabi M., 2013, Do we spend more time online or watching TV. [online]
Available at http://www.theguardian.com/politics/reality-check/2013/oct/08/spend-moretime-online-or-watching-tv-internet
[Accessed 7th April 2016]
CHEN, S. Y. & LU, C. C. 2016. Exploring the relationships of green perceived value, the
diffusion of innovations, and the technology acceptance model of green
transportation. Transportation Journal, 55, 51-77.
42
8 Bibliography
CRAIG, C. L., TUDOR-LOCKE, C. & BAUMAN, A. 2007. Twelve-month effects of Canada
on the Move: A population-wide campaign to promote pedometer use and walking.
Health Education Research, 22, 406-413.
DICLEMENTE, C. C. & HUGHES, S. O. 1990. Stages of change profiles in outpatient
alcoholism treatment. Journal of Substance Abuse, 2, 217-235.
DIJKSTRA, A. & BORLAND, R. 2003. Residual outcome expectations and relapse in exsmokers. Health Psychology, 22, 340-346.
JACOBS, M. A. & GRAHAM, A. L. 2016. Iterative development and evaluation methods of
mHealth behavior change interventions. Current Opinion in Psychology, 9, 33-37.
JANE, M., FOSTER, J., HAGGER, M. & PAL, S. 2015. Using new technologies to promote
weight management: a randomised controlled trial study protocol. BMC Public
Health, 15, 1-9.
JEFFREY, T. K., GEOFFREY, C. W., KENNETH, R., LAWRENCE, C. A., AMY, R., KEVIN,
G. V. & MICHELE, H. 2016. The promise of tailoring incentives for healthy behaviors.
International Journal of Workplace Health Management, 9, 2-16.
Khaleeli H., 2013, How to get more free time in your day. [online]
Available at http://www.theguardian.com/money/shortcuts/2013/jun/07/how-get-more-freetime
Keller, G. (2013) The One Thing: The Surprisingly Simple Truth Behind Extraordinary
Results
KOYUN, A. & EROLU, K. 2016. The effect of transtheoretical model-based individual
counseling, training, and a 6-month follow-up on smoking cessation in adult women:
A randomized controlled trial. Turkish Journal of Medical Sciences, 46, 105-111.
KOZICA, S. L., TEEDE, H. J., HARRISON, C. L., KLEIN, R. & LOMBARD, C. B. 2016.
Optimizing Implementation of Obesity Prevention Programs: A Qualitative
Investigation Within a Large-Scale Randomized Controlled Trial. Journal of Rural
Health, 32, 72-81.
MAHER, C., RYAN, J., KERNOT, J., PODSIADLY, J. & KEENIHAN, S. 2016. Social media
and applications to health behavior. Current Opinion in Psychology, 9, 50-55.
MOY, M. L., COLLINS, R. J., MARTINEZ, C. H., KADRI, R., ROMAN, P., HOLLEMAN, R.
G., KIM, H. M., NGUYEN, H. Q., COHEN, M. D., GOODRICH, D. E., GIARDINO, N.
D. & RICHARDSON, C. R. 2015. An internet-mediated pedometer-based program
improves health-related quality-of-life domains and daily step counts in COPD: A
randomized controlled trial. Chest, 148, 128-137.
NISHIYAMA, Y., OKOSHI, T., YONEZAWA, T., NAKAZAWA, J., TAKASHIO, K. & TOKUDA,
H. Towards health exercise behavior change for teams using life-logging. 2014 IEEE
16th International Conference on e-Health Networking, Applications and Services,
Healthcom 2014, 2015. 397-403.
43
8 Bibliography
PONCE, P., POLASKO, K. & MOLINA, A. 2016. End user perceptions toward smart grid
technology: Acceptance, adoption, risks, and trust. Renewable and Sustainable
Energy Reviews, 60, 587-598.
PORTNOY, D. B., SCOTT-SHELDON, L. A. J., JOHNSON, B. T. & CAREY, M. P. 2008.
Computer-delivered interventions for health promotion and behavioral risk reduction:
A meta-analysis of 75 randomized controlled trials, 19882007. Preventive Medicine,
47, 3-16.
Prochaska J.O. et al, 2015, The Transtheoretical Model [online]
Avilable at http://www.prochange.com/transtheoretical-model-of-behavior-change
[Accessed at 17th April 2016]
PROCHASKA, J. O. & DICLEMENTE, C. C. 1982. Transtheoretical therapy: Toward a more
integrative model of change. Psychotherapy: Theory, Research & Practice, 19, 276288.
PROCHASKA, J. O., VELICER, W. F., GUADAGNOLI, E., ROSSI, J. S. & DICLEMENTE, C.
C. 1991. Patterns of Change: Dynamic Typology Applied to Smoking Cessation.
Multivariate Behavioral Research, 26, 83-107.
ROSENKRANZ, R. R., DUNCAN, M. J., CAPERCHIONE, C. M., KOLT, G. S.,
VANDELANOTTE, C., MAEDER, A. J., SAVAGE, T. N. & MUMMERY, W. K. 2015.
Validity of the Stages of Change in Steps instrument (SoC-Step) for achieving the
physical activity goal of 10,000 steps per day. BMC Public Health, 15, 1-10.
Sapadin, L. 2013, The Anchoring Effect: How it Impacts Your Everyday Life. Psych Central
[online]
Available at http://www.psychcentral.com/blog/archives/2013/07/27/the-anchoring-effecthow-it-impacts-your-everyday-life/
SEBASTIO, E., CHODZKO-ZAJKO, W. & SCHWINGEL, A. 2015. The need to modify
physical activity messages to better speak to older African American women: A pilot
study. BMC Public Health, 15.
SOFAER, S. 1999. Qualitative methods: what are they and why use them? Health Services
Research, 34, 1101-1118.
Sorenson K., 2013, Why you should roll out technology in small groups first [online]
Available at http://keithosorensen.blogspot.co.uk/2013/03/reasons-research-and-rogers-whyyou.html
[Accessed at 17th April 2016]
STEINFIELD, C., ELLISON, N. B. & LAMPE, C. 2008. Social capital, self-esteem, and use of
online social network sites: A longitudinal analysis. Journal of Applied Developmental
Psychology, 29, 434-445.
TEN HACKEN, N. H. T. & DE GREEF, M. H. G. 2008. Pedometers for monitoring and
improvement of the level of physical activity. Nederlands Tijdschrift voor
Geneeskunde, 152, 193-197.
44
8 Bibliography
TUDOR-LOCKE, C., BELL, R. C., MYERS, A. M., HARRIS, S. B., ECCLESTONE, N. A.,
LAUZON, N. & RODGER, N. W. 2004. Controlled outcome evaluation of the First
Step Program: A daily physical activity intervention for individuals with type II
diabetes. International Journal of Obesity, 28, 113-119.
VELICER, W. F., DICLEMENTE, C. C., PROCHASKA, J. O. & BRANDENBURG, N. 1985.
Decisional balance measure for assessing and predicting smoking status. Journal of
Personality and Social Psychology, 48, 1279-1289.
VELICER, W. F., DICLEMENTE, C. C., ROSSI, J. S. & PROCHASKA, J. O. 1990. Relapse
situations and self-efficacy: An integrative model. Addictive Behaviors, 15, 271-283.
VELLOZA, J., L'ENGLE, K., MWAROGO, P., CHOKWE, J., MAGARIA, L., SINKELE, W. &
KINGOLA, N. 2015. Stages and Processes of Change Utilized by Female Sex
Workers Participating in an Alcohol-Reduction Intervention in Mombasa, Kenya.
Substance Use and Misuse, 50, 1728-1737.
WILSON, J. J., KIRK, A., HAYES, K., BRADBURY, I., MCDONOUGH, S., TULLY, M. A.,
ONEILL, B. & BRADLEY, J. M. 2016. Applying the transtheoretical model to physical
activity behavior in individuals with non-cystic fibrosis bronchiectasis. Respiratory
Care, 61, 68-77.
YALNKAYA-ALKAR, . & KARANCI, A. N. 2007. What are the differences in decisional
balance and self-efficacy between Turkish smokers in different stages of change?
Addictive Behaviors, 32, 836-849.
45
Appendix A
Briefing Statement for Participant
Title of Project: Wearable technology and its potential
opportunities, perceived benefits and concerns in health related behaviour change, an
experiential perspective
Name of Researcher: Joshua Richard Hirst j.hirst@newcastle.ac.uk
Objective of Study: To investigate the use of wearable technology and its applications in individuals
and their experiences while exploring opportunities, benefits and concerns. Using this information
to investigate into the role of wearable technology in health related behaviour change, its ability to
effect behaviour change, its benefits and also its limitations.
This interview will be a series of pre-planned questions on the topic stated above, further questions
may follow if any opportunities are presented. This interview will be audio recorded and written up
into a transcript. Both audio and transcript will be kept with complete anonymity and will be
destroyed once analysis of transcript is complete.
As a participant of the study, you have the right to refuse to be interviewed or recorded for any
reason which does not have to be stated. You also have the right to revoke your given consent and
choose not to participate in the study. This will mean your data will be destroyed immediately and
not be used any further in the study.
46
Appendix B
Consent Form
Title of Project: Wearable technology and its potential
opportunities, perceived benefits and concerns in
health related behaviour change, an experiential perspective
Name of Researcher: Joshua Richard Hirst j.hirst@newcastle.ac.uk
Please tick box
1. I confirm that I have read and understood the information sheet for the
above study. I have had the opportunity to consider the information and
to ask questions. Any questions asked have been answered satisfactorily.
2. I understand that my participation is voluntary and that I am free to
withdraw at any time without giving any reason, without my legal or
personal rights being affected.
3. I understand that the researchers will hold all audio recordings and transcripts
of these collected during the study confidentially and all efforts will be made to
ensure I cannot be identified as a participant of the study (except as might be
required by law). I give permission for the researchers involved in the study to
hold relevant personal data on me.
4. I understand that other researchers will have access to this data only if they
agree to preserve the confidentiality of the data and if they agree to the terms
I have specified in this form.
5. I agree to take part in the above study.
Name of participant (please

print)
Signature
Date (ddmmmyy)
Name of person taking consent

(if different from researcher)
Signature
Date (ddmmmyy)
Name of Researcher
Signature
Date (ddmmmyy)
47
Appendix D
Newcastle University Ethics Approval
48
Appendix C
Interview questions
Today I want to talk with you briefly about a time in your life where you have changed a behaviour from a
negative (problem) behaviour to a positive behaviour
-
Can you tell me one time in the past where you have committed to a change in behaviour to
improve your health, whether that be to stop smoking, drinking, eat more vegetables, walk
more, exercise etc.
I want to walk through in detail what you were thinking and doing throughout this change so,
-
Before actually committing to this change, how long approximately did you think about changing
the behaviour?
Why was this thinking time as short or as long as it was, what was preventing you from
committing?
Before even thinking about the change, what was it that made you consider changing this
behaviour
Finally when you did finally change that behaviour can you recall what provoked you to do so
What did you find most challenging about the change?
Looking back is there anything that you wouldve given or old yourself to help you change the
behaviour quicker or easier?
To this day did you ever have trouble maintaining this new behaviour? Why do you think that is?
Is there a cause for relapsing for yourself?
In an ideal world what would you need in order to prevent relapsing into your old behaviour?
Looking into possible future behaviours, or behaviours that you may be thinking about changing soon
-
Are there any behaviours that you are looking to change right now that will benefit your health
in some way? How is that going?
Is there anything preventing you from committing to that change
What do you think would help you finally commit to that change, what kind of tools would you
think would benefit you?
We are just going to go into how technology and what role this has in your behaviour change, this will
mainly include wearable devices and exercise behaviour.
-
Do you use or have you ever used any apps or activity trackers, any technology to help with
changing behaviour? Whether that be dieting, exercising more, setting goals etc.
How do you think they helped you if at all?
Speaking about activity trackers, such as pedometers, or step counters on your smartphone, how
do you think they affect you and your exercise behaviour?
What are your feelings towards wearable devices that is devices that you have on to track
exercise, track heartrate etc.?
Can you tell me what prevented you from getting a wearable device
What was preventing you from using a wearable device or step counter on your phone?
What aspects of step counters do you find most effective and appealing?
Do they motivate you in any way? If so in what way?
Are there any aspects that you would improve on or you would like to see in this technology?
49

Wearable Technology As A Facilitator of Behaviour Change

Încărcat de

Informații document

Titlu original

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

Wearable Technology As A Facilitator of Behaviour Change

Încărcat de

Drepturi de autor:

Formate disponibile

ACE 3090

PROJECT AND DISSERTATION

2 Aims and Objectives.15

1.1 Stages of Change (trans-theoretical model)

1.2 Processes of change

1.3 Key Constructs in Behaviour Change theory

1.3.2 Decisional Balance

1.4 Behaviour change theory in practice

1.5 Acceptance of technology

Figure 2: visual representation of the diffusion of innovation theory.

1.6 Uses of technology in health related behavioural change

Function and Measures

Device Make and Model

-Fitness tracking, calories,

- Stand, exercise and move

- Fitness tracking, calories,

- Fitness tracking, calories,

1.7 Future of wearable technology and health related behaviour change

2 Aims and Objectives

Table 3: table of participants interviewed in the study

Smartphone apps, Polar wearable

Smartphone apps, Fitbit

Smartphone apps, Fitbit

Smartphone apps, Pedometer

Smartphone apps, Pedometer

Smartphone apps, Fitbit

Smartphone apps, Smartwatch

Smartphone apps, Fitbit

Smartphone apps, Jawbone

3.3.1 Analysis Framework

3.3.2 Thematic Analysis Procedure

Table 4: table of themes derived from thematic analysis of interview transcripts

4.2 Barriers to health related behaviour change

4.2.1 Time and lifestyle constraints

4.2.2 Perception of barriers

4.2.3 Mental barriers

4.2.4 Lack of Knowledge and awareness

4.3 Perception of smart wearable technology

4.3.1 Unfamiliarity of technology

4.3.2 Obsessive behaviour

4.3.3 Attitudes towards new technology

4.4 Barriers and facilitators of wearable technology use

4.4.2 Ease of use

4.4.3 Financial Cost

4.4.4 Attitudes towards technology

4.5 Wearable technology experiential links with the stages of change in

4.6 Wearable technology experiential links with the core constructs in

4.6.2 Decisional Balance

4.7 Wearable technology as a facilitator of health related behaviour change

4.7.1 Progress logging and recognition

4.7.2 Momentum of behaviour change and increased awareness

4.7.3 Goal setting

5.1 Overcoming Barriers towards health related behaviour change with

5.1.2 Mental Barriers

5.1.3 Overcoming wearable technology use barriers

5.2 Wearable technology and the trans-theoretical model of behaviour change

5.2.1 Progression through the stages of change

5.2.2 Decisional Balance

Please tick box

Name of participant (please

Name of person taking consent

S-ar putea să vă placă și