Purnell Larissa, Sierra Maribel, Lisker Sarah, Lim Melissa S, Bailey Emma, Sarkar Urmimala, Lyles Courtney R, Nguyen Kim H
School of Public Health, University of California Berkeley, Berkeley, CA, United States.
Division of General Internal Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, United States.
JMIR Form Res. 2023 Jun 5;7:e43067. doi: 10.2196/43067.
Sleep disorders are common and disproportionately affect marginalized populations. Technology, such as wearable devices, holds the potential to improve sleep quality and reduce sleep disparities, but most devices have not been designed or tested with racially, ethnically, and socioeconomically diverse patients. Inclusion and engagement of diverse patients throughout digital health development and implementation are critical to achieving health equity.
This study aims to evaluate the usability and acceptability of a wearable sleep monitoring device-SomnoRing-and its accompanying mobile app among patients treated in a safety net clinic.
The study team recruited English- and Spanish-speaking patients from a mid-sized pulmonary and sleep medicine practice serving publicly insured patients. Eligibility criteria included initial evaluation of obstructed sleep apnea, which is most appropriate for limited cardiopulmonary testing. Patients with primary insomnia or other suspected sleep disorders were not included. Patients tested the SomnoRing over a 7-night period and participated in a 1-hour semistructured web-based qualitative interview covering perceptions of the device, motivators and barriers to use, and general experiences with digital health tools. The study team used inductive or deductive processes to code interview transcripts, guided by the Technology Acceptance Model.
A total of 21 individuals participated in the study. All participants owned a smartphone, almost all (19/21) felt comfortable using their phone, and few already owned a wearable (6/21). Almost all participants wore the SomnoRing for 7 nights and found it comfortable. The following four themes emerged from qualitative data: (1) the SomnoRing was easy to use compared to other wearable devices or traditional home sleep testing alternatives, such as the standard polysomnogram technology for sleep studies; (2) the patient's context and environment, such as family and peer influence, housing status, access to insurance, and device cost affected the overall acceptance of the SomnoRing; (3) clinical champions motivated use in supporting effective onboarding, interpretation of data, and, ongoing technical support; and (4) participants desired more assistance and information to best interpret their own sleep data summarized in the companion app.
Racially, ethnically, and socioeconomically diverse patients with sleep disorders perceived a wearable as useful and acceptable for sleep health. Participants also uncovered external barriers related to the perceived usefulness of the technology, such as housing status, insurance coverage, and clinical support. Future studies should further examine how to best address these barriers so that wearables, such as the SomnoRing, can be successfully implemented in the safety net health setting.
睡眠障碍很常见，且对边缘化人群的影响尤为严重。可穿戴设备等技术有改善睡眠质量和减少睡眠差距的潜力，但大多数设备在设计或测试时并未考虑种族、民族和社会经济背景各异的患者。在数字健康的开发和实施过程中纳入并让不同患者参与进来，对于实现健康公平至关重要。
本研究旨在评估一款可穿戴睡眠监测设备——SomnoRing及其配套移动应用程序在一家安全网诊所接受治疗的患者中的可用性和可接受性。
研究团队从一家为参加公共保险的患者提供服务的中型肺病与睡眠医学诊所招募了讲英语和西班牙语的患者。纳入标准包括对阻塞性睡眠呼吸暂停的初步评估，这最适合有限的心肺功能测试。原发性失眠或其他疑似睡眠障碍的患者未被纳入。患者在7个晚上测试了SomnoRing，并参加了一次为期1小时的基于网络的半结构化定性访谈，内容涵盖对该设备的看法、使用的动机和障碍以及对数字健康工具的总体体验。研究团队采用归纳或演绎方法，在技术接受模型的指导下，对访谈记录进行编码。
共有21人参与了该研究。所有参与者都拥有智能手机，几乎所有人（19/21）都对使用手机感到自在，很少有人已经拥有可穿戴设备（6/21）。几乎所有参与者都佩戴SomnoRing达七个晚上，并感觉佩戴舒适。定性数据中出现了以下四个主题：（1）与其他可穿戴设备或传统家庭睡眠测试方法（如用于睡眠研究的标准多导睡眠图技术）相比，SomnoRing易于使用；（2）患者的背景和环境，如家庭和同伴影响、住房状况、保险覆盖情况以及设备成本，影响了对SomnoRing的总体接受度；（3）临床支持者推动了该设备的使用，为有效的入门指导、数据解读及持续的技术支持提供了帮助；（4）参与者希望获得更多帮助和信息，以便更好地解读配套应用程序中总结的自身睡眠数据。
患有睡眠障碍的不同种族、民族和社会经济背景的患者认为可穿戴设备对睡眠健康有用且可接受。参与者还发现了与该技术的感知有用性相关的外部障碍，如住房状况、保险覆盖范围和临床支持。未来的研究应进一步探讨如何最好地克服这些障碍，以便像SomnoRing这样的可穿戴设备能够在安全网医疗环境中成功应用。
