Acceptability and Usability of a Wearable Device for Sleep Health Among English- and Spanish-Speaking Patients in a Safety Net Clinic: Qualitative Analysis

Larissa Purnell; Maribel Sierra; Sarah Lisker; Melissa S Lim; Emma Bailey; Urmimala Sarkar; Courtney R Lyles; Kim H Nguyen

doi:10.2196/43067

Acceptability and Usability of a Wearable Device for Sleep Health Among English- and Spanish-Speaking Patients in a Safety Net Clinic: Qualitative Analysis

JMIR Form Res. 2023 Jun 5:7:e43067. doi: 10.2196/43067.

Authors

Larissa Purnell¹, Maribel Sierra^{2

3}, Sarah Lisker^{2

3}, Melissa S Lim^{4

5}, Emma Bailey⁴, Urmimala Sarkar^{2

3}, Courtney R Lyles^{1

2

3

6}, Kim H Nguyen^{2

3}

Affiliations

¹ School of Public Health, University of California Berkeley, Berkeley, CA, United States.
² Division of General Internal Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, United States.
³ Center for Vulnerable Populations, School of Medicine, University of California San Francisco, San Francisco, CA, United States.
⁴ Redwood Pulmonary Medical Associates, Redwood City, CA, United States.
⁵ Somnology, Redwood City, CA, United States.
⁶ Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, United States.

PMID: 37098152
PMCID: PMC10280334
DOI: 10.2196/43067

Abstract

Background: 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.

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: health equity; medical informatics; sleep disorders; user-centered design; wearable electronic devices.

©Larissa Purnell, Maribel Sierra, Sarah Lisker, Melissa S Lim, Emma Bailey, Urmimala Sarkar, Courtney R Lyles, Kim H Nguyen. Originally published in JMIR Formative Research (https://formative.jmir.org), 05.06.2023.