JMIR Publications

ABSTRACT

Background:

Wearable devices are increasingly incorporated into interventions aimed at promoting physical activity in children. However, limited research has examined the feasibility, usability, and acceptability of these devices among younger children, particularly those aged 5-8 years, who may have difficulty articulating their experiences through traditional research methods (i.e., surveys or traditional interviews). Developmentally appropriate, child-centered approaches are needed to better understand how young children perceive and interact with wearable technologies to support future physical activity intervention development.

Objective:

To evaluate child perspectives of a wearable activity tracker among children aged 5-8 years and to identify key barriers and facilitators to its use using talk–draw–play methods.

Methods:

A pilot, exploratory mixed–methods study was conducted with 10 children enrolled as part of a larger mother–child dyadic study. Participants completed a 30-day wear period using a Fitbit Charge 6 device. To align with developmental capabilities, data were collected using integrated talk–draw–play methods during parallel semi–structured interviews. Children were invited to express their experiences with the Fitbit through conversation, drawing activities, and interactive engagement with provided toys. These methods were used to elicit feedback on barriers, facilitators, preferences, and overall engagement. Observational notes were also recorded to capture behaviors that supported communication (e.g., children more readily discussing the device while drawing). Rapid qualitative analysis was used to identify themes across interview, drawing, and observational data, and descriptive analyses summarized accelerometry and usage data.

Results:

Children accumulated a mean of 1447 minutes of moderate–to–vigorous physical activity per week (standard deviation = 1131; median = 1350; range = 0-3130) and averaged 18.4 Fitbit compliant–-wear days. Two primary themes emerged, Barriers and Facilitators, with 5 subthemes. First, device functionality, particularly buttons and alerts (e.g., notifications from synced parental accounts), was identified as a barrier due to confusion or annoyance. Second, comfort and routine integration influenced sustained use; barriers included issues with fit (e.g., band size), and parental support for charging and remembering to wear the device. Third, autonomy of tracking and select features (e.g., steps counts and timers) enhanced enjoyment and engagement with devices. Fourth, social influences, including peer attention and interest, enhanced motivation to wear the device. The talk–draw–play approach revealed insights that may not have emerged through verbal methods alone, particularly regarding children’s preferences and experiential understanding, such as showing how a toy character might enjoy showing their friends their Fitbit.

Conclusions:

 Talk–draw–play methods were a feasible and effective approach for eliciting meaningful feedback from young children about wearable device use. Findings highlight the importance of child–centered design, simplified functionality, and family–supported routines to enhance device acceptability. Our findings can inform the development and implementation of wearable–based physical activity interventions for early childhood populations. Future research should further refine these methods and evaluate wearable use over longer durations and implementation strategies for the use within physical activity interventions.