JMIR Publications

ABSTRACT

Background:

Young adults in the US have some of the highest rates of alcohol and substance misuse, which is associated with a host of health issues including chronic diseases, mental disorders and other significant long-term effects on individuals’ health and wellbeing. Recent advances in ubiquitous technologies have prompted interest and innovation in using technology-based data collection instruments to understand substance misuse and associated consequences. However, existing methods primarily rely on smartphones to study and understand substance misuse in young adults. Wearables, such as smartwatches, show significant potential as platforms for data collection in this domain but are currently underutilized.

Objective:

The purpose of this work is to describe the design and user evaluation of a smartwatch-based data collection application, which uses ecological momentary assessments to understand young adult substance use.

Methods:

This study used a 2-phase iterative design and acceptability evaluation process with young adults (aged 18 - 25) reporting frequent alcohol or cannabis use. In the Phase 1, participants (n = 8) used the data collection application for 14 days on their Apple Watches to report their substance use patterns, social contexts in which they use substances, and the affect and moods that are associated with their substance use. Following this 14-day deployment, participants completed a user experience survey and a semi-structured interview to record their perspectives and experiences of using the application. Formative feedback from this phase informed feature modification and refinement of the application. In Phase 2, seven participants used the modified application for 2 weeks, and provided feedback through surveys and interviews conducted after the app use period.

Results:

Analyses of overall app usage patterns indicated high, consistent usage of the app, with participants using the app for an average of 11.73 out of 14 days of data collection. Participants reported 67 instances of substance use throughout the study, and our analysis indicates that participants were able to respond to EMA prompts in diverse temporal and situational contexts. Our findings from the user experience survey indicate that participants found the application usable and functional. In assessing the effect of the iterative design approach on user experience, we found that the number of days participated, number of days compliant, number of sessions completed, and longest consecutive use of the app were all higher among Phase 2 than Phase 1 participants. Participants in Phase 2 also rated the app higher on SUS and uMARS functionality scales compared to Phase 1 participants, indicating that iterative application design had a measurable and positive impact on users’ experience. Qualitative data from the participant interviews in Phase 1 identified key areas for performance and speed improvements that were implemented in Phase 2. Finally, analyses of the interview data highlighted the value of recording substance use patterns, low disruption to daily life, minimal overall burden, preference of platforms (smartphones vs. smartwatches), and perspectives relating to privacy and app usage in social contexts.

Conclusions:

This study demonstrated the acceptability of using a smartwatch-based application to collect intensive, longitudinal substance use data among young adults. The findings establish the potential for smartwatches to be used as a novel platform to understand sensitive and oft-stigmatized behaviors such as substance use with minimal burden. Further, these findings illuminate various design considerations that can guide future development of effective smartwatch-based tools to understand substance use and associated experiences.