JMIR Publications

ABSTRACT

Background:

Home health aides and attendants (HHAs) provide essential in-home care to the growing population of older adults who want to age in place. Despite their vital role in patient care, HHAs are an underserved and vulnerable population of healthcare professionals who often experience poor health themselves. Activity tracking devices offer a promising way to improve HHAs’ health-related awareness and promote health behavior change, particularly with respect to physical activity (PA) and sleep quality, two areas in which the workforce struggles.

Objective:

This study aimed to understand how feasible it is for HHAs to use activity tracking devices and assess their perceptions toward such devices with respect to improving their health. Specifically, we conducted (1) a field study to assess the usage, feasibility, and acceptability of these devices among HHAs and (2) a qualitative study to understand HHAs' perspectives and reactions to activity trackers on and off the job.

Methods:

We partnered with the 1199SEIU Training and Employment Fund to conduct a field study with home care agency employed HHAs working in New York, NY. Participants wore activity tracking devices for four weeks which collected data on PA and sleep. HHAs were subsequently interviewed on their experiences and attitudes towards the devices and asked to reflect on personalized visualizations of their data to prompt them to think-aloud. Quantitative data were analyzed with descriptive statistics. Qualitative data were analyzed using grounded theory.

Results:

A total of 17 HHAs participated; they had a mean age of 48.7 (SD 12.2) years, 15 were women (88%), 11 identified as Black (65%), 5 identified as Hispanic or Latinx, and they worked as HHAs for a mean of 11.7 years (SD 7.5). Sixteen out of 17 HHAs (94%) wore their activity trackers for the full 28-day study period. Participants took a mean of 10,230 (SD 3,586) steps during the study period and slept for a mean of 6.27 (SD 0.58) hours per night. Overall, 4 key themes emerged: (1) Activity tracking devices enhanced participants' health awareness by providing empirical data for self-reflection; (2) This increased awareness led to positive behavioral changes, including setting and achieving health-related goals; (3) HHAs believed these devices could potentially improve not only their own health but also that of their patients through sustained positive behavioral changes; and (4) Despite this optimism, participants emphasized that their ability to modify sleep and activity patterns was constrained by social and occupational determinants, with sleep improvements being particularly challenging.

Conclusions:

Our findings suggest that appropriately designed personal tracking interventions could offer a promising approach to supporting positive health-related changes in this historically overlooked workforce, potentially improving both their wellbeing and, by extension, the quality of care they provide to their patients.