JMIR Publications

ABSTRACT

Background:

Wearable mobile health (mHealth) technologies offer a promising approach to promote physical activity (PA) among adolescents. However, little is known about factors influencing adherence to these tools in underserved school settings.

Objective:

To examine behavioral and contextual predictors of adherence to a consumer-grade wearable PA tracker among predominantly Black/African American and Hispanic high school students.

Methods:

In this school-based observational study, 63 students (mean age = 14.8 ± 1.17 years) enrolled in physical education received Fitbit devices. Adherence was defined as ≥21 valid days of step count data. Baseline and follow-up measures included self-reported PA behaviors, neighborhood perceptions, physical fitness, and device usage. Group comparisons used t-tests and chi-square tests. Logistic regression identified predictors of adherence.

Results:

Forty-six students (73%) met the adherence threshold. Adherent students reported fewer days of moderate-to-vigorous PA (2 vs. 4 days/week, p = .004), lower participation in team sports (46% vs. 71%, p = .004), and higher perceived neighborhood safety (p = .023) than non-adherent peers. In adjusted models, lower PA frequency and greater perceived safety were significant predictors of adherence (χ²(6) = 16.23, p = .013, Nagelkerke R² = 0.61).

Conclusions:

Wearable mHealth tools may appeal most to adolescents with lower baseline activity and fewer structured PA opportunities. Integrating wearables into school-based programs that address environmental barriers may support equitable PA promotion in high-risk youth populations. Clinical Trial: Human Rights: All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. It was approved by the Western Institutional Review Board (W-IRB) and the Research Ethics Board of the School Board of Broward County’s Institutional Review Board. Informed consent was obtained from all participants included in the study. Transparency Statements: Study Registration: This study was not formally registered. This analysis plan was not formally pre-registered. Analytic code used to conduct the analyses are not available in a public archive; may be available by emailing the corresponding author. Materials used to conduct the study are not publicly available.