Currently submitted to: JMIR Formative Research
Date Submitted: Mar 17, 2026
Open Peer Review Period: Mar 17, 2026 - May 12, 2026
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Integrating Wearable-enabled mHealth Reports into Recovery High School Care Planning: A Mixed Methods Pilot Study
ABSTRACT
Background:
Recovery High Schools (RHS) integrate academics and therapeutic support for youth with substance use disorders, yet staff often have limited visibility into students’ day-to-day health behaviors between check-ins. Wearable technology can generate objective indicators (e.g., activity, sleep) that may support individualized recovery care planning, but RHSs have not yet implemented these tools.
Objective:
This pilot study evaluated the feasibility, engagement, acceptability, and perceived impact of integrating wearable-derived health reports into care planning at one RHS in the Northeast United States. Secondary aims explored changes in psychosocial outcomes (school belonging, social identity, recovery capital, and social-emotional learning).
Methods:
Thirteen adolescents (Mages 15-21) and school staff (n = 3) participated in a single-site, mixed methods 3-month pilot. Data included baseline and monthly surveys, Fitbit wear-time and activity data collected via Fitabase, weekly staff surveys, and staff interviews. Outcomes were summarized descriptively, and qualitative feedback was synthesized to characterize workflow integration and implementation barriers to care.
Results:
Survey retention declined from 100% to 46.2% at Month 3; 2 students left the school during the study. Wearable engagement was inconsistent, with 69.2% (n = 9) participants wearing the device at least once, declining to 23.1%-30.8% (n = 3-4) by Weeks 9-12. Staff adopted weekly device report usage at a high rate (88.2% of survey weeks) and described them as helpful for care planning and opening dialogue with students regarding sleep, activity, and substance use. Key implementation challenges included inconsistent student device wear and logistical barriers on assessment days.
Conclusions:
Wearable-derived health reports were acceptable to RHS staff and feasibly integrated into care planning workflows, though sustained student device engagement was a critical barrier. Future implementation studies should prioritize structures including device-use protocols, enhance syncing tech support, and strategies to sustain adolescent engagement across the full study period. Clinical Trial: https://osf.io/q6jt4/overview?view_only=eb1606b3bfa44e658383a63ab734fde1
Citation
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