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Consider end-user values and beliefs to improve sustained technology use and impact in healthcare

Fitbit Aria HR - Wearable

I’m wearing a Fitbit Aria HR (a wearable watch device) as I type this post, and take a moment to peek over to the app on my phone positioned next to the keyboard wondering if my key strokes are counted as a steps? Looks like the device is too smart for that, making me feel that much prouder about the 2,818 steps registered on my device so far this morning. I work from home, in a moderately sized NYC apartment, and glean over to the other side of my bedroom to see the Fitbit Aria HR I bought my wife sitting on the dresser, it’s been there for about 2 months! Like much digital technology in healthcare, impact is directly related to use. From the end user perspective, upon purchasing a wearable, updating your behavior and sustaining that change beyond the initial novelty period occurs variably among consumers. I’ve kept my Fitbit on for 3 months, my wife used hers for the first week only. Like any behavior change, magnitude and sustainment is largely impacted by your values, beliefs, and expectations of the outcomes or impact of that behavior. Early adopters of new technology typically have well aligned values and beliefs, but as technology is pushed into the mainstream, there is less alignment, and the impact or the ability of technology to disrupt healthcare is blunted. At first glance, learning how to use a wearable technology is very simple, but nonetheless there are things to learn (it took me 10 minutes to figure out how to pair the device with my phone).

Almost 70 years ago Benjamin Bloom published the Taxonomy of Educational Objectives1, a hierarchical model designed to facilitate communication among educators and classify learning objectives into levels of complexity and specificity. It included three domains, beginning with the cognitive domain focused on the development of mental skills and acquisition of knowledge, this is the primary focus of most education. Then there is the psychomotor domain, which to some degree is focused on gaining physical skills. Last, is the affective domain, focused on awareness and growth in attitudes, values, beliefs and emotions. It’s not enough to teach an individual how to use new technology, it is becoming vitally important for them to receive, value and subsequently integrate the importance of the technology into their value system, to sustain the associated new behaviors long-term. Whether learning to get started and continuously use a $150 wearable device, to teaching several hundred physicians how to use an EHR as part of a $150 million implementation, the focus only on cognitive or psychomotor skills might leave additional opportunity for engagement on the table. Similar to the adoption of the Fitbit Aria HR in my home, variable adoption of digital disruptions like the EHR is largely influenced by the end user’s preceding values and beliefs. I’m a doctor, and I value the ability to gain insight provided by my wearable device. My wife stays at home with the children, and she values most of all peace and quiet!

In a recent Forbes article titled Riding the Disruption Wave in Healthcare, the author referred to healthcare as being a paradox, both a hare and a tortoise when it comes to new technology adoption2. This duel in duality, between agility and stability is not uncommon, both operationally and culturally, and especially when considering technology in organizations dealing with human lives. An organizational culture that favors stability, often incorporates engagement strategies aiming to fit into the end-user’s existing value system untouched. One such model is Max Weber’s typology of social action championed by Thomas Lee from Press Ganey and Toby Cosgrove from Cleveland Clinic3. Engagement by appealing to existing beliefs and values to drive use and subsequent impact is extremely valuable. An organization that operationally and culturally favors agility on the other hand, might consider the incorporation of affective learning strategies, in addition to Cognitive and Psychomotor. The goal is to educate in a way to make aware and eliminate biases that disrupts the progression of value system updates (the way we deal with things emotionally). Allowing the end-user to move through the following steps:

  1. Receiving-initially paying attention to information presented about the wearable.

  2. Responding-taking action to learn how to use the wearable.

  3. Valuing-using the wearable.

  4. Internalizing- alignment of the value system, which controls the individual’s behavior to use the wearable.

Internalization is the most complex level in the affective domain, fueling a path towards sustained use and subsequent impact. This is an often-overlooked aspect of learning and engagement, with the potential to reduce the uncertainty of the hare and turbocharge the tortoise.

According to a recent Statista report, the number of connected wearable devices worldwide is expected to leap from 325 million in 2016 to 830 million in 2020, with smart watches like the Fitbt Aria HR accounting for about half of all wearable unit sales worldwide4. As significant investments are made into this type of digital technology as a tool to positively impact healthcare, we must consider the values and beliefs of the end-users. Being mindful of the affective domain of learning could be a great strategy to support alignment, moving the individual from receiving, to valuing, integration, and ultimately long-term use. Hopefully, this will keep more of these devices off the dresser, and on the consumer’s body like they were designed.


1Bloom et al. (1956) "The idea for this classification system was formed at an informal meeting of college examiners attending the 1948 American Psychological Association Convention in Boston. At this meeting, interest was expressed in a theoretical framework which could be used to facilitate communication among examiners”. Retrieved on September 8, 2018 from

2Murphy et al. (2018). Riding The Disruption Wave In Healthcare. Retrieved on September 8 2018 from

3Lee, Cosgrove (2014). Engaging doctors in the healthcare revolution. Retrieved on September 9, 2018 from

4Statistica (2018). Statistics & Facts on Wearable Technology. Retrieved on September 9, 2018 from

#wearable #fitbit #aria #technologyuse #learning #affectivedomain

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