Monitoring Adolescent and Young Adult Patients With Cancer via a Smart T-Shirt: Prospective, Single-Cohort, Mixed Methods Feasibility Study (OncoSmartShirt Study).

Background: Wearables that measure vital parameters can be potential tools for monitoring patients at home during cancer treatment. One type of wearable is a smart T-shirt with embedded sensors. Initially, smart T-shirts were designed to aid athletes in their performance analyses. Recently however, researchers have been investigating the use of smart T-shirts as supportive tools in health care. In general, the knowledge on the use of wearables for symptom monitoring during cancer treatment is limited, and consensus and awareness about compliance or adherence are lacking. objectives: The aim of this study was to evaluate adherence to and experiences with using a smart T-shirt for the home monitoring of biometric sensor data among adolescent and young adult patients undergoing cancer treatment during a 2-week period. Methods: This study was a prospective, single-cohort, mixed methods feasibility study. The inclusion criteria were patients aged 18 to 39 years and those who were receiving treatment at Copenhagen University Hospital - Rigshospitalet, Denmark. Consenting patients were asked to wear the Chronolife smart T-shirt for a period of 2 weeks. The smart T-shirt had multiple sensors and electrodes, which engendered the following six measurements: electrocardiogram (ECG) measurements, thoracic respiration, abdominal respiration, thoracic impedance, physical activity (steps), and skin temperature. The primary end point was adherence, which was defined as a wear time of >8 hours per day. The patient experience was investigated via individual, semistructured telephone interviews and a paper questionnaire. Results: A total of 10 patients were included. The number of days with wear times of >8 hours during the study period (14 d) varied from 0 to 6 (mean 2 d). Further, 3 patients had a mean wear time of >8 hours during each of their days with data registration. The number of days with any data registration ranged from 0 to 10 (mean 6.4 d). The thematic analysis of interviews pointed to the following three main themes: (1) the smart T-shirt is cool but does not fit patients with cancer, (2) the technology limits the use of the smart T-shirt, and (3) the monitoring of data increases the feeling of safety. Results from the questionnaire showed that the patients generally had confidence in the device. Conclusions: Although the primary end point was not reached, the patients' experiences with using the smart T-shirt resulted in the knowledge that patients acknowledged the need for new technologies that improve supportive cancer care. The patients were positive when asked to wear the smart T-shirt. However, technical and practical challenges in using the device resulted in low adherence. Although wearables might have potential for home monitoring, the present technology is immature for clinical use.

Willingness to use a wearable device capable of detecting and reversing overdose among people who use opioids in Philadelphia.

BACKGROUND: The incidence of opioid-related overdose deaths has been rising for 30 years and has been further exacerbated amidst the COVID-19 pandemic. Naloxone can reverse opioid overdose, lower death rates, and enable a transition to medication for opioid use disorder. Though current formulations for community use of naloxone have been shown to be safe and effective public health interventions, they rely on bystander presence. We sought to understand the preferences and minimum necessary conditions for wearing a device capable of sensing and reversing opioid overdose among people who regularly use opioids. METHODS: We conducted a combined cross-sectional survey and semi-structured interview at a respite center, shelter, and syringe exchange drop-in program in Philadelphia, Pennsylvania, USA, during the COVID-19 pandemic in August and September 2020. The primary aim was to explore the proportion of participants who would use a wearable device to detect and reverse overdose. Preferences regarding designs and functionalities were collected via a questionnaire with items having Likert-based response options and a semi-structured interview intended to elicit feedback on prototype designs. Independent variables included demographics, opioid use habits, and previous experience with overdose. RESULTS: A total of 97 adults with an opioid use history of at least 3 months were interviewed. A majority of survey participants (76%) reported a willingness to use a device capable of detecting an overdose and automatically administering a reversal agent upon initial survey. When reflecting on the prototype, most respondents (75.5%) reported that they would wear the device always or most of the time. Respondents indicated discreetness and comfort as important factors that increased their chance of uptake. Respondents suggested that people experiencing homelessness and those with low tolerance for opioids would be in greatest need of the device. CONCLUSIONS: The majority of people sampled with a history of opioid use in an urban setting were interested in having access to a device capable of detecting and reversing an opioid overdose. Participants emphasized privacy and comfort as the most important factors influencing their willingness to use such a device. TRIAL REGISTRATION: NCT04530591.

Interventions Using Wearable Physical Activity Trackers Among Adults With Cardiometabolic Conditions: A Systematic Review and Meta-analysis.

Importance: Wearable physical activity (PA) trackers, such as accelerometers, fitness trackers, and pedometers, are accessible technologies that may encourage increased PA levels in line with current recommendations. However, whether their use is associated with improvements in PA levels in participants who experience 1 or more cardiometabolic conditions, such as diabetes, prediabetes, obesity, and cardiovascular disease, is unknown. Objective: To assess the association of interventions using wearable PA trackers (accelerometers, fitness trackers, and pedometers) with PA levels and other health outcomes in adults with cardiometabolic conditions. Data Sources: For this systematic review and meta-analysis, searches of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO were performed from January 1, 2000, until December 31, 2020, with no language restriction. A combination of Medical Subject Heading terms and text words of diabetes, obesity, cardiovascular disease, pedometers, accelerometers, and Fitbits were used. Study Selection: Randomized clinical trials or cluster randomized clinical trials that evaluated the use of wearable PA trackers, such as pedometers, accelerometers, or fitness trackers, were included. Trials were excluded if they assessed the trackers only as measuring tools of PA before and after another intervention, they required participants to be hospitalized, assessors were not blinded to the trackers, or they used a tracker to measure the effect of a pharmacological treatment on PA among individuals. Data Extraction and Synthesis: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. A random-effects model was used for the meta-analysis. Main Outcomes and Measures: The primary outcome was mean difference in PA levels. When the scale was different across studies, standardized mean differences were calculated. Heterogeneity was quantified using the I2 statistic and explored using mixed-effects metaregression. Results: A total of 38 randomized clinical trials with 4203 participants were eligible in the systematic review; 29 trials evaluated pedometers, and 9 evaluated accelerometers or fitness trackers. Four studies did not provide amenable outcome data, leaving 34 trials (3793 participants) for the meta-analysis. Intervention vs comparator analysis showed a significant association of wearable tracker use with increased PA levels overall (standardized mean difference, 0.72; 95% CI, 0.46-0.97; I2 = 88%; 95% CI, 84.3%-90.8%; P < .001) in studies with short to medium follow-up for median of 15 (range, 12-52) weeks. Multivariable metaregression showed an association between increased PA levels and interventions that involved face-to-face consultations with facilitators (23 studies; ß = -0.04; 95% CI, -0.11 to -0.01), included men (23 studies; ß = 0.48; 95% CI, 0.01-0.96), and assessed pedometer-based interventions (26 studies; ß = 0.20; 95% CI, 0.02-0.32). Conclusions and Relevance: In this systematic review and meta-analysis, interventions that combined wearable activity trackers with health professional consultations were associated with significant improvements in PA levels among people with cardiometabolic conditions.

Pricing through health apps generated data-Digital dividend as a game changer: Discrete choice experiment.

OBJECTIVES: The objective of this paper is to study under which circumstances wearable and health app users would accept a compensation payment, namely a digital dividend, to share their self-tracked health data. METHODS: We conducted a discrete choice experiment alternative, a separated adaptive dual response. We chose this approach to reduce extreme response behavior, considering the emotionally-charged topic of health data sales, and to measure willingness to accept. Previous experiments in lab settings led to demands for high monetary compensation. After a first online survey and two pre-studies, we validated four attributes for the final online study: monthly bonus payment, stakeholder handling the data (e.g., health insurer, pharmaceutical or medical device companies, universities), type of data, and data sales to third parties. We used a random utility framework to evaluate individual choice preferences. To test the expected prices of the main study for robustness, we assigned respondents randomly to one of two identical questionnaires with varying price ranges. RESULTS: Over a period of three weeks, 842 respondents participated in the main survey, and 272 respondents participated in the second survey. The participants considered transparency about data processing and no further data sales to third parties as very important to the decision to share data with different stakeholders, as well as adequate monetary compensation. Price expectations resulting from the experiment were high; pharmaceutical and medical device companies would have to pay an average digital dividend of 237.30€/month for patient generated health data of all types. We also observed an anchor effect, which means that people formed price expectations during the process and not ex ante. We found a bimodal distribution between relatively low price expectations and relatively high price expectations, which shows that personal data selling is a divisive societal issue. However, the results indicate that a digital dividend could be an accepted economic incentive system to gather large-scale, self-tracked data for research and development purposes. After the COVID-19 crisis, price expectations might change due to public sensitization to the need for big data research on patient generated health data. CONCLUSION: A continuing success of existing data donation models is highly unlikely. The health care sector needs to develop transparency and trust in data processing. An adequate digital dividend could be an effective long-term measure to convince a diverse and large group of people to share high-quality, continuous data for research purposes.

Wearable Devices Are Well Accepted by Patients in the Study and Management of Inflammatory Bowel Disease: A Survey Study.

BACKGROUND: Wearable devices are designed to capture health-related and physiological data. They may be able to improve inflammatory bowel disease management and address evolving research needs. Little is known about patient perceptions for their use in the study and management of inflammatory bowel disease. AIMS: The aim of this survey study is to understand patient preferences and interest in wearable technology. METHODS: Consecutive adult patients who self-reported having inflammatory bowel disease were approached at the Susan and Leonard Feinstein Inflammatory Bowel Disease Center at the Mount Sinai Hospital to complete a 28-question survey. Reponses were analyzed with descriptive statistics. The Pearson Chi-square test and Fischer's exact test were used to determine the association between demographic and disease-related features and survey responses. RESULTS: Four hundred subjects completed the survey. 42.7% of subjects reported prior or current use of wearable devices. 89.0% of subjects believed that wearable devices can provide important information about their health, while 93.8% reported that they would use a wearable device if it could help their doctor manage their IBD. Subjects identified wrist-worn devices as the preferred device type and a willingness to wear these devices at least daily. CONCLUSIONS: Patients with inflammatory bowel disease believe that wearable devices can provide important information about their health and report a willingness to wear them frequently in research studies and as part the routine management of inflammatory bowel disease.

Seizure forecasting and cyclic control of seizures.

Epilepsy is a unique neurologic condition characterized by recurrent seizures, where causes, underlying biomarkers, triggers, and patterns differ across individuals. The unpredictability of seizures can heighten fear and anxiety in people with epilepsy, making it difficult to take part in day-to-day activities. Epilepsy researchers have prioritized developing seizure prediction algorithms to combat episodic seizures for decades, but the utility and effectiveness of prediction algorithms has not been investigated thoroughly in clinical settings. In contrast, seizure forecasts, which theoretically provide the probability of a seizure at any time (as opposed to predicting the next seizure occurrence), may be more feasible. Many advances have been made over the past decade in the field of seizure forecasting, including improvements in algorithms as a result of machine learning and exploration of non-EEG-based measures of seizure susceptibility, such as physiological biomarkers, behavioral changes, environmental drivers, and cyclic seizure patterns. For example, recent work investigating periodicities in individual seizure patterns has determined that more than 90% of people have circadian rhythms in their seizures, and many also experience multiday, weekly, or longer cycles. Other potential indicators of seizure susceptibility include stress levels, heart rate, and sleep quality, all of which have the potential to be captured noninvasively over long time scales. There are many possible applications of a seizure-forecasting device, including improving quality of life for people with epilepsy, guiding treatment plans and medication titration, optimizing presurgical monitoring, and focusing scientific research. To realize this potential, it is vital to better understand the user requirements of a seizure-forecasting device, continue to advance forecasting algorithms, and design clear guidelines for prospective clinical trials of seizure forecasting.

Feasibility and acceptability of a novel tool for the study of interpersonal processes in psychotherapy.

Psychotherapy process research methods often require extensive time and resources. Technology innovations, such as wearable sensors, have the potential to increase the efficiency of process data collection and processing. One such tool is the Sociometric Badge (SB), which is a portable, palm-sized device that can simultaneously record raw audio and data on social signals (e.g., speech patterns, body movement) in real-time and in varied contexts. In addition to describing the nature and implications of wearable sensing devices for psychotherapy research, this article reports results from a pilot study that examined the feasibility and acceptance of these assessment devices in comparison with traditional audio recording equipment. Undergraduate students (N = 306; Mage = 19.16 years, SD = 1.44; 50.3% female) were randomly placed into 153 dyads to mimic a psychotherapy dyad. Each dyad was randomly assigned to either a SB condition (n = 75 dyads) or a standard recording device condition (n = 78 dyads), and engaged in a conversation task. Participants completed self-report items assessing perceived relationship quality and experience with the respective recording device. Between-condition tests showed that perceived relationship quality did not differ between conditions. Participants in the audio recorder (vs. SB) condition reported more awareness of the device in the room. These findings reveal comparable acceptability and feasibility of SBs to traditional audio recorders in a simulated dyad, suggesting that wearable sensing devices may be suitable for research and practice in routine psychotherapy contexts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Implementing a Wearable Sensor for Lymphedema Garments: A Prospective Study of Training Effectiveness.

Lymphedema garments apply therapeutic pressure to maintain minimum leg volume. Practitioners and patients apply these garments and seek to achieve appropriate compression pressure "by feel." PURPOSE: A study was conducted to assess the feasibility of applying a sensor-feedback device to train staff to accurately apply garments. METHODS: A convenience sample of wound care and rehabilitation staff volunteered for a prospective, randomized, unblinded, single-center pilot study. Participants were randomized to instruction+feedback (ie, receiving training on compression application and using the device to determine whether they achieved desired pressure) or instruction only groups (n = 6 each). Each volunteer applied hook-and-loop closures on the author's leg pre- and post-training with a target of 35 mm Hg, or |Ppre- 35|= |Ppost- 35|=0. (|P| is absolute value of P). The feedback group used a device to measure the applied compression; the device consists of a capacitive sensor of thin polyurethane foam between conductive fabric layers and a microcomputer/Bluetooth transmitter under a vacuum seal that fits into a fabric pocket of a lymphedema garment at the posterior ankle and pairs with a mobile device. A lymphology-certified therapist coordinated training. Data were collected with a pen/paper tool and analyzed with Student's t test. RESULTS: The instruction+feedback group was closer to target after training (|Ppre - 35|= 10 ± 12 mm Hg; |Ppost - 35|=5 ± 4 mm Hg; P <.05; paired t test) than the instruction only group (|Ppre- 35|=19 ± 11 mm Hg; |Ppost - 35|=12 ±12 mm Hg; not significant). CONCLUSION: This wearable mobile pressure sensor device assists practitioners in applying hook-and-loop lymphedema garments closer to target pressure. Larger studies with clinicians and research that involves patient application of compression are warranted.

Health promotion with physiolytics: What is driving people to subscribe in a data-driven health plan.

Data-driven health promotion programs and health plans try to harness the new possibilities of ubiquitous and pervasive physiolytics devices. In this paper we seek to explore what drives people to subscribe to such a data-driven health plan. Our study reveals that the decision to subscribe to a data-driven health plan is strongly influenced by the beliefs of seeing physiolytics as enabler for positive health behavior change and of perceiving health insurances as trustworthy organizations that are capable of securely and righteously manage the data collected by physiolytics.

Wearable sensor-based detection of stress and craving in patients during treatment for substance use disorder: A mixed methods pilot study.

AIMS: To determine the accuracy of a wearable sensor to detect and differentiate episodes of self-reported craving and stress in individuals with substance use disorders, and to assess acceptability, barriers, and facilitators to sensor-based monitoring in this population. METHODS: This was an observational mixed methods pilot study. Adults enrolled in an outpatient treatment program for a substance use disorder wore a non-invasive wrist-mounted sensor for four days and self-reported episodes of stress and craving. Continuous physiologic data (accelerometry, skin conductance, skin temperature, and heart rate) were extracted from the sensors and analyzed via various machine learning algorithms. Semi-structured interviews were conducted upon study completion, and thematic analysis was conducted on qualitative data from semi-structured interviews. RESULTS: Thirty individuals completed the protocol, and 43 % (N = 13) were female. A total of 41 craving and 104 stress events were analyzed. The differentiation accuracies of the top performing models were as follows: stress vs. non-stress states 74.5 % (AUC 0.82), craving vs. no-craving 75.7 % (AUC 0.82), and craving vs. stress 76.8 % (AUC 0.8). Overall participant perception was positive, and acceptability was high. Emergent themes from the exit interviews included a perception of connectedness and increased mindfulness related to wearing the sensor, both of which were reported as helpful to recovery. Barriers to engagement included interference with other daily wear items, and perceived stigma. CONCLUSIONS: Wearable sensors can be used to objectively differentiate episodes of craving and stress, and individuals in recovery from substance use disorder are accepting of continuous monitoring with these devices.

Seizure detection devices and health-related quality of life: A patient- and caregiver-centered evaluation.

INTRODUCTION: The unpredictability of epilepsy has a severe impact on health-related quality of life (HR-QOL) for people with epilepsy. Seizure detection devices have the potential to improve HR-QOL by improving seizure safety, reducing caregiver hypervigilance, and reducing seizure anxiety. Emerging data have led to an improved understanding of characteristics that promote acceptability of detection devices for people with epilepsy and caregivers. However, whether usage of seizure detection devices is associated with clinically meaningful improvement in anxiety and HR-QOL remains poorly understood. METHODS: We analyzed cross-sectional survey data collected first-hand from 371 people with epilepsy and caregivers on seizure detection device and HR-QOL using an enriched population of electronic seizure diary users. Metrics related to quality of life and anxiety reduction were compared between users and nonusers of seizure detection devices. RESULTS: Compared with nonusers of seizure detection devices, device users were significantly more likely to have been impacted by epilepsy in multiple HR-QOL domains, including anxiety, mood, emotional regulation/aggression, speech/language, sleep quality, social life, activities of daily living, independence, and education/academic potential. The majority (80.2%) of people using seizure detection devices experienced moderate or greater anxiety reduction from seizure detection device usage, while 11.1% reported that detection devices did not help at all with anxiety. Despite potential benefit, seizure detection devices were used only by a minority (21.8%) of people with epilepsy surveyed, and usage tended to be skewed toward younger patient age, higher income, and caregivers. There was no significant difference in overall HR-QOL between users and nonusers. CONCLUSIONS: Seizure detection devices provide moderate or greater anxiety reduction among the majority of people with epilepsy and their caregivers, but current translatability into improvements in overall HR-QOL may be limited. Affordability and technological support are potential barriers to maximizing benefit equally among the epilepsy community. These considerations may be useful to help guide future device development and inform patient-clinician discussions on device usage and HR-QOL.

Perceived acceptability of wearable devices for the treatment of mental health problems.

OBJECTIVE: This study examined the potential acceptability of wearable devices (e.g., smart headbands, wristbands, and watches) aimed at treating mental health disorders, relative to conventional approaches. METHODS: A questionnaire assessed perceptions of wearable and nonwearable treatments, along with demographic and psychological information. Respondents (N = 427) were adults from a community sample (Mage = 44.6, SDage = 15.3) which included current (30.2%) and former (53.9%) mental health help-seekers. RESULTS: Perceived effectiveness of wearables was a strong predictor of interest in using them as adjuncts to talk therapies, or as an alternative to self-help options (e.g., smartphone applications). Devices were more appealing to those with negative evaluations of psychological therapy and less experience in help-seeking. CONCLUSIONS: Interest in using wearable devices was strong, particularly when devices were seen as effective. Clients with negative attitudes to conventional therapies may be more responsive to using wearable devices as a less directive treatment approach.

Social Processes: What Determines Industrial Workers' Intention to Use Exoskeletons?

OBJECTIVE: The aim of this study is to test the unified theory of acceptance and use of technology (UTAUT) model for explaining the intention to use exoskeletons among industrial workers. BACKGROUND: Exoskeletons could help reduce physical workload and risk for injuries among industrial workers. Therefore, it is crucial to understand which factors play a role in workers' intention to use such exoskeletons. METHOD: Industrial workers (N = 124) completed a survey on their attitudes regarding the use of exoskeletons at their workplace. Using partial least squares (PLS) path modeling, the UTAUT model and a revised version of the UTAUT model were fitted to these data. RESULTS: The adapted UTAUT model of Dwivedi et al. (2017) was able to explain up to 75.6% of the variance in intention to use exoskeletons, suggesting a reasonable model fit. CONCLUSION: The model fit suggests that effort expectancy (how easy it seems to use an exoskeleton) plays an important role in predicting the intention to use exoskeletons. Social influence (whether others think workers should use exoskeletons) and performance expectancy (how useful exoskeletons seem to be for work) play a smaller role in predicting the intention to use. APPLICATIONS: This research informs companies about the optimal implementation of exoskeletons by improving the determinants of acceptance among their workers.

The impact of IoT security labelling on consumer product choice and willingness to pay.

The Internet of Things (IoT) brings internet connectivity to everyday electronic devices (e.g. security cameras and smart TVs) to improve their functionality and efficiency. However, serious security and privacy concerns have been raised about the IoT which impact upon consumer trust and purchasing. Moreover, devices vary considerably in terms of the security they provide, and it is difficult for consumers to differentiate between more and less secure devices. One proposal to address this is for devices to carry a security label to help consumers navigate the market and know which devices to trust, and to encourage manufacturers to improve security. Using a discrete choice experiment, we estimate the potential impact of such labels on participant's purchase decision making, along with device functionality and price. With the exception of a label that implied weak security, participants were significantly more likely to select a device that carried a label than one that did not. While they were generally willing to pay the most for premium functionality, for two of the labels tested, they were prepared to pay the same for security and functionality. Qualitative responses suggested that participants would use a label to inform purchasing decisions, and that the labels did not generate a false sense of security. Our findings suggest that the use of a security label represents a policy option that could influence behaviour and that should be seriously considered.

Wearable strain sensor suit for infants to measure limb movements under interaction with caregiver.

Development of motion capture technology has enabled the measurement of body movements over long periods of time in daily life. Although accelerometers have been used as primary sensors, problems arise when they are used to measure the movements of infants. Because infants and caregivers interact frequently, accelerometer data from infants may be significantly distorted by a caregiver's movement. To overcome this problem, a strain sensor suit was developed for infants to measure flexion and extension movements of the limbs. A case study was performed to analyze the strain sensor data of an infant in relation to the accelerometer data of the infant's and a caregiver's body under various types of infant-caregiver interaction. The results demonstrated that the strain sensor data had low correlation with the accelerometer data of the infant and caregiver while the accelerometer data between infant and caregiver had higher correlation. This suggests that the strain sensor is suitable to detect limbs' angular displacements mostly independent from the translational body movements exerted by a caregiver.

Human factors considerations in designing a personalized mobile dialysis device: An interview study.

Recent technical advances have enabled the creation of mobile dialysis device prototypes. These prototypes have been tested for their ability to allow an individual to be dialyzed continuously rather than sporadically. The most recent prototype of a mobile dialysis device aims at increased functionality, which suggests that human factors issues (e.g., efficiency, bulkiness, and weight) are now considered carefully. This study describes advances in the design of an Ambulatory Kidney to Improve Vitality (AKTIV), using an interview protocol during the early stages of product development to capture patients' and caregivers' reactions. The AKTIV has the potential to improve patients' quality of life and decrease mortality rates. The goal of our study is to examine patients' and caregivers' design preferences and feature considerations for an AKTIV. We interviewed 22 participants (age M = 57.50, SD = 13.30), of whom 12 were female and 16 were patients. A pre-interview survey was distributed to the participants, and semi-structured interviews were subsequently held. The pre-interview results show that the belt and backpack designs were preferred over the shoulder bag and distributed designs. The participants also indicated on their pre-interview forms that safety and accuracy were more important to them than attachment ease, comfort, compactness, or operational simplicity. Invisibility and mobility were frequently mentioned when determining the strengths of each of the five design types during the interviews. Finally, individual differences in preferences for the various design types and attributes were identified. The results from our study have important implications for improving efficiency, effectiveness, and user satisfaction in relation to AKTIV prototypes and products. The findings from this interview study will help to ensure engineers and clinicians have target parameters for redesigning the AKTIV.

Technology anxiety and resistance to change behavioral study of a wearable cardiac warming system using an extended TAM for older adults.

With advances in technology, wireless and sensor technologies represent a method for continuously recording people's biomedical signals, which may enhance the diagnosis and treatment of users' everyday health conditions. These technologies mostly target older adults. In this study, we examine a smart clothing system targeting clinically high-risk patients, including older adults with cardiovascular disease (31 outpatients) and older adults in general (81 participants), to obtain an understanding of the patients' perception of using wearable healthcare technologies. Given that technology anxiety has been shown to affect users' resistance to using new technology and that perceived ubiquity is considered a characteristic of wearable devices and other mobile wireless technologies, we included three external variables: i.e., technology anxiety, perceived ubiquity, and resistance to change, in addition to the traditional components of the technology acceptance model (TAM). The results of the hypothesized model showed that among older adults in general, technology anxiety had a negative effect on the perceived ease of use and perceived ubiquity. The perceived ubiquity construct affects both user groups' perceived ease of use and perceived usefulness of wearing smart clothes. Most relationships among the original constructs of the TAM were validated in older adults in general. Interestingly, we found that perceived usefulness had an indirect effect on behavioral intention through attitude. These results further confirm the validity of the extended TAM in determining older users' technology acceptance behavior.

The Impact of Externally Worn Diabetes Technology on Sexual Behavior and Activity, Body Image, and Anxiety in Type 1 Diabetes.

BACKGROUND: We aimed to explore the impact of externally worn diabetes technologies on sexual behavior and activity, body image, and anxiety in adopters and nonadopters of these devices. METHODS: People with type 1 diabetes aged 16-60 years living in Western Australia were invited to complete an online survey. RESULTS: Of the 289 respondents (mean age 34.3 years), 45% used continuous subcutaneous insulin infusion (CSII) and 35% used continuous glucose monitoring (CGM). Approximately half of CSII users stated that the pump interferes with sex. Of these, 75% disconnect their pump during sexual activity to avoid this issue. Comfort during sex influenced the location of the CSII insertion site in 22% of respondents, with the abdomen being preferred. One in four non-CSII users cited sex-related concerns as a factor for not adopting the technology. CGM interfered with sexual activity in 20% of users, but did not commonly affect CGM placement (only 18%). Sexual activity was reported as a factor for not adopting the technology in 10% of non-CGM users. No differences in body dissatisfaction (P = .514) or anxiety (P = .304) between CSII and non-CSII users were observed. No differences in sexual activity and behavior between technology users and nontechnology users were observed. CONCLUSION: Wearable technologies impact upon sexual activity and this influences the decision to adopt the technology. Despite this, technology users are similar in terms of sexual behavior, anxiety, and body image compared to nontechnology users. Where appropriate, these data can be used to identify potential concerns, address strategies to mitigate them, and inform people with diabetes when considering adopting external technologies.

Factors Affecting Caregivers' Acceptance of the Use of Wearable Devices by Patients With Dementia: An Extension of the Unified Theory of Acceptance and Use of Technology Model.

PURPOSE: This study aims to examine the factors affecting caregivers' acceptance of the use of wearable devices by patients with dementia by extending the Unified Theory of Acceptance and Use of Technology (UTAUT) model with 2 additional constructs: resistance to change (RC) and technology anxiety (TA). METHODS: A structured online questionnaire was developed and distributed to caregivers who have either dealt previously with or were currently taking care of patients with dementia in sub-Saharan Africa. The selection of countries for the study was purely based on the availability of caregivers of patients with dementia and their readiness to take part in the survey. Questionnaire data from 350 respondents were analyzed and the hypothesis tested using partial least squares based on structural equation modeling. RESULT: The results of the extended model show that social influence, effort expectancy, facilitating conditions, and behavioral intention (BI) all had P < .05, thus were statistically significant in explaining the perceived BI and actual use of health-care wearable devices among patients with dementia as reported by caregivers. However, P value for RC and TA was greater than .05, hence were insignificant.