A Mixed Methods Evaluation of Wearable Technology: Findings from the Vivo Play Scientist (VPS) Program

Abstract

During the COVID-19 pandemic, a Canadian recreation centre launched a community-based intervention to increase physical activity (PA) and reduce sedentary behaviour (SB). The Vivo Play Scientist (VPS) program provided a free wearable device (Garmin Vivofit4) that synchronized with a customized eHealth dashboard. Aim: The study investigated the feasibility and effectiveness of the VPS program through the participants’ use and experiences of the device and dashboard using the Technology Acceptance Model (TAM). Method: We employed a concurrent mixed-methods approach of online surveys and semi-structured telephone interviews and estimated the device and dashboard’s perceived usefulness and ease of use with TAM. Results: Of the 318 participants (mean age 39.8) 87 enrolled and completed the survey at baseline-T₀, 4 wks-T₁, and 8 wks-T₂. Maximal-variation sampling was used to select 23 participants (78%, F) for interviews. We compared frequency of use, perceived usefulness and ease of use of the device and dashboard across all surveys using non-parametric statistical tests. A thematic analysis was used to analyze data. Participants had some experience using a wearable device (46%) or eHealth application (49%). A high use (≥4 d/wk.) of Vivofit4 at T₁ (93%) and T₂ (87%) occurred, but dashboard use was less frequent (≥1 d/wk. T₁ 54.0% and T₂ 47.1%). Average levels of perceived usefulness and ease of use for the Vivofit4 and dashboard remained constant from T₁ to T₂. Average daily PA scores decreased from T₁ to T₂ (4.9 to 4.5; p = 0.017). Conclusion: Participants were guarded about the value of the dashboard use and reported several challenges associated with the VPS program, but the free device and dashboard did provide PA support during the pandemic.

1. Introduction

Wearable technology (WTech) is becoming increasingly popular among researchers and the public for monitoring health analytics, levels of fitness, and physical activity (PA) [1,2,3]. WTech, such as pedometers, accelerometers, and smart watches, capture movement and biometric data that can be synced to a smartphone and web-based software platforms (eHealth). Intervention studies suggest that the use of WTech can enhance awareness, motivation [1,4], attitudes [5], and can increase physical activity [1,6,7]. WTech may also improve self-rated health [5], support weight control [8], and create a sense of accomplishment [9]. Wearable devices provide personalized data for tracking and goal setting and often deliver data-driven health promotion notifications to users [2,5,7,10].

Vivo for Healthier Generations (Vivo), a large recreation centre located in north central Calgary (Canada), developed the Vivo Play Scientist program (VPS), which provided WTech to members of the local community as a strategy to increase PA and reduce sedentary behaviour (SB). This pilot intervention aimed to provide individuals and/or families with the capacity to evaluate and potentially modify their PA goals and behaviour via feedback from either a provided (free of cost) Garmin Vivofit4 or their own wearable activity tracking device with the option of pairing it to the customized eHealth dashboard. Vivo implemented this 8-week program between November 2020 and March 2021, during the second wave of the COVID-19 pandemic.

The Vivofit4 monitors and displays steps, calorie expenditure, distance travelled, and sleep patterns. While not a requirement of the VPS program, participants could also synchronize their Vivofit4 with the Garmin Connect^TM application on their smartphones. Garmin Connect™ provides additional movement data (e.g., PA intensity, goal progress) and opportunities for engagement in movement challenges with other Garmin Connect™ users. Participants were encouraged to wear the Vivofit4 during all waking hours. The VPS dashboard was a customized eHealth application developed by White Whale Analytics (https://www.whitewhale.ai, accessed on 18 July 2022) to calculate a vScore that used data from the Vivofit4. The vScore was developed by Vivametrica (https://support.vivametrica.com/vScoreHealth, accessed on 18 July 2022) [11] and provided personalized health analytic information based on a participant’s age, sex, height, weight, and device-measured daily steps. The vScore ranged between 0 and 100 and scores were ranked based on defined categories (0–49 poor; 60–62 fair; 63–73 good; 74–85 very good; 86–100 excellent). Participants could share their vScores with household members and compare their scores with population-level normative data based on their age and sex. Little evidence exists on the influence of the vScore on participant engagement and physical activity decision-making. A previous study found that over one-quarter of participants (28%) did not access the Vivametrica output data, and the majority of those who accessed that output did so fewer than five times during a 12-week intervention [12]. For this study, VPS program participants were encouraged to synchronize the Vivofit4 and dashboard at least once per week.

We previously found evidence that participation in the 8-week VPS program resulted in significant increases in weekly walking time and decreases in weekly sitting time [13]. In this paper, we also reviewed the background associated with wearable activity trackers, although few studies have had the opportunity to explore the factors influencing the use and adoption of WTech during a pandemic [13]. To garner further insights into how the VPS program facilitated changes in PA and SB, this study’s aim was to explore VPS participant experiences including their uptake and use of WTech, and specifically their perceptions regarding the usefulness and ease of using the Vivofit4 and dashboard through the Technology Acceptance Model (TAM) [5].

2. Materials and Methods

The TAM is a theoretical framework that posits that users have more favourable attitudes toward the use of technology when it is perceived to be useful and easy to use [14]. Perceived usefulness is the value that users find in adopting the technology [5], while perceived ease of use is the ability to use the technology without difficulty or effort [5,15]. Studies have used the TAM when investigating the adoption of different types of technology, including wearable devices for improving PA [4,5,14,16]. Given that the intention of the VPS program was to offer access to the Vivofit4 and dashboard, we employed a concurrent mixed-methods approach involving quantitative and qualitative data collection to evaluate participant experiences enrolled in the VPS program. Mixed method approaches are known to be useful when quantitative or qualitative data alone cannot sufficiently address the research aim [17].

Quantitative data collection included an online self-administered survey before participants received the Vivofit4 and had access to the dashboard (i.e., baseline), and at 4 weeks and 8 weeks during the program. Qualitative data collection involved semi-structured interviews with enrolled participants in the program. Congruent with a concurrent mixed methods design [18], qualitative and quantitative data were triangulated during the interpretation of the results. The University of Calgary Conjoint Human Research Ethics Board approved this study (REB 20-2018).

2.1. Recruitment

Enrolled participants (N = 318) were invited to participate in the evaluation of the VPS program. Of those enrolled, 153 adults completed the baseline survey, 112 completed the 4-week survey, and 97 completed the 8-week survey with 87 providing valid data for all three surveys. As an incentive, participants who completed all three surveys were entered into a draw to win one of two CAD 500 gift cards. Although multiple adults and children per household could participate in the program, only one adult (≥18 years of age) per household was eligible to participate in the evaluation. At the end of the 8-week intervention, 23 participants (18 females and 5 males; 22–56 years) agreed to complete a follow-up interview about their experiences with the program. Interviews were conducted via telephone and/or video conferencing (i.e., Zoom). Interview participants were purposely selected from those who completed at least one online survey. We used a maximum variation strategy [19] and selected participants based on sociodemographic characteristics (i.e., age, gender, ethnicity, education, employment status, and marital status) and level of household participation (i.e., the mix of adults and children participating in the program). Nineteen of the twenty-three interviewed participants reported enrolling in the program with other household members. Participants who completed the follow-up interview received a CAD 25 gift card.

2.2. Data Collection

2.2.1. Surveys (Quantitative Data)

Each online survey (T₀, prior to device and dashboard access; T₁ at 4 weeks; and T₂, at 8 weeks), took approximately 20 min to complete. The surveys were comprehensive, capturing data related to the use, attitudes towards, and perceptions of the Vivofit4 and dashboard, PA motivation, attitudes, benefits, barriers, and self-efficacy, and sociodemographic characteristics. Self-reported PA and SB were also captured; however, these outcomes have been reported elsewhere [13].

2.2.2. Physical Activity Self-Efficacy

The baseline survey included a modified version of the Self-Efficacy Scale for Exercise [20], and we replaced the term “exercise” with “physical activity” and included seven (i.e., very unlikely to very likely) instead of nine response options for each of the nine items. The modified scale had acceptable internal consistency (Cronbach’s (α) = 0.90). We also included two separate PA self-efficacy items aligned with the program’s focus on WTech (i.e., “how confident are you right now that you could undertake physical activity if you had access to a: (1) device for tracking health and physical activity, and; (2) health application for tracking health and physical activity”.

2.2.3. Physical Activity Control, Attitudes, and Intention

Informed by the Theory of Planned Behaviour, [21,22] the baseline survey included items capturing perceived behavioural control (PBC), attitudes, and intentions towards physical activity. All items included seven response options. Two items captured PBC (i.e., “It is difficult/easy to engage in daily MVPA”, and “I have the resources to participate in daily MVPA”; α = 0.71). Five items captured attitudes by asking whether participating in physical activity every day would be harmful–beneficial, useless–useful, boring–interesting, unpleasant–pleasant, and unenjoyable–enjoyable; α = 0.91). A single item captured participants intention to participate in physical activity every day (i.e., definitely do–definitely not).

2.2.4. Physical Activity Benefits and Barriers

The baseline survey included a modified version of the Exercise Benefits/Barriers Scale 2017 [23] where we replaced the term “exercise” with “physical activity”. The scale included nine barrier items (α = 0.81) and six benefit items (α = 0.82), with each item having five response options (i.e., strongly disagree to strongly agree).

2.2.5. WTech Prior Use

At baseline, participants reported if they had ever used (i.e., yes or no) a wearable device (e.g., Fitbit, Apple Watch, Garmin) or an eHealth application (e.g., Strava, Garmin Connect, Apple Health).

2.2.6. WTech Attitudes

The baseline survey included five items (each with seven response options) that captured attitudes towards using the Vivofit4 and dashboard. Participants reported whether using the Vivofit4 or dashboard every day would be harmful–beneficial, useless–useful, boring–interesting, unpleasant–pleasant, and unenjoyable–enjoyable (Vivofit4: α = 0.94 and dashboard: α = 0.97).

2.2.7. WTech Frequency of Use

The 4-week and 8-week surveys captured the number of days in the past week that participants had used the Vivofit4 and dashboard. The frequency of use for the Vivofit4 was categorized to depict participants who used the device on most days of the week (i.e., ≥4 days/week vs. <4 days/week). The frequency of use of the VPS dashboard was categorized into ≥1 day/week versus <1 day/week to reflect the dashboard outputs being updated only once per week (i.e., Sundays).

2.2.8. WTech Perceived Ease of Use

Three items, each with seven response options (i.e., strongly disagree to strongly agree), captured perceived ease of operating the Vivofit4 and dashboard at 4 weeks and at 8 weeks (i.e., Operating the [Vivofit4/dashboard] is easy for me; I find the [Vivofit4/dashboard] easy to use, and; Using the [Vivofit4/dashboard] does not require a lot of my mental effort) [5,14]. Item responses were averaged to estimate perceived ease of use scores for the Vivofit4 (α = 0.89) and dashboard (α = 0.94).

2.2.9. WTech Perceived Usefulness for Physical Activity

The perceived usefulness of the Vivofit4 and the dashboard for supporting PA was assessed at 4 weeks and at 8 weeks. Participants rated the usefulness (four response options: not useful at all to extremely useful) of the Vivofit4 and dashboard for supporting five activities including: increasing daily step count, improving overall PA level, increasing MVPA, reducing sitting, and increasing time spent walking [24]. Item responses were averaged to create two usefulness scores (Vivofit4 α = 0.86; dashboard α = 0.97). Two additional questions captured participant agreement (seven response options: strongly disagree to strongly agree) with the following statement “Using the [Vivofit4/dashboard] makes it easier to participate in daily MVPA” [5].

2.2.10. Sociodemographic Variables

Measured baseline sociodemographic characteristics included sex, age, highest education attained (no university vs. completed university), household gross annual income (<CAD 80,000, CAD 80,000–119,999, >CAD 119,999, and do not know/refuse to answer), marital status (married/common law vs. other), employment status (full-time/part-time vs. other), dog ownership, number of children in the household, ethnicity (Chinese, Caucasian, vs. other), and household participation in the VPS program (one adult only, multiple adults only, vs. adult(s) and child(ren)).

2.3. Interviews (Qualitative Data)

Semi-structured interview guides were employed because they provide a flexible approach to capturing in-depth data on a broad topic [18]. Participants were asked about their motivations for joining the VPS program, their experiences using the Vivofit4 and dashboard, and recommendations for improving the program. Questions related to the TAM (i.e., perceived usefulness and perceived ease of use) [24] were also incorporated into the interview. Interviews were audio-recorded, transcribed verbatim, and assigned a pseudonym. Member checking was conducted with participants who expressed interest in reviewing their transcripts [19].

2.4. Analysis

2.4.1. Quantitative Data

Descriptive statistics for baseline characteristics were calculated. We used McNemar’s test of proportions to compare differences in frequency of using the Vivofit4 and dashboard between the 4-week and 8-week surveys. We also used Wilcoxon Signed Ranks Tests to compare differences in perceived usefulness of the Vivofit4 and dashboard for PA and the perceived ease of using the Vivofit4 and dashboard, respectively, between the 4-week and 8-week surveys. Between the 4-week and 8-week surveys, differences in perceptions of usefulness and ease of use of the Vivofit4 and dashboard between sociodemographic groups were also compared using Kruskal–Wallis (comparison of >2 groups) and Mann–Whitney U Tests (two group comparisons only). Analysis was undertaken using IBM SPSS Statistics for Windows (version 25, 2017). We considered p-values less than 0.05 as statistically significant.

2.4.2. Qualitative Data

The step-by-step process of thematic analysis [25] was used to describe participant experiences during the VPS program. Three members of the research team (JP, DG, PKDB) inductively coded the data and identified emerging themes. To enhance trustworthiness, other research team members reviewed the themes (GM, AB). Detailed notes and reflexivity journaling were also used to inform data coding and analysis decisions [19]. The qualitative analysis was undertaken and organized using NVivo V12 (QSR International, 2021).

2.4.3. Triangulation

The interview responses were interpreted alongside the survey data to gain an in-depth understanding of how participants perceived the ease of use and usefulness of the Vivofit4 and dashboard. A convergence coding matrix was used to integrate findings from the quantitative and qualitative data [26]. Key findings from the quantitative and qualitative (themes) data were extracted and triangulated to identify agreement, partial agreement (data complemented each other), silence (only one source contributing), or dissonance (data conflicted with each other) [24,26,27]. All authors participated in the triangulation process to enhance the credibility of the findings [18,19,28].

3. Results

3.1. Survey Sample Characteristics

The sample profiles for those participants who completed the baseline survey and those who completed all three surveys were similar, and there were no significant differences between the profiles (

Table 1. Characteristics of VPS participants by completion of the baseline survey and by completion of all three surveys.

Characteristics	Variables	Baseline Survey (n = 153)	All Three Surveys (n = 87)
		% or Mean (SD)
Age		39.5 (7.7)	39.8 (7.4)
Sex	Male	26.7	25.3
	Female	73.3	74.7
Education	No university	33.1	28.7
	Completed university	63.4	71.3
Annual gross Household income	<CAD 80,000	27.5	25.3
	CAD 80,000–119,999	27.5	37.9
	>CAD 199,999	26.8	26.4
	Do not know/refused	18.3	10.3
Ethnicity	Chinese	40.5	36.8
	Caucasian	20.9	26.4
	Other	38.8	36.8
Dog ownership	Yes	24.1	19.5
	No	71.9	80.5
Employment status	Full-time/part-time	73.1	73.6
	Other	26.9	26.4
Marital status	Married/common law	84.0	83.9
	Other	16.0	16.1
Household members participating	One adult only	22.6	25.3
	Multiple adults only	15.3	9.2
	One adult and child(ren)	22.6	33.3
	Multiple adults and child(ren)	29.8	32.2
Children per household		1.7 (1.0)	1.8 (1.1)
PA self-efficacy		4.7 (1.3)	4.7 (1.3)
PA perceived behaviour control		4.9 (1.4)	5.0 (1.4)
PA attitudes		6.0 (1.0)	6.0 (0.9)
PA intention		6.0 (1.4)	6.0 (1.3)
PA barriers		2.4 (0.6)	2.4 (0.7)
PA benefits		4.4 (0.5)	4.5 (0.5)
PA confidence using Vivofit4		5.9 (1.3)	6.0 (1.4)
PA confidence using dashboard		5.8 (1.4)	5.8 (1.4)
Attitude toward using Vivofit4		6.4 (0.9)	6.3 (0.9)
Attitude toward using dashboard		6.2 (1.0)	6.2 (1.0)

). Participants with complete data for all three surveys (n = 87) had an average age of 39.8 (SD 7.4) years. While use of their own wearable devices was optional, all participants received and used the Vivofit4. The sample included mostly females (74.7%), university graduates (71.3%), those married or in common law relationships (83.9%), from households with incomes of ≥ CAD 80,000/year (64.3%), and working full or part-time (73.6%). Most participants identified as either Chinese (36.8%) or Caucasian (26.4%). On average, there were 1.8 (SD 1.1) children per household. The majority of participants reported that other household members were participating in the VPS program (74.7%). Prior to the intervention, participants reported high levels of self-efficacy, perceived behavioural control, positive attitudes, and positive intentions concerning PA (Table 1). Furthermore, participants perceived few barriers and positive benefits associated with undertaking PA and reported high levels of self-efficacy and positive attitudes towards using the Vivofit4 and dashboard for undertaking PA (Table 1).

Use of the Vivofit4 and Dashboard

Almost half of all participants reported prior use of a wearable device (46%) or an eHealth application (49.4%) (

Table 2. Frequency of use and perceptions of the Vivofit4 and dashboard among VPS participants (n = 87).

	Survey
	Baseline (T0)	4 Weeks (T1)	8 Weeks (T2)
	%	% or Mean (SD)	% or Mean (SD)
Device
History of use	46.0
Frequency of use (≥4 days per week)		93.1%	87.4%
Perceived usefulness for PA **		2.6 (0.8)	2.5 (0.8)
Perceived ease of use ***		5.8 (0.9)	5.9 (1.0)
Made it easier to participate in daily MVPA ***		4.9 (1.4) *	4.5 (1.3) *
Dashboard
History of use	49.4
Frequency of use (≥1 day per week)		54.0%	47.1%
Perceived usefulness for PA **		1.9 (1.0)	2.0 (1.0)
Perceived ease of use ***		4.7 (1.3)	4.8 (1.4)
Made it easier to participate in daily MVPA ***		4.4 (1.3)	4.2 (1.5)

* p < 0.05 statistically significant difference between T₁ and T₂ (McNemar’s test for proportions or Wilcoxon Signed Ranks Test for continuous outcomes). ** Score range: 1 to 4 (higher scores represent increases in perceived usefulness/ease of use). *** Score range: 1 to 7 (higher scores represent increase ease in participating in PA).

). The use of the Vivofit4 was high, with 93.1% of participants at 4 weeks and 87.4% at 8 weeks wearing the Vivofit4 for at least 4 days/week. Participants who wore the Vivofit4 at least 4 days/week were significantly older than those who wore the device less frequently (46.1 vs. 29.8 years; p = 0.045).

Participants reported that wearing the Vivofit4 was useful for supporting PA and that it was easy to use (Table 2). Participants, on average, also reported that wearing the Vivofit4 made it easier to participate in daily moderate to vigorous PA (MVPA) during the program, although this perception significantly decreased from 4 weeks to 8 weeks (4.9 to 4.5 days/wk.; p = 0.017), respectively. Compared to those without a university degree, average scores for perceived usefulness of the Vivofit4 were significantly higher among those who held a university degree both at the 4-week (degree = 2.78 vs. no degree = 2.22, p < 0.001) and 8-week follow-up (degree = 2.60 vs. no degree = 2.23, p = 0.036). Moreover, participants with an annual household income of <CAD 80,000 reported, on average, significantly lower perceived ease of use compared to those with an income of CAD 80,000–119,999 (<$80,000 = 5.21 vs. CAD 80,000–119,999 = 5.97; p = 0.008). Similarly, compared to those with an annual household income of <CAD 80,000, those in the highest income group reported higher perceived ease of use (<CAD 80,000 = 5.31 vs. >CAD 119,999 = 5.96; p = 0.015).

The frequency of using the dashboard was low, with almost half of participants at 4 weeks (54.0%) and 8 weeks (47.1%) reporting use at least 1 day/week. Those who reported using the dashboard at least once per week were significantly older than those who used the dashboard less frequently (50.2 vs. 38.5 years; p = 0.029). Participants perceived the dashboard easy to use and of moderate usefulness in terms of supporting PA, particularly when considering daily MVPA (Table 2).

3.2. Qualitative Results

During interviews, participants described their experiences with the VPS program. Two major themes emerged from the thematic analysis of the interview data that were relevant to how participants engaged with the WTech and the VPS program: (1) Perceived benefits of technology, and (2) Experiences of the VPS program. Both of these themes were developed from a thematic map.

3.2.1. Perceived Benefits of Technology (Theme 1)

Participants spoke about the ways in which the Vivofit4 and dashboard facilitated their physical activity. They also mentioned both positive and negative thoughts about the ease of use with regard to both the Vivofit4 and the dashboard.

Experiences of Using the Vivofit4

Participants’ perceptions regarding the usefulness of different functions of the Vivofit4 varied. For example, more than 10 participants perceived the caloric expenditure data as useful, while others described it as not useful. The majority of participants shared that the steps feature was the most useful function for supporting their PA. For example, Elena (female, 40 years) explained, “It’s like, did I hit my 10,000 or did I not?” Similarly, Nadine (female, 46 years) commented that she used the steps feature to ensure she was “doing what I’m supposed to be doing to stay healthy” and to “improve myself… and motivate me to want to do it every day or beat it”.

Participants described the Vivofit4 as providing an opportunity to compare or compete with others, especially in households where multiple members were participating in the VPS program. Amy (female, 43 years) explained, “every week one of us will put in a challenge, and then we’ll all try to beat the challenge… I never win… but I try… it’s the participation that counts, not the winning”. Kelly (female, 38 years) also described the fun her family had with comparing their steps, “at the end of the day, my daughter will be like, mom, how many steps did you get? Me and my kids have it, it’s a lot of fun”. Kurt (male, 45 years) explained how using the Vivofit4 became a motivator for PA for his family, “It’s almost like a game for my kids now. It’s like, let’s just reach that [step] goal, and get that beep sound that says ‘goal’”.

Some participants questioned the accuracy of the Vivofit4 for monitoring movement, which influenced their perceived usefulness of the device. Taylor (female, 29 years) described, “I couldn’t find much use in that [Vivofit4] device and the metrics that it was measuring… with steps I’ve noticed… sometimes with hand rolling motion, like you could play the piano and you could add like 2000 steps”. Participants also questioned the accuracy of the Vivofit4 for tracking their children’s steps and PA, as the device was not intended to be worn by children. As Kurt (male, 45 years) shared, “[I] can’t see the calories being accurate and I can’t see the distance being accurate. There’s really no point of even trying to figure it out… I’ve been home and most of the time my kids have been home, and we reach our goal, and we’re like, “Did we really do five miles in our house?”

Many participants discussed how they liked the simplicity of the Vivofit4. They also appreciated how easy it was to synchronize the Vivofit4 to Garmin Connect™, which provided access to additional features and outputs. Susie (female, 33 years) explained, “I like that there’s just one button. You can scroll through, and then you can hold the button, but there’s not much else you can do, which I think is a good thing”. Other participants commented that they liked not having to look at another application to view their steps or other output because it was available directly from the Vivofit4 device. Participants with children also highlighted that they liked the simplicity of the device. Deanna (female, 37 years), whose three children were participating in the program, illustrated her preferences for keeping the Vivofit4 simple for children, “I don’t think that I would change the watches for the kids… I love how simple it is for them and that it’s not a distraction. Whereas if they had the more high-tech watches with the screens and apps and all this extra stuff… the amount of time that they would be screen timing on their watch would increase”.

Participants expressed differences in personal preferences concerning the physical design and esthetics of the Vivofit4. Some participants liked the fit of the Vivofit4 or that the device was discrete (slim), whereas others did not like the fit or the physical design of the device.

Experiences of Engaging with the Dashboard

Some participants described benefits of using the dashboard, although many reported not using the application at all (

Table 3. Triangulation of qualitative and quantitative data to the TAM dimensions using a convergence coding matrix.

Qualitative Finding	Quantitative Finding	Triangulation Outcome
Usefulness of the Vivofit4 and dashboard
Participants perceived many benefits from using the Vivofit4. Most participants described the Vivofit4 device as useful, whereas fewer participants described the dashboard as useful.	Participants reported high levels of usefulness of the Vivofit4 for undertaking PA. Frequency of the Vivofit4 use was high.	Agreement
	The perceived level of usefulness was moderate-to-high for the dashboard. Frequency of dashboard use was low-to-moderate.	Partial agreement (findings complement one another)
Many participants described how the Vivofit4 enhanced their awareness, motivation, and engagement in PA. Very few, if any, participants described how the dashboard enhanced their awareness, motivation, and engagement in PA.	The Vivofit4 made it easier to participate in daily MVPA.	Partial agreement (findings complement one another)
	The dashboard made it easier to participate in daily MVPA.	Silence
Some participants questioned the accuracy of the Vivofit4 and dashboard output data.	Participant perceptions of the accuracy of the Vivofit4 or dashboard were not collected.	Silence
Participants from households where multiple members participated in VPS differed in their perceptions of the usefulness of the Vivofit4 compared with those who participated as individuals.	No differences for perceived usefulness of the Vivofit4 found between those who participated in the VPS program as individuals and those who participated with other household members.	Dissonance
Ease of using the Vivofit4 and dashboard
Most participants described the Vivofit4 device as easy to use.	High levels of perceived ease of use for the Vivofit4.	Agreement
Many participants described not using the dashboard. Some stated they were not able to access the dashboard.	Moderate-to-high levels of perceived ease of use of the dashboard. Frequency of the dashboard use was low.	Partial agreement (findings complement one another)

Note: MVPA = moderate to vigorous physical activity.

). Two participants who found the application useful explained they liked the comparisons the dashboard made to others of the same sex and age. For example, Alison (female, 23 years) commented, “I would always look first at my weekly vScore… I would compare it to what the other people in the age cohort got… if it was a little lower than what the average was, it would motivate me to work a little harder for next week”. Others who found the dashboard useful, particularly those with children involved in the program, suggested the application led to family discussions and comparisons with their data. Allan (male, 41 years) explained that his family would discuss their data at the dinner table, “I’ll summarize it for dinner time conversation… I’ll say to my wife, ‘What’s up with your v-score being on a 50?’ Even our children are hovering around the high 60’s, low 70’s, and myself in the mid-70’s?”

Amongst participants who did not perceive the dashboard as useful, many commented that they did not understand the significance of the vScore or how they could influence their score. Emily (female, 43 years) illustrated, “I go on there and I see a vScore… one week it was 49 and another it’s 61. What does that mean? Does that mean they were super active or less active? I tried to look in there, but I don’t see a legend as to what it truly means”. Kurt (male, 45 years) shared a similar experience, “The Vivo dashboard, I did not find helpful at all… we’d log on every Sunday, look at our data, but overall, it didn’t give me any information… I wish there was more detail”.

Participants described the dashboard as difficult to access. Participants experienced technical issues with their passwords, finding the URL to access the dashboard, or observing a blank screen after they had logged in. Jamie (female, 35 years) contacted Vivo to get support with the dashboard after becoming frustrated with the amount of time it took to set up an account, “[Vivo staff] sent me that link and asked me to set up a Garmin account, which I did, and then [they] sent me the link and [they] said, I just have to click on this link and it should give me instructions, but the link is not working. So, I’m just, at this point I feel it’s taking way too much of my personal time to do this…”

Some participants reported the lack of a smartphone application that connects to the dashboard as a reason for not accessing the dashboard. For example, Renee (female, 41 years) highlighted “It’s not as convenient, [as] I’m not on my computer as consistently to just tap into that. It’s more convenient to have the app on your phone and carry it around rather than going into the website itself”. Other participants reported further barriers related to the use of the dashboard as Amy (female, 43 years) explains, “really hard for those that can’t afford a device [smart device] as each individual participating requires their own to access the dashboard”. Similarly, Susie (female, 33 years) who had two younger children participate in the program commented, “As a parent with kids who aren’t really independent on apps and emails and they’re not really on the internet that much yet… I have to have three devices charged all the time, and then checking [the dashboard] is just another thing that is a bit too much to do”. Finally, some participants shared that they stopped synchronizing the Vivofit4 with the dashboard. As Colin (male, 56 years) explained, “I think I was more consistent at uploading within the week. I’m not sure [what] my wife and daughter did, they might’ve fell off more than I did”.

3.2.2. Experiences of the Vivo Play Scientist Program (Theme 2)

Many participants valued their experience in the VPS program and recommended the program to others in their community. Participants also offered insights about their motivations for enrolling in the program, the challenges they experienced during their involvement, and recommendations for improving the program.

Reasons for Enrolling

A majority of participants reported becoming aware of the VPS program via their involvement in other Vivo-delivered programs and services. Many participants mentioned that staying physically active during the COVID-19 pandemic was a key reason for their enrollment in the program. Johnathan (male, 38 years) described, “it [VPS program] was the best timing because we were all in lockdown and not physically active, so this was a good motivation… [it’s] something we can compete with ourselves, so overall we all participated… and the kids… it kept them active… it was a good experience”. Similarly, Grace (female, 54 years) explained how the program was beneficial for supporting her son’s health during the pandemic. She highlighted, “I think part of the reason why we wanted him in the program… is because I know he’s not as active as before, and I know he’s not getting the sleep that he needs. So, when there’s data showing him… that he could see it for himself… it’s up to him to change that”.

Other participants shared that they joined the program to stay motivated during the winter months. Additional reasons for joining the program included the “free Vivofit4”, having the opportunity to “contribute to the evidence base”, and because they felt it would motivate them to be active because “other [were] people watching” their behaviour.

Challenges and Recommendations

Participants frequently discussed challenges with registering for the VPS program. Participants noted that “registering took a really long time”, there were “lot of steps”, “too much information to read”, and “too many different accounts and passwords” involved with the onboarding process. Other participants expressed frustration in the delay between registering and receiving the Vivofit4. For example, Johnathan (male, 38 years) highlighted, “we submitted something, and we didn’t get a reply for at least a week or so… that was a gap because we submitted a lot of paperwork, and not even hear back so like, okay, I put in the time to finish all the work and then I didn’t even get a reply”. Other participants suggested that they did not have a clear understanding about some aspects of the program, such as the requirement that all family members needed their own smart device or computer to set up the dashboard, and clarity about the number of adults that could participate in the program.

Another commonly reported challenge related to a lack of clarity about the objectives of the VPS program was identified by Elena (female, 40 years). She explained, “I misunderstood the purpose of the study… I understood it at the time, was just to have someone monitor family activities, family exercise profiles like to see, okay, this community is really active. Maybe we should have more play hubs in the area or maybe another facility. That’s kind of what I thought the purpose of it was until the onboarding session with the technical [Vivo] team. Then I learned [what] it was about… does having a device and the programs make you more active?” Deanna (female, 37 years) also commented, “we were really excited to do it when we met with the VPS crew at one of the play events… [but] the [program] changed about 15 times before we actually got on board with it”. One participant said they “signed up not knowing what the program was”, while another described the program as a “self-led” program.

Participants recommended ways in which the VPS program could be improved, such as receiving weekly emails from Vivo containing health promotion and educational content, creating a newsletter describing strategies for improving PA, setting up activity challenges within the dashboard, and offering Vivo-led activities to bring community members together. Some participants mentioned that they would like to have received more instruction on device setup and on how to use the Vivofit4 (and Garmin Connect™) functions and dashboard. Some also suggested features that would allow participants to connect with each other and to see the progress of others, which could have enhanced their motivation. For example, Sandra (female, 52 years) commented, “It didn’t compare you with other families. It didn’t compare you even on the average of whatever other people were doing. It just compared you and your family and what you were doing as a family as a whole. Even just to see, not names or anything, but just to see on average, this is how everybody else is doing… just something to motivate me… there really wasn’t any interaction you could really do with that app”.

3.3. Data Integration of Quantitative and Qualitative Results

Findings from the quantitative and qualitative portions of the study were integrated through the use of a convergence coding matrix (Table 3). Aspects of the TAM were identified in both the quantitative and qualitative findings. For perceived usefulness, there were areas of agreement, partial agreement, dissonance, and silence between the qualitative and quantitative findings. For perceived ease of use, agreement and partial agreement were indicated between the qualitative and quantitative findings. Triangulating the data was a helpful process for identifying deeper levels of complexity and considering meta-themes in relation to our research purpose [26].

4. Discussion

The focus of this study was to explore experiences of participants enrolled in the VPS program, including their perceptions of using WTech. Our findings indicate that WTech interventions such as the VPS program may be a feasible and an effective strategy for supporting PA. However, the uptake depends on the participant’s unique perception of the benefits that WTech provides. Furthermore, our findings indicate that the interactions individuals have with organizations offering WTech programs can influence their experience and commitment to stay involved.

Our findings support other previous studies and indicate that the TAM is useful for identifying factors that influence the uptake of WTech [5,14,29]. The level of agreement between our quantitative and qualitative findings demonstrates that participants perceived the Vivofit4 as being useful for supporting their PA, and most perceived the Vivofit4 as easy to use. Based on this, it is not surprising that a high proportion of participants reported using the Vivofit4 at least four or more days per week in the two follow-up surveys. The dashboard did not achieve the same success as the Vivofit4, with only about half of the participants engaging in the use of the dashboard at least once per week. The lower frequency use score for the dashboard was accompanied by lower levels of participant perceived usefulness and ease of use for the dashboard. During interviews, a number of participants indicated that they were not clear on the meaning of the vScore featured on the dashboard or how their score could be changed. The limited functionality of the dashboard affected their perceptions of how useful the dashboard was in supporting their health and PA. Previous research states that consumer uptake of WTech is influenced by the degree to which the technology is functional for the user [30,31]. An emphasis on functionality may be appealing for users that exhibit a high degree of self-efficacy; however, to increase uptake, wearable technologies need to be functional for the ‘average/typical person’, and not just those who are highly motivated to use new technologies [29,31]. Perhaps WTech could be improved through a persuasive design technology strategy for those that are less motivated.

Notably, perceived usefulness of the Vivofit4 was significantly higher among those who held a university degree and perceived usefulness of the Vivofit4 was higher among those from households with higher incomes. In Alberta (Canada), almost 35% of adults own a consumer-based activity tracker, with higher ownership found among those more highly educated [32]. Data from Australia suggests that among adults with less than a tertiary education, 27% had previously used an activity tracker [33]. In the US, activity tracker use in the past year was more prevalent among adults with high versus low household incomes [34]. Lastly, a recent systematic review of 19 randomized control trials involving digital technology interventions found that low SES adults were less likely than higher SES adults to benefit in terms of improvements in physical activity [35]. Our findings offer some insight into these socioeconomic disparities in the adoption and use of wearable devices, and like others, they suggest that education and income may be associated with attitudes towards these devices. However, more research is needed to untangle the benefits of activity trackers by SES.

Our qualitative data suggest that a possible reason for the lower uptake of the dashboard was its lack of a smartphone application. This is not surprising, as smartphones are known to play a crucial role in receiving and analyzing data when collected from a wearable device [29,31]. The compatibility of a device is defined as “the degree to which a technology complies with the technical functionalities of other existing products (e.g., smartphones and tablets) and with the needs and lifestyles of [the user]” (Li et al., 2019, p. 75) [29]. Therefore, the compatibility between different forms of wearable devices and dashboards are a central element of technology acceptance [31]. Participants who reported lower levels of dashboard use likely had smartphone and dashboard connections issues resulting in limited to no immediate feedback. This lack of feedback would decrease participants’ perceived ease of use and, subsequently, the usefulness of the dashboard. Another related issue was that the platform only allowed Vivofit4 users to synchronize with the dashboard once a week, likely influencing the frequency of use. Regardless, the degree to which a new technology is seamlessly integrated with a users’ existing technology appears to influence the uptake of that new technology [31].

Participants often described personal preferences for the Vivofit4 esthetics. For some participants, they liked the fit of the device—the slimness—whereas others did not like the fit or thought it was not wide enough. These differences are important for companies to consider as consumers’ intentions to adopt WTech are seemingly influenced by comfort, look, and general appeal while wearing it [36]. These attributes have the potential to effect WTech adoption and patterns of use. Future studies may want to design a program that allows participants the opportunity to use different wearable devices (e.g., a loaning system similar to a library).

Participants shared how the VPS recruitment process and communication from the program team were important for their continued engagement and use of the Vivofit4 and dashboard. However, other participants reported a lack of clarity about the objectives of the program and others signed up without really knowing what was required to participant. Minimalist interventions, involving only the use of WTech as the primary strategy for increasing PA, have had success [32,33,34]. However, based on interview data, providing participants with clear behavioural goals and targets for people to achieve might enhance the effectiveness of the VPS program. Moreover, there was a desire from some participants to receive health promotion content as part of the VPS program. While the VPS program encouraged participants to self-determine their PA behaviour with the access of free WTech, more benefits could occur in the future if other behaviour change strategies were included [37].

Strengths and Limitations

This study is one of a few that occurred during the COVID-19 pandemic that focused on PA and SB in households [38,39]. Our mixed method study draws on results from survey data and the lived experiences of participants enrolled in an innovative community-based program designed to influence the tracking of PA behaviours through WTech. Although the intervention took place during the pandemic, the initial design of the program occurred pre-pandemic. The VPS program was therefore adapted (recruitment/onboarding process) to ensure COVID-19 pandemic public health measures were complied with (e.g., to allow physical distancing during the sign-up process). The success of the VPS program may have benefited, oddly enough, from the timing associated with the launch of the intervention by improving adherence. The pandemic created an unusual environment where most individuals in this study were in a position to comply with the stay-at-home restrictions and subsequently the intervention could be seen as being tailored to the individual’s given situation [40].

The recruitment strategy used by Vivo may have been very attractive to our sample of mostly female, nearing middle-age, and highly educated individuals who were more likely to already be active or involved in recreation. Lower incomes families and households often report barriers to recreation access and subsequently would be less likely to visit a centre, and therefore not be aware of the no cost to the VPS. Access to opportunities for PA and sports, and potential benefits of participation, are well known to not be distributed equitably [41,42]. Although Vivo wanted this to be a community-based intervention, the recruitment seemed to target only a small segment of the community, limiting generalizability.

We evaluated the VPS program for only eight weeks and thus the long-term impacts of the intervention on physical activity remain unknown. Based on previous research [43], most interventions need a duration of at least 8 weeks to stabilize behaviour routines so that they become habitual. Nevertheless, despite its short duration, the VPS program appeared to have positive impacts on PA and SB [13]. We also acknowledge that the online surveys may increase the potential for both recall bias and social desirability bias often associated related to the self-report measures [44].

5. Conclusions

This study intervention took place during the COVID-19 pandemic; however, the initial design of the program occurred pre-pandemic. The VPS program was therefore adapted (recruitment/onboarding process) to ensure COVID-19 pandemic public health measures were complied with (e.g., to allow physical distancing during the sign-up process). Participants received free WTech and access to an e-Health dashboard, which may have influenced the ease of use, thus supporting the increase in PA and reduction in SB. However, participants in this study were highly motivated, mostly middle-aged, educated women, with circumstances that may have also advantaged them (i.e., the ability to stay at and/or work from home during the pandemic) in taking part in the VPS program during the pandemic.

Future research should focus on recruiting a broader demographic to assist with more equitable stakeholders given the small segment of the community reported on. Seeking out and increasing role models from underrepresented groups may help to increase the sample generalizability as well as the uptake of WTech. A longer study duration that reaches 12 weeks and beyond to identify whether participants will maintain the long-term adoption of the WTech should be considered in future research studies. Also, with a longer durational study, multiple health behaviour changes (MHBC) can be included either simultaneously or sequentially, as there is currently only limited evidence to suggest that MHBC may have a greater impact on public health.