Technology is becoming an increasingly prominent part in the lives of modern workers. A simple search of “well-being” in any app store can yield thousands of results, with each application claiming to improve different facets of users’ daily behaviors to lead a healthier lifestyle. To understand more about the value of health technology in organizations, HealthyWorkplaces conducted a literature review of existing health technologies in the marketplace and their corresponding scientific support. By combining academic and commercial sources, we explored the efficacy of different technologies and their use in workplaces for promoting healthy behaviors. This literature review was conducted by Helen Lee, student researcher, under the guidance of Center Director Cristina Banks and Core Member David Lindeman.
The Current Status
Health technology is defined by the World Health Organization as “the application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures and systems developed to solve a health problem and improve quality of lives.” With an overall heightened awareness towards health and well-being, an increasing number of technologies developed for the purpose of establishing healthy behaviors has emerged in the marketplace. However, the effectiveness of these applications and technologies are largely unknown due to the lack of independent testing, validation, and scientific studies of effectiveness. This fact was the impetus for our systematic review.
Developer claims of positive impact on user health are questionable at best. Quality assessments of weight-loss-related mobile applications have found that most apps lack elements of Behavior Change Theory (BCT), an underlying foundation critical for adoption of healthy behaviors. Cognitive training apps also show considerable variability in in efficacy, with some platforms showing no greater impact on their users’ cognitive functioning than regular video games
Conflicting evidence is commonly found in evaluations of health-related technologies, which makes it difficult to draw a conclusion regarding their efficacy. Activity trackers are a good example. One study showed that quantification of physical activity provided “value” for users and could induce long-term behavior change, while another studyfound that wearables which tracked physical activity showed no significant advantage in weight-loss over a standard self-monitoring weight-loss approach. Conflicting results are also found for sit-stand workstations and their effect on worker productivity. The mixed evidence on sit-stand desks led one reviewer to conclude that while they may not increase productivity, they will not decrease productivity and is effective in reducing discomfort.
The lack of randomized controlled trials, which generate preferred scientific evidence for evaluating impact contributes to the difficulty of evaluating efficacy and usefulness. These studies are time-consuming and expensive to execute, especially given the ever-changing landscape of new technologies. Many developers attempt to conduct in-house studies to showcase the effectiveness of their product. A study conducted by Elevate is an exampleElevate conducted a four-week study during which the treatment group was “instructed to play each of four different games at least five times per week.” Pre- and post-test were sent to both control and treatment group to “access the practical skills being taught within the [Elevate] app.” The study found that the treatment group significantly improved 69% more than the control group in test scores. Participants who completed an average of 4+ Elevate training sessions per week also showed more improvement than less frequent users. Studies conducted in-house can be biased, and reports of these studies lack specificity in their methodology and should be interpreted with caution.
Why is this a problem?
Health technologies can play a significant role in the creation of effective health promotion initiatives in the workplace if integrated successfully. The Technology Acceptance Model (TAM) proposed by Fred D. Davis states that users’ acceptance of new technology relies on the tool’s perceived usefulness and ease of use by the user. Perceived usefulness is defined as the degree to which users believe the technology will help them perform their jobs better, whereas perceived ease of use refers to the degree to which a person believes that using a particular system would be free of effort. Both Davis and a more recent study identified a strong relationship between perceived usefulness and actual usage of the technology. The more an individual believed a technology to be useful, the more likely they were to adopt the tool.
For a technology aimed at inducing healthier behavior in the workplace, it is essential for a developer to demonstrate the its efficacy and convince the organization of the value it can add to the users’ health and well-being. In the current marketplace, it is challenging for organizations and individuals to be able to distinguish between effective and ineffective technologies. Without needed scientific evidence, it is also difficult to convince employees of its perceived usefulness and to successfully integrate technologies that can induce healthier behavior change.
What now?
Understanding theories underlying the development of health-related technologies and their corresponding efficacies is essential for successful integration into the workplace and determining how they can induce long-term, healthy behavior change. It is clear that there is a lack of scientific support for many technologies currently in the market. Our review of the evidence serves as the first step towards understanding what works and what doesn’t. At HealthyWorkplaces, we hope our work assists organizations in making informed choices among the myriad of health technology products available to adopt in their efforts to promote employee health and well-being.