Sixty percent of all mothers today work, either part-time or full time outside their home. Moreover, statistics show that the No. 1 emotion working mothers struggle with is guilt – guilt because they are not home when the kids get home from school, guilt because their son does not like his sitter and guilt because they cannot be a room mother. “Working mothers suffer from two major ailments: guilt and role strain,” says Devika Singh, psychologist at International based in Dubai Herbal Treatment Center.

A universal mom problem

Guilt and parenting go hand in hand. Every mother experiences it, as she somehow believes if something is wrong with the children it must be her fault. In addition, because a working mother is not physically present with her kids 24 hours a day, she naturally blames herself even more when there is even the slightest of problems.

Working mothers face challenges all the time. Mixed with the responsibilities they have as concerning their children are the commitments of their careers. Devika adds, “Women who must work, may feel guilty that they do not spend sufficient time with their children and worry that their child-care arrangements are inadequate, but they find some comfort in the fact that their working will provide the best for their children.”

“Women who choose to work in order to develop their own potential and to prevent boredom or even depression, which may result if they feel forced to stay home, feel guilty that they are ‘abandoning’ their children. Professional women also feel guilty that they are not devoting themselves as thoroughly to their careers as they ought to in order to move forward. These women struggle with their anger at children who present extra, time-consuming demands.

Whatever the reasons why they work, few working mothers do not feel a constant undercurrent of guilt about the effects of their working on their children. The guilt is usually most intense for mothers of infants and preschool children,” she says.

Affects On Moms Guilt On Mental And Physical Health

“Role Strain’ is the somewhat euphemistic term for the chronic fatigue, anxiety, sense of always being behind, and near panic that working mothers so commonly feel from trying to manage their separate and often conflicting roles. Working mothers of small children who need them in the night may suffer as well from sleep deprivation, which leaves them less alert, less productive, and somewhat irritable on the job. Even those rare few who seem to manage both work and mothering without suffering stress may face periodic exhaustion, lack of private time, and neglect of exercise and appearance.”

“A crucial conflict in professional women today is between achievement and the fear of loss of love. They worry that men will be put off by their competence or their interest in their careers may present conflicts in their marriages. Most women do not realize that these conflicts may underlie their anxieties, disappointments, loss of meaning, lack of ambition, frustrations, or boredom in their working lives.”

“It is important for working women to recognize the internal obstacles that they bring to the situation. Then they will be freer to recognize and deal with external limitations that society continues to impose on women in the workplace. Most working mothers keep their guilt and role strain within tolerable limits, although some may need professional help to deal with the stress and self-criticism. Most try hard to focus on the quality of the time they spend with their children rather than its amount. Many try to compensate with special activities and material benefits they are able to shower their child with. They cope with role strain; most often by lowering their career ambitions or slowing down, at least until the children no longer need them as much, and by teaching their children earlier to be self-reliant and independent.”

Tip For Moms To Ease Their Mommy Guilt

A mother should recognize that her feelings are trying to tell her to change something and the change always requires at least a two-step process. First, you have to learn to let go of the things that are causing you problems. Sometimes it is just a matter of looking at a situation in a new light. Other times it is a matter of getting the training of handling your parenting job differently (like learning yell-free discipline techniques or meal-planning tricks). Second, you have to replace the old ways with new ones, which is not hard. Once you begin prioritizing the enjoyment of your parenting experience, you will want to create even more ways to do so. You will be modelling for your kids what it means to be a happy, balanced, well-adjusted parent, so your whole family will be better off.

Moms, View Your Career In A Positive Light

You do not have to be there every second; most children will obey and act accordingly. Even if you are not around all the time, they instinctively know when they are loved.

Set your priorities and evaluate them often. Focus only on what is truly important, not what that stereotype in your head is saying.

Do not be slack on the rules for discipline and routine give them a sense of security no matter how much they rebel and complain about it. Your children want to know that you are there if they need you.

Remember when you leave your child at day-care that nonworking parents may also use childcare help even though they are at home. If your child is having a particularly rough time with separation, it is most likely a phase that he/she is going through rather than something that she would really want to change.

Working Moms Can Benefit Their Children, Too

They encourage independence and cultivates a sense of responsibility in children. Kids of working moms are with adults who are not their parents for at least part of the day. This separation, which makes moms feel guilty, can actually breed a kind of self-reliance that improves self-esteem. Children with working moms get used to starting homework on their own; watch their siblings and help with dinner preparation.

For children, having two working parents can go a long way in shaping their understanding of men, women and families. This means boys may be more likely to have supportive attitudes toward the woman being equal in his future household. For little girls, the idea of achievement in a career outside of mothering can be stimulating, and encourage them to do the same.

Seeing a mom as a working person often confirms for children the sense that people, especially women, are multidimensional. Best of all, their feelings of pride in you doing your job well can carry over into feelings about their own self-worth and give them encouragement about their own capabilities in the future.

Many working parents see the benefit of having caregivers, who offer more opportunities for socialization and a wider range of activities for children than they could at home.

Want to write for InnoHEALTH? send us your article at  magazine@innovatiocuris.com

Read all the issues of InnoHEALTH magazine:
InnoHEALTH Volume 2 Issue 3 (July to September 2017) – https://goo.gl/MCVjd6
InnoHEALTH Volume 2 Issue 2 (April to June 2017) – https://goo.gl/Nv3eev
InnoHEALTH Volume 1 Issue 2 (October to December 2016) – https://goo.gl/4GGMJz
InnoHEALTH Volume 1 Issue 1 (July to September 2016) – https://goo.gl/iWAwN2

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Medela India, the world’s leading global producer of breast pumps and nursing accessories recently launched their unique MyMedela application that offers first-of-its kind digital breastfeeding support for pregnant, new and experienced mothers. The app which is available for Android and iPhone, is a 24/7 resource providing mothers with robust tracking tools, along with personalized, expert advice on nursing and pumping.

A survey conducted by Medela showed that only 33 per cent mothers initiate breastfeeding in the first hour and even seasoned ones need assistance and encouragement to ensure the most successful experience for baby and mom. MyMedela app delivers proactive guidance for overcoming issues and challenges and gives tips that can lead to a positive breastfeeding experience for mother and child. The app has been created to empower mothers with all the necessary information and support at the click of a button with provisions of customized solutions based on each mom’s individual situation to make their breastfeeding journey smooth and enjoyable.

Unique features of MyMedela App:

• Offers an exclusive confidence assessment to understand mom’s strengths and focus on her goals to then deliver customized feedback and support based on mom’s answers and other data entries

• Provides a problem solver tool for quick answers to common breastfeeding questions, featuring tips from expert healthcare professionals

• Sends tailored articles and videos within the app, based on where each mom is on her breastfeeding journey

• Tracks breastfeeding and pumping routines (e.g., time spent, volume and frequency)

• Records information about baby’s growth and daily activities, such as height, weight, sleep and diapers

• Snapshots of mom and baby’s activities are available on easy to- read dashboards

• Sends personalized reminders, alerts and notifications that celebrate accomplishments and help moms manage breastfeeding challenges and goals

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Prathistha Jain is Director, VibaZone Private Limited (India). She is an aspiring Entrepreneur having been involved with start-ups and her passion is in Entrepreneurial Development and Innovation. She is also an image consultant and a regular co-speaker at Entrepreneurship conferences.

Healthcare innovation should be sustainability beyond anything else. Sustainability can be weak or strong. It is weak only when technology is the focus. There will come a time when the technology would be outgrown, thus, it is important that a strong sustainability model should be the focus as it would consider multiple parameters to ensure sustainability. Healthcare innovation should focus on frugal innovation and recombinant innovation.

What is healthcare innovation first?

Healthcare innovation should focus on innovative information technologies, devices, workflow processes, care models or business models. Many companies focus on devices as the returns on these are more tangible. However, it is equally important to focus on the other areas mentioned too.

Technology for Healthcare vs. Healthcare Technology

It is important to understand the difference between the two. Technology for healthcare would be things like mobile phones which can be used for better health and interventions that reduce malnutrition, improve sanitation, and increase safety on roads. Healthcare technology would be specifically designed to prevent, diagnose, or treat an illness, from the highly specific focused on a disease to the more widely applicable monitoring devices.

Why is innovation in healthcare so critical and yet hard?

Innovation is critical because of the need, potential and impact of affordable healthcare technologies on a society like India. Given India’s low healthcare spending, is it possible to use technology efficiently and effectively to tackle India’s healthcare challenges? Besides the core technology aspects, we need to examine the nature and pathways of healthcare R&D and innovations in India, proposed evidence-based policy measures to overcome the bottlenecks and barriers, and to enable positive and healthy growth of the med-tech industry, eventually leading to strengthening the public health care system and the public health conditions of the country.

In the 12th 5-year plan for India the following was cited in the chapter on health. “Health should be viewed as not merely the absence of disease but as a state of complete physical, mental and social well-being. The determinants of good health are : access to various types of health services and an individual’s lifestyle choices, personal, family and social relationships. The focus is on the strategy to deliver preventive, curative and public health services. Other sectors that impact good health, such as clean drinking water and sanitation are dealt under other headers. These are essentials in health care hence the chapter should cover and handle these areas carefully.” Innovation should also focus on basic needs like clean water and hygiene besides affordable healthcare technology, along with advanced communications as these will be able to reduce disease burden and improve healthcare.

The healthcare system suffers from the following weaknesses:

1. Availability of health care services from the public and private sectors taken together are both qualitatively and quantitatively inadequate. We are short of medical personnel and hence we should focus on increasing the number of people by bringing in methodologies which require minimal training to up-skill an individual to use medical equipments and carry out processes.

2. The quality of healthcare services varies considerably in both the public and private sector depending on various factors. As we do not have proper regulation, it is difficult to measure the standard of care and effectiveness of healthcare delivery.

3. Affordability of health care is a serious problem for a vast majority of the population, especially in tertiary care. As many cannot afford the services and most families end up selling their assets to treat the family members, in some cases, treating the bread winners themselves. Also, drugs for chronic conditions are expensive and require regular monitoring and management.

4. Physical Reach / Accessibility of a healthcare facility which is having an outpatient department (OPD) for common ailments, and an inpatient department (IPD) for hospitalization.

The problems outlined above are likely to worsen in future with increasing disease burden and limited health systems capacity. Over the next several years, the cost of health care would go up unless proper regulations and new models are created in India to provide health care.

The Indian medical devices industry is a very small part of the total manufacturing industry, accounting for only 0.2 percent of all certified facilities. Following points are worth noting in this context.

1. Indian Government’s National health policy aims to increase and upgrade healthcare facilities.

2. The government acknowledges the need for foreign/ private involvement in medical technology.

3. The duties on medical equipment have been reduced over a period.

4. Most critical medical devices do not require import duties.

5. Make in India Policy to boost this sector.

Need for Indigenous Technology is well felt in the sector due to following factors.

• Huge growing market supplies predominantly by imports
• High healthcare delivery costs
• Growth of indigenous technology essential for strengthening the Indian industry
• Public supported R&D is hugely required
• Development of materials and devices is a major challenge.

Other Challenges

It is worth noting that currently there is no act for Biotechnology Regulatory and the one which was drafted has lapsed in the parliament that covered primarily biotechnology and not medical technology. A specific medical device bill (currently it is covered under Drugs and Cosmetics Act) and Indian’s own certification (like FDA in US, CE in Europe) is important; passing a bill in this area will make a huge difference to the market needs.

Infrastructure gaps remain substantial and are exacerbated by under utilisation of existing resources. Healthcare infrastructure is poor, compared to urban areas. Underutilization of infrastructure further compounds the problem of meagre infrastructure.

Current World Bank data shows India spends only 4.7 % of its GDP on healthcare. This has only grown 0.7 % in over 20 years. We have 0.7: 1000 ratio for physicians, 1.7:1000 ratio for nurses and midwives and 0.7:1000 ratio for hospital beds.

Leading economics spend up to 10 % of the GDP on healthcare and have two or three times as many medical personals and beds.

The healthcare sector is currently multi-layered and complex, which makes it difficult to unlock its true potential and provide quality services.

It extends to information gathering, interactions across roles, and the potential for control over wider ranges.

How can co-working spaces, incubators and accelerators in India help innovation?

Given the severe challenges of cost, availability of health care personal and weak delivery system – the rise of co-working spaces, incubators and accelerators in India can play a role in helping innovative projects to bring medical care to the masses at a reasonable cost. These innovations will also create business and impact the employment generated by these start-ups. Unlike e-commerce and aggregated models based start-ups, healthcare start-ups require specialized skill sets, larger funding and entail longer gestation period.

All three can play a different role, let us look at each of their roles.

Co-working space

Co-working spaces have easy access in most cities and are affordable so start-ups which are technology light like application, business models and systems can surface in these places. Most of these places have a reasonable amount of networking events with minimal support and can help start-ups get going.

Incubators

These are generally publicly funded and housed in colleges and research centers. Here technology development can happen as these facilities have some equipment and that can be used by start-ups to build their products. The start-ups would get expert advice and assistance from faculty and staff.

Accelerators

Accelerators are usually managed by organizations which are looking for good technology to be applied to their existing products and customer line. They are crucial because they would give a start-up a channel for distribution and manufacturing as these companies would already have successfully entered markets earlier and would have a good market reach to support the new technology.

Opportunities in the Healthcare Innovation

The Indian healthcare sector is diversifying and opportunities are emerging in every segment, be it providers, payers or medical technology. New players are building their entry strategy and domestic players are exploring new care models to stay ahead.

Innovation and Entrepreneurship

Healthcare as a driver for Innovation and Entrepreneurship can create innovative products and generate manpower in the healthcare sector. With the advent of alternate and innovative healthcare models, such as wellness centres, diabetes clinic, day care centres, diagnostic chains, among others, the entrepreneurial spirit in the sector has heightened.

Medical Research & Technology

Medical technology is a broad field where innovation plays a crucial role in sustaining health. From “small” innovations like adhesive bandages and ankle braces, to larger, more complex technologies like MRI machines, artificial organs, and robotic prosthetic limbs, technology has undoubtedly made an incredible impact on medicine. Medical scientists and physicians are constantly conducting research and testing new procedures to help prevent, diagnose, and cure diseases as well as developing new drugs and medicines that can lessen symptoms or treat ailments.

Growing demand

Rising income levels, ageing population, growing health awareness and changing attitude towards preventive healthcare is expected to boost healthcare services demand in future. Growing elderly population, changing disease patterns, rise in medical tourism, better awareness of wellness, preventive care and diagnosis has led to an increase in demand for healthcare services.

Private and Public Partnership

Private providers have shown a keen interest in partnering with the government on various kinds of projects, including primary health centres, emergency and trauma units, radiology and dialysis centres in public hospitals, as well as health insurance schemes.

Policy Support

NITI Aayog has allocated USD 55 billion under the 12th Five-Year Plan to the Ministry of Health and Family Welfare, which is about three times the actual expenditure under the 11th Five-Year Plan The share of healthcare in total plan allocation is set to rise to 2.5 percent of GDP in the 12th Plan from 0.9 per cent in the 11th Plan. The 12th plan focuses on providing universal healthcare, strengthening healthcare infrastructure, promoting R&D and enacting strong regulations for the healthcare sector. Establishing a system of Universal Health Coverage (UHC) in the country that means each individual would have assured access to a defined essential range of medicines and treatment at an affordable price, which should be entirely free for a large percentage of the population.

Way forward

Healthcare innovation should be sustainability beyond anything else. Sustainability can be weak or strong. It is weak only when technology is the focus. There will come a time when the technology would be outgrown, thus, it is important that a strong sustainability model should be the focus as it would consider multiple parameters to ensure sustainability.

Healthcare innovation should focus on frugal innovation and recombinant innovation.

Frugal innovation

Frugal innovation is the process of reducing the complexity and cost of a product and its production. Designing products for such countries may also call for an increase in durability and when selling the products, reliance on unconventional distribution channels. When trying to sell to so-called “overlooked consumers”, firms hope volume will offset razor-thin profit margins. Globalization and rising incomes in developing countries may also drive frugal innovation. Such services and products need not be of inferior quality but must be provided cheaply. Some great Indian examples are the Jaipur foot, oral dehydration salt and many more.

Recombinant Innovation

Innovators rarely come up with new ideas; instead, they convert old ideas into new ones, adapting them from one context to another. Henry Ford adapted his automobile assembly-line technologies from meat packing plant assembly lines. The Reebok “pump” was an athletic-shoe air bladder borrowed from intravenous bag technology. Even abstruse and highly specialized technologies like polymerase chain reaction have their roots in the existing practices of other genres.

Conclusion

Healthcare innovation should be focused on future needs and not today’s needs. Market needs are changing at a rapid rate with India’s rapid growth and modernisation. Technology will keep changing hence it is not suitable to depend on it alone. The key to healthcare innovation is simplicity based on strong sustainability combining technology, accessibility, affordability, quality and availability.

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About 72.6 percent of the rural population in India do not have access to basic oral health. Unfortunately, in our prevalent war against diabetes, cardiac issues, HIV/AIDS, et al, we ignore the seemingly less-important battles – like oral health, for instance – that can actually strengthen our chances of success. Enhancing access to affordable dental care is important in its own right, but is unlikely to be a sufficient strategy for reducing the burden of disease. The innovation that India needs today is an integration of public health solutions for oral diseases with those for chronic diseases and with the national public health programmes.

When we think of innovation in healthcare, most of us tend to look for the ‘Eureka’ moments. The wonder drug that can cure cancer, the surgical procedure that can revive a brain-dead patient, the hi-tech diagnostic tool that can predict cardiac adversities. But these innovations – no matter how spectacular – are of little value without the right healthcare delivery processes.

A very interesting article that appeared in the November 2013 issue of Harvard Business Review looked at how some Indian hospitals are able to provide world-class healthcare at as much as 95 percent lower costs than those at US hospitals. The answers, the authors argue, don’t always lie in grand designs, but in smart delivery systems.

Addressing the Issue

In a recent interview, US-based surgeon and bestselling author Atul Gawande called India’s public health system one of the “most complex things” in the world. And that’s true, given the sheer magnitude of the burden of infectious diseases as well as non-communicable diseases that the country has to tackle.

Unfortunately, in our prevalent war against diabetes, cardiac issues, HIV/AIDS, et al, we ignore the seemingly less-important battles – like oral health, for instance – that can actually strengthen our chances of success. According to the WHO, the risk factors for oral diseases include an unhealthy diet, tobacco use and harmful alcohol use. These risk factors are the same for the major chronic diseases – cardiovascular ailments, cancer, respiratory diseases and diabetes.

Studies have shown that periodontal diseases (also known as gum diseases) pose a risk to general health, especially for patients with other chronic diseases. Among patients with diabetes, periodontal disease can accelerate the chances of pancreatic failure, stroke, myocardial infarction and renal failure.

Similarly, maternal periodontal disease during pregnancy is sometimes associated with increased risk of pre-term delivery and low birth weight. Yet only 50 percent of pregnant women with a dental problem visit a dentist during their pregnancy. Despite studies affirming that most dental care procedures are safe during pregnancy, myths of perceived risks still prevail even within the medical fraternity.

Integrative Approach

The innovation that India needs today is an integration of public health solutions for oral diseases with those for chronic diseases and with the national public health programmes. Say a patient is seeking treatment for HIV, it’s significant to examine his oral health condition too. Research has shown that inadequate oral healthcare can undermine the success of HIV treatment regimens.

World Health Assembly in 2005 included Oral Health with other non-communicable diseases for health promotion and disease prevention strategies. However, most of our policymakers as well as medical practitioners are still in the dark about the burden of oral diseases in the country and their impact on our overall health and wellbeing. Although there has been no nation-wide study to determine the burden of oral health conditions in India, individual studies indicate that the average prevalence of dental caries is 40-45 percent in all age-groups; periodontal diseases is 90 percent; malocclusion is 30 percent.

In 2000, the US Surgeon General identified oral disease as a “silent epidemic”, wherein a significant amount of money is spent on expensive, invasive treatments that could have been either avoided with simple preventive measures or at least treated at a lower cost and lower risk if identified earlier.

Reality Check

The biggest challenge in implementing an integrative approach vis-a-vis oral health and other diseases is the dismal dentist: population ratio (1:8,000 in urban areas and 1:50,000 in rural areas). About 72.6 percent of the rural population, says the data from Dental Council of India, do not have access to basic oral health.

Enhancing access to affordable dental care is important in its own right, but is unlikely to be a sufficient strategy for reducing the burden of disease, states a white paper on Oral Health commissioned by the National Interprofessional Initiative (Oral Health: An Essential Component of Primary Care). Sometimes, we just need to go back to the basics. Prevention is still better than cure. Primary care providers, such as general physicians, nurses and midwives, need to be trained to expand the disease prevention workforce. Children, pregnant women, diabetes and other patients who visit the hospital regularly are ideal candidates for preventive healthcare.

There are several examples of promising healthcare delivery innovations. The challenge is to ensure that they are successfully and widely adopted. And this calls for a change in the attitudes of medical practices, healthcare organisations and policymakers. We need to move away from the traditional doctor-centric healthcare setup and make it patient-centric. Thanks to the advances in information technology, it’s now possible to deliver medical care to patients at a time and place of their convenience. Telemedicine makes the remote delivery of healthcare over the phone a reality, while electronic health records facilitate easier access to expert medical opinions.

Innovations in diagnostic technology, pharmaceuticals, surgical procedures and medical devices are undoubtedly important. But what’s more important is inventive methods to deliver these services in a timely, safe and effective manner to patients. Obviously, this can’t happen overnight. But as Bill Gates so succinctly put it, “We overestimate what we can accomplish in two years, but we underestimate what we can accomplish in 10.”

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Wearable technology, also referred to as ‘wearables’, ‘fashionable technology’, ‘wearable devices’, ‘tech togs’ or ‘fashion electronics’, is defined by Wikipedia as “clothing and accessories incorporating computer and advanced electronic technologies”[1]. We would argue that health technology wearables, with their increasing popularity and growing demand, are the better-known members of the Internet of Things family. In this paper we will touch upon the history of wearables, discuss their evolution and adoption, outline five main categories of wearables with a particular emphasis on wristwear as the most popular health technology wearable today, and the potential of such wearables for tracking health measurements. We will also touch upon certain challenges and opportunities associated with wearable devices and discuss what is to come.

Health Consumers circa 2016

There is a lot of research dedicated to the new generation of health consumers. The common agreement is that the new generation of consumers extensively uses the Internet to obtain health related information[2]. Such consumers feel empowered due to the fact that they are not only able to consult their family doctors, but also get extensive Internet information about their topics of interest, get in touch with the communities and groups of consumers that are interested in the same issues, and even get recommended the best specialists in the area or country to get a second opinion[3]. However, a number of health consumers these days do not stop there – they take health matters in their own hands and use various digital tools, also known as health technology wearables, to track and monitor health measurements, such as heart rate, number of steps, sleep patterns, calories burnt, food consumed, and more. These wearable devices are highly popular amongst the modern connected generation who are impatient, information and data hungry, value convenience above all and expect personalised, on-demand services that enable them to take control over their health[4].

The existing usage statistics and forecasts demonstrate that the use of health technology wearables has doubled over the last two years (21% in 2016 vs. 9% in 2014)[5]. Moreover, 78% of healthcare consumers across the globe wear or are willing to wear gadgets to track their lifestyle habits and/or vital signs[6]. Juniper Research forecasts the wearable market to grow extensively in the next few years with the anticipated global revenue from smart wearable devices reaching $53.2 billion by 2019[7].

Other findings suggest that the number of wearables produced for the healthcare segment will be growing steadily over the next five years[8]. Such predictions are easy to believe given the amount of non-traditional players that are stepping into the healthcare field with their original and competitive offerings, e.g. multiple startups that offer various wearables and devices that capture health measurements, analyse and share them in real time and on demand[9].

Health Technology Wearables

It is well known that we cannot effectively track something that we do not measure. The fact that health technology wearables allow users to effectively track health measurements in real time is one of the key factors that make them popular with the new generation of health consumers. As a proud owner of a fitness band for the last four years, I can unequivocally state that the ability to get instant access to my data (e.g. heart rate, amount of calories burnt, etc.) when I need it and with minimal effort from my part is the most useful feature of my fitness band. Moreover, there are a number of other attractions that help health technology wearables gain popularity:

– Availability and variety of wearables (different colours, shapes, interfaces, etc.);

– Effortless wireless connectivity and integration with smartphones;

– The convenience of getting real-time data at any given moment, at a glance and from anywhere;

– Different types of information and health measurements that are getting tracked, stored, analysed and presented in a user-friendly manner, and often in a manner conducive for decision-making;

– Relatively inexpensive price;

– Some of the wearables are highly customisable (e.g. classy designer cases made especially for Fitbit fitness bands);

– Plethora of applications that can be easily installed on and removed from smartphones and other smart devices, e.g. tablets, phablets, ipads, etc.;

– Provision of ‘extra’ functions, e.g. ability to see the caller or read a message using the wearable, that are similar to the functions of smartwatches that are often more expensive.

Moreover, there are a number of principles related to the design and performance of wearables that make empowered health consumers appreciate their wearable devices even more (see Figure 1).

When it comes to the wearable devices currently available on the market, there are various types of wearables that can literally cover us from head to toe. Whilst some of the wearables are very popular (e.g. fitness wristbands), others are not so well known (e.g. sensors that help adjust one’s posture in real time). Overall, all existing wearables can be divided into five distinctive categories as illustrated in Figure 2.

It is clear that consumers have plenty of choices when it comes to wearable devices, and each one of the five categories listed above, has a lot of potential when it comes to

tracking health measurements. However, from our perspective the most interesting and promising wearables from the world of health technology today are the wristwear, namely various fitness bands or activity trackers, along with smartwatches that often offer more extensive functionality. Further in this paper we will discuss the evolution of wristwear, elaborate on how this technology facilitates taking health measurements globally and talk about ‘A Life of Active’ – a case study from Singapore that demonstrates how wearables are currently being used in the Asian context.

It is clear that consumers have plenty of choices when it comes to wearable devices, and each one of the five categories listed above, has a lot of potential when it comes to tracking health measurements. However, from our perspective the most interesting and promising wearables from the world of health technology today are the wristwear, namely various fitness bands or activity trackers, along with smartwatches that often offer more extensive functionality. Further in this paper we will discuss the evolution of wristwear, elaborate on how this technology facilitates taking health measurements globally and talk about

‘A Life of Active’ – a case study from Singapore that demonstrates how wearables are currently being used in the Asian context.

Evolution and Adoption of Wristwear

According to Forbes, the wearables industry has been blooming with its market worth $5.1 billion in 2015, and is expected to grow by 25% more by 2020 . Wristwear is the most popular category of wearables as it currently accounts for 9 in 10 wearables bought worldwide . The wristwear has gone a long way before becoming the world’s most popular wearable (see Figure 3).

While Jawbone Up was the first wristwear of its kind with the ability to track and store health measurements on the go, some might argue that it was not always connected to the smartphones or laptops, which is partially true. Jawbone did not have a screen and could only display health measurements (such as the number of steps, hours of sleep, calories burnt, etc.) when plugged into a smartphone or connected to a laptop. However, the invention of this wristwear device was revolutionary, and was followed by a number of fitness trackers and smart watches that had displays and could be wirelessly connected to smartphones.

Inspired by a resounding success of Jawbone Up, Nike designed and manufactured Nike Fuelband released in 2012. The device had a small graphical display that notified the user of their daily activities, proximity to hitting their goals and provided other feedback. The fitness band came with its own Nike+ connect software that enabled calculation and customisation of personal statistics and achievements once the device was plugged into a laptop or a smartphone.

Pebble watch developed by Pebble Technology Corporation, USA in 2012-2013, was the first of its kind smartwatch that could wirelessly via Bluetooth connect to and display messages and notifications from iOS as well as Android smartphones. Pebble watch also had an online application store where users could download applications customised for Pebble watch that were developed by a myriad of third party sellers.

In the end of 2013, Nissan, a Japanese automobile manufacturer, created Nissan Nismo Smartwatch, the first smartwatch to communicate with a car and a smartphone via Bluetooth. The watch could connect with Nissan vehicles and monitor drivers’ biometrics, e.g. heart rate, in order to identify when the drivers were becoming tired. That information then would be matched to the car’s performance data, e.g. its current speed, and an appropriate action, e.g. to slow down or take a break, would be suggested to the driver.

Starting 2013 every big player in the smartphone market, such as Apple, Samsung, Sony, LG and many others have been working on their own smartwatches. In parallel, Fitbit, a consumer electronics company based in the USA, released Fitbit Flex in 2013, which was worn on a wrist as opposed to their other trackers that needed to be clipped onto the clothes. Since then, Fitbit released a large number of wristwear devices, and while they do not offer the extensive functionality of smartwatches, they meticulously track health measurements, easily and wirelessly connect to various smartphones and are offered at competitive prices.

The wristwear market keeps growing and offering more and more devices of various colours, sizes and functionalities. Nevertheless, it is important to understand whether the variety and availability of wearables drive their adoption, or are there other factors in play when it comes to choosing health technology wearables that empower users to measure progress towards their goals and trigger subsequent behavioural change.

According to Dr Mitesh Patel and his colleagues from the Philadelphia VA Medical Center, there are four major challenges pertaining to the use of wearables, including wristwear devices that need to be addressed in order to enable behavioural change:

1. Health consumers should be motivated and interested enough to be willing to invest in the wearable device;

2. Once acquired, the user needs to remember to wear the device and to recharge it;

3. The device has to be customisable enough to enable the user to regularly and accurately track their targeted behaviour;

4. Tracked information has to be presented back to the user in a way that can be easily understood, supports decision-making and motivates the user to take action[10].

Statistics demonstrates that 27.2% of US adults do not intend to use wristwear or other wearable devices to track their fitness or health measurements[11]. Therefore, it’s safe to assume that whilst some, more technologically savvy, health consumers are comfortable to use various wristwear and other wearable devices, others might find such devices not particularly useful, interesting or needed. However, half of these same respondents state that they would be prepared to reconsider if:

1. The tracking device is provided by their physician, or;

2. Wearing such a device would result in better healthcare advice from their physician, or;

3. There would be a possibility of lowering their health insurance premiums.

To conclude, the respondents indicate that they would be willing to use wristwear and other wearables to track and store their health measurements, if that would result in certain tangible benefits for them, whether it’s monetary incentives or better health advice. However, we would argue that simply tracking and storing health measurements using wristwear and other wearable devices might not be enough to trigger behavioural change. Therefore, the increasingly growing popularity of wristwear does not always suggest that just because the health consumers are enabled to track their health measurements, they will readily change their behaviour or adjust their lifestyle habits.

Wristwear to Support Behavioural Change

There are a number of books and articles written about behavioural change. Most authors agree that it is a complex phenomenon that does not happen overnight.

While it is difficult to persuade people to perform their tasks in a different way to trigger behavioural change, it is even more challenging to maintain such behaviour change in the long run. Therefore, the importance of persuasion and the right motivation in enabling and promoting behavioural change cannot be overstated and emphasised enough.[12]

Researchers from the Philadelphia VA Medical Centre suggest that whilst wristwear and other wearable devices have the potential to trigger behavioural change in health consumers, the devices alone cannot trigger such a change. In fact, there is little evidence to suggest that the gap between recording information and changing user behaviour is being effectively bridged by wearable devices. The authors suggest that a combination of various behavioural economics concepts and engagement strategies, such as individual encouragement, social competition and collaboration, effective feedback loops, gamification, could help initiate and achieve behavioural change.[13]

In Asia, a new Singapore-based startup ‘A Life of Active’ [14](ALOA) has created an online wellness portal that rewards its members for walking. According to a 2012 survey, seven out of ten Singaporeans do not get enough daily exercise, which contributes to health conditions such as heart disease and diabetes[15]. Studies show that regular but short periods of physical activity can help reduce the risk of such health issues[16]. ALOA was created to encourage Singaporeans to engage in and maintain a healthy lifestyle. Each consumer subscribed to the ALOA portal, has a wearable device – a wristband – that collects data about the number of steps taken and distance walked. The data is then synced from the wristband to the portal and displayed back to the users. Members are encouraged to take part in various challenges of different intensity to win cash, vouchers or to participate in lucky draws.

The ALOA founders wanted to determine whether implementation of various engagement strategies could, in fact, lead to and promote behavioural change, and how such strategies would influence consumers’ motivation. A number of studies talk about the power of intrinsic motivation that can be defined as a desire to act in a specific manner because of the sense of fulfilment gained, and how it can supersede external rewards.[17]

However, the ALOA founders have found that the intrinsic motivation often encourages the creation of a variety of motivational techniques but not the behaviour change per se. In the meantime, there are cases where external motivators, such as cash rewards, positively influence behaviour changes. Such cases demonstrate that successful behaviour change initiatives, such as quitting smoking, changing diets and increasing exercise frequency, have been encouraged and facilitated by cash rewards.[18]

The ALOA founders wanted to determine whether health consumers would increase their level of physical activity if they were rewarded for walking more, and set out to become the external motivational trigger for members to become more active. The level of physical activity was measured by an increase in either the frequency of the consumers’ sessions or the number of steps taken. The consumers were invited to participate in weekly challenges, where they were asked to walk between 4,000 to 15,000 steps either in one go, daily or over five to seven consecutive days.

The ALOA founders found that the monetary incentives proved to be a substantial motivator for the consumers to take part in physical activities. In fact, out of the 15 challenges ran from June until September 2016, those with monetary rewards were the most popular and had the highest number of members completing them. Interestingly, lucky draws (for big-ticket items) that represented the element of chance were not as popular as challenges with guaranteed monetary rewards. Based on the three months trial run of the portal, the ALOA founders conclude that the external motivation can serve as a framework or even a backbone of their programme to drive behaviour change. They identify three important lessons learnt:

1. Engage consumers in early stages of their adopting a new behaviour

Giving health consumers realistic and achievable targets with the means to monitor their achievements is most effective when done in early stages of adopting new behaviour, i.e. when the consumers are starting to establish new habits.

2. Customise and diversify
Health consumers operate in a range of personal situations and no external trigger affects them in the same way. To that end, while the majority of members enjoyed receiving monetary rewards, the others looked to earn vouchers or lucky draw prizes that addressed practical matters. Therefore, diversifying and introducing a variety of engagement strategies and rewards, facilitates behavioural change.

3. Money talks
It is necessary to establish baseline levels of activity to gauge fitness improvements and to determine behaviour change. Incentives, especially monetary ones, can help overcome inertia and procrastination barriers towards starting and maintaining participation in a walking programme.

The ALOA founders state they are looking forward to the next stage of engaging with their members. Having built up an understanding of triggers and a walking programme baseline, they want to move into providing challenges on demand (‘Start a challenge just before the daily walk and earn!’) as well as stronger personalisation with thresholds, where the portal alerts the consumers when they fall under or go above their pre-selected milestones.

Challenges and Opportunities

The world of wearables has its own challenges and hurdles to overcome. Despite the growing popularity of wristwear and other health technology wearables, the research suggests that, depending on a wearable, anywhere between 33% to 50% of health customers will stop using a device within six months from the day of purchase. This can be attributed to a number of factors, including the fierce competition amongst manufacturers of wristwear and other health technology wearables. The reality is that for every one hundred of wearable devices, less than five per cent will be somewhat successful when they make it to the market.[19] Other factors that pose a significant challenge when it comes to the use and adoption of wearables by health consumers are:

1. Safety
Most of the health technology wearables give users a unique and enticing opportunity to be constantly connected to the smartphones via the means of Wi-Fi, Bluetooth and NFC. However, would a prolonged use of such devices expose health consumers to unwanted health risks? Most scientists believe that wearable devices emit low levels of electromagnetic radiation (typically two orders of magnitude less than a mobile phone) and therefore, pose no health risk. However, there are some researchers who are more sceptical on the matter and believe that more work needs to be done in order to unequivocally state that wearables cause no harm to their users.[20] Another safety related concern is about the fact that at times wearables can be rather distracting. Whilst it is impressive to have a smartwatch that monitors all your email accounts, phone calls and messages in real-time, and notifies you the moment there is new activity detected (including health-related notifications), such alerts can be distracting and potentially dangerous in certain situations, e.g. when driving a car.

2. Unreliable or inaccurate data
The drawback of most of the health technology wearables is that the data is not quite captured in the real-time. There is almost always a delay from the moment when the data is captured to the moment when it is displayed. This is not a critical issue in most cases, however, as more and more health consumers rely on the wearables to track their fitness activities, amount of calories burnt, etc. it is important to ensure that the information is tracked, analysed and presented accurately and the right way. Instead of taking collected data at face value without being concerned about how accurately it has been captured or whether it is correct, the manufacturers of the wearables should ensure that the health consumers can fully trust their devices. This issue can become paramount when such wearable devices are used for specific medical purposes (e.g. measuring blood glucose levels) and the collected data gets integrated into the hospitals’ electronic health records systems.

3. Privacy issues
There is no secret that some of the health consumers are rather reluctant to share their data with the rest of the world. Therefore, manufacturers of health technology wearables have to ensure that the data is protected at all times. Along with data accuracy, data privacy is of particular importance if such data gets transferred to and stored in the hospitals’ electronic health records systems.

4. Information overload
Wristwear devices that track health measurements on a daily basis, such as the number of steps taken, sleep patterns, heart rate, etc. generate a huge amount of data per user. Therefore, another challenge for the manufacturers of the health technology wearables is to make sure that the data is presented in a way that does not overwhelm with information, but instead allows the user to get an accurate synthesis of information that will enable them to make better decisions and lifestyle choices.

The manufacturers of wearable devices collecting data that has a potential to be used by the physicians, face a similar challenge. In fact, one of the cases against health technology wearables is that encouraging physicians to work with data derived from wearable devices could result in a technology overload and drive physicians away from face-to-face patient-physician interactions[21]. Therefore, it is important to ensure that the data that could potentially be used by the physicians is accurate, reliable and presented in a way that is easily understood and digested by the medical professionals. Moreover, engaging the medical community in the design of such wearable devices as early as possible will ensure that doctors and other medical professionals will get the right data at the right time and in the preferred format.

5. Over-engineering
While most of the manufacturers strive to make their wearables user friendly, unfortunately it does not always work. One of the studies suggests that 24% of consumers find the monitor of their health technology wearable to be too complicated. Various factors, such as the number of functions available, a lack of wristwear buttons, the size of displays contribute to the fact that the users sometimes find it hard to understand multifaceted applications of their wearables, or appreciate their sleek designs.[22]

6. Limited plug-and-play features
Some of the manufacturers of wearable devices, in an effort to emulate Apple, create products that are only capable to operate on a restrictive proprietary platform.

Needless to say, this poses certain challenges for the health consumers as well as third party developers because it limits their application development options.[23]

Despite some of the drawback and existing challenges, the number of heath technology wearables and their applications keeps growing. Therefore, another question to ask is whether these gadgets are merely a trend or do they have real staying power and the ability to disrupt healthcare and create a substantial impact?

Where to from Here?

We, the authors of this paper, firmly believe that the future of wearables lies in a firm understanding of their existing limitations and challenges, and uncovering ways to overcome them. One of the very first questions that the manufacturers of health technology wearables should ask themselves is whether they would like to position their device as a consumer device for health and wellness, or as a true medical-grade product validated for use in the clinical setting and approved for clinical decision-making.

If certain health technology wearables are created and marketed as a health and wellness device used to track the number of steps and calories burnt, the manufacturers should continue on working with the users to build better and more user-friendly interfaces and desirable functionality. Given that smartwatches will reportedly replace fitness bands as the most purchased wristwear by 2017[24], the current wearables’ manufacturers along with other industry players might want to reassess their strategy and rethink their offerings in the near future. Moreover, such manufacturers might want to consider engaging with the consumers by proactively supporting them in managing health and wellness through utilisation of both ‘push’ and ‘pull’ methods of information delivery. Accurateness of measurements, privacy and security have to be of high priority as well, as discussed earlier in this paper. There should be emphasis on value, i.e. identifying what functionality matters to the customers most, and high performance, e.g. there should be no noticeable delays in the device’s performance. The manufacturers might also consider a better adoption of outcome-based models and algorithms that will enable users to state their ultimate goals (e.g. their fitness goals) so that the device can work with the user towards achieving such goals, as well as remind the user to take necessary actions on a day-to-day basis. This functionality can be particularly appreciated by the users who share data collected by their wearables, with their insurance companies in order to get future discounts or better premiums.[25]

However, if manufacturers decide to create a health technology wearable that can be used as a medical device in a clinical setting, the number of challenges to overcome grows exponentially. There is no doubt that there is a huge market for such devices, and they are much needed in this day and age. Most medical institutions and insurance providers might be willing to pay significant amounts of money for such wearables; various venture capitalist firms might consider investing large sums in such project, but most importantly, such devices have a real opportunity to make a huge difference in people’s lives. However, every one of such manufacturers will have a few hurdles to overcome before the devices can successfully reach their targeted patient base:

1. Specific health technology wearables developed specifically for the physicians and other medical professionals require an extensive collaboration between medical personnel and IT teams. Such devices will have to have the ability to deliver exactly what is expected of them, provide accurate data and be endorsed by the clinicians;

2. Safety is another serious matter that is taken to the whole new level once a wearable gets classified as a medical device, as it would have to undergo the Food and Drug Administration, USA (or similar organisations in other countries) regulatory scrutiny to ensure it is safe to use;[26]

3. Privacy becomes a major challenge that has to be addressed. For instance, in the USA any data that comes from patient-bought wearables is not required to be protected under HIPAA, but hospital-assigned devices that contain protected health information must be HIPAA-compliant.[27] Therefore, such device manufacturers have to make sure that their wearables are HIPAA compliant, or compliant with other Data Protection Acts (e.g. in Canada, UK, etc.).

Amongst the three challenges listed above, privacy is one of the most complex and crucial ones. Case in point – when the creators of GoogleGlass realised that their device could be recalibrated and used in a clinical setting, e.g. to audio or video tape clinicians’ conversations with their patients and transcribe them directly into the hospitals’ electronic health records systems, or to assist the surgeons with certain real-time time data during complicated procedures, they faced the HIPAA compliance issue that is yet to be resolved.[28]

In conclusion, there is no doubt that health technology wearables have a potential to enrich lives of and help millions of people globally. In the technology enabled world where health consumers are getting empowered and willing to take responsibility for their lifestyle choices, the shift from intervention to prevention when it comes to healthcare is undeniable. There is little argument that increased interconnectedness and enhanced technological knowledge of the general population facilitates a slow transformation of patient care from episodic visits into continuous support of patient wellness and wellbeing, and health technology wearables certainly have a huge role to play in this powerful transition.

References:
[1] https://en.wikipedia.org/wiki/Wearable_technology
[2]Tabitha Tonsaker, Gillian Bartlett and Cvetan Trpkov (2014) “Health information on the Internet: Gold mine or minefield?”, Canadian Family Physician; 60(5): 407-408.
[3] Carmen Wong, Christopher Harrison, Helena Britt and Joan Henderson (2014) “Patient use of the internet for health information”, Australian Family Physician; 43(12): 875-877.
[4] https://www.accenture.com/us-en/insight-predictable-disruption-digital-health
[5] https://www.accenture.com/us-en/insight-research-shows-patients-united-states-want-heavy
[6] https://www.accenture.com/us-en/insight-research-shows-patients-united-states-want-heavy
[7] http://www.juniperresearch.com/press/press-releases/smart-wearables-market-to-generate-$53bn-hardware
[8] https://www.strategyanalytics.com/strategy-analytics/news/strategy-analytics-press-releases/strategy-analytics-press-release/2016/06/22/strategy-analytics-wearables-revenues-projected-to-grow-31-percent-in-2016-as-smartwatches-lead-value-share
[9] https://www.accenture.com/us-en/insight-predictable-disruption-digital-health
[10] Mitesh S. Patel; David A. Asch and Kevin G. Volpp (2015) “Wearable Devices as Facilitators, Not Drivers, of Health Behavior Change”, JAMA; 313 (5): 459-460
[11] Research.technologyadvice.com/wearable-technology-study
[12] Garvin, David A., and Michael A. Roberto. “Change Through Persuasion.” Harvard Business Review 83, no. 2 (February 2005): 104–112.
[13] Mitesh S. Patel; David A. Asch and Kevin G. Volpp (2015) “Wearable Devices as Facilitators, Not Drivers, of Health Behavior Change”, JAMA ;313(5):459-460.
[14] http://alifeofactive.com/
[15] http://health.asiaone.com/health/body-mind/3-ways-busy-singaporeans-can-reduce-their-chances-getting-diabetes
[16] Tikkanen O, Haakana P, Pesola AJ, et al. Muscle Activity and Inactivity Periods during Normal Daily Life. Johannsen D, ed. PLoS ONE. 2013;8(1):e52228. doi:10.1371/journal.pone.0052228.
[17] Ryan, Richard M., and Edward L. Deci (2000) “Intrinsic and extrinsic motivations: Classic definitions and new directions.” Contemporary educational psychology 25.1: 54-67.
[18] Gneezy, U., Meier, S., & Ray-Biel, P. (2011). When and Why Incentives (Don’t) Work to Modify Behavior. Journal of Economic Perspectives, 25(4), 191-210.)
[19] http://www.forbes.com/sites/reenitadas/2016/01/07/the-future-of-wearables-can-companies-avoid-the-pitfalls-threatening-healthcare-wearables
[20] http://www.nytimes.com/2015/03/19/style/could-wearable-computers-be-as-harmful-as-cigarettes.html
[21] http://searchhealthit.techtarget.com/essentialguide/Wearable-health-technology-in-medical-and-consumer-arenas
[22] http://mobihealthnews.com/39382/global-survey-finds-8-percent-adoption-of-fitness-wearables
[23] http://forbes.com/sites/reenitadas/2016/01/07/the-future-of-wearables-can-companies-avoid-the-pitfalls-threatening-healthcare-wearables
[24] http://www.juniperresearch.com/press/press-releases/smart-wearables-market-to-generate-$53bn-hardware
[25] http://www.asiainsurancereview.com/Magazine/ReadMagazineArticle?aid=35855
[26] http://internetofthingsagenda.techtarget.com/feature/Wearable-device-heart-rate-monitoring-entering-the-consumer-mainstream
[27] http://searchhealthit.techtarget.com/essentialguide/Wearable-health-technology-in-medical-and-consumer-arenas
[28] http://hitconsultant.net/2016/01/19/future-wearables-healthcare/

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