Positive Health in the Co-design of a Wearable Heart Rate Variability Monitor

Introduction: Technology-driven wellness tools, many taking the form of mobile applications or wearable monitors, are becoming more prevalent and have the capabilities to address the needs of a wide range of people. However, health technologies often optimally support only the communities that reflect the demographics of the team of developers and are therefore not designed to address the unique needs of vulnerable communities [1,2]. Particularly regarding the use of wearable devices and connected apps, there is a lack of studies that include community engagement, focus on vulnerable populations, or are present in environments with limited resources [3]. Adolescents are one community with a lack of quality apps that target their wellbeing needs [4]. In Irish secondary school student populations, barriers to thriving have been observed, with increasing levels of loneliness and stress, and decreasing general wellbeing [5]. Digital tools provide accessible and scalable resources to address these barriers, and students should be included in the design of new interventions and tools developed specifically to support their wellbeing goals. Co-design sessions are one way to encourage participant-driven systems in which participants are empowered to have an active role in the development of systems that they will use [6]. During these sessions, participants engaged in a series of conversations and activities to inform the design and goals of the system.

This presentation aims to outline the insights gained from students during the co-design phase of a study aimed at creating positive health, evidence-based tools to encourage the flourishing of secondary school students in Ireland.


Materials and Methods: This study used a mixed methods approach to guide the co-design of a mobile health app and wearable device. The first stage in this study was to assess the wellbeing of secondary students (year 4; transition year) through an online, anonymous survey sent to parents (legal guardians), teachers, and students at two secondary schools. This survey focused on stress management, sleep, study habits, relationships, and health technologies. The second stage of this project included a series of four co-design sessions with the students at each of the schools. These sessions were based on previous frameworks for co-design with the addition of activities that focused on how the co-designed technology can promote student flourishing [6]. This included focus group discussions and workshop activities to reflect on students’ wellbeing goals and allow them to make decisions about features of the wearable system that would address these goals. The wearable device and mobile application are being developed based on the feedback from these sessions. The third stage in the co-development process will include iterative testing and feedback from students.


Results, Conclusions, and Discussions: In the responses to the wellbeing survey from the two classes (n=60), 92% of students wanted additional support in learning how to manage stress while 81% wanted support with study habits and 71% with sleep. Less than 50% of students at either school report getting the recommended hours of sleep for adolescents (8-10 hours) over 5 days a week. In an open-response question about ways stress influences students’ health, the most common answer in each school mentioned their sleep. Additionally, 83% of students said they were interested in using a wearable device to help them manage their wellbeing goals. In the co-design sessions, the main areas for support that students identified included stress management, sleep, time management, and digital wellbeing. The survey and the co-design sessions have guided the development of the wearable system that will be tested by the students for additional feedback in September 2023.

Eventually, this work aims to build a framework, based on this study, that is rooted in positive health science and participatory design for the development of wellbeing focused wearables and applications. This framework will have the potential to encourage the use of these co-design practices for the vast applications of wearable systems to support the unique needs of participants.


Acknowledgements: I'd like to acknowledge each of the secondary schools that participated in this research so far. I'd also like to acknowledge Pádraic and Elaine for continued supervision on this project, and Jennifer for the support to run the co-designs.

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[3] Raeside, R. & Halim, Nicole & Partridge, Stephanie & Redfern, Julie. (2020). 713 A Review of Mobile Apps for Prevention of Chronic Disease in Adolescents Across a Range of Behaviours. Heart, Lung and Circulation. 29. S357. 10.1016/j.hlc.2020.09.720.

[4] Al-Dhahir I, Reijnders T, Faber J, et al. The Barriers and Facilitators of eHealth-Based Lifestyle Intervention Programs for People With a Low Socioeconomic Status: Scoping Review. J Med Internet Res 2022;24(8):e34229 DOI: 10.2196/34229

[5] Rosas LG, Lv N, Xiao L, et al. Effect of a Culturally Adapted Behavioral Intervention for Latino Adults on Weight Loss Over 2 Years: A Randomized Clinical Trial. JAMA Netw Open. 2020;3(12):e2027744. doi:10.1001/jamanetworkopen.2020.27744

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