In this study, we analyzed responses from 948 caregivers of our National Caregiver Health Survey to assess the relationship between caregiver characteristics and use of three types of digital health technology: fitness tracker, smartwatch, and mobile apps. Prior studies have examined use of fitness trackers, smartwatches, and number of mobile apps among other populations, including the general US public, caregivers of children with cancer, older adults with dementia, and caregivers of older adults [17, 33–36]. However, to our knowledge, these variables (fitness tracker, smartwatches and number of apps) have not been explored in the context of caregivers of patients undergoing HCT. With the rapid insurgence of telehealth, propelled by the current COVID-19 pandemic, having a better understanding of health technology is important for future study design [17, 33, 36, 37].
Herein, two caregiver characteristics emerged in the use of digital health technology: i) caregiver relationship with care recipient and ii) care burden (i.e., hours per week spent caregiving and allogeneic vs. autologous transplant type). Interestingly, compared with parents caregiving for their children as the referent group, spousal caregivers were the least likely group to use a fitness tracker, smartwatch, or mobile apps. It is possible that the other cohorts of caregivers (e.g., parent caregivers, adult child caregivers, other caregivers) were more likely to have younger aged children, often referred to as the “sandwich generation,” based on having dual responsibilities to both a younger and older generation. Further, despite adjusting for coping styles in order to account for possible individual differences, we found no evidence of a relationship between any specific coping approach and use of fitness-related technology. Thus, our study contrasts with prior findings that problem-solving coping was associated with caregiver physical activity .
Our data suggest relatively high adoption of digital health technology (e.g., fitness trackers, smartwatches, mobile apps) among HCT caregivers in this national sample. Caregiver use of fitness trackers in our sample (40–65%) was slightly higher compared with digital health technology use among the general adult public, as reported in other studies (20–30%) [17, 38]. There may be possible explanations for higher use of digital health technology (e.g., fitness tracker, smartwatches, mobile apps) among caregivers . Considerable literature has established the time factor associated with caregiver burden as well as the impact on caregivers’ capacity to care for their own health (self-care) [39–41]. It is possible that these technologies enable caregivers to monitor their own health in an accessible way and provide a means to support their well-being. In the current climate of extended use of telehealth during the pandemic, incorporating digital health technology, such as non-invasive, consumer-grade wearables, might give providers a platform for real-time monitoring in the outpatient setting of both caregivers and patients. Given that almost all participants in our sample own a smartphone, providers and health systems could create and implement novel ways to reach a large number of caregivers through mobile apps.
Findings from this study also provide us with a greater understanding of the needs of HCT caregivers who are experiencing greater burden associated with their responsibilities (i.e., differential circumstances based on caregiver type – spouse, parent vs. adult child) and with their care recipient’s needs (i.e., allogeneic vs autologous transplant). Indeed, our study suggests that digital health technology may play a role in supporting family caregivers. Future research should examine the circumstances under which caregivers use different types of digital health technology, the frequency of this use, and caregiver outcomes such as their ability to meet their own lifestyle goals while supporting a care recipient. Further, clinical trials could incorporate consumer technologies to collect physiological and/or health behavior data. Most importantly, interventions to support caregivers should be tailored to “at risk” subgroups based on caregiver burden (i.e., time spent caregiving, donor type) or relationship between caregiver and care recipient. New interventions may with confidence incorporate a fitness tracker for caregivers supporting their parents. Future research should identify the types of technologies that spousal caregivers are more likely to use, in addition to potential barriers to their use before attempts are made to tailor interventions using fitness technologies for this segment of caregivers.
There are some limitations to our study. First, our study was conducted at a cross-sectional time point in each of the caregiver’s transplant journey. Thus, findings may not be generalizable across all caregivers of patients undergoing HCT. Our study may reflect some unavoidable selection bias, such as high proficiency in digital health technology use among participants. Further, respondents may have been able to participate in the study because they may have been receiving caregiving support, thereby enabling them to do so, or they may not have been experiencing as much burden associated with their caregiving responsibilities. The sample was also highly educated and relatively affluent.