Digital tools like motivational text messages that try to nudge people to do more physical activity aren’t effective for poor people, according to a new meta-analysis. In one of the most comprehensive efforts to tease apart the impact of behavioral change programs on people with different income levels, the study authors showed that apps and wearables only helped bump physical activity levels for people with high socioeconomic status.
The finding bolsters arguments that digital health interventions can end up widening health gaps between groups and that they’re designed for people with more money and more education.
The new analysis looked at 19 studies that tested whether things like text messages, web-based prompts, or wearable step trackers could nudge people to increase their levels of physical activity. Across all of the studies, the behavioral tools were not effective for people with low socioeconomic status, even when they worked well for wealthier people. That pattern held across every type of approach tested.
Digital health tools are often described as ways to shrink health inequality because they can package useful health interventions into cheaper, easy-to-distribute forms. More and more people are gaining access to the tools and technologies (like phones and wearable devices) that deploy them. This study, though, indicates that even when people in high- and low-income brackets both have access to digital health tools, those tools don’t necessarily narrow health gaps.
The study authors point to a few reasons why that might be the case. People of lower socioeconomic status tend to have lower electronic health literacy, meaning that they are less able to use technology to improve their health. They may not be as able to navigate the physical activity tools or apply them as effectively. They may also not have as much time as wealthier consumers to do the types of things the digital tools suggest, like going for more walks or exercising more frequently.
This analysis looked specifically at digital tools that aim to boost physical activity, but the study authors wrote that it’s reasonable to assume that there would be the same pattern in programs that target other types of health behaviors. As health becomes more and more digitized — with the adoption of electronic health records, introduction of more systems that track patients’ at home, and a shift towards telemedicine — figuring out how technological change exacerbates inequality is even more critical, the authors say.
But even if the problem appears to be industry-wide, it might be difficult to convince the people developing digital health tools to figure out ways to ensure that their products benefit lower-income groups, the study authors wrote. The goal for most consumer-focused digital health companies is to make money, and their focus is often on the customers mostly like to buy their products. “The onus will likely be on researchers and public health advocates to address the discrepancy,” the authors wrote.
