Does pairing wearable devices with health coaches change lifestyle habits?

 A team from Alexandra Hospital (AH) is testing if using wearable fitness devices alone can change lifestyle habits, or if there is a need for a human health coach to nudge people regularly.

The pilot programme, called Activation, is a randomised controlled trial of both a wearable technology-based intervention and the presence of a digital health coach for increasing physical activity and reducing sedentary behaviour.

Gastroenterologist Alexander Yip, who is leading this research initiative, said its focus is on preventive health, or “slowing down the progression of chronic diseases such as diabetes and hypertension, and reducing healthcare expenditure”.

Activation, which was started in August 2024, aims to recruit 1,700 participants aged between 21 and 75 who are at risk of developing hypertension, diabetes, obesity, and hyperlipidaemia or high cholesterol.

They will be randomly assigned to three groups – 700 participants will receive only a smartwatch each, 500 will get a smartwatch and a dashboard with a nudging system downloaded onto their smartphones, and the remaining 500 will get a smartwatch and a health coach who assists them digitally via the dashboard and WhatsApp.

The ConnectedLife dashboard is designed by a Singapore-based health tech company of the same name. It partners Google’s Fitbit to create wearable-based solutions for wellness, condition management and other health-focused applications.

“Healthcare redesign is a fundamental part of the hospital’s redevelopment, and we look at how we can use technology to enable new kinds of care transformations and workflows or job redesign,” said Dr Yip, who heads the healthcare redesign department at AH. “(This project) is not strictly research because we have to be very practical and pragmatic about our approaches.”

Participants will be monitored for a year, with follow-up sessions at the three-, six-, nine- and 12-month marks. At the end of the study, the data will be analysed and published so that there is better understanding of the “intrinsic motivations, personalities and readiness for change”, said Dr Yip.

“Participants get to keep the watch,” he added.

The Activation initiative is financed by the MOH Health Innovation Fund under the Ministry of Health. The ministry declined to comment on how much of the fund was allocated to the study.

The new initiative supports the broader Healthier SG strategy, a national game plan on preventive health.

Healthier SG gets people to be more connected with their primary care physicians who will draw up a health development plan, according to Dr Yip. “It is made up of lifestyle adjustments, vaccinations, and regular health screening and a regular follow-up,” he noted.

“In six months, when you return for a follow-up, things do not change because there are no lifestyle adjustments on our part,” said Dr Yip. “The primary care physicians cannot leave us alone. Yet, it is too manpower intensive to go out and hand-hold everyone.”

He added: “With technology, doctors will be able to digitally understand the parameters of our lives and... reach out to us in a low physical touch manner, which is what the healthcare system is today.”

In the past, users of wearable devices – ranging from smartwatches to wristbands – made positive health changes only in the short term and motivation quickly waned, with many no longer wearing them after six months.

In 2015, Singapore initiated the world’s first population-level fitness tracker-based physical activity initiative to get Singaporeans moving. The premise was simple: the more steps taken, the more rewards earned. However, there were anecdotes of people cheating by putting the trackers in plastic bags and shaking them, or tying them to their pet dogs, in order to accumulate enough steps to earn supermarket vouchers.

Dr Yip said: “The basic observation is that many who are wearing a smartwatch do not actually respond to the notifications. That was when we asked ourselves whether it was just about nudges.

“There were studies that told us that nudges do work, but only for some people and not others. This is where we strongly believe that... a human component is required.”

The task of the health coaches is to monitor the participants assigned to them and nudge them by offering advice. Currently, AH has hired three health coaches for the study.

“Coaching is a fundamental part of essentially motivating (people) and triggering those kinds of health behaviour changes that lead to self-directed care, but you cannot have a third of the population (nudging) the rest. So this is where the study will help identify the different personas,” said Dr Yip.

One of the health coaches is Ms Carol Yap, a former nurse with 28 years of experience.

Ms Yap said: “The nudges are sent at an appropriate time, such as before lunch for food suggestions, and only one nudge is sent. They come as suggestions, not as orders.

“We also limit the nudges we send in a day as the goal is to make the person think about his or her choices, and not dictate what the person does. We will check in once a month so we do get feedback from the participants.”

One person who is ready to make changes to her lifestyle is logistics executive Wahidah Abdul Rahim.

The 61-year-old, who lost her husband to diabetes, wants to improve her health so that she can watch her grandson grow up.

“I was big to begin with, and because I was not careful with my health, I developed diabetes and high cholesterol. I also get breathless and sweat a lot whenever I do brisk walking. I believe that by signing up for this study, I will be pushed to leading a healthier lifestyle,” she said.

Madam Wahidah, who signed up at AH on Nov 7, will know which group she is assigned to when she collects her smartwatch at Jurong Polyclinic on Nov 30.

As at Nov 9, the team had recruited 387 participants. It hopes to complete recruitment by February 2025.

Those who are interested can sign up at AH or the seven polyclinics under the National University Health System (NUHS).

Participants must have medical records of any chronic conditions with AH, the seven polyclinics or general practitioners under the NUHS Primary Care Network.

This article was originally published in The Straits Times.