Research ArticleContinued use of wearable fitness technology: A value co-creation perspective
Introduction
The wearable fitness tracker (WFT) has gained academic attention due to its ability to track physical activity in real time and engage individuals in tracking their performance to optimize long-term health behaviours. In recent years, the development of the WFT and related services has been afforded attention in both theory and practice, and the service delivery of wearable devices is an emerging topic in healthcare service research (Danaher & Gallan, 2016). WFT sales have increased in recent years and are expected to continue rising by 16.5 % annually until 2023 (Prescient & Strategic Intelligence, 2018).
However, despite large-scale adoption, the WFT has faced a critical challenge in sustainable usage; in response, research on the abandonment of personal quantification has increased (Attig & Franke, 2020). Users tend to discontinue using wearables in less than six months with an abandonment rate of approximately 30 % (Gartner, 2016). One possible explanation for this rate of abandonment is that the device is useful but fails to have a meaningful impact on users’ behaviours and habits; in other words, the device is an object that provides data but does not inspire action. To ensure sustainable usage, a WFT needs more compelling value propositions. Determining an effective engagement process for WFT users that motivates them to continue using the device is essential in generating sustained value (Ledger, 2014). Therefore, rather than focusing on adoption alone, WFT designers need to take into consideration the value propositions that the device should provide in order to inspire users to continue using it.
Newer WFT devices may work with cloud services, third-party apps, and mobile devices to store data gathered from the device and simultaneously enable users to interact with other users and service providers integrated with the device. The provision of this additional value through the integration of several actors forms a service system. Service-Dominant Logic (S-DL) posits that a service system is a dynamic configuration of resources, including people, information, and technology, connected by value propositions (Vargo, Maglio, & Akaka, 2008). According to S-DL, value reconceptualization emphasizes multi-actor interactions and value co-creation (Chandler & Vargo, 2011) because each actor is connected to other actors, which provides a context for actors to experience value (Lusch & Nambisan, 2015). Perceived and co-created value offer additional benefits that influence users’ evaluation of devices. It is beneficial to adopt the concept of a service system to understand how a user, WFT device, and associated services interact and affect continued use intention from the perspective of value co-creation.
In service systems, the S-DL posits that, rather than the physical form of the device, the value enclosed in the device is what determines service sustainability (Vargo & Lusch, 2008). Value is determined not only by the features that the device offers but also by the benefits acknowledged by the user (Vargo & Lusch, 2016). Under the system view, created values might undergo changes of form during the interaction process, which could also be different for each individual user (Figueiredo & Scaraboto, 2016). Hence, in this study, we focus on the value outcome resulting from the value co-creation between engaged actors - users’ continued use intention.
Value co-creation is at the core of S-DL, which emphasizes actors' interactions and resource sharing. During interactions and resource sharing, users are enabled, activated, and more willing to co-create value with a device. The value of a WFT is defined by individuals based on their positive experiences in health enhancement (Joiner & Lusch, 2016). This concept is in line with the concepts of “patient engagement” and the “digitally engaged patient” in healthcare, which both encourage patients to be proactive in self-care by using technology-assisted health services (Lupton, 2013). Value co-creation emphasizes actors’ volition to engage in resource sharing. Therefore, this study places the user as the focal actor.
This paper argues that WFT usage is an inseparable component of the service system. WFT usage is key to maintaining continuous actor-to-actor (A2A) interactions beyond the dyadic user-device relationship. WFT devices interact with the user and simultaneously connect with other actors in the service system to co-create value; the WFT thus serves as a mediating actor (actant), and the focal actor is the user.
To investigate A2A interactions in terms of users’ centricity in value co-creation, this study highlights two interactions: user-health professional interactions (human-to-human) and user-device interactions (human-to-technology). Focusing on these two types of interactions helps to explain the interactions between actors playing different roles in social systems. User-to-user interactions, another type of human-to-human interaction, are not considered in this study since user-to-user interactions refer to interactions between actors playing the same role in social systems. Rather, actors with different roles are emphasized in this study since involvement of actors playing different roles can enrich value co-creation further due to the greater variety of resources available to the user (Pinho et al., 2014). Furthermore, the social structures and forces inherent in each role have implications for value co-creation and resource integration in service systems (Edvardsson, Tronvoll, & Gruber, 2011). User-device engagement can be encouraged by providing options that enable a user to act based on the recommendations given by the device. This study also investigates the role of expert actors within technology-assisted health management. For example, the study considers the role of healthcare professionals, whose feedback is considered by users in the resource exchange process to be more helpful than automated feedback.
This study also examines the roles of two services in value-co-creation in the WFT service system: choice and the involvement of healthcare professionals. Recent literature has found that one determinant of the success of a self-tracking device is whether the device treats users as people responsible for their own health decisions (Cosley, Churchill, Forlizzi, & Munson, 2017). Cosley et al. (2017) argue that internally triggered behaviour, which entails the user becoming self-reliant, can sustain motivation over time. Agency is part of what it means to be human; humans should be able to determine independently which course of action to take (Bandura, 1999). In user-device relationships, users, as the active agents, have the ability to assess their own needs and make choices based on the information offered by the device. For instance, users who read information on calories burnt can determine whether it is necessary for them to do additional exercise or change their diet; those opportunities to make choices are key to activating users’ agency in the value co-creation process.
Enabling engagement with third-party actors is another important service. WFT devices provide value by either using their own resources (built-in algorithms) to generate feedback or involving other third-party actors such as doctors, physical trainers, or dietitians to offer greater value to the user. WFT users may be individuals who require additional support to maintain their physical condition. Although receiving automated reports from the WFT device is a form of support, users may perceive higher value when there is additional feedback from human actors rather than simple automated and generic feedback. A system that involves third-party actors may encourage profound resource sharing between actors and help users to determine follow-up actions. Furthermore, human feedback has been proven to encourage and motivate users to keep using a certain information system (Hassan, Dias, & Hamari, 2019).
To study interactions within the service system, this research examines the moderating factors of self-efficacy in health management and healthcare system satisfaction. In the assessment of service system performance, the study considers internal and external factors perceived by the user. On the one hand, users’ internal perceptions in the form of self-efficacy in health management can be a proxy for evaluating users’ internal capability to maintain self-health. On the other hand, users may also be affected by their perceptions of external support. The WFT service system is a subsystem of the broader health system which includes hospitals, insurance providers, and other health facilities. Value perceptions and the evaluations of the macro healthcare service system may affect users’ self-reliance. This study examines how the effects of choice and the involvement of healthcare professionals are moderated by users’ perceived values of the broader health system and self-efficacy in health management.
This study offers insights into WFT devices by adopting a service system perspective and treating its users as active agents that need to maintain their own agency with the device in the value co-creation process for managing their own health. This research uses a randomized experiment with scenario-based surveys to explore whether a WFT, from the perspective of human agency, can sustain usage by offering choices and the involvement of healthcare professionals. This research also aims to understand the mechanisms of the process of the WFT service system by examining the moderating roles of macro health systems, including the self-efficacy of health management (internal perceptions) and healthcare system satisfaction (external support).
This research contributes to existing literature on the continued use of wearable devices from both theoretical and practical perspectives. It has been acknowledged that an acceptance-discontinuance phenomenon exists in the WFT market. This study adopted the perspective of value co-creation in service systems in terms of the sustained use of technology-enabled services, which has not been the focus of previous empirical work. This focus allows the study to expand the view on user-device interactions in health technology beyond traditional dyadic relationships into a network of actors and beyond the user-device system to a broader health service system. This study also provides practical suggestions for service providers to offer effective features that encourage WFT users’ prolonged usage.
Section snippets
Continued use of wearable devices
In mainstream literature on IT/IS adoption, continuance refers to a form of post-adoption behaviour. Expectation-confirmation theory discusses an IS user’s intention to continue using an IS based on post-acceptance satisfaction (Storbacka, Brodie, Böhmann, Maglio, & Nenonen, 2016). This theory is also widely used to explain the continued use of technology applications. In more specific contexts, such as health technology, empirical research has used the Technology Acceptance Model (TAM) and its
Hypothesis development
Fig. 1 presents this paper’s conceptual model. This research investigates two experimental factors embedded in WFT service: choice and the involvement of healthcare professionals. The WFT acts as a mediating value proposing actor that integrates different actors to form the WFT service system. This research also incorporates two moderators: self-efficacy of health management to reflect on how users enhance their ability to maintain their own health, and satisfaction with healthcare systems to
Research design
The hypotheses were tested by conducting a scenario-based randomised experiment with a 2 (options versus no options) x 2 (dietitian versus no dietitian) between-subject design (Table 2). Each of the groups was exposed to a scenario of WFT device use with options and dietitian involvement being turned on or off.
The experiment was conducted in an online environment. The procedure began with a pre-test survey that collected respondents’ demographic information (age, gender, education, insurance
Constructs and manipulation checks
All items were included in the analysis because they had sufficiently high loadings (higher than 0.7). Continued use intention (CR = 0.939, AVE = 0.793, Cronbach’s Alpha = 0.913), self-efficacy in maintaining health (CR = 0.916, AVE = 0.785, Cronbach’s Alpha = 0.864), and healthcare system satisfaction (CR = 0.87, AVE = 0.626, Cronbach’s Alpha = 0.805) were found to be above the threshold, which indicated high validity and reliability.
To conduct a manipulation check, respondents were able to
Discussion
By adopting the perspective of the service system, this study designed a scenario-based experiment to study the effects of a WFT service that offers choice and dietitian involvement on continued use of WFT.
The results prompt several important discussions. Firstly, the study found that dietitians had a strong, positive effect. The presence of a dietitian can directly improve continued use intentions and provide the effect of choice. The presence of the dietitian can overturn the negative effect
Conclusion
This paper has highlighted the importance of examining actor-to-actor interactions in a service system and users’ agency in shaping health behaviours when using WFT devices. This study contributes to the literature by providing empirical evidence in value co-creation practices that addresses squarely the A2A interactions, both human-to-human and human-to-technology interactions. The study found that the involvement of healthcare professionals was an important value co-creation enabling feature
Authorship statement
All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript.
List of Authors: N.A. Windasari, F.R. Lin, Y.C. Kato-Lin
N.A Windasari developed the conceptual framework, performed the data collection and analysis. F.R Lin and Y.C. Kato-Lin supervised the work and writing. All
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