Background/Purpose: Using wearables to self-monitor physical activity is a promising approach to support self-management among persons with arthritis. Evidence indicates, from perspectives of persons with arthritis, using a wearable influences interaction with health professionals in positive and negative ways. Questions remain about benefits and downsides that may be experienced by persons with arthritis in relationships with themselves (i.e., self-perception) and others, if using a wearable in self-management. Relational ethics is a suitable conceptual lens to explore positives or negatives encountered in these relationships. Our aim was to use this ethics lens to better understand how persons with rheumatoid arthritis (RA) experience their use of a wearable as part of a physical activity counselling intervention study involving a physiotherapist (PT).

Methods: A constructivist grounded theory design and a relational ethics lens guided data collection and analysis. A sample of persons with RA took part in an initial and follow-up interview following participation in an 8-week randomized controlled trial. Participants used a Fitbit-Flex-2 paired with a new web-based application to self-monitor physical activity, received education and counselling from a study PT and received 4 biweekly calls from the PT. We took a systematic approach of coding transcripts, and forming concepts and key categories to construct a conceptual framework underpinned by concepts of relational ethics.

Results: Initial interviews took place with 14 participants (12 female; 2 male) aged 29-71 years. Of these, 11 took part in a follow-up interview. A conceptual framework was developed to illustrate key categories identified in analysis. These categories describe positive and negative influences of using a wearable with the PT on how participants constructed a valued moral identity: 1) Participants expressed how being active intertwined with moral values placed on self-control within cultural norms in which they lived. For some, using a wearable helped to “do something right” by reaching step goals or sitting less. Some, however, felt ambivalent (feeling both justified and at fault) when they could not reach a physical activity goal; 2) Participants described how their distrust of wearable data raised moral tensions in their relationship with the PT, which had implications for how mutual trustworthiness was negotiated; 3) Participants conveyed being active as a means of preserving or regaining respect for themselves as an independent and productive person. Some described how interpreting wearable data with the PT helped them to affirm this valued sense of self.

Conclusion: This study contributes a situated relational ethics conceptual framework grounded in empirical evidence to sparse literature on how persons with arthritis experience their use of a physical activity wearable positively or negatively. It brings to light salient ethical issues pertaining to autonomy, mutual trust, and respect for further study in the context of everyday self-management. It is a key step to informing how to incorporate wearable-enabled programs that support physical activity participation in ways that are ethically aware.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/experiences-using-wearable-technology-by-persons-with-rheumatoid-arthritis-participating-in-a-physical-activity-counselling-intervention-study-a-relational-ethics-analysis/