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Journal ArticleDOI

Pedometers, the frustrating motivators: a qualitative investigation of users' experiences of the Yamax SW-200 among people with multiple sclerosis.

TL;DR: The Yamax SW-200 Digi-walker raised awareness and enhanced participant motivation to engage in physical activity, and accuracy and usability concerns highlighted warrant consideration in the selection of this pedometer within a population with multiple sclerosis.
Abstract: Purpose: Self-monitoring may represent a mechanism to enhance physical activity among people with multiple sclerosis. To optimise activity monitoring as a behavioural tool to increase physical activity, user experience must be understood. This study evaluated user experience of the Yamax SW-200 Digi-walker pedometer in a group of people with MS.Methods: Semi-structured interviews were conducted with 15 adults who participated in a 12-week pedometer-supported behavioural change intervention, the iStep-MS trial. Interviews were audio-recorded and transcribed verbatim. Data were analysed using the Framework Method.Results: An overarching theme Pedometers, the frustrating motivators captures the complex and often contradictory experience of the pedometer. Sub-themes include: Increasing activity awareness, which describes the pedometer's utility in raising activity consciousness; Numeric motivation provides insight into dual motivating and demotivating experiences of using an objective feedback device; (Un) usability focuses on practical concerns encountered in the day-to-day use of the monitor.Conclusion: The Yamax SW-200 Digi-walker raised awareness and enhanced participant motivation to engage in physical activity. Accuracy and usability concerns highlighted warrant consideration in the selection of this pedometer within a population with multiple sclerosis. Trial registration: Changing physical activity behaviour in people with MS: the iStep-MS trial; ISRCTN15343862; https://doi.org/10.1186/ISRCTN15343862Implications for rehabilitationUse of self-monitoring tools such as pedometers can enhance physical activity awareness.Objective, numeric step count feedback is an effective motivational tool for physical activity.Accuracy and usability concerns may limit the value of the Yamax SW-200 Digiwalker for people with MS.Identification of individualised, reliable, usable and acceptable tools is important to ensure engagement with self-monitoring.

Summary (2 min read)

Introduction

  • People with multiple sclerosis (MS) engage in substantially lower levels of physical activity compared with the general population and other groups with chronic illness [1].
  • The objective feedback they provide motivates physical activity engagement in clinical [12] and non-clinical populations [13] with demonstrable increases in physical activity [14, 15].
  • Among people with MS, promising impacts on physical activity have been shown in theory-based interventions supported by a pedometer [16, 17].
  • While these studies indicate the utility of pedometers to promote physical activity most studies are short term and the user experience is under-examined [16, 17].
  • This complex intervention was evaluated by feasibility randomised controlled trial and parallel embedded process evaluation [22].

Trial design and setting

  • Comprehensive details of the design and outcomes of the iStep-MS trial are described elsewhere [21, 24].
  • Participants were requested to wear the pedometer during waking hours and record their daily step count in their handbook for a minimum of one week in between each of the four intervention sessions.
  • Participants A sampling frame was created and participants (n=15) were purposively sampled based on features that the literature suggests are relevant to engagement with physical activity and experiences of living with MS which the authors believed could potentially influence the experience of the programme [28].
  • Ethical approval was obtained from the College of Health and Life Sciences Research Ethics Committee (REC) in Brunel University London (6181-NHS-Apr/2017-7016-2).
  • The five iterative stages of the Framework method (familiarisation; thematic framework identification; indexing; charting; mapping and interpretation) were followed in the examination of the data presented [36, 37].

Results

  • The desired sample was achieved demonstrating a range in all variables of interest.
  • Table 1 Participant demographic and clinical data.
  • An overarching theme Pedometers, the frustrating motivators was identified from the data, which describes the conflicting benefits and difficulties that participants experienced in using the pedometer.
  • Increasing activity awareness describes the utility of the pedometer as an awareness-raising tool and the impact of this enhanced awareness on activity modification.

Increasing activity awareness

  • Self-monitoring through continuous activity feedback on the pedometer’s digital display raised participant consciousness regarding current activity levels.
  • Step count was no longer abstract and conceptualising activity through this medium enhanced awareness of recommended daily activity requirements.
  • Because it is your day off you don’t do anything basically.
  • This enhanced awareness of activity patterns allowed participants to identify sedentary periods and mobilised them to purposefully modify their behaviour to compensate.

Numeric motivation

  • The objective numeric feedback provided by the pedometer was a powerful motivational tool for ten participants.
  • Visualizing daily step count progress and comparing it with individualized goals gave participants a focus to work towards.
  • The pedometer was described as “temperamental” with poor step measurement reliability.
  • Well, when it worked, it was great because you’d say, “Oh, oh, now tomorrow, tomorrow, I’m going to do a little bit more because I want to beat that.”.
  • While attachment to waist belts was favourable, one participant highlighted the space and compatibility considerations with other hip-based devices used in ongoing treatment (e.g. functional electrical stimulation (FES)).

It kept falling off. Because you’re going to the loo all the time, and more often if you’ve

  • Got MS, it kept falling off onto the tiled floor in the bathroom.
  • (Anna) Additional to attachment problems, five participants highlighted issues with opening and closing the pedometer.
  • Inability to easily view step count on the digital display reduced motivation as participants were unable to monitor their steps throughout the day and “check-up” on how they were progressing.
  • And even with two good hands my wife struggles every day to do it.
  • And it needs an easy flick or something just so you can look at it, glance at it during the day to see how you're doing and I couldn't do that and I've no idea what I've done so far today.

Discussion

  • To their knowledge, this is the first qualitative evaluation of the Yamax SW-200 Digi-walker, a pedometer with established reliability [26], and validity [27] for people with MS.
  • In line with previous research, wearability issues including the practicality of waist attachment to different clothing [12, 50] and security of device placement impacted on perceived ease of use and decision to persist with monitoring [50, 51].
  • While the pedometers proved unsuitable for some participants, the continued value derived from activity tracking and progress quantification through alternative measurement devices reaffirms the value attributed to objective monitoring [18] and underlines the need for accurate and acceptable measurement tools for people with MS.
  • Participants were recruited through their local MS Therapy Centre.

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Title: Pedometers, the frustrating motivators: A qualitative investigation of users’
experiences of the Yamax SW-200 among people with multiple sclerosis
Running Head: Pedometer user experience among people with MS.
Article category: Research Paper

Abstract
Purpose: Self-monitoring may represent a mechanism to enhance physical activity among people
with multiple sclerosis. To optimise activity monitoring as a behavioural tool to increase physical
activity, user experience must be understood. This study evaluated user experience of the Yamax
SW-200 Digi-walker pedometer in a group of people with MS.
Methods: Semi-structured interviews were conducted with 15 adults who participated in a 12-week
pedometer-supported behavioural change intervention, the iStep-MS trial. Interviews were audio-
recorded and transcribed verbatim. Data were analysed using the Framework Method.
Results: An overarching theme Pedometers, the frustrating motivators captures the complex and
often contradictory experience of the pedometer. Sub-themes include: Increasing activity awareness,
which describes the pedometer’s utility in raising activity consciousness; Numeric motivation
provides insight into dual motivating and demotivating experiences of using an objective feedback
device; (Un) usability focuses on practical concerns encountered in the day-to-day use of the monitor.
Conclusion: The Yamax SW-200 Digi-walker raised awareness and enhanced participant motivation to
engage in physical activity. Accuracy and usability concerns highlighted warrant consideration in the
selection of this pedometer within a population with multiple sclerosis.
Keywords: Multiple sclerosis, pedometer, activity monitoring, qualitative, physical activity, step
count, behaviour change
Trial registration: Changing physical activity behaviour in people with MS: the iStep-MS trial;
https://doi.org/10.1186/ISRCTN15343862; ISRCTN15343862

Introduction
People with multiple sclerosis (MS) engage in substantially lower levels of physical activity
compared with the general population and other groups with chronic illness [1]. Increasing
physical activity is associated with improved fatigue [2], muscular strength and aerobic capacity
[3] and health-related quality of life [2] and is a key therapeutic aim for people with MS [4].
Moreover, physical inactivity is associated with deconditioning and increased risk of secondary
health conditions including cardiovascular disease [5, 6].
Effective strategies to promote physical activity are warranted. Walking is a safe and cost-
effective method of increasing physical activity in sedentary populations [7] and is the most
common activity undertaken by people with MS [8, 9]. Supporting people with MS to be active
and engage in walking is appropriate but the optimal method to achieve this is unknown.
Interventions incorporating digital tools such as pedometers or accelerometers have gained
popularity as a mechanism to increase physical activity among people with MS [10]. Pedometers
measure step count and represent an objective and cost-effective method to quantify activity [11].
The objective feedback they provide motivates physical activity engagement in clinical [12] and
non-clinical populations [13] with demonstrable increases in physical activity [14, 15]. Among
people with MS, promising impacts on physical activity have been shown in theory-based
interventions supported by a pedometer [16, 17]. Moreover health tracking and disease
monitoring is associated with improved self-management and feelings of control [18]
demonstrating the potential of these devices and the objective feedback they provide to support
the initiation and maintenance of physical activity behaviour.
While these studies indicate the utility of pedometers to promote physical activity most studies
are short term and the user experience is under-examined [16, 17]. To maximise acceptance and

long term adoption, self-monitoring devices must be valid, reliable, and integrate easily into daily
life [19]. Exploration of how people with MS experience self-monitoring with a pedometer
through qualitative enquiry can ascertain specific pedometer-based contributions to physical
activity behaviour and lead to a better understanding of the motivational and practical device
issues of using pedometers for physical activity promotion [18-20].
The iStep-MS trial, a behaviour-change intervention supported by the Yamax SW-200 Digi-
walker pedometer, aimed to increase physical activity and reduce sedentary behaviour in people
with MS [21]. This complex intervention was evaluated by feasibility randomised controlled trial
and parallel embedded process evaluation [22]. One aim of the iStep-MS trial was to evaluate
intervention outcomes and process in order to develop an in-depth understanding of the
experience of trial participation [23]. While this covered all aspects of the trial, a dominant point
raised was the usability and effectiveness of the pedometer. Consequently, this paper specifically
draws on qualitative data from the process evaluation to describe the user experience of the
Yamax SW-200 Digi-walker during home-based ambulatory monitoring in a group of people with
MS.
Methods
Trial design and setting
Comprehensive details of the design and outcomes of the iStep-MS trial are described
elsewhere [21, 24]. Briefly, sixty people with MS were recruited from a single MS Therapy
Centre in southeast England and the MS Society UK website and randomly allocated to the
intervention or usual care group following baseline assessment in a 1:1 ratio. Participants
allocated to the usual care group received ongoing care which ranged from intensive
physiotherapy to no treatment [21].

Eligibility criteria were a self-reported diagnosis of MS, ability to independently walk at a
minimum within the home with or without a walking aid, relapse-free for the past 3 months,
and free of unstable medical conditions (e.g., unstable angina) that would make participation
in physical activity unsafe. Participants had to be able to travel to the centre, converse in
English and have sufficient cognition to complete assessments and participate in the
intervention. Exclusion criteria were pregnancy and ongoing participation in other trials. The
trial consisted of four face-to-face sessions with a physiotherapist delivered at intervals of
between 2 and 4 weeks over a three month period. Intervention sessions were supported by
a handbook and a Yamax SW-200 Digi-walker (Yamax Corporation, Tokyo, Japan)
pedometer. The Yamax SW-200 Digi-walker provides quantifiable and objective indicators
of activity through measurement of the total number of steps. It has established accuracy
[25], reliability [26], and validity [27] in people with MS. Participants were requested to
wear the pedometer during waking hours and record their daily step count in their handbook
for a minimum of one week in between each of the four intervention sessions. Recording step
count beyond this seven-day timeframe was at the discretion of the participants.
Participants
A sampling frame was created and participants (n=15) were purposively sampled based
on features that the literature suggests are relevant to engagement with physical activity and
experiences of living with MS which we believed could potentially influence the experience of
the programme [28]. Criteria included gender [29], type of MS (relapsing-remitting (RR) or any
other)[30], age (older or younger than 60) to capture participants with different life commitments
(e.g. employment) [31] and low and high physical activity engagement (above or below 5000
steps per day) to capture the experiences of active and sedentary participants [32]. People with
MS identified as potential participants for interview were approached face-to-face by a member
of the research team following their 12-week appointment. Participants provided explicit written

Citations
More filters
Journal ArticleDOI
TL;DR: In this article , the authors assess the validity and acceptability of commercially available devices for monitoring step-count and activity time among people with multiple sclerosis (MS) by providing feedback on their performance.
Abstract: Multiple wearable devices that purport to measure physical activity are widely available to consumers. While they may support increases in physical activity among people with multiple sclerosis (MS) by providing feedback on their performance, there is little information about the validity and acceptability of these devices. Providing devices that are perceived as inaccurate and difficult to use may have negative consequences for people with MS, rather than supporting participation in physical activity. The aim of this study was, therefore, to assess the validity and acceptability of commercially available devices for monitoring step-count and activity time among people with MS. Nineteen ambulatory adults with MS [mean (SD) age 52.1 (11.9) years] participated in the study. Step-count was assessed using five commercially available devices (Fitbit Alta, Fitbit Zip, Garmin Vivofit 4, Yamax Digi Walker SW200, and Letscom monitor) and an activPAL3μ while completing nine everyday activities. Step-count was also manually counted. Time in light activity, moderate-to-vigorous activity, and total activity were measured during activities using an Actigraph GT3X accelerometer. Of the 19 participants who completed the validity study, fifteen of these people also wore the five commercially available devices for three consecutive days each, and participated in a semi-structured interview regarding their perception of the acceptability of the monitors. Mean percentage error for step-count ranged from 12.1% for the Yamax SW200 to -112.3% for the Letscom. Mean step-count as manually determined differed to mean step-count measured by the Fitbit Alta (p = 0.002), Garmin vivofit 4 (p < 0.001), Letscom (p < 0.001) and the research standard device, the activPAL3μ (p < 0.001). However, 95% limits of agreement were smallest for the activPAL3μ and largest for the Fitbit Alta. Median percentage error for activity minutes was 52.9% for the Letscom and 100% for the Garmin Vivofit 4 and Fitbit Alta compared to minutes in total activity. Three inductive themes were generated from participant accounts: Interaction with device; The way the device looks and feels; Functionality. In conclusion, commercially available devices demonstrated poor criterion validity when measuring step-count and activity time in people with MS. This negatively affected the acceptability of devices, with perceived inaccuracies causing distrust and frustration. Additional considerations when designing devices for people with MS include an appropriately sized and lit display and ease of attaching and charging devices.

1 citations

References
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Book
20 Dec 2013
TL;DR: The Foundations of Qualitative Research as mentioned in this paper The applications of qualitative methods to social research are discussed in detail in the context of qualitative research in the field of social science research, with a focus on the use of qualitative data.
Abstract: The Foundations of Qualitative Research - Rachel Ormston, Liz Spencer, Matt Barnard, Dawn Snape The Applications of Qualitative Methods to Social Research - Jane Ritchie and Rachel Ormston Design Issues - Jane Lewis and Carol McNaughton Nicholls Ethics of Qualitative Research - Stephen Webster, Jane Lewis and Ashley Brown Designing and Selecting Samples - Jane Ritchie, Jane Lewis, Gilliam Elam, Rosalind Tennant and Nilufer Rahim Designing Fieldwork - Sue Arthur, Martin Mitchell, Jane Lewis and Carol McNaughton Nicholls In-depth Interviews - Alice Yeo, Robin Legard, Jill Keegan, Kit Ward, Carol McNaughton Nicholls and Jane Lewis Focus Groups - Helen Finch, Jane Lewis, and Caroline Turley Observation - Carol McNaughton Nicholls, Lisa Mills and Mehul Kotecha Analysis: Principles and Processes - Liz Spencer, Jane Ritchie, Rachel Ormston, William O'Connor and Matt Barnard Traditions and approaches Analysis in practice - Liz Spencer, Jane Ritchie, William O'Connor, Gareth Morrell and Rachel Ormston Generalisability Writing up qualitative Research - Clarissa White, Kandy Woodfield, Jane Ritchie and Rachel Ormston

9,682 citations


"Pedometers, the frustrating motivat..." refers methods in this paper

  • ...The Framework Method is a transparent process of analysing qualitative data which provides a clear audit trail of the iterative, analytical process from original transcripts to final themes, including the illustrative quotes [35]....

    [...]

  • ...Transcripts were analysed using the Framework Method [34]....

    [...]

Journal ArticleDOI
29 Sep 2008-BMJ
TL;DR: The Medical Research Council's evaluation framework (2000) brought welcome clarity to the task and now the council has updated its guidance.
Abstract: Evaluating complex interventions is complicated. The Medical Research Council9s evaluation framework (2000) brought welcome clarity to the task. Now the council has updated its guidance

8,896 citations

Book ChapterDOI
09 Sep 2002
TL;DR: The last two decades have seen a notable growth in the use of qualitative methods for applied social policy research as discussed by the authors, which is underpinned by the persistent requirement in social policy fields to understand complex behaviours, needs, systems and cultures.
Abstract: The last two decades have seen a notable growth in the use of qualitative methods for applied social policy research. Qualitative research is now used to explore and understand a diversity of social and public policy issues, either as an independent research strategy or in combination with some form of statistical inquiry. The wider use of qualitative methods has come about for a number of reasons but is underpinned by the persistent requirement in social policy fields to understand complex behaviours, needs, systems and cultures.

7,396 citations


"Pedometers, the frustrating motivat..." refers methods in this paper

  • ...The five iterative stages of the Framework method (familiarisation; thematic framework identification; indexing; charting; mapping and interpretation) were followed in the examination of the data presented [36,37]....

    [...]

Journal ArticleDOI
TL;DR: Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research.
Abstract: The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations. The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study. Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research.

5,939 citations


"Pedometers, the frustrating motivat..." refers methods in this paper

  • ...The Framework Method is a transparent process of analysing qualitative data which provides a clear audit trail of the iterative, analytical process from original transcripts to final themes, including the illustrative quotes [35]....

    [...]

Journal ArticleDOI
21 Nov 2007-JAMA
TL;DR: The results suggest that the use of a pedometer is associated with significant increases in physical activity and significant decreases in body mass index and blood pressure.
Abstract: ContextWithout detailed evidence of their effectiveness, pedometers have recently become popular as a tool for motivating physical activity.ObjectiveTo evaluate the association of pedometer use with physical activity and health outcomes among outpatient adults.Data SourcesEnglish-language articles from MEDLINE, EMBASE, Sport Discus, PsychINFO, Cochrane Library, Thompson Scientific (formerly known as Thompson ISI), and ERIC (1966-2007); bibliographies of retrieved articles; and conference proceedings.Study SelectionStudies were eligible for inclusion if they reported an assessment of pedometer use among adult outpatients, reported a change in steps per day, and included more than 5 participants.Data Extraction and Data SynthesisTwo investigators independently abstracted data about the intervention; participants; number of steps per day; and presence or absence of obesity, diabetes, hypertension, or hyperlipidemia. Data were pooled using random-effects calculations, and meta-regression was performed.ResultsOur searches identified 2246 citations; 26 studies with a total of 2767 participants met inclusion criteria (8 randomized controlled trials [RCTs] and 18 observational studies). The participants' mean (SD) age was 49 (9) years and 85% were women. The mean intervention duration was 18 weeks. In the RCTs, pedometer users significantly increased their physical activity by 2491 steps per day more than control participants (95% confidence interval [CI], 1098-3885 steps per day, P < .001). Among the observational studies, pedometer users significantly increased their physical activity by 2183 steps per day over baseline (95% CI, 1571-2796 steps per day, P < .0001). Overall, pedometer users increased their physical activity by 26.9% over baseline. An important predictor of increased physical activity was having a step goal such as 10 000 steps per day (P = .001). When data from all studies were combined, pedometer users significantly decreased their body mass index by 0.38 (95% CI, 0.05-0.72; P = .03). This decrease was associated with older age (P = .001) and having a step goal (P = .04). Intervention participants significantly decreased their systolic blood pressure by 3.8 mm Hg (95% CI, 1.7-5.9 mm Hg, P < .001). This decrease was associated with greater baseline systolic blood pressure (P = .009) and change in steps per day (P = .08).ConclusionsThe results suggest that the use of a pedometer is associated with significant increases in physical activity and significant decreases in body mass index and blood pressure. Whether these changes are durable over the long term is undetermined.

2,085 citations


"Pedometers, the frustrating motivat..." refers result in this paper

  • ...In line with previous research, the present findings demonstrate that pedometers serve as a motivational tool to promote physical activity [14]....

    [...]

Frequently Asked Questions (2)
Q1. What have the authors contributed in "Title: pedometers, the frustrating motivators: a qualitative investigation of users’ experiences of the yamax sw-200 among people with multiple sclerosis running head: pedometer user experience among people with ms" ?

This study evaluated user experience of the Yamax SW-200 Digi-walker pedometer in a group of people with MS. Sub-themes include: Increasing activity awareness, which describes the pedometer ’ s utility in raising activity consciousness ; Numeric motivation provides insight into dual motivating and demotivating experiences of using an objective feedback device ; ( Un ) usability focuses on practical concerns encountered in the day-to-day use of the monitor. 

Participants ’ experiences in the present study provide valuable information regarding usability concerns, which may assist in the design of future activity monitor supported interventions. Future research should consider the pedometer ’ s reliability, validity and acceptability in diverse groups with varying disease course and mobility impairments and explore alternative devices. Determining a practical and easy to use method for assessing free-living physical activity among people with MS has the potential to enhance activity engagement but requires further examination.