Utilizing the All of Us Research Program : exploring the use of wearable activity trackers in adults with heart failure

Heart Failure (HF) continues to be a social and economic problem in the United States (US). Interventions to improve outcomes have focused on reducing 30-day readmissions while concerns remain with increasing post-discharge mortality and 60- and 90-day readmission rates. Self-care interventions are essential to improve outcomes, yet there remain issues with the sustained engagement of behavioral changes. Activity trackers have been shown to increase physical activity for adults with HF; however, questions remain if they motivate individuals for sustained engagement over time as well as influence health care utilization and quality of life (QoL). This study aims to understand the overall impact of wearable activity trackers as a self-care tool on health behaviors and health outcomes in adults with HF using the All of Us dataset. Firstly, a systematic review examined six research articles using a Fitbit or Apple Watch as an intervention in adults with HF. Study participants improved or had no change from baseline in QoL, health behaviors (steps/day or general daily activity), and physical parameters (6MWT, weight, or blood pressure); not all results were statistically significant. Subsequently, a cross-sectional analysis of the All of Us Research Program participant data (survey responses, Fitbit, and electronic health record [EHR] data) of adults with HF (n = 93) was conducted. Multiple linear regression was performed to predict scores for Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Short Form subscale scores for Physical Health and Mental Health based on Fitbit usage (duration and level of activity), social support, perceived stress, food security, and neighborhood safety. People with HF and reported Fitbit use (n = 93) and lack of reported perceived stress (B = -0.312, p = .022) and level of activity (B = 3.868, p= 0.044) were significant predictors for Physical Health. Perceived stress (B= -0.689, p < 0.001) was a significant predictor of Mental Health. Fitbit users (n = 93) were compared to non-reported users (n = 1,577) and the analysis failed to demonstrate a difference in days hospitalized and self-reported Physical Health and Mental Health. Finally, the last aim of this dissertation was to demonstrate methods for using the All of Us Research Program in a nursing dissertation by providing a step-by-step guide for designing a research project, exemplar R codes for calculating outcome scores such as PROMIS Global Health, and a review of the facilitators and barriers encountered. This dissertation advances science in several ways, including (1) addressing personalized self-care strategies important for developing precision health interventions in adults with HF, (2) providing a longitudinal perspective on the influence of Fitbit usage in adults with HF, and (3) providing a guide for nursing doctoral students to utilize the All of Us Research Program in dissertation studies.