Association of Environmental Pollutants and the Prevalence of Intellectual Disability in Caribbean Countries from 2006 to 2016

## **Feasibility and Acceptability of Wearable Devices for Climate Change and Health Research in the Low-Resource Contexts of Burkina Faso and Kenya**

#### **Sophie Huhn, Mara Koch, and Ina Matzke**

Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg Germany

Climate change has an early and strong impact on vulnerable sub-Saharan regions. However, data on these regions to power climate change and health research remain scarce. Wearable devices may provide new opportunities to generate reliable data. In the last decade, health research using wearables has increased considerably, emphasizing the enormous potential. In particular, studies on health effects and exposure to heat have increasingly used wearables. However, most studies have been conducted in upper-middle- and high-income countries. We aim to investigate the feasibility and acceptability of using wearables for research on climate change and health in two health and demographic surveillance systems (HDSS): Nouna, Burkina Faso (BF), and Siaya, Kenya (K). To understand the usage of wearables for health research and to scope the literature on the use of wearables for the measurement of climate change-related health impact and exposure, we conducted two scoping reviews that provided the scientific background to design the field studies. For the feasibility field studies, we recruited 244 individuals (50% female, aged 6-84 years). Participants wore wearables (Withings Pulse HR fitness tracker, Tucky thermometer patch) over a period of three weeks and completed acceptability questionnaires every 4-7 days. Informal feedback from field staff was also collected. Acceptability questions had an overall agreement of 97% (BF), and many participants were positive about the wearables, at times even perceived them as fashionable items. Some reported concerns were accidentally damaging the wearables (n=40, 5%) and health hazards (n=15, 2%). Acceptability, as well as data completeness, was similar between gender, age, and study arms. Data completeness of heart rate and temperature measurements was considerably lower than of accelerometry (steps, sleep). Technical issues like malfunctioning synchronization (n=6, 1%) and lack of adhesion for the thermometer patch (n=25, 3%) were reported. Based on our results, wearables may become an accepted, feasible, and valuable tool for lowresource health research, also investigating individuals' exposures and real-time health effects of climate change-related events such as extreme weather occurrences. Particular emphasis should be placed on study implementation (regular visits and comprehensive participant information necessary), wearable sturdiness, and data handling.

Sophie Huhn, Mara Koch and Ina Matzke

Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg Germany

#### Background

Climate change has had an early and strong impact on vulnerable sub-Saharan regions. However, data from these regions to power climate change and health research remain scarce. Wearable devices may provide new opportunities to conduct reliable research, given their advantages in continuously capturing data in real-life settings of individuals, even in low-resource contexts. This approach can be used to gain insights regarding the effectiveness of interventions.

*Figure 1. Participant in K receiving the wearable device.*

#### Results

The acceptability questions had an overall agreement of 97%/93% (BF/K). Participants emphasized the practicability of the watch function (K) of the wearable, at times even perceived the wearable as fashionable (BF, K), and stated that others showed great interest in the wearables (K). Of the participants, 40.5% (BF) were afraid of accidentally damaging the wearable. The data completeness of heart rate and temperature measurements was considerably lower than of accelerometry (steps, sleep). Difficulties encountered included malfunctioning synchronization and use of the adhesive wearable (BF: lack of adhesion, K: tape too sticky/painful).

#### Conclusions

Based on our results, wearables are an accepted, feasible and valuable method to generate health insights into low- resource contexts and to potentially investigate individuals' exposures to and direct health effects of climate- change-related environmental conditions.

#### Recommendations

We have found that data completeness was higher when there were regular visits from field workers to study participants. More focused research is needed to increase data quality and implement research standards.

*"Nothing can stop me from participating"*

*"It helps me control my health"*

*"Is it dangerous to wear?"*

### Objectives

Is the use of wearables for climate change and health research in cohorts in the Siaya region, Kenya (K), and Nouna region, Burkina Faso (BF), feasible and accepted?

(participants in K, BF)

Methodology
