Keywords

1 Introduction to the Study

In the contemporary consumption environment, characterized by constant interaction and information exchange between people, devices and other entities [1], consumers utilize digital technologies to track various aspects of their daily lives [2]. Since it has been argued that digital technologies have a tremendous potential to improve individuals’ quality of life [3], it is only fitting that technological innovations, such as wearables, are increasingly adopted within the healthcare sector [4].

Earlier research demonstrates that healthcare professionals have adopted digital technology, for example, to promote weight control [5] and to assists in the care of health conditions such as cancer [6] and rheumatism [7]. Alongside this, connected mobile devices, such as wearables and sensors are progressively utilized to improve individuals’ health and wellbeing [8]. Interestingly, while such technologies are adopted in an increasing rate, research that takes a user-centric approach into digital health experience is limited, and has, for the most part, focused on experiences with “wellbeing” technology, such as smart and -fitness watches [9]. Since it has been identified that the focus of the digital health market is progressively shifting towards developing technology for disease-specific uses and management of chronic conditions such as diabetes [8], more research is needed to understand user’s daily experiences with such technology.

In line with that, this paper adopts a user-centric approach, i.e., an approach focused on the experiences of the users, into the exploration of digital health experience. Theoretically, this is done with reference to marketing literature focused on experience, and multidisciplinary research concerning the digital health domain. Empirically, this paper relies on three qualitative datasets concerned with the experiences of diabetics who utilize a wearable sensor to support their daily diabetes management. According to the World Health Organization [10], the prevalence of diabetes has been steadily increasing over the past decades, making it the 7th leading cause of death globally. Arguably, diabetes technology not only makes diabetes management easier, but also has the possibility to improve the health of people with diabetes [11]. Thus, by exploring user’s day-to-day experiences with diabetes technology, this paper aims to identify characteristics of such experiences and provide insights into the ways in which users shape their digital health experiences in their daily lives to ease up their diabetes management and to improve their overall wellbeing.

This paper begins with an introduction, after which the theoretical concepts relevant for the study – experience and digital health – will be introduced. That will be followed by a chapter focused on the study’s methodology and empirical data, after which the findings of the study will be presented. The paper concludes with a discussion of the study’s contributions and suggestions for future research.

2 Literature Review

2.1 Defining Experience

Experience, “an all-embracing term which is often used to indicate some experience that a person has during everyday life” [12, p. 269] has captured the interest of researchers across disciplines for centuries. As research on experience has expanded throughout the years, nuances on how experience is understood have become prevalent. For example, while some regard experiences as something we passively go through, others regard them as being influenced by the actions individuals consciously take [12]. Overall, these different perspectives inevitably affect not only how experience is understood, but also how it is approached in research.

Across disciplines, interest in digital experiences has grown in recent years. Within the marketing research domain, it has been stipulated that as reliance on digital technologies has increased across sectors, consumption has started to progressively move from commercial settings, such as retail spaces, to non-commercial ones, such as consumers’ homes [1, 13]. As a result, it is perceived that individuals can get access to a number of services through digital technologies wherever and whenever they so desire [14]. As reliance on networked devices increases, we become “tethered to technologies” in a way that makes us adapt our modes of interaction into something that accommodate the bounds of the digital solutions in use [15]. In light of these developments, there is an increasing demand for capturing a qualitative, in-depth understanding of the digital experience phenomenon [16] from a perspective which regards experience as something individuals can consciously shape to fit their preferences in their day-to-day lives.

2.2 Defining Digital Health

The digital health field, characterized by hybrid objects that can perform multiple activities [17], presents itself as a promising, relevant context wherein to study digital experiences. While digital health technologies and solutions, e.g., telemedicine, wearables and electronic health records are frequently used in clinical settings, namely hospitals, to enhance quality of care and cut costs [18], digital health solutions are increasingly relied on also by individuals to help in the management of health and wellbeing.

To make sense of the quickly evolving field of digital health solutions, three prominent, overlapping domains have been identified: 1) health in our hands (monitoring, tracking, and informing about health through technology), 2) interacting for health (relying on technology to communicate about health information, for instance, between professionals and patients), and 3) data enabling health (collecting, managing, and utilizing health data) [19]. This paper focuses principally on the domain of “health in our hands”, as the focus is on users’ experiences of utilizing a digital health solution to monitor, track, and inform about their health.

The “health in our hands” domain can arguably be divided into two categories – wellness management solutions and health condition management solution - in line with arguments presented by IQVIA, the Institute for Human Data Science [8]. While wellness management solutions, are designed for the monitoring of fitness and lifestyle factors, such as steps [20], diet [21], and sleep [22], health management solutions are used for the daily monitoring and treatment of specific illnesses and chronic conditions [23]), such as diabetes.

Previous studies have primarily explored the ephemeral nature of user experiences with digital health solutions utilized for wellness management, including fitness trackers [24] and happiness applications [25]. These studies demonstrate that experiences with digital health solutions can be fleeting as a result of eventual disuse, neglect, or inconsistent usage [26]. Although this body of work has shed some light into the transient nature of users’ experiences, there is a growing demand for studies that explore the sustained use of digital health solutions over time [27]. A promising way to do this is to examine the experiences of individuals who utilize digital health solutions for the management of chronic conditions, such as diabetes, where continuous care is necessary. In these situations, it is challenging for users to simply abandon or overlook their interactions with digital health solutions, which makes it possible to access longitudinal insights about the user’s digital experience.

3 Methodology and Data Analysis

By adopting a qualitative, exploratory research approach, this paper seeks an in-depth, user-centric understanding of digital health experiences. This approach facilitates the generation of novel ideas and theoretical insights from empirical observation [28, 29]. This paper employs a social constructionist perspective, which advocates for the comprehension and elucidation of social worlds and processes from the perspective of actors involved [30]. Coupled with “Thick Data”, meaning data rich in context and authentic in details of individuals’ emotions, narratives, and worldviews [31], the paper aims to uncover the nuances of users’ digital health experiences within the context of their everyday lives.

The empirical material considered in this paper consists of three qualitative datasets collected by the first author between March 2020 and August 2021. Overall, the combination of the three datasets ensured access to a detailed, holistic understanding of the studied phenomenon. The first dataset, consisting of 15 in-depth open-ended interviews with diabetics assisted in producing a comprehensive understanding about the daily lives of diabetics and about the role of digital technology in diabetes management. Based on the initial analysis of the interviews, wherein it was stated by a number of interviewees that they utilize online platforms to share and discuss their experiences with other diabetics, a decision was made to acquire online data to expand on the insights gathered during the interview process.

The first online dataset was collected from a discussion forum web mastered by a Finnish diabetics’ foundation. A total of 53 discussion threads with approximately 1000 messages were identified by using the brand name of a digital health solution named by the interviewees as the one they utilize in their daily diabetes management as a keyword. To ensure the identification of all relevant data, keyword combinations [brand name] + experience and experience of [brand name] were also used. After the initial analysis revealed the tendency of the discussants to share YouTube videos with each other on the forum, the same keywords were used on YouTube to identify relevant videos. A total of 142 videos were identified and collected from YouTube to form the study’s second online dataset. Overall, the study’s three datasets ensured data triangulation [32] and access to multiple perspectives of the same phenomenon. Details of the paper’s three empirical datasets can be accessed from Table 1 below.

Table 1. Summary of the paper’s three empirical datasets
Full size table

After the data collection was finalized, the paper’s multimodal media data consisting of recollections of digital health user experiences presented both in oral and written form were “fused” [33] to gain rich insights of the studied phenomenon. In practice, this was done through the transcription of all non-textual data (i.e., audio recordings of the interviews and videos from YouTube) into textual Form. to analyze the empirical data, the paper relies on reflexive thematic analysis, which enables the identification and organization of qualitative data into patterns of meaning (themes) through the process of coding [34].

This paper’s reflexive thematic analysis consisted of the six phases defined by Braun and Clarke [34]. In the first phase, familiarization with the dataset, the data transcripts were read through multiple times to ensure optimal level of immersion. Some initial notes were written down during this phase as a reference for the upcoming phases. In the second phase, coding, the three datasets were systematically explored to identify and code segments connected to the study’s objectives. A new code was generated every time something new and interesting in relation to the studied phenomenon emerged from the data transcripts. Examples of codes established during the coding process included ‘customization of the experience’ and ‘feeling like a robot’. When no new codes relevant for the studied phenomenon were identified, the coding process was finalized and the analysis moved to the third phase, generation of initial themes. During this third phase, the codes were clustered into categories that reflected key ideas relevant for the paper’s aims. The initial theme development highlighted, for instance, users’ active involvement in the construction of experiences, and the emerging sense of safety enhanced by the digital health solution. In the fourth phase, development and review of themes, the connections between initial themes were explored, resulting in the unification of some themes. Overall, this helped to clarify the process and set the stage for the fifth stage of refining, defining and naming of themes. During this penultimate stage of the reflexive thematic analysis process, three themes were refined and named as always on, co-creation through interaction, and it makes things so much easier. The final phase, the writing up of the thematic analysis, is presented in the following sections.

4 Findings of the Study

As the previous section indicates, the qualitative, thematic analysis of the empirical material regarding diabetics’ experiences of digital health technology resulted in the identification of three themes: always on, co-creation through interaction, and it makes things so much easier. These themes, both separately and put together, aid in identifying characteristics of users’ experience with a wearable sensor designed for the measurement of glucose levels from interstitial fluid, and shed light on the ways in which the users shape their experiences with the digital health solution in their daily lives.

4.1 Theme 1: Always on

The data indicates that though diabetes can be defined in simple terms as a chronic condition that affects how one’s body processes blood sugar (glucose), the experience of living with diabetes is different for everyone. Since diabetes requires recurring care activities and careful monitoring, it can be regarded as something that is “completely part of one’s life” (Interview 1) and thus “always on”. As one of the interviewees indicated, “It’s always part of my life. There’s no break or vacation from diabetes” (Interview 3).

The empirical data demonstrates that in addition to the “always on” nature of diabetes, the digital health solution designed for its care is also regarded as something that is always present. The wearable sensor, which measures glucose levels from interstitial fluid, is inserted into one’s skin for a 14-day period, after which it is replaced with a new sensor. Resulting from this, the sensor goes wherever its wearer goes, as is indicated in the data through recollections wherein the sensor is part of one’s vacations, gym trips, dates, swimming hall visits, and so on. The always on nature of the wearable sensor comes with many benefits, demonstrated, for instance, through access to “trend arrows and graphs” (Discussion forum), and “information about blood glucose movements at all times (YouTube). Yet, acknowledgement is also made of the adverse consequences of the always on presence of the digital health solution and the data it supplies, such as unwanted attention, neuroticism about the data it provides, feelings of anxiety, and the sense that one is like a machine or a barcode that is “scanned repeatedly” (Discussion forum).

Overall, this complexity in perspectives points towards the subjective nature of the user’s experience and the possibility to perceive the digital health experience as something that consists of both positive and negative aspects. It should be noted, though, that the majority consensus identified from the empirical material points towards a tendency to perceive and highlight the positive influence of the always on nature of the wearable sensor in diabetes management, as a result of which less attention is paid to the negative and/or aesthetic aspects of the experience.

4.2 Theme 2: Co-creation Through Interaction

To use the wearable sensor in its designed way and to its full benefit, users are expected to interact with it and the data it provides in a recurring manner. As a result of this, the experience with the digital health solution can be perceived as co-created through interaction that takes place between the user and the digital health solution. The data indicates that in the users’ day-to-day lives, recurring interactions take the form of, for instance, checking the graphs displaying trends in blood glucose levels to get a “sense of direction for the day” (Interviewee 4) or utilizing the data to “know whether to have insulin, sugar, or just keep living life” (YouTube).

Thus, the co-creative nature of the user’s digital health experience is reliant on the following facts: 1) the user must interact with the device in order to access data and 2) the data from the device is relevant only if the user reacts on it. While the interactions with the digital health solution make it possible for the device to produce, for instance, trend graphs, the data becomes relevant only if the user acts on it. Otherwise, it is just numbers and lines of a graph. At the time of the data collection, the interactions with the device involved scanning the sensor at least once every eight hours, either with a sensor reader or a mobile phone. While updates to the technology have made scanning unessential, interactions with the data are still required as the users are expected to use the data to modify their care actions, if necessary. In practice, this means that the digital health solution does not have the capability to take over the daily care activities associated with diabetes. Rather, it is designed to take on an assistive role, making the care of diabetes more convenient and balanced. Thus, “you’re responsible for your own care” (Interview 7), which can be made “so much easier” (Interview 6) with the help of the digital health solution.

4.3 Theme 3: It Makes Things so Much Easier

Defined as “life changing” (YouTube), the data reveals that the digital health technology offers significant benefits for its users, including continuous access to data and the possibility “to stay fit for work for years, even decades longer than I would without it” (Discussion forum). Interestingly, the empirical material demonstrates that the digital health technology is often perceived as an educative tool that has the capacity to increase the user’s awareness of their condition. This is demonstrated, for example, by the following: “While using the sensor, I noticed how the point where I inject insulin affects how long it takes to work. Now I use this information, for example, when I know that dinner will take longer and inject insulin in my thigh, as the effect will not be felt instantly. Conversely, if I eat fast food, I will inject insulin to my stomach because then the effect will be quicker” (Discussion forum). Overall, such improvements are seen not only to improve daily life and wellbeing by reducing the chance of complications and additional illnesses, but also to benefits to society as better balance of diabetes ensures “fewer additional costs” (Interview 3).

The analysis indicates that the capability to shape their experiences with the digital health solution further improves the potential of it in meeting subjective care needs. As was indicated previously, everyone’s diabetes is different, which means that everyone’s needs for care are different too. While the digital health device comes with some set parameters, perhaps most importantly the need to wear the sensor at all times for a period of 14-days at a time, the data shows that beyond this requirement, the experience is actually quite modifiable. The three most common ways of shaping the experience identified from the empirical material include 1) altering the placement site of the sensor from upper arm to other areas of the body, such as one’s abdomen, 2) altering the appearance of the sensor, and 3) altering the technological aspects of the digital health solution.

The data demonstrates that altering the placement site of the wearable sensor is motivated by the desire to hide the sensor, to make its placement more convenient and secure when engaged in physical activity, and/or by the desire to experiment with the technology to test out the accuracy of glucose readings from different placement sites. Importantly, whatever the reason for alternative placement is, it is acknowledged in the data that such altering is done “at your own risk” (YouTube), as it goes against the instructions given by the digital health solution’s manufacturer. Therefore, those shaping their experience through alterations of the placement site are willing to take the risk in order to modify the digital health experience into something that better serves their subjective needs.

Shaping the appearance of the sensor points towards practices that help to hide, secure and/or emphasize its appearance. While the desire to hide the sensor can also lead to trying out alternative placement sites, the data demonstrates that by utilizing tapes and stickers, users are able to diminish the appearance of the sensor. Interestingly, such hiding is associated in the empirical material with the wish to “avoid questions from strangers” (YouTube) and to save oneself from awkward and even potentially hurtful interactions wherein one is expected to act like a “traveling dictionary who has to explain everything related to diabetes to people […] who just happen to spot the sensor” (Discussion forum). Yet, while some wish to diminish the appearance of the sensor, others are looking for ways to accessorize and personalize it, to “make it pretty” (YouTube) and turn it into something that people, including other diabetics, can easily spot. By making the sensor “cute” (YouTube), the user is able to turn the sensor into something that they carry similarly to a piece of jewelry or another wearable accessory.

Finally, the empirical material indicates that if the user so desires (and has the technological capability to do so), the technological aspects of the experience can be modified. In practice, this means, for instance, the insertion of a third-party Bluetooth transmitter on top of the sensor to make it possible to get alerts to one’s smartwatch and to “see my blood glucose levels on my watch at the same time as I check the time” (Discussion forum). Overall, the empirical material shows that such shaping practices are less common as they tend to require a certain level of technological expertise and financial input.

4.4 Summary of the Findings

Altogether, the findings of the study demonstrate that the digital health solution utilized for diabetes management becomes integrated into its user’s daily life and through that has the potential to improve not only the users’ management of diabetes, but also their overall wellbeing, both in the short and long term. By having the capability to shape their interactions with the technology that is “always on”, the user is able to modify the experience into something that best serves their subjective needs and wants, both in relation to diabetes management and to their wishes regarding the visibility of their diabetes for others.

5 Contributions and Future Research Suggestions

The seeking out of an understanding of digital health experience from a user-centric perspective offers various contributions to existing literature. Firstly, while research on digital experience has increased in recent years [14], in the digital health context studies which adopt a user-centric approach have been limited [35]. Secondly, by focusing on experiences of those who utilize digital health technology for health condition management, the paper answers to recent calls for research regarding users’ longitudinal experiences with digital health technology [27] and the influence of digital health technology in shaping users’ daily lives [26]. Thirdly, in particular for marketing researchers, this paper offers fresh insights into the understanding of user, or customer experience in the contemporary consumption environment, and especially within a domain, which has not been studied extensively in the marketing context despite the digital health market’s immerse growth [8].

Since users are increasingly looking for digital solutions that can effectively and fluidly serve their subjective needs [36], this paper highlights the importance for health professionals and health technology developers to understand how digital solutions become integrated into users’ lives. Importantly, the paper indicates that allowing users to modify their experiences with digital health technology, at least to some degree, is likely to positively affect the formation of an ongoing relationship between the user and the digital health solution.

It is also important to note that as the digital health market becomes more and more saturated with solutions possessing similar technological functionalities, companies developing digital health solutions must find ways to differentiate themselves on the market. Thus, an understanding of the user perspective will undoubtedly become even more relevant in the future, as it offers digital health companies the possibility to communicate on their promises and values more efficiently for existing and potential users. In practice, a user-centric exploration into digital health experience, such as the one presented in this paper, can be used by digital health companies, for example, to generate brand promises, i.e. assurances of what the digital health brand will and will not deliver to its users [37].

To expand the user-centric understanding of digital health experience beyond this paper, future research should concern itself not only with how experiences are reflected on, either in speech or writing, but also on depicting how the experiences actually look like. Such research could adopt an ethnographic approach through which the daily life of the user and the role digital health technology plays in it could be observed in more detail. Alternatively, research could rely on a combination of videography [38] and diary method [39] to capture both how the experiences look like and how, for example, the role of contextual factors, such as users’ education, economic status, and technological know-how potentially influence digital health experience. In order to expand the understanding of digital experiences of users (or customers), marketing researchers in particular should pay more attention to the co-creative nature of the interactions that take place between users and digital health devices, and conduct, for instance, studies focused on users’ motivations to engage in recurring interactions with digital health solutions. Though earlier research has indicated the necessity of considering negative user/customer experiences, for the most part focus has been on experience as a positive phenomenon [40]. Thus, future research could expand on this by more carefully considering the factors that have the possibility to contribute negatively to digital health experiences.