Pew Internet Research: 21% Self-Track with Technology

Today the Pew Research Center’s Internet & American Life Project released their latest findings in their ongoing research on the role of the Internet and technology in health and wellness. This latest report, Tracking for Health, is of particular interest to the Quantified Self community because it focuses on self-tracking. Thanks to Pew Associate Director, Susannah Fox, who gave us an advanced look at the results, we are able to bring you some reflections on this initial foray into measuring the impact of self-tracking.

Before we get to our discussion with Susannah it’s probably best to help set the stage with some of the most interesting findings.

Overview of Tracking

  • 69% of adults track a health indicator for themselves or others.
  • 34% of individuals who track use non-technological methods such as notebooks or journals.
  • 21% of individuals who track use at least one form of technology such as apps or devices.

The Impact of Tracking

  • 46% of trackers say that this activity has changed their overall approach to maintaining their health or the health of someone for whom they provide care.
  • 40% of trackers say it has led them to ask a doctor new questions or to get a second opinion from another doctor.
  • 34% of trackers say it has affected a decision about how to treat an illness or condition.

Tracking and Sharing

  • 34% of trackers share their data or notes with someone else.
  • 52% share with a health professional.
  • 22% share with a spouse/partner.

We were able to ask Susannah a few questions about the report and some of the more interesting findings.

QS: What were some of the differences between people who use technology to track and people who don’t? Do they learn different things?

Susannah FoxSusannah Fox: For this report we divided trackers into two groups: formal and informal. 50% of trackers are in the “formal” group and use paper, a medical device, an app, a spreadsheet, a website or some other online tool to take notes. 44% of trackers are in the “informal” group and only track in their heads.

Since we allowed multiple responses to this question, and because your readers are as geeky as I am, I’ll provide even more detail: 85 people say they both keep track “in their heads” and use some more formal method. We decided to put them in the “formal” group in order to be able to analyze the “purely informal” group alone. You’ll also notice that 6% of the tracker population is missing from this analysis – they just didn’t answer the question.

The “formal” trackers are more likely to report that this activity has had an impact on their health:

    • 54% of trackers who record their notes say it has changed their overall approach to health, compared with 39% of informal, “in their heads” trackers.
    • 48% of trackers who record their notes say it has led them to ask a doctor new questions, compared with 33% of informal trackers.
    • 42% of trackers who record their notes say it has affected a health decision, compared with 26% of informal trackers.

Some analysis we plan to do will focus on the “technology” trackers – those who use devices, apps, or other tools – but for this report, we kept the lens wide open. And, in a way, I was happy to honor the “technology” of paper alongside all the gadgets.

QS: You mention how often people are sharing their tracking data. Do we know how they are sharing?

SF: We didn’t have space on this survey to ask how they shared, whether online or offline, on paper, verbally, or by showing an app. On Twitter, i.e. anecdotally, Natasha Burgert, MD, a pediatrician, told me that she had two patients just today who brought in a baby tracking app to review the data with her:

2 moms just *today* in clinic – We hovered over iphone together to review feeding and poop app. #newparenttracking CC: @susannahfox

— Natasha Burgert (@DoctorNatasha) January 25, 2013

And Bryan Vartabedian, MD, wrote:

@susannahfox Parents are the original quants.Love to keep their own diaries, graphs, etc

— Bryan Vartabedian (@Doctor_V) January 25, 2013

I’d love to do a survey of clinicians: Do they ask people about their personal tracking? What do they do when people bring in their own data or notes? What insights – or pitfalls – have they found in working with patients and caregivers who track? What’s on their wish list for new tracking tools?

QS: What was the most surprising result?

SF: I wasn’t expecting to see such significant age differences: Older adults are much more likely than younger adults to be trackers, particularly in the “health indicators or symptoms” category. I had thought of tracking as a younger person’s pursuit, probably because I focus on the tech and gadgetry that I see associated with tracking. Broadening our questions to include all adults and all forms of tracking educated me about the reality of people’s lives.

QS: What is the biggest mystery or unanswered question this research left you with?

SF: What prompts someone to track in the first place? Are certain diagnoses or life stages more likely to prompt someone to track?

Our next two reports may help to answer a few of my unanswered questions. The first, focused on caregivers, will look more closely at how this unsung army does (or doesn’t) use technology as they tend to a loved one. The second, focused on people living with chronic conditions, will shed some more light on the diagnosis question.

But I look forward to learning from more personal testimony and qualitative research, like the work being done at QS and other citizen-scientist venues. Pew Internet provides N=3000 or N=1000 data, but I think N=1 studies contribute just as much – or more – to our understanding of tracking’s impact on health and health care.

Of particular interest to us here at Quantified Self Labs was how many people were using “formal” vs “informal” tracking methods. Technology isn’t the whole story here. Technology is bringing new methods of learning into simple and familiar practices that go back a long time. How does the new fit with the old? Susannah discovered that formal tracking was more influential when it came to health decisions than informal tracking. Perhaps formal tracking makes learning easier; it may also increase confidence and communicability. When our observations about ourselves are formally collected, rather than just remembered, it’s easier to get advice and comment, and to improve our reasoning with the help of others. “Remember kids, the only difference between screwing around and science is writing it down,” said Adam Savage of Mythbusters. Technology helps us write it down.

We asked Susannah what she was most curious about, and she said “What prompts someone to track in the first place?” Her report suggests that diagnosis with a chronic conditions, or the normal concerns of aging, perhaps play a role. One factor I think we’ve seen operate in the QS community may also be important: the influence of others.

In his 1981 paper Self Experimentation: A Call for Change, Allen Neuringer wrote:

Finally, a most significant problem is that we are not surrounded by models who demonstrate the possibilities and rewards of engaging in the scientific analysis or our own behaviors. It is difficult to do research: time consuming, tension-producing, often disappointing. The difficulty is exacerbated by our own lack of experience in formulating questions about own behaviors in a rigorous, empirically testable manner. Perhaps we don’t do science of self partly because it simply is not yet done by others.

Maybe this is where the personal practice of self-tracking and the broader cultural trends intersect. In order to begin, we need someone to show us how. Fortunately it is no longer true that the “science of self” suffers from a lack of models, of individuals engaging in the practice. Individuals all over the world are sharing their methods, their tools, their knowledge in Quantified Self meetups and elsewhere. 

If you’ve ever made an intentional shift from informal to formal tracking, or have other comments on the Pew report, we’d like to hear from you in the comments.

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42 Responses to Pew Internet Research: 21% Self-Track with Technology

  1. peter bering says:

    Ernesto, great article and insights. Thanks.
    I believe that Tech must add something extra to the specific something that really matters from a user perspective; i.e. Solve a real pain. Ofte, I see apps being more focused on providing “rationalistic” Benefits which may not stimulate the motivation to use and keep using such Tech.

    which tangible pains do you envision Self tracking Tech to help relieve?
    Best regards

    • Ernesto Ramirez says:

      Peter, we spoke a bit in the post about how tech is helping relieve “pains” related to self-tracking. I think part of what it really helps with is having tangible, objective data that is easily recalled. As I stated above, technology helps us write it down.

      What benefits do you see to technology and self-tracking in general?

  2. Jon Cousins says:

    Fascinating report Ernesto, and thanks for sharing it along with Susannah’s comments. The first thing that completely astonished me was the fact that so many Americans are self-tracking something. Seven out of ten! I felt sure that this had to be an error, but there it was in the report – 69% are tracking some aspect of health for themselves or on behalf of a loved one. Admittedly half of these are ‘doing it in their head’, but it’s still an extraordinary number.

    None are measuring their mood though…

    • Ernesto Ramirez says:

      Hi Jon! Thanks for comment here. I agree, it is quite fascinating that such a high number are tracking something. I wonder if we’ll see the ratio of formal to informal tracking (in their heads) shift in the coming years. What do you think?

      Also, while they didn’t explicitly ask about tracking mood I think we can assume that mood and mental health could grouped into the following question: “How about any other health indicators or symptoms? Do you happen to track your own blood pressure, blood sugar, sleep patterns, headaches, or any other indicator?” It’s hard to know exactly what everyone was expressing when they answered that, but 33% said they were tracking those other health indicators.

      • Susannah Fox says:

        Yes, I’d agree with Ernesto that although we didn’t name “mood” specifically, it’s a real possibility that respondents may have had it in mind when answering the question about health indicators.

        In a separate section of the survey, we asked cell phone owners if they have any health apps. Those who said yes were asked a follow-up question: “What kind of health apps do you currently have on your phone?” and we allowed people to answer in their own words. A small number named “mood” — many more named apps related to exercise and diet. You can see some of the verbatim responses at the end of our Mobile Health 2012 report:

  3. Thanks for bringing this report to our attention. And for the additional analysis and QA, of course. Some really interesting nuggets in there.

    • Ernesto Ramirez says:

      What did you find most interesting Edison?

      • I am particularly intrigued by the informal group of people who track health-related data in their heads. From a commercial perspective, this answers the question of why there are so many established and startup companies emerging in the space. I’ve been curious about this. But even more importantly, from the point of view of health literacy, we might be making more progress than we think. It could be that these people are just really inefficient at being healthier, but the motivation is there. This is analogous to the 10:00 min/mile runner who wants to get faster. There’s tons of low hanging fruit – a tempo or interval run here and there will probably bring the time down significantly. Compare that to the 6:00 min/mile runner who has to work a lot harder to shave off those extra seconds. So, overall I think this is good news.

  4. Ian Eslick says:

    I believe that tracking will become, in various ways, more central to the practice of medicine. Combine this with the surprising degree of acceptance of tracking that Susannah and company have identified in the general population and I think we’ll see a big shift to passive, invisible tracking as a common part of our daily lives. Active tracking, gaming, social sharing, etc will likely remain niche populations within the larger movement, but the integration of personal tracking and professional medicine is what excites me most.

    The biggest benefit we’re seeing at C3N from tracking is the establishment of a shared context between clinician and patient. The patient’s memory is more accurate and the doctor can better trust what they hear from the patient when it doesn’t line up with their expectations. In fact, patients are often surprised by the amount and nature of variation in their measurements and it is this variation that provides critical clues making improvements.

    • Ernesto Ramirez says:

      Thanks Ian! The formal integration of self-tracking and medical care is very interesting and a topic we want to explore in the future. Thanks as well for the link to the article that highlights what you’re doing with C3N. Awesome work.

  5. Great post, important interview!

    First – I think this report provides some fascinating hypothesis-generating data…not a surprise considering the effort that Pew and Susannah invest in focusing their objectives and validating their survey design.

    Second – (in my opinion) the topic itself lends itself to overreach inasmuch as the idea that someone is or isn’t a quantified selfer is NOT a simple binary – yet I see folks discuss the topic as if this were the case. Let me add, that I do not feel as if the reporting of this data was misleading, but the data points in-and-of themselves cannot stand out of context.

    For example, Susannah has publicly stated that she has a pair of jeans in her closet that help her track her weight and fitness. Similarly, I have a few pairs of pants that remind me of where I stand…and I have a scale. But there are many other areas of my health and fitness that I do not track…though I’ve played with the idea.

    My father tracked his doctor’s appointments over 9+ years as a heart patient, but doesn’t do anything with the information – his records are not quant data as much as they are a record of his appointments and the ‘things he remembered’ about the appointments.

    My mother can tell you with surprising clarity what her day-by-day pain levels were following each of her hip replacement more than a decade later….but she is still 90 lbs overweight and this disconnect does not escape her.

    My point is that tracking something about your health is not the same as tracking ‘everything’ about your health. And tracking your fitness, is not the same as tracking your medical care. Tracking your medical care for disease X does not necessarily mean you will be willing or able to track your medical care for disease Y…

    …i just urge caution in what we make of this data.

    (ps. did I mention I am a fan of the topic and the authors…)

  6. Greg Weidner says:

    Ernesto, thanks for your take on this thought-provoking survey. I’m drawn to your comment that “in order to begin, we need someone to show us how.” Self-tracking (in all its forms) would accelerate in both adoption and value if it were encouraged and demonstrated by healthcare providers. Especially with tech tracking, there’s a hurdle to overcome in terms of understanding the tools and how they can be deployed for an individual’s benefit. We have some examples of tracking tools that providers prescribe with some success (like glucose monitors), but there are many others that have lived mostly in the consumer digital space and could easily add value to patient experience and outcomes. Many factors contribute to this gap, including culture, education/training and reimbursement. Ian Eslick’s comment above describes the “establishment of a shared context between clinician and patient.” That is precisely our opportunity, and would add to that a dimension of real-time engagement and mutual accountability. All of which leaves the question: how can traditional healthcare providers advance self-tracking as a critical element in health and wellness, using existing and emerging technologies?
    Appreciate the insights provided by the survey, your article, and the thoughtful comments they have generated.

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  11. Susannah Fox says:

    A reporter emailed me this morning asking why Latinos are less likely than other ethnic groups to track their health:

    - 51% of Latinos track weight, diet, exercise routine, compared with 62% of non-Hispanic whites and 59% of non-Hispanic blacks.
    - 25% of Latinos track health indicators or symptoms, compared with 41% of non-Hispanic blacks and 33% of non-Hispanic whites.

    We don’t have much data to answer the “why” but I did send her the following:

    Latinos age 18+ are less likely than non-Hispanic whites and African Americans to report that they have a chronic condition: 34% of Latinos say they have diabetes, high blood pressure, asthma, heart disease, cancer, or another chronic condition, compared with 47% of non-Hispanic whites and 46% of African Americans.

    This could be one reason why they are less likely to track a health indicator or symptom – they may have less need to do so.

    I’d love to hear from other people about what you think about her question — any observations or data to share?

    (Note: Thanks to funding from the California HealthCare Foundation, our health surveys have been conducted in English or Spanish & on landline and cell since 2008, so we’re confident about our Latino data. That’s now standard procedure at the Pew Research Center, btw.)

    • Bernardo says:

      We can make the argument that a Latino’s health tracking is more socialized than individual.

      I don’t think it is just an issue of having closer family ties (everybody and your 3rd degree uncle meets every Sunday…), but also a matter of personal space.

      Every Latino must kiss and/or hug a wide variety of acquaintances. Germophobe or not, you’ll always make an assessment of who you are coming in close contact with – they might be paler, down, sweaty… It is no secret that we are much better at recognizing facial features than anything else, and even hand movements (and smell) in such close range are telltale signs.

      There is self-policing or social policing, of course. The long and short of it is: if you can’t kiss/hug anyone for a while, you are sick. If you can’t do it for a long time, you should go see a doctor (if you haven’t seen one yet).

      It would be interesting to see some research trying to connect personal space, self-tracking and chronic condition reporting. I would argue we might see some strong correlations.

      • Susannah Fox says:

        Bernardo, thanks so much for making the jump from Twitter to a longer explanation of your perspective here!

        I would *love* to either conduct this type of research or highlight other people’s work if it exists. Most of Pew Internet’s health research has focused on the social life of information — how people gather, share & create it — but we are increasingly including the context of offline life and what you point out is fascinating.

        Maybe there is someone already part of the QS community making these types of observations?

        • Rupa says:

          We published a paper at the American Medical Informatics Association last year on self-tracking in cancer. Qualitatively, it’s interesting to see what happens when patients with cancer are given a tool to track symptoms while they are in treatment.

          Probing the benefits of real-time tracking during cancer care

          Susannah, you might find some of the references interesting — such as Hermansen’s 2009 survey on self-monitoring by cancer patients and survivors.

          We found similar proportions to the Pew study in our own research. People just don’t realize what tools are out there to help unless they are already in the habit of tracking.

          More than happy to discuss results further!


      • Paul says:

        Hey, Bernardo–
        That’s a really interesting perspective. I’m working on a project about, among other things, data and health care, and would love to hear more about that, if you’d be up for a conversation, or could point me to other resources. Thanks!

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  13. Gary Wolf says:

    I’ve loved reading these comments and discussion. I thought I would add one thought for us to circle back to in the future. What is a “chronic condition?” As wellbeing and general lifestyle topics are increasingly seen as relevant to medicine, the same motives that people with chronic conditions have to self-track may become more widespread than the typical diagnostic frameworks are primed to recognize. When we have curiosity and intentions related to things like mood, energy, focus, empathy: they are not easily subsumed under the category of “chronic conditions,” and yet some of the same impulse to reflect carefully, using data, may apply.

    • Susannah Fox says:

      YES. Chronic conditions are a placeholder category. I’d love to figure out how to measure what you’re describing in future research, whether it’s in a survey or some other method.

  14. Josh Manley says:

    Great article Ernesto and very timely. I just had a conversation yesterday with a doctor who did not believe that tracking was suitable for the older patients in his practice. While I was inclined to agree I suggested we not discount that population before at least engaging them in conversation and attempting a few projects. The next time that comes up, I’ll have a nice statistic to cite and a fresh outlook.

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