The State of Self-Tracking

(Co-written with Gary Wolf)

In January we started asking ourselves, “How many people self-track?”  It was an interesting question that stemmed from our discussion with Susannah Fox about the recent Pew report on Tracking for Health. Here’s a quick recap of the discussion so far.

The astute Brian Dolan of MobiHealthNews suggested that the Pew data on self-tracking for health seems to show constant – not growing – participation. According to Pew, in 2012 only 11% of adults track their health using mobile apps, up from 9% in 2011.

All this in the context of a massive increase in smartphone use. Pew data shows smartphone ownership rising 20% just in the last year, and this shows no signs of slowing down. Those smartphones are not just super-connected tweeting machines. They pack a variety of powerful sensors and technologies that can be used for self-tracking apps. We notice a lot of people using these, but our sample is skewed toward techies and scientists.

What is really going on in the bigger world? How many people are actually tracking?

A few weeks ago ABI, a market research firm, released a report on Wearable Computing Devices. According to the report there will be an estimated 485 million wearable computing devices shipped by 2018. Josh Flood, the analyst behind this report indicated that they estimated that 61% of all devices in wearable market are fitness or activity trackers. “Sports and fitness will continue to be the largest in shipments,” he mentioned “but we’ll start to see growth in other areas such as watches, cameras, and glasses.”

One just needs to venture into their local electronics retailer to see that self-tracking devices are becoming more widespread. So why are our observations out of synch with the Pew numbers?

The answer may lie in the framing of the Pew questions as “self-tracking for health?” For instance:

On your cell phone, do you happen to have any software applications or “apps” that help you track or manage your health, or not?

Thinking about the health indicator you pay the most attention to, either for yourself or someone else (an adult you provide unpaid care for), how do you keep track of changes? Do you use paper, like a notebook or journal, a computer program, like a spreadsheet, a website or other online tool, an app or other tool on your phone or mobile device, a medical device, like a glucose meter, or do you keep track just in your head?

We think it is likely that many practices we include in our definition of Quantified Self are not being captured by the Pew Research. A person who tracks a daily run with a Garmin GPS watch might show up in the wearables data that ABI looks at, and might look to us as a self-tracker for health, but might be invisible to Pew. There may be even self-tracking practices that fall outside health or wearables. We’ve seen a large number of people who track time and productivity using computer applications such as RescueTime, apps that support well-being such as meditation trackers, mood trackers, and diet trackers; and apps that support general self-reflection and journaling, such as a life-logging app. Many self-tracking practices do not fit neatly into “health.” (Though they may influence health!)

In a way, there is a parallel here to what we found when we compared Fitbit with Fuelband data. Both of them produced different numbers for “steps.” When we got into the details, we ended up thinking that this was not a matter of one being closer to the “ground truth,” but of intentionally different interpretations of messy accelerometer data. Fitbit gives more step credit for general movement, because it is a lifestyle/activity tracker; Nike might prefer to credit intentional exercise, since the Nike brand sits closer to sports. Context matters.

This confusion about what is health tracking, what fits in the frame, is closely analogous to many other confusions in the conversation about health generally. It is common now in the healthcare world to talk about how the larger determinants of public health are outside the control of the healthcare industry; for instance, diet, exercise, stress, and exposure to environmental toxins. Sometimes people who make these observations follow them with a call for the healthcare industry to begin addressing these larger concerns; for instance, to “medicalize” tracking apps by making them prescribable and reimbursable by health insurers.

But maybe this isn’t the only approach. If the “healthcare” frame isn’t adequate to capture the most important determinants of health, we could try switching frames. What our journey through the self-tracking data suggests is that the opposite approach might be useful to consider: start with the bigger world of self-care practices, and enhance these. Why? Because that’s where we trackers already are. That is, how are we deriving meaning from self-tracking? That’s the mental framework that we typically use, and that we like to use. That’s where the growth – in terms both of us, and of cultural understanding, engagement, and knowledge-making – might really be happening.

We don’t know this for sure. We take the Pew data as evidence that this approach is worth trying.

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12 Responses to The State of Self-Tracking

  1. Susannah Fox says:

    Hi guys!

    As I wrote in a comment on the January post, use caution in comparing studies. I stand by my own “soft” comparison to our 2010 self-tracking study AND the Pew Research trend data on health apps, but note that these are two separate questions. In one part of the survey, we asked about health apps — not just tracking ones, but any kind. In the tracking part of the survey, we asked about methods — paper, spreadsheet, medical device, website, etc. This was the first time that anyone (to my knowledge) has asked this question in a nationally-representative survey:

    Q26 Thinking about the health indicator you pay the MOST attention to, either for yourself or someone else, how do you keep track of changes? Do you use… [READ 1-6]
    Based on those who track a health indicator for themselves or others [N=2,183]
    CURRENT
    % 34 Paper, like a notebook or journal
    5 A computer program, like a spreadsheet
    1 A website or other online tool
    7 An app or other tool on your phone or mobile device
    8 A medical device, like a glucose meter
    49 Or do you keep track just in your head?
    2 (VOL.) Other (SPECIFY)
    2 (VOL.) Don’t know
    1 (VOL.) Refused
    Note: Total may exceed 100% due to multiple responses.

    Do you think someone who uses wearables would not hear an option that they’d say yes to? If so, let’s work on an update to the question for the next time we field it so we capture that (probably small, but growing) segment.

  2. Susannah Fox says:

    I realized that I should also post the screener questions for the tracking section. You had to answer yes to at least one of the following to get the methods question:

    Q24 Now thinking about your health overall… Do you currently keep track of your own weight, diet, or exercise routine, or is this not something you currently do?
    CURRENT
    % 60 Yes, keep track
    39 No, not something R currently does
    * Don’t know
    * Refused

    Q25 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?
    CURRENT
    % 33 Yes
    67 No
    * Don’t know
    * Refused

    CARE10 Turning again to the UNPAID care you provide to family, friends or others… Do you happen to keep track of any health indicators or symptoms for any of the people you care for?
    Based on all caregivers [N=1,171]
    CURRENT
    % 31 Yes
    69 No
    * Don’t know
    * Refused

    I’m interested in suggestions for broadening these questions to be sure we are picking up everyone who tracks (note that 7 in 10 US adults are picked up by the 3 questions above though! That’s a big group already.)

  3. Gary Wolf says:

    Thank you Susannah – these are important comments. We asked exactly the same question of ourselves: Could we imagine a person fielding these questions, and saying “no” to websites, apps, and medical devices while actually wearing, say, a running watch? I trust the Pew data very much, so if there is a mystery here it has to be about the frame, the mental context of respondents as they interpret the question. I looked up how many insulin users there were in the US, and got an estimate of more than 4.5 million. It seems likely that most people who are taking insulin are doing some tracking of blood glucose levels. In my reading of the Pew results, this means there are more insulin users than the total number of people tracking themselves using a medical device, including a glucose meter. I realize it’s quite possible I’ve made a mistake here, and I’m glad to know what it is, because I’m being forced to imagine somebody on the phone telling an interviewer than they don’t use any medical devices to track themselves, and then hanging up and pricking their finger. Can that be what’s happening?

    • Susannah Fox says:

      The best compliment to our research is engagement, so let me say again that Pew Research in general (and I, in particular) appreciate hearing from experts like you and the QS community. Pew Research offers a mirror and a window for people to see themselves or to look at another group, using data.

      I am not an expert on diabetes management – is it possible that there are people who are not adequately tracking their data? Or who are not using any technology to do track it?

      As for wearables, such as the running watch example, I wonder if we are measuring the population who not only wears the watch but uses it in a meaningful way — meaningful enough that they’d answer “yes” to our survey questions. The ABI report might be measuring the population who has bought the watch but may or may not wear it or be using it in a way that triggers that “yes” answer when asked if they track their exercise routine. In other words, actual vs. aspirational.

  4. Gary Wolf says:

    Thanks Susannah – actual vs. aspirational is promising, I think. And, with some thought, there might be a way to formulate a question that would get to this. In my own self-tracking I find myself experimenting a lot, and most of the things I do end up NOT being very meaningful. I’m asking myself how I would answer a question if I were in this phase of “maybe” with a practice or device….

  5. Rajiv Mehta says:

    Seeing Gary’s observation about the discrepancy between the number of glucometers (apparently) being used vs the number of people who say they are “tracking”, reminded me again about a distinction I make between short-term tracking and long-term tracking.

    Long-term tracking has to do with analyzing a data series to see what you can learn, presumably to make some improvement to whatever is being tracked. This is what “tracking” seems to mean when the term is used by the QS community, Pew, etc. And also what the I imagine a lay person would think “tracking” means.

    Short-term tracking has to do with getting and using a data point in-the-moment, to make a decision. I would not be surprised if this is what most glucometer users are doing. They get a reading, and then decide how much or what to eat, whether to inject or not, etc. They are just “using” their glucometer; they’re not “tracking” their glucose levels. The glucometers make it possible to save and then later to study the user’s glucose patterns, but perhaps many people never do that. So, they don’t consider themselves trackers. And, I think in the spirit of Susannah’s question #26 perhaps they are not.

    In my own product efforts (Zume Life, then Tonic, now Unfrazzle) I focus on helping people with short-term tracking — to make the everyday care tasks easier. The fact that the tools then end up creating a very useful long term track of analysis and learning is an important, but secondary, benefit. I would not be surprised if most of the users of my products would not consider themselves trackers.

  6. Gary Wolf says:

    I think Raj’s theory is a good one. To me QS means everything from momentary feedback to cognitively demanding analysis of long-term data, but I’ve also noticed that the quick “hit” of a number to make a decision does not necessary register as “tracking.”

  7. Susannah Fox says:

    Hi all,

    We have now posted detailed demographic tables in an Appendix to the “Tracking for Health” report:

    http://www.pewinternet.org/Reports/2013/Tracking-for-Health/Appendix/Detailed-demographic-tables.aspx

    I wrote a quick post to explain a few items and am hoping to lure some of the commenters on my blog here since they are sharing interesting insights about older adults in Canada and the current state of tracking in Greece:

    http://susannahfox.com/2013/03/20/tracking-for-health-detailed-demographics/

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  10. Bob Fenton says:

    This is an interesting discussion. I think there is a lot of resistance to tracking health data or medical data on mobile devices. This may help explain part of the slow growth – http://patients.about.com/b/2012/03/09/beware-of-app-wolves-in-app-sheeps-conflict-of-interest-clothing.htm?nl=1
    The conflict of interest has caused one friend to stop using his mobile app because of insurance problems.

    This is one reason I will not use a mobile app. Those of us with diabetes do track our blood glucose numbers whether we know it or not. All meters hold the readings for 90 plus days or even longer. Some clinics and doctors have the software to download the data and all owners of meters can contact the manufacturer and purchase the cable and program to download the data to a computer.

    I do and use mine. I also record (log) my readings to paper and then transfer the information to a spreadsheet for analyzing the data as well. I also record daily food logs, daily health logs, and lab results received from my doctors. I have friends that use databases for the same activity.

    I am now writing out my replies or comments because of CAPTCHA code problems. I am tired to typing everything out and then miss guessing one letter and seeing everything disappear.

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