Ernesto Ramirez

March 14, 2013

(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.