Factors associated with longitudinal survey adherence and smartwatch usage among older adults in the electronic Framingham Heart Study

Sustaining long-term adherence to digital health protocols remains a major challenge, and factors influencing sustained use of digital devices among older adults are poorly understood. We identified sociodemographic, health-related, and technological factors associated with longitudinal adherence to smartphone-based surveys (32 weeks) and smartwatch usage (52 weeks) among 611 older adults (median age 74 years, 57% women) in the electronic Framingham Heart Study, using multivariable mixed-effects regressions and longitudinal K-means clustering. Younger age (≤ 75 years), iPhone use, and lower depressive symptom scores were associated with higher survey response rates, whereas higher education, better diet quality, and lower medication counts were associated with higher smartwatch usage among the 405 smartwatch users.

Cluster analysis identified three trajectories for each outcome: consistently high adherence or usage (63% and 67%, respectively), initially high with progressive decline (12% and 15%), and low initial adherence or usage with rapid decline (25% and 18%). Cluster characteristics reinforced the regression findings. These results identify smartphone type, age, depressive symptoms, education, diet quality, and medication use as key factors associated with digital health adherence among older adults, and they inform tailored strategies to promote sustained participation, particularly among older participants and those with greater health burdens.

The electronic Framingham Heart Study is supported by R01AG076757 and R01-HL141434. The Framingham Heart Study is supported by the National Heart, Lung, and Blood Institute at the National Institutes of Health (contracts N01-HC-25195, HHSN268201500001I, 75N92019D00031, and 75N92025D00012). Benjamin was supported in part by National Institutes of Health, The National Heart, Lung, and Blood Institute R01HL092577.

The investigators thank the Framingham Heart Study participants. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA Yuankai Zhang, Xuzhi Wang, Chathurangi H. Pathiravasan, Jie He & Chunyu Liu Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA Center for Behavioral Science Research, Boston University Henry M.

Goldman School of Dental Medicine, Boston, MA, USA Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA, USA Section of Cardiovascular Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA The authors declare no competing interests. This study was reviewed and approved by the Boston University Medical Campus Institutional Review Board (H-36586, H-40737, and H-32132). All participants provided electronic informed consent for their participation in the eFHS.

Data were deidentified for analysis. Participants were not compensated for participating in the study. All methods in this study were performed in accordance with the relevant guidelines and regulations.