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Acceptability of the Fitbit in behavioural activation therapy for depression: a qualitative study

Abstract

Introduction Major depressive disorder is characterised by low mood and poor motivation. Literature suggests that increased physical activity has positive effects on alleviating depression. Fitness-tracking devices may complement behavioural activation (BA) therapy to improve physical activity and mental health in patients with depression.

Objectives To understand patients’ perceived benefit from the Fitbit and explore themes associated with patient experiences. To compare perceived benefit, patient factors, Fitbit usage and Beck’s Depression Inventory (BDI) scores.

Methods Semistructured interviews were conducted with patients (n=36) who completed a 28-week BA group programme in a mood disorders outpatient clinic. All patients were asked to carry a Fitbit One device. We conducted thematic analyses on the interviews and exploratory quantitative analyses on patient characteristics, Fitbit usage, steps recorded, perceived benefit and BDI scores.

Findings Twenty-three patients found the Fitbit helpful for their physical activity. Themes of positive experiences included self-awareness, peer motivation and goal-setting opportunities. Negative themes included inconvenience, inaccuracies and disinterest. Age, baseline and change in BDI scores, prior physical activity goals and familiarity with technology were not associated with perceived benefit from the Fitbit or usage. Perceived benefit was significantly (p<0.01) associated with usage.

Conclusions Overall, the Fitbit is an acceptable tool to complement BA therapy for patients with depression. Many positive themes were concordant with current literature; however, patients also reported negative aspects that may affect use.

Clinical implications Clinicians and researchers should consider both strengths and limitations of activity trackers when implementing them to motivate patients with depression.

Trial Registration Number NCT02045771; Pre-results.

  • mental health
  • qualitative research
  • adult psychiatry

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors JC, MSK and ZS conceived and designed the experiments. JC, MSK, LZ, MB, DC and SY interviewed the participants and collected data. KL, KM, JW, LG, LO, SG, CM and YP recruited the patients, conducted the baseline interviews, developed Fitbit use manual and instructed the patients on Fitbit use. JC and MSK analysed the data and wrote the first draft of the manuscript. JC, MSK and ZS jointly developed the structure and arguments of the paper. All authors reviewed and approved the final manuscript.

  • Funding ZS (PI) was supported by Canadian Institutes of Health Research (CIHR) (Randomised Controlled Trials: Mentoring, code number 201303MTP-303860-182743) to conduct the BRAVE study. CIHR mentorship award (2013–2015) is to support PI research time.

  • Competing interests None declared.

  • Ethics approval The study was approved by the Hamilton Integrated Research Ethics Board (HIREB).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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