Determining the Constituents for the advancement of

Healthcare Wearable Technologies in Oman

Abstract
Globalization and the revolution have led the technological companies to come up with very special devices
that are wearable and multi-functional. In the healthcare industry, the use of smart technology such as
wearable devices is increasing and gaining much interest. The wearable devices are used to measure, record,
and analyze patients’ data and provide necessary advice and guidance through alert messages. These
devices have been extensively studied and implemented, but the usage of these smart devices in Oman is
limited.
This research consisted of conducting an empirical study on identifying the constituents affecting the
advancement of healthcare wearable technologies in Oman.
Stakeholders from different profiles and age groups participated in the study. The total number of relevant
responses obtained being 149 through-tailored survey. The study identifies infrastructure, perceived
usefulness, and experience as important determinants in the usage, effectiveness, applicability, and future
prospects of wearable technologies in the healthcare sector.

Keywords: wearable technologies; wearable technologies acceptance; healthcare wearable technologies;

wearable devices; technology acceptance; healthcare technology; mobile technology; health monitoring.

1. Introduction
The past decade has witnessed many technological breakthroughs, resulting in strong demand for new and
highly developed technologies in all fields. The high demand for digitalized information has made it
necessary to design and suggest new devices embedding the latest technologies that can help in
communication and information management. The ICT (Information and Communication Technology) in
health have reduced time and cost of treatment (Ker et al., 2018)

Connectivity, wireless capabilities, Internet availability, and high speed make it possible to interconnect
various wearable healthcare devices and applications with specific systems and servers as one of the various
aspects of what is called today the Internet of Things (IoT). The demand of the u-health (ubiquitous health)
and p-health (pervasive health) technologies have increased. The use of smart devices for health information
and health promotion has grown rapidly (Willoughby and Liu, 2018). It is predicted that global healthcare
smart wearable healthcare (SWH) devices market will rise to 25 Billion by 2020 (Papa et al., 2018).

As defined by (Fotiadis et al., 2006) a wearable healthcare device is “a device that is autonomous, that is
noninvasive, and that performs a specific medical function such as monitoring or support over a prolonged
period of time”.
There are a variety of wearable devices for self-quantification of diet, exercise, sleep, medication, mood,
blood pressure, body temperature and environmental exposure (Gray and Gilbert, 2018). The wearable
devices can be smart band, Lark sleep sensors, eyeglasses, clothing, contact lenses, shoes, necklaces, smart
watches, sensors etc. Smart eyewear has enabled to replace the traditional eyeglasses (Wang and Hsieh,
2018). The smart healthcare-enabling technologies are of two types: on-body (wearable) and off-body
products (Mou and Shin, 2018). These smart devices have collect, receive, process, manage and transmit
data, thereby helping the doctors in early diagnosis and accurate decision.

The developing countries can enhance their healthcare and lower its cost by using smart sensors, the Internet
of Things (IoT), cognitive computing, medical image processing, and lab-on-chips technologies (Raza et
al., 2017). Smart devices based weight loss has a lot of scope (Ayisi Addo and Steiner-Asiedu, 2018,
Turner-McGrievy et al., 2017). Although ICT in health a has number of opportunities to improve the
quality, efficiency, outcomes, patient safety and cost reduction, it has remained unutilized in many countries
(Ahlan and Ahmad, 2014, Merhi et al., 2018) due to perceived value, perceived threat, organizational
support, self-efficacy, and system circumvention availability (Samhan and Joshi, 2017). There are very few
studies on the acceptance of wearable technologies and most of the studies are focusing on application and
usage of smart glasses, smart clothing, smartwatches, or fitness trackers (Tuzovic et al., 2017). The middle
income countries can have significant advantages of smart health provided successful implementation
strategy (Kumar et al., 2016). Therefore, this study, to the best of knowledge, is the first of its kind on
wearable technologies use in the healthcare sector in Oman.

This paper is structured as follows. There are seven sections. Section 2 explains the research methodology
used. Section 3 is about literature review. Section 4 presents the wearable technologies constituents and
hypothesis. Section 5 is about survey design and data processing. Section 6 discusses and presents a detailed
discussion. Finally, section 7 summarizes the major findings and future work orientation.

2. Research method
The research method used in this study consists of five steps as shown in Figure1. Firstly, a literature review
was conducted searching databases of google scholar, science direct, springer, and ‘IEEE Explore’ to
identify and explore relevant articles published in the period of 2010 to 2019.
The keywords considered and used during the search consisted of “(wearable technology OR wearable
devices) AND (healthcare OR medical) AND (advancement OR challenges OR issues OR factors)”. The
articles published in indexed journals, indexed conferences, and book chapters relevant to the topic were
considered.

The literature review step is followed by a set of hypotheses on important constituents affecting the
acceptance and implementation of wearable technologies in healthcare inside Oman. A survey was designed
and distributed in Oman to validate the developed hypotheses.

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 Step4: Survey Step5: Data
Step1: Literature Step2: Hypothesis
instruments design processing and
review development
and data collection Hypothesis testing

Fig 1. Research method

3. Literature review

Every day new products are entering the healthcare field. Many researchers have discussed the use of
different types of wearable devices in healthcare. The virtual environment has a lot of scope for
administering healthcare services (Suh and Prophet, 2018, Jafar et al., 2015). The wearable device benefits
include, but are not limited to real time data (Awolusi et al., 2018). In diabetes, body sensors, wearable
monitors, and other specialized devices are used to get real time data (Miah et al., 2017). The sensor base
technologies can be flex, accelerometer, vision-based, stretch sensor, and magnetic sensor-based for the
rehabilitation of joints (Rashid and Hasan, 2018, Banerjee et al., 2018). ICT in the healthcare systems has
been helpful in the management of chronic diseases, health professional staffing, travel time reduction, and
shorter hospital stays (Kasemsap, 2018). Android-based wearable devices are used for collecting
information about patients, analyzing it and using it for helping the patient to sustain better health. There
are various examples and instances where wearable devices are supporting the healthcare system. Table 1
shows the benefits of wearable technologies.

Table1. Wearable technology benefits in healthcare

Researcher Highlighted benefits
(Zhao et al., 2019) Sensors for gesture recognition
(Abtahi et al., 2018) E-textile IoT system to quantify gait abnormalities
(Lapierre et al., 2018) Sensors are used in fall detection
(Almobaideen et al., 2017) Wearable technology for tourist to selects a route with medical centers.
(Latif et al., 2018) Handling of non-communicable diseases.
(Seshadri et al., 2017) Wearable technology for measuring patients’ blood pressure.
(Nanda, 2017) Wearable technology to measure electrocardiograph (ECG)
(Kuo et al., 2016) Smart sensors and intelligent devices for old age people.

According to (Harrison et al., 2015) the healthcare environment in many countries suffers from poor
compliance with technology, safety devices, entertaining tools or therapy devices. The Asian countries are
facing many challenges in deploying wearable technologies (Ezenwoke and Ezenwoke, 2016). They need
to plan for cheaper healthcare by using technology (Paul and Das, 2017). The doctors’ (Pediatrics) intention
to adopt tablets in health system is influenced due to compatibility, reliability, perceived usefulness, and
perceived ease of use (Ducey and Coovert, 2016). The main challenges in the implementation and

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acceptance of wearable technologies include financial feasibility, infrastructure, access, equity, and quality;
knowledge and research evidence; leadership and governance; security and interoperability; and social and
technological environments (Ariani et al., 2017). The challenges of M-Health include funding, literacy
barriers, power breakdown, data security, and privacy (Brian and Ben-Zeev, 2014). The M-Health has not
been evaluated in terms of security and awareness (Iwaya et al., 2013). Trust, awareness, and security
affects smart healthcare product acceptance (Mou and Shin, 2018).
There are few empirical studies on wearable technologies in healthcare and very few explored the
constituents affecting the acceptance (Papa et al., 2018). Table 2 shows the important constituents found in
literature affecting wearable technologies acceptance in different parts of the world.

Table2. Wearable technologies acceptance challenges in healthcare

Researcher Year Wearable technology Identified challenges
under study
(Papa et al., 2018) 2018 Smart wearable Intrusiveness and comfort have no
healthcare (SWH) significant on BI (Behavior Intention) SWH
devices devices.
Intrusiveness have a significant impact on
perceived usefulness and ease of use.
(Lee and Lee, 2018b) 2018 Wearable fitness Consumer attitudes, personal
tracker innovativeness, and health interests.
(Hogaboam and Daim, 2018 Wearable sensor Patient perspective (Patient experience,
2018) products for pervasive Clinical benefits for Patients,
care in neurosurgery Privacy/security), technical (Ease of data
and orthopedics access, Interoperability, Usefulness,
Reliability, Physician’s ease of use), and
financial (Cost of acquisition, economies of
scale, Cost of maintenance) factors
(Abandu and Kivunike, 2018 Health apps on e-health knowledge; trust; ICT skills;
2018) smartphones. accessibility; support; awareness;
knowledge sharing and compatibility
(Zhang et al., 2017) 2017 Wearable technologies Technical attributes, health attributes, and
consumer attributes.
(Ray et al., 2017) 2017 Wearable system-based Clinical inertia, communication network
cancer detection limitation, lack of awareness, and high cost
(Pelegrín-Borondo et 2017 Technological implants Perceived usefulness, perceived ease of use,
al., 2017) (e.g., memory and past experience positive with the use of
implants). the technology
(Nanda, 2017) 2017 Wearable technologies Lack of product experience, minimal
market influence, health awareness, low
trust level and low usage of smart phones
affect their level of awareness, and
ultimately motivation to accept and use
them

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 (Marakhimov and Joo, 2017 Wearable technologies Privacy, accuracy and reliability of health
2017) information

(Cho, 2016) 2016 Health apps on Perceived usefulness, perceived ease of use,
smartphones. confirmation, and satisfaction.
(Lunney et al., 2016) 2016 Wearable fitness Perceived usefulness, perceived ease of use,
technologies (WFT) previous experience related to wearable
devices use
(Li et al., 2016) 2016 Wearable technologies Risk–benefit analyses such as high benefits
of less risk and more privacy and assurance
(Nelson et al., 2016) 2016 Smart wristbands- Attractiveness, feedback, privacy
activity trackers protection, readability,
and gamification

4. Wearable technologies acceptance constituents and hypotheses designing

In the literature, several factors have been identified as being related to wearable technologies acceptance
an implementation. A critical analysis of the literature results in nine important constituents. These are age,
gender, individual profile, previous experience, perceived usefulness, technological infrastructure, external
support, data security and privacy, and data accuracy. Figure 2 shows the diagrammatic presentation of
these constituents. The signs “+”, “-”, “0” indicate the positive impact, negative impact, or no impact,
respectively.

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 Data accuracy
H9 (+)

Data security,
Age H1 (+) and privacy H8
(-)

-
External
Gender
support
H2 (0)
Wearable H7 (+)
technologies
implementation
and acceptance

Technlogical
Profile
infrastructure
H3 (0)
H6 (+)

Previous Perceived
experience usefulness
H4 (+) H5 (+)

Fig 2. Constituents of wearable technologies in healthcare

There are nine hypotheses, H1 to H9, that have been designed to evaluate the identified constituents. These
hypotheses are as described below:

H1: Age has a positive influence on the acceptance of wearable technologies in healthcare.
The younger generations are more likely to adopt wearable technologies in healthcare than to older ones.
ICT usage in the health system depends upon the age (Zhao et al., 2017). Despite widespread use of
technology the acceptance among the older generation is very low (Hoque and Sorwar, 2017, Magsamen-
Conrad et al., 2015, Van Volkom et al., 2013). Old people are less used to digital devices such as smart
phones, smart watches and therefore a digital divide exists between generations.

H2: Gender has no influence on the acceptance of wearable technologies in healthcare.

The gender difference (between male and female) is less likely to influence the acceptance of wearable
technologies in healthcare. Gender has no influence on smartwatch acceptance in the consumers market
(Wu et al., 2016).

H3: Individual profile has no influence on the acceptance of wearable technologies in healthcare.
The user’s profiles are less likely to influence the acceptance of wearable technologies. The users profile
such as student, manager, shopkeeper etc. have no influence on wearable technologies acceptance.

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H4: Previous experience positively affects the acceptance of wearable technologies in healthcare.
The experience and awareness of wearable technologies among the users has a positive impact on the
acceptance. Continuous use of health monitoring devices brings a change in attitude towards the technology
(Shaw et al., 2018). One of the problems in the use of wellness apps is the lack of experience and guidance
(Pais et al., 2017). The more experience a user has in wearable technologies the more likely it is that he will
adopt their use in healthcare.

H5: Perceived usefulness positively affects the acceptance of wearable technologies in healthcare.
Users of wearable technologies in healthcare, on perceiving the benefits, will be motivated and more likely
to adopt wearable technologies. The perceived usefulness drives users to adopt Online Fitness Community
(OFC) platforms (e.g., Fitbit, Strava, RunKeeper) (Stragier et al., 2016). The use of wearable fitness trackers
among people is mostly influenced by awareness besides attitude, innovativeness, and health interests (Lee
and Lee, 2018a).

H6: Technological infrastructure positively affects acceptance of wearable technologies in healthcare.

The infrastructure is very important in the acceptance and usage of wearable technologies in healthcare.
The poor infrastructure desists people in using the wearable technologies (Watkins et al., 2018). The
availability of the internet, battery backup and continuous support will positively affect wearable
technologies acceptance in healthcare. The implementation require more planning and effort in utilizing
whatever resources are at hand (Rehman et al., 2017).

H7: External support (i.e. government initiative, management support) positively affects the acceptance of
wearable technologies in healthcare.
Governments should help the healthcare organizations, especially the public ones, to use wearable devices
and provide them at affordable and reasonable. Investment is needed in wearable technologies (Levine,
2017). The government may make partnership with Non-Governmental Organizations (NGO) for the
successful implementation. The NGOs are effective and useful in realizing and understanding the most
suitable cultural context for using wearable devices. The top management support is essential for the
diffusion of ICT in healthcare (Alsyouf and Ishak, 2018). The end users will not adopt wearable
technologies in healthcare unless the government and hospital management provide support in terms of
training, workshops, and incentives.

H8: Data security, and privacy negatively affects acceptance of wearable technologies in healthcare.
One of the important features of wearable technologies in healthcare is remote accessibility and storage of
patients’ data. These data might be stored on a centralized server or on interlinked computers. The
unauthorized access to patients’ data is a serious concern, so that any breach of data will negatively affect
wearable technologies in healthcare. The privacy issue plays a critical role in health technology acceptance
due to the sensitivity of health information (Gao et al., 2015, Li et al., 2016). It is central to wearable
technology acceptance in healthcare (Adapa et al., 2018). The privacy concern arises due to the sharing of
patient data with third parties such as insurance companies.

H9: Data accuracy and reliability positively affect acceptance of wearable technologies in healthcare.
The end users are less likely to adopt wearable technologies in healthcare in case of inaccurate data, faulty
devices, and devices with bugs. The smart devices should provide accurate data as it is required for the

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social acceptance of wearable technologies in healthcare (Dehghani, 2018). A credible smart phone-based
health system is acceptable (Shin et al., 2017).Trust and ease of use has had a significant impact on the use
of ICT in healthcare in Bangladesh (Hoque et al., 2017).

5. Survey design and data collection

A survey was designed with eight sets of questions to validate the hypotheses. Some of the questions were
divided into sub-questions. The survey questions were of three types; multiple-choice questions, Likert
scale, and open-ended. The survey questions and corresponding hypotheses are attached in Appendix A.
The survey was initially pilot-tested and modified before the actual data collection. The survey was
developed using Google forms and distributed online among the stakeholders. The total number of complete
responses obtained with no duplicate was 149. The responses were then coded and SPSS 2.1* was used for
data analysis.
* https://www.ibm.com/analytics/spss-statistics-software

6. Results and discussion

The analyzed survey consisted of 61% male and 39% female respondents. The Cronbach's Alpha was found
to be 0.842 while the Cronbach's Alpha based on standardized items is 0.890. A Cronbach's Alpha value
above 0.70 is acceptable, so the items used in the survey have relatively high internal consistency. Table 3
shows the descriptive statistics of gender, age, profile, WT (Wearable technology) experience, and WT use
in the future.

Table 3. Descriptive statistics

Variables Mean Std. Deviation N

Gender 0.41 0.493 149
Age (in years) 2.88 1.542 149
Profile 3.77 2.629 149
WT experience 3.03 1.294 149
Willingness to use WT in future 1.20 0.604 149

A standard multiple regression analysis was carried out using willingness to adopt WT with respect to
predictor variables (i.e. gender, age, profile, WT experience). Table 4 shows the results of multiple
regression analysis.

Table 4. Regression of WT willingness on the predictor variables

Variables B Beta
Constant 0.573
Gender 0.066 0.054
Age -0.030 -0.076
Profile -0.005 -0.021
WT experience 0.233* 0.499
R = .520a, R2 = .271, Adjusted R2 = .250, *p<.05; Predictors a: (Constant), gender, age, profile, WT experience

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The multiple regression coefficient is 0.27 which means that 27% of the variance that exists in the
willingness to adopts WT is accounted for by the predictors variables of gender, age, profile and WT
experience. Furthermore, the higher Beta value of WT experience (0.499) shows that the more experience
of WT people have, the more likely they are to adopt WT in healthcare in Oman. This confirms the
truthfulness of H4. The impact of gender, age, profile, and WT experience on WT acceptance was assessed
by using Pearson’s correlation coefficient. Table 5 shows the output. The notation “1”, “2”, “3”, “4”, and
“5”, represents gender, age, profile, WT experience, and the willingness to adopt it, respectively.

Table 5. Pearson’s correlation coefficient

Variables 1 2 3 4 5
1. Gender - - - - -
2. Age - - - - -
3. Profile - - - - -
4. WT experience -0.07 -0.164* -0.183* - -
5. WT willingness to adopt 0.02 -0.16 -0.11 0.512** -
Note: N=149, *p<.05, **p<.01,
*. Correlation is significant at the 0.05 level (2-tailed),
**. Correlation is significant at the 0.01 level (2-tailed).

The Pearson’s correlation coefficient corresponding to gender (0.02), age (-0.16), and profile (-0.11) are
not significant at either 0.05 or 0.01. The gender (i.e. male or female) has no impact on WT acceptance (H1
confirmed). The variable age is negatively related to WT experience, the older people having had less
experience in using WT, are less likely to adopt it (H2 confirmed). The users’ profile have little impact on
WT acceptance (H3 confirmed). Table 6 shows the results of Likert scale questions related to the usefulness
of WT in healthcare.

Table 6. Pearson’s correlation coefficient between perceived usefulness and willingness to adopt WT
6a 6b 6c 6d 6e 6f 6g
6a. Monitoring health issues using WT - - - - - - -
6b. Clinical decision-making using WT - - - - - - -
6c. Information management using WT - - - - - - -
6d. Time management using WT - - 0.725** - - - -
6e. Healthcare cost reduction using WT - - 0.550** - - - -
**
6f. Remote monitoring using WT - - 0.617 - - - -
** **
6g. Epidemic outbreak tracking using WT - - 0.541 - - 0.615 -
8. Willingness to use WT in future? 0.259** 0.01 0.400** 0.464** 0.15 0.297** 0.13
Note: N=149, *p<.05, **p<.01, *. Correlation is significant at the 0.05 level (2-tailed),
**. Correlation is significant at the 0.01 level (2-tailed).

While people like to adopt WT because of usefulness in monitoring health issues, information management,
time management, and remote monitoring of health, they are less likely to adopt it due to perceptions of
clinical decision-making, epidemic outbreak tracking, and cost reduction. They believe that WT does not

9
bring a reduction in cost. This assumption is true because WT development is still evolving. Thus, H5 is
partially accepted. The WT in healthcare has a number of constraints. Some of these, to be found in the
literature, were assessed in Oman. Table 7 shows the list of constraints and corresponding Pearson’s
correlation coefficient obtained from the data analysis.

Table 7. Pearson’s correlation coefficient between constraints and willingness to adopt WT

7a 7b 7c 7d 7e 7f 7g
7a. Internet availability constraint for WT
7b. Battery backup constraint for WT - - - - - - -
7c. Training and workshops for awareness - - - - - - -
constraints for WT
7d. Government initiatives constraints for 0.371** - 0.518** - - - -
WT
7e. Management support constraint for WT 0.414** 0.566** 0.600** 0.763** - - -
** **
7f. Data security and privacy constraint for - - - 0.467 0.530 - -
WT
7g. Data accuracy and reliability constraint - - - - 0.550** - -
for WT
8. Willingness to use WT in future? 0.259** 0.179* 0.15 0.12 0.11 0.205* 0.16

Note: N=149, *p<.05, **p<.01, *. Correlation is significant at the 0.05 level (2-tailed),
**. Correlation is significant at the 0.01 level (2-tailed).

In Oman, technological infrastructure (i.e. internet availability and battery power) is highly significant in
WT acceptance (H6 accepted). The external support (i.e. government initiative, management support) is
not significant either at 0.01 or 0.05 correlation coefficient in the acceptance of wearable technologies in
healthcare (H7 rejected). The data security and privacy is of a concern among the WT users (H8 accepted).
The WT is new to most people, so they are more concerned about privacy issues. The recent developments
of cryptographic-based healthcare system could eliminate the concerns (Omotosho et al., 2017).The data
accuracy and reliability are not related to WT acceptance in healthcare. Table 8 shows the outcome of the
study.

Table 8. Outcome of the study

Constituents Positive Negative Neutral
Age Accept - -
Gender - Accept
Individual profile - - Accept
Previous experience Accept - -
Perceived usefulness Partially accept - -
Technological infrastructure Accept - -
External support Reject - -
Data security and privacy - Accept -
Data accuracy and reliability Reject - -

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7. Conclusion

People are now seeking higher technology and wishing to use wearable smart devices in order to maintain
contact virtually with their doctors and take advice virtually due to the lower cost, and the fast and flexible
service. Wearable technologies present many opportunities in the healthcare sector because of their multi-
functional and multi-tasking characteristics. The acceptance of these devices is still a challenge. This study
identifies important constituents affecting the acceptance of wearable technologies in Oman. It has been
observed that previous experience, age, technological infrastructure, and security and privacy concerns
affect wearable technologies’ acceptance significantly. Perceived usefulness has been found to be partially
significant. The gender, profile, external support, and data accuracy and reliability has low significance on
wearable technologies’ acceptance in Oman.
The study has covered only the most important factors identified through the literature; however, a future
study will cover the more factors. The research outcome is localized to Oman only. Further studies will
cover other Middle Eastern countries such as UAE.

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Appendix A: Mapping between survey questions and the hypotheses
Survey Questions
1. Please, indicate your gender
2. Please, indicate your age (in years)
3. Please, indicate your profile
4. Which of the following Wearable technologies have
you used?
5. How do you rate your experience in using Wearable
technologies? [Experience in using Wearable
technologies] (Very high=5, High=4, Neutral=3,
Low=2, Very low=1)
6. Do you see the following benefits in the use of
Wearable technologies? (Strongly agree=5,
agree=4, neutral=3, disagree=2, strongly
disagree=1)
[Monitor health issues (e.g., blood sugar, breathing
function, and mood)], [Clinical decision-making],
[Information management], [Time management],
[Healthcare cost reduction], [Remote monitoring],
[Epidemic outbreak tracking].
7. Please rate the importance of following constraints
for successful implementation of Wearable
technologies (Strongly agree=5, agree=4, neutral=3,
disagree=2, strongly disagree=1)
[Internet availability], [Wearable technologies battery
backup], [Training and workshops for awareness],
[Government initiatives], [Management support],
[Data security and privacy (health, or GPS
location)], [Data accuracy and reliability]
8. Are you willing to use Wearable technologies in
future?
9. Please, provide suggestions, which would help in
successful acceptance of Wearable technologies
15
Hypotheses
H1: Age has positive influence on the
acceptance of wearable technologies in
healthcare
H2: Gender has no influence on the acceptance
of wearable technologies in healthcare
H3: Individual profile has no influence on the
acceptance of wearable technologies in
healthcare
H4: Previous experience positively affects
acceptance of wearable technologies in
healthcare
H4: Previous experience positively affects
acceptance of wearable technologies in
healthcare
H5: Perceived usefulness positively affects
acceptance of wearable technologies in
healthcare
H6: Technological infrastructure positively
affects acceptance of wearable technologies in
healthcare
H7: External support (i.e. government
initiative, management support) positively
affects acceptance of wearable technologies in
healthcare
H8: Data security and privacy negatively
affects acceptance of wearable technologies in
healthcare
H9: Data accuracy and reliability positively
affects acceptance of wearable technologies in
healthcare