Behavioural readiness, not demographics, predicts wearable adoption and digital medicine integration in a diverse multinational population: a cross-sectional study of 3,004 adults in Qatar

Whether diverse populations outside Western settings are behaviourally ready to integrate wearable-derived data into clinical care remains poorly understood. This study examines sociotechnical determinants of wearable adoption and digital health data-sharing readiness in a large, highly diverse multinational population in Qatar, a rapidly digitising health ecosystem with advanced eHealth infrastructure.

We conducted a cross-sectional community-based survey of 3,004 adults across Qatar, assessing wearable device use, behavioural engagement, and willingness to integrate wearable-generated data into healthcare workflows. Multivariable logistic regression identified independent predictors of wearable adoption.

Wearable device use prevalence was 34.1%. Behavioural factors were the strongest independent predictors of adoption: daily exercisers had more than four times the odds of wearable use compared with rarely active participants, and willingness to share data with healthcare providers was independently associated with adoption after full adjustment. Notably, education level was not independently associated with wearable use, suggesting that behavioural readiness outweighs traditional socioeconomic indicators as a determinant of digital health engagement. Older age (≥56 years) and African ethnicity were associated with lower adoption odds, highlighting persistent digital inequities.

These findings challenge the assumption that digital health equity is primarily an education or access problem, repositioning it as a behavioural engagement challenge. Health systems scaling remote monitoring programmes should prioritise identifying behaviourally engaged subpopulations rather than relying solely on demographic targeting. Targeted digital engagement strategies addressing older adults and underrepresented ethnic groups are essential for equitable implementation of digital medicine.

Author Summary

Wearable health devices - such as fitness trackers and smartwatches - are increasingly being considered not just as consumer gadgets but as tools that could help doctors monitor patients continuously between clinic visits. For this to work at a population level, we need to understand who is actually using these devices and why. Most research on this question has come from Western countries, leaving large gaps in our understanding of more diverse, rapidly developing health systems.

We surveyed 3,004 adults living in Qatar, one of the most culturally and linguistically diverse countries in the world, and found that about one in three people already uses a wearable health device. More importantly, we found that the strongest predictors of who uses these devices were not education level or socioeconomic status, as is commonly assumed, but rather behavioural factors: how often someone exercises, and whether they are willing to share their device data with a doctor. Daily exercisers were more than four times as likely to use a wearable compared with rarely active individuals, and education level made no difference once we accounted for these behavioural factors.

These findings suggest that efforts to expand the use of digital health tools should focus on identifying and engaging people who are already motivated about their health, rather than assuming that technology training alone will drive adoption. At the same time, older adults and African participants used wearables less often, a reminder that targeted and culturally sensitive approaches remain essential for health equity.