SomnoRing
Somnology is Sleep Lab as a Service (SLaaS) SaaS company that provides cost-effective, comprehensive solutions for managing sleep disorders. This project showcases partnership between Somnology and UCSF S.O.L.V.E. Health Tech — where I served as a researcher — to assess the usability and acceptance of the SomnoRing product.
Role: Qualitative researcher
Team: UCSF: Principal Investigator, two qualitative researchers, including myself. Somnology: Clinical Lead/Founder, Registered Nurse, and an administrative coordinator.
Methods: In-depth interviews
Skills: Research planning, IRB application, interviewing in Spanish, synthesizing, and coordinating with project partners.
Deliverables: Usability and acceptance themes summary and an academic paper published in JMIR
Tools: SomnoRing Device, System Usability Scale
GOAL
Uncover Acceptance and Usability of a Wearable Sleep Device (SomnoRing)
Poor sleep health is associated with conditions like cardiovascular disease, obesity, and mental health problems. These health impacts disproportionately affect racial and ethnic minorities. Wearable devices that capture bio-signals and collect data could improve health monitoring and clinical care. However, not many studies had yet been published on sleep technology use among low-income patients. Somnology, a private company, partnered with UCSF S.O.L.V.E. Heath Tech to assess the SomnoRing’s usability and acceptance among Somnology clinical patients who benefit from Medi-Cal (Medicaid).
Research Methods
Device Use
Participants tested the SomnoRing device over a 7-night period and sent screenshots of their sleep reports to the clinical staff.
Qualitative Interviews:
Participants were asked to complete a 60-minute interview with a study researcher to share their experiences with the sleep device. I conducted the Spanish interviews.
System Usability Scale
The SUS is a 10-item validated usability questionnaire that measure how easily people accomplish their goals using a product or system. We asked these questions and collected results at the end of each interview.
Key Questions:
Will the SomnoRing sleep device be difficult to use?
What are te barriers and facilitators that impact the device’s use?
How will participants interact with the associated device app?
Participants
Our team recruited and interviewed 21 participants, including 9 Spanish Speakers and 12 English Speakers.
Characteristics
Publicly insured through Medi-Cal (Medicaid)
Had an initial evaluation of obstructive sleep apnea
Seen at a mid-size sleep clinical practice in Redwood City, CA.
IRB Approval
This study was approved by the University of California San Francisco Institutional Review Board (20-30579), and all participants provided verbal consent to participate in the in-depth interviews. Participants were given the opportunity to ask questions before deciding to participate and were told that they can discontinue the study at any time with no repercussions. All participants were compensated with a US $25 gift card.
Findings
Technology Acceptance Model
Leveraging the Technology Acceptance Model our team identified external variables: barriers and facilitators that contributed to perceived usefulness, attitudes, ease of use, and usability the sleep device (SomnoRing).
Facilitators
Partners and Family Members
Partners and family members played in an important role in encouraging participants to use the SomnoRing. In fact, interviews revealed that the reason they first went into a sleep clinic was to address problematic sleeping, snoring, and tiredness from inadequate sleep.
Clinical Staff
Study participants were introduced to the study by the team’s nurse who onboarded participants to the project. The nurse provided the sleep device, instructions, and facilitated patients in downloading the mobile app that comes with the SomnoRing. This human touch point ensured that each study participant felt comfortable using the device and that there was someone to help with questions.
Barriers
Cost
Participants remarked on cost and insurance status limiting the affordability of technologies like the SomnoRing. One participant sensed they were experiencing sleep problems and wanted to “figure it out,” but was deterred from seeking help because they “didn’t have insurance for a long time.” Another participant said this about cost: “it’s a waste…they [other devices] cost US $400 or US $300.” Others said that, although they would “like one of those [smart]watches,” their partners “don’t like [them] spending money.”
Housing Instability
Housing situations could be a barrier to the use of wearables like the SomnoRing. For example, a participant noted that they found it difficult to charge the ring and would “would have to be careful [because they] moved around a lot” between homes. Along with cost, lack of stable housing is a factor that impacts how well technologies are accepted by people who are publicly insured.
Usability
88/100 Usability Score
The SomnoRing was easy to use compared to other wearable devices or traditional home sleep testing alternatives, such as the standard polysomnogram technology for sleep studies. Despite the wearable sleep device’s written instructions and app only being available in English, both English- and Spanish-speaking participants were pleased with the wearable sleep device’s ease of use, as demonstrated by the mean System Usability Scale score of 88 out of 100.
Impact and Reflections
The study was a great way to collaborate with a start-up company and learn about the acceptance and usability of emerging technologies for use in clinical care. Through this work, our team increased confidence in using the SomnoRing device as part of clinical care. Additionally, our team published a paper written in the Journal of Medical Internet Research (JMIR) to share our learnings so that others in the academic community may benefit (see the article here).
Collaboration During COVID
Normally, the interviews would have been conducted in person but because of COVID-19 related restrictions in 2021, we had to develop a process for interviews done over the phone. I’m grateful for the Somnology partner clinical team who helped with in-person recruitment and study coordination to ensure that we could collect the data successfully.
Positive outlook for new technologies
It's important to continue to test and include diverse audiences in the product design and development process. When marginalized user groups are left out of the design and development process, we miss opportunities to retain users and expand to new products/services that could benefit more people.