The Hawthorne effect on wearable technology: A systematic review

The use of wearable technology has increased over time. Wearable technology can be used to track, measure, and document physical activity, and to assess performance in healthcare. The Hawthorne effect may play an important role in wearable technology, such that awareness of being monitored can influence the behavioural outcomes of interest. The aim of this systematic review was to ascertain the acknowledgement and management of the Hawthorne effect in studies pertaining to wearable technology.

Published and unpublished literature databases, conference proceedings and the reference lists of included studies were searched to the 31st of August 2024. Studies were eligible if they acknowledged the Hawthorne effect on wearable technology, attempted to control for it, measured its impact on patient outcomes, or leveraged it to achieve behaviour change.

A total of 16,314,027 records implementing wearable technology were identified. Of these, only 28 addressed the Hawthorne effect (0.0002 %) (2786 subjects). "Acknowledgment" studies (n = 21, 75 %) mentioned the Hawthorne effect but did not measure or control for it. Of these, only 13 gave a clear indication (speculation) of how it may have impacted outcomes. "Minimising" studies (n = 4, 14.3 %) attempted to mitigate the Hawthorne effect. Of these, only two measured and reported its impact on outcomes, yielding conflicting results. Finally, "Harnessing" studies (n = 3, 10.7 %) attempted to utilize the Hawthorne effect to achieve behavioural change. All three measured and reported its impact on outcomes, with two finding that awareness of being monitored increased behaviour change.

Very few studies on wearable technology acknowledge the impact of the Hawthorne effect on outcomes. The Hawthorne effect must be considered, measured, and reported in randomised controlled trials implementing such technologies. Clinicians might also consider harnessing the Hawthrone effect to increase behaviour change and positive outcomes.