Trusted but Not Understood: Older Adults and Privacy In Smart Health Devices

Background and Purpose
The use of smart health devices (SHDs), including wearable and non-wearable technologies, has grown rapidly among older adults, driven by increased availability and healthcare provider recommendations. These devices offer significant benefits, such as improved chronic disease management, enhanced independence, and reduced healthcare utilization. However, SHDs collect and transmit personal health information (PHI), raising important privacy concerns. While prior research suggests older adults value these technologies, there remains limited understanding of how they perceive privacy risks, data use, and information sharing. Existing literature also indicates that older adults may have gaps in digital literacy, particularly regarding how technologies function “under the hood.” This study aimed to address these gaps by exploring how older adults use SHDs, their awareness of privacy risks, and their practices related to sharing personal data.

Methods
An exploratory qualitative design was employed using semi-structured interviews with 42 older adults (aged 60–93). Participants were recruited from 14 community-based organizations across urban and rural communities and were required to be SHD users. Interviews were conducted virtually and averaged 35 minutes. The study was guided by a multidimensional digital literacy framework, emphasizing both technical skills and cognitive/social-emotional understanding of technology. Data were analyzed using thematic analysis, combining deductive and inductive coding approaches. Coding was iterative, with peer debriefing used to enhance rigor, and themes were developed to reflect patterns in SHD use, privacy awareness, and data-sharing behaviors.

Findings
Five major themes emerged. First, SHDs were widely used as tools for sustained self-management, with participants relying on them daily to manage chronic conditions, promote wellness, and support routine activities. Second, devices were viewed as tools for health and reassurance, offering convenience, ease of use, and perceived improvements in health outcomes. Third, participants demonstrated uncertainty and limited awareness of data governance, including how data are collected, stored, and shared; many did not read privacy agreements or understand device connectivity. Fourth, despite this limited awareness, participants expressed perceived security through trust and low risk appraisal, often viewing their data as non-sensitive and relying on trust in healthcare providers or device manufacturers. Finally, participants reported exercising control over data sharing, selectively sharing PHI with healthcare providers, family, and occasionally other entities, primarily for personal benefit.

Conclusion and Implications
This study highlights a critical disconnect between older adults’ widespread use of SHDs and their limited understanding of how these technologies collect, store, and share personal data. Although participants perceived benefits and expressed confidence in device security, their limited awareness of privacy risks suggests potential vulnerability to data misuse. These findings underscore the importance of expanding digital literacy beyond technical skills to include cognitive and social-emotional understanding of technology. Social workers are uniquely positioned to address these knowledge gaps by educating older adults on how smart health devices function, including data collection, transmission, and privacy risks. By supporting older adults in developing a more comprehensive understanding of SHDs, social workers can promote safer technology use, enhance informed decision-making, and ultimately help maximize the benefits of these devices while minimizing potential harms.