穿戴式科技應用於促進大專自閉症學生健康行為之成效探討

Effectiveness of Wearable Technology in Promoting Healthy Behaviors Among College Students With Autism Spectrum Disorder

使用穿戴式科技來促進健康，已是世界健康產業及建立健康行為的趨勢。本研究目的在探討穿戴式科技如何協助大專自閉症學生透過自我監控促進健康行為，並評估智慧手環在健康行為養成中的應用成效。自閉症者在參與身體活動時常面臨諸多障礙，而智慧手環提供即時視覺化數據回饋，能增強自我監控能力，並適合大專自閉症學生在開放環境中發展健康生活型態。本研究採多重個案混合研究法，六位大專輕度自閉症學生參與資源教室健康行為促進方案，結合質性（半結構訪談瞭解配戴經驗與自我監控歷程）與量性（智慧手環記錄步伐數變化）資料收集方法。研究結果發現，穿戴式科技能增強參與者自我健康監控意識，視覺化回饋有助於建立內在行為調節機制，進而增進日常活動的步伐數。在介入策略方面，智慧手環本身具有自然增強效果，而個別化支持系統（如目標設定策略、生態系統如家庭或社交支持，以及轉化個人特質成為正向的健康習慣等）對健康行為的維持有重要影響力。質性分析進一步顯示，參與者透過穿戴裝置能從對數據的被動記錄，轉變為主動調整生活形態，增進自我行為管理能力。本研究顯示穿戴式科技作為自我管理工具，有助於大專自閉症學生建立自主健康意識及長期健康行為模式。建議大專資源教室輔導人員可運用穿戴式科技搭配個別化支持策略，促進學生發展自我監控能力和健康行為內化過程，協助學生培養更具身心健康的生活型態。

Rationale & Purpose: Individuals with autism spectrum disorder (ASD) often encounter barriers to participation in physical activity, which reduces engagement in exercise and increases health complication risks. Studies have consistently demonstrated that adults with ASD are less physically active than their neurotypical counterparts. Low physical activity in adults with ASD increases the risks of obesity, cardiovascular disease, type 2 diabetes, and other related health concerns. Moreover, challenges related to motor coordination, sensory processing, and social participation further limit their involvement in physical activity. The absence of inclusive physical activity programs and limited self-regulation skills can contribute to a sedentary lifestyle, exacerbating both physical and mental health problems. The benefits of physical activity for individuals with ASD are well documented. Regular exercise enhances physical fitness, improves overall quality of life, facilitates social interactions, and supports emotional regulation. Furthermore, participation in structured exercise programs improves executive functioning, reduces anxiety, and enhances sleep patterns. Given the key role of physical activity in promoting overall well-being, developing interventions that support individuals with ASD in establishing and maintaining active lifestyles is essential. Recent advances in wearable technology offer promising opportunities for promoting self-determined health behaviors in individuals with ASD. Devices such as smartwatches and fitness trackers provide real-time feedback on physical activity levels, serving as self-monitoring tools that encourage movement and goal-setting. The visual and haptic feedback offered by these devices can be particularly beneficial for individuals with ASD, who often respond positively to structured routines and data-driven reinforcement. In college settings, where autonomy influences lifestyle choices, wearable technology may effectively promote healthy behaviors. On the basis of the Transtheoretical Model and Self-Determination Theory, the present study explored the experiences of college students with ASD in using smartwatches and evaluated the effectiveness of these devices in increasing daily step counts. Methods: This mixed-methods multiple case study incorporated elements of single-subject research methodology to investigate the effect of wearable technology on physical activity in college students with ASD. The study sample comprised six college students with mild ASD (age: 21–26; men = 5), all of whom were enrolled in a health behavior promotion program at a national university resource center. The study was conducted in three phases: baseline, intervention, and maintenance phases. In the baseline phase, participants wore the Garmin Vivofit 4 smartwatch for≥5 days while maintaining their usual daily routines. Individual baseline activity levels were established in this phase. In the intervention phase, participants set daily step count targets, aiming to exceed their baseline average by 1,000 steps. They received contingent reinforcement (e.g., verbal praise and small incentives) upon meeting step count goals. In the maintenance phase, participants continued wearing the smartwatch without external reinforcement, enabling researchers to assess the sustainability of behavior changes. Qualitative data were collected through semi-structured interviews both before and after the intervention. These interviews explored participants’experiences, their perceptions of smartwatches, and any changes in their daily routines. The qualitative data were transcribed and subjected to thematic analysis (NVivo 12). Quantitative data were obtained through continuous monitoring of participants’daily step counts, which provided objective measurements of their physical activity levels. Additionally, a dynamic lifestyle stage questionnaire was administered to assess changes in participants’health behavior stages, as outlined in the Transtheoretical Model. Results: The qualitative analysis revealed four overarching themes. (1) Benefits of smartwatches: Participants reported that the real-time feedback provided by the smartwatch served as a motivating factor, reinforcing their engagement in physical activity. Some participants found the visual display and haptic reminders particularly useful for tracking movement throughout the day. (2) Barriers to exercise and daily routines: Various factors influenced participants’ability to meet their step count goals—for example, academic workload, weather conditions, accessibility to exercise facilities, and class schedules. Sensory sensitivities and executive functioning difficulties further limited their participation in physical activity. (3) Establishment of ecological support networks: The presence of peers, family members, and university resource room counselors played a crucial role in fostering participants’motivation for physical activity. Although some participants emphasized the importance of social reinforcement, others preferred individualized goal-setting strategies. (4) Self-growth and proactive changes: Some participants developed considerable self-awareness regarding their physical activity levels and made proactive lifestyle adjustments. Notably, participants who had initially exhibited reluctance toward exercise became more willing to incorporate movement into their daily routines. The quantitative findings revealed that three participants successfully met their step count goals during the intervention phase. The remaining three participants had already averaged over 10,000 steps per day during the baseline phase, indicating a predisposition toward an active lifestyle. Among those who increased their step counts, improvements ranged from an additional 1,000 to 3,000 steps per day. However, during the maintenance phase, three participants exhibited a decline in daily step counts, ranging from approximately 2,800 to 5,500 fewer steps than in the intervention phase. This reduction suggests a decline in motivation once external reinforcement was removed. The responses to the dynamic lifestyle stage questionnaire revealed that three participants advanced in their health behavior stages following the program, whereas the remaining three exhibited no change. One participant consistently maintained an active lifestyle, engaging in exercise at least thrice a week for 6 months. The variability in responses underscores the individualized nature of behavior change in college students with ASD. Conclusion: This study demonstrated that wearable technology could serve as a ''natural reinforcement tool'' for promoting physical activity among college students with ASD. The real-time feedback provided by smartwatches facilitated self-monitoring and goal-setting, leading to increased step counts in some participants. However, the observed decline in activity levels during the maintenance phase suggests that the initial novelty effect may diminish over time, underscoring the necessity of sustained reinforcement strategies. The findings underscore the importance of personalized support in the design of health promotion interventions for individuals with ASD. Although some participants responded positively to goal-setting and reinforcement, others required additional environmental modifications and structured support systems to maintain engagement. Furthermore, this study highlights the critical role of ecological support networks, including university resource room counselors and peer groups, in fostering long-term behavior change. For practical applications, university resource room counselors are encouraged to integrate wearable technology into student wellness programs, ensuring that interventions are tailored to meet diverse needs. Future research should evaluate long-term engagement strategies, such as adaptive reinforcement schedules, gamification elements, and social accountability mechanisms, to enhance sustained participation. Additional studies are required to determine the most effective method for sustaining behavior change beyond the initial intervention period. Overall, the present study provides valuable insights into the intersection of wearable technology, self-determined health behaviors, and physical activity promotion in individuals with ASD. By leveraging personalized, technology-driven strategies, university resource room counselors can create supportive environments that empower individuals with ASD to adopt and maintain healthier lifestyles.