Using Wearable Technology For Behaviour Change

Posted on January 8, 2026 by oliver.bastiani

Written by Chris Stone

Smartwatches are back. The 2010s was the decade when wearable technology became established, with companies such as Apple, Motorola, Samsung, LG and Sony all producing wrist worn computing devices capable of communicating with their owners’ smartphones. At the same time, fitness bands became popular amid a growing trend for personal health and fitness monitoring. Then in 2024 sales declined, largely as a result of consumer loss of faith in the then-market leading Apple watch after a lack of new features and a rumoured upgrade which failed to materialise. However, the smartwatch market rebounded in 2025 with an 8% year-on-year growth in global smartwatch shipments. China became a major player in the wearable tech industry, with the rise of manufacturers such as Huawei and Xiaomi driven by a growing domestic consumer appetite causing it to overtake the US as the world’s largest market for advanced smartwatches for the first time [ref 1].

As use of smartwatches has become more widespread, their adoption as a lifestyle management tool has also increased. Health tracking apps have become popular as smartwatch users take advantage of the capability to monitor their health and fitness levels in real time and use the devices to measure progress towards their goals. The digital health tracking app market has been forecast to grow from US$16.11bn in 2024 to US$67.97bn by 2034, a compound annual growth rate of 15.94% [2]. Capturing data on health metrics such as physical activity, sleep patterns, and heart rate, allows users to make informed decisions about their lifestyle behaviour and monitor chronic conditions, while the growing use of machine learning and artificial intelligence provides increasing accuracy and the potential for greater personalisation.

The presence of an array of on-board sensors, together with mobile communications, storage, capability for data processing, and an intuitive touch-screen interface makes smartwatches powerful tools for health monitoring. These same features enable the smartwatch to be used for capturing a wide range of behavioural data which can be used for research purposes. Much of psychological research takes place in the laboratory, where conditions can be carefully controlled and one variable is manipulated in isolation to study its effect on another. However, the laboratory setting doesn’t necessarily reflect the reality of human life. Now, mobile and wearable technology can give us the ability to measure human behaviour out “in the wild”. We can even extend this concept, by taking advantage of the messaging capabilities of the smartwatch, to develop behaviour change interventions hosted on the smartwatch itself which respond in real time to an individual’s need for support. This type of intervention, delivered in the moment of need and tailored to the individual’s circumstances at the time, is known as a “just-in-time adaptive intervention” – often referred to by its acronym, JITAI.

In the Translational and Applied Research Group here at the University of Bristol we have developed a smartwatch-based JITAI to help prevent smoking relapse. Stopping smoking brings a number of health benefits, some relatively quickly and others on a more sustained basis as smoking cessation continues. But quitting is notoriously difficult, and many have tried all sorts of ways to stop smoking, with limited success. We need to find innovative methods of helping smokers quit, and this is where a JITAI can help. For those who are trying to give up, an initial lapse is a vulnerable moment, and risks leading to a full relapse to habitual smoking. If we can identify this point of lapse, and deliver intervention support precisely at that moment, we have an opportunity to improve the success of the quit attempt.

The basis of our intervention, known as “StopWatch”, is passive detection of smoking, where data from the motion sensors in the smartwatch is processed by an algorithm which identifies the “signature gesture” of cigarette smoking and triggers the delivery of a supportive message on the smartwatch screen. Development of the system took the form of a two-stage process, firstly to determine the algorithm for passive detection of smoking (“passive” meaning no input is needed from the user) and iteratively improve its performance through a series of tests with smokers in the laboratory and in free-living conditions, and secondly to build the intervention mechanism onto the passive detection such that detection triggers the intervention at the right moment. We adopted patient/public involvement in the design of the intervention, working with a stakeholder panel of cancer patients and holding focus group sessions with smokers to take their views into account, and using the Person-Based Approach, an established methodology for intervention design. We promoted the study through community-based health provider networks in inner-city areas of east and south Bristol, and engaged a marketing agency to help us target participant recruitment across a range of socio-economic positions and amongst seldom-reached groups. We then conducted tests with smokers themselves trialing the system over two weeks in their natural living environment to evaluate the feasibility and acceptability of the intervention.

Participants in our feasibility study reported increased awareness of smoking and motivation to quit. Our results indicated that alerting participants when smoking was detected reduced the automaticity of smoking behaviour, and the ability to track smoking was viewed as helpful in progressing participants’ quit attempts. Adherence to using the intervention was high throughout the testing period, but there were however some challenges with keeping the smartwatch battery charged which could potentially reduce adherence. Our overall findings indicate that the StopWatch smoking relapse intervention is both feasible and acceptable to smokers wishing to quit, and that a smartwatch is a convenient platform on which to host such an intervention.

Full details of this work can be found in our paper published in JMIR Formative Research [3]. In carrying out this project, we have aimed to harness the latest thinking in intervention design, and deliver it in a convenient wearable package with minimal burden to the user and maximum engagement with behaviour change; and in doing so, demonstrate the potential for interventions such as this to make a difference to people’s lives.

In addition to this work, we have explored other applications for the use of wearable technology in health and behavioural research, notably the potential for objective assessment of eating [4] and the use of wearable cameras for researching parent-child interactions [5]. We have also developed a smartwatch-based system for frequent capture of self-reported data over extended periods of time, using a technique known as ecological momentary assessment, where an individual is prompted to respond to brief questions about their state or circumstances. We have used this to measure patterns of alcohol use among young adults [6] and nutrition in children and adolescents in semi-rural Malaysia [7]. Our work has attracted widespread media attention; on publication, the StopWatch smoking relapse intervention was reported by over 200 news outlets worldwide, including in the UK front-page coverage in The Times newspaper and national news interviews on ITV News and Channel 4 News; the smartwatch app for capturing data on alcohol use also raised interest, being featured on a number of websites including BBC News and resulting in interviews on BBC local radio stations.

Acknowledgements

Research like this is very much a collaborative effort, and over the timescale of the project has involved colleagues in the Translational and Applied Research Group (formerly the Tobacco and Alcohol Research Group) at the University of Bristol, PPI specialists in Cancer Research UK’s Integrative Cancer Epidemiology Programme, and intervention development experts at Southampton University and the University of East Anglia, as well as several undergraduate placement students and students undertaking research apprenticeships in the School of Psychological Science at the University of Bristol. I would like to acknowledge the contribution of the other authors of our StopWatch paper: Professor Angela Attwood, Dr Andy Skinner and Dr Joe Matthews (Bristol); Professor Felix Naughton (UEA); and Dr Rosie Essery (Southampton); and in particular would like to thank Dr Andy Skinner for his guidance, insight and inspiration in his role as project lead, without which this work would not have been possible.

Funding

This project has been undertaken within the Integrative Cancer Epidemiology Programme (ICEP), which is part of the Medical Research Council Integrative Epidemiology Unit (MRC IEU) at the University of Bristol. ICEP is funded by Cancer Research UK (grant reference C18281/A29019). The MRC IEU is supported by the Medical Research Council and the University of Bristol (grant references MC_UU_00032/05 and MC_UU_00032/07). The author of this report and the authors of the paper resulting from the project have no conflicts of interest in relation to it.

Bio

Chris Stone started out in vision research at the University of Bristol in the early 1980s. He then pursued a career in the information systems and tech development industry, later returning to the School of Psychological Science to create innovative applications of wearable technology to improve lifestyle health choices through ecologically-valid, data-driven behaviour change interventions.

References

Singh B, Jain A (2025). “Global Smartwatch Market Analysis and Insights”. Counterpoint Technology Market Research.
Pandey D, Shivarkar A (2024). “Digital Health Tracking App Market Sizing”. Towards Healthcare.
Stone C, Essery R, Matthews J, Naughton F, Munafò M, Attwood A, Skinner A (2024). “Presenting and evaluating a smartwatch-based smoking relapse intervention (‘StopWatch’): feasibility and acceptability study”. JMIR Formative Research 2024;8:e56999. doi:10.2196/56999. https://doi.org/10.2196/56999
Skinner A, Toumpakari Z, Stone C and Johnson L (2020). “Future Directions for Integrative Objective Assessment of Eating Using Wearable Sensing Technology”. Frontiers in Nutrition, 7:80. doi: 10.3389/fnut.2020.00080
Skinner A, Costantini I, Stone CJ, Darios J, Gray M, Culpin I, & Pearson RM (2023). “Identifying stakeholder priorities in use of wearable cameras for researching parent-child interactions”. Frontiers in Child and Adolescent Psychiatry, doi:10.3389/frcha.2023.1111299
Stone C, Adams S, Wootton R, Skinner A (2025). “Smartwatch-based Ecological Momentary Assessment for high temporal density longitudinal measurement of alcohol use (‘AlcoWatch’): feasibility evaluation”. JMIR Formative Research 2025;9e63184. doi:10.2196/63184. https://doi.org/10.2196/63184
Lane R, Millard L, Salway R, Brady S, Skinner A, Stone C, Mariapun J, Rajakumar S, Ramadas A, Rizal H, Johnson L, Su TT, Armstrong M (2026). “The Feasibility of Smartwatch Micro Ecological Momentary Assessment for Tracking Eating Patterns of Malaysian Children and Adolescents in the SEACO Child Health Update 2020: a Cross-Sectional Study”. Journal of Medical Internet Research, in press. doi:10.2196/73435. https://doi.org/10.2196/73435

TARG heads north

Posted on November 26, 2025 by oliver.bastiani

Society for the Study of Addiction annual conference 2025, Newcastle

Written by Chris Stone

Five members of the University of Bristol’s Translational and Applied Research Group, covering all career stages in the group from PhD student to director, have attended the 141^st annual conference of the Society for the Study of Addiction, held in Newcastle. The SSA’s annual conference is the UK’s foremost gathering of addiction researchers, policymakers, practitioners, and experts by experience. This was a highly relevant and very worthwhile conference, with a wide range of sessions covering topics such as the neuropsychology of addiction, monitoring of addictive behaviours and policy, tackling alcohol and gambling harms, public health aspects of no-/low-alcohol drinks, priorities and innovations in addiction research, capturing lived experience, predicting and preventing tobacco harm, and integrating substance use treatments into hospital care. A highlight was the Society Lecture given by Professor Trevor Robbins , former Head of Department of Psychology at the University of Cambridge, on the neural and psychological basis of compulsive drug-seeking.

The conference enabled dissemination of some of TARG’s recent work. Olivia Maynard gave a talk presenting the findings of a pilot investigation of vaping information provision for people attending lung health checks which supported the “Swap to Stop” initiative helping smokers switch to e-cigarettes, while Angela Attwood and Claire Garnett made poster presentations of their research. It also provided informal opportunities to network with other researchers; for example, many of those I spoke to showed great interest in the smartwatch-based smoking relapse intervention which has been developed in TARG, and one conference speaker in particular had carried out some recent work on making digital support tools that help people quit smoking both effective and user-friendly, involving ecological momentary assessment and use of machine learning algorithms – research which has a synergy with our current work on using motion capture to detect and identify lifestyle health-related behaviours – prompting a useful and timely conversation. There were many other opportunities over the two days to discover the current state of research into addiction and its behavioural aspects, thanks to the varied conference programme and the extensive array of poster presentations.

How a Simple Swap Led to Lasting Changes in Pubs and Bars Across South West England: What Happened After Our Study Introducing Alcohol-Free Draught Beer?

Posted on September 18, 2025September 19, 2025 by oliver.bastiani

Written by Katie De-loyde

Back in 2022, a few colleagues and I from the University of Bristol set out to explore a simple but important question:

Could offering a draught alcohol-free beer in pubs and bars reduce how much alcoholic beer people drink?

To find out, we ran a field study in a range of bars and pubs in South West England. You can read about the full study right here: http://bit.ly/3FjygnK

The idea was to see whether giving customers an alcohol-free option on draught would change their drinking behaviour. We were also interested in whether it would affect the venue’s takings, to avoid possible unintended consequences of a well-intended intervention.

Why did we conduct the study?

We all know that drinking too much alcohol isn’t great for our health. In fact, excessive alcohol consumption is one of the leading global risk factors for a whole host of serious health issues – everything from liver and heart disease to certain types of cancer (1). The impact stretches far beyond personal health with alcohol-related harm also putting huge pressure on public services like healthcare and the emergency services (2).

So, what can we do about it?

One promising approach is to make alcohol-free and low-alcohol drinks more available in places where people typically drink, like bars and pubs.

The idea is simple: if people have easier access to alcohol-free alternatives, they might choose those options more often, especially in social settings where the act of having a drink can sometimes be just as important as what’s in the drink.

That’s exactly what our study set out to explore. We wanted to see whether adding a draught alcohol-free beer option would make a difference. Would it lead to a drop in alcoholic beer sales? And just as importantly, would it impact the venue’s takings?

What did we do?

To find out, we signed up 14 pubs and bars across South West England. Rather than running a lab experiment or a survey, we went straight to where the action happens: real venues, with real customers, making real choices.

Over an 8-week period, each venue recorded their drink sales, including their draught beer sales. For a total of 4 weeks, it was business as usual: only alcoholic draught beers were available. Then, for another 4 weeks, we made a small but key change: one of the alcoholic draught beers was swapped out for a draught alcohol-free beer.

We then could compare the volume of alcoholic draught beer sales during the draught alcohol-only weeks to the weeks when an alcohol-free draught option was available.

What did we find out and what does this mean?

When the venues added a draught alcohol-free beer to their taps, sales of alcoholic draught beer dropped by around 4 – 5% on average. This equated to 42 – 61 fewer pints of draught alcoholic beer being sold per week across all venues. From a public health perspective, scaling this up to more venues could represent a meaningful shift.

Even more interestingly, this change didn’t hurt the venues financially. In fact, venues actually saw a slight increase in takings, about 1%, during the weeks when the alcohol-free beer was on offer. This increase was small and varied across venues, so may just be statistical noise. However, the important point is that takings did not reduce, which offers reassurance that the venues weren’t penalised financially by offering an alcohol-free option.

What this tells us is important: giving customers a well-placed alcohol-free option leads to lower alcohol consumption without hurting the venue’s takings.

For venue owners, it means a new way to meet customer demand for alternative choices while still protecting profits. And for policymakers, it highlights a simple, real-world intervention that could support broader efforts to reduce alcohol-related harm.

What happened in the first few months after the study?

The study concluded in November 2022, and we were curious to know whether the venues that took part in our study continued offering draught alcohol-free beer once the research had finished. So, in the first few months after the study had ended, we checked in with the venues to find out. At that point, 13 of the original 14 venues were still operating, and nine of them got back to us with updates.

While we were disappointed that a few venues didn’t respond to our update request – possibly introducing a bias in the information we obtained, given that those who didn’t respond may no longer have been offering the alcohol-free draught option – the results were still promising. Of the nine venues that did get back to us, six (67%) confirmed they were still serving alcohol-free draught beer (Figure 1).

Quotes included: (quotes are indicative of conversations with the venues):

Furthermore, the three venues that reported not currently serving alcohol-free draught mentioned that they do bring the alcohol-free draught option back during specific times of the year, such as January. This flexibility indicates that while alcohol-free draught beer might not be a permanent fixture everywhere, venues are tuning in to demand and increasing the availability based on customer demand and seasonal trends.

What happened years later?

Of course, short-term change is one thing, but what about in the long-term? That’s why in 2025 (two and a half years after the study ended), we followed up with venues to see if they still offered the alcohol-free draught beer option.

Of the 11 venues still in operation, seven venues (64%) were permanently offering an alcohol-free draught option (Figure 1). Two other venues were again very postive about the alcohol-free option, stating that they put it back on occasionally (Figure 1).

Quotes included (quotes are indicative of conversations with the venues):

Figure 1. Were the venues still selling alcohol-free beer on draught after the study finished?

Unknown indicates we were unable to contact the venue and therefore we are unsure as to whether they continued to sell alcohol-free beer on draught after the study.
Occasionally refers to a venue offering an alcohol-free option on draught at intermitted periods, mainly in the months of January, February, September and / or October. These venues reported seeing the highest demand for alcohol-free choices because of public health initiatives such as Dry January and Sober-October.

These follow-up results are a strong sign that this relatively simple intervention can have a real-world impact. For these venues, alcohol-free beer isn’t just a novelty for designated drivers or a temporary health trend; it’s become a regular part of the lineup.

This kind of sustained adoption matters. It shows that venues can support more mindful drinking habits and keep customers happy, all without sacrificing takings. And with more people looking for balance in how they drink, it’s clear that demand for quality alcohol-free options is here to stay.

That’s a promising takeaway. It shows that alcohol-free draught options have the potential to become a standard part of the offering in venues, especially as more people seek out healthier choices without giving up the social ritual of going out for a drink.

Why did venues agree to take part?

Many of the venues were keen to take part in research to further knowledge in this area, but to offset any possible financial losses associated with taking part (although in the end no financial losses transpired) venues each received a £500 financial incentive.

During the recruitment process, it quickly became clear just how important this incentive was. For many, the idea of offering alcohol-free draught beer had been on their radar before. However, the cost of committing to a full keg of alcohol-free beer, which can be around £100, often held them back.

Our study’s financial incentive gave venues the confidence to take part without the fear of financial loss – whether from not being able to sell the newly purchased keg, or from missing out on profits they might have earned from the alcoholic beer it replaced. The £500 incentive allowed venues to purchase the alcohol-free keg option themselves and still have money left over for any other loses they may incur.

And just out of interest………

We recruited from a list of 433 venues which we sourced via Google Maps and contacts from a previous research project. Armed with email addresses and phone numbers, we started reaching out, one venue at a time. From this list, we were able to recruit 15 venues into the study – a hit rate of 3.5%! One venue later dropped out due to logistics, but overall, it was a solid result driven by alot of persistence and determination!

What’s next?

Looking ahead, the next step is clear: we need more research on the availability of alcohol-free options. By expanding this kind of work to more venues, across different regions, different sociodemographic groups and customer groups, we can build a clearer picture of how alcohol-free options fit into our ever-evolving drinking culture.

Ideally, we would also like to see the units of alcohol being served recorded, not just the volume. This could be calculated at the end of a study, and it would be a more precise measurement of the consumption of alcohol.

Furthermore, it is crucial that we actively promote the findings of this study, as well as any future research, to both the public and the hospitality industry. Highlighting success stories and showcasing venues where these changes have led to positive permanent outcomes can help shift industry perceptions. Additionally, it is important to show businesses that offering alcohol-free alternatives can boost demand and therefore make it easier for others to follow suit. Sharing these insights widely helps normalise the presence of alcohol-free alternatives and demonstrates that there is a growing, legitimate demand for them.

Financial support is just as important. As discussed, some venues may hesitate to offer alcohol-free options due to cost and uncertain demand. Targeted incentives – like subsidised equipment, grants, or further research – could ease that risk and show a real commitment to supporting inclusive, health-conscious options.

Final thoughts

Ultimately, this isn’t just about one study. It’s about helping people make choices that support both their health and lifestyle, while also supporting the businesses that bring communities together. Furthermore, if that future includes more options for everyone at the bar, that is even better!

For bar and pub owners, that’s a win. For policymakers, it’s a compelling case for supporting low- and no-alcohol options and research. And for the rest of us, it’s one more sign that making healthier choices doesn’t have to mean losing out on the things we enjoy.

Acknowledgments

A huge thank you to Claire Garnett, Angela Attwood and Marcus Munafò for their valuable input and support in shaping this blog.

The study would not have been possible without the research team: Jennifer Ferrar, Mark A. Pilling, Gareth J. Hollands, Natasha Clarke, Joe A. Matthews, Olivia M. Maynard, Tiffany Wood, Carly Heath, Marcus R. Munafò and Angela S. Attwood.

This study was funded by the Medical Research Council Integrative Epidemiology Unit at the University of Bristol; the National Institute for Health and Care Research Bristol Biomedical Research Centre; the Bristol Health Partners Academic Health Science Centre Drug and Alcohol Health Integration Team; and the Behaviour Change by Design collaboration between the University of Bristol and the University of Cambridge. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

The study was supported by the Communities and Public Health People Directorate and the Bristol Nights Project, Bristol City Council.

References

World Health Organisation. Factors affecting alcohol consumption and alcohol-related harm. January 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/alcohol.
Institute of Alcohol Studies. Alcohol, the emergency services and the criminal justice system. May 2025. Available from: https://www.ias.org.uk/report/alcohol-the-emergency-services-and-the-criminal-justice-system/?utm_source=chatgpt.com.