Harnessing Wearable Technology for Mental Health and Well-being: Innovations from the TOPOWA Study

In recent years, wearable technology and mobile health (mHealth) innovations have reshaped health research worldwide, offering new ways to track mental health, sleep, and daily behaviors in real-time. However, implementing these tools in low-resource settings presents unique challenges—from infrastructure limitations to cultural acceptability.

The TOPOWA Study, an NIH funded innovative research project in Kampala, Uganda, is at the forefront of integrating wearable smartwatch sensors (Garmins) as a digital health tool into our global health research in low resource settings. The multidisciplinary team of researchers has examined how young women in urban slums engage with wearable smartwatches, daily diaries, and mHealth strategies to better understand their mental health, sleep patterns, and behavioral health.

Three recent publications from the TOPOWA research team provide critical insights into the feasibility, challenges, and future potential of using wearable technology in low-resource settings and with populations with limited education and literacy levels. These studies are shaping new methodologies for tracking health data and for incorporating mHealth strategies into prospective cohorts, offering innovative solutions to longstanding research barriers.

Photo of the Garmin Wearables and the Daily Diaries

Advancing mHealth Research in Uganda: What We’ve Learned

The TOPOWA Study’s latest research findings highlight how wearable smartwatches and daily self-reporting methods can provide richer, more dynamic health insights—but also reveal key obstacles that must be addressed for successful large-scale implementation.

1. Wearable Smartwatches for Mental Health Monitoring

In a study published in Cambridge Prisms: Global Mental Health (2025), by Dr. Karen Nielsen and colleagues, piloted a combined approach: equipping young women with Garmin smartwatches while having them maintain daily diaries to track their mental health, emotional well-being and their sleep.

Key Finding: The dual-method approach of using wearable sensors and self-reported diaries provided deep insights into the mental health stressors affecting young women in Kampala’s urban slums.
Challenges: Some participants experienced device discomfort, while others faced technical barriers and maintaining battery life.
Significance: The study demonstrated high participant compliance, suggesting that wearable technology can be successfully integrated into mental health research—if adapted to local social and infrastructural conditions.

2. Sleep Tracking and Behavioral Health Insights

Another key study, published in Digital Health (2024), also led by Dr. Karen Nielsen, focused on how wearable smartwatches can help measure sleep health among young women in Kampala. Over five days, participants wore Garmin devices and recorded their sleep habits and activity levels.

Key Finding: 98% of participants adhered to wearing the devices, proving that wearable sleep tracking is feasible and well-received in this setting.
Challenges: Some discomfort was reported, and occasional data syncing issues posed challenges for seamless analysis.
Significance: This research highlights the importance of objective sleep data in understanding how stress, work, and social environments impact women’s sleep health in low-resource settings.

3. Participant Perspectives on Wearable Technology

A 2024 study published in Sensors by Dr. Monica Swahn and colleagues, captured young women’s experiences using wearable smartwatches for health monitoring in Uganda. Through focus groups, researchers gathered participants' perceptions, concerns, and challenges with the technology.

Key Finding: Participants appreciated real-time health tracking, but for some, concerns arose about device safety, cultural perceptions, and the practicality of long-term use.
Challenges: Fears of theft or loss of the device, discomfort while wearing the devices, and community perceptions about the devices were noted as some key issues warranting additional focus and training.
Significance: The study underscores the need for localized, community-driven strategies to integrate wearable technology into global health initiatives successfully.

The TOPOWA Study: A Global Model for Digital Health Innovation

These findings from the TOPOWA Study provide a blueprint for future mHealth research in low-resource settings. Unlike traditional self-reported surveys, the integration of wearable sensors and digital health tools offers:

✔ Real-time, objective health data

✔ Greater insight into daily health behaviors

✔Scalability for larger public health interventions

By pioneering new methodologies, TOPOWA is:

Expanding Mental Health Research: Combining wearable sensors with self-reported diaries allows for more nuanced, real-time tracking of stress, mood, and well-being (findings from these analyses are forthcoming).
Enhancing Sleep & Behavioral Insights: Smartwatches provide continuous sleep tracking, offering data on how urban stressors, heat and other factors affect rest and recovery.
Overcoming Implementation Barriers: By engaging participants in focus groups we obtained extensive information about the perceptions, excitements and concerns that the young women faced. As such, the TOPOWA project ensures that cultural, logistical, and safety concerns are addressed and integrated into the research design.
Shaping the Future of mHealth across Africa: This research is laying the groundwork for scalable, culturally relevant health technology applications across sub-Saharan Africa as we have thoroughly documented the user experiences and other important lessons learned that can be leveraged for new studies and health initiatives.

What’s Next? The Future of Wearable mHealth Research

The TOPOWA Study’s work is just the beginning. Future research are advised to:

Address wearable device challenges (e.g., battery life, connectivity, and data syncing).
Ensure sustainability through community partnerships and locally-driven solutions.
Expand implementation to larger study populations, refining mHealth strategies for global public health applications.

The TOPOWA team’s innovative research is creating new opportunities for mHealth research across Africa, proving that wearable technology and digital health tools can be successfully integrated into global health initiatives in low resource settings—if done thoughtfully and collaboratively.

🚀 Stay tuned for more groundbreaking insights from the TOPOWA Study and our team of researchers and community partners like the Uganda Youth Development Link! We are now busy analyzing all the data and using an integrated data science approach for building multidimensional models leveraging the different data structures to better understand mental health and well-being among young women in Kampala.

References

All are open access and can be viewed online or downloaded.

Nielsen, K., Mobley, K., Culbreth, R., Palmier, J., Nabulya, A., & Swahn, M. H. (2024). Feasibility and acceptability of wearable devices and daily diaries to assess sleep and other health indicators among young women in the slums of Kampala, Uganda. Digital health, 10, 20552076241288754. https://doi.org/10.1177/20552076241288754

Nielsen K. E., Mobley, K., Culbreth, R., Palmier, J. B., Matovu, G., Nabulya, A., & Swahn, M. H. (2025). Wearable technology and daily diaries for studying mental health: lessons learned from pilot studies in Kampala, Uganda. Cambridge Prisms: Global Mental Health, 12:e17. doi:10.1017/gmh.2025.9

Swahn, M. H., Gittner, K. B., Lyons, M. J., Nielsen, K., Mobley, K., Culbreth, R., Palmier, J., Johnson, N. E., Matte, M., & Nabulya, A. (2024). Advancing mHealth Research in Low-Resource Settings: Young Women’s Insights and Implementation Challenges with Wearable Smartwatch Devices in Uganda. Sensors, 24(17), 5591. https://doi.org/10.3390/s24175591