Report on the society of Kuwait is facing a common issue of discomfort

The society of Kuwait is facing a common issue of discomfort, which is low back pain. It has been revealed by various research studies that the world population, which has suffered from low back pain, is around 80%, who at least faced this issue once during their lifetime (WHO). It is important to know that low back pain can be avoided, and an overload of the spine can also be protected, if people are ready to adopt healthy postural habits in their daily routine life (Foltran et al., 2012). If discomfort has to be prevented, which happens due to lower back pain; then it is vital to use sensors. Moreover, it is a fact that information regarding the use of smart wearable devices by Kuwaiti students is insufficient, and more exploration is needed in this regard.

               It is a fact that when new technology is being implemented in the IT field, acceptance from the users is a major issue. That’s why the role of information system researchers is critical to draw the attention of people towards the use of sensors so that health problems can be prevented.

               It is good to see that the education sector has shown a concern for the health of students so that they may start using new technologies. The field of information technology has introduced a handful of technology of wearable sensors, which is great to reduce lower back pain by making adjustments in the sitting posture of students. In different school stages, the students can get better postures with this technology. To improve the situation regarding lower back pain, it is important that Kuwait’s Ministry of Education, offices, institutions, and private schools consider using wearable sensors. It will also help to increase the positive perception of students about wearable devices, which is going to be important to reduce lower back pain.

In addition, the study is trying to address the issue of minimum descriptive statistics available about high school students in Kuwait, like what is the attitude and usage of these smart wearable devices.

               It was found in a study that lower back pain is one of the serious concerns regarding public health, because more than half a billion individuals around the world are affected, and it was predicted that numbers will continue to grow with aging (Hurwitz et al., 2018). Few other research studies have revealed that low back pain rates vary among school children on the basis of methods, as well as, low back pain definition. It was initially thought that the children age group can’t have low back pain, that’s why data about children in this regard is very little.

                When children and adolescents were focused in relation to low back pain, it was found that it is very common. One of the studies has reported the prevalence from 10% to 40% (Shehab et al., 2004). On the other hand, other studies came with different results like American schoolchildren found to have a 30.4% rate of low back pain (Andetson, 1992). This variation in these rates can be due to too various reasons such as methodology, age factor, perception of low back pain, as well as, the prevalence of pain in a lifetime. It was found in studies having population around 300 children hat lifetime prevalence was between 30% to 50% regarding low back pain (Andetson, 1992; Salminen et al., 1992; Kristjánsdóttir, 1996), whereas point prevalence had the range of12% to the range of 33%. The low back pain relevant research studies are important because these studies have seen a positive relationship between low back pain in adults and children (Hestbaek et al., 2006).

The most common posture associated with humans is sitting (Huang et al., 2017). It was found in a study that one of the biggest sources of disability is low back pain worldwide. In the health and education sector, the low back pain due to sitting posture has become an important concern for the stakeholders (Buchbinder et al., 2013). It is also found that if sitting posture is poor, then it can cause a lot of pain and it can develop other complications as well (Lis et al., 2007; van DieËn et al., 2001). It has been observed that children having back pain have a lower quality of life, and they use to get more medical attention as compared to other children with zero low back pain (Geldhof et al., 2007).

            Another previous research is also telling that the study regarding the posture of the body impacts on the self-evaluation found that standing postures effect the attitudes of self-relatedness as well as it also enhances the optimistic norms (Briñol et al., 2009). Furthermore, the research on the people with the symptoms of depressiveness proves that stooped postures essentially increase the emotions, severity of depression as well as fatigue in the negative sense as compared to the upright postures. Although the negative emotions are very extensive, powerful as well as can be very dangerous (Wilkes et al., 2017).

To serve the purpose of this study, a smart wearable device is considered to be a user worn accessory, which is integrated with computing and electronic technologies that can report or capture the various forms of data for the analysis (Puri, 2017). If posture habits are healthy, the overload on the spine is lower, and it prevents any postural deviations, which may cause pain (Foltran et al., 2012). The progress of technology has limited the scope of physical activity because the screen time of people is increased, which means using smart devices without doing any physical activities (Twenge et al., 2018).

In today’s society, poor posture happens to be the cause of various health issues such as musculoskeletal disorder, chronic disease, low back pain, and spinal pain. That’s why research in this area has increased because it is a major health concern. The posture education programs were employed by Santos et al. (2017) so that school children can improve their dynamic posture. An intelligent wearable device was created by Wang et al. (2018) which monitored the cervical curvature levels of a patient, and data was sent to the smartphone application. This device not only helped physicians, but patients were also able to monitor their postures in real-time and made required adjustments to prevent the issue of cervical disease. But it is a fact that voluntary use of such devices is critical to get accurate and reliable data. Despite the expectation of increase, the rate of adoptions and usage of smart wearable devices has been on the lower side (Wiles, 2005; Cheung et al., 2019), and it cannot be known what attitudes are associated with this behavior (Puri et al., 2017).

            However, it is a fact that wearable devices are becoming more prevalent which use to track different things such as heart rate and physical activity, and this use of such devices is expected to reach 187m devices till the end of 2020. The wearable devices do not only have the potential to decrease the involvement of health professionals, but it can also help to improve postures. Still, when these devices are analyzed in practical terms, their validity is questioned in so many different ways. It has been indicated by the studies that the validity of the device can be increased with the use of more sensors, which are attached to the human body (Simpson et al., 2019).

            A research study came with top 7 devices to buy for correct postures in 2019, and these devices are the Leonisa Perfect Everyday Posture Corrector, Evoke Pro Back Posture Corrector, ITA-MED Posture Corrector, Back Brace Posture Corrector, Upright Go Posture Trainer, FitCare Posture Corrector, and Marakym Posture Corrector. Out of these devices, six devices are used to support neck/back braces, which are important for the function of relieving neck/back pain, and correct alignment of the spine is also trained. There are so many wearable posture correctors available in the market, and only a few of them are able to provide real-time feedback.

One of the postures training devices is called the Upright Go, which attached to the upper back portion of human skin with silicone adhesives. A smartphone app is also used with Upright Go so that users can track posture progress in real-time. A personalized training schedule, as well as, daily goals are also provided by Upright Go. When a phone is on tracking mode, it does not vibrate; rather data is simply recorded in the application. Instant feedback for posture is provided in a training mode.

It has been claimed by the Upright Go team that their device will help to boost confidence, boost productivity, reduce stress, as well as, reduce back strain. So, this study was conducted to verify the claims made by the Upright Go. So, the study continued to evaluate the relationship between wellness and posture, and various testable hypotheses were generated for the improvements in students’ postural health. The hypotheses were made that back slouch will be prevented by the Upright Go, thus reducing the percentage of time slouching for the students. It is assumed that the Upright Go usage will help to improve posture, and it is predicted that overall neck & back pain will decrease in these students.

The design of the Upright Go device is non-invasive and sleek, and it did not show any noticeable or obstructive aspects of the body of users. The students’ work or lab activities have not interfered with these experimental procedures (Elliott, 2019).

A smart wearable device should have low power consumption and its weight should be light at an affordable price (Huang & Lai, 2016). A small silicon stick is used with the Upright Go device, and it is attached to the adhesive tabs of the user. A specialist designed strain sensor is used along with IMU for the detection of slouching. An additional Bluetooth module is also included with the Upright Go, which helps in pairing with the smartphone applications. The positive reviews and commercial success of Upright Go is another indicator, like how posture improvement can be made with real-time feedback. On the basis of availability, different product reviews were analyzed, which showed that users have found improvements in their postures as well as they got much relief from pain and discomfort, and they also showed better understanding and awareness like what the correct posture is (Pfab, 2016).

            The Kuwaiti students living in Hawalli Governorate were found to commonly face low back pain. In both genders, there was an increase in low back pain due to aging. The low back pain reported by female students was more frequent as compared to male students (Shehab et al., 2004).

            According to Ministerial Decree number 76 released in 2003, the new proposed educational ladder has elementary education of 5 years, intermediate education of 4 years, and secondary education of 3 years.

The data collected in this study is based on public opinion, however, it can be concluded that it is believed by majority of individuals in the country that a lot of improvements can be made in Kuwait’s education system, like developing a comprehensive system to satisfy students’ need, improvements in recruitment of teachers, and encouraging the usage of technology (Murad & Awadhi, 2018).

            The Theory of Reason Action (TRA) to predict behavioral intention was introduced in the 1960s, which suggested that said action is performed by the behavioral intention of an individual. The moderation of behavioral intention is done by subjective norms and attitudes of an individual (Puri, 2017).

The definition of subjective norm suggests that the perception of an individual about other people like who is important or not important for him (Celler et al., 1995). As per TRA, the behavior is driven by the attitude, which is actually motivated by the beliefs of a person, and his/her evaluation regarding the outcome of certain behavior. It has been suggested by the framework that any external factor has the capability to influence the attitude of a person by changing his/her existing beliefs. However, subjective norms and attitudes which are behind a certain behavior can come up with an actual behavior more likely (Celler et al., 1995)

To change existing behavior, one of the most important frameworks is Fishbein's framework, which is used in the development of strategies. On the other hand, TRA is identified as a theory based on generic social psychology, which is used as a framework for identifying the reasons for a certain behavior, however, the factors with comprehensive identification are not found, which play their part in affecting the behavioral intention. 

The Davis’s Technology Acceptance Model (TAM) has got its inspiration from TRA, and it is further used with the Azjen & Fishbein’s framework so that interaction factors can be recognized, and their impact on behavioral attention & attitude is also measured which results in a certain behavior of individuals [Davis, 1989]. The purpose associated with the framework is to identify how decisions of employees are determined regarding the use and perception of new technologies, which are introduced at the workplace. In terms of assessing and predicting the acceptance of new technology, the TAM framework has used two factors; one is the ease of use perception, and the other is perceived usefulness. Ease of use is associated with the perception of how much effort will be taken, and perceived usefulness is associated with the perception like how much job performance will be increased (Davis, 1989).

A variety of literature was reviewed by Davis (1986) on the topic of technology adoption so that a person’s belief structure is identified regarding the use of technology in different organizational settings. He adopted the framework of TRA for the theoretical basis model to be used for TAM. The primary objective of TAM is to trace the impact made by external factors on the intentions, attitudes, and beliefs of internal nature (Davis, et al., 1989, p. 985).

When TAM and TRA are compared, it was examined by Davis what is behavioral intention associated with usage in terms of predictive power, and how TAM & TRA can help in explaining the intention of a user to use some system, and if attitude has played the role of mediator between intentions and beliefs. The comparison came up with results that showed that one of the key predictors in relation to acceptance is the behavioral intention, and it was also found that ease of use perception is less important as compared to the perceived usefulness. It means that users are ready to put effort to learn new technology if it is going to be beneficial for them in their work. Moreover, a relationship between behavioral intention and attitude was also proposed (Davis et al., 1989). Different other research studies have also shown the effective application of different methods in extension to the TAM so that the acceptance of users regarding technology is predicted. Around 16 research studies were assessed, conducted by clinicians, who used health information technologies, and they found considerable evidence that the model can be applied to the validity and use of health technologies (Holden & Karsh, 2010).

The design of a Sensor Acceptance Index (SAI) has been made, which is able to define the satisfaction of patients regarding wearable smart devices. In this model, two questionnaires were used to measure the acceptance level of patients for wearable sensors

The theoretical model used in this study is taken from TAM and SAM models. The external variables used in this model are equipment, anxiety, skin reactions, physical activity, hygienic aspects, perceived ease of use, and perceived usefulness.  The Sensor Acceptance Index is influenced by these variables. Various studies use different models as well as external variables to base hypotheses, which is tested accordingly.

There is a variety of wearable data like physical movement and activity, which can be used for reference and analysis. However, there are different forms of devices, like some are used on the back by sticking them, and others are necklace style smart sensors, but functionalities almost remain the same.

It is a fact that out of 5 Americans, one American adult has a wearable device, but only 1 out of 10 are found to use these wearable devices on daily basis, and the third portion of these users stop using their devices within six months, after purchasing their devices (Puri, 2017). The most common usage associated with off the shelf smart devices is health monitoring, motivational feedback, and activity tracking (Wild et al., 2008).

            A survey was conducted by taking data from more than 10,000 citizens of the United States, and they suggested that they hope wearable devices will benefit them, but only 1 out of 10 is using the device on daily basis. These users of smart wearable devices are youth as well as young adults in the majority (Puri, 2017).

            A study was conducted by Fesli et al. (2008) in Norway, which focused on the fact how user patients have responded to wearable biomedical sensors, and it was suggested that the use of such monitoring devices is important for improving the quality of data. A quantitative methodology was used by the research study. The patients were given two questionnaires to answer questions regarding wearable devices. The dimensions linked with the study are equipment, anxiety, skin reactions, physical activity, and hygienic aspects. In the end, the calculation of the Sensor Acceptance Index (SAI)  is done for each patient, which showed reasonable variances and dependencies in scores.

            A study was conducted by Puri (2017) in Canada, who examined the acceptance and attitude of older adults regarding two wearable smart devices; the Xiaomi Mi Band and the Microsoft Band. The methodology of the study was based on mixed methods so that descriptive statistics and experiences & attitudes of patients are explored. The participants were given questionnaires to answer about the two devices so that considerable data can be collected. Moreover, semi-structured interviews were also made part of the study. After analyzing the data, the results showed that acceptance by older adults regarding wearable devices was positive as they believed health monitoring can be useful. The awareness level of older adults was also high about wearable devices.

            Another research study was conducted by Shehab et al. (2004) in Kuwait, and the purpose of this study was the measurement of the low back pain problem with its magnitude among Kuwaiti school children with age range 10-18 years old. A set of questions was used in the study to conduct personal interviews of the participants to get their feedback and information regarding low back pain. Two high schools and two junior schools were used in the study, and 400 children were taken to take part. The results showed that the prevalence of low back pain on a lifetime basis was around 57.8%, whereas 35% was the score for point of prevalence in students. It was found that the number of female students complaining of low back pain was more as compared to male students. It was also found that female students revealed that continual low back pain is more recurrent in them.

            One of the studies was conducted in Taiwan, where the research was done by Huang et al. (2016) to examine TAM’s applicability so that technology’s acceptance is recorded for road runners. The questionnaire was used by the researchers to collect the data. After analyzing the data, it was evident that health anxiety, perceived usefulness, and perceived ease of use were significant to affect the attitude for the usage of technology. It was also supposed that health promotion and disease prevention can be achieved by using smart wearable devices.

            One more study was conducted in Kuwait, where the aim of the researcher Akbar et al. (2019) was to make an estimation of the prevalence of low back pain in students of public high school, with age range 14 to 19 years old. The investigation was made to see the relationship between school bags’ weight and low back pain. A structured questionnaire was developed to collect data in interviews. After analyzing the data, it was evident that school bags’ weight had an effect on low back pain, and prevalence was there for both male and female students. The issue with females was higher as compared to the male students.