The evolution of smartwatches that can check your blood pressure and track your sleep rhythms can be traced to clinical trials in St. Paul that have overcome historical barriers by recruiting minority participants.
Fairview Frontiers has recruited almost 1,000 participants this year alone in studies seeking to elevate smartwatches from fitness novelties to diagnostic health care machines. Almost 34% of the participants are minority members, doubling last year's rate and fueling the growth that made Frontiers a go-to recruiter when Apple, Garmin and other companies launch studies.
The diversity is a breakthrough itself but also an important step in research to determine if optical sensors in smartwatches can identify sleep apnea, irregular heartbeats and other health problems, said Andrew Snyder, director of clinical trials for M Health Fairview, the health system that oversees Frontiers.
"How do they translate that to an actual clinical diagnosis? That's what they're working on," he said. "All of these sensors are optically based, which means they are trying to read things through light. That's one of the reasons why we need so many people with different colored skin, because the results might be quite different."
Frontiers leaders credited their success to targeted recruiting and a move last year to an accessible location in the former St. Joseph's Hospital.
Minority mistrust in research is historically associated with infamous studies, such as the federally funded Tuskegee experiment in the mid-20th century when doctors feigned treatment of syphilis in Black men in Alabama to understand the course of the sexually transmitted disease. But numerous other factors play a role, including higher poverty rates among minority members that make it logistically harder for them to volunteer.
As a result, research has been inadequate when it comes to how certain drugs and treatments affect minority populations. Mysteries such as the prevalence of gout among Hmong people also remained unsolved until researchers finally amassed enough study participants to identify genetic factors.
A 2021 study by Mayo Clinic researchers showed some progress: minority participation in federally funded trials increased from 3% in 2008 to 11% in 2018, but participation in commercially funded research lagged behind.
Frontiers' minority participation exceeded the 24% rate for Minnesota's population overall and even resulted in overrepresentation of minority members in some studies.
Frontiers had advantages over researchers studying new prescription drugs or treatments, which often require multiple clinic visits and can have side effects. Some of the wearable device studies required one visit or asked participants to do little more than wear the watches at home.
The number of studies has increased as companies compete to make their devices more clinically useful than others, Snyder said. "The lines between what you buy at Target and what you see in the hospital are going to become really blurred."
Frontiers consulted with Fairview's health equity leaders to find out why minority communities might mistrust it. Data privacy emerged as a key issue, so Frontiers made that a focal point of promotional materials. It also enlisted leaders of minority communities to promote research opportunities and sent recruiters to popular gathering places.
"A big one was a grocery store in north Minneapolis," Snyder said. "We just posted fliers and talked to people there ... and boy, we got a lot of people who were very interested."
More tailoring is needed. The messages hit home with Black people, but Frontiers didn't reach its recruiting goals for Hispanic participants.
Fred Brim II heard about Frontiers because he directs an environmental services division on another floor of the old St. Joseph's, which is now a community health center. Research staff took time to answer his questions when he stopped in, which convinced him to sign up and then encourage coworkers to participate.
The 38-year-old grew up in a small Virginia town where he said the expectation among Black people was to work hard and endure health problems rather than bring them to doctors — much less researchers.
"It's a stigma from years ago: 'The doctor isn't going to do anything for you. They're just going to give you bad news,'" he said.
Brim completed his first trial in one visit, wearing a watch to see if it could read his blood pressure. He then took another device home for a month in a second trial to see if it could detect sleep apnea.
Results from the trials are used by companies internally and aren't published in medical journals. Completed studies include those by Garmin and Apple to see if their watches could detect atrial fibrillation, a type of irregular heartbeat.
The trials are still subject to federal ethics guidelines and approved and monitored by an institutional review board at the University of Minnesota. They also comply with federal requirements against coercive payments to research subjects, but they do pay more than prior studies to compensate for time and transportation, Snyder said.
"The days of the $25 gift card are over," he said.
Fairview leaders hope the Frontiers success story could boost minority participation in other research and health care in general.
Brim became more comfortable with medical care in the end. After the first trial suggested his blood pressure was high, he made an appointment with his family doctor, who confirmed the result and prescribed medication to reduce his risk of heart problems.