The Ethics of Digital Well-Being: A Thematic Review

Technology and the Situationist Challenge to Virtue Ethics

In this paper, I introduce a "promises and perils" framework for understanding the "soft" impacts of emerging technology, and argue for a eudaimonic conception of well-being. This eudaimonic conception of well-being, however, presupposes that we have something like stable character traits. I therefore defend this view from the "situationist challenge" and show that instead of viewing this challenge as a threat to well-being, we can incorporate it into how we think about living well with technology. Human beings are susceptible to situational influences and are often unaware of the ways that their social and technological environment influence not only their ability to do well, but even their ability to know whether they are doing well. Any theory that attempts to describe what it means for us to be doing well, then, needs to take these contextual features into account and bake them into a theory of human flourishing. By paying careful attention to these contextual factors, we can design systems that promote human flourishing.

The participatory value-sensitive design (VSD) of a mHealth app targeting citizens with dementia in a Danish municipality

The Sammen Om Demens (together for dementia), a citizen science project developing and implementing an AI-based smartphone app targeting citizens with dementia, is presented as an illustrative case of ethical, applied AI entailing interdisciplinary collaborations and inclusive and participative scientific practices engaging citizens, end users, and potential recipients of technological-digital innovation. Accordingly, the participatory Value-Sensitive Design of the smartphone app (a tracking device) is explored and explained across all of its phases (conceptual, empirical, and technical). Namely, from value construction and value elicitation to the delivery, after various iterations engaging both expert and non-expert stakeholders, of an embodied prototype built on and tailored to their values. The emphasis is on how moral dilemmas and value conflicts, often resulting from diverse people's needs or vested interests, have been resolved in practice to deliver a unique digital artifact with moral imagination that fulfills vital ethical-social desiderata without undermining technical efficiency. The result is an AI-based tool for the management and care of dementia that can be considered more ethical and democratic, since it meaningfully reflects diverse citizens' values and expectations on the app. In the conclusion, we suggest that the co-design methodology outlined in this study is suitable to generate more explainable and trustworthy AI, and also, it helps to advance towards technical-digital innovation holding a human face.

Smartphone Usage before and during COVID-19: A Comparative Study Based on Objective Recording of Usage Data

Most studies that claimed changes in smartphone usage during COVID-19 were based on self-reported usage data, e.g., that collected through a questionnaire. These studies were also limited to reporting the overall smartphone usage, with no detailed investigation of distinct types of apps. The current study investigated smartphone usage before and during COVID-19. Our study used a dataset from a smartphone app that objectively logged users’ activities, including apps accessed and each app session start and end time. These were collected during two periods: pre-COVID-19 (161 individuals with 77 females) and during COVID-19 (251 individuals with 159 females). We report on the top 15 apps used in both periods. The Mann–Whitney U test was used for the inferential analysis. The results revealed that the time spent on smartphones has increased since COVID-19. During both periods, emerging adults were found to spend more time on smartphones compared to adults. The time spent on social media apps has also increased since COVID-19. Females were found to spend more time on social media than males. Females were also found to be more likely to launch social media apps than males. There has also been an increase in the number of people who use gaming apps since the pandemic. The use of objectively collected data is a methodological strength of our study. Additionally, we draw parallels with the usage of smartphones in contexts similar to the COVID-19 period, especially concerning the limitations on social gatherings, including working from home for extended periods. Our dataset is made available to other researchers for benchmarking and future comparisons.

Investigating Employees’ Concerns and Wishes for Digital Stress Management Interventions with Value Sensitive Design: Mixed Methods Study (Preprint)

BACKGROUND

Work stress places a heavy economic and disease burden on society. Recent technological advances include digital health interventions for helping employees prevent and manage their stress at work effectively. Although such digital solutions come with an array of ethical risks, especially if they involve biomedical big data, the incorporation of employees' values in their design and deployment has been widely overlooked.

OBJECTIVE

To bridge this gap, we used the value sensitive design (VSD) framework to identify relevant values concerning a digital stress management intervention (dSMI) at the workplace, assess how users comprehend these values, and derive specific requirements for an ethics-informed design of dSMIs. VSD is a theoretically grounded framework that front-loads ethics by accounting for values throughout the design process of a technology.

METHODS

We conducted a literature search to identify relevant values of dSMIs at the workplace. To understand how potential users comprehend these values and derive design requirements, we conducted a web-based study that contained closed and open questions with employees of a Swiss company, allowing both quantitative and qualitative analyses.

RESULTS

The values health and well-being, privacy, autonomy, accountability, and identity were identified through our literature search. Statistical analysis of 170 responses from the web-based study revealed that the intention to use and perceived usefulness of a dSMI were moderate to high. Employees' moderate to high health and well-being concerns included worries that a dSMI would not be effective or would even amplify their stress levels. Privacy concerns were also rated on the higher end of the score range, whereas concerns regarding autonomy, accountability, and identity were rated lower. Moreover, a personalized dSMI with a monitoring system involving a machine learning-based analysis of data led to significantly higher privacy (P=.009) and accountability concerns (P=.04) than a dSMI without a monitoring system. In addition, integrability, user-friendliness, and digital independence emerged as novel values from the qualitative analysis of 85 text responses.

CONCLUSIONS

Although most surveyed employees were willing to use a dSMI at the workplace, there were considerable health and well-being concerns with regard to effectiveness and problem perpetuation. For a minority of employees who value digital independence, a nondigital offer might be more suitable. In terms of the type of dSMI, privacy and accountability concerns must be particularly well addressed if a machine learning-based monitoring component is included. To help mitigate these concerns, we propose specific requirements to support the VSD of a dSMI at the workplace. The results of this work and our research protocol will inform future research on VSD-based interventions and further advance the integration of ethics in digital health.

Ethical issues in virtual workplaces: evidence from an emerging economy

Purpose

However, while the benefits of adopting virtual work structures have been extensively discussed, ethical considerations have been largely ignored in the existing literature. To fill this gap, this study aims to investigate the key ethical issues associated with virtual workplaces. It also aimed to examine the various preventive measures that could be considered for effectively managing such challenges.

Design/methodology/approach

The study adopted an inductive research approach using qualitative methodology. Data was collected by executing the technique of dual moderator focus group discussion. By using the purposive sampling technique, the sample comprised 24 software professionals from emerging economies such as India. All sessions were transcribed, and the data were analysed using the content analysis method.

Findings

The study reports some interesting results related to various ethical issues and the preventive measures to handle such issues in virtual workplaces. The themes that emerged related to ethical issues have been categorised into three broad categories, i.e. People, Technology and Culture. In contrast, preventive measures have been reported in both contexts, i.e. pre-preventive and post-preventive measures. Furthermore, few recommendations have been made to improve virtual work experiences for remote work professionals. The identified themes and categories were classified and arranged in “Network View”, a feature embedded in Atlas.ti7 software, to analyse the conceptual relationships.

Practical implications

The findings may help managers regarding various ethical issues in virtual work settings. It may also provide an insight to the managers about the benefits of adopting preventive measures for handling ethical dilemmas in virtual workplaces in an emerging economy like India.

Originality/value

The study may be seen as one of the earliest attempts to consider the lingering debate on ethics in virtual workplaces. The findings of the study have implications for further theoretical research on the topic.

Commercial mHealth Apps and Unjust Value Trade-offs: A Public Health Perspective

Mobile health (mHealth) apps for self-monitoring increasingly gain relevance for public health. As a mobile technology, they promote individual participation in health monitoring with the aim of disease prevention and the mitigation of health risks. In this paper, I argue that users of mHealth apps must engage in value trade-offs concerning their fundamental dimensions of well-being when using mobile health apps for the self-monitoring of health parameters. I particularly focus on trade-offs regarding the user's self-determination as well as their capacity to form personal attachments. Depending on the user's level of advantage or disadvantage, value trade-offs can pose a threat to the users' sufficient fulfillment of the dimensions of well-being. As such, value trade-offs can entrench existing structural injustices and prevent disadvantaged users to benefit from this technology. I argue that value trade-offs are, to some, a type of injustice that can drive disadvantaged users away from a sufficiency threshold of well-being, risk users to fall below the threshold, or have an accumulative effect on different dimensions of the user's well-being.

“Seeing and Being Seen” or Just “Seeing” in a Smart Classroom Context When Videoconferencing: A User Experience-Based Qualitative Research on the Use of Cameras

This research examines the form in which undergraduates use video cameras during videoconferencing class sessions in a Smart Classroom context and, more specifically, the reasons why a considerable number of students opt to turn off their cameras when videoconferencing during the sessions while others keep them on. The study was carried out in an institution that had previously switched from face-to-face teaching to an Emergency Remote Teaching solution, initially adopted in 2019–2020 to cope with the COVID-19 pandemic restrictions. Findings suggest that using cameras when videoconferencing is associated with increasing and enhancing the interaction between the student and the rest of the class, although not all students agreed with this conclusion. In addition, having the video cameras switched fomented socialization and improved the overall online learning experience for students. However, the surveyed students pointed out diverse negative elements, such as why they had to turn on their personal cameras, privacy concerns, and limitations derived from the available technology infrastructure, in addition to other factors such as distractions, anxiety, and cognitive load. This work discusses how these elements can influence the well-being and the user experience of the students, both positively and negatively.

Enhancing engineering ethics education (EEE) for green intelligent manufacturing: Implementation performance evaluation of core mechanism of green intelligence EEE

The characteristics of green intelligent (GI) engineering ethics emphasize the necessity of GI engineering ethics education (EEE). The ethics education of GI engineering is in the development stage, and it is urgent to fully understand the significance of evaluating the development of GI EEE. Only based on the GI manufacturing situation system to understand the implementation status of the core education of EEE can we objectively grasp the improvement space of GI EEE. In this study, the corresponding indicators were selected from three dimensions of cultivation education, collaborative education, and situational education to form the element community of evaluation indicators. The fuzzy analytic hierarchy process and the fuzzy comprehensive evaluation method were used to empirically evaluate the implementation of the key mechanism of GI EEE. The results are as follows. (1) The key education of GI EEE includes cultivation education of micro dimension, collaborative education of medium dimension, and situational education of macro dimension. (2) The most important education is to strengthen the ethics education of GI engineering in the training process of college students. The coordination of GI EEE is becoming more and more important, and the integration and construction are the important pursuit of GI EEE. (3) The cultivation education, collaborative education, and situational education of GI EEE are all at a general level. (4) There is not only a gap between theory and practice in GI EEE but also insufficient attention to localization and coordination issues. The willingness of the government to participate in the ethical education of GI engineering is very insufficient. The optimized space of training education includes teaching cases and full-cycle ethical education.

Six Drivers to Face the XXI Century Challenges and Build the New Healthcare System: "La Salute in Movimento" Manifesto

The aging of the population, the burden of chronic diseases, possible new pandemics are among the challenges for healthcare in the XXI century. To face them, technological innovations and the national recovery and resilience plan within the European Union can represent opportunities to implement changes and renovate the current healthcare system in Italy, in an effort to guarantee equal access to health services. Considering such scenario, a panel of Italian experts gathered in a multidisciplinary Think Tank to discuss possible design of concepts at the basis of a new healthcare system. These ideas were summarized in a manifesto with six drivers for change: vision, governance, competence, intelligence, humanity and relationship. Each driver was linked to an action to actively move toward a new healthcare system based on trust between science, citizens and institutions.

Politics by Automatic Means? A Critique of Artificial Intelligence Ethics at Work

Calls for “ethical Artificial Intelligence” are legion, with a recent proliferation of government and industry guidelines attempting to establish ethical rules and boundaries for this new technology. With few exceptions, they interpret Artificial Intelligence (AI) ethics narrowly in a liberal political framework of privacy concerns, transparency, governance and non-discrimination. One of the main hurdles to establishing “ethical AI” remains how to operationalize high-level principles such that they translate to technology design, development and use in the labor process. This is because organizations can end up interpreting ethics in an ad-hoc way with no oversight, treating ethics as simply another technological problem with technological solutions, and regulations have been largely detached from the issues AI presents for workers. There is a distinct lack of supra-national standards for fair, decent, or just AI in contexts where people depend on and work in tandem with it. Topics such as discrimination and bias in job allocation, surveillance and control in the labor process, and quantification of work have received significant attention, yet questions around AI and job quality and working conditions have not. This has left workers exposed to potential risks and harms of AI. In this paper, we provide a critique of relevant academic literature and policies related to AI ethics. We then identify a set of principles that could facilitate fairer working conditions with AI. As part of a broader research initiative with the Global Partnership on Artificial Intelligence, we propose a set of accountability mechanisms to ensure AI systems foster fairer working conditions. Such processes are aimed at reshaping the social impact of technology from the point of inception to set a research agenda for the future. As such, the key contribution of the paper is how to bridge from abstract ethical principles to operationalizable processes in the vast field of AI and new technology at work.

Emotions and Digital Well-Being: on Social Media’s Emotional Affordances

Social media technologies (SMTs) are routinely identified as a strong and pervasive threat to digital well-being (DWB). Extended screen time sessions, chronic distractions via notifications, and fragmented workflows have all been blamed on how these technologies ruthlessly undermine our ability to exercise quintessential human faculties. One reason SMTs can do this is because they powerfully affect our emotions. Nevertheless, (1) how social media technology affects our emotional life and (2) how these emotions relate to our digital well-being remain unexplored. Remedying this is important because ethical insights into (1) and (2) open the possibility of designing for social media technologies in ways that actively reinforce our digital well-being. In this article, we examine the way social media technologies facilitate online emotions because of emotional affordances. This has important implications for evaluating the ethical implications of today’s social media platforms, as well as for how we design future ones.

Divergent decennial trends in mental health according to age reveal poorer mental health for young people: repeated cross-sectional population-based surveys from the HUNT Study, Norway

OBJECTIVES

Public health trends are formed by political, economic, historical and cultural factors in society. The aim of this paper was to describe overall changes in mental health among adolescents and adults in a Norwegian population over the three last decades and discuss some potential explanations for these changes.

DESIGN

Repeated population-based health surveys to monitor decennial changes.

SETTING

Data from three cross-sectional surveys in 1995-1997, 2006-2008 and 2017-2019 in the population-based HUNT Study in Norway were used.

PARTICIPANTS

The general population in a Norwegian county covering participants aged 13-79 years, ranging from 48 000 to 62 000 000 in each survey.

MAIN OUTCOME MEASURES

Prevalence estimates of subjective anxiety and depression symptoms stratified by age and gender were assessed using the Hopkins Symptom Checklist-5 for adolescents and the Hospital Anxiety and Depression Scale for adults.

RESULTS

Adolescents' and young adults' mental distress increased sharply, especially between 2006-2008 and 2017-2019. However, depressive symptoms instead declined among adults aged 60 and over and anxiety symptoms remained largely unchanged in these groups.

CONCLUSIONS

Our trend data from the HUNT Study in Norway indicate poorer mental health among adolescents and young adults that we suggest are related to relevant changes in young people's living conditions and behaviour, including the increased influence of screen-based media.

Towards Robot-Assisted Therapy for Children With Autism—The Ontological Knowledge Models and Reinforcement Learning-Based Algorithms

Robots are more and more present in our lives, particularly in the health sector. In therapeutic centers, some therapists are beginning to explore various tools like video games, Internet exchanges, and robot-assisted therapy. These tools will be at the disposal of these professionals as additional resources that can support them to assist their patients intuitively and remotely. The humanoid robot can capture young children’s attention and then attract the attention of researchers. It can be considered as a play partner and can directly interact with children or without a third party’s presence. It can equally perform repetitive tasks that humans cannot achieve in the same way. Moreover, humanoid robots can assist a therapist by allowing him to teleoperated and interact from a distance. In this context, our research focuses on robot-assisted therapy and introduces a humanoid social robot in a pediatric hospital care unit. That will be performed by analyzing many aspects of the child’s behavior, such as verbal interactions, gestures and facial expressions, etc. Consequently, the robot can reproduce consistent experiences and actions for children with communication capacity restrictions. This work is done by applying a novel approach based on deep learning and reinforcement learning algorithms supported by an ontological knowledge base that contains relevant information and knowledge about patients, screening tests, and therapies. In this study, we realized a humanoid robot that will assist a therapist by equipping the robot NAO: 1) to detect whether a child is autistic or not using a convolutional neural network, 2) to recommend a set of therapies based on a selection algorithm using a correspondence matrix between screening test and therapies, and 2) to assist and monitor autistic children by executing tasks that require those therapies.

Exploring engagement, well-being, and welfare on engagement platforms: Insight into the personal service sector from the DACH region

Engagement platforms (EPs) are an essential technology to enable co-creation and service innovation. Therefore, the design and governance of these platforms are receiving increasing attention in research. In this study, we aim to identify which activities and mechanisms foster engagement and which governance mechanisms are implemented to avoid harm on EPs. To this end, we conducted expert interviews with founders, CEOs, and managers of 14 personal and household-related service platform companies from the DACH region (Germany(D), Austria(A), Switzerland(CH)), to gain insights into their activities and mechanisms for creating and maintaining successful EPs. We found eight mechanisms, e.g., moderation of content, limitations of entry and certification, employed by personal EPs (PEPs) as self-regulatory mechanisms to avoid misconduct and negative experiences of actors. The identified governance mechanisms may guide the design and governing of PEPs by providing tangible examples to foster actor engagement while considering externalities on a societal and individual level.

Leveraging Artificial Intelligence in Marketing for Social Good-An Ethical Perspective

Artificial intelligence (AI) is (re)shaping strategy, activities, interactions, and relationships in business and specifically in marketing. The drawback of the substantial opportunities AI systems and applications (will) provide in marketing are ethical controversies. Building on the literature on AI ethics, the authors systematically scrutinize the ethical challenges of deploying AI in marketing from a multi-stakeholder perspective. By revealing interdependencies and tensions between ethical principles, the authors shed light on the applicability of a purely principled, deontological approach to AI ethics in marketing. To reconcile some of these tensions and account for the AI-for-social-good perspective, the authors make suggestions of how AI in marketing can be leveraged to promote societal and environmental well-being.

A Focus on Ethical Value under the Vision of Leadership, Teamwork, Effective Communication and Productivity

The new economy and the knowledge-based society brought significant changes in all the areas of our daily lives. Also, the COVID-19 pandemic and the COVID-19 crisis implicated tremendous transformations in all the domains, on the one hand, threatening the balance of our society and, on the other hand, challenging the dynamic of the new economy development and the rhythm of the societal modernization. In these delicate times, the all-important relationship between ethics, leadership, teamwork, effective communication, productivity, and performance is brought to the attention, in particular, due to its benefits for our society, taking into consideration the pivotal advancement that a well governed relationship of this type could provide to the knowledge-based economy. The present research describes the implication of ethics in leadership, teamwork, effective communication, and productivity, which includes the application of ethical values as university graduates assume the role of each of the mentioned dimensions of study in the organizations. The absence of research that relates ethics to these four elements simultaneously was noticed. This information is essential to know how these dimensions influence the organizational level. The sample that included 410 university graduates was applied in Baja California, Mexico, and the industrial nucleus of great relevance, bordering California in the United States of America. The data was obtained using a questionnaire. A reliability and validity analysis of the measurement instrument was carried out in terms of the ethical values associated with the dimensions mentioned using the exploratory factor analysis by the principal components method. Qualitative items were also analyzed using the constant comparison method. The results obtained in this research provide a greater perspective and practical knowledge and support of usefulness and practical reality to businesspeople and employees, leaders and university graduates; and also extensive to students, teachers, and human beings in general, in order to be better prepared to give and apply solutions with their consequent ethical and productive achievements desired by all. Additionally, this current research has the purpose to raise the will to understand, at a higher level and at a more in-depth degree of knowledge, the relationship between ethics, leadership, teamwork, effective communication, productivity, and performance, in the attempt to foster a creative and innovative business environment, based on a robust and sustainable business administration and business competencies, capable to position at higher ranks the strengths, opportunities, aspirations and outcomes that today’s new economy is due to offer and diminish the dangerous effects of the COVID-19 pandemic and the COVID-19 crisis in all the domains.

The effects of a sleep robot intervention on sleep, depression and anxiety in adults with insomnia - Study protocol of a randomized waitlist-controlled trial

Insomnia is a common sleep disorder characterized by difficulties initiating sleep, maintaining sleep and/or early-morning awakenings. Hyperarousal is a common causal and maintaining factor in insomnia models. Different techniques to decrease arousal have shown to be effective. Calm breathing can be one approach to enhance sleep. The Somnox sleep robot looks like a bean-shaped cushion to hug, and it gives physical and auditive guidance to calm down the users' breathing. There is currently no impartial empirical evidence of the sleep robot's effects on insomnia. This study is a randomized waitlist-controlled trial with a recruitment target of a minimum of 44 adults with insomnia and sleep disturbing arousal. Participants will complete pre-, mid- and post-intervention assessments, in addition to a 1-month follow-up. The primary outcome measure is the Insomnia Severity Index. Secondary sleep outcome measures are the Pre-Sleep Arousal Scale, a sleep diary and actigraphy. A secondary comorbid symptoms outcome measure is the Hospital Anxiety and Depression Scale. The main research question is whether treated participants have greater improvements regarding symptoms of insomnia post-intervention, compared with the waitlist control group. The analytic approach will be mixed-effects models. The current study will increase the knowledge on breath guidance as a way to reduce hyperarousal and enhance sleep. The sleep robot is a novel method and a potential treatment option for people with insomnia, when the recommended first-line treatments of Cognitive Behavioral Therapy and pharmaceuticals are inaccessible or undesirable. The ethics of healthcare robotics is discussed.

Smart Workplaces for older adults: coping 'ethically' with technology pervasiveness

Pervasive technologies such as Artificial Intelligence, Virtual Reality and the Internet of Things, despite their great potential for improved workability and well-being of older workers, entail wide ethical concerns. Aligned with these considerations we emphasize the need to present from the viewpoint of ethics the risks of personalized ICT solutions that aim to remedy health and support the well-being of the ageing population at workplaces. The ethical boundaries of digital technologies are opaque. The main motivation is to cope with the uncertainties of workplaces' digitization and develop an ethics framework, termed SmartFrameWorK, for personalized health support through ICT tools at workplace environments. SmartFrameWorK is built upon a five-dimensional approach of ethics norms: autonomy, privacy, transparency, trustworthiness and accountability to incite trust in digital workplace technologies. A typology underpins these principles and guides the ethical decision-making process with regard to older worker particular needs, context, data type-related risks and digital tools' use throughout their lifecycle. Risk analysis of pervasive technology use and multimodal data collection, highlighted the imperative for ethically aware practices for older workers' activity and behaviour monitoring. The SmartFrameWorK methodology has been applied in a case study to provide evidence that personalized digital services could elicit trust in users through a well-defined framework. Ethics compliance is a dynamic process from participants' engagement to data management. Defining ethical determinants is pivotal towards building trust and reinforcing better workability and well-being in older workers.

Advanced natural language processing technique to predict patient disposition based on emergency triage notes

OBJECTIVE

To demonstrate the potential of machine learning and capability of natural language processing (NLP) to predict disposition of patients based on triage notes in the ED.

METHODS

A retrospective cohort of ED triage notes from St Vincent's Hospital (Melbourne) was used to develop a deep-learning algorithm that predicts patient disposition. Bidirectional Encoder Representations from Transformers, a recent language representation model developed by Google, was utilised for NLP. Eighty percent of the dataset was used for training the model and 20% was used to test the algorithm performance. Ktrain library, a wrapper for TensorFlow Keras, was employed to develop the model.

RESULTS

The accuracy of the algorithm was 83% and the area under the curve was 0.88. Sensitivity, specificity, precision and F1-score of the algorithm were 72%, 86%, 56% and 63%, respectively.

CONCLUSION

Machine learning and NLP can be together applied to the ED triage note to predict patient disposition with a high level of accuracy. The algorithm can potentially assist ED clinicians in early identification of patients requiring admission by mitigating the cognitive load, thus optimises resource allocation in EDs.

Towards a Theory of Digital Well-Being: Reimagining Online Life After Lockdown

Global lockdowns during the COVID-19 pandemic have offered many people first-hand experience of how their daily online activities threaten their digital well-being. This article begins by critically evaluating the current approaches to digital well-being offered by ethicists of technology, NGOs, and social media corporations. My aim is to explain why digital well-being needs to be reimagined within a new conceptual paradigm. After this, I lay the foundations for such an alternative approach, one that shows how current digital well-being initiatives can be designed in more insightful ways. This new conceptual framework aims to transform how philosophers of technology think about this topic, as well as offering social media corporations practical ways to design their technologies in ways that will improve the digital well-being of users.

Digital well-being under pandemic conditions: catalysing a theory of online flourishing

The COVID-19 pandemic has catalysed what may soon become a permanent digital transition in the domains of work, education, medicine, and leisure. This transition has also precipitated a spike in concern regarding our digital well-being. Prominent lobbying groups, such as the Center for Humane Technology (CHT), have responded to this concern. In April 2020, the CHT has offered a set of 'Digital Well-Being Guidelines during the COVID-19 Pandemic.' These guidelines offer a rule-based approach to digital well-being, one which aims to mitigate the effects of moving much of our lives online. The CHT's guidelines follow much recent interest in digital well-being in the last decade. Ethicists of technology have recently argued that character-based strategies and redesigning of online architecture have the potential to promote the digital well-being of online technology users. In this article, I evaluate (1) the CHT's rule-based approach, comparing it with (2) character-based strategies and (3) approaches to redesigning online architecture. I argue that all these approaches have some merit, but that each needs to contribute to an integrated approach to digital well-being in order to surmount the challenges of a post-COVID world in which we may well spend much of our lives online.

Satisfied or Frustrated? A Qualitative Analysis of Need Satisfying and Need Frustrating Experiences of Engaging With Digital Health Technology in Chronic Care

Introduction: Digital health technologies such as self-monitoring devices and apps are becoming increasingly important as tools to promote healthy habits and support individuals in their self-care. There is still a scarcity of research that builds on motivational theory to better understand the functioning of digital health technologies. The self-determination theory (SDT) is a macro theory of motivation that delineates three basic psychological needs that are linked to different types of motivation and lead to well-being when satisfied and illbeing when frustrated.

Objective: To explore how the use of a digital tool for self-monitoring and communication with healthcare satisfies or frustrates basic psychological needs across four spheres of user experience: interface, task, behavior, and life.

Methods: The study was conducted in a Swedish primary care setting with individuals who participated in a pilot study of a digital health intervention for self-monitoring in chronic care management. Data from a follow-up survey with participants 7 months after recruitment were analyzed using a thematic approach mixing inductive and deductive analysis. The unit of analysis is based on a total of 642 individual answers to seven open-ended questions, from 121 respondents.

Results: The analysis identified positive and negative influences of self-monitoring and digital communication with healthcare on all three psychological needs. Three main findings are that: (1) data covered all four spheres of user experiences, but most user experiences concerned the behavior and task spheres; (2) satisfaction and frustration of competence needs was more prominent than influences on other needs; (3) the same experience may be perceived as both need frustrating and need satisfying, which suggests a tension that reflects individual differences.

Conclusion: Designers of digital health technologies need to take into account basic psychological needs within all spheres of user experience, from interface to life in general. Because some features may be simultaneously experienced as satisfying and frustrating by different users, these types of tools need to be flexible to accommodate for variation of user experiences. Careful design considerations that take motivational theory into account would contribute to the transformation of care for individuals with chronic conditions.

The Digital Therapeutic Alliance and Human-Computer Interaction

The therapeutic alliance (TA), the relationship that develops between a therapist and a client/patient, is a critical factor in the outcome of psychological therapy. As mental health care is increasingly adopting digital technologies and offering therapeutic interventions that may not involve human therapists, the notion of a TA in digital mental health care requires exploration. To date, there has been some incipient work on developing measures to assess the conceptualization of a digital TA for mental health apps. However, the few measures that have been proposed have more or less been derivatives of measures from psychology used to assess the TA in traditional face-to-face therapy. This conceptual paper explores one such instrument that has been proposed in the literature, the Mobile Agnew Relationship Measure, and examines it through a human-computer interaction (HCI) lens. Through this process, we show how theories from HCI can play a role in shaping or generating a more suitable, purpose-built measure of the digital therapeutic alliance (DTA), and we contribute suggestions on how HCI methods and knowledge can be used to foster the DTA in mental health apps.

Public Health and Risk Communication During COVID-19-Enhancing Psychological Needs to Promote Sustainable Behavior Change

Background: The current COVID-19 pandemic requires sustainable behavior change to mitigate the impact of the virus. A phenomenon which has arisen in parallel with this pandemic is an infodemic-an over-abundance of information, of which some is accurate and some is not, making it hard for people to find trustworthy and reliable guidance to make informed decisions. This infodemic has also been found to create distress and increase risks for mental health disorders, such as depression and anxiety. Aim: To propose practical guidelines for public health and risk communication that will enhance current recommendations and will cut through the infodemic, supporting accessible, reliable, actionable, and inclusive communication. The guidelines aim to support basic human psychological needs of autonomy, competence, and relatedness to support well-being and sustainable behavior change. Method: We applied the Self-Determination Theory (SDT) and concepts from psychology, philosophy and human computer interaction to better understand human behaviors and motivations and propose practical guidelines for public health communication focusing on well-being and sustainable behavior change. We then systematically searched the literature for research on health communication strategies during COVID-19 to discuss our proposed guidelines in light of the emerging literature. We illustrate the guidelines in a communication case study: wearing face-coverings. Findings: We propose five practical guidelines for public health and risk communication that will cut through the infodemic and support well-being and sustainable behavior change: (1) create an autonomy-supportive health care climate; (2) provide choice; (3) apply a bottom-up approach to communication; (4) create solidarity; (5) be transparent and acknowledge uncertainty. Conclusion: Health communication that starts by fostering well-being and basic human psychological needs has the potential to cut through the infodemic and promote effective and sustainable behavior change during such pandemics. Our guidelines provide a starting point for developing a concrete public health communication strategy.