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van Velsen L, Schokking L, Siderakis E, Knospe GM, Brandl L, Mooser B, Madörin S, Jacinto S, Gouveia A, Brodbeck J. Development of an online service for coping with spousal loss by means of human-centered and stakeholder-inclusive design: the case of LEAVES. DEATH STUDIES 2024; 48:187-196. [PMID: 37102731 DOI: 10.1080/07481187.2023.2203680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
To support older mourners after the loss of their partner, LEAVES, an online self-help service that delivers the LIVIA spousal bereavement intervention, was developed. It integrates an embodied conversational agent and an initial risk assessment. Based on an iterative, human-centered, and stakeholder inclusive approach, interviews with older mourners and focus groups with stakeholders were conducted to understand their perspective on grief and on using LEAVES. Subsequently, the resulting technology and service model were evaluated by means of interviews, focus groups, and an online survey. While digital literacy remains a challenge, LEAVES shows promise of being supportive to the targeted end-users.
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Affiliation(s)
- Lex van Velsen
- eHealth group, Roessingh Research and Development, Enschede, Netherlands
| | - Lotte Schokking
- National Foundation for the Elderly, Amersfoort, Netherlands
| | - Eva Siderakis
- National Foundation for the Elderly, Amersfoort, Netherlands
| | | | - Lena Brandl
- eHealth group, Roessingh Research and Development, Enschede, Netherlands
- Department of Human Media Interaction, University of Twente, Enschede, Netherlands
| | - Bettina Mooser
- Department for Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sarah Madörin
- School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Sofia Jacinto
- Department for Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
- School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Lisboa, Portugal
| | - Afonso Gouveia
- Psychiatric Department at The Health Unit of Baixo Alentejo, Beja, Portugal
| | - Jeannette Brodbeck
- Department for Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
- School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
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Bartali V, van Velsen L. An experiment on data sharing options designs for eHealth interventions. Internet Interv 2023; 33:100642. [PMID: 37635947 PMCID: PMC10457541 DOI: 10.1016/j.invent.2023.100642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 04/20/2023] [Accepted: 06/30/2023] [Indexed: 08/29/2023] Open
Abstract
Background With eHealth technology interventions, users' personal health data can be easily shared among different stakeholders. Users should decide with whom they want to share their data. As support, most eHealth technology has data sharing options functionalities. However, there is little research on how to design these visually. In this paper, we took two possible data sharing options designs - data and party perspective - for an existing eHealth technology intervention, and we explored them. Objective The aim was to find which of the two designs is the best in terms of trust, privacy concerns, ease of use, and information control. Additionally, to investigate how these factors influence each other with also the goal of giving practical advice on designing for privacy. Method We conducted a between-subjects online design experiment (N = 123). After having visualised one of the two data sharing options designs, participants filled in an online questionnaire. To analyse the data, t-test analyses, correlation analyses, and backward regression analyses were conducted. Results Information control scored higher in the data perspective condition (t (97) = 2.25, p = .03). From the different regression analyses, we found that trust and ease of use play a role in all sharing-related factors. Conclusions We concluded that the design of data-sharing options in eHealth technology affects the experience of the user, mostly for trust and ease of use. In the end, we provided several actionable design advices on how to design for privacy.
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Affiliation(s)
- Valentina Bartali
- Roessingh Research and Development and University of Twente, Roessinghsbleekweg 33b, 7522 AH Enschede, the Netherlands
| | - Lex van Velsen
- Roessingh Research and Development and University of Twente, Roessinghsbleekweg 33b, 7522 AH Enschede, the Netherlands
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Brandl L, van Velsen L, Brodbeck J, Jacinto S, Hofs D, Heylen D. Developing an eMental health monitoring module for older mourners using fuzzy cognitive maps. Digit Health 2023; 9:20552076231183549. [PMID: 37361430 PMCID: PMC10286164 DOI: 10.1177/20552076231183549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
Objective Effective internet interventions often combine online self-help with regular professional guidance. In the absence of regularly scheduled contact with a professional, the internet intervention should refer users to professional human care if their condition deteriorates. The current article presents a monitoring module to recommend proactively seeking offline support in an eMental health service to aid older mourners. Method The module consists of two components: a user profile that collects relevant information about the user from the application, enabling the second component, a fuzzy cognitive map (FCM) decision-making algorithm that detects risk situations and to recommend the user to seek offline support, whenever advisable. In this article, we show how we configured the FCM with the help of eight clinical psychologists and we investigate the utility of the resulting decision tool using four fictitious scenarios. Results The current FCM algorithm succeeds in detecting unambiguous risk situations, as well as unambiguously safe situations, but it has more difficulty classifying borderline cases correctly. Based on recommendations from the participants and an analysis of the algorithm's erroneous classifications, we propose how the current FCM algorithm can be further improved. Conclusion The configuration of FCMs does not necessarily demand large amounts of privacy-sensitive data and their decisions are scrutable. Thus, they hold great potential for automatic decision-making algorithms in mental eHealth. Nevertheless, we conclude that there is a need for clear guidelines and best practices for developing FCMs, specifically for eMental health.
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Affiliation(s)
- Lena Brandl
- Roessingh Research and Development, eHealth group, Enschede, The Netherlands
- Department of Human Media Interaction, University of Twente, Enschede, The Netherlands
| | - Lex van Velsen
- Roessingh Research and Development, eHealth group, Enschede, The Netherlands
| | - Jeannette Brodbeck
- FHNW School of Social Work, Institute for Consulting, Coaching and Social Management, Olten, Switzerland
- Institute for Psychology, University of Bern, Bern, Switzerland
| | - Sofia Jacinto
- FHNW School of Social Work, Institute for Consulting, Coaching and Social Management, Olten, Switzerland
- Institute for Psychology, University of Bern, Bern, Switzerland
| | - Dennis Hofs
- Roessingh Research and Development, eHealth group, Enschede, The Netherlands
| | - Dirk Heylen
- Department of Human Media Interaction, University of Twente, Enschede, The Netherlands
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Brodbeck J, Jacinto S, Gouveia A, Mendonça N, Madörin S, Brandl L, Schokking L, Rodrigues AM, Gonçalves J, Mooser B, Marques MM, Isaac J, Nogueira V, Matos Pires A, van Velsen L. A Web-Based Self-help Intervention for Coping With the Loss of a Partner: Protocol for Randomized Controlled Trials in 3 Countries. JMIR Res Protoc 2022; 11:e37827. [DOI: 10.2196/37827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/15/2022] [Accepted: 08/10/2022] [Indexed: 12/02/2022] Open
Abstract
Background
The death of a partner is a critical life event in later life, which requires grief work as well as the development of a new perspective for the future. Cognitive behavioral web-based self-help interventions for coping with prolonged grief have established their efficacy in decreasing symptoms of grief, depression, and loneliness. However, no study has tested the efficacy for reducing grief after losses occurring less than 6 months ago and the role of self-tailoring of the content.
Objective
This study aims to evaluate the clinical efficacy and acceptance of a web-based self-help intervention to support the grief process of older adults who have lost their partner. It will compare the outcomes, adherence, and working alliance in a standardized format with those in a self-tailored delivery format and investigate the effects of age, time since loss, and severity of grief at baseline as predictors. Focus groups to understand user experience and a cost-effectiveness analysis will complement the study.
Methods
The study includes 3 different randomized control trials. The trial in Switzerland comprises a waitlist control group and 2 active arms consisting of 2 delivery formats, standardized and self-tailored. In the Netherlands and in Portugal, the trials follow a 2-arm design that will be, respectively, complemented with focus groups on technology acceptance and cost-effectiveness analysis. The main target group will consist of adults aged >60 years from the general population in Switzerland (n≥85), the Netherlands (n≥40), and Portugal (n≥80) who lost their partner and seek help for coping with grief symptoms, psychological distress, and adaptation problems in daily life. The trials will test the intervention’s clinical efficacy for reducing grief (primary outcome) and depression symptoms and loneliness (secondary outcomes) after the intervention. Measurements will take place at baseline (week 0), after the intervention (week 10), and at follow-up (week 20).
Results
The trials started in March 2022 and are expected to end in December 2022 or when the needed sample size is achieved. The first results are expected by January 2023.
Conclusions
The trials will provide insights into the efficacy and acceptance of a web-based self-help intervention among older adults who have recently lost a partner. Results will extend the knowledge on the role of self-tailoring, working alliance, and satisfaction in the effects of the intervention. Finally, the study will suggest adaptations to improve the acceptance of web-based self-help interventions for older mourners and explore the cost-effectiveness of this intervention. Limitations include a self-selective sample and the lack of cross-cultural comparisons.
Trial Registration
Switzerland: ClinicalTrials.gov NCT05280041; https://clinicaltrials.gov/ct2/show/NCT05280041; Portugal: ClinicalTrials.gov NCT05156346; https://clinicaltrials.gov/ct2/show/NCT05156346
International Registered Report Identifier (IRRID)
PRR1-10.2196/37827
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Can the internet mitigate the negative effect of widowhood on Quality of Life? A gender analysis. JOURNAL OF POPULATION AGEING 2022. [DOI: 10.1007/s12062-022-09373-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AbstractWidowhood often reduces the Quality of Life of individuals of advanced ages by negatively affecting their social network ties. Yet conversely, the Internet has also created new opportunities for communication and interaction, thus contributing to improved Quality of Life. This research analyses the role of the Internet in the relationship between widowhood and Quality of Life from a gender perspective.This study focuses on 31,814 individuals aged 65 or over residing in 17 European countries who participated in Wave 6 of SHARE – the Survey of Health, Ageing and Retirement in Europe.The linear regression analyses highlighted that the role of the Internet in the relationship between widowhood and Quality of Life varies according to gender. More specifically, in Europe, the Quality of Life for widowed women aged 65+ using the Internet is .414 higher (CI=.006 to .0822) than widows who do not use the Internet and married women or women in a de facto relationship whether or not they use the Internet. The results have relevant implications for the development of social policies and suggest a need to develop digital inclusion projects targeting older people, particularly widows, to help promote their Quality of Life.
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Brandl L, Cabrita M, Brodbeck J, Heylen D, van Velsen L. Consulting the Oracle: A Delphi study for determining parameters for a mental health user profile and personalization strategy for an online service to aid grieving older adults. Internet Interv 2022; 28:100534. [PMID: 35462943 PMCID: PMC9019256 DOI: 10.1016/j.invent.2022.100534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 11/16/2022] Open
Abstract
While much effort has been devoted to the development of mental e-health interventions, the tailoring of these applications to user characteristics and needs is a comparatively novel field of research. The premise of personalizing mental e-health interventions is that personalization increases user motivation and (thereby) mitigates intervention dropout and enhances clinical effectiveness. In this study, we selected user profile parameters for personalizing a mental e-health intervention for older adults who lost their spouse. We conducted a three-round Delphi study involving an international and interdisciplinary expert panel (N = 16) with two objectives. The first aim was to elicit adaptation strategies that can be used to dynamically readjust the intervention to the user's needs. The second aim was to identify a set of meaningful indicators for monitoring the user from within the grief intervention to escalate from self-help to blended care, whenever advisable. This Delphi study used as starting point an evaluated, text-based grief intervention composed of ten modules, including psychoeducation about grief and cognitive-behavioral exercises to support the user in adjusting their lives after bereavement. Every user follows this grief intervention in a linear fashion from beginning to end. The resulting conceptual adaptation model encompasses dynamic adjustments, as well as one-time adjustments performed at the initialization of the service. On the level of the application structure, the adaptations affect when which topic module is presented to the user. The adaptations further provide strategies for adjusting the text-based content of individual intervention modules dependent on user characteristics and for selecting appropriate reactions to user input. Eighteen monitoring parameters were elicited and grouped into four categories: clinical, behavioral/emotional, interactive, and external. Parameters that were perceived as most urgent to attend to for escalation were Suicidality, Self-destructive behavior, Client-initiated escalation, Unresponsiveness and (Complicated) Grief symptoms.
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Affiliation(s)
- Lena Brandl
- Roessingh Research and Development, P.O. Box 1212, Enschede, the Netherlands,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Department of Human Media Interaction, P.O. Box 217, 7500AE Enschede, the Netherlands,Corresponding author at: University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Department of Human Media Interaction, P.O. Box 217, 7500AE Enschede, the Netherlands.
| | - Miriam Cabrita
- Roessingh Research and Development, P.O. Box 1212, Enschede, the Netherlands,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Department of Biomedical Signals and Systems, P.O. Box 217, 7500AE Enschede, the Netherlands
| | - Jeannette Brodbeck
- Institute for Consulting, Coaching and Social Management, FHNW School of Social Work, Riggenbachstrasse 16, 4600 Olten, Switzerland,Universität Bern, Institut für Psychologie, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Dirk Heylen
- University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Department of Human Media Interaction, P.O. Box 217, 7500AE Enschede, the Netherlands
| | - Lex van Velsen
- Roessingh Research and Development, P.O. Box 1212, Enschede, the Netherlands,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Department of Biomedical Signals and Systems, P.O. Box 217, 7500AE Enschede, the Netherlands
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Beinema T, op den Akker H, Hurmuz M, Jansen-Kosterink S, Hermens H. Automatic topic selection for long-term interaction with embodied conversational agents in health coaching: A micro-randomized trial. Internet Interv 2022; 27:100502. [PMID: 35198412 PMCID: PMC8842031 DOI: 10.1016/j.invent.2022.100502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Embodied Conversational Agents (ECAs) can be included in health coaching applications as virtual coaches. The engagement with these virtual coaches could be improved by presenting users with tailored coaching dialogues. In this article, we investigate if the suggestion of an automatically tailored topic by an ECA leads to higher engagement by the user and thus longer sessions of interaction. METHODS A Micro-Randomized Trial (MRT) was conducted in which two types of interaction with an ECA were compared: (a) the coach suggests a relevant topic to discuss, and (b) the coach asks the user to select a topic from a set of options. Every time the user would interact with the ECA, one of those conditions would be randomly selected. Participants interacted in their daily life with the ECA that was part of a multi-agent health coaching application for 4-8 weeks. RESULTS In two rounds, 82 participants interacted with the micro-randomized coach a total of 1011 times. Interactions in which the coach took the initiative were found to be of equal length as interactions in which the user was allowed to choose the topic, and the acceptance of topic suggestions was high (71.1% overall, 75.8% for coaching topics). CONCLUSION Tailoring coaching conversations with ECAs by letting the coach automatically suggest a topic that is tailored to the user is perceived as a natural variation in the flow of interaction. Future research could focus on improving the novel coaching engine component that supports the topic selection process for these suggestions or on investigating how the amount of initiative and coaching approach by the ECA could be tailored.
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Affiliation(s)
- Tessa Beinema
- eHealth Group, Roessingh Research and Development, Enschede, the Netherlands,Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands,Corresponding author at: Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands.
| | - Harm op den Akker
- eHealth Group, Roessingh Research and Development, Enschede, the Netherlands,Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands,Innovation Sprint, Brussels, Belgium
| | - Marian Hurmuz
- eHealth Group, Roessingh Research and Development, Enschede, the Netherlands,Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands
| | - Stephanie Jansen-Kosterink
- eHealth Group, Roessingh Research and Development, Enschede, the Netherlands,Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands
| | - Hermie Hermens
- eHealth Group, Roessingh Research and Development, Enschede, the Netherlands,Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands
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