To track or not to track: user reactions to concepts in longitudinal health monitoring

Multi Perspective Considerations for Health Smart Home: Early Phase Exploratory Study

AIMS

This study engaged key stakeholders-older adults, family caregivers, home care support workers, nurses, and home healthcare leaders-to explore perspectives on essential components and integration into home care models, and to explore the role of their technology readiness for health smart homes adoption.

DESIGN

A qualitative methodology with a quantitative component, early-phase exploratory design.

METHODS

Semi-structured interviews underwent qualitative thematic analysis, with cross-case analysis comparing stakeholder perspectives to identify convergences and divergences. Descriptive statistics were used to analyse Technology Readiness Index (TRI 2.0) survey data to provide background and context to the qualitative findings.

RESULTS

Among 18 participants-older adults (n = 6), family caregivers (n = 2), nurses (n = 7), and support workers/healthcare leaders (n = 3)-findings reflected optimism for health smart home adoption and its potential to support ageing in place. Nurses and care workers saw health smart home as a tool for improving care coordination and quality of life. Key adoption considerations included education, data visualisation, privacy, and security. Technology readiness scores were moderate, with nurses scoring highest (3.52), followed by caregivers (3.41), support workers (3.13), and older adults (3.10).

CONCLUSION

While stakeholders were open to integrating health smart home into home care, concerns around usability, security, and training must be addressed to facilitate adoption.

IMPLICATIONS FOR THE PROFESSION

Findings suggest that while health smart home technology holds promise for enhancing ageing in place, varying levels of technology readiness across stakeholders highlight the need for tailored education and support strategies to ensure successful implementation.

PROBLEM ADDRESSED

Despite a strong preference for ageing in place among older adults, integrating health smart home technologies into home care remains challenging. Key issues include ensuring intuitive functionality, protecting privacy, and clarifying the roles of caregivers and healthcare professionals in a technology-enhanced care model. This study addresses the critical gap in understanding how health smart home solutions can be effectively tailored to support the diverse needs of older adults, family caregivers, and home care nurses and support workers.

MAIN FINDINGS

Stakeholders were generally optimistic about health smart home technologies supporting ageing in place and improving quality of life. Nurses and support workers highlighted the need for tailored data visualisations, alert parameters, and clear role guidelines. A novel finding was that older adults and family caregivers viewed health smart home as a way to reduce intrusive monitoring, promote independence, and maintain a familiar living environment. Family caregivers valued the ability to stay involved remotely through activity data, offering reassurance and peace of mind. Across all groups, privacy safeguards were seen as essential, with strong concerns about data security, transparent usage policies, and user control over data sharing.

IMPACT

Findings have implications for community-dwelling older adults, family caregivers, home care professionals, researchers, and technology developers. Insights from this study can inform the design of user-friendly health smart home technologies, shape future research, and guide tailored implementation strategies in home care settings.

PATIENT OR PUBLIC CONTRIBUTION

An advisory group of community-dwelling older adults in Western Australia provided input on study design and methodology. Their recommendations led to the use of one-on-one interviews to ensure accessibility and relevance for older adults when exploring technology readiness and smart home integration. While the advisory group did not contribute to the data itself or its analysis, their feedback shaped the method of engagement to ensure its relevance and accessibility to potential participants.

Factors Affecting Clinician Readiness to Adopt Smart Home Technology for Remote Health Monitoring: Systematic Review

BACKGROUND

The population of older adults worldwide continues to increase, placing higher demands on primary health care and long-term care. The costs of housing older people in care facilities have economic and societal impacts that are unsustainable without innovative solutions. Many older people wish to remain independent in their homes and age in place. Assistive technology such as health-assistive smart homes with clinician monitoring could be a widely adopted alternative to aged-care facilities in the future. While studies have found that older persons have demonstrated a readiness to adopt health-assistive smart homes, little is known about clinician readiness to adopt this technology to support older adults to age as independently as possible.

OBJECTIVE

The purpose of this systematic review was to identify the factors that affect clinician readiness to adopt smart home technology for remote health monitoring.

METHODS

This review was conducted in accordance with the Joanna Briggs Institute methodology for systematic Reviews and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for reporting.

RESULTS

Several factors affected clinicians' perspectives on their readiness to adopt smart home technology for remote health monitoring, including challenges such as patient privacy and dignity, data security, and ethical use of "invasive" technologies. Perceived benefits included enhancing the quality of care and outcomes.

CONCLUSIONS

Clinicians, including nurses, reported both challenges and benefits of adopting smart home technology for remote health monitoring. Clear strategies and frameworks to allay fears and overcome professional concerns and misconceptions form key parts of the Readiness for Adoption Pathway proposed. The use of more rigorous scientific methods and reporting is needed to advance the state of the science.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42020195989; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=195989.

The extended reality technology (ERT) framework for designing customer and service experiences in phygital settings: a service research agenda

Purpose

Because new-age technologies are gaining a broader interest among service scholars and practitioners, it is critical to identify these technologies and examine the roles they play. The examination needs to be conducted to design engaging customer and service experiences in new phygital settings that connect physical and digital environments. This review article aims to provide researchers with a new comprehensive and integrative extended reality technology (ERT) framework. The framework serves as the basis for an all-inclusive view of ERT types in order to explore the different types of technology used to design phygital customer and service experiences.

Design/methodology/approach

This article reviews prior works on the role technology plays in terms of customer experiences across various fields of research, including consumer, marketing and service literature. Adopting an experiential and phygital perspective as well as considering a consumer standpoint, this article defines the scope of the ERT framework by identifying categories of new-age technologies and their effects related to the design of phygital customer and service experiences.

Findings

The ERT framework proposed in this article offers directions for future research by adopting an experiential approach to technologies in order to categorize additional technological devices, platforms and tools that can be considered in the design of phygital experiences following several extension processes. These processes can enhance the cognitive, social, sensory and contextual dimensions of the phygital experience and thus create a continuum in terms of customer value from physical to digital settings and vice versa.

Research limitations/implications

Companies and service providers may benefit from a new, comprehensive, focused framework that assembles different types of technology. The technologies can be utilized to design engaging customer and service experiences that deliver customer value from physical to digital spaces and inversely.

Originality/value

No prior works have proposed a comprehensive ERT framework for service research following an experiential perspective and a consumer view of the experience occurring in a new setting: phygital. By embracing the ERT framework provided in this article, future service scholars can examine the dynamics and types of technologies that can positively or negatively affect the design of consumption and service experiences in phygital settings.

A Systematic Review on Visualizations for Self-Generated Health Data for Daily Activities

Due to the development of sensing technology people can easily track their health in various ways, and the interest in personal healthcare data is increasing. Individuals are interested in controlling their wellness, which requires self-awareness and an understanding of various health conditions. Self-generated health data are easily accessed through mobile devices, and data visualization is commonly used in applications. A systematic literature review was conducted to better understand the role of visualizations and learn how to develop effective ones. Thirteen papers were analyzed for types of data, characteristics of visualizations, and effectiveness for healthcare management. The papers were selected because they represented research on personal health data and visualization in a non-clinical setting, and included health data tracked in everyday life. This paper suggests six levels for categorizing the efficacy of visualizations that take into account cognitive and physical changes in users. Recommendations for future work on conducting evaluations are also identified. This work provides a foundation for personal healthcare data as more applications are developed for mobile and wearable devices.

Wave of Wearables: Clinical Management of Patients and the Future of Connected Medicine

The future of connected health care will involve the collection of patient data or enhancement of clinician workflows through various biosensors and displays found on wearable electronic devices, many of which are marketed directly to consumers. The adoption of wearables in health care is being driven by efforts to reduce health care costs, improve care quality, and increase clinician efficiency. Wearables have significant potential to achieve these goals but are currently limited by lack of widespread integrations into electronic health records, biosensor data collection types, and a lack of scientifically rigorous literature showing benefit.

A Systematic Review of Patient-Facing Visualizations of Personal Health Data

OBJECTIVES

As personal health data are being returned to patients with increasing frequency and volume, visualizations are garnering excitement for their potential to facilitate patient interpretation. Evaluating these visualizations is important to ensure that patients are able to understand and, when appropriate, act upon health data in a safe and effective manner. The objective of this systematic review was to review and evaluate the state of the science of patient-facing visualizations of personal health data.

METHODS

We searched five scholarly databases (PubMed, Embase, Scopus, ACM Digital Library [Association for Computing Machinery Digital Library], and IEEE Computational Index [Institute of Electrical and Electronics Engineers Computational Index]) through December 1, 2018 for relevant articles. We included English-language articles that developed or tested one or more patient-facing visualizations for personal health data. Three reviewers independently assessed quality of included articles using the Mixed methods Appraisal Tool. Characteristics of included articles and visualizations were extracted and synthesized.

RESULTS

In 39 articles included in the review, there was heterogeneity in the sample sizes and methods for evaluation but not sample demographics. Few articles measured health literacy, numeracy, or graph literacy. Line graphs were the most common visualization, especially for longitudinal data, but number lines were used more frequently in included articles over past 5 years. Article findings suggested more patients understand the number lines and bar graphs compared with line graphs, and that color is effective at communicating risk, improving comprehension, and increasing confidence in interpretation.

CONCLUSION

In this review, we summarize types and components of patient-facing visualizations and methodologies for development and evaluation in the reviewed articles. We also identify recommendations for future work relating to collecting and reporting data, examining clinically actionable boundaries for diverse data types, and leveraging data science. This work will be critically important as patient access of their personal health data through portals and mobile devices continues to rise.

Using the IBM SPSS SW Tool with Wavelet Transformation for CO₂ Prediction within IoT in Smart Home Care

Standard solutions for handling a large amount of measured data obtained from intelligent buildings are currently available as software tools in IoT platforms. These solutions optimize the operational and technical functions managing the quality of the indoor environment and factor in the real needs of residents. The paper examines the possibilities of increasing the accuracy of CO₂ predictions in Smart Home Care (SHC) using the IBM SPSS software tools in the IoT to determine the occupancy times of a monitored SHC room. The processed data were compared at daily, weekly and monthly intervals for the spring and autumn periods. The Radial Basis Function (RBF) method was applied to predict CO₂ levels from the measured indoor and outdoor temperatures and relative humidity. The most accurately predicted results were obtained from data processed at a daily interval. To increase the accuracy of CO₂ predictions, a wavelet transform was applied to remove additive noise from the predicted signal. The prediction accuracy achieved in the selected experiments was greater than 95%.

Health Care Provider Perceptions of Consumer-Grade Devices and Apps for Tracking Health: A Pilot Study

Background

The use of Web- or mobile phone–based apps for tracking health indicators has increased greatly. However, provider perceptions of consumer-grade devices have not been widely explored.

Objective

The purpose of this study was to determine primary care physicians’ and advanced practice registered nurses’ perceptions of consumer-grade sensor devices and Web- or mobile phone–based apps that allow patients to track physical activity, diet, and sleep.

Methods

We conducted a cross-sectional mailed survey with a random sample of 300 primary care physicians and 300 advanced practice registered nurses from Michigan, USA. Providers’ use and recommendation of these types of technologies, and their perceptions of the benefits of and barriers to patients’ use of the technologies for physical activity, diet, and sleep tracking were key outcomes assessed.

Results

Most of the respondents (189/562, 33.6% response rate) were advanced practice registered nurses (107/189, 56.6%). Almost half of the sample (93/189, 49.2%) owned or used behavioral tracking technologies. Providers found these technologies to be helpful in clinical encounters, trusted the data, perceived their patients to be interested in them, and did not have concerns over the privacy of the data. However, the providers did perceive patient barriers to using these technologies. Additionally, those who owned or used these technologies were up to 6.5 times more likely to recommend them to their patients.

Conclusions

Our study demonstrated that many providers perceived benefits for their patients to use these technologies, including improved communication. Providers’ concerns included their patients’ access and the usability of these technologies. Providers who encountered data from these technologies during patient visits generally perceive this to be helpful. We additionally discuss the barriers perceived by the providers and offer suggestions and future research to realize the potential benefits to using these data in clinical encounters.

Health and Fitness Apps for Hands-Free Voice-Activated Assistants: Content Analysis

Background

Hands-free voice-activated assistants and their associated devices have recently gained popularity with the release of commercial products, including Amazon Alexa and Google Assistant. Voice-activated assistants have many potential use cases in healthcare including education, health tracking and monitoring, and assistance with locating health providers. However, little is known about the types of health and fitness apps available for voice-activated assistants as it is an emerging market.

Objective

This review aimed to examine the characteristics of health and fitness apps for commercially available, hands-free voice-activated assistants, including Amazon Alexa and Google Assistant.

Methods

Amazon Alexa Skills Store and Google Assistant app were searched to find voice-activated assistant apps designated by vendors as health and fitness apps. Information was extracted for each app including name, description, vendor, vendor rating, user reviews and ratings, cost, developer and security policies, and the ability to pair with a smartphone app and website and device. Using a codebook, two reviewers independently coded each app using the vendor’s descriptions and the app name into one or more health and fitness, intended age group, and target audience categories. A third reviewer adjudicated coding disagreements until consensus was reached. Descriptive statistics were used to summarize app characteristics.

Results

Overall, 309 apps were reviewed; health education apps (87) were the most commonly occurring, followed by fitness and training (72), nutrition (33), brain training and games (31), and health monitoring (25). Diet and calorie tracking apps were infrequent. Apps were mostly targeted towards adults and general audiences with few specifically geared towards patients, caregivers, or medical professionals. Most apps were free to enable or use and 18.1% (56/309) could be paired with a smartphone app and website and device; 30.7% (95/309) of vendors provided privacy policies; and 22.3% (69/309) provided terms of use. The majority (36/42, 85.7%) of Amazon Alexa apps were rated by the vendor as mature or guidance suggested, which were geared towards adults only. When there was a user rating available, apps had a wide range of ratings from 1 to 5 stars with a mean of 2.97. Google Assistant apps did not have user reviews available, whereas most of Amazon Alexa apps had at least 1-9 reviews available.

Conclusions

The emerging market of health and fitness apps for voice-activated assistants is still nascent and mainly focused on health education and fitness. Voice-activated assistant apps had a wide range of content areas but many published in the health and fitness categories did not actually have a clear health or fitness focus. This may, in part, be due to Amazon and Google policies, which place restrictions on the delivery of care or direct recording of health data. As in the mobile app market, the content and functionalities may evolve to meet growing demands for self-monitoring and disease management.

Year-round effects of a four-week randomized controlled trial using different types of feedback on employees' physical activity

Background

This follow-up study investigated the year-round effects of a four-week randomized controlled trial using different types of feedback on employees’ physical activity, including a need-supportive coach intervention.

Methods

Participants (n = 227) were randomly assigned to a Minimal Intervention Group (MIG; no feedback), a Pedometer Group (PG; feedback on daily steps only), a Display Group (DG; feedback on daily steps, on daily moderate-to-vigorous physical activity [MVPA] and on total energy expenditure [EE]), or a Coaching Group (CoachG; same as DG with need supportive coaching). Daily physical activity level (PAL; Metabolic Equivalent of Task [MET]), number of daily steps, daily minutes of moderate to vigorous physical activity (MVPA), active daily EE (EE > 3 METs) and total daily EE were measured at five time points: before the start of the 4-week intervention, one week after the intervention, and 3, 6, and 12 months after the intervention.

Results

For minutes of MVPA, MIG showed higher mean change scores compared with the DG. For steps and daily minutes of MVPA, significantly lower mean change scores emerged for MIG compared with the PG. Participants of the CoachG showed significantly higher change scores in PAL, steps, minutes of MVPA, active EE, total EE compared with the MIG. As hypothesized, participants of the CoachG had significantly higher mean change scores in PAL and total EE compared with groups that only received feedback. However, no significant differences were found for steps, minutes of MVPA and active EE between CoachG and PG.

Conclusions

Receiving additional need-supportive coaching resulted in a higher PAL and active EE compared with measurement (display) feedback only. These findings suggest to combine feedback on physical activity with personal coaching in order to facilitate long-term behavioral change. When it comes to increasing steps, minutes of MVPA or active EE, a pedometer constitutes a sufficient tool.

Trial registration

Clinical Trails.gov NCT01432327. Date registered: 12 September 2011.

Self-tracking for Mental Wellness: Understanding Expert Perspectives and Student Experiences

Previous research suggests an important role for self-tracking in promoting mental wellness. Recent studies with college student populations have examined the feasibility of collecting everyday mood, activity, and social data. However, these studies do not account for students' experiences and challenges adopting self-tracking technologies to support mental wellness goals. We present two studies conducted to better understand self-tracking for stress management and mental wellness in student populations. First, focus groups and card sorting activities with 14 student health professionals reveal expert perspectives on the usefulness of tracking for three scenarios. Second, an online survey of 297 students examines personal experiences with self-tracking and attitudes toward sharing self-tracked data with others. We draw on findings from these studies to characterize students' motivations, challenges, and preferences in collecting and viewing self-tracked data related to mental wellness, and we compare findings between students with diagnosed mental illnesses and those without. We conclude with a discussion of challenges and opportunities in leveraging self-tracking for mental wellness, highlighting several design considerations.

Assessing the usability by clinicians of VISION: A hierarchical display of patient-collected physiological information to clinicians

BACKGROUND

The inability of patients to accurately and completely recount their clinical status between clinic visits reduces the clinician's ability to properly manage their patients. One way to improve this situation is to collect objective patient information while the patients are at home and display the collected multi-day clinical information in parallel on a single screen, highlighting threshold violations for each channel, and allowing the viewer to drill down to any analog signal on the same screen, while maintaining the overall physiological context of the patient. All this would be accomplished in a way that was easy for the clinician to view and use.

METHODS

Patients used five mobile devices to collect six heart failure-related clinical variables: body weight, systolic and diastolic blood pressure, pulse rate, blood oxygen saturation, physical activity, and subjective input. Fourteen clinicians practicing in a heart failure clinic rated the display using the System Usability Scale that, for acceptability, had an expected mean of 68 (SD, 12.5). In addition, we calculated the Intraclass Correlation Coefficient of the clinician responses using a two-way, mixed effects model, ICC (3,1).

RESULTS

We developed a single-screen temporal hierarchical display (VISION) that summarizes the patient's home monitoring activities between clinic visits. The overall System Usability Scale score was 92 (95% CI, 87-97), p < 0.0001; the ICC was 0.89 (CI, 0.79-0.97), p < 0.0001.

CONCLUSION

Clinicians consistently found VISION to be highly usable. To our knowledge, this is the first single-screen, parallel variable, temporal hierarchical display of both continuous and discrete information acquired by patients at home between clinic visits that presents clinically significant information at the point of care in a manner that is usable by clinicians.

Reduced Healthcare Use and Apparent Savings with Passive Home Monitoring Technology: A Pilot Study

OBJECTIVES

To conduct a cost analysis of ambient assisted living technology, which is promising for improving the ability of individuals and care providers to monitor daily activities and gain better awareness through proactive management of health and safety.

DESIGN

Three-arm cohort study.

SETTING

Homes of enrollees of a state-based healthcare plan for older adults.

PARTICIPANTS

Enrollees dually eligible for Medicare and Medicaid (N = 268).

INTERVENTION

Health and safety passive remote patient monitoring (PRPM) systems were installed in enrollees' homes (the intervention group) with monitoring and proactive intervention of a case manager when deviation from baseline subject behavior was detected.

MEASUREMENTS

Claims data were collected over 12 months to assess healthcare use and costs in the intervention group and to compare use and costs with those of two control groups: a concurrent group of enrollees who declined the technology and a historical cohort matched on age to the participation group.

RESULTS

Although the small sample size precluded cost differences that were statistically significant, the participant group used substantially less custodial care, emergency department (ED) services, inpatient stays, and ED costs than the two control groups.

CONCLUSION

In this pilot study, the PRPM system was associated with apparent healthcare cost savings. Although more cost analyses are warranted, ambient assisted living technologies are a potentially valuable investment for older adult care.

Social rhythms of the heart

A long-term research focus on the temporality of everyday life has become revitalised with new tracking technologies that allow methodological experimentation and innovation. This article approaches rhythms of daily lives with heart-rate variability measurements that use algorithms to discover physiological stress and recovery. In the spirit of the 'social life of methods' approach, we aggregated individual data (n = 35) in order to uncover temporal rhythms of daily lives. The visualisation of the aggregated data suggests both daily and weekly patterns. Daily stress was at its highest in the mornings and around eight o'clock in the evening. Weekend stress patterns were dissimilar, indicating a stress peak in the early afternoon especially for men. In addition to discussing our explorations using quantitative data, the more general aim of the article is to explore the potential of new digital and mobile physiological tracking technologies for contextualising the individual in the everyday.

Adaptation and Customization in Virtual Rehabilitation

Background. Adaptation and customization are two related but distinct concepts that are central to virtual rehabilitation if this motor therapy modality is to succeed in alleviating the demand for expert supervision. These two elements of the therapy are required to exploit the flexibility of virtual environments to enhance motor training and boost therapy outcome. Aim. The chapter provides a non-systematic overview of the state of the art regarding the evolving manipulation of virtual rehabilitation environments to optimize therapy outcome manifested through customization and adaptation mechanisms. Methods. Both concepts will be defined, aspects guiding their implementation reviewed, and available literature suggesting different solutions discussed. We present “Gesture Therapy”, a platform realizing our contributions to the field and we present results of the adaptation techniques integrated into it. Less explored additional dimensions such as liability and privacy issues affecting their implementation are briefly discussed. Results. Solutions to implement decision-making on how to manipulate the environment are varied. They range from predefined system configurations to sophisticated artificial intelligence (AI) models. Challenge maintenance and feedback personalization is the most common driving force for their incorporation to virtual rehabilitation platforms. Conclusions. Customization and adaptation are the main mechanisms responsible for the full exploitation of the potential of virtual rehabilitation environments, and the potential benefits are worth pursuing. Despite encouraging evidence of the many solutions proposed thus far in literature, none has yet proven to substantially alter the therapy outcome. In consequence, research is still on going to equip virtual rehabilitation solutions with efficacious tailoring elements.

Development and testing of a visualization application software, implemented with wireless control system in smart home care

This article describes the development of a visualization application software used to control operational and technical functions in the Smart Home system or Smart Home Care system via the wireless xComfort control system. Graphic visualization of a home electrical control system gives the user unprecedented comfort when controlling home systems. The user is able to obtain the information necessary to optimise the management of operational and technical functions in the building as well as information about energy consumption. Selected definitions of requirements for the visualization system, online access via the Internet, control via USB interface, and control requirements executed via mobile phone are the reasons why these technical elements were selected. This article describes their mutual relations, functions and connections within the system. At the end of this article we propose a method to test the reliability of the created software application as well as the wireless xComfort system under different conditions which stimulate different implementation methods applicable to a real building/apartment unit. Measurement results can be used for the actual installation process and for optimal implementation of the active elements of the wireless system.

A web-based non-intrusive ambient system to measure and classify activities of daily living

Background

The number of older adults in the global population is increasing. This demographic shift leads to an increasing prevalence of age-associated disorders, such as Alzheimer’s disease and other types of dementia. With the progression of the disease, the risk for institutional care increases, which contrasts with the desire of most patients to stay in their home environment. Despite doctors’ and caregivers’ awareness of the patient’s cognitive status, they are often uncertain about its consequences on activities of daily living (ADL). To provide effective care, they need to know how patients cope with ADL, in particular, the estimation of risks associated with the cognitive decline. The occurrence, performance, and duration of different ADL are important indicators of functional ability. The patient’s ability to cope with these activities is traditionally assessed with questionnaires, which has disadvantages (eg, lack of reliability and sensitivity). Several groups have proposed sensor-based systems to recognize and quantify these activities in the patient’s home. Combined with Web technology, these systems can inform caregivers about their patients in real-time (eg, via smartphone).

Objective

We hypothesize that a non-intrusive system, which does not use body-mounted sensors, video-based imaging, and microphone recordings would be better suited for use in dementia patients. Since it does not require patient’s attention and compliance, such a system might be well accepted by patients. We present a passive, Web-based, non-intrusive, assistive technology system that recognizes and classifies ADL.

Methods

The components of this novel assistive technology system were wireless sensors distributed in every room of the participant’s home and a central computer unit (CCU). The environmental data were acquired for 20 days (per participant) and then stored and processed on the CCU. In consultation with medical experts, eight ADL were classified.

Results

In this study, 10 healthy participants (6 women, 4 men; mean age 48.8 years; SD 20.0 years; age range 28-79 years) were included. For explorative purposes, one female Alzheimer patient (Montreal Cognitive Assessment score=23, Timed Up and Go=19.8 seconds, Trail Making Test A=84.3 seconds, Trail Making Test B=146 seconds) was measured in parallel with the healthy subjects. In total, 1317 ADL were performed by the participants, 1211 ADL were classified correctly, and 106 ADL were missed. This led to an overall sensitivity of 91.27% and a specificity of 92.52%. Each subject performed an average of 134.8 ADL (SD 75).

Conclusions

The non-intrusive wireless sensor system can acquire environmental data essential for the classification of activities of daily living. By analyzing retrieved data, it is possible to distinguish and assign data patterns to subjects' specific activities and to identify eight different activities in daily living. The Web-based technology allows the system to improve care and provides valuable information about the patient in real-time.

The Quantified Self: Fundamental Disruption in Big Data Science and Biological Discovery

A key contemporary trend emerging in big data science is the quantified self (QS)-individuals engaged in the self-tracking of any kind of biological, physical, behavioral, or environmental information as n=1 individuals or in groups. There are opportunities for big data scientists to develop new models to support QS data collection, integration, and analysis, and also to lead in defining open-access database resources and privacy standards for how personal data is used. Next-generation QS applications could include tools for rendering QS data meaningful in behavior change, establishing baselines and variability in objective metrics, applying new kinds of pattern recognition techniques, and aggregating multiple self-tracking data streams from wearable electronics, biosensors, mobile phones, genomic data, and cloud-based services. The long-term vision of QS activity is that of a systemic monitoring approach where an individual's continuous personal information climate provides real-time performance optimization suggestions. There are some potential limitations related to QS activity-barriers to widespread adoption and a critique regarding scientific soundness-but these may be overcome. One interesting aspect of QS activity is that it is fundamentally a quantitative and qualitative phenomenon since it includes both the collection of objective metrics data and the subjective experience of the impact of these data. Some of this dynamic is being explored as the quantified self is becoming the qualified self in two new ways: by applying QS methods to the tracking of qualitative phenomena such as mood, and by understanding that QS data collection is just the first step in creating qualitative feedback loops for behavior change. In the long-term future, the quantified self may become additionally transformed into the extended exoself as data quantification and self-tracking enable the development of new sense capabilities that are not possible with ordinary senses. The individual body becomes a more knowable, calculable, and administrable object through QS activity, and individuals have an increasingly intimate relationship with data as it mediates the experience of reality.

Making sense of mobile- and web-based wellness information technology: cross-generational study

Background

A recent trend in personal health and wellness management is the development of computerized applications or information and communication technologies (ICTs) that support behavioral change, aid the management of chronic conditions, or help an individual manage their wellness and engage in a healthier lifestyle.

Objective

To understand how individuals across 3 generations (young, middle-aged, and older) think about the design and use of collaborative health and wellness management technologies and what roles these could take in their lives.

Methods

Face-to-face semistructured interviews, paper prototype systems, and video skits were used to assess how individuals from 3 age cohorts (young: 18-25 years; middle-aged: 35-50 years; and older: ≥65 years) conceptualize the role that health and wellness computing could take in their lives.

Results

A total of 21 participants in the 3 age cohorts took part (young: n=7; middle-aged: n=7; and older: n=7). Young adults expected to be able to actively manage the presentation of their health-related information. Middle-aged adults had more nuanced expectations that reflect their engagement with work and other life activities. Older adults questioned the sharing of health information with a larger audience, although they saw the value in 1-way sharing between family members or providing aggregated information.

Conclusions

Our findings inform our suggestions for improving the design of future collaborative health and wellness applications that target specific age groups. We recommend that collaborative ICT health applications targeting young adults should integrate with existing social networking sites, whereas those targeting middle-aged and older adults should support small social networks that rely on intimate personal relationships. Systems that target middle-aged adults should support episodic needs, such as time-sensitive, perhaps intermittent, goal setting. They should also have a low barrier to entry, allowing individuals who do not normally engage with the Internet to participate with the application for the specific purposes of health engagement. Collaborative ICT health applications targeting older adults should allow discreet 1-way sharing, and also support sharing of information in aggregate with others’ data. These systems should also provide mechanisms to preselect recipients of different kinds of data, or to easily direct specific information to individuals in real time.

Privacy versus autonomy: a tradeoff model for smart home monitoring technologies

Smart homes are proposed as a new location for the delivery of healthcare services. They provide healthcare monitoring and communication services, by using integrated sensor network technologies. We validate a hypothesis regarding older adults' adoption of home monitoring technologies by conducting a literature review of articles studying older adults' attitudes and perceptions of sensor technologies. Using current literature to support the hypothesis, this paper applies the tradeoff model to decisions about sensor acceptance. Older adults are willing to trade privacy (by accepting a monitoring technology), for autonomy. As the information captured by the sensor becomes more intrusive and the infringement on privacy increases, sensors are accepted if the loss in privacy is traded for autonomy. Even video cameras, the most intrusive sensor type were accepted in exchange for the height of autonomy which is to remain in the home.

How do health care providers perceive technologies for monitoring older adults?

Monitoring and assistive technologies for the older adults, by sensing and recording activities and status, provide an objective record of a patient's functioning within natural environments. Yet the data derived from these technologies do not directly address the clinical aims of health care providers. We conducted focus groups with health care providers who work with older adults to elicit their perspectives on monitoring technologies. Identified themes centered around the benefits and risks of technologies, patient needs, the clinical utility of information, and specific monitoring domains that might improve the health care of older adults. Providers highlighted the primary importance of involving families and caregivers, and of sustaining human interactions. They explored the difficulties with how to use information for clinical ends, and challenged the notion that more objective information would automatically improve their heath care. Designers, developers, and researchers might improve the utility and uptake of health-related technologies for older adults and their families by eliciting the viewpoints of clinical providers.

People's perceptions and expectations of assistive health-enabling technologies: an empirical study in Germany

Demographic shifts and their consequences will lead to changes in the way health care is provided. Although assistive health-enabling technologies are regarded as one means to support these changes, they are minimally used, despite the maturity of the underlying technologies. This may partly be attributable to a disregard of users' needs and preferences. The aim of this article is to assess acceptance of health-enabling technologies with regard to their perceived usefulness, risks, and people's readiness to actually use them. Furthermore, we attempted to find out to whom individuals would entrust their health information, and what their basic fears are. We used a questionnaire presenting four exemplary technologies: emergency call systems, videophones, activity and health status monitoring. We conducted 147 face-to-face interviews and analyzed the results using descriptive statistics. Emergency call systems, health status and activity monitoring were rated as useful or very useful, videophones as hardly useful. Intrusion into one's privacy was the most prominent concern. Regarding fears in old age, people were mostly afraid of diseases and loss of independence. They would entrust their medical data to their physicians rather than relatives or caregivers. This study may contribute to systematic analyses of users' perceptions and preferences concerning assistive health-enabling technologies.

A visual approach to providing prognostic information to parents of children with retinoblastoma

OBJECTIVE

Parents must rapidly assimilate complex information when a child is diagnosed with cancer. Education correlates with the ability to process and use medical information. Graphic tools aid reasoning and communicate complex ideas with precision and efficiency.

METHODS

We developed a graphic tool, DePICT (Disease-specific electronic Patient Illustrated Clinical Timeline), to visually display entire retinoblastoma treatment courses from real-time clinical data. We report retrospective evaluation of the effectiveness of DePICT to communicate risk and complexity of treatment to parents. We assembled DePICT graphics from multiple children on cards representing each stage of intraocular retinoblastoma. Forty-four parents completed a 14-item questionnaire to evaluate the understanding of retinoblastoma treatment and outcomes acquired from DePICT.

RESULTS

As a proposed tool for informed consent, DePICT effectively communicated knowledge of complex medical treatment and risks, regardless of the education level. We identified multiple potential factors affecting parent comprehension of treatment complexity and risk. These include language proficiency (p=0.005) and age-related experience, as younger parents had higher education (p=0.021) but lower comprehension scores (p=0.011), regardless of first language.

CONCLUSION

Provision of information at diagnosis concerning long-term treatment complexity helps parents of children with cancer. DePICT effectively transfers knowledge of treatments, risks, and prognosis in a manner that offsets parental educational disadvantages.

Social uses of personal health information within PatientsLikeMe, an online patient community: what can happen when patients have access to one another's data

BACKGROUND

This project investigates the ways in which patients respond to the shared use of what is often considered private information: personal health data. There is a growing demand for patient access to personal health records. The predominant model for this record is a repository of all clinically relevant health information kept securely and viewed privately by patients and their health care providers. While this type of record does seem to have beneficial effects for the patient-physician relationship, the complexity and novelty of these data coupled with the lack of research in this area means the utility of personal health information for the primary stakeholders-the patients-is not well documented or understood.

OBJECTIVE

PatientsLikeMe is an online community built to support information exchange between patients. The site provides customized disease-specific outcome and visualization tools to help patients understand and share information about their condition. We begin this paper by describing the components and design of the online community. We then identify and analyze how users of this platform reference personal health information within patient-to-patient dialogues.

METHODS

Patients diagnosed with amyotrophic lateral sclerosis (ALS) post data on their current treatments, symptoms, and outcomes. These data are displayed graphically within personal health profiles and are reflected in composite community-level symptom and treatment reports. Users review and discuss these data within the Forum, private messaging, and comments posted on each other's profiles. We analyzed member communications that referenced individual-level personal health data to determine how patient peers use personal health information within patient-to-patient exchanges.

RESULTS

Qualitative analysis of a sample of 123 comments (about 2% of the total) posted within the community revealed a variety of commenting and questioning behaviors by patient members. Members referenced data to locate others with particular experiences to answer specific health-related questions, to proffer personally acquired disease-management knowledge to those most likely to benefit from it, and to foster and solidify relationships based on shared concerns.

CONCLUSIONS

Few studies examine the use of personal health information by patients themselves. This project suggests how patients who choose to explicitly share health data within a community may benefit from the process, helping them engage in dialogues that may inform disease self-management. We recommend that future designs make each patient's health information as clear as possible, automate matching of people with similar conditions and using similar treatments, and integrate data into online platforms for health conversations.