Designing for Motivation, Engagement and Wellbeing in Digital Experience

Identifying Factors of User Acceptance of a Drone-Based Medication Delivery: User-Centered Design Approach

BACKGROUND

The use of drones in the health care sector is increasingly being discussed against the background of the aging population and the growing shortage of skilled workers. In particular, the use of drones to provide medication in rural areas could bring advantages for the care of people with and without a need for care. However, there are hardly any data available that focus on the interaction between humans and drones.

OBJECTIVE

This study aims to disclose and analyze factors associated with user acceptance of drone-based medication delivery to derive practice-relevant guidance points for participatory technology development (for apps and drones).

METHODS

A controlled mixed methods study was conducted that supports the technical development process of an app design for drone-assisted drug delivery based on a participatory research design. For the quantitative analysis, established and standardized survey instruments to capture technology acceptance, such as the System Usability Scale; Technology Usage Inventory (TUI); and the Motivation, Engagement, and Thriving in User Experience model, were used. To avoid possible biasing effects from a continuous user development (eg, response shifts and learning effects), an ad hoc group was formed at each of the 3 iterative development steps and was subsequently compared with the consisting core group, which went through all 3 iterations.

RESULTS

The study found a positive correlation between the usability of a pharmacy drone app and participants' willingness to use it (r=0.833). Participants' perception of usefulness positively influenced their willingness to use the app (r=0.487; TUI). Skepticism had a negative impact on perceived usability and willingness to use it (r=-0.542; System Usability Scale and r=-0.446; TUI). The study found that usefulness, skepticism, and curiosity explained most of the intention to use the app (F3,17=21.12; P<.001; R2=0.788; adjusted R2=0.751). The core group showed higher ratings on the intention to use the pharmacy drone app than the ad hoc groups. Results of the 2-tailed t tests showed a higher rating on usability for the third iteration of the core group compared with the first iteration.

CONCLUSIONS

With the help of the participatory design, important aspects of acceptance could be revealed by the people involved in relation to drone-assisted drug delivery. For example, the length of time spent using the technology is an important factor for the intention to use the app. Technology-specific factors such as user-friendliness or curiosity are directly related to the use acceptance of the drone app. Results of this study showed that the more participants perceived their own competence in handling the app, the more they were willing to use the technology and the more they rated the app as usable.

A Smartphone App to Support Self-Management for People Living With Sjögren's Syndrome: Qualitative Co-Design Workshops

BACKGROUND

Sjögren's syndrome (SS) is the second most common autoimmune rheumatic disease, and the range of symptoms includes fatigue, dryness, sleep disturbances, and pain. Smartphone apps may help deliver a variety of cognitive and behavioral techniques to support self-management in SS. However, app-based interventions must be carefully designed to promote engagement and motivate behavior change.

OBJECTIVE

We aimed to explore self-management approaches and challenges experienced by people living with SS and produce a corresponding set of design recommendations that inform the design of an engaging, motivating, and evidence-based self-management app for those living with SS.

METHODS

We conducted a series of 8 co-design workshops and an additional 3 interviews with participants who were unable to attend a workshop. These were audio recorded, transcribed, and initially thematically analyzed using an inductive approach. Then, the themes were mapped to the Self-Determination Theory domains of competency, autonomy, and relatedness.

RESULTS

Participants experienced a considerable demand in the daily work required in self-managing their SS. The condition demanded unrelenting, fluctuating, and unpredictable mental, physical, and social efforts. Participants used a wide variety of techniques to self-manage their symptoms; however, their sense of competency was undermined by the complexity and interconnected nature of their symptoms and affected by interactions with others. The daily contexts in which this labor was occurring revealed ample opportunities to use digital health aids. The lived experience of participants showed that the constructs of competency, autonomy, and relatedness existed in a complex equilibrium with each other. Sometimes, they were disrupted by tensions, whereas on other occasions, they worked together harmoniously.

CONCLUSIONS

An SS self-management app needs to recognize the complexity and overlap of symptoms and the complexities of managing the condition in daily life. Identifying techniques that target several symptoms simultaneously may prevent users from becoming overwhelmed. Including techniques that support assertiveness and communication with others about the condition, its symptoms, and users' limitations may support users in their interactions with others and improve engagement in symptom management strategies. For digital health aids (such as self-management apps) to provide meaningful support, they should be designed according to human needs such as competence, autonomy, and relatedness. However, the complexities among the 3 Self-Determination Theory constructs should be carefully considered, as they present both design difficulties and opportunities.

Effects of Technology Use on Self-Reported Physical Activity: A Behavioral Change Perspective

Previous research finds initial evidence that affordances of interactivity, agency, and modality can help increase physical activity (PA). However, the cross-sectional nature of these studies provides a snapshot of behavior but does not assess the impact of affordances of technology on change in PA behavior. In this study, we bridge this gap and test if features of technology that afford interactivity, agency, and choice of modality will be associated with an increase in PA across time. Guided by the Motivational Technology Model (MTM), we scraped 784 user profiles from the BodySpace App (a social weightlifting smartphone application) at baseline and after 70 days and establish the relationship between the use of features that afford interactivity, agency, and modality and behavioral change. Theoretical and methodological implications are discussed.

Bridging gaps in the design and implementation of socially assistive technologies for dementia care: the role of occupational therapy

Dementia is a global health challenge, and people living with dementia (PLWD) are especially susceptible to reduced engagement in meaningful occupations, including social participation. In the past few decades, socially assistive technologies continue to be developed amidst a rapidly evolving technological landscape to support the social health of PLWD and their caregivers. Examples include social robots, virtual reality, smart home technology, and various digital technologies, such as mobile applications for tablets and smartphones. Despite an increasing body of research and interest in this field, several gaps relating to the design and implementation process of socially assistive technologies continue to undermine their relevance for PLWD in daily life. In this paper, some of these gaps are highlighted and the role of occupational therapy in the design and implementation of socially assistive technology is presented. In the design process, occupational therapists are uniquely skilled to advise and advocate for the tailoring and personalisation of technology to address the occupational needs of PLWD. In the implementation of socially assistive technologies, occupational therapists are skilled to educate, train, and conduct ongoing evaluations with PLWD and their caregivers, to incorporate socially assistive technologies into their routine and daily lives. We recommend that occupational therapists should continue to be acquainted with such technologies through continuous professional development and educational curricula. Moreover, we highlight the necessary collaboration between occupational therapists, technology developers, and researchers to enhance the process of designing and implementing socially assistive technology, so that their relevance for PLWD and their caregivers can be maximised.Implications for rehabilitationDevelopers and designers of socially assistive technology should consider the disease trajectory of different types of dementia, as well as the different needs, abilities, preferences, occupations and routines of people living with dementia (PLWD) and/or their caregivers.Collaborations between technology developers, researchers, and occupational therapists should take place iteratively throughout the process of designing and implementing socially assistive technology to maximise their relevance and applicability for people living with dementia and their caregivers.To continue enhancing the current role of occupational therapy in socially assistive technology provision, occupational therapists should keep up to date with socially assistive technology that are being developed to support the social health of PLWD.

Development of the intelligent knee osteoarthritis lifestyle app: a person-based approach

BACKGROUND

Knee osteoarthritis is one of the most prevalent long term health conditions globally. Exercise and physical activity are now widely recognised to significantly reduce joint pain, improve physical function and quality of life in patients with knee osteoarthritis. However, prescribed exercise without regular contact with a healthcare professional often results in lower adherence and poorer health outcomes. Digital mobile health (mHealth) technologies offer great potential to support people with long-term conditions such as knee osteoarthritis more efficiently and effectively and with relatively lower cost than existing interventions. However, there are currently very few mHealth interventions for the self-management of knee osteoarthritis. The aim of the present study was to describe the development process of a mHealth app to extend the support for physical activity and musculoskeletal health beyond short-term, structured rehabilitation through self-management, personalised physical activity, education, and social support.

METHODS

The development of the intelligent knee osteoarthritis lifestyle application intervention involved an iterative and interconnected process comprising intervention 'planning' and 'optimisation' informed by the person-based approach framework for the development of digital health interventions. The planning phase involved a literature review and collection of qualitative data obtained from focus groups with individuals with knee osteoarthritis (n = 26) and interviews with relevant physiotherapists (n = 5) to generate 'guiding principles' for the intervention. The optimisation phase involved usability testing (n = 7) and qualitative 'think aloud' sessions (n = 6) with potential beneficiaries to refine the development of the intervention.

RESULTS

Key themes that emerged from the qualitative data included the need for educational material, modifying activities to suit individual abilities and preferences as well as the inclusion of key features such as rehabilitation exercises. Following a user-trial further changes were made to improve the usability of the application.

CONCLUSIONS

Using a systematic person-based, development approach, we have developed the intelligent knee osteoarthritis lifestyle application to help people maintain physical activity behaviour. The app extends the support for physical activity and musculoskeletal health beyond short-term, structured rehabilitation through personalised physical activity guidance, education, and social support.

Feasibility and effectiveness study of applying a hallucinogen harm reduction and integration model to a mindfulness thinking intervention using virtual reality: A randomized controlled trial

Objective

The purpose of this study was to investigate whether a virtual reality (VR) program designed and developed based on the hallucinogenic harm reduction and integration (PHRI) clinical model could be more effective in guiding positive thinking training, improving positive thinking awareness and ability, and, to some extent, facilitating personal efficacy and emotional state compared to a traditional VR program that places users in a virtual natural ecological environment to guide positive thinking training. We also sought to understand the factors that may influence the effectiveness of VR interventions and user experience.

Method

Seventy-six randomly recruited participants were divided into a control group and an experimental group of 38 participants, each according to a random number table, and were trained in VR meditation for eight weeks. The experimental group used a PHRI-based mindfulness program, while the control group used a traditional mindfulness meditation program. We used The Mindful Attention Awareness Scale and the PAD emotional three-dimensional scale to assess the level of state mindfulness and changes in the emotional state before and at the end of the experiment. The Immersive Tendencies Questionnaire measured the user's sense of presence and immersion in the virtual environment. The Five Facet Mindfulness Questionnaires and the Depression Anxiety and Stress Scale (DASS-21) were used at the baseline assessment stage before and at the 4-week follow-up after the experiment to assess the change in trait mindfulness levels due to the mindfulness training. The Five Facet Mindfulness Questionnaires and the DASS-21 were used to assess changes in mindfulness and mental health trait levels.

Results

At the end of the experiment, the MMSQ score was significantly lower in the control group than in the experimental group, while the ITQ score was significantly higher than in the experimental group, and both scores were statistically significant (p < 0.05). In the follow-up assessment four weeks after the end of the experiment, the FFMQ-15 score and the DASS-21 were significantly and statistically higher in the experimental group than in the control group (p < 0.05). Since the scores of the PAD scale did not obey a normal distribution, we used the Wilcoxon signed-rank test to assess the results, which proved that the experimental group had higher levels of emotional activation and arousal.

Conclusion

The VR positive thinking program developed based on PHRI can significantly increase the positive thinking state and emotional arousal and activation of the general population participants but does not directly lead to the growth of positive emotions. Moreover, this detached psychedelic scene brings users a weaker sense of presence and presence than traditional natural space scenes. Furthermore, it does not bring any intense simulator motion sickness symptoms. These findings suggest that VR programs developed based on PHRI have a more positive facilitation effect on the positive state and that this increase lasts longer than conventional VR-positive programs.

Empirical Evidence of Internal and External Factors Influencing Users' Motivation Toward Teleconsultation Use

Introduction: The use of teleconsultation systems has increased in recent years, which has improved patients' access to health care providers and enabled seamless interaction between them. The literature points out several factors that either facilitate or impede the use of teleconsultation. However, there is a lack of studies that provide empirical evidence of factors that influence consumers' motivation toward the use of teleconsultation systems. Aim and Objective: This study aimed to provide empirical evidence of the internal and external factors that influence consumers' motivation toward the use of teleconsultation systems. Methods: A cross-sectional survey was used to collect data from consumers who used a real-time teleconsultation system called the Sehha application in Saudi Arabia between March 13 and June 14, 2021. SPSS 27.0.1 was used for descriptive analysis. Results: Four hundred eighty-five participants completed the survey, 471 of whom were included in the analysis. The findings confirmed that internal and external factors exert an influence on consumers' motivation toward the use of teleconsultation systems. The findings indicated that the presence of factors such as saving time, saving cost, accessibility to health care, ease-of-use, reliable internet access, availability of devices, and appropriate places during the online connection would increase consumers' motivation toward teleconsultation systems use. Also, the findings indicated that users' familiarity with systems similar to teleconsultation systems, users' perception of teleconsultation convenience, the influence of others on users' decision to use teleconsultation, and user's skills and confidence in using teleconsultation easily, and their trust in the teleconsultation system would also increase their motivation to use it. Furthermore, the findings showed that demographic factors, including age, gender, level of education, and employment status, did not influence users' motivation toward the use of teleconsultation Conclusions: This study provided empirical evidence of a variety of internal and external factors that exert an influence on consumers' motivation toward the use of teleconsultation systems.

High School Teachers' Experiences of Consumer Technologies for Stress Management During the COVID-19 Pandemic: Qualitative Study

BACKGROUND

Stress in education is an adverse reaction that teachers have to excessive pressures or other types of demands placed on them. Consumer digital technologies are already being used by teachers for stress management, albeit not in a systematic way. Understanding teachers' experiences and the long-term use of technologies to support stress self-management in the educational context is essential for meaningful insight into the value, opportunity, and benefits of use.

OBJECTIVE

The aim of this study was first to understand teachers' experiences of consumer technologies for stress management. They were chosen by teachers from a taxonomy tailored to their stress management. The second aim was to explore whether their experiences of use evolved over time as teachers transitioned from working at home during lockdown to working full time on school premises.

METHODS

A longitudinal study intended for 6 weeks in the summer term (2020) was extended because of COVID-19 into the autumn term, lasting up to 27 weeks. Teachers chose to use a Withings smartwatch or the Wysa, Daylio, or Teacher Tapp apps. In total, 2 semistructured interviews and web-based surveys were conducted with 8 teachers in South London in the summer term, and 6 (75%) of them took part in a third interview in the autumn term. The interviews were analyzed by creating case studies and conducting cross-case analysis.

RESULTS

The teachers described that the data captured or shared by the technology powerfully illustrated the physical and psychosocial toll of their work. This insight gave teachers permission to destress and self-care. The social-emotional confidence generated also led to empathy toward colleagues, and a virtuous cycle of knowledge, self-compassion, permission, and stress management action was demonstrated. Although the COVID-19 pandemic added a new source of stress, it also meant that teachers' stress management experiences could be contrasted between working from home and then back in school. More intentional self-care was demonstrated when back in school, sometimes without the need to refer to the data or technology.

CONCLUSIONS

The findings of this study demonstrate that taking a situated approach to understand the real-world, existential significance and value of data generates contextually informed insights. Where a strategic personal choice of consumer technology is enabled for high school heads of year, the data generated are perceived as holistic, with personal and professional salience, and are motivational in the educational context. Technology adoption was aided by the pandemic conditions of home working, and this flexibility would otherwise need workplace facilitation. These findings add to the value proposition of technologies for individual stress management and workforce health outcomes pertinent to educators, policy makers, and designers.

The Development of Game-Based Digital Mental Health Interventions: Bridging the Paradigms of Health Care and Entertainment

Game elements are increasingly used to improve user engagement in digital mental health interventions, and specific game mechanics may yield therapeutic effects per se and thereby contribute to digital mental health intervention efficacy. However, only a few commercial game-based interventions are available. We suggest that the key challenge in their development reflects the tension between the 2 underlying paradigms, health care and entertainment, which have disparate goals and processes in digital development. We describe 3 approaches currently used to negotiate the 2 paradigms: the gamification of health care software, designing serious games, and purpose shifting existing entertainment games. We advanced an integrative framework to focus attention on 4 key themes in intervention development: target audience, engagement, mechanisms of action, and health-related effectiveness. On each theme, we show how the 2 paradigms contrast and can complement each other. Finally, we consider the 4 interdependent themes through the new product development phases from concept to production. Our viewpoint provides an integrative synthesis that facilitates the research, design, and development of game-based digital mental health interventions.

Impacts of technology implementation on nurses' work motivation, engagement, satisfaction and well-being: A realist review

AIM

To examine current literature for causal explanations on how, why and under what circumstances, implementation of a new hospital electronic medical record system or similar technology impacts nurses' work motivation, engagement, satisfaction or well-being.

BACKGROUND

Implementation of new technology, such as electronic medical record systems, affects nurses and their work, workflows and inter-personal interactions in healthcare settings. Multiple individual and organisational-level factors can affect technology adoption by nurses and may have negative consequences for nurses and patient safety.

DESIGN

Five-step realist review method and Realist And Meta-narrative Evidence Syntheses: Evolving Standards checklist was used to guide this review. Eight initial theories (programme theories) were used as the basis to explore, examine and refine literature from a range of sources.

DATA SOURCES

Literature from five databases (APA PsycInfo, CINAHL, Embase, IEEE Xplore and MEDLINE Complete) and grey literature (from 1 January 2000 to 31 October 2021) were systematically searched and retrieved on 4 November 2021.

RESULTS

In all, 8980 records were screened at the title and abstract level, of which 1027 full texts were screened and 10 were included in the review. Seven studies assessed concepts in both pre- and post-technology implementation. Most common contexts related to knowledge, rationale and skills to use new technology. Mechanisms that impacted nurses or nursing care delivery included: nurses' involvement in technology implementation processes; nurses' perceptions, understanding and limitations of technology impact(s) on patient care delivery; social supports; skills; implementation attitude and hardware. Work satisfaction was the most frequently examined outcome. An analysis led to nine final programme theories (including two original, six revised and one new programme theory).

CONCLUSION

Nurses must be informed about the rationale for new technology and have the knowledge and skills for its use. Understanding nurses' work motivation and attitudes related to technology adoption in the workplace can support work engagement, satisfaction and well-being.

IMPLICATIONS FOR THE PROFESSION

Complex contexts and mechanisms play a role in nurses' work motivation, engagement, satisfaction and well-being with the implementation of new technology into healthcare settings.

RELEVANCE TO CLINICAL PRACTICE

Nurses, their work and workflows are all influenced by the implementation of new technologies (such as electronic medical records), which in turn has consequences for patient safety and quality of care.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

PROSPERO REGISTRATION NUMBER

CRD42020131875 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=131875).

Who needs what (features) when? Personalizing engagement with data-driven self-management to improve health equity

OBJECTIVES

To examine the feasibility of promoting engagement with data-driven self-management of health among individuals from minoritized medically underserved communities by tailoring the design of self-management interventions to individuals' type of motivation and regulation in accordance with the Self-Determination Theory.

METHODS

Fifty-three individuals with type 2 diabetes from an impoverished minority community were randomly assigned to four different versions of an mHealth app for data-driven self-management with the focus on nutrition, Platano; each version was tailored to a specific type of motivation and regulation within the SDT self-determination continuum. These versions included financial rewards (external regulation), feedback from expert registered dietitians (RDF, introjected regulation), self-assessment of attainment of one's nutritional goals (SA, identified regulation), and personalized meal-time nutrition decision support with post-meal blood glucose forecasts (FORC, integrated regulation). We used qualitative interviews to examine interaction between participants' experiences with the app and their motivation type (internal-external).

RESULTS

As hypothesized, we found a clear interaction between the type of motivation and Platano features that users responded to and benefited from. For example, those with more internal motivation reported more positive experience with SA and FORC than those with more external motivation. However, we also found that Platano features that aimed to specifically address the needs of individuals with external regulation did not create the desired experience. We attribute this to a mismatch in emphasis on informational versus emotional support, particularly evident in RDF. In addition, we found that for participants recruited from an economically disadvantaged community, internal factors, such as motivation and regulation, interacted with external factors, most notably with limited health literacy and limited access to resources.

CONCLUSIONS

The study suggests feasibility of using SDT to tailor design of mHealth interventions for promoting data-driven self-management to individuals' motivation and regulation. However, further research is needed to better align design solutions with different levels of self-determination continuum, to incorporate stronger emphasis on emotional support for individuals with external regulation, and to address unique needs and challenges of underserved communities, with particular attention to limited health literacy and access to resources.

Protocol for a systematic literature review of smartphone apps to support the self-management of rheumatic and musculoskeletal diseases: development strategies, theoretical underpinnings and barriers to engagement

BACKGROUND

Rheumatic and musculoskeletal diseases (RMDs) cause significant burden to the individual and society, requiring lifelong management and specialist healthcare resource use. Costing over 200 billion euros per year in Europe, RMDs are the most expensive of all diseases for European healthcare systems. The incidence and burden of RMDs are projected to rise with the ageing global population and increase in sedentary, obesogenic lifestyles. In parallel, there is a global crisis in the rheumatology workforce, whereby capacity to deliver specialist care is being exceeded by demand. Pervasive, scalable mobile health technologies, such as apps, are being developed to support the self-management of RMDs and reduce pressure on healthcare services. However, it is unknown whether these apps are informed by theory or their use supported by an appropriate evidence base. The purpose of this review is therefore to provide a comprehensive overview of the development strategies, interventional components and theoretical underpinnings of existing smartphone apps, designed to support the self-management of RMDs.

METHODS

Searches will be conducted within PubMed, Scopus, Web of Science, Embase, MEDLINE and PsycINFO. Reference lists and citing articles of the included studies will be searched. Identified publications will be screened for eligibility by two independent reviewers. Any discrepancies between reviewers will be resolved by consensus, with input from a third reviewer if required. Data will be extracted on study designs, methods, populations, setting, utilised theoretical frameworks, intervention components, behaviour change techniques, methods to evaluate effectiveness and barriers/facilitators to intervention engagement. Exploratory outcomes include reported effectiveness, acceptability and usability. A systematic, narrative synthesis of evidence will be presented. If appropriate (depending on quality and pool of evidence identified), qualitative meta-summary techniques will be used to combine and summarise qualitative findings regarding barriers/facilitators to intervention engagement.

DISCUSSION

The results of this systematic literature review will provide insights for healthcare professionals, researchers, app designers and policy makers, to inform future development and implementation of smartphone apps to support self-management of RMDs. Evidence gaps for future research will be identified. Findings will be disseminated through a final manuscript/publication of results and via a conference abstract, patient organisations and social media.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022359704.

Technology evaluations are associated with psychological need satisfaction across different spheres of experience: an application of the METUX scales

Introduction

Digital technologies have the capacity to impact psychological wellbeing in both positive and negative ways. Improving technologies with respect to wellbeing requires nuanced understanding of this impact and reliable ways to measure it. Here, we aim to further this understanding by investigating the relations between psychological needs and people's evaluations of technologies (with respect to satisfaction, usability, and measures of value).

Method

Across two studies with 1,521 participants, we improved and validated four scales that were first put forward as part of the METUX model of technology interaction. These scales measure psychological needs in the life, behavior, task, and interface spheres of experience. We applied these scales to four separate technologies (Facebook, TikTok, Blackboard, and Moodle), and examined the relationships between people's need satisfaction and frustration in the four spheres of experience and their overall evaluations of the technologies.

Results and discussion

Each of the four scales had good psychometric properties across the four technologies. For each sphere of experience, psychological need satisfaction and frustration were associated with standard measures of usability and user satisfaction, and correlation patterns supported the METUX model and its approach to differentiating spheres of technology experience.

Establishing Requirements for Technology to Support Clinical Trial Retention: Systematic Scoping Review and Analysis Using Self-determination Theory

BACKGROUND

Retaining participants in clinical trials is an established challenge. Currently, the industry is moving to a technology-mediated, decentralized model for running trials. The shift presents an opportunity for technology design to aid the participant experience and promote retention; however, there are many open questions regarding how this can be best supported. We advocate the adoption of a stronger theoretical position to improve the quality of design decisions for clinical trial technology to promote participant engagement.

OBJECTIVE

This study aimed to identify and analyze the types of retention strategies used in published clinical trials that successfully retain participants.

METHODS

A systematic scoping review was carried out on 6 electronic databases for articles published from 1990 to September 2020, namely CINAHL, The Cochrane Library, EBSCO, Embase, PsycINFO, and PubMed, using the concepts "retention," "strategy," "clinal trial," and "clinical research." This was followed by an analysis of the included articles through the lens of self-determination theory, an evidence-based theory of human motivation.

RESULTS

A total of 26 articles were included in this review. The motivational strategies identified in the clinical trials in our sample were categorized into 8 themes: autonomy; competence; relatedness; controlled motivation; branding, communication material, and marketing literature; contact, tracking, and scheduling methods and data collection; convenience to contribute to data collection; and organizational competence. The trials used a wide range of motivational strategies. Notably, the trials often relied on controlled motivation interventions and underused strategies to support intrinsic motivation. Moreover, traditional clinical trials relied heavily on human interaction and "relatedness" to support motivation and retention, which may cause problems in the move to technology-led decentralized trials. We found inconsistency in the data-reporting methods and that motivational theory-based approaches were not evident in strategy design.

CONCLUSIONS

This study offers direction and a framework to guide digital technology design decisions for future decentralized clinical trials to enhance participant retention during clinical trials. This research defines previous clinical trial retention strategies in terms of participant motivation, identifies motivational strategies, and offers a rationale for selecting strategies that will improve retention. It emphasizes the benefits of using theoretical frameworks to analyze strategic approaches and aid decision-making to improve the quality of technology design decisions.

Trojan technology in the living room?

Definition of the problem

Assistive technologies, including “smart” instruments and artificial intelligence (AI), are increasingly arriving in older adults’ living spaces. Various research has explored risks (“surveillance technology”) and potentials (“independent living”) to people’s self-determination from technology itself and from the increasing complexity of sociotechnical interactions. However, the point at which self-determination of the individual is overridden by external influences has not yet been sufficiently studied. This article aims to shed light on this point of transition and its implications.

Arguments

The identification of this “tipping point” could contribute to analysis of familiar issues of conflict between the ethical principles of beneficence and respect for autonomy. When using technology in the living spaces of older adults, relationships, among other factors, may play a crucial role in older adult’s self-determination. We find the tipping point to occur subjectively and variably. To this end, the article combines theoretical ethical considerations with two examples from a qualitative study illustrating the perspective of older adults aged 65–85 years.

Conclusion

The study of the tipping point underscores the importance of perceiving an older person’s perspective. Particularly at the tipping point, this might be the only way to effectively identify whether the individual concerned perceives their self-determination as externally overridden. In conceptualizing the tipping point itself as well as its variability, we might create the basis for a normative call to shift the tipping point to promote self-determination and prevent overriding the will of older adults. We highlight individual, relational, and societal implications of our findings.

An interpretable machine learning approach to multimodal stress detection in a simulated office environment

BACKGROUND AND OBJECTIVE

Work-related stress affects a large part of today's workforce and is known to have detrimental effects on physical and mental health. Continuous and unobtrusive stress detection may help prevent and reduce stress by providing personalised feedback and allowing for the development of just-in-time adaptive health interventions for stress management. Previous studies on stress detection in work environments have often struggled to adequately reflect real-world conditions in controlled laboratory experiments. To close this gap, in this paper, we present a machine learning methodology for stress detection based on multimodal data collected from unobtrusive sources in an experiment simulating a realistic group office environment (N=90).

METHODS

We derive mouse, keyboard and heart rate variability features to detect three levels of perceived stress, valence and arousal with support vector machines, random forests and gradient boosting models using 10-fold cross-validation. We interpret the contributions of features to the model predictions with SHapley Additive exPlanations (SHAP) value plots.

RESULTS

The gradient boosting models based on mouse and keyboard features obtained the highest average F1 scores of 0.625, 0.631 and 0.775 for the multiclass prediction of perceived stress, arousal and valence, respectively. Our results indicate that the combination of mouse and keyboard features may be better suited to detect stress in office environments than heart rate variability, despite physiological signal-based stress detection being more established in theory and research. The analysis of SHAP value plots shows that specific mouse movement and typing behaviours may characterise different levels of stress.

CONCLUSIONS

Our study fills different methodological gaps in the research on the automated detection of stress in office environments, such as approximating real-life conditions in a laboratory and combining physiological and behavioural data sources. Implications for field studies on personalised, interpretable ML-based systems for the real-time detection of stress in real office environments are also discussed.

Personalized Help-Seeking Web Application for Chinese-Speaking International University Students: Development and Usability Study

BACKGROUND

The mental health of international students is a growing concern for education providers, students, and their families. Chinese international students have low rates of help seeking owing to language, stigma, and mental health literacy barriers. Web-based help-seeking interventions may improve the rate of help seeking among Chinese international students.

OBJECTIVE

This study aimed to describe the development of a mental well-being web app providing personalized feedback and tailored psychoeducation and resources to support help seeking among international university students whose first language is Chinese and test the web application's uptake and engagement.

METHODS

The bilingual MindYourHead web application contains 6 in-app assessments for various areas of mental health, and users are provided with personalized feedback on symptom severity, psychoeducation tailored to the person's symptoms and information about relevant interventions, and tailored links to external resources and mental health services. A feasibility study was conducted within a school at the University of Sydney to examine the uptake and engagement of the web application among Chinese international students and any demographic characteristics or help-seeking attitudes or intentions that were associated with its engagement.

RESULTS

A total of 130 Chinese international students signed up on the web application. There was an uptake of 13.4% (122/908) in the schools' Chinese student enrollment. Most participants (76/130, 58.5%) preferred to use the web application in Chinese and used informal but not formal help for their mental health. There was considerable attrition owing to a design issue, and only 46 students gained access to the full content of the web application. Of these, 67% (31/46) of participants completed 1 or more of the in-app mental well-being assessments. The most commonly engaged in-app assessments were distress (23/31, 74%), stress (17/31, 55%), and sleep (15/31, 48%), with the majority scoring within the moderate- or high-risk level of the score range. In total, 10% (9/81) of the completed in-app assessments led to clicks to external resources or services. No demographic or help-seeking intentions or attitudes were associated with web-application engagement.

CONCLUSIONS

There were promising levels of demand, uptake, and engagement with the MindYourHead web application. The web application appears to attract students who wished to access mental health information in their native language, those who had poor mental health in the past but relied on informal support, and those who were at moderate or high risk of poor mental well-being. Further research is required to explore ways to improve uptake and engagement and to test the efficacy of the web application on Chinese international students' mental health literacy, stigma, and help seeking.

Off-World Mental Health: Considerations for the Design of Well-being-Supportive Technologies for Deep Space Exploration

During future long-duration space exploration missions, humans will be exposed to combinations of extreme physical, psychological, and interpersonal demands. These demands create risks for the safety, performance, health, and well-being of both individuals and crew. The communication latency in deep space means that explorers will increasingly have to operate independently and take responsibility for their own self-care and self-management. At present, several research programs are focused on developing and testing digital technologies and countermeasures that support the effective functioning of deep space crews. Although promising, these initiatives have been stimulated mostly by technological opportunity rather than cogent theory. In this perspective, we argue that digital technologies developed for spaceflight should be informed by well-being-supportive design principles and be cognizant of broader conversations around the development and use of digital health applications, especially pertaining to issues of autonomy, privacy, and trust. These issues are important for designing potentially mission-critical health technologies and may be determining factors in the safe and successful completion of future off-world endeavors.

Motivation to interaction media: The impact of automation trust and self-determination theory on intention to use the new interaction technology in autonomous vehicles

Introduction

This research investigated the effects of three psychological needs (competence, autonomy, and relatedness) of self-determination theory (SDT) and automation trust on the intention of users to employ new interaction technology brought by autonomous vehicles (AVs), especially interaction mode and virtual image.

Method

This study focuses on the discussion from the perspective of psychological motivation theory applied to AV interaction technology. With the use of a structured questionnaire, participants completed self-report measures related to these two interaction technologies; a total of 155 drivers' responses were analyzed.

Result

The results indicated that users' intentions were directly predicted by their perceived competence, autonomy, and relatedness of SDT and automation trust, which jointly explained at least 66% of the variance in behavioral intention. In addition to these results, the contribution of predictive components to behavioral intention is influenced by the type of interaction technology. Relatedness and competence significantly impacted the behavioral intention to use the interaction mode but not the virtual image.

Discussion

These findings are essential in that they support the necessity of distinguishing between types of AV interaction technology when predicting users' intentions to use.

Assessing the Feasibility of a Text-Based Conversational Agent for Asthma Support: Protocol for a Mixed Methods Observational Study

BACKGROUND

Despite efforts, the UK death rate from asthma is the highest in Europe, and 65% of people with asthma in the United Kingdom do not receive the professional care they are entitled to. Experts have recommended the use of digital innovations to help address the issues of poor outcomes and lack of care access. An automated SMS text messaging-based conversational agent (ie, chatbot) created to provide access to asthma support in a familiar format via a mobile phone has the potential to help people with asthma across demographics and at scale. Such a chatbot could help improve the accuracy of self-assessed risk, improve asthma self-management, increase access to professional care, and ultimately reduce asthma attacks and emergencies.

OBJECTIVE

The aims of this study are to determine the feasibility and usability of a text-based conversational agent that processes a patient's text responses and short sample voice recordings to calculate an estimate of their risk for an asthma exacerbation and then offers follow-up information for lowering risk and improving asthma control; assess the levels of engagement for different groups of users, particularly those who do not access professional services and those with poor asthma control; and assess the extent to which users of the chatbot perceive it as helpful for improving their understanding and self-management of their condition.

METHODS

We will recruit 300 adults through four channels for broad reach: Facebook, YouGov, Asthma + Lung UK social media, and the website Healthily (a health self-management app). Participants will be screened, and those who meet inclusion criteria (adults diagnosed with asthma and who use WhatsApp) will be provided with a link to access the conversational agent through WhatsApp on their mobile phones. Participants will be sent scheduled and randomly timed messages to invite them to engage in dialogue about their asthma risk during the period of study. After a data collection period (28 days), participants will respond to questionnaire items related to the quality of the interaction. A pre- and postquestionnaire will measure asthma control before and after the intervention.

RESULTS

This study was funded in March 2021 and started in January 2022. We developed a prototype conversational agent, which was iteratively improved with feedback from people with asthma, asthma nurses, and specialist doctors. Fortnightly reviews of iterations by the clinical team began in September 2022 and are ongoing. This feasibility study will start recruitment in January 2023. The anticipated completion of the study is July 2023. A future randomized controlled trial will depend on the outcomes of this study and funding.

CONCLUSIONS

This feasibility study will inform a follow-up pilot and larger randomized controlled trial to assess the impact of a conversational agent on asthma outcomes, self-management, behavior change, and access to care.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/42965.

Enhancing Visual Exploration through Augmented Gaze: High Acceptance of Immersive Virtual Biking by Oldest Olds

The diffusion of virtual reality applications dedicated to aging urges us to appraise its acceptance by target populations, especially the oldest olds. We investigated whether immersive virtual biking, and specifically a visuomotor manipulation aimed at improving visual exploration (augmented gaze), was well accepted by elders living in assisted residences. Twenty participants (mean age 89.8 years, five males) performed three 9 min virtual biking sessions pedalling on a cycle ergometer while wearing a Head-Mounted Display which immersed them inside a 360-degree pre-recorded biking video. In the second and third sessions, the relationship between horizontal head rotation and contingent visual shift was experimentally manipulated (augmented gaze), the visual shift being twice (gain = 2.0) or thrice (gain = 3.0) the amount of head rotation. User experience, motion sickness and visual exploration were measured. We found (i) very high user experience ratings, regardless of the gain; (ii) no effect of gain on motion sickness; and (iii) increased visual exploration (slope = +46%) and decreased head rotation (slope = -18%) with augmented gaze. The improvement in visual exploration capacity, coupled with the lack of intolerance signs, suggests that augmented gaze can be a valuable tool to improve the "visual usability" of certain virtual reality applications for elders, including the oldest olds.

"Of course, drones delivering urgent medicines are necessary. But I would not use them until…" Insights from a qualitative study on users' needs and requirements regarding the use of medical drones

BACKGROUND

The current COVID-19 pandemic, demographic trends, and the increasing shortage of skilled workers pose major challenges for the care of people with and without care needs. The potential of drones as unmanned aerial vehicles in health care is being discussed as an effective innovative way of delivering much-needed medicines, especially in rural areas. Although the advantages are well known, the needs of the users have not yet been taken into account.

METHODS

Online-based focus groups (via WebEx) were conducted with participants from different disciplines: nursing, pharmacy, physicians. Focus groups with COVID-19 patients were conducted face-to-face. The focus was primarily on potential problems and requirements of the users regarding the use of drones. Structured and contrastive snowball sampling has been deployed. The focus groups were audio recorded, transcribed by a transcription-company, and coded with the help of the program "f4analyse 2" for content (Elo et al. 2008).

RESULTS

Especially during the pandemic situation, delays, and restrictions in the delivery of medicines have been noticed. All interview partners (patients, pharmacists, physicians, and nurses; n = 36 participants) see drones as useful in cases of limited mobility, time-critical medicines (rapid availability), emergencies, and disasters (e.g., floods), but also for the delivery of regular medicines in rural areas (e.g., for the treatment of chronic diseases). Moreover, only 16.7% of the participants have experiences with drones.

DISCUSSION

Drone deliveries do not play a role in the health system yet despite their great importance, which is perceived as particularly evident in the pandemic situation. The results lead to the conclusion that this is mainly due to knowledge and application deficits, so that educational and advisory work is absolutely necessary. There is also a need for further studies that go beyond the scope of acceptance research to describing and evaluating concrete scenarios of drone delivery on the basis of a user-centered approach.

Positive cyberpsychology as a field of study of the well-being of people interacting with and via technology

The aim of the article is to postulate introducing and developing positive cyberpsychology (PCyb) as a subdiscipline of cyberpsychology, which emerges at the intersection of cyberpsychology, positive psychology, and well-being informed design, and focuses on studying determinants of human well-being through interactions with and via technology. The article presents the rationale for considering the emergence of PCyb based on the importance of research on the positive transformation of people in the era of progressive digitalization and cyborgization, and the growing partnership of cyberpsychology, positive psychology, and well-being informed design in the form of paradigms and ongoing research. Moreover, it highlights the need to reframe cyberpsychology dominated by the study of the "dark side" of technology and the need to integrate and increase the "visibility" of research results on the beneficial effects of technology. The article also accentuates the opening perspective of a more in-depth analysis of the positive transformation process than the one existing within the well-being informed design and underlines a broader plan of innovation use than is taken into account in cyberpsychology and positive psychology. Lastly, it discusses the use of the results of research conducted within PCyb in the design of new technologies, consulting, and education, as well as the possibility of strengthening the voice of psychologists in the debate about the future of humans functioning in the constantly changing technosphere.

Perceived Autonomy Support in Telerehabilitation by People With Chronic Respiratory Disease: A Mixed Methods Study

BACKGROUND

Autonomy-supportive health environments can assist patients in achieving behavior change and can influence adherence positively. Telerehabilitation may increase access to rehabilitation services, but creating an autonomy-supportive environment may be challenging.

RESEARCH QUESTION

To what degree does telerehabilitation provide an autonomy-supportive environment? What is the patient experience of an 8-week telerehabilitation program?

STUDY DESIGN AND METHODS

Individuals undertaking telerehabilitation or center-based pulmonary rehabilitation within a larger randomized controlled equivalence trial completed the Health Care Climate Questionnaire (HCCQ; short form) to assess perceived autonomy support. Telerehabilitation participants were invited 1:1 to undertake semistructured interviews. Interviews were transcribed verbatim and coded thematically to identify major themes and subthemes.

RESULTS

One hundred thirty-six participants (n = 69 telerehabilitation) completed the HCCQ and 30 telerehabilitation participants (42%) undertook interviews. HCCQ summary scores indicated that participants strongly agreed that the telerehabilitation environment was autonomy supportive, which was similar to center-based participants (HCCQ summary score, P = .6; individual HCCQ items, P ≥ .3). Telerehabilitation interview data supported quantitative findings identifying five major themes, with subthemes, as follows: (1) making it easier to participate in pulmonary rehabilitation, because telerehabilitation was convenient, saved time and money, and offered flexibility; (2) receiving support in a variety of ways, including opportunities for peer support and receiving an individualized program guided by expert staff; (3) internal and external motivation to exercise as a consequence of being in a supervised group, seeing results for effort, and being inspired by others; (4) achieving success through provision of equipment and processes to prepare and support operation of equipment and technology; and (5) after the rehabilitation program, continuing to exercise, but dealing with feelings of loss.

INTERPRETATION

Telerehabilitation was perceived as an autonomy-supportive environment, in part by making it easier to undertake pulmonary rehabilitation. Support for behavior change, understanding, and motivation were derived from clinicians and patient-peers. The extent to which autonomy support translates into ongoing self-management and behavior change is not clear.

TRIAL REGISTRY

ClinicalTrials.gov; No.: ACTRN12616000360415; URL: www.

CLINICALTRIALS

gov.

Effective Online Engagement Strategies Through Gamification

Gamification has recently been discovered as an excellent user engagement strategy that has the potential to improve online education, online brand engagement, and information system engagement. Even though the number of studies on gamification has expanded, there is currently no systematic literature review approach for categorizing its online engagement strategies. Therefore, the main purpose of this systematic literature review is to find effective online engagement strategies based on gamification. The literature, as published in top management, information systems, and education journals, was reviewed using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and authors categorized the studies published during the period 2016 to 2021. This study can be considered as among the first to include a systematic literature review with a potential future research agenda on effective online engagement strategies through gamification. The findings indicate several effective online engagement strategies through gamification for three major aspects.

A Value-centered Exploration of Data Privacy and Personalized Privacy Assistants

In the current post-GDPR landscape, privacy notices have become ever more prevalent on our phones and online. However, these notices are not well suited to their purpose of helping users make informed decisions. I suggest that instead of utilizing notice to elicit informed consent, we could repurpose privacy notices to create the space for more meaningful, value-centered user decisions. Value-centered privacy decisions, or those that accurately reflect who we are and what we value, encapsulate the intuitive role of personal values in data privacy decisions. To explore how we could design for such decisions, I utilize Suzy Killmister’s Four-Dimensional Theory of Autonomy (4DT) to operationalize value-centered privacy decisions. I then utilize 4DT to help design a system—called a value-centered privacy assistant (VcPA)—that could help create the space for value-centered data privacy decisions using privacy notices. Using this 4DT lens, I further assess the degree that an existing technology, personalized privacy assistants (PPAs), use notices in a manner that allows for value-centered decision-making. I lastly utilize insights from the PPA assessment to inform the design of a VcPA, concluding that a VcPA could utilize notices to assist users in value-centered app selection and in other data privacy decisions.

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.

Does platform type matter? A semantic analysis of user attitude formation on online platforms

An online platform is a setting where users may express their attitude in text or visual content. The doctrine thinking in consumer psychology is that greater perceived product value (e.g., more product features or lower price) gives more positive consumer attitude. Because of different types of platforms, however, online users might form their product/brand attitudes in different ways. We gathered 7,264 lines of online reviews about two famous brands on two types of social media platforms: online text-based forums and live-streaming platforms. The data were collected through a web crawler, and semantic analysis was employed to process the data before hypothesis testing. The findings of this study indicate that users’ perception of product features, price levels and brand culture significantly influence user attitude. The more product characteristics communicated on online platforms, the more difficult to formulate a positive user attitude, and users tend to have more positive attitude with higher perceived price. Compared with traditional text-based platforms, contents in live-streaming platforms (e.g., Tik Tok) with less product features, wider culture distance and lower perceived price are favored among users.

Designing a conversational agent to promote teamwork and collaborative practices using design thinking: An explorative study on user experiences

Appearance, voice features, and communication style affect users trust in conversational agents (chatbots), but few studies have assessed what features users like and dislike. Using design thinking, we developed Susa, a conversational agent, to help workplaces promote teamwork and collaborative practices. Design thinking prioritizes co-creation and multidisciplinary teamwork to develop innovative solutions to complex problems. The aim of this qualitative study was to explore users’ interactions with and reactions toward Susa and explain how we used user inputs to adapt and refine the first prototype. The employees and managers from four workplaces participated in three workshops to test and refine the agent. We applied an explorative thematic analysis of data collected via video recordings of the workshops. The results of the analyses revealed that visual identity, communication style and personality was important for acceptability. Users favored a more human like agent that primarily communicated with the team via text messages. Users disliked emoticons and humor because these features clashed with the seriousness of the topic. Finally, users highlighted that Susa helped structure organizational change processes, develop concrete action plans, and stay on track. It is a weakness that Susa is a simple robot based on a preprogrammed script that does not allow users to adapt the process.

One size does not fit all: Participants' experiences of the selfBACK app to support self-management of low back pain-a qualitative interview study

BACKGROUND

Low back pain (LBP) is one of the most common reasons for disability globally. Digital interventions are a promising means of supporting people to self-manage LBP, but implementation of digital interventions has been suboptimal. An artificial intelligence-driven app, selfBACK, was developed to support self-management of LBP as an adjunct to usual care. To better understand the process of implementation from a participant perspective, we qualitatively explored factors influencing embedding, integrating, and sustaining engagement with the selfBACK app, and the self-perceived effects, acceptability, and satisfaction with the selfBACK app.

METHODS

Using a qualitative interview study and an analytic framework approach underpinned by Normalization Process Theory (NPT), we investigated the experiences of patients who participated in the selfBACK randomized controlled trial (RCT). Interviews focused on the motivation to participate in the RCT, experiences of using the selfBACK app, and views about future intended use and potential of using digital health interventions for self-management of LBP. Participants were purposively sampled to represent diversity in age, sex, and implementation reflected by a proxy measure of number of app-generated self-management plans during the first three months of RCT participation.

RESULTS

Twenty-six participants aged 21-78, eleven females and fifteen men, with two to fourteen self-management plans, were interviewed between August 2019 and April 2020. A broad range of factors influencing implementation of selfBACK within all constructs of NPT were identified. Key facilitating factors were preferences and beliefs favoring self-management, a friendly, motivational, and reassuring supporter, tailoring and personalization, convenience and ease of use, trustworthiness, perceiving benefits, and tracking achievements. Key impeding factors were preferences and beliefs not favoring self-management, functionality issues, suboptimal tailoring and personalization, insufficient time or conflicting life circumstances, not perceiving benefits, and insufficient involvement of health care practitioners. Self-perceived effects on pain and health, behavior/attitude, and gaining useful knowledge varied by participant.

CONCLUSIONS

The high prevalence of LBP globally coupled with the advantages of providing help through an app offers opportunities to help countless people. A range of factors should be considered to facilitate implementation of self-management of LBP or similar pain conditions using digital health tools.

The Empowerment of Artificial Intelligence in Post-Digital Organizations: Exploring Human Interactions with Supervisory AI

Technology evolves together with humans. Across industrial revolutions, its role has evolved from that of a simple tool used by humans to that of intelligent decision-maker and teammate. In the post-digital era where ongoing advances in artificial intelligence are widely visible, the question arises regarding the extent to which technology will be “upgraded” into roles previously filled by human supervisors, thereby replacing persons in managerial positions. This text aims to delineate how the organizational role of technology has been transformed across decades and the forms that it currently takes within companies, with an eye to the future. We draw on posthuman managerial literature and known cases of organizations where some forms of supervisory artificial intelligence are already used. The text is conceptual-reflective by nature; it seeks to initiate a discussion on the many challenges that humanity will face in connection with the deployment of empowered posthuman agents in companies.

The potential of learning with (and not from) artificial intelligence in education

AI-powered technologies are increasingly being developed for educational purposes to contribute to students' academic performance and overall better learning outcomes. This exploratory review uses the PRISMA approach to describe how the effectiveness of AI-driven technologies is being measured, as well as the roles attributed to teachers, and the theoretical and practical contributions derived from the interventions. Findings from 48 articles highlighted that learning outcomes were more aligned with the optimization of AI systems, mostly nested in a computer science perspective, and did not consider teachers in an active role in the research. Most studies proved to be atheoretical and practical contributions were limited to enhancing the design of the AI system. We discuss the importance of developing complementary research designs for AI-powered tools to be integrated optimally into education.

Nurses’ Experiences After Implementation of an Organization-Wide Electronic Medical Record: Qualitative Descriptive Study

Background

Reports on the impact of electronic medical record (EMR) systems on clinicians are mixed. Currently, nurses’ experiences of adopting a large-scale, multisite EMR system have not been investigated. Nurses are the largest health care workforce; therefore, the impact of EMR implementation must be investigated and understood to ensure that patient care quality, changes to nurses’ work, and nurses themselves are not negatively impacted.

Objective

This study aims to explore Australian nurses’ postimplementation experiences of an organization-wide EMR system.

Methods

This qualitative descriptive study used focus group and individual interviews and an open-ended survey question to collect data between 12 and 18 months after the implementation of an EMR across 6 hospital sites of a large health care organization in Victoria, Australia. Data were collected between November 2020 and June 2021, coinciding with the COVID-19 pandemic. Analysis comprised complementary inductive and deductive approaches. Specifically, reflexive thematic analysis was followed by framework analysis by the coding of data as barriers or facilitators to nurses’ use of the EMR using the Theoretical Domains Framework.

Results

A total of 158 nurses participated in this study. The EMR implementation dramatically changed nurses’ work and how they viewed their profession, and nurses were still adapting to the EMR implementation 18 months after implementation. Reflexive thematic analysis led to the development of 2 themes: An unintentional divide captured nurses’ feelings of division related to how using the EMR affected nurses, patient care, and the broader nursing profession. This time, it’s personal detailed nurses’ beliefs about the EMR implementation leading to bigger changes to nurses as individuals and nursing as a profession than other changes that nurses have experienced within the health care organization. The most frequent barriers to EMR use by nurses were related to the Theoretical Domains Framework domain of environmental context and resources. Facilitators of EMR use were most often related to memory, attention, and decision processes. Most barriers and facilitators were related to motivation.

Conclusions

Nurses perceived EMR implementation to have a mixed impact on the provision of quality patient care and on their colleagues. Implementing technology in a health care setting was perceived as a complex endeavor that impacted nurses’ perceptions of their autonomy, ways of working, and professional roles. Potential negative consequences were related to nursing workforce retention and patient care delivery. Motivation was the main behavioral driver for nurses’ adoption of EMR systems and hence a key consideration for implementing interventions or organizational changes directed at nurses.

Tech Ethics Through Trust Auditing

The public's trust in the technology sector is waning and, in response, technology companies and state governments have started to champion "tech ethics". That is, they have pledged to design, develop, distribute, and employ new technologies in an ethical manner. In this paper, I observe that tech ethics is already subject to a widespread pathology in that technology companies, the primary executors of tech ethics, are incentivized to pursue it half-heartedly or even disingenuously. Next, I highlight two emerging strategies which might be used to combat this problem, but argue that both are subject to practical limitations. In response, I suggest an additional way of augmenting the practice of tech ethics. This is to employ "trust audits," a new form of public participation in the socio-technical environment. In the remainder of the paper, I offer a description of how trust audits work, what they might look like in practice, and how they can fit in alongside those other strategies for improving tech ethics.

The Psychology of Personalization in Digital Environments: From Motivation to Well-Being – A Theoretical Integration

The personalization of digital environments is becoming ubiquitous due to the rise of AI-based algorithms and recommender systems. Arguably, this technological development has far-reaching consequences for individuals and societies alike. In this article, we propose a psychological model of the effects of personalization in digital environments, which connects personalization with motivational tendencies, psychological needs, and well-being. Based on the model, we review studies from three areas of application—news feeds and websites, music streaming, and online dating—to explain both the positive and the negative effects of personalization on individuals. We conclude that personalization can lead to desirable outcomes such as reducing choice overload. However, personalized digital environments without transparency and without the option for users to play an active role in the personalization process potentially pose a danger to human well-being. Design recommendations as well as avenues for future research that follow from these conclusions are being discussed.

Supporting a Sustainable and Engaging Online Transition for Co-Design through Gamification

Co-design approach is increasingly popular in many organizations that address global change and social sustainability challenges, thanks to its unique and diverse methods of engaging relevant people in design processes and decision-making. However, the social distancing led by the COVID-19 pandemic seriously problematized the traditional in-person co-design activities. A sustainable online transition is unprecedentedly pressing. By acknowledging the limitations of online co-design, i.e., lack of means for participant engagement, we argue that gamification holds great promise for online co-design. This paper presents an empirical study to investigate this potential qualitatively. Based on the data collected from three gamified online co-design implementations, we examine the benefits of gamification and how future activities should be designed and implemented from the participants’ perspectives. Based on the participants’ perceptions, we propose several recommendations for designing impactful gamification. The finding suggests that gamification can facilitate online co-design activities in an enjoyable, relaxing, structuring, and creative manner, since they are perceived and recognized by the participants. Moreover, the successful implementation of online co-design implies that great sustainability benefits can be achieved through online transition, i.e., reducing paper consumption and time spent on meetings and unproductive discussions, supporting extensive diversity and density in representation. Online can enable this by overcoming not only the geographic and time limitations but also relevant social issues.

Understanding and shaping the future of work with self-determination theory

Self-determination theory has shaped our understanding of what optimizes worker motivation by providing insights into how work context influences basic psychological needs for competence, autonomy and relatedness. As technological innovations change the nature of work, self-determination theory can provide insight into how the resulting uncertainty and interdependence might influence worker motivation, performance and well-being. In this Review, we summarize what self-determination theory has brought to the domain of work and how it is helping researchers and practitioners to shape the future of work. We consider how the experiences of job candidates are influenced by the new technologies used to assess and select them, and how self-determination theory can help to improve candidate attitudes and performance during selection assessments. We also discuss how technology transforms the design of work and its impact on worker motivation. We then describe three cases where technology is affecting work design and examine how this might influence needs satisfaction and motivation: remote work, virtual teamwork and algorithmic management. An understanding of how future work is likely to influence the satisfaction of the psychological needs of workers and how future work can be designed to satisfy such needs is of the utmost importance to worker performance and well-being.

Technology is changing the nature of work by enabling new forms of automation and communication. In this Review, Gagné et al. describe how self-determination theory can help researchers and practitioners to shape the future of work to ensure that it meets the psychological needs of workers.

Too Low Motivation, Too High Authority? Digital Media Support for Co-Curation in Local Cultural Heritage Communities

Over the last decades, a shift towards participatory approaches could be observed in cultural heritage institutions. In co-curation processes, museums collaborate with public audiences to identify, select, prepare, and interpret cultural materials. This article focuses on the question how to engage and motivate local communities or individuals in rethinking dominant discourses or expert narratives regarding cultural heritage and bringing in their own experiences and knowledge. Based on four case studies of cultural co-curation, we delineate two basic challenges for this process: (1) Authority—even though museums strive to involve the public, there is still an imbalance in participation due to the museums’ authoritative status. (2) Motivation—participation in co-curation processes requires high levels of motivation, which are difficult to achieve. Based on the media synchronicity theory, we discuss which characteristics of new media technologies can be helpful to overcome these challenges. Media can increase awareness on counternarratives and blind spots in cultural collections. They can provide a setting where the participants can easily contribute, feel competent to do so, are empowered to rethink dominant discourses, develop a sense of relatedness with other contributors, and maintain autonomy in how and to which degree they engage in the discourse.

Engaging with EPIO, a digital pain self-management program: a qualitative study

Background

Chronic pain conditions entail significant personal and societal burdens and improved outreach of evidence-based pain self-management programs are needed. Digital cognitive-behavioral self-management interventions have shown promise. However, evidence is still scarce and several challenges with such interventions for chronic pain exist. Exploring patients' experiences and engagement with digital interventions may be an essential step towards developing meaningful digital self-management interventions for those living with chronic pain.

Objectives

This study aimed to gain insight into the experiences of people with chronic pain when engaging with EPIO, an application (app)-based cognitive-behavioral pain self-management intervention program.

Methods

Participants (N = 50) living with chronic pain received access to the EPIO intervention in a feasibility pilot-study for 3 months. During this time, all participants received a follow-up phone call at 2–3 weeks, and a subsample (n = 15) also participated in individual semi-structured interviews after 3 months. A qualitative design was used and thematic analysis was employed aiming to capture participants’ experiences when engaging with the EPIO intervention program.

Results

Findings identifying program-related experiences and engagement were organized into three main topics, each with three sub-themes: (1) Engaging with EPIO; motivation to learn, fostering joy and enthusiasm, and helpful reminders and personalization, (2) Coping with pain in everyday life; awareness, practice and using EPIO in everyday life, and (3) The value of engaging with the EPIO program; EPIO – a friend, making peace with the presence of pain, and fostering communication and social support.

Conclusions

This qualitative study explored participants’ experiences and engagement with EPIO, a digital self-management intervention program for people living with chronic pain. Findings identified valued aspects related to motivation for engagement, and showed how such a program may be incorporated into daily life, and encourage a sense of acceptance, social support and relatedness. The findings highlight vital components for facilitating digital program engagement and use in support of self-management for people living with chronic pain.

Trial registration

ClinicalTrials.gov NCT03705104.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07963-x.

From Digital Health to Digital Well-being: Systematic Scoping Review

Background

Digital health refers to the proper use of technology for improving the health and well-being of people and enhancing the care of patients through the intelligent processing of clinical and genetic data. Despite increasing interest in well-being in both health care and technology, there is no clear understanding of what constitutes well-being, which leads to uncertainty in how to create well-being through digital health. In an effort to clarify this uncertainty, Brey developed a framework to define problems in technology for well-being using the following four categories: epistemological problem, scope problem, specification problem, and aggregation problem.

Objective

This systematic scoping review aims to gain insights into how to define and address well-being in digital health.

Methods

We followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Papers were identified from 6 databases and included if they addressed the design or evaluation of digital health and reported the enhancement of patient well-being as their purpose. These papers were divided into design and evaluation papers. We studied how the 4 problems in technology for well-being are considered per paper.

Results

A total of 117 studies were eligible for analysis (n=46, 39.3% design papers and n=71, 60.7% evaluation papers). For the epistemological problem, the thematic analysis resulted in various definitions of well-being, which were grouped into the following seven values: healthy body, functional me, healthy mind, happy me, social me, self-managing me, and external conditions. Design papers mostly considered well-being as healthy body and self-managing me, whereas evaluation papers considered the values of healthy mind and happy me. Users were rarely involved in defining well-being. For the scope problem, patients with chronic care needs were commonly considered as the main users. Design papers also regularly involved other users, such as caregivers and relatives. These users were often not involved in evaluation papers. For the specification problem, most design and evaluation papers focused on the provision of care support through a digital platform. Design papers used numerous design methods, whereas evaluation papers mostly considered pre-post measurements and randomized controlled trials. For the aggregation problem, value conflicts were rarely described.

Conclusions

Current practice has found pragmatic ways of circumventing or dealing with the problems of digital health for well-being. Major differences exist between the design and evaluation of digital health, particularly regarding their conceptualization of well-being and the types of users studied. In addition, we found that current methodologies for designing and evaluating digital health can be improved. For optimal digital health for well-being, multidisciplinary collaborations that move beyond the common dichotomy of design and evaluation are needed.

Creating positive learning experiences with technology: A field study on the effects of user experience for digital concept mapping

Learning and assessment are increasingly mediated by digital technologies. Thus, learners’ experiences with these digital technologies are growing in importance, as they might affect learning and assessment. The present paper explores the impact of user experience on digital concept mapping. It builds on user experience theory to explain variance in the intention to use digital concept mapping tools and in concept map-based assessment scores. Furthermore, it identifies fulfillment of psychological needs as an important driver of positive experiences. In a field study in three schools and a university (N = 71), we tested two concept mapping prototypes on computers and tablets. We found that user experience is a significant factor explaining variance in intention to use. User experience also explained variance in three out of four concept mapping scores on tablets, potentially related to the lower pragmatic quality of the tablet prototypes. Fulfillment of psychological needs strongly affected perceptions of different qualities of user experience with digital concept mapping. These results indicate that user experience needs to be considered in digital concept mapping to provide a positive and successful environment for learning and assessment. Finally, we discuss implications for designers of digital learning and assessment tools.

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User experience (UX) is a vital success factor for digital education tools.

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Fulfillment of psychological needs defines user experience.

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User experience is a strong predictor of intention to use.

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User experience can explain variance in concept map scores.

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User experience models can complement technology acceptance models.

The use of digital technologies by people with mild-to-moderate dementia during the COVID-19 pandemic: A positive technology perspective

A growing body of research has shown that people with dementia are using digital technologies to enhance lived experience. The COVID-19 pandemic has brought new digital opportunities and challenges and so provides a unique opportunity to understand how people with dementia have adapted to this new digital landscape. Semi-structured interviews were conducted with 19 people with dementia and analysed thematically. We generated five themes, showing how participants used digital means to combat the stresses of the pandemic by facilitating social connection, self-actualisation, enhanced well-being and by assisting with activities of daily life. These technologies helped to reduce isolation, provide access to support groups, create opportunities for cognitive stimulation and self-development, and engendered a sense of identity at a time of perceived loss. Despite these benefits, participants also reported challenges regarding cognitive fatigue and usability issues. We recommend that training on how to use digital technologies is co-produced with people with dementia and designers engage with the voices of people with dementia throughout the design process. In turn, this could promote the social connectedness, well-being and self-worth of people with dementia.

Systematic Review of Digital Interventions for Adolescent and Young Adult Women's Body Image

Background

A growing number of digital interventions have been developed to address a range of mental health issues including body image. Identifying effective interventions for body image is important given the prevalence of body image concerns and their associated negative outcomes among young women. This review aimed to critically evaluate current evidence on the use of digital interventions for adolescent and young adult women's body image.

Methods

A literature search was performed in November 2021 across three databases, PsychINFO, Web of Science and Pubmed to identify studies published with keywords and synonyms of "body image" and "digital interventions" that have been conducted with girls/women aged 10-25 years. Studies were included if they assessed a universal body image intervention delivered through a digital platform (e.g., web-based, mobile phone) and if they reported body image outcomes using validated measures. Two authors independently screened studies extracted data and assessed the quality of studies.

Results

Eight of 15 interventions were effective in improving at least one body image outcome from pre-post intervention; however, effect sizes were mostly small-medium, and few effects were maintained at follow-up. Studies were heterogeneous in terms of delivery format, duration, sample characteristics, quality, and outcomes.

Discussion

Findings suggest that digitally delivered interventions can effectively improve some body image outcomes in young women. Characteristics of effective studies are discussed and suggestions for future work on intervention development in this field are provided.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021281435, identifier CRD42021281435.

Implementation of Cognitive Behavioral Therapy in e-Mental Health Apps: Literature Review

Background

To address the matter of limited resources for treating individuals with mental disorders, e–mental health has gained interest in recent years. More specifically, mobile health (mHealth) apps have been suggested as electronic mental health interventions accompanied by cognitive behavioral therapy (CBT).

Objective

This study aims to identify the therapeutic aspects of CBT that have been implemented in existing mHealth apps and the technologies used. From these, we aim to derive research gaps that should be addressed in the future.

Methods

Three databases were screened for studies on mHealth apps in the context of mental disorders that implement techniques of CBT: PubMed, IEEE Xplore, and ACM Digital Library. The studies were independently selected by 2 reviewers, who then extracted data from the included studies. Data on CBT techniques and their technical implementation in mHealth apps were synthesized narratively.

Results

Of the 530 retrieved citations, 34 (6.4%) studies were included in this review. mHealth apps for CBT exploit two groups of technologies: technologies that implement CBT techniques for cognitive restructuring, behavioral activation, and problem solving (exposure is not yet realized in mHealth apps) and technologies that aim to increase user experience, adherence, and engagement. The synergy of these technologies enables patients to self-manage and self-monitor their mental state and access relevant information on their mental illness, which helps them cope with mental health problems and allows self-treatment.

Conclusions

There are CBT techniques that can be implemented in mHealth apps. Additional research is needed on the efficacy of the mHealth interventions and their side effects, including inequalities because of the digital divide, addictive internet behavior, lack of trust in mHealth, anonymity issues, risks and biases for user groups and social contexts, and ethical implications. Further research is also required to integrate and test psychological theories to improve the impact of mHealth and adherence to the e–mental health interventions.

Digital Companion Choice to Support Teachers' Stress Self-management: Systematic Approach Through Taxonomy Creation

BACKGROUND

There are thousands of digital companions designed for emotional well-being and stress, including websites, wearables, and smartphone apps. Although public evaluation frameworks and ratings exist, they do not facilitate digital companion choice based on contextual or individual information, such as occupation or personal management strategies.

OBJECTIVE

The aim of this study is to establish a process for creating a taxonomy to support systematic choice of digital companions for teachers' stress self-management.

METHODS

We used a 4-step study design. In step 1, we identified the dimension of stress self-management and strategic classifications. In step 2, we identified the dimension of the digital techniques and conceptual descriptions. In step 3, we created 6 criteria for the inclusion of digital companions. In step 4, we used the taxonomy framework created by steps 1 and 2 and populated it with digital companions for stress self-management, as identified in step 3.

RESULTS

First, in the dimension of stress self-management, we identified four classes of strategies: educational, physiological, cognitive, and social. Second, in the digital techniques dimension, we derived four conceptual descriptions for the digital companions' mechanisms of action: fostering reflection, suggesting treatment, peer-to-peer support, and entertainment. Third, we created six criteria for digital companion inclusion in the taxonomy: suitability, availability, evaluation, security, validity, and cost. Using the taxonomy framework and criteria, we populated it with digital companions for stress management ahead of presentation to teachers in a stress study workshop.

CONCLUSIONS

The elements of our approach can be generalized as principles for the creation of taxonomies for other occupations or conditions. Taxonomies such as this could be a valuable resource for individuals to understand which digital companion could be of help in their personal context.

An integrated model of school students’ academic achievement and life satisfaction. Linking soft skills, extracurricular activities, self-regulated learning, motivation, and emotions

The role of soft skills at school is still debated, but they have emerged as important factors for students’ academic achievement and life satisfaction. This study focuses on the combined influence of soft skills (in terms of adaptability, curiosity, leadership, initiative, perseverance, and social awareness), extracurricular activities, achievement emotions, self-regulated learning, motivation, and cognitive abilities on academic achievement and life satisfaction. A sample of 603 students (5th to 12th graders) participated in the study. The results of a Bayesian path analysis based on meta-analytical priors show that soft skills were (i) directly positively associated with students’ achievement emotions, self-regulated learning, motivation, and life satisfaction and (ii) indirectly related with academic achievement through the mediation of self-regulated learning and motivation. On the other hand, only soft skills and achievement emotions were directly related to life satisfaction. Extracurricular activities showed a positive association with both soft skills and cognitive abilities. These results are the first to demonstrate the importance of soft skills and extracurricular activities when integrating all the above-mentioned factors in a model of students’ academic achievement and life satisfaction.