Learning functional human anatomy with a new interactive three-dimensional digital tool

Human anatomy requires understanding spatial relationships among anatomical structures and is often perceived as difficult to learn by students. To overcome this concern, several digital tools exist with some strengths and limitations among which the lack of interactivity especially for complex functional anatomy learning. In this way, a new interactive three-dimensional tool called Antepulsio was designed. Antepulsio was assessed by comparing three groups of first year kinesiology students to test whether it is likely to favor functional anatomy learning during three training sessions spread over a week. The experiment was conducted during a real academic course. Laterality judgment, 3D spatial abilities and working memory abilities from all participants were previously collected to create three homogeneous groups: the active group (n = 17, 17.76 ± 0.56 years) interacted with Antepulsio, the passive group (n = 18, 17.89 ± 0.83 years) watched videos of Antepulsio while the control group (n = 15, 18.07 ± 0.80 years) performed a neutral activity unrelated to anatomy. Anatomy knowledge was also assessed during pretest, posttest, and retention test (8 weeks after the posttest). The most significant outcome of this study revealed that in case of better working visual memory, the active group outperformed the passive group between pretest and retention test (p < 0.01). In other words, Antepulsio tool is efficient only for students with high visuospatial working memory. These selective benefits of Antepulsio are discussed in terms of cognitive load, training duration and the necessary period of familiarization with the tool.

Greater usage and positive mood change for users of a dynamic VR app before and after the COVID-19 pandemic onset

Americans reported an increase in stress during the novel coronavirus disease 2019 (COVID-19). Virtual reality (VR) apps have been shown to distract users from stressors in the environment, but little is known about the efficacy of specific content features to reduce stress or improve mood for consumer users during a pandemic. The present study investigated secondary archival data to explore how mood and usage behavior changed before and after the onset of COVID-19 for consumer users of a VR app with dynamic, interactive content. Study findings indicate that the COVID-19 pandemic had significant effects on user behavior and mood. Users created more accounts and used app content more often during the pandemic, while reporting increased negative mood states. This suggests that users were motivated to use the content to cope with pandemic stressors. Users also experienced a greater positive mood change after using the content during the pandemic than before, which implies that elements related to the VR app content met users' psychological needs. Passive content with less interactivity resulted in a greater positive mood state after the COVID-19 onset, likely related to its capacity to reduce stress, facilitate restoration, and improve persistent affective states in stressful environments. This study offers a vital window into how consumer users respond to psychosocial pandemic stressors outside of a controlled environment as well as the prospective for VR app content to serve as a valuable mental health intervention during similar stressful events.

Are interactive and tailored data visualizations effective in promoting flu vaccination among the elderly? Evidence from a randomized experiment

OBJECTIVE

Although interactive data visualizations are increasingly popular for health communication, it remains to be seen what design features improve psychological and behavioral targets. This study experimentally tested how interactivity and descriptive titles may influence perceived susceptibility to the flu, intention to vaccinate, and information recall, particularly among older adults.

MATERIALS AND METHODS

We created data visualization dashboards on flu vaccinations, tested in a 2 (explanatory text vs none) × 3 (interactive + tailored, static + tailored, static + nontailored) + questionnaire-only control randomized between-participant online experiment (N   = 1378).

RESULTS

The flu dashboards significantly increased perceived susceptibility to the flu compared to the control: static+nontailored dashboard, b = 0.14, P = .049; static-tailored, b = 0.16, P = .028; and interactive+tailored, b = 0.15, P = .039. Interactive dashboards potentially decreased recall particularly among the elderly (moderation by age: b = -0.03, P = .073). The benefits of descriptive text on recall were larger among the elderly (interaction effects: b = 0.03, P = .025).

DISCUSSION

Interactive dashboards with complex statistics and limited textual information are widely used in health and public health but may be suboptimal for older individuals. We experimentally showed that adding explanatory text on visualizations can increase information recall particularly for older populations.

CONCLUSION

We did not find evidence to support the effectiveness of interactivity in data visualizations on flu vaccination intentions or on information recall. Future research should examine what types of explanatory text can best support improved health outcomes and intentions in other contexts. Practitioners should consider whether interactivity is optimal in data visualization dashboards for their populations.

The Effect of Interactivity, Tailoring, and Use Intensity on the Effectiveness of an Internet-Based Smoking Cessation Intervention Over a 12-Month Period: Randomized Controlled Trial

BACKGROUND

eHealth approaches show promising results for smoking cessation (SC). They can improve quit rates, but rigorous research is sparse regarding their effectiveness and the effects of their interactivity, tailoring, and use intensity.

OBJECTIVE

We examined the effectiveness of Techniker Krankenkasse Smoking Cessation Coaching (TK-SCC), an internet-based, tailored, and interactive SC intervention. Our hypotheses were as follows: hypothesis 1, in the intervention group (IG; access to TK-SCC), a clinically relevant number of participants will be abstinent at the 12-month follow-up (T3); hypothesis 2, the number of abstinent participants will be significantly greater in the IG than the control group (CG) at T3; and hypothesis 3, in the IG, more intense use of TK-SCC will be positively associated with abstinence.

METHODS

Individuals who smoke were randomized into the IG (563/1115, 50.49%) or CG (552/1115, 49.51%), which received a noninteractive, nontailored, and information-only web-based intervention. Data were collected before the intervention, at the postintervention time point (T1), at the 4-month follow-up (T2), and at T3. We tested hypothesis 1 through equivalence tests between the IG's success rate and success rates of comparable effective interventions reported in 2 current meta-analyses. For hypothesis 2, we conducted binary logistic regressions. For hypothesis 3, we assigned the IG participants to 1 of 4 user types and used binary logistic regressions with user types as the independent variable and smoking abstinence as the dependent variable.

RESULTS

In the IG, 11.5% (65/563) and 11.9% (67/563) of participants were smoke free at T1 and T3, respectively. These values were statistically equivalent to the effects in the 2 meta-analyses, which reported 9% (z score=0.64, P=.74) and 10.9% (z score=-0.71, P=.24) success rates, respectively. In the CG, 6.2% (34/552) of the participants were smoke free at T1, which increased up to 8.2% (45/552) at T3. The difference between the IG and CG was statistically significant only at T1 (odds ratio [OR] 2.0, 99% CI 1.1 to 3.6; P=.002), whereas the effect was nonsignificant following α error corrections at T3 (OR 1.6, 99% CI 0.9 to 2.7; P=.02). In the IG, constant users of the program became smoke free significantly more often than rare users of the program (T1: OR 15.0, 99% CI 6.1 to 36.9; P<.001; T3: OR 6.5, 99% CI 2.8 to 15.5; P<.001).

CONCLUSIONS

TK-SCC is effective for SC. However, its superiority compared with a minimal SC intervention could not be confirmed in the long term. Insufficient implementation of the techniques used and cotreatment bias could explain this outcome. Higher use intensity of TK-SCC was positively related to abstinence. Therefore, additional efforts to motivate users to adhere to intervention use as intended could improve the intervention's effectiveness.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00020249, Universal Trial Number U1111-1245-0273; https://drks.de/search/de/trial/DRKS00020249.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s13063-021-05470-8.

An "in vivo" analysis of crafts practices and creativity-Why affordances provide a productive lens

Scholars are increasingly recognizing that creativity is grounded in the active sensorimotor engagement with the environment and materiality. Affordances-recognizable pointers to action opportunities in the ecology-provide a helpful prism for analyzing how this happens. Creative practitioners, as they seek aesthetic opportunities or innovation, depend on their sensitivity toward potentialities in their action space. Presently, we apply a high-zoom lens to a crafts process, giving our micro-genetic research design an affordance focus. By investigating one of the authors, a ceramicist and a practitioner-researcher, through her process of making of a vase, we tracked how affordances are responded to, developed, shaped, invited or, where necessary, rejected, as the ceramicist "routes" her creative trajectory. Several insights emerge: (1) The ceramicist's decisions-initially about general directions, then about aesthetic details-unfold while engaging with the clay; they emerge in stepwise fashion, but with a holistic orientation. (2) Choosing among affordances requires parallel sensitivities to object functionality, aesthetics and creativity, as well as technical feasibility; adhering to the proper technical procedure that provides the very basis for creatively relevant affordances to later arise. (3) While the hands and eyes engage with short-lived affordances the ceramicist must keep in view higher-timescale affordances that ensure a good task progression for making a vase, and affordances for the material's overall "workability". (4) The ceramicist typically relates to momentary affordances in light of expected as well as imagined others, to ensure a coherent end product. (5) Affordances contribute to material creativity in more ways than typically recognized in the literature. They range from serendipitous "finds" to options developed with a large degree of creative autonomy; affordances may also be indirectly invited and practitioners strategically change probability distributions as well as providing an enabling background for generative action. Thus, a crafts practitioner brings forth unconventional affordances through active engagement, using a mix of exploration, strategy, and imaginative potential. Affordance theorists err when stressing the possibility to just "find" creative options or that perceptual acuity is the sole skill.

Human-to-Computer Interactivity Features Incorporated Into Behavioral Health mHealth Apps: Systematic Search

BACKGROUND

While there are thousands of behavioral health apps available to consumers, users often quickly discontinue their use, which limits their therapeutic value. By varying the types and number of ways that users can interact with behavioral health mobile health apps, developers may be able to support greater therapeutic engagement and increase app stickiness.

OBJECTIVE

The main objective of this analysis was to systematically characterize the types of user interactions that are available in behavioral health apps and then examine if greater interactivity was associated with greater user satisfaction, as measured by app metrics.

METHODS

Using a modified PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) methodology, we searched several different app clearinghouse websites and identified 76 behavioral health apps that included some type of interactivity. We then filtered the results to ensure we were examining behavioral health apps and further refined our search to include apps that identified one or more of the following terms: peer or therapist forum, discussion, feedback, professional, licensed, buddy, friend, artificial intelligence, chatbot, counselor, therapist, provider, mentor, bot, coach, message, comment, chat room, community, games, care team, connect, share, and support in the app descriptions. In the final group of 34 apps, we examined the presence of 6 types of human-machine interactivities: human-to-human with peers, human-to-human with providers, human-to-artificial intelligence, human-to-algorithms, human-to-data, and novel interactive smartphone modalities. We also downloaded information on app user ratings and visibility, as well as reviewed other key app features.

RESULTS

We found that on average, the 34 apps reviewed included 2.53 (SD 1.05; range 1-5) features of interactivity. The most common types of interactivities were human-to-data (n=34, 100%), followed by human-to-algorithm (n=15, 44.2%). The least common type of interactivity was human-artificial intelligence (n=7, 20.5%). There were no significant associations between the total number of app interactivity features and user ratings or app visibility. We found that a full range of therapeutic interactivity features were not used in behavioral health apps.

CONCLUSIONS

Ideally, app developers would do well to include more interactivity features in behavioral health apps in order to fully use the capabilities of smartphone technologies and increase app stickiness. Theoretically, increased user engagement would occur by using multiple types of user interactivity, thereby maximizing the benefits that a person would receive when using a mobile health app.

Virtual Reality-Based Joy Induction: The Role of Interactivity and Prior Mood

This study evaluates the effectiveness of virtual reality (VR) as a novel tool for mood induction, specifically for inducing joy, and examines the role of interactivity and prior mood. We conducted an experiment using a 2 × 2 factorial design with 124 participants who were randomly assigned to either a neutral or negative prior mood condition, and an interactive or noninteractive joy induction condition. Prior mood was experimentally manipulated using a VR scenario that simulated a terror attack at a train station (negative mood condition) compared with a control condition in which no incidents occurred at the train station (neutral mood condition). Subsequently, participants entered a virtual park scenario that either allowed for playful interaction with objects in the park (interactive condition) or not (noninteractive condition). We found that interactive VR experiences lead to lower levels of negative affect compared with a noninteractive experience irrespective of participants' prior mood, but playful interaction in VR only increased joy when participants were in a neutral (not negative) prior mood. We suggest interactivity as a design principle for effective negative mood reduction, but further research is required on how to successfully transform a prior negative mood into joy.

User Experience Evaluation in Shared Interactive Virtual Reality

Virtual reality (VR) has served the entertainment industry all the way to world-leading museums in delivering engaging experiences through multisensory virtual environments (VEs). Today, the rise of the Metaverse fuels a growing interest in leveraging this technology, bringing along an emerging need to better understand the way different dimensions of VEs, namely social and interactive, impact overall user experience (UX). This between-subject exploratory field study investigates differences in the perceived and lived experience of 28 participants engaging, either individually or in dyads, in a VR experience comprising different levels of interactivity, i.e., passive or active. A mixed methods approach combining conventional UX measures, i.e., psychometric surveys and user interviews, as well as psychophysiological measures, i.e., wearable bio- and motion sensors, allowed for a comprehensive assessment of users' immersive and affective experiences. Results pertaining to the social dimension of the experience reveal that shared VR elicits significantly more positive affect, whereas presence, immersion, flow, and state anxiety are unaffected by the copresence of a real-world partner. Results pertaining to the interactive dimension of the experience suggest that the interactivity afforded by the VE moderates the effect of copresence on users' adaptive immersion and arousal. These results support that VR can be shared with a real-world partner not only without hindering the immersive experience, but also by enhancing positive affect. Hence, in addition to offering methodological directions for future VR field research, this study provides interesting practical insights into guiding VR developers toward optimal multiuser virtual environments.

Rethinking the Difficult Patient: Formative Qualitative Study Using Participatory Theater to Improve Physician-Patient Communication in Rheumatology

BACKGROUND

Effective physician-patient communication is crucial for positive health outcomes for patients with chronic diseases. However, current methods of physician education in communication are often insufficient to help physicians understand how patients' actions are influenced by the contexts within which they live. An arts-based participatory theater approach can provide the necessary health equity framing to address this deficiency.

OBJECTIVE

The aim of this study was to develop, pilot, and conduct a formative evaluation of an interactive arts-based communication skills intervention for graduate-level medical trainees grounded in a narrative representative of the experience of patients with systemic lupus erythematosus.

METHODS

We hypothesized that the delivery of interactive communication modules through a participatory theater approach would lead to changes in both attitudes and the capacity to act on those attitudes among participants in 4 conceptual categories related to patient communication (understanding social determinants of health, expressing empathy, shared decision-making, and concordance). We developed a participatory, arts-based intervention to pilot this conceptual framework with the intended audience (rheumatology trainees). The intervention was delivered through routine educational conferences at a single institution. We conducted a formative evaluation by collecting qualitative focus group feedback to evaluate the implementation of the modules.

RESULTS

Our formative data suggest that the participatory theater approach and the design of the modules added value to the participants' learning experience by facilitating interconnection of the 4 communication concepts (eg, participants were able to gain insight into both what physicians and patients were thinking about on the same topic). Participants also provided several suggestions for improving the intervention such as ensuring that the didactic material had more active engagement and considering additional ways to acknowledge real-world constraints (eg, limited time with patients) in implementing communication strategies.

CONCLUSIONS

Our findings from this formative evaluation of communication modules suggest that participatory theater is an effective method for framing physician education with a health equity lens, although considerations in the realms of functional demands of health care providers and use of structural competency as a framing concept are needed. The integration of social and structural contexts into the delivery of this communication skills intervention may be important for the uptake of these skills by intervention participants. Participatory theater provided an opportunity for dynamic interactivity among participants and facilitated greater engagement with the communication module content.

Technology Acceptance and Authenticity in Interactive Simulation: Experimental Study

BACKGROUND

Remote and virtual simulations have gained prevalence during the COVID-19 pandemic as institutions maintain social distancing measures. Because of the challenges of cost, flexibility, and feasibility in traditional mannequin simulation, many health care educators have used videos as a remote simulation modality; however, videos provide minimal interactivity.

OBJECTIVE

In this study, we aimed to evaluate the role of interactivity in students' simulation experiences. We analyzed students' perceptions of technology acceptance and authenticity in interactive and noninteractive simulations.

METHODS

Undergraduate nursing students participated in interactive and noninteractive simulations. The interactive simulation was conducted using interactive video simulation software that we developed, and the noninteractive simulation consisted of passively playing a video of the simulation. After each simulation, the students completed a 10-item technology acceptance questionnaire and 6-item authenticity questionnaire. The data were analyzed using the Wilcoxon signed-rank test. In addition, we performed an exploratory analysis to compare technology acceptance and authenticity in interactive local and remote simulations using the Mann-Whitney U test.

RESULTS

Data from 29 students were included in this study. Statistically significant differences were found between interactive and noninteractive simulations for overall technology acceptance (P<.001) and authenticity (P<.001). Analysis of the individual questionnaire items showed statistical significance for 3 out of the 10 technology acceptance items (P=.002, P=.002, and P=.004) and 5 out of the 6 authenticity items (P<.001, P<.001, P=.001, P=.003, and P=.005). The interactive simulation scored higher than the noninteractive simulation in all the statistically significant comparisons. Our exploratory analysis revealed that local simulation may promote greater perceptions of technology acceptance (P=.007) and authenticity (P=.027) than remote simulation.

CONCLUSIONS

Students' perceptions of technology acceptance and authenticity were greater in interactive simulation than in noninteractive simulation. These results support the importance of interactivity in students' simulation experiences, especially in remote or virtual simulations in which students' involvement may be less active.

Ethics education in pediatrics: Implementation and evaluation of an interactive online course for medical students

INTRODUCTION

The COVID-19 pandemic has catalyzed the development of online learning formats in virtually all areas of medical education. In pediatric ethics, online learning may not only substitute but also offer specific advantages over traditional classroom teaching. Many pediatricians rate their ethics education as poor and medical ethics education lacks evaluation, especially regarding the students' needs. The aim of this project was to implement and evaluate a novel interactive distance learning approach to engage medical students in pediatric ethics education.

METHODS

An online ethics course was designed and delivered between May and June 2020. Core item of this course was a moderated, written forum discussion spanning several days. Evaluation was mixed methods. We evaluated the effectiveness of the course in terms of quality of the learning environment with a particular focus on relevance to students as well as interactive learning and reflective thinking. The Constructivist On-Line Learning Environment Survey (COLLES) was used to evaluate six different domains of the course. Data are presented as mean (standard deviation [SD]). The respective score range is 1-5, whereby a score of 4 or 5 means that the participants indicated the corresponding item as frequently or almost always present.

RESULTS

Responses were available from 104 (78.3%) of the 133 participating students. "Relevance" yielded a score of 4.17 (0.83), "reflective thinking" a score of 4.22 (0.83). "Interactivity" was scored 3.76 (0.99) and "tutor support" 4.72 (0.53). "Peer support" and "interpretation" scored 3.87 (0.98) and 4.49 (0.60), respectively. In qualitative analysis, students particularly valued the structure of the course, the relevance for their professional practice, their active participation and the incentive to reflective thinking. Students also indicated that this was an innovative and exciting format, which fills a current educational gap and should hence be continued beyond the pandemic.

CONCLUSION

In conclusion, students actively engaged in online learning and perceived this ethics course as highly relevant for their professional practice.

The Enactive and Interactive Dimensions of AI: Ingenuity and Imagination Through the Lens of Art and Music

Dualisms are pervasive. The divisions between the rational mind, the physical body, and the external natural world have set the stage for the successes and failures of contemporary cognitive science and artificial intelligence.1 Advanced machine learning (ML) and artificial intelligence (AI) systems have been developed to draw art and compose music. Many take these facts as calls for a radical shift in our values and turn to questions about AI ethics, rights, and personhood. While the discussion of agency and rights is not wrong in principle, it is a form of misdirection in the current circumstances. Questions about an artificial agency can only come after a genuine reconciliation of human interactivity, creativity, and embodiment. This kind of challenge has both moral and theoretical force. In this article, the authors intend to contribute to embodied and enactive approaches to AI by exploring the interactive and contingent dimensions of machines through the lens of Japanese philosophy. One important takeaway from this project is that AI/ML systems should be recognized as powerful tools or instruments rather than as agents themselves.

Antecedents of Viewers' Live Streaming Watching: A Perspective of Social Presence Theory

Live streaming commerce as a popular marketing method has attracted wide attention, but little is known about why consumers continue to watch live streaming. To fill this research gap, this study draws on social presence theory to examine the impact of sense of community, emotional support, and interactivity on viewers’ social presence, which, in turn, influences their live streaming watching. Furthermore, the moderating role of streamer attractiveness is also investigated. The authors collected survey data from 386 live streaming viewers and used the structural equation model to test the research model. The results reveal that sense of community, interactivity, and emotional support positively affects viewers’ social presence, leading to viewers’ watching live streaming. Furthermore, streamer attractiveness plays a significant moderating role between social presence and live streaming watching. This study provides a unified theoretical framework to explain the intention to watch live streaming based on social presence theory.

Exploring the Relationship Between Social Commerce Features and Consumers' Repurchase Intentions: The Mediating Role of Perceived Value

The popularity of social media, such as WeChat and Weibo in China, has provided an opportunity to develop social commerce. Although shopping through social commerce platforms is widely favored by consumers, the factors affecting consumers’ decision-making behavior in the social commerce environment remain unclear. Therefore, from the perspective of the stimulus–organism–response (SOR) theory, we construct a consumer repurchase decision model in the social commerce environment and analyze the influencing mechanism of social commerce features (interactivity, recommendations, and feedback) on perceived value (utilitarian value and hedonic value) and consumers’ repurchase intention. The empirical results found that social commerce features are positively related to the generation of perceived value, which in turn drives consumers to form repurchase intentions. We also found some mediating effects of perceived value. The study’s conclusions clarify the intrinsic influence mechanism of social commerce features on consumers’ perceived value and repurchase intentions. In addition, it can provide some theoretical guidance for future research and business.

How Flow Experience and Self-Efficacy Define Students' Online Learning Intentions: View From Task Technology Fit (Framework)

The ongoing pandemic has transformed communication modes globally. Especially in the case of higher education, where countermeasures against coronavirus disease 2019 (COVID-19) have affected students’ learning experience. This study emphasized the case of business simulation games, where critical factors were underlined to define learners’ intention to use an online learning environment through the lens of task technology fit (TTF) as a theoretical stance. This study considered the statistical analysis of 523 students who attended the business simulation module online at the tertiary level of education. Findings conclude that flow experience is the most critical factor to define learners’ perceived TTF in the case of an online learning experience. However, the learners’ self-efficacy is significant enough to map learners’ intentions to use an online environment for learning. The study discussed several theoretical and practical implications for learners’ educators and policymakers.

Exploring the Influence of Determinants on Behavior Intention to Use of Multiple Media Kiosks Through Technology Readiness and Acceptance Model

The use of multiple media kiosks (MMKs) is witnessing an increasingly strong uptrend in 24-h chain convenient stores in developed countries. However, as the functions of MMKs intensifies and increases, how to retain consumers has been a topic that raises concerns of managers and researchers. In this study, we adopt the integrated technology acceptance model, which combines technology readiness and acceptance model with interactivity that serves as the moderating factor, with the purpose of discussing the relationships among all these variables and their impacts on behavior intention to use. Through the cross-sectional survey and purposive sampling, a total of 623 copies of questionnaire from Taiwan were collected in this study. Smart-PLS for PLS-SEM was applied in the structural model to conduct a verification of the hypotheses and comparative analysis in this study. The results show that all hypotheses were significantly supported; technology readiness has a positive impact on perceived ease to use and perceived usefulness; and interactivity also positively moderates the relationship among perceived ease to use, perceived usefulness and attitude toward using. Our results will offer more insights and advice concerning theories of service technology.

A Distributed Interactive Decision-Making Framework for Sustainable Career Development

The purpose of this article is to present a new distributed interactive career decision-making framework (diCDM) in which person and context together determine the development of a sustainable career. We build upon recent theories from two disciplines: decision theory and career theory. Our new conceptual framework incorporates distributed stakeholders into the career decision-making process and suggests that individuals make decisions through a system of distributed agency, in which they interact with their context to make each career decision, at varying levels of participation, from proactive to reactive. We focus on two key career decision-making drivers originating from the person (exercising personal agency and seeking meaning), and two key drivers from the career context (making demands on an individual’s resources and affording scripts). This manuscript challenges the individual-driven approach to career development, and instead proposes that a process of distributed career decision-making takes place between each person and the various stakeholders, both individual and institutional, that also drive their career. Career seekers and counselors can use this framework to supplement an individual-focused approach and incorporate the role of distributed decision-makers in sustaining an individual’s career. Empirical research is needed to explore and test the applicability of the framework to career decisions in practice.

mHealth Interventions for Self-management of Hypertension: Framework and Systematic Review on Engagement, Interactivity, and Tailoring

BACKGROUND

Engagement is essential for the effectiveness of digital behavior change interventions. Existing systematic reviews examining hypertension self-management interventions via mobile apps have primarily focused on intervention efficacy and app usability. Engagement in the prevention or management of hypertension is largely unknown.

OBJECTIVE

This systematic review explores the definition and role of engagement in hypertension-focused mobile health (mHealth) interventions, as well as how determinants of engagement (ie, tailoring and interactivity) have been implemented.

METHODS

A systematic review of mobile app interventions for hypertension self-management targeting adults, published from 2013 to 2020, was conducted. A total of 21 studies were included in this systematic review.

RESULTS

The engagement was defined or operationalized as a microlevel concept, operationalized as interaction with the interventions (ie, frequency of engagement, time or duration of engagement with the program, and intensity of engagement). For all 3 studies that tested the relationship, increased engagement was associated with better biomedical outcomes (eg, blood pressure change). Interactivity was limited in digital behavior change interventions, as only 7 studies provided 2-way communication between users and a health care professional, and 9 studies provided 1-way communication in possible critical conditions; that is, when abnormal blood pressure values were recorded, users or health care professionals were notified. The tailoring of interventions varied at different aspects, from the tailoring of intervention content (including goals, patient education, advice and feedback from health professionals, reminders, and motivational messages) to the tailoring of intervention dose and communication mode. Tailoring was carried out in a number of ways, considering patient characteristics such as goals, preferences, disease characteristics (eg, hypertension stage and medication list), disease self-management experience levels, medication adherence rate, and values and beliefs.

CONCLUSIONS

Available studies support the importance of engagement in intervention effectiveness as well as the essential roles of patient factors in tailoring, interactivity, and engagement. A patient-centered engagement framework for hypertension self-management using mHealth technology is proposed here, with the intent of facilitating intervention design and disease self-management using mHealth technology.

E-Learning Success Model in the Context of COVID-19 Pandemic in Higher Educational Institutions

Nowadays, the extensive use of e-learning in higher educational institutions in many countries leads us to apprehend the reality, precisely the key success/failure factors of the implementation, of e-learning systems in these institutions. This motivation becomes more and more important, inevitable, and urgent, especially for institutions that have heavily adopted e-learning systems under exceptional conditions without any prior planning, such as the COVID-19 pandemic. From this perspective, this research aimed to provide an e-learning success model in the context of the COVID-19 pandemic by assessing e-learning effectiveness and by investigating the key antecedents of e-learning effectiveness. The literature review led to the identification of four main factors influencing e-learning effectiveness: The e-learning system, e-learning readiness, interactivity, and resistance to change. These four variables constituted the antecedents of an effective e-learning system, which was tested in a KSA context. A structured survey, including a sample of 1202 students from Imam Mohammad Ibn Saud Islamic University was used to examine the linkages among our proposed model. The model, with a total of ten direct and six indirect relationships, was tested by using structural equation modeling. The research findings indicate that effective e-learning is supported by the interactions between four factors: the e-learning system, e-learning readiness, interactivity, and resistance to change.

A randomized controlled trial of an mHealth application with nursing interaction to promote quality of life among community-dwelling older adults

SIGNIFICANCE

Using mHealth apps alone at home without the support of healthcare experts could mean that older adults might not fully utilize the functions of the apps, recognize their benefits, and sustain their use. Incorporating an integrated health-social partnership model to support the app usage when further help is needed by the older adults might maximize the apps' benefits in the long term.

OBJECTIVES

This study aimed to examine the benefits of adding nursing interaction supported by a health-social partnership model in the use of mHealth, and the sustained beneficial effects on psychological outcomes, including quality of life, self-efficacy, and depression, among older adults after the completion of the program.

METHODS

A three-arm, randomized controlled trial design was adopted. Community-dwelling older adults with chronic pain, hypertension, or diabetes, were randomly assigned to either the mHealth, mHealth with interactivity, or control group. Subjects in both the mHealth and the mHealth with interactivity groups received the mHealth application. In addition, the mHealth with interactivity group received support from a nurse case manager, who was supported by a health-social partnership team. mHealth apps and services from a nurse case manager were not provided to the control group. The primary outcome measure was quality of life, and secondary outcomes were self-efficacy and depression. Data were collected at pre-intervention (T1), post-intervention (T2), and at 3 months post-intervention to measure the sustained effect of the program.

RESULTS

There were 74 mHealth+I, 71 mHealth, and 76 control group subjects enrolled in the program. No statistically significant between-group, within-group, and interaction effects between group and time in both physical component summary (PCS) and mental component summary (MCS) scores were found among the three groups. The mHealth group showed an improvement in PCS and depression scores from T1 to T2, sustained at T3; while the mHealth+I group demonstrated improved self-efficacy from T1 to T2, with a decrease at T3.

CONCLUSION

Adding nurse-directed telephone calls may be of little to no benefit at all in the long term. Future studies may consider a longer intervention period to build and sustain quality of life and self-efficacy levels among community-dwelling older adults.

CLINICAL TRIAL REGISTRATION

www.ClinicalTrials.gov, identifier: NCT03878212.

The Impact of the Interactivity of Internet Celebrity Anchors on Consumers' Purchase Intention

The current study focuses on a novel and recently popular internet phenomenon – celebrity livestreaming marketing. As one of the primary advantages of livestreaming marketing by Internet celebrities, we propose that the timely interactivity of Internet celebrities plays an important role in consumers’ purchase intention. Based on stimulus-organism-response theory, this paper further identifies social presence and flow experience as mediators and the consistency of Internet celebrities’ image and product image as a moderator and constructs an influence model of Internet celebrities’ interactivity on consumers’ purchase intention. The responses of a sample of 277 participants were collected by a questionnaire survey. SPSS and Amos were used to analyse the data. The results show that consumers’ social presence and flow experience mediate the positive impact of the interactivity of Internet celebrity anchors on influencing consumers’ purchase intention. However, there is no significant moderating effect of the consistency of Internet celebrities’ image and product image on the relationship between social presence or flow experience and purchase intention. A discussion and implications are offered.

What Motivates You to Share? The Effect of Interactive Tailored Information Aids on Information Sharing about Clinical Trials

Cancer patients learn about research studies outside of the clinical environment, including websites, print and online advertisements, and interpersonal interactions. When cancer patients share credible information about clinical trials, they also frequently help clarify misunderstandings that may exist in their social networks. The present study investigated how an interactive tailored information aid on clinical trial participation motivated patients' information sharing behaviors. In this study of 312 cancer patients and survivors, an interactive tailored information aid improved patients' likelihood of sharing online and offline information more than a non-interactive tool. Information sharing was directly predicted by cognitive absorption and perceived visual informativeness. In addition, perceived utility and ease of use indirectly impact information sharing positively through the antecedent factors of user engagement and design esthetics. Education level further moderated this effect; information sharing was higher among patients with more education. The implications of these findings are discussed and recommendations for future research are provided.

Virtual Reality (VR)-Based Environmental Enrichment in Older Adults with Mild Cognitive Impairment (MCI) and Mild Dementia

Background: Despite an alarming rise in the global prevalence of dementia, the available modalities for improving cognition and mental wellbeing of dementia patients remain limited. Environmental enrichment is an experimental paradigm that has shown promising anti-depressive and memory-enhancing effects in pre-clinical studies. However, its clinical utility has remained limited due to the lack of effective implementation strategies. Objective: The primary objective of this study was to evaluate the usability (tolerability and interactivity) of a long-term virtual reality (VR)- based environmental enrichment training program in older adults with mild cognitive impairment (MCI) and mild dementia. A secondary objective was to assess the effect of VR-based environmental enrichment on stabilization of cognitive functioning and improvement of mental wellbeing in older adults with MCI and mild dementia. Methods: A total of seven participants (four patients with MCI and three with mild dementia) received biweekly VR-based environmental enrichment over a course of 6 months. The tolerability and interactivity of the participants in the VR training was serially assessed via virtual reality sickness questionnaire (VRSQ) and recording of input-error ratio. Cognitive functioning was assessed through Montreal cognitive assessment (MoCA) before and after the study. Mental wellbeing was assessed through Warwick-Edinburgh Mental Well Being Scale (WEMWBS). Results: VR-based environmental enrichment was well-tolerated by the patients with significant decrease in VRSQ scores (p < 0.01) and input-error ratio (p < 0.001) overtime. VR training was also effective in stabilization of MoCA scores over the course of therapy (non-significant difference in the MoCA scores before and after the therapy) and was associated with a trend (p < 0.1) towards improvement in WEMWBS scores between the first and the last assessments. Qualitative observations by the care-givers further corroborated a noticeable improvement in mental wellbeing of patients. Conclusions: This pilot study shows that VR can be a feasible, tolerable, and potentially effective tool in long-term support of older adults with MCI and mild dementia.

Interactive Video Simulation for Remote Healthcare Learning

Simulation is an essential component of healthcare education as it enables educators to replicate clinical scenarios in a controlled learning environment. Simulation has traditionally been conducted in-person through the use of manikins, however, the COVID-19 pandemic has challenged the practice of manikin simulation. Social distance constraints were enforced during the pandemic to reduce the potential spread of the virus and as a result, many educators and students were denied physical access to their universities' simulation facilities. Healthcare educators sought remote alternatives to manikin simulation and many resorted to instructional videos to educate their learners. While the use of videos increases safety, passively watching videos lacks interactivity which is an important component of simulation learning. In response to these challenges, we developed an interactive video simulation software that uses educators' existing video content to conduct a simulation remotely, thereby promoting safety during the pandemic while also meeting the interactivity standards of best practice for healthcare simulation. In this paper, we compare the interactive video simulation to the current practice of watching non-interactive video of a simulation using the same content. We found that interactivity promotes higher order learning, increases teamwork and enhances the perception of authenticity. Additionally, the majority of participants demonstrated positive reception of the interactive simulation. The simulation software provides the safety desired of a remote simulation during the pandemic while also engaging students in interactive learning experiences.

Informed Consent for Online Research-Is Anybody Reading?: Assessing Comprehension and Individual Differences in Readings of Digital Consent Forms

Informed consent is an important part of the research process; however, some participants either do not read or skim the consent form. When participants do not read or comprehend informed consent, then they may not understand the potential benefits, risks, or details of the study before participating. This study used previous research to develop experimentally manipulated online consent forms utilizing various presentations of the consent form and interactive elements. Participants (n = 576) were randomly exposed to one of six form variations. Results found that the highly interactive condition was significantly better for comprehension than any of the other conditions. The highly interactive condition also performed better for readability, though not significantly. Further research should explore the effects of interactive elements to combat habituation and to engage participants with the parts of the consent form unique to the study.

How Framed Messages Influence Depression Assessment Intentions: Interactivity of Social Media as a Moderator

This study examines how the framing and interactivity of messages influence the intentions of individuals to take a depression assessment. An experiment with a 2 (message framing: gain-versus loss-) × 2 (interactivity: low versus high) between-subject design was conducted among 269 Chinese participants (M = 30.70, SD = 7.34). The results showed that those reading loss-framed messages had a higher intention to take a depression assessment compared to those reading gain-framed messages. Secondly, those reading messages delivered with high interactivity had a higher intention to take a depression assessment than those reading messages delivered with low interactivity. Further, the interaction effect of framed messages and their varying degrees of interactivity was found to influence the intentions of individuals to take a depression assessment as well. Specifically, participants who read the loss-framed message reported stronger intention in the high interactivity group. In contrast, there was no significant difference between the effectiveness of loss-framed and gain-framed messages in promoting the intention to take a depression assessment in the low interactivity condition.

Ethics in times of physical distancing: virtual training of ethical competences

Ethics teaching in medicine, nursing and other health care professions does not only consist of knowledge transfer that can be easily implemented digitally. Rather, it focuses on specific ethical competences (such as arguing and articulating one's own moral position) and attitudes (such as empathic patient orientation, critical self-reflection, and ambiguity tolerance), for whose development interactive formats are superior. Competence-oriented ethical learning goals are important for the development of professionalism, but require time, space and personal exchange. Due to contact restrictions and the widespread cancellation of (face-to-face) courses in the wake of the corona pandemic, ethics teaching was forced to keep its distance in many places, which posed great challenges. This article is based on an exchange of experiences from members of the working group ethik learning of the Academy for Ethics in Medicine about ethics teaching in times of physical distancing. Recommendations will be given on how ethical competence can be successfully taught in the context of exclusively digital teaching. Starting with the question what is at risk of being lost in digital teaching, the potentials of digital formats are explored and illustrated with concrete practical examples. Beyond ethics teaching, the article also aims to provide ideas and suggestions for other specialist and cross-sectional areas where interactive formats are central.

Effects of Website Interactivity on Skin Cancer-Related Intentions and User Experience: Factorial Randomized Experiment

BACKGROUND

Digital media technologies provide users with the ability to interact with content and to receive information based on their preferences and engagement.

OBJECTIVE

We used skin cancer and sun protection as a health topic to explore how modality interactivity, interface tools that afford users greater activity, resulting in greater depth and breadth of mentally representing and experiencing mediated content, and message interactivity, the extent to which the system allows users to exchange messages back and forth on health websites, influenced users' attitudes, knowledge, behavioral intentions, and experience.

METHODS

We employed a 2×2 (modality interactivity: high vs low; message interactivity: high vs low) between-subject online experiment for which 4 websites were created. Participants (n=293) were recruited using Amazon Mechanical Turk and randomly assigned into to 1 of 4 conditions. After browsing the website, participants completed an online survey regarding their experience and cognitive perceptions. General linear models and path analysis were used to analyze the data.

RESULTS

Both modality interactivity (P=.001) and message interactivity (P<.001) had an impact on intention to use sun protection. Attitudes toward health websites and perceived knowledge mediated the effects of modality interactivity and message interactivity on sun protection use intention, individually. Participants in the high modality interactivity and high message interactivity condition felt more satisfied (P=.02). Participants in the low message interactivity condition had more interest in the experience with health websites than participants in the high message interactivity condition (P=.044).

CONCLUSIONS

Findings suggested that modality interactivity influenced intention to use sun protection directly as well as via attitudes toward the websites. Message interactivity impacted intention to use sunscreen directly and also through perceived knowledge. Implications for designing health websites and health intervention content are discussed.

Healthcare at Your Fingertips: The Acceptance and Adoption of Mobile Medical Treatment Services among Chinese Users

Mobile health (mHealth) services have recently been receiving increasing attention. However, there is a lack of knowledge about how users accept and adopt mobile medical treatment (MMT) services, some of the most promising mHealth services that aim to extend the patient-physician relationship beyond the conventional clinic environment. To fill this research gap, this study proposes a research model for predicting consumers' acceptance behavior toward MMT services based on the Technology Acceptance Model (TAM). A survey was conducted among 303 Chinese MMT service users to evaluate the proposed model and relevant hypotheses using partial least squares. Several key findings were summarized from the results: (1) the attitude toward using MMT, technology anxiety, and trust are significantly associated with users' behavioral intention to use MMT services; (2) the perceived ease of use, perceived usefulness, and trust significantly influence users' attitude toward using MMT services; (3) the perceived interactivity, perceived personalization, and privacy concerns have significant impacts on users' perceptions of ease of use, usefulness, and trust toward MMT services. The current findings have both theoretical and practical implications that may guide practitioners and researchers to better understand consumers' acceptance of MMT services.

Characteristics of Children's Media Use and Gains in Language and Literacy Skills

Media use could be detrimental to children's language and literacy skills because it may displace other language-enhancing activities like shared reading and caregiver-child interactions. Furthermore, the extent to which children use media with adults (joint media engagement), the extent to which they use interactive media (apps/games), and the time of the day and week during which media use occurs may attenuate any negative effects. The current study examines the relation between characteristics of children's media use and gains in first graders' language and literacy skills. Children (N = 488) completed direct assessments of language and literacy skills in the spring of kindergarten and the spring of first grade. Parents reported how many hours children used both interactive and non-interactive media during different times of the day on the most recent weekday and weekend day and responded to items about the extent to which they engage with their children during media use. A quadratic relationship between media use and language gains showed that a moderate amount of media use was related to larger language gains, whereas high use was related to smaller gains. For literacy, an interaction between media use and joint media engagement showed a small negative effect of media use at low levels of joint media engagement and little to no relation between media use and literacy gains at higher levels of joint media engagement. Children's language and literacy skills were not predicted by either the proportion of media time that was spent with apps/games or morning and weekday media use. These results show that moderate amounts of media use may not be a negative influence on children's developing language skills, whereas high levels may displace other language-enhancing activities. Additionally, joint media engagement may play an important buffering role in the relation between media use and early literacy skills, aligned with current recommendations encouraging co-viewing.

Effects of the Level of Interactivity of a Social Robot and the Response of the Augmented Reality Display in Contextual Interactions of People with Dementia

The well-being of people with dementia (PWD) living in long-term care facilities is hindered due to disengagement and social isolation. Animal-like social robots are increasingly used in dementia care as they can provide companionship and engage PWD in meaningful activities. While most previous human–robot interaction (HRI) research studied engagement independent from the context, recent findings indicate that the context of HRI sessions has an impact on user engagement. This study aims to explore the effects of contextual interactions between PWD and a social robot embedded in the augmented responsive environment. Three experimental conditions were compared: reactive context-enhanced robot interaction; dynamic context-enhanced interaction with a static robot; a control condition with only the dynamic context presented. Effectiveness evaluations were performed with 16 participants using four observational rating scales on observed engagement, affective states, and apathy related behaviors. Findings suggested that the higher level of interactivity of a social robot and the interactive contextualized feedback helped capture and maintain users’ attention during engagement; however, it did not significantly improve their positive affective states. Additionally, the presence of either a static or a proactive robot reduced apathy-related behaviors by facilitating purposeful activities, thus, motivating behavioral engagement.

Viewpoint: Homeostasis as Inspiration-Toward Interactive Materials

Homeostatic systems combine an ability to maintain integrity over time with an incredible capacity for interactive behavior. Fundamental to such systems are building blocks of "mini-homeostasis": feedback loops in which one component responds to a stimulus and another opposes the response, pushing the module to restore its original configuration. Particularly when they cross time and length scales, perturbation of these loops by external changes can generate diverse and complex phenomena. Here, it is proposed that by recognizing and implementing mini-homeostatic modules-often composed of very different physical and chemical processes-into synthetic materials, numerous interactive behaviors can be obtained, opening avenues for designing multifunctional materials. How a variety of controlled, nontrivial material responses can be evoked from even simple versions of such synthetic feedback modules is illustrated. Moreover, random events causing seemingly random responses give insights into how one can further explore, understand and control the full interaction space. Ultimately, material fabrication and exploration of interactivity become inseparable in the rational design of such materials. Homeostasis provides a lens through which one can learn how to combine and perturb coupled processes across time and length scales to conjure up exciting behaviors for new materials that are both robust and interactive.

When do Online Audiences Amplify Benefits of Self-Disclosure? The Role of Shared Experience and Anticipated Interactivity

As individuals increasingly write about their distressing experiences online, it is important to understand how perceived online audiences influence the effects of self-disclosure. In an experiment, participants wrote about recent breakups for online audiences purportedly varying in 1) whether they shared recent breakup experiences and 2) their ability to leave comments. Participants perceiving audiences with shared experience showed more cognitive processing in their writing and reported increased post-traumatic growth at follow-up than participants perceiving general audiences. Those anticipating comments wrote less about emotions than those who did not. Mechanisms accounting for the benefits of shared experience warrant further investigation.

Listening and question-asking behaviors in resident and nurse handoff conversations: a prospective observational study

OBJECTIVE

To characterize interactivity during resident and nurse handoffs by investigating listening and question-asking behaviors during conversations.

MATERIALS AND METHODS

Resident (n = 149) and nurse (n = 126) handoffs in an inpatient medicine unit were audio-recorded. Handoffs were coded based on listening behaviors (active and passive), question types (patient status, coordination of care, clinical reasoning, and framing and alignment), and question responses. Comparisons between residents and nurses for listening and question-asking behaviors were performed using the Wilcoxon rank-sum tests. A Poisson regression model was used to investigate differences in the question-asking behaviors between residents and nurses, and the association between listening and question-asking behaviors.

RESULTS

There were no significant differences between residents and nurses in their active (18% resident vs 39% nurse handoffs) or passive (88% resident vs 81% nurse handoffs) listening behaviors. Question-asking was common in resident and nurse handoffs (87% vs 98%) and focused primarily on patient status, co-ordination, and framing and alignment. Nurses asked significantly more questions than residents (Mresident = 2.06 and Mnurse = 5.52) by a factor of 1.76 (P < 0.001). Unit increase in listening behaviors was associated with an increase in the number of questions during resident and nurse handoffs by 7% and 12%, respectively.

DISCUSSION AND CONCLUSION

As suggested by the Joint Commission, question-asking behaviors were common across resident and nurse handoffs, playing a critical role in supporting resilience in communication and collaborative cross-checks during conversations. The role of listening in initiating question-asking behaviors is discussed.

How physical interaction with insight problems affects solution rates, hint use, and cognitive load

So-called insight problems are widely studied because they tap into the creative thinking that is crucial for solving real problems. However, insight problems are typically presented in static formats (on paper, computer) that allow no physical interaction with the problem elements, whereas such an interaction might in fact reduce the load on limited cognitive resources, such as working memory (WM) capacity, thereby facilitating solutions. To test this proposition, 124 young adults were allowed to interact physically with nine established insight problems, while another 124 people attempted to solve these problems using paper and pencil. Additionally, hints were provided for three problems that typically no-one solves. No general facilitating effect of physical interaction was found, with only one problem clearly benefitting from it. Furthermore, making use of hints was actually hindered by physical interaction. No difference in perceived task load and correlation with WM capacity was observed between the formats, and subjective ratings of insight were virtually unaffected by presentation format. Overall, physical interaction minimally affected insight problem-solving, which appears to rely strongly on internalized cognitive processing involving WM.

Characteristics of Children's Media Use and Gains in Language and Literacy Skills

Media use could be detrimental to children's language and literacy skills because it may displace other language-enhancing activities like shared reading and caregiver-child interactions. Furthermore, the extent to which children use media with adults (joint media engagement), the extent to which they use interactive media (apps/games), and the time of the day and week during which media use occurs may attenuate any negative effects. The current study examines the relation between characteristics of children's media use and gains in first graders' language and literacy skills. Children (N = 488) completed direct assessments of language and literacy skills in the spring of kindergarten and the spring of first grade. Parents reported how many hours children used both interactive and non-interactive media during different times of the day on the most recent weekday and weekend day and responded to items about the extent to which they engage with their children during media use. A quadratic relationship between media use and language gains showed that a moderate amount of media use was related to larger language gains, whereas high use was related to smaller gains. For literacy, an interaction between media use and joint media engagement showed a small negative effect of media use at low levels of joint media engagement and little to no relation between media use and literacy gains at higher levels of joint media engagement. Children's language and literacy skills were not predicted by either the proportion of media time that was spent with apps/games or morning and weekday media use. These results show that moderate amounts of media use may not be a negative influence on children's developing language skills, whereas high levels may displace other language-enhancing activities. Additionally, joint media engagement may play an important buffering role in the relation between media use and early literacy skills, aligned with current recommendations encouraging co-viewing.

Reformed conventional curriculum promoting the professional interest orientation of students of medicine: JENOS

Introduction: In the last ten years, the medical faculty at Friedrich Schiller University Jena has reformed its traditional curriculum for human medicine. The reformed JENa professional interest-Oriented Studies (JEnaer Neigungs-Orientiertes Studium, JENOS) - with the objective to facilitate career entry through a professional interest-oriented practical approach - emerged due to the stipulation of cost neutrality. Methods: Report on the process sequence of JENOS from the reform idea to implementation: the initial processes, the development and assessment process with accompanying dialogue and dispute of the reform process within the faculty shall be discussed. The 17 objectives of the JENOS reformed traditional curriculum shall be presented and the current level of fulfilment assessed. Results: The structural link of the professional interest-oriented proposals was achieved through the recognition by the "Landesprüfungsamt" (State Examination Board) as elective subjects with 21 semester hours (SH). Feedback and evaluations were conducted using lecturer and student information systems that were implemented in parallel. Eleven of 17 objectives have been achieved, three are still in process and three have not been achieved. Discussion: A professional interest orientation could be achieved through the reform. The weaknesses are found primarily in the links between teaching content. These are currently undergoing a mapping process in order to be optimised. Conclusions: Despite cost neutrality, JENOS is the successful result of reforming the curriculum. The academic reform complied with some requirements for the Master Plan 2020 for Medical Studies in order to be able to implement future changes.

Interactivity, Presence, and Targeted Patient Care: Mapping e-Health Intervention Effects Over Time for Cancer Patients with Depression

This study examined the interplay of depression and different types of e-health interventions on breast cancer patients' perceived healthcare competence, emotional processing, and social well-being over time. The three e-health interventions--Internet Only as a control condition, CHESS (Comprehensive Health Enhancement Support System) Only, and CHESS with a Human Mentor, a cancer information specialist--provided varying degrees of interactivity and presence. A total of 328 women with breast cancer participated in one of the three interventions for a 6-month period. Women were further split into two groups based on reported levels of depression. For perceived healthcare competence and social well-being, results revealed significant interaction effects for intervention type by depression over time, such that breast cancer patients with higher levels of depression benefited most from the CHESS with Mentor intervention over the 6-month study period. For emotional processing, depressed cancer patients benefited more from the CHESS with Mentor than the other two interventions, regardless of time. These findings have (a) theoretical implications on how mental health factors can intersect with interactivity and presence to influence psychosocial outcomes, (b) conceptual implications for the role of human interaction within e-health systems, and (c) practical implications for the development of e-health interventions for cancer patients with depression.

Interactivity: A Potential Determinant of Learning by Preparing to Teach and Teaching

It has been suggested that preparing to teach and teaching are conditionally effective in enhancing one's own learning. This paper focuses on interactivity - the level of teacher-student interaction in expected or actual teaching - as the potential key to understanding and controlling the variability in the effectiveness of learning by preparing to teach and teaching. By summarizing and reanalyzing the results of previous studies, I suggest that the learning benefits of studying with the expectation of direct teaching (i.e., teaching a student face-to-face) are greater than those of studying with the expectation of indirect teaching (i.e., teaching a student indirectly by creating a lecture video, providing written explanations, or using other means) and that learning by direct teaching surpasses learning by explaining to oneself or indirect teaching at least after preparing to do so. Next, three candidate explanations for the impact of interactivity are discussed: the advantages of asking and answering questions, obtaining additional information about and from one's student, and enhancing one's motivation to process learning material deeply while preparing to teach and teaching. Finally, I conclude with the remaining questions and directions for future research.

Ready to Make A Decision: A Model of Informational Aids to Improve Informed Participation in Clinical Trial Research

Enrollment rates for cancer clinical trials remain low, affecting the generalizability of new treatments. Research shows that many patients face significant challenges in understanding basic clinical trial vocabulary and making informed decisions about participation. Informational aids (IA) are developed to address these challenges and support decision making of cancer clinical trial participation. The present study proposed and tested a structural path model to explain the efficacy of three (i.e., interactive, non-interactive, non-cancer control) IAs. The results revealed that clinical trial participation intention was associated with attitudes and social constructs (i.e., social norm, social sharing, and cues to action). Ease of use, rather than knowledge, was the primary communication feature of IA that influenced the outcome variables. The path relations linking messages features, mediators, and outcome variables were different across all three IAs. The results therefore provide theoretical and practical implications for the use and development of IAs to support clinical trial accrual.

Action-Centered Exposure Therapy (ACET): A New Approach to the Use of Virtual Reality to the Care of People with Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder (PTSD) can be seen as the result of dysfunctional beliefs that associate stimuli with a danger or a threat leading to anxious reactions. Exposure therapy is so far considered to be the most effective treatment, and research suggests that it is mainly based on a habituation process. Based on learning theories, it appears that a passive systemic exposure to traumatic stimuli should not be the best option for the treatment of PTSD. We hypothesis that an active learning of safer and healthier coping strategies combined with systematic exposure should be more effective in reducing the psychological distress associated with PTSD. In this paper, we describe the theoretical foundations of this approach that focuses on the action and activity of the patient in his or her exposure environment. In this approach, we take advantage of Virtual Reality technologies and learning mechanics of serious games to allow the patient to learn new safe associations while promoting the empowerment. We named this action-centered exposure therapy (ACET). This approach exploits behaviorism, cognitivism, and constructivism learning theories. With the different benefits of virtual reality technologies, this approach would easily integrate with in-virtuo exposure therapy and would allow us to exploit as much as possible the enormous potential of these technologies. As a first step toward validation, we present a case study that supports the ACET approach.

Network Dynamics of Attention During a Naturalistic Behavioral Paradigm

This study investigates the dynamics of attention during continuous, naturalistic interactions in a video game. Specifically, the effect of repeated distraction on a continuous primary task is related to a functional model of network connectivity. We introduce the Non-linear Attentional Saturation Hypothesis (NASH), which predicts that effective connectivity within attentional networks increases non-linearly with decreasing distraction over time, and exhibits dampening at critical parameter values. Functional magnetic resonance imaging (fMRI) data collected using a naturalistic behavioral paradigm coupled with an interactive video game is used to test the hypothesis. As predicted, connectivity in pre-defined regions corresponding to attentional networks increases as distraction decreases. Moreover, the functional relationship between connectivity and distraction is convex, that is, network connectivity somewhat increases as distraction decreases during the continuous primary task, however, connectivity increases considerably as distraction falls below critical levels. This result characterizes the non-linear pattern of connectivity within attentional networks, particularly with respect to their dynamics during behavior. These results are also summarized in the form of a network structure analysis, which underscores the role of various nodes in regulating the global network state. In conclusion, we situate the implications of this research in the context of cognitive complexity and an emerging theory of flow during media exposure.

Designing Smart Objects to Support Affording Situations: Exploiting Affordance Through an Understanding of Forms of Engagement

In this paper I consider how the concept of “affordance” has been adapted from the original writings of Gibson and applied to interaction design. I argue that a clear understanding of affordance shifts the goal of interaction design from one of solely focusing on either the physical object or the capabilities of the person, toward an understanding of interactivity. To do this, I develop the concept of Forms of Engagement, originally proposed to account for tool use. Finally, I extend this concept to interacting with modified tangible user interfaces, or “animate objects.” These animate objects not only sense how they are being used, but also communicate with each other to develop a shared intent, and provide prompts and cues to encourage specific actions. In this way, the human-object-environment system creates affording situations in pursuit of shared intentions and goals. In order to determine when to provide prompts and cues, the objects need to have a model of how they ought to be used and what intention they are being used to achieve. Consequently, affordances become not only the means by which actions are encouraged but also the manner in which intentions are identified and agreed.

Interactivity and Trust as Antecedents of E-Training Use Intention in Nigeria: A Structural Equation Modelling Approach

Background: The last few decades saw an intense development in information technology (IT) and it has affected the ways organisations achieve their goals. Training, in every organisation is an ongoing process that aims to update employees’ knowledge and skills towards goals attainment. Through adequate deployment of IT, organisations can effectively meet their training needs. However, for successful IT integration in training, the employees who will use the system should be positively disposed towards it. This study predicts employees’ intention to use the e-training system by extending the technology acceptance model (TAM) using interactivity and trust. Methods: Two hundred and fourteen employees participated in the study and structural equation modelling was used in the analysis. Results: The findings of the structural equation modelling reveal that interactivity, trust, perceived usefulness and perceived ease of use have direct and positive effects on employees’ intention to use e-training. It was also shown that perceived ease of use had no effects on perceived usefulness, while trust has the strongest indirect effects on employees’ intention. In addition, the results of Importance-Performance Map Analysis (IPMA), which compares the contributions of each construct to the importance and performance of the model, indicate that to predict intention to use e-training, priorities should be accorded to trust and perceived usefulness.

Making room for interactivity: using the cloud-based audience response system Nearpod to enhance engagement in lectures

Active and collaborative learning provides distinct advantages for students in higher education, yet can often be hampered by the barrier of large class sizes. Solutions that combine a 'bring your own device culture' with cloud-based technologies may facilitate a more interactive learning experience. In this pilot study, we describe the use of one such technology, Nearpod, to enhance interactivity in lectures delivered to pharmacy and bioscience students at Ulster University. Existing material in PowerPoint or Keynote format is uploaded to the instructor area of Nearpod, interactive elements are added, and the lecture is then broadcasted via the internet to student devices. The lecturer may choose to share polling responses or examples of submissions from the drawing tool or open-ended questions, thereby providing instant feedback on learning. Students commented favourably on the interactivity and engagement afforded by Nearpod. Most students were happy to use their own electronic devices (smartphones, tablets and laptops) for such activities with a minority expressing concern over problems with connecting to the institutional Wi-Fi. Nearpod and similar products represent a new class of feature-rich audience response systems that have potential to transform learning even in large classes.

Reducing speeding in web surveys by providing immediate feedback

It is well known that some survey respondents reduce the effort they invest in answering questions by taking mental shortcuts - survey satisficing. This is a concern because such shortcuts can reduce the quality of responses and, potentially, the accuracy of survey estimates. This article explores "speeding," an extreme type of satisficing, which we define as answering so quickly that respondents could not have given much, if any, thought to their answers. To reduce speeding among online respondents we implemented an interactive prompting technique. When respondents answered faster than a minimal response time threshold, they received a message encouraging them to answer carefully and take their time. Across six web survey experiments, this prompting technique reduced speeding on subsequent questions compared to a no prompt control. Prompting slowed response times whether the speeding that triggered the prompt occurred early or late in the questionnaire, in the first or later waves of a longitudinal survey, among respondents recruited from non-probability or probability panels, or whether the prompt was delivered on only the first or on all speeding episodes. In addition to reducing speeding, the prompts increased response accuracy on simple arithmetic questions for a key subgroup. Prompting also reduced later straightlining in one experiment, suggesting the benefits may generalize to other types of mental shortcuts. Although the prompting could have annoyed respondents, it was not accompanied by a noticeable increase in breakoffs. As an alternative technique, respondents in one experiment were asked to explicitly commit to responding carefully. This global approach complemented the more local, interactive prompting technique on several measures. Taken together, these results suggest that interactive interventions of this sort may be useful for increasing respondents' conscientiousness in online questionnaires, even though these questionnaires are self-administered.

From the Experience of Interactivity and Entertainment to Lower Intention to Smoke: A Randomized Controlled Trial and Path Analysis of a Web-Based Smoking Prevention Program for Adolescents

Background

Web-based programs for smoking prevention are being increasingly used with some success among adolescents. However, little is known about the mechanisms that link the experience of such programs to intended nicotine or tobacco control outcomes.

Objective

Based on the experiential learning theory and extended elaboration likelihood model, this study aimed to evaluate the impact of a Web-based intervention, A Smoking Prevention Interactive Experience (ASPIRE), on adolescents’ intention to smoke, while considering the experience of interactivity and entertainment as predictors of reduced intention to smoke, under a transitional user experience model.

Methods

A total of 101 adolescents were recruited from after-school programs, provided consent, screened, and randomized in a single-blinded format to 1 of 2 conditions: the full ASPIRE program as the experimental condition (n=50) or an online , text-based version of ASPIRE as the control condition (n=51). Data were collected at baseline and immediate follow-up. Repeated-measures mixed-effects models and path analyses were conducted.

Results

A total of 82 participants completed the study and were included in the analysis. Participants in the experimental condition were more likely to show a decrease in their intention to smoke than those in the control condition (beta=−0.18, P=.008). Perceived interactivity (beta=−0.27, P=.004) and entertainment (beta=−0.20, P=.04) were each associated with a decrease in intention to smoke independently. Results of path analyses indicated that perceived interactivity and perceived entertainment mediated the relationship between ASPIRE use and emotional involvement. Furthermore, perceived presence mediated the relationship between perceived interactivity and emotional involvement. There was a direct relationship between perceived entertainment and emotional involvement. Emotional involvement predicted a decrease in intention to smoke (beta=−0.16, P=.04).

Conclusions

Adolescents’ experience of interactivity and entertainment contributed to the expected outcome of lower intention to smoke. Also, emphasis needs to be placed on the emotional experience during Web-based interventions in order to maximize reductions in smoking intentions. Going beyond mere evaluation of the effectiveness of a Web-based smoking prevention program, this study contributes to the understanding of adolescents’ psychological experience and its effect on their intention to smoke. With the results of this study, researchers can work to (1) enhance the experience of interactivity and entertainment and (2) amplify concepts of media effects (eg, presence and emotional involvement) in order to better reach health behavior outcomes.

Trial Registration

Clinicaltrials.gov NCT02469779; https://clinicaltrials.gov/ct2/show/NCT02469779 (Archived by WebCite at http://www.webcitation.org/6nxyZVOf0)

Efficacy of three-dimensional visualization in mobile apps for patient education regarding orthognathic surgery

'Sur-face' is an interactive mobile app illustrating different orthognathic surgeries and their potential complications. This study aimed to evaluate the efficacy of Sur-face by comparing two methods of delivering patient information on orthognathic surgeries and their related potential complications: a mobile app with interactive three-dimensional (3D) animations and a voice recording containing verbal instructions only. For each method, the participants' acquired knowledge was assessed using a custom-designed questionnaire. Participants in the 'app' group performed significantly better (P<0.0034) than those in the 'voice' group and retained more knowledge, suggesting that interactive visualizations play a key role in improving understanding of the orthognathic surgical procedure and its associated complications. This study emphasizes the impact of 3D visualizations in delivering information regarding orthognathic surgery and highlights the advantage of delivering validated patient information through mobile apps.

Social value of high bandwidth networks: creative performance and education

This paper considers limitations of existing network technologies for distributed theatrical performance in the creative arts and for symmetrical real-time interaction in online learning environments. It examines the experience of a multidisciplinary research consortium that aimed to introduce a solution to latency and other network problems experienced by users in these sectors. The solution builds on the Multicast protocol, Access Grid, an environment supported by very high bandwidth networks. The solution is intended to offer high-quality image and sound, interaction with other network platforms, maximum user control of multipoint transmissions, and open programming tools that are flexible and modifiable for specific uses. A case study is presented drawing upon an extended period of participant observation by the authors. This provides a basis for an examination of the challenges of promoting technological innovation in a multidisciplinary project. We highlight the kinds of technical advances and cultural and organizational changes that would be required to meet demanding quality standards, the way a research consortium planned to engage in experimentation and learning, and factors making it difficult to achieve an open platform that is responsive to the needs of users in the creative arts and education sectors.