Assessing the Importance of Content Versus Design for Successful Crowdfunding of Health Education Games: Online Survey Study

Background

Health education games make health-related tasks enjoyable and interactive, thereby encouraging user participation. Entrepreneurs and health educators can leverage online crowdfunding platforms, such as Kickstarter, to transform their innovative ideas into funded projects.

Objective

This research focuses on health education game initiatives on Kickstarter. Through an online user survey, it aims to understand user perceptions and evaluate the significance of 8 distinct components that may influence the success of such crowdfunding initiatives.

Methods

A total of 75 participants evaluated games using 8 dimensions: game rules, learning objectives, narrative, content organization, motivation, interactivity, skill building, and assessment and feedback. The survey data were analyzed using descriptive statistical analysis, exploratory factor analysis, the Wilcoxon-Mann-Whitney test, and multivariate analysis.

Results

Exploratory data analysis showed that, among the 8 dimensions, skill building, content organization, and interactivity were the top-ranking dimensions most closely associated with crowdfunding health education game. The 8 dimensions can be grouped into 3 categories from the exploratory factor analysis: game content-, instruction-, and game design-related components. Further statistical analysis confirmed the correlation between these dimensions with the successful crowdfunding of health education games.

Conclusions

This empirical analysis identified critical factors for game proposal design that can increase the likelihood of securing crowdfunding support.

Exploring the Impact of Security Technologies on Mental Health: A Comprehensive Review

This comprehensive review explores the intricate relationship between security technologies and mental health. Security technologies, including physical security, cybersecurity, and surveillance measures, are integral components of our modern world, designed to protect individuals, organizations, and society from various threats. While they are vital in enhancing safety, they also have profound implications for mental well-being. The review delves into the positive impacts of security technologies, including their capacity to enhance personal safety, reduce anxiety and fear, and instill a sense of security. However, it also reveals the negative consequences, such as privacy invasion, surveillance-related stress, paranoia, and ethical concerns, which can erode mental health. User perception and trust are central to understanding how individuals experience security technologies. The review emphasizes the importance of ethical guidelines, user education, and technological advancements in mitigating negative impacts. By embracing an ethical-by-design approach, empowering users, and promoting public awareness, a balanced equilibrium between security and mental health can be achieved. The conclusion highlights the significance of ongoing research and interdisciplinary collaboration to navigate this intricate relationship effectively. By prioritizing ethical considerations and fostering a dialogue that values security and individual well-being, we can ensure a safer and more mentally healthy future in our technologically interconnected world.

Perceptions of Autonomous Shuttles for Adults With Spinal Cord Injuries

Individuals with a spinal cord injury (SCI) have challenges using transportation. Autonomous shuttles (ASs), if accessible, may support their transportation needs. This study quantified the perceptions of AS for adults with and without SCI, before and after riding in the AS. We hypothesized that the perceptions of AS for individuals with SCI would improve, by the greatest magnitude, after riding in the AS. This mixed-method quasi-experimental design included 16 adults with SCI and 16 age-matched controls. While there were no differences between the groups, both groups reported having fewer perceived barriers to using AS after riding in the AS (p = .025). After riding in the AS, both groups stated that the AS must be available, accessible, and affordable if they are to use AS. In conclusion, adults with SCI should experience AS if they are to accept and adopt this mode of transportation.

Standardized Comparison of Voice-Based Information and Documentation Systems to Established Systems in Intensive Care: Crossover Study

BACKGROUND

The medical teams in intensive care units (ICUs) spend increasing amounts of time at computer systems for data processing, input, and interpretation purposes. As each patient creates about 1000 data points per hour, the available information is abundant, making the interpretation difficult and time-consuming. This data flood leads to a decrease in time for evidence-based, patient-centered care. Information systems, such as patient data management systems (PDMSs), are increasingly used at ICUs. However, they often create new challenges arising from the increasing documentation burden.

OBJECTIVE

New concepts, such as artificial intelligence (AI)-based assistant systems, are hence introduced to the workflow to cope with these challenges. However, there is a lack of standardized, published metrics in order to compare the various data input and management systems in the ICU setting. The objective of this study is to compare established documentation and retrieval processes with newer methods, such as PDMSs and voice information and documentation systems (VIDSs).

METHODS

In this crossover study, we compare traditional, paper-based documentation systems with PDMSs and newer AI-based VIDSs in terms of performance (required time), accuracy, mental workload, and user experience in an intensive care setting. Performance is assessed on a set of 6 standardized, typical ICU tasks, ranging from documentation to medical interpretation.

RESULTS

A total of 60 ICU-experienced medical professionals participated in the study. The VIDS showed a statistically significant advantage compared to the other 2 systems. The tasks were completed significantly faster with the VIDS than with the PDMS (1-tailed t59=12.48; Cohen d=1.61; P<.001) or paper documentation (t59=20.41; Cohen d=2.63; P<.001). Significantly fewer errors were made with VIDS than with the PDMS (t59=3.45; Cohen d=0.45; P=.03) and paper-based documentation (t59=11.2; Cohen d=1.45; P<.001). The analysis of the mental workload of VIDS and PDMS showed no statistically significant difference (P=.06). However, the analysis of subjective user perception showed a statistically significant perceived benefit of the VIDS compared to the PDMS (P<.001) and paper documentation (P<.001).

CONCLUSIONS

The results of this study show that the VIDS reduced error rate, documentation time, and mental workload regarding the set of 6 standardized typical ICU tasks. In conclusion, this indicates that AI-based systems such as the VIDS tested in this study have the potential to reduce this workload and improve evidence-based and safe patient care.

Developing a Quality Evaluation Index System for E-Consultation Doctor-Patient Communication Using the Delphi Method

Background

E-consultation medical services have become popular globally, which offers patients more options, regardless of time or location. However, research indicates a prevalent issue with the communication quality in e-consultations, leading to sub-optimal patient experiences.

Objective

This study aims to design an evaluation system for e-consultation quality. The developed scale guides operators in improving services and users in assessing their experience. It aids in selecting e-consultation services, saving costs, and assisting doctors in making informed decisions.

Methods

This study combines existing scales, literature analysis, and expert consultation to form preliminary evaluation indicators. Fourteen experts were invited using stratified purposive sampling. Two rounds of Delphi method were conducted to exclude indicators that did not meet basic conditions. The final evaluation system was determined through expert discussions and revisions. The Analytic Hierarchy Process (AHP) quantified indicator weights.

Results

Both rounds of the questionnaire saw compelling response rates of 100% (14 out of 14) and 92.86% (13 out of 14), respectively. Meanwhile, the Expert Authority Coefficient (Cr) was recorded at 0.89 and 0.88, respectively, while the Kendall Consistency Coefficient (Kendall W) for all level indicators fluctuated between 0.133 and 0.37 (P<0.05). The ultimate indicator system formulated includes three primary indicators, ten secondary indicators, and thirty-two tertiary indicators. The highest to lowest weighted first-level indicators were 'Joint Decision-Making between Doctors and Patients' (0.6232), 'Patient Responsiveness' (0.2395), and "Interpersonal Relationship between Doctors and Patients" (0.1373). Weights for the second-level and third-level indicators were also determined.

Conclusion

A scientific scale for e-consultation quality evaluation has been created, which effectively captures the essence of online medical communication and patient experiences. It enriches the theoretical framework for evaluating e-consultation quality, broadens perspectives in Internet medicine, provides practical guidance for network medical service managers and users and the development of the "Internet + medical health" service model.

User Perceptions of Avatar-Based Patient Monitoring for Intensive Care Units: An International Exploratory Sequential Mixed-Methods Study

Visual Patient Avatar ICU is an innovative approach to patient monitoring, enhancing the user's situation awareness in intensive care settings. It dynamically displays the patient's current vital signs using changes in color, shape, and animation. The technology can also indicate patient-inserted devices, such as arterial lines, central lines, and urinary catheters, along with their insertion locations. We conducted an international, multi-center study using a sequential qualitative-quantitative design to evaluate users' perception of Visual Patient Avatar ICU among physicians and nurses. Twenty-five nurses and twenty-five physicians from the ICU participated in the structured interviews. Forty of them completed the online survey. Overall, ICU professionals expressed a positive outlook on Visual Patient Avatar ICU. They described Visual Patient Avatar ICU as a simple and intuitive tool that improved information retention and facilitated problem identification. However, a subset of participants expressed concerns about potential information overload and a sense of incompleteness due to missing exact numerical values. These findings provide valuable insights into user perceptions of Visual Patient Avatar ICU and encourage further technology development before clinical implementation.

First impressions of a financial AI assistant: differences between high trust and low trust users

Calibrating appropriate trust of non-expert users in artificial intelligence (AI) systems is a challenging yet crucial task. To align subjective levels of trust with the objective trustworthiness of a system, users need information about its strengths and weaknesses. The specific explanations that help individuals avoid over- or under-trust may vary depending on their initial perceptions of the system. In an online study, 127 participants watched a video of a financial AI assistant with varying degrees of decision agency. They generated 358 spontaneous text descriptions of the system and completed standard questionnaires from the Trust in Automation and Technology Acceptance literature (including perceived system competence, understandability, human-likeness, uncanniness, intention of developers, intention to use, and trust). Comparisons between a high trust and a low trust user group revealed significant differences in both open-ended and closed-ended answers. While high trust users characterized the AI assistant as more useful, competent, understandable, and humanlike, low trust users highlighted the system's uncanniness and potential dangers. Manipulating the AI assistant's agency had no influence on trust or intention to use. These findings are relevant for effective communication about AI and trust calibration of users who differ in their initial levels of trust.

The Impact and Perception of England's Web-Based Heart Age Test of Cardiovascular Disease Risk: Mixed Methods Study

BACKGROUND

It is well documented that individuals struggle to understand cardiovascular disease (CVD) percentage risk scores, which led to the development of heart age as a means of communicating risk. Developed for clinical use, its application in raising public awareness of heart health as part of a self-directed digital test has not been considered previously.

OBJECTIVE

This study aimed to understand who accesses England's heart age test (HAT) and its effect on user perception, knowledge, and understanding of CVD risk; future behavior intentions; and potential engagement with primary care services.

METHODS

There were 3 sources of data: routinely gathered data on all individuals accessing the HAT (February 2015 to June 2020); web-based survey, distributed between January 2021 and March 2021; and interviews with a subsample of survey respondents (February 2021 to March 2021). Data were used to describe the test user population and explore knowledge and understanding of CVD risk, confidence in interpreting and controlling CVD risk, and effect on future behavior intentions and potential engagement with primary care. Interviews were analyzed using reflexive thematic analysis.

RESULTS

Between February 2015 and June 2020, the HAT was completed approximately 5 million times, with more completions by men (2,682,544/4,898,532, 54.76%), those aged between 50 to 59 years (1,334,195/4,898,532, 27.24%), those from White ethnic background (3,972,293/4,898,532, 81.09%), and those living in the least deprived 20% of areas (707,747/4,898,532, 14.45%). The study concluded with 819 survey responses and 33 semistructured interviews. Participants stated that they understood the meaning of high estimated heart age and self-reported at least some improvement in the understanding and confidence in understanding and controlling CVD risk. Negative emotional responses were provoked among users when estimated heart age did not equate to their previous risk perceptions. The limited information needed to complete it or the production of a result when physiological risk factor information was missing (ie, blood pressure and cholesterol level) led some users to question the credibility of the test. However, most participants who were interviewed mentioned that they would recommend or had already recommended the test to others, would use it again in the future, and would be more likely to take up the offer of a National Health Service Health Check and self-reported that they had made or intended to make changes to their health behavior or felt encouraged to continue to make changes to their health behavior.

CONCLUSIONS

England's web-based HAT has engaged large number of people in their heart health. Improvements to England's HAT, noted in this paper, may enhance user satisfaction and prevent confusion. Future studies to understand the long-term benefit of the test on behavioral outcomes are warranted.

Quality of care in the EsSalud emergency service, northern Region, Peru

This study explores the user's quality of medical attention. The aim was to analyze the quality-of-care indicators in the EsSalud emergency service of the hospitals of the Lambayeque Juan Aita Valle Healthcare Network, according to the perceptions and expectations of the patients. The research has a descriptive, correlational, cross-sectional design, which includes the description, registration, analysis, and interpretation of the current nature of the quality of emergency medical care in the selected hospital institutions. The population is represented by patients who attended the emergency department of the hospital institution's understudy for one month. The sample was obtained using a simple random system. The technique used was the application of Servqual Quality of Emergency Care questionnaire. The instrument consisted of three parts, General Data, Expectations of the External User, and Perceptions of the External User. All statistical tests were processed using SPSS v.25 through the T-test of means. Higher customer dissatisfaction was revealed with regard to intangibility, lack of security, lack of reliability, and lack of empathy towards the user. User expectations and perceptions regarding the health service quality are also marked by dissatisfaction and great dissatisfaction.

The effects of anthropomorphism and multimodal biometric authentication on the user experience of voice intelligence

Voice intelligence is a revolutionary "zero-touch" type of human-machine interaction based on spoken language. There has been a recent increase in the number and variations of voice assistants and applications that help users to acquire information. The increased popularity of voice intelligence, however, has not been reflected in the customer value chain. Current research on the socio-technological aspects of human-technology interaction has emphasized the importance of anthropomorphism and user identification in the adoption of the technology. Prior research has also pointed out that user perception toward the technology is key to its adoption. Therefore, this research examines how anthropomorphism and multimodal biometric authentication influence the adoption of voice intelligence through user perception in the customer value chain. In this study we conducted a between-subjects online experiment. We designed a 2 × 2 factorial experiment by manipulating anthropomorphism and multimodal biometric authentication into four conditions, namely with and without a combination of these two factors. Subjects were recruited from Amazon MTurk platform and randomly assigned to one of the four conditions. The results drawn from the empirical study showed a significant direct positive effect of anthropomorphism and multimodal biometric authentication on user adoption of voice intelligence in the customer value chain. Moreover, the effect of anthropomorphism is partially mediated by users' perceived ease of use, perceived usefulness, and perceived security risk. This research contributes to the existing literature on human-computer interaction and voice intelligence by empirically testing the simultaneous impact of anthropomorphism and biometric authentication on users' experience of the technology. The study also provides practitioners who wish to adopt voice intelligence in the commercial environment with insights into the user interface design.

Evaluating the Adequacy of Emoji Use in Positive and Negative Messages from Close and Distant Senders

Computer-mediated communication allows people to communicate across several contexts (e.g., friends, professional settings) by using video-based or text-based channels. In the latter case, communication lacks nonverbal cues (e.g., tone of voice) that are critical to message interpretation. Including emoji can help express emotion and reinforce or clarify the meaning of a message. However, the benefits of using emoji are likely to depend on the context (e.g., the relationship between interlocutors) and the messages' features (e.g., the valence of the message). To date, studies have not systematically and empirically examined how the use of emoji is perceived across different communication scenarios. In the current study, we asked 175 participants (49.5 percent women; M_age = 36.32, SD = 12.22) to imagine receiving either a negative or a positive message from 22 senders (e.g., friend; bank manager) and to indicate, for each case, how much they would like to receive an emoji and how useful and appropriate they considered the use of emoji. These ratings were combined into a single index of emoji use adequacy. Based on factor analysis, the 22 scenarios were aggregated in distant and close scenarios. Overall, results showed that participants considered emoji use more inadequate in distant (vs. close) scenarios and for negative (vs. positive) messages. These findings suggest that the perceived benefits of emoji use for text-based communication may not be generalized to all text-based communication contexts, such that relationship proximity and message valence should not be overlooked. Implications for the fields of consumer psychology and communication are discussed.

User Perceptions and Experiences of a Handheld 12-Lead Electrocardiographic Device in a Clinical Setting: Usability Evaluation

Background

Cardiac arrhythmias are a leading cause of death. The mainstay method for diagnosing arrhythmias (eg, atrial fibrillation) and cardiac conduction disorders (eg, prolonged corrected QT interval [QTc]) is by using 12-lead electrocardiography (ECG). Handheld 12-lead ECG devices are emerging in the market. In tandem with emerging technology options, evaluations of device usability should go beyond validation of the device in a controlled laboratory setting and assess user perceptions and experiences, which are crucial for successful implementation in clinical practice.

Objective

This study aimed to evaluate clinician and patient perceptions and experiences, regarding the usability of a handheld 12-lead ECG device compared to a conventional 12-lead ECG machine, and generalizability of this user-centered approach.

Methods

International Organization for Standardization Guidelines on Usability and the Technology Acceptance Model were integrated to form the framework for this study, which was conducted in outpatient clinics and cardiology wards at Westmead Hospital, New South Wales, Australia. Each patient underwent 2 ECGs (1 by each device) in 2 postures (supine and standing) acquired in random sequence. The times taken by clinicians to acquire the first ECG (efficiency) using the devices were analyzed using linear regression. Electrocardiographic parameters (QT interval, QTc interval, heart rate, PR interval, QRS interval) and participant satisfaction surveys were collected. Device reliability was assessed by evaluating the mean difference of QTc measurements within ±15 ms, intraclass correlation coefficient, and level of agreement of the devices in detecting atrial fibrillation and prolonged QTc. Clinicians’ perceptions and feedback were assessed with semistructured interviews based on the Technology Acceptance Model.

Results

A total of 100 patients (age: mean 57.9 years, SD 15.2; sex: male: n=64, female n=36) and 11 clinicians (experience acquiring ECGs daily or weekly 10/11, 91%) participated, and 783 ECGs were acquired. Mean differences in QTc measurements of both handheld and conventional devices were within ±15 ms with high intraclass correlation coefficients (range 0.90-0.96), and the devices had a good level of agreement in diagnosing atrial fibrillation and prolonged QTc (κ=0.68-0.93). Regardless of device, QTc measurements when patients were standing were longer duration than QTc measurements when patients were supine. Clinicians’ ECG acquisition times improved with usage (P<.001). Clinicians reported that device characteristics (small size, light weight, portability, and wireless ECG transmission) were highly desired features. Most clinicians agreed that the handheld device could be used for clinician-led mass screening with enhancement in efficiency by increasing user training. Regardless of device, patients reported that they felt comfortable when they were connected to the ECG devices.

Conclusions

Reliability and usability of the handheld 12-lead ECG device were comparable to those of a conventional ECG machine. The user-centered evaluation approach helped us identify remediable action to improve the efficiency in using the device and identified highly desirable device features that could potentially help mass screening and remote assessment of patients. The approach could be applied to evaluate and better understand the acceptability and usability of new medical devices.

Factors Influencing the Adoption of Contact Tracing Applications: Protocol for a Systematic Review

BACKGROUND

Following the onset of the COVID-19 pandemic, digital contact tracing apps have become prevalent worldwide in a coordinated effort to curb the spread of COVID-19. However, their uptake has been low and slow due to privacy concerns, the lack of trust and motivational affordances, and their minimalist design.

OBJECTIVE

The objective of this article is to present a protocol for a systematic review of the main factors, including facilitators and barriers, that influence the adoption of contact tracing apps.

METHODS

We searched seven databases, namely, Scopus, CINAHL, PubMed (MEDLINE), IEEE Xplore Digital Library, Association for Computing Machinery (ACM) Digital Library, Web of Science, and Google Scholar, for relevant publications between October 30, 2020, and January 31, 2021. Three authors were involved in removing duplicates, screening, and selection of relevant articles according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-analysis Protocols) guidelines.

RESULTS

Altogether, we retrieved 777 articles from the seven databases. As of May 14, 2021, we have completed the screening process and arrived at 13 eligible articles to be included in the systematic review. We hope to elicit, summarize, and report the main findings in the systematic review article by the end of August 2021. We expect to uncover facilitators and barriers related to app utility, data security, ease of use, and persuasive design that are deemed important to adoption of contact tracing apps.

CONCLUSIONS

The findings of the systematic review will help researchers to uncover the gaps in the adoption of contact tracing apps, and decision makers and designers to focus on the principal adoption factors necessary to create better and more effective contact tracing apps.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/28961.

Determining Factors in the Use of Urban Parks That Influence the Practice of Physical Activity in Children: A Systematic Review

The design and/or remodelling of urban parks is a good health strategy to alleviate the lack of physical activity (PA) in children and, consequently, the different health problems derived from this. The main objective of the present study was to obtain a systematic review of the design features and characteristics that influence users’ visits to urban parks and the PA engagement in them. A literature search was carried out in the Web of Science (WOS) and Scopus databases during the months of June and July 2020. After considering and applying inclusion criteria, the final review sample was formed of 31 scientific papers published between 2010–2020. The results obtained in the review lead us to conclude that the needs of the population (children and family members who care for them) and socio-economic context of the area in which they are built must be considered when constructing and/or remodelling parks. Involving community members in playground renovations can have a positive effect on park use and PA engagement in children.

A Mobile- and Web-Based Health Intervention Program for Diabetes and Prediabetes Self-Management (BetaMe/Melon): Process Evaluation Following a Randomized Controlled Trial

BACKGROUND

Technology-assisted self-management programs are increasingly recommended to patients with long-term conditions such as diabetes. However, there are a number of personal and external factors that affect patients' abilities to engage with and effectively utilize such programs. A randomized controlled trial of a multi-modal online program for diabetes self-management (BetaMe/Melon) was conducted in a primary care setting, and a process evaluation was completed at the end of the study period.

OBJECTIVE

This process evaluation aimed to examine the utilization patterns of BetaMe/Melon, identify which components participants found most (and least) useful, and identify areas of future improvement.

METHODS

Process evaluation data were collected for intervention arm participants from 3 sources: (1) the mobile/web platform (to identify key usage patterns over the 16-week core program), (2) an online questionnaire completed during the final study assessment, and (3) interviews conducted with a subset of participants following the study period. Participants were classified as "actively engaged" if any usage data was recorded for the participant (in any week), and patterns were reported by age, gender, ethnicity, and diabetes/prediabetes status. The online questionnaire asked participants about the usefulness of the program and whether they would recommend BetaMe/Melon to others according to a 5-point Likert Scale. Of 23 invited participants, 18 participated in a digitally recorded, semistructured telephone interview. Interview data were thematically analyzed.

RESULTS

Out of the 215 participants, 198 (92%) received an initial health coaching session, and 160 (74%) were actively engaged with the program at some point during the 16-week core program. Engagement varied by demographic, with women, younger participants, and ethnic majority populations having higher rates of engagement. Usage steadily declined from 50% at Week 0 to 23% at Week 15. Participants ranked component usefulness as education resources (63.7%), health coaches (59.2%), goal tracking (48.8%), and online peer support (42.1%). Although 53% agreed that the program was easy to use, 64% would recommend the program to others. Interview participants found BetaMe/Melon useful overall, with most identifying beneficial outcomes such as increased knowledge, behavioral changes, and weight loss. Barriers to engagement were program functionality, internet connectivity, incomplete delivery of all program components, and participant motivation. Participants suggested a range of improvements to the BetaMe/Melon program.

CONCLUSIONS

The program was generally well received by participants; active engagement was initially high, although it declined steadily. Maintaining participant engagement over time, individualizing programs, and addressing technical barriers are important to maximize potential health benefits from online diabetes self-management programs.

TRIAL REGISTRATION

Australian New Zealand Clinical Trial Registry ACTRN12617000549325; https://tinyurl.com/y622b27q.

User Perception of a Smartphone App to Promote Physical Activity Through Active Transportation: Inductive Qualitative Content Analysis Within the Smart City Active Mobile Phone Intervention (SCAMPI) Study

Background

Physical inactivity is globally recognized as a major risk factor for morbidity, particularly the incidence of noncommunicable diseases. Increasing physical activity (PA) is therefore a public health priority. Engaging in active transportation (AT) is a viable approach for promoting daily PA levels. Mobile health interventions enable the promotion of AT to a larger population. The Smart City Active Mobile Phone Intervention (SCAMPI) study was a randomized controlled trial designed to evaluate the ability of a behavior change program delivered via a smartphone app to motivate participants to increase their PA by engaging in AT.

Objective

This qualitative study aims to examine the acceptance and user experience of the app promoting AT that was used in the SCAMPI trial (the TRavelVU Plus app).

Methods

A total of 17 residents of Stockholm County (13 women; age range 25-61 years) who completed the 3-month app-based behavioral change program (delivered through the TRavelVU Plus app) in the SCAMPI randomized controlled trial during 2018 agreed to participate in a semistructured telephone-based interview. These participants were well representative of the whole intervention group (n=127) in terms of baseline characteristics such as age, sex, and area of residence. The interviews were audiorecorded, transcribed verbatim, and analyzed using an inductive qualitative content analysis.

Results

The content analysis revealed 2 themes and 4 subcategories. The first theme, “main motivators: monitoring and messages,” highlighted that monitoring AT and being able to set weekly goals using the app were the primary motivators reported by study participants. The second theme, “acceptable but modifiable,” reflects that the app was well accepted and effectively encouraged many participants to use more AT. Nevertheless, there were functions in the app that require modification. For example, while the semiautomated travel tracking feature was appreciated, participants found it time-consuming and unreliable at times.

Conclusions

This study contributes novel insight into adults’ experiences of using a mobile app to promote the use of AT. The results showed that the app was well accepted and that self-monitoring and goal setting were the main motivators to engage in more AT. The semiautomated tracking of AT was appreciated; however, it was also reported to be energy- and time-consuming when it failed to work. Thus, this feature should be improved going forward.

Trial Registration

ClinicalTrials.gov NCT03086837; https://clinicaltrials.gov/ct2/show/NCT03086837

International Registered Report Identifier (IRRID)

RR2-10.1186/s12889-018-5658-4

Multidimensional Benefits of Improved Sanitation: Evaluating 'PEE POWER®' in Kisoro, Uganda

With 2.3 billion people around the world lacking adequate sanitation services, attention has turned to alternative service provision models. This study suggests an approach for meeting the sanitation challenge, especially as expressed in Sustainable Development Goal 6.2, using a toilet technology system, such as Pee Power® that generates electricity using diverted urine as a fuel. A field trial was carried out in a girls' school in Kisoro, Uganda, where the generated electricity was used to light the existing toilet block. The trial was evaluated in terms of social acceptability and user experience using a multidimensional assessment protocol. The results of our assessment show that users felt safer when visiting the toilets at night. Lights provided from the technology also helped with the perceived cleanliness of the toilets. The technology was well accepted, with 97% of the respondents saying that they liked the idea of the Pee Power® technology and 94% preferring it over other facilities on site. This shows how the technology helps meet SDG target 6.2, with its particular focus on vulnerable populations.

Healthcare Signage Design: A Review on Recommendations for Effective Signing Systems

This article provides a set of recommendations, selected from the systematic literature review carried out, regarding signage systems for healthcare institutions that can be used for designing or redesigning more competent signage systems. The signage systems in healthcare settings are usually poorly designed due to the expansion of the original facilities, a lack of awareness of existing guidelines by the developers, and a lack of agreement between the existing recommendations. There are several guidelines and recommendations available in the literature; however, each work was developed for specific cultural contexts, so there is a lack of uniformity among them. Hence, there is a need to uniformize the guidelines for signage design in healthcare, in order to provide supportive information for developers to build and implement effective and efficient signage systems. This study examined the available literature on the subject and established a set of guidelines organized in categories to help the design process. A literature review was conducted, and 34 selected publications were analyzed from which recommendations were created. A best practices manual was also studied and used as the analytical framework to establish the design categories of the developed recommendations. This review resulted in guidelines divided into nine design categories that should be considered in the design and implementation process of signage systems in healthcare facilities.