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Despite the growing popularity of digital health interventions, limitations of traditional behavior change theories and a lack of theory integration hinder theory-driven behavior change applications. In this paper, we aim to review theories relevant to lifestyle behavior change from the broader psychology literature and then integrate these theories into a new theoretical framework called adaptive decision-making to address two specific problems. First, our framework represents lifestyle behaviors at two levels—one of individual daily decisions (action level) and one of larger behavioral episodes (reflection level)—to more closely match the temporal characteristics of lifestyle behaviors and their associated digital data. Second, the framework connects decision-making theories and learning theories to explain how behaviors and cognitive constructs dynamically influence each other, making it a suitable scaffold for building computational models. We map common digital intervention techniques onto the behavioral and cognitive processes in the framework and discuss possible contributions of the framework to both theory development and digital intervention design.

BackgroundE–mental health (EMH) offers various possibilities for mental health care delivery, with many studies demonstrating its clinical efficacy. However, the uptake of EMH technologies by mental health care professionals remains to be low. One of the reasons for this is the lack of knowledge and skills in using these technologies. Skill enhancement by means of serious gaming has been shown to be effective in other areas but has not yet been applied to the development of EMH skills of mental health care professionals. ObjectiveThe aim of this paper is to describe a study protocol for the user requirements analysis for the design of a game-based training environment for mental health care professionals to enhance their skills in EMH. MethodsThe user requirements are formulated using three complementary outputs: personas (lively descriptions of potential users), scenarios (situations that require EMH skills), and prerequisites (required technical and organizational conditions). We collected the data using a questionnaire, co-design sessions, and interviews. The questionnaire was used to determine mental health care professionals’ characteristics, attitudes, and skill levels regarding EMH and was distributed among mental health care professionals in the Netherlands. This led to a number of recognizable subuser groups as the basis for personas. Co-design sessions with mental health care professionals resulted in further specification of the personas and an identification of different user scenarios for the game-based training environment. Interviews with mental health care professionals helped to determine the preferences of mental health care professionals regarding training in EMH and the technical and organizational conditions required for the prospective game-based training environment to be used in practice. This combination of requirement elicitation methods allows for a good representation of the target population in terms of both a broad view of user needs (through the large N questionnaire) and an in-depth understanding of specific design requirements (through interviews and co-design). ResultsThe questionnaire was filled by 432 respondents; three co-design sessions with mental health care professionals and 17 interviews were conducted. The data have been analyzed, and a full paper on the results is expected to be submitted in the first half of 2021. ConclusionsTo develop an environment that can effectively support professionals’ EMH skill development, it is important to offer training possibilities that address the specific needs of mental health care professionals. The approach described in this protocol incorporates elements that enable the design of a playful training environment that is user driven and flexible and considers the technical and organizational prerequisites that influence its implementation in practice. It describes a protocol that is replicable and provides a methodology for user requirements analyses in other projects and health care areas. International Registered Report Identifier (IRRID)RR1-10.2196/18815

BackgroundThe COVID-19 pandemic has necessitated an immediate and large-scale uptake of online treatment for mental health care. However, there is uncertainty about what the “new normal” in mental health care will be like in post–COVID-19 times. To what extent will the experiences gained during the pandemic influence a sustainable adoption and implementation of online mental health care treatment in the future? ObjectiveIn this paper, we aim to formulate expectations with regard to the sustainability of online mental health care after COVID-19. MethodsIn an interview study, 11 mental health care professionals were asked about their experiences and expectations for the future. Participants were recruited from a mental health care organization in the Netherlands. The interviews took place between April 7-30, 2020, at the peak of the COVID-19 crisis in the Netherlands. The data were analyzed using a thematic coding method. ResultsFrom the interviews, we learn that the new normal in mental health care will most likely consist of more blended treatments. Due to skill enhancement and (unexpected) positive experiences with online treatment, an increase in adoption is likely to take place. However, not all experiences promise a successful and sustainable upscaling of online treatment in the future. Mental health care professionals are learning that not all clients are able to benefit from this type of treatment. ConclusionsSustainable upscaling of online mental health care requires customized solutions, investments in technology, and flexibility of mental health care providers. Online treatment could work for those who are open to it, but many factors influence whether it will work in specific situations. There is work to be done before online treatment is inherently part of mental health care.

BackgroundHome-based cardiac rehabilitations (CRs) with digital technologies have been researched and implemented to replace, augment, and complement traditional center-based CR in recent years with considerable success. One problem that technology-enhanced home-based CR can potentially address is the gap between cardiac interventions and formal CR programs. In the Netherlands and some other countries (eg, Australia), patients after cardiac interventions stay at home for 3-4 weeks without much support from their physicians, and often engage in very little physical activity (PA). A home-based exercise program enabled by digital technologies may help patients to better prepare for the later center-based CR programs, potentially increasing the uptake rate of those programs. ObjectiveIn a randomized controlled trial (RCT), we will evaluate the effectiveness of a home-based walking exercise program enhanced by self-tracking and mobile-based coaching (treatment condition), comparing it with a version of the same program without these technologies (control condition). The added value of the digital technologies is justified if patients in the treatment group walk more steps on average (primary outcome) and show better physical fitness in a bicycle ergometer test and higher self-efficacy toward PA (secondary outcomes). MethodsBased on a power analysis, we will recruit 100 cardiac patients and assign them evenly to the 2 parallel groups. Eligible patients are those who are scheduled in the postanesthesia care unit, know the Dutch language, have basic literacy of using smartphones, and are without medical conditions that may increase risks associated with PA. In a face-to-face meeting with a nurse practitioner, all patients are prescribed a 3-week exercise program at home (2 walking exercises per day with increasing duration), based on national and international guidelines and tailored to their physical conditions after cardiac intervention. Their physical activities (daily steps) will be measured by the Axivity AX3 accelerometer worn at hip position. Patients in the treatment group will also be supported by a Neo Health One self-tracking device and a mobile platform called Heart Angel, through which they are monitored and coached by their nurses. After the study, all patients will perform a bicycle ergometer test and return the devices within 1 week. In addition, 5 questionnaires will be sent to the patients by emails to assess their self-efficacy toward PA and other psychological states for exploratory analyses (at discharge, at the end of each monitoring week, and 1 week after the study). To minimize bias, the randomization procedure will be performed after introducing the exercise program, so the nurse practitioners are blind to the experimental conditions until that point. ResultsThe study protocol has been approved by the Medical Research Ethics Committees United on February 26, 2018 (NL 62142.100.17/R17.51). By the end of 2018, we completed a small pilot study with 8 patients and the results based on interviews and app usage data suggest that a larger clinical trial with the targeted population is feasible. We expect to complete the RCT by the end of 2021, and statistical analyses will follow. ConclusionsResults of the RCT will help us to test the hypothesized benefits of self-tracking and mobile-based coaching for cardiac patients in home-based exercise programs during the discharge–rehabilitation gap. If the results are positive, cost-effectiveness analysis will be performed based on the insights of the study to inform the translation of the technology-enhanced program to clinical practice. We also note limitations of the trial in the discussion. Trial RegistrationRegistered at Netherlands Trial Register NL8040; https://www.trialregister.nl/trial/8040 International Registered Report Identifier (IRRID)PRR1-10.2196/16737

BackgroundPhysical exercise is an effective lifestyle intervention to improve blood pressure. Although aerobic sports can be performed anywhere, resistance exercises are traditionally performed at the gym; extending the latter to the home setting may promote an increase in the number of practitioners. ObjectiveThis study aims to evaluate a sensor-based system that guides resistance exercises through ambient lighting and sonification (A/S) feedback in a home setting in 34 study participants who were normotensive and prehypertensive. MethodsParticipants took part in a 1.5-hour exercise session in which they experienced the A/S feedback (ie, experimental condition) as well as a control condition (ie, no feedback) and a reference condition (ie, verbal feedback through a human remote coach). The system was evaluated for improving exercise form (range of motion, timing, and breathing patterns) as well as psychophysiological experience (perceived exertion, attentional focus, competence, and motivation). ResultsA/S feedback was significantly better than the control for concentric (mean 2.48, SD 0.75 seconds; P

BackgroundThere is growing evidence that physical activity is related to a better prognosis after a breast cancer diagnosis, whereas sedentary behavior is associated with worse outcomes. It is therefore important to stimulate physical activity and reduce sedentary time among patients with breast cancer. Activity trackers offer a new opportunity for interventions directed at stimulating physical activity behavior change. ObjectiveThis study aimed to explore the experience of patients with breast cancer who used an activity tracker in addition to a supervised exercise intervention in the randomized UMBRELLA Fit trial. MethodsA total of 10 patients with breast cancer who completed cancer treatment participated in semistructured in-depth interviews about their experience with and suggestions for improvements for the Jawbone UP2 activity tracker. ResultsThe activity tracker motivated women to be physically active and created more awareness of their (sedentary) lifestyles. The women indicated that the automatically generated advice (received via the Jawbone UP app) lacked individualization and was not applicable to their personal situations (ie, having been treated for cancer). Furthermore, women felt that the daily step goal was one-dimensional, and they preferred to incorporate other physical activity goals. The activity tracker’s inability to measure strength exercises was a noted shortcoming. Finally, women valued personal feedback about the activity tracker from the physiotherapist. ConclusionsWearing an activity tracker raised lifestyle awareness in patients with breast cancer. The women also reported additional needs not addressed by the system. Potential improvements include a more realistic total daily physical activity representation, personalized advice, and personalized goals.

Digital support during self-regulated learning can improve metacognitive knowledge and skills in learners. Previous research has predominantly focused on embedding metacognitive support in domain-specific content. In this study, we examine a detached approach where digital metacognitive support is offered in parallel to ongoing domain-specific training via a digital tool. The primary support mechanism was self-explication, where learners are prompted to make, otherwise implicit, metacognition concrete. In a controlled pre-test/post-test quasi-experiment, we compared domain-specific and domain-general support and assessed the effects, use, and learners' perceptions of the tool. The results showed that self-explication is an effective mechanism to support and improve metacognition during self-regulated learning. Furthermore, the results confirm the effectiveness of offering detached metacognitive support. While only domain-specific metacognitive support was found to be effective, quantitative and qualitative analysis warrant further research into domain-general and detached metacognitive support. The results also indicated that, while students with higher metacognition found a lack of relevance of using the tool, students with lower metacognition are less likely to make (structural) use of the available support. A key challenge for future research is thus to adapt metacognitive support to learner needs, and to provide metacognitive support to those who would benefit from it the most. The paper concludes by formulating implications for future research as well as design of digital metacognitive support.

Learner metacognition can positively impact learning. However, little is known about how to effectively design gamebased learning environments such that metacognition is promoted in learners. Previous research does not provide sufficiently structured and empirically verified insights for designers and researchers to make informed design decisions. This paper describes the development of a design framework for metacognition in game-based learning. The framework is derived from existing literature and cases, and further elaborated through a formative expert evaluation. For instruction, gameplay, and the integration of both, the resulting framework defines specific design dimensions that indicate the relevant areas in which informed design-decisions are likely to affect learners' metacognition. As such, this framework aids specification of designs, structured comparisons between different designs, and focused research effort in identifying specific design guidelines for metacognition in game-based learning.

Gratitude is a moral emotion that demonstrates our appreciation of altruism. In psychology, feeling grateful is linked to an increase in well-being, yet there is a lack of HCI research on if gratitude can be cultivated through and with conversational agents. We quantitatively studied whether a chatbot can increase people's gratitude (N = 133), as well as its influence on people's positive and negative emotions. Compared to the control condition, a chatbot that shared gratitude interventions significantly enhanced people's gratitude and positive emotions, while lowering negative emotions. Interestingly, people's experience of gratitude differed from other positive emotions: Simple positive emotions, like joy, can go up while reported gratitude decreases. We share qualitative observations on how gratitude can be a complex emotional experience, encompassing positive and negative emotions, such as finding relief in admitting to a chatbot about one's sadness over friendship during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Dementia can be associated with social withdrawal, mood changes, and decreased interaction. Animal-assisted therapies and robotic companions have shown potential in enhancing well-being but come with limitations like high maintenance costs and complexity. This research presents an interactive digital aquarium called Mindful Waters, which was developed to promote social interaction and engagement among People with Dementia. The pilot study involved interactive sessions at a community center and a care facility, with situated observations, video and audio recordings, and interviews to assess user engagement motivation, behavior, and user experience with Mindful Waters. The study revealed that Mindful Waters functioned well with People with Dementia and stimulated conversational topics about aquariums through engagement. User feedback was generally positive, with participants appreciating the visual appeal and simplicity. However, some participants with advanced dementia found it challenging to interact due to their mobility limitations, cognitive impairments, and the limited duration of interaction sessions. The overall results suggest that Mindful Waters can benefit dementia care; further research is needed to optimize its design and functionality for long-term placement in care facilities. [ABSTRACT FROM AUTHOR]

During the pre-design phase of supportive intelligent systems, interviews with future users, such as people with dementia, aim to explore the problems for which technology may present a solution. However, interviewing someone with dementia in this unstructured design phase is reported to be challenging resulting in systems that are not truly addressing the needs of the people with dementia. Existing guidelines on creating engaging interviews are often based on post-hoc reflections of researchers and participants. In this study we performed line-to-line sequential in-depth analyses on transcripts of 10 interviews conducted to co-design an interactive intelligent gaming system. Both interviewers and interviewees were subsequently asked to reflect on their experiences. Results show that information exchange with people with dementia can be supported by carefully constructed questions, well-designed probes, and an appropriate length of the interview. To create a pleasant atmosphere during the interviews, researchers should design the interview as a fulfilling experience, be prepared to respond respectfully to negative responses and be able to adapt to different signs of consent. Improving the engagement with people with dementia during interviews can enhance the design and development of intelligent systems that cater to their unique challenges and requirements. [ABSTRACT FROM AUTHOR]