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Loneliness and social isolation are important social determinants of wellbeing of older adults. Conversational exchanges can promote connectedness between older adults, however, conversations may not always come easy. Research shows that exposure to nature-based stimuli such as pictures and videos can stimulate social aspirations and trigger associations that could facilitate conversations, in particular when nature scenery is perceived as fascinating, mysterious, spacious and suited for social interaction. Therefore, this study investigated whether exposure to these nature characteristics (high versus low) lead to associations that could act as conversational material. A randomised factorial design, using a virtual reality-based approach for experimental control, led to 17 different virtual representations of nature (VN). In total, 150 participants (60 years and older) were recruited for an online survey. Spontaneous associations were coded on personal engagement and valence. The number of associations was measured with one multiple-choice question. VN exposure successfully triggered personally engaging and positively valenced associations and were related to multiple associations, in particular when the VN were high on mystery. Furthermore, positive effects of VN exposure was more pronounced for participants with high (rather than low) levels of nature relatedness and many (rather than few) available nature opportunities. These findings indicate that VN exposure provides fertile ground for conversations as a means to promote connectedness and social wellbeing of older adults.

Background Psychosocial eHealth interventions for people with cancer are promising in reducing distress; however, their results in terms of effects and adherence rates are quite mixed. Developing interventions with a solid evidence base while still ensuring adaptation to user wishes and needs is recommended to overcome this. As most models of eHealth development are based primarily on examining user experiences (so-called bottom-up requirements), it is not clear how theory and evidence (so-called top-down requirements) may best be integrated into the development process. Objective This study aims to investigate the integration of top-down and bottom-up requirements in the co-design of eHealth applications by building on the development of a mobile self-compassion intervention for people with newly diagnosed cancer. Methods Four co-design tasks were formulated at the start of the project and adjusted and evaluated throughout: explore bottom-up experiences, reassess top-down content, incorporate bottom-up and top-down input into concrete features and design, and synergize bottom-up and top-down input into the intervention context. These tasks were executed iteratively during a series of co-design sessions over the course of 2 years, in which 15 people with cancer and 7 nurses (recruited from 2 hospitals) participated. On the basis of the sessions, a list of requirements, a final intervention design, and an evaluation of the co-design process and tasks were yielded. Results The final list of requirements included intervention content (eg, major topics of compassionate mind training such as psychoeducation about 3 emotion systems and main issues that people with cancer encounter after diagnosis such as regulating information consumption), navigation, visual design, implementation strategies, and persuasive elements. The final intervention, Compas-Y, is a mobile self-compassion training comprising 6 training modules and several supportive functionalities such as a mood tracker and persuasive elements such as push notifications. The 4 co-design tasks helped overcome challenges in the development process such as dealing with conflicting top-down and bottom-up requirements and enabled the integration of all main requirements into the design. Conclusions This study addressed the necessary integration of top-down and bottom-up requirements into eHealth development by examining a preliminary model of 4 co-design tasks. Broader considerations regarding the design of a mobile intervention based on traditional intervention formats and merging the scientific disciplines of psychology and design research are discussed.