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History culture (broadly, the use of history) always reflects changing culture. We now live in a kind of aftermath of the twentieth century, which Eric Hobsbawm called “the age of extremes”. This characterisation describes very well the state of western culture today as well: rapidly changing information technology, postmodern relativisation of traditional values and optimistic belief in progressive modernisation, new global problems with nature (climate change, species extinction, Covid) are all signs of extreme times. So far as history always reflects the present, this current state of the world brings many new challenges for historians. New trends like environmental history try to answer these challenges from a historical perspective. In this paper, I take only one specific aspect of this state of culture into consideration: how does ‘experience society’, in which people seek strong affective experiences, effect our view of history? I approach this question conceptually, taking the concept of ‘living experience’ (originally in German: Erlebnis) into consideration. Through its analysis, I sketch a kind of present-state anthropology of historical knowledge. Especially the commercial pressures of experience society, competition with other brands of popular culture, effects the use of history in the present culture. The German word Erlebnis is difficult to translate into English. It refers to existentially important experiences and I’ll translate it here as ‘living experience’. This relatively young concept was born at the beginning of the nineteenth century (Fichte) and later in German philosophy of life at the end of the century signified existentially important experiences. I analyse in my article the conceptual history of this concept in German philosophy until Heidegger, who connected it critically to modern, in his mind shallow, culture. ‘Experience society’ was later analysed by German sociologist Gerhard Schulze in his book Erlebnisgesellschaft (1997). Experience society expresses the extensive aestheticization of our life: how we present ourselves in Twitter, Facebook and so on has created new fields of everyday aesthetics. Our identities are shallow and changing. My hypothesis in this paper is that our concept of history is changing accordingly: when not totally forgotten, history must become more affective and interesting, full of curiosities which appeal to our senses. There is also a danger that historical research increasingly picks up such subjects that respond to this shallow culture.

Tiivistelmä Suomen taksiala on ollut myllerryksessä 2018 kesällä voimaan tulleen liikennepalvelulain jälkeen. Taksamittariin liittyvä sääntely on ollut suurimpia epäselvyyden lähteitä. Olemme Oulun yliopiston Interact-tutkimusyksikössä tutkineet taksialan digimuutosta jo vuodesta 2017 alkaen. Taksamittarisääntely on yksi tutkimuksemme painopisteistä. Tässä raportissa kerromme analyysimme taksamittarisääntelyn nykytilanteesta ja tulkintamahdollisuuksien ongelmakohdista. Tunnistimme kaksi kohtaa, joita tulkitaan monilla eri tavoilla: (1) milloin hinta perustuu ajan tai matkan mittaamiseen, ja (2) millainen on taksamittaria vastaava laite tai järjestelmä. Olemme tunnistaneet nämä epäselvyydet, analysoineet eri toimijoiden tulkintoja sääntelystä ja tutkineet markkinalla käytössä olevia teknologisia ratkaisuja hinnan määrittämiseen. Analyysimme auttaa ymmärtämään eri tulkintojen taustoja ja tekemään tarpeellisia korjauksia lainsäädäntöön. Tunnistimme kuusi nykyisin käytössä olevaa teknologiaa, joilla hinta määritellään ja ilmoitetaan: tyyppisertifioitu kiinteästi asennettu taksamittari; kiinteästi asennettu taksamittari, jonka tyyppisertifiointi on kesken; sertifioimaton fyysinen taksamittari, jota ei ole kiinteästi asennettu; internet-pohjainen kyydinvälitysalusta, jossa hinta on sitova; internet-pohjainen kyydinvälitysalusta, jossa hinta ei ole sitova; ja sovelluskaupasta ladattu ”taksamittarisovellus.” Lisäksi käytössä on tapa, jossa kuljettaja ja asiakas sopivat hinnasta ilman teknologiaa. Ehdotamme myös huomioonotettavia asioita ja kysymyksiä lainsäädäntöuudistusta varten, koskien taksamittaria ja sille rinnakkaisia laitteita tai järjestelmiä.

The Finnish taxi industry has already long been technologically developed, and since 2011 taxi hailing apps have been available in Finland. The amount of these apps has steadily increased, spurred by the arrival of Uber and Taxify in Finland in 2014, and by the de-regulation of the Finnish taxi industry in July 2018. In the present paper, the aim was to identify ridehailing app acquisition related strategies that traditional Finnish dispatch organizations (DOs) employ. A qualitative case study with five focus organizations was conducted between 2018–2020. This study contributes to extant research in two ways. First, by identifying five ride-hailing app strategies employed by DOs (three related to the question of make vs. buy, two related to discontinuing/selling). Second, by showing that different ridehailing apps can play different strategic roles — which helps explain DOs’ multihoming strategy — and that the strategic role of a specific ride-hailing app can change over time.

Digital transformation has become a central construct in information systems (IS) research. Current conceptualizations largely attribute transformation to intentionality, focus on transformation within a single organization, or assign technology the role of a disruptive agent of change. Likewise, “digital” tends to be a general category of technology, rather than a specific technology enacted in a time and place. Inspired by Schatzkian practice theory and its site ontology, we suggest a contextual viewpoint on digital transformation and call it “relational digital transformation.” We analyzed the change dynamics in the context of taxi dispatch practice in Finland, studying the changing taxi dispatch platforms over years. We investigated five powerful industry actors: two incumbents, two entrants, and a federation of taxi entrepreneurs. We identified events of change in the material arrangements in sites and explain the changes through the process dynamics in the focal practice. We define relational digital transformation as a process through which practice-arrangement bundles of digital technologies evolve over time. This approach assumes the default nature of an industry is to be found in the changing relations between entities rather than in entities themselves. This provides a theoretical extension to the prevailing views of digital transformation in IS literature. It enables studying digital transformation in retrospect without attributing change agency to any entities or technologies a priori. We also contribute to practice-theoretical IS literature by demonstrating how the applicability of practice theoretical analysis extends beyond microphenomena to larger industry-level changes.

Institutions influence the design, use and adoption of information technologies. The IS field has a long tradition in institutional analyses, especially concerning how ICT gains legitimacy in organizational settings. However, few analyses have been con-ducted on how legal reforms influence regulative ICT legitimacy. We studied the effect of policy ambiguity on regulative legitimacy through a revelatory case study of a legal reform concerning the taximeter regulation in Finland. The regulation changed from being specific and providing legal certainty to being ambiguous and resulting in legal indeterminacy. We contribute to the IS institutions and legitimacy research stream by arguing that the transition from specific to ambiguous regulation shifted the locus of regulative legitimacy from an inherent property of legal formulation to a processual form, and provide a framework to support studies on regulative change by distinguishing between type of policy and legal state of the technology. Our study has methodological implications.

Background: Insurance organizations are essential stakeholders in health care ecosystems. For addressing future health care needs, insurance companies require access to health data to deliver preventative and proactive digital health services to customers. However, extant research is limited in examining the conditions that incentivize health data sharing. Objective: This study aimed to (1) identify the expectations of insurance customers when sharing health data, (2) determine the perceived intrinsic value of health data, and (3) explore the conditions that aid in incentivizing health data sharing in the relationship between an insurance organization and its customer. Methods: A Web-based survey was distributed to randomly selected customers from a Finnish insurance organization through email. A single open-text answer was used for a qualitative data analysis through inductive coding, followed by a thematic analysis. Furthermore, the 4 constructs of commitment, power, reciprocity, and trust from the social exchange theory (SET) were applied as a framework. Results: From the 5000 customers invited to participate, we received 452 surveys (response rate: 9.0%). Customer characteristics were found to reflect customer demographics. Of the 452 surveys, 48 (10.6%) open-text responses were skipped by the customer, 57 (12.6%) customers had no expectations from sharing health data, and 44 (9.7%) customers preferred to abstain from a data sharing relationship. Using the SET framework, we found that customers expected different conditions to be fulfilled by their insurance provider based on the commitment, power, reciprocity, and trust constructs. Of the 452 customers who completed the surveys, 64 (14.2%) customers required that the insurance organization meets their data treatment expectations (commitment). Overall, 4.9% (22/452) of customers were concerned about their health data being used against them to profile their health, to increase insurance prices, or to deny health insurance claims (power). A total of 28.5% (129/452) of customers expected some form of benefit, such as personalized digital health services, and 29.9% (135/452) of customers expected finance-related compensation (reciprocity). Furthermore, 7.5% (34/452) of customers expected some form of empathy from the insurance organization through enhanced transparency or an emotional connection (trust). Conclusions: To aid in the design and development of digital health services, insurance organizations need to address the customers’ expectations when sharing their health data. We established the expectations of customers in the social exchange of health data and explored the perceived values of data as intangible goods. Actions by the insurance organization should aim to increase trust through a culture of transparency, commitment to treat health data in a prescribed manner, provide reciprocal benefits through digital health services that customers deem valuable, and assuage fears of health data being used to prevent providing insurance coverage or increase costs.

Background: Advanced sensor, measurement, and analytics technologies are enabling entirely new ways to deliver health care. The increased availability of digital data can be used for data-driven personalization of care. Data-driven personalization can complement expert-driven personalization by providing support for decision making or even by automating some parts of decision making in relation to the care process. Objective: The aim of this study was to analyze how digital data acquired from posture scanning can enhance physiotherapy services and enable more personalized delivery of physiotherapy. Methods: A case study was conducted with a company that designed a posture scan recording system (PSRS), which is an information system that can digitally record, measure, and report human movement for use in physiotherapy. Data were collected through interviews with different stakeholders, such as health care professionals, health care users, and the information system provider, and were analyzed thematically. Results: Based on the results of our thematic analysis, we propose three different types of support that posture scanning data can provide to enhance and enable more personalized delivery of physiotherapy: 1) modeling the condition, in which the posture scanning data are used to detect and understand the health care user’s condition and the root cause of the possible pain; 2) visualization for shared understanding, in which the posture scanning data are used to provide information to the health care user and involve them in more collaborative decision-making regarding their care; and 3) evaluating the impact of the intervention, in which the posture scanning data are used to evaluate the care progress and impact of the intervention. Conclusions: The adoption of digital tools in physiotherapy has remained low. Physiotherapy has also lacked digital tools and means to inform and involve the health care user in their care in a person-centered manner. In this study, we gathered insights from different stakeholders to provide understanding of how the availability of digital posture scanning data can enhance and enable personalized physiotherapy services.

Information Systems (IS) researchers have become increasingly interested in policy. Government policy enables and constrains the range of technologies operating on the market. In the spirit of enabling innovation, governments around the world have moved to the principle of technological neutrality: regulating goals instead of specific technologies. In this paper, we focus on the legislative context of the Finnish taxi industry. Finland’s previous legislation mandated all taxicabs to be equipped with a taximeter, while prohibiting other vehicle classes from using it. Finland’s recent deregulation reform The Act on Transport Services adopted the principle of technology neutrality and thus introduced deliberate ambiguity into legal text. This ambiguity leaves room for different stakeholders to construct their own interpretations. For this paper, we conducted 19 interviews with five stakeholder types in the Finnish taxi industry and related regulatory bodies: legislators, legislation implementers, new entrants, incumbent taxi industry, and incumbent technology providers. We found how policy ambiguity opened a plethora of contesting discourses about what this seemingly mundane technology is for. We depart from the mainstream conception of policy, which views policy as a “best practice” that can be easily transferred across contexts. Instead, we call for more attention to policy ambiguity, multi-stakeholder policy contexts, and conflicting power interests.

Persuasive technologies for health behavior change often include social influence features. Social influence in the design of persuasive technology has been described as a black box. This case study sheds light on design practices by identifying factors that affect the design of social influence features in health behavior change applications and the designers’ understanding of the social influence aspects. Our findings are twofold: First, the two most positively inclined social influence features, namely cooperation and normative influence, were missing from the reviewed applications. Second, the medical condition — the persuasive technology targets — has a major influence on consideration and integration of social influence features in health behavior change applications. Our findings should be taken into account when frameworks and guidelines are created for the design of social influence features in health behavior change applications.

In this study, we analyze how a telemedicine system can be used in health service personalization. Telemedicine refers to the use of ICT to deliver health services at a distance. Through a case study, we identify and analyze how a telemedicine system used as a monitoring platform supporting home-based self-measurement of various parameters of Asthma and Diabetes, and measurement of International Normalized Ratio (INR) and Hypertension can support personalization of health service pathways. In our qualitative analysis, we analyzed personalization in the service level and identified three different roles the telemedicine system plays for health service personalization: generating user data, detecting anomalies, and supporting interaction. The results provide insight on the role of information systems in service level personalization.

While the worldwide market expansion of Uber has raised controversy, Uber has also received praise for its mobile phone app. Its many features — taxi ordering, pricing, real-time location information, paying, and service evaluation — have provided significant customer value. When Uber entered Finland in November 2014, few other taxi apps were available. Between 2014 and 2018, this shortage of taxi apps turned into an abundance, with many companies introducing their own taxi apps. By leaning on institutional theory, and more specifically by applying coercive, mimetic and normative pressures as a lens, we provide an explanation for why three Finnish taxi apps now resemble Uber in some features, whereas they differ in others. Based on our interviews, we can explain the present-day differences between these apps by coercive and normative pressures in the institutional environment of the Finnish taxi industry. We contribute to the IT and institutionalization research stream by illustrating how mobile applications as IT artefacts can be seen as carriers of institutional pressures materializing in the features they provide.

Social comparison as an aspect of social influence has an effect on health behavior, and technology can be used to support desired behavior change. However, no concrete guidelines exist on how to design social comparison features. This paper examines how designers have actually designed social comparison in IT artifacts supporting individuals in a behavior change process. We apply qualitative evidence synthesis review method and analyze twelve studies reporting experiences of designing social comparison features. As a result, we present six design dimensions for social comparison features emerging from the literature, and several alternative design options for each dimension. The dimensions can be used as a guide for designers and as a repository for researchers to design and evaluate social comparison features for technologies targeting behavior change in different contexts.

The insurance industry in Finland is making a shift towards providing proactive healthcare services. Increasing availability of health data can provide means for creating personalized healthcare services. However, insurance companies are facing obstacles to access health data. This paper presents a case study of a large Finnish insurance company that is currently dealing with barriers of access during their transition to a more proactive organization. We identified nine barriers which fall into three categories — institutional, legislation, and use and participation. By identifying these barriers, we reveal critical factors for companies that seek to make use of their customers’ health data are likely to face.

Global virtual teams (GVT) continue to struggle with the challenges of communication. In order to understand and study GVT actors’ behaviour in GVTs, it is imperative to understand what they attribute their own and others’ communication behaviour to. We examined a multinational corporation, with its headquarters in Europe and conducted 11 interviews with GVT actors. With our qualitative research we investigated how GVT members explain their own as well as others’ communication behaviour in GVT. This study enriches the existing GVT literature by providing information on how actors make sense of their own social world in a different way than they make sense of their co-workers’ social world. We show that there is a mismatch in the types of explanations given for the interviewee’s own commu-nication behaviour and others’ communication behaviour. One example of the mismatch is that GVT actors tended to explain their own constructive communication behaviour, but placed greater emphasis on explaining other persons’ defensive and negative communication behaviour. Another example is that GVT actors explain others’ communication behaviour with the other persons’ cultural background, but not their own communication behaviour. Our study contributes to research on communication behav-iour in GVTs.

This paper presents a qualitative evidence synthesis of facilitators and barriers of accessibility and interoperability of electronic health records in the Nordic Countries, i.e. Sweden, Norway, Denmark, Finland and Iceland. The findings are based on a thematic analysis of 19 papers selected through a systematic search strategy from databases covering research on medicine and information systems. We recognise three dimensions in accessibility facilitators, five dimensions in accessibility barriers, two dimensions in interoperability facilitators, and three in interoperability barriers. Our findings indicate that there is an imbalance in research addressing different stakeholders, and there are differences on how stakeholders affect or are affected by the accessibility and interoperability barriers and facilitators. The findings can help in designing policies and solutions for creating health record platforms which support all relevant stakeholders in healthcare delivery.

Information technology (IT) is a primary enabler of personalization. Various personalization approaches are used to design and implement personalization in technologies and to classify personalization through technologies. Still, personalization studies rarely consider personalization and the role of IT more holistically at the level of digital services. The objective of this thesis is to investigate the role of IT in the personalization of digital health service pathways. The present work applies a service pathway concept as it provides the means by which to consider all the available health services to be included for the individual healthcare user in the context of digital health services. This thesis is framed in information systems (IS) and specifically IS in healthcare. The present work investigates the role of IT in the personalization of digital health service pathways through a multiple-case study approach. The data collected are thematically analyzed to provide understanding on the role IT can play in the personalization of digital health service pathways. As a result of the thematic analysis, this thesis proposes personalization filters that represent the role of IT in the personalization of digital health service pathways. The personalization filters are as follows: (1) the contextual filter, where the role of IT is to consider the healthcare-specific parameters for personalization; (2) the data-driven filter, where the role of IT is to consider the aggregated data parameters for personalization; and (3) the user-specific filter, where the role of IT is to consider the characteristics and preferences of the healthcare user as parameters for personalization. In these personalization filters, IT plays a role that varies from fully automated personalization to a more collaborative form of data-driven decision making to make digital health service pathways more personalized for the individual healthcare user. The work undertaken in this thesis contributes to research and practice by proposing personalization filters that can collectively represent the roles IT can play in the personalization of digital health service pathways. Tiivistelmä Personoinnin suunnittelussa voidaan hyödyntää erilaisia lähestymistapoja ja luokituksia. Tietojärjestelmätieteissä nämä lähestymistavat ja luokitukset keskittyvät personoinnin suunnitteluun pääasiassa teknologisen artefaktin, kuten suosittelujärjestelmän, tasolla. Suunnittelu ei niinkään tarkastele personointia ja teknologian roolia kokonaisvaltaisemmin digitaalisten palveluiden tasolla. Tämä tietojärjestelmätieteiden väitöskirja tarkastelee teknologian roolia digitaalisten terveyspalvelupolkujen personoinnissa. Väitöskirja hyödyntää palvelupolun käsitettä, sen mahdollistaessa personoinnin laajemman tarkastelun teknologisen artefaktin sijaan. Väitöskirja tarkastelee tutkittavaa ilmiötä monitapaustutkimuksen kautta ja hyödyntää laadullisia menetelmiä aineiston keräämisessä ja analysoinnissa. Temaattisen analyysin tuloksena väitöskirja esittää kolme personoinnin filtteriä, jotka kuvaavat teknologian rooleja digitaalisten terveyspalvelupolkujen personoinnissa. Personoinnin filtterit ovat: (1) kontekstuaalinen filtteri, missä teknologian rooli on huomioida terveydenhuollolle keskeisiä personoinnin parametreja; (2) datavetoinen filtteri, missä teknologian rooli on huomioida kerääntyneestä datasta nousevia personoinnin parametreja; ja (3) käyttäjäkeskeinen filtteri, missä teknologian rooli on huomioida terveyspalveluiden käyttäjän ominaisuuksia ja mieltymyksiä personoinnin parametreina. Personointifilttereissä teknologian rooli vaihtelee täysin automatisoidusti toteutetusta personoinnista yhteistyöperustaisempaan, datavetoiseen päätöksentekoon, mikä yhdessä muovaa digitaalisesta terveyspalvelupolusta personoidumman yksittäiselle terveyspalvelun käyttäjälle. Tämän väitöskirjan tuloksia voidaan hyödyntää personoinnin tutkimuksessa ja suunnittelussa. Väitöskirjassa esitetyt personoinnin filtterit täydentävät personoinnin tutkimuskentässä esitettyjä personoinnin lähestymistapoja ja luokituksia ja niitä voidaan hyödyntää suunniteltaessa personoituja palvelupolkuja eri konteksteihin.

The use of digital technologies is driving the mass creation and collection of health data, fuelling disruptions in the healthcare ecosystem, and shifting the competitive landscape of health service provision. In response to this paradigm shift, the insurance industry is exploring new avenues of value creation as part of the digital health economy. Connected insurance has emerged as a strategy to leverage digitalization efforts for preventative and proactive health services. As insurance organizations strive towards implementing novel data-driven services, they are grappling with organizational and legislative challenges surrounding four necessary health data factors: access, control, sharing, and use. The research followed a qualitative methodological approach that was conducted in two phases as part of a single holistic case study of a transforming Finnish insurance organization. In the first phase, five empirical studies have been conducted which ascertain four case study boundaries: the health data environment in the Nordic countries, governance within the EU, insurance organizations as processors and controllers of health data, and customers as data subjects. In the second phase, a theory-driven narration of digital transformation in the insurance organization has been developed. The narration is a synthesis of data collected from interviews, ethnography, and a survey. The four health data factors — access, control, sharing, and use — were thematically analyzed and content-driven themes were empirically crafted to produce an inductive framework of health data mechanisms. The resulting framework of eleven health data mechanisms provides tactics for the design and development of proactive digital health services, stressing the importance of culture, interoperability, and transparency for service provision. How health data can be utilized as a resource for value creation requires key strategic decision-making practices by policymakers, organizations, and management and is informed by the conditions inherent in the boundaries of health data. Theoretical contributions indicate the capacity of health data as part of digital transformation. More holistic research is required to expand the mechanisms of health data which support fair, equal, and open value creation among stakeholders in the digital health economy. Tiivistelmä Digitaalisilla teknologioilla voidaan tuottaa ja kerätä terveysdataa, mikä vauhdittaa terveydenhuollon ekosysteemin murrosta ja muuttaa terveydenhuollon palveluiden kilpailuasetelmaa. Paradigman muutoksen ansiosta vakuutussektori etsii tapoja luoda lisäarvoa osana digitaalisten terveyspalvelujen markkinoita. Digitaalinen vakuutuspalvelu on uusi strategia, ja se hyödyntää digitalisaatiota ennaltaehkäisevissä ja ennakoivissa terveyspalveluissa. Ottaessaan käyttöön uusia dataan perustuvia palveluja vakuutusyhtiöt kohtaavat organisatorisia ja lainsäädännöllisiä haasteita. Nämä liittyvät neljään terveysdatan elementtiin: saavutettavuus, hallinta, jakaminen ja käyttö. Tutkimuksen metodologiseksi lähtökohdaksi valittiin kvalitatiivinen lähestymistapa ja se tehtiin kahdessa vaiheessa osana yhden tapauksen kokonaisvaltaista tapaustutkimusta, jossa tarkasteltiin muuttuvaa suomalaista vakuutusorganisaatiota. Ensimmäisessä vaiheessa toteutettiin viisi empiiristä tutkimusta, joiden perusteella määritettiin neljä tapaustutkimuksessa tarkasteltavaa osa-aluetta: pohjoismainen terveysdataympäristö, EU-ohjaus, vakuutusorganisaatiot terveysdatan käsittelijöinä ja hallinnoijina ja asiakkaat rekisteröityinä henkilöinä. Toisessa vaiheessa kehitettiin teoriapohjainen kertomus digitaalisesta transformaatiosta vakuutusyhtiössä. Kertomus yhdistelee haastattelujen, etnografisten menetelmien ja kyselyiden avulla kerättyjä tutkimusaineistoja. Neljä terveysdatan elementtiä — saavutettavuus, hallinta, jakaminen ja käyttö — analysoitiin temaattisesti ja niistä laadittiin empiirisesti sisältölähtöiset teemat. Näin luotiin terveysdatan mekanismeja kuvaava induktiivinen malli. Syntynyt malli käsittää yksitoista terveysdatan mekanismia ja tarjoaa keinoja ennakoivien digitaalisten terveyspalvelujen suunnitteluun ja kehittämiseen painottaen kulttuuria, yhteensopivuutta ja läpinäkyvyyttä palvelujen tarjoamisessa. Terveysdatan hyödyntäminen lisäarvon tuottamiseksi vaatii strategisen päätöksenteon avainkäytäntöjä päättäjiltä, organisaatioilta ja johdolta. Siihen vaikuttavat myös terveysdatan osa-alueiden reunaehdot. Teoreettiset tulokset osoittavat terveysdatan potentiaalin osana digitaalista transformaatiota. Kokonaisvaltaista tutkimusta tarvitaan laajentamaan terveysdatan mekanismeja, jotka tukevat reilua, tasa-arvoista ja avointa tapaa luoda lisäarvoa eri osapuolille digitaalisten terveyspalvelujen markkinoilla.

Health behaviour change is challenging and is addressed by the international community. Many people try to effect change for a healthier lifestyle, but they find it difficult to sustain their new habits. Today, technological applications support people who want to change their behaviour, oftentimes by utilising social influence: The influence of others on one’s behaviour. Social influence consists of different aspects, the particularities of which are often neglected in design. This thesis focusses on the design of the social comparison aspect of social influence. Social comparison psychology supports the view that when facing a lack of objective measurements, people tend to compare themselves to others who are similar to them for self-evaluation, self-enhancement, self-prediction, and coping. In psychology, social comparison theory has shown great potential in the aforementioned areas as well as challenges regarding its application. In the design of technology, social comparison theory has been utilised but lacks extensive exploration. In this thesis, four perspectives are considered to better understand social comparison in design: Existing designs, designers’ perspective, healthcare professionals’ perspective, and user research for social comparison. The four perspectives are explored using qualitative methodologies and through design science research. The knowledge took the form of a Multiple-perspective Approach Design (MAD) for social comparison features in technology that supports health behaviour change. MAD aims to support designers when working with social comparison in health behaviour change, by presenting social comparison potentials and challenges informed by the different perspectives. MAD builds upon the knowledge transferred from the field of psychology regarding social comparison and on the research conducted to understand the four perspectives of social comparison. Tiivistelmä Terveyskäyttäytymisen muutos on haastavaa ja sitä käsittelee kansainvälinen yhteisö. Monet ihmiset yrittävät tehdä muutoksia kohti terveellisempiä elämäntapoja, mutta heidän on vaikea ylläpitää uusia tapojaan. Tänä päivänä teknologiset sovellukset tukevat ihmisiä, jotka haluavat muuttaa käyttäytymistään, usein hyödyntämällä sosiaalista vaikutusta: toisten vaikutusta omaan käyttäytymiseen. Sosiaalinen vaikutus koostuu erilaisista näkökulmista, joiden erityispiirteitä on usein laiminlyöty suunnittelussa. Tässä opinnäytetyössä keskitytään sosiaalisen vertailun näkökulman suunnitteluun sosiaalisessa vaikutuksessa. Sosiaalisen vertailun psykologia tukee näkemystä siitä, että objektiivisten mittausten puuttuessa, ihmiset pyrkivät vertaamaan itseään muihin, jotka ovat samankaltaisia, itsearvioinnin, itsensä vahvistamisen, itsearvioinnin ja selviytymisen kannalta. Psykologiassa sosiaalisen vertailun teoria on osoittanut potentiaalinsa edellä mainituilla aloilla, mutta sen soveltamiseen liittyy haasteita. Sosiaalisen vertailun teoriaa on hyödynnetty teknologian suunnittelussa, mutta laaja-alaisempi tutkimus aiheesta on puutteellista. Tässä opinnäytetyössä tarkastellaan neljää näkökulmaa ymmärtämään paremmin sosiaalista vertailua suunnittelussa: Olemassa olevat mallit, suunnittelijoiden näkökulma, terveydenhuollon ammattilaisten näkökulma ja käyttäjätutkimus sosiaaliseen vertailuun. Näitä neljää näkökulmaa tutkitaan käyttämällä laadullisia tutkimusmenetelmiä ja suunnittelutieteellistä tutkimusta. Kerätyn tiedon perusteella muodostettiin monia toimijoita tarkasteleva lähestymistapa suunnitteluun (MAD), joka koskee sosiaalisen vertailun ominaisuuksia teknologiassa, joka tukee terveyskäyttäytymisen muutosta. MAD pyrkii tukemaan suunnittelijoita, jotka työskentelevät sosiaalisen vertailun parissa terveyskäyttäytymisen muutoksessa, esittämällä sosiaalisen vertailun mahdollisuuksia ja haasteita, joita on kerätty eri näkökulmista. MAD perustuu psykologian alalta kerättyyn tietämykseen sosiaalista vertailusta ja toteutettuun tutkimukseen, joka on tehty sosiaalisen vertailun neljän näkökulman ymmärtämiseksi.

Chronic conditions are the leading cause of death in the world. Major improvements in acute care and diagnostics have created a tendency towards the chronification of formerly terminal conditions, requiring people with these conditions to learn how to self-manage. Mobile technologies hold promise as self-management tools due to their ubiquity and cost-effectiveness. The delivery of health-related services through the use of mobile technologies (mHealth) has grown exponentially in recent years. However, only a fraction of these solutions takes into consideration the views of relevant stakeholders like healthcare professionals or even patients. The use of behavioral change models (BCM) has proven important in developing successful health solutions, yet engaging patients remains a challenge. There is a trend in mHealth solutions called gamification that attempts to use game elements to drive user behavior and increase engagement. As it stands, designers of mHealth solutions for behavioral change in chronic conditions have no clear way of deciding what factors are relevant to consider. This doctoral thesis is framed in Consumer Health Informatics within the field of Medical Informatics and Information Systems. The focus of this work was to discover factors for the design of mHealth solutions for chronic patients; to do so, negotiations between medical knowledge, BCM and gamification were explored through an embedded case study research methodology. The data obtained was thematically analyzed to create the Model for Motivational Mobile-health Design for Chronic conditions (3MD). The 3MD model guides the design of condition-oriented gamified behavioral change mHealth solutions. The main components are: 1) Condition specific, which describe factors that need to be adjusted and adapted for each particular chronic condition; 2) Motivation related, which are factors that address how to influence behaviors in an engaging manner; and 3) Technology based, which are factors that are directly connected to the technical capabilities of mobile technologies. 3MD also provides a series of high level illustrative design questions for designers to use and consider during the design process. The work on this thesis addresses a recognized gap in research and practice, and proposes a unique model that could be of use in the generation of new solutions to help chronic patients. Tiivistelmä Krooniset sairaudet ovat maailman yleisin kuolinsyy. Akuutissa hoidossa ja diagnostiikassa on tapahtunut merkittäviä parannuksia, ja aikaisemmin kuolemaan johtaneista sairauksista on tullut kroonisia ja ihmisten on opittava hallitsemaan niitä itse. Mobiiliteknologiat tarjoavat mahdollisuuksia sairauksien itsehallintaan, koska teknologiaa on yleisesti saatavilla ja se on kustannustehokasta. Terveyspalvelujen tarjoaminen mobiiliteknologian avulla on lisääntynyt huomattavasti viime vuosina. Kuitenkin vain murto-osa näistä ratkaisuista ottaa huomioon sidosryhmien, kuten terveydenhuollon ammattilaisten ja jopa potilaiden, näkemykset. Käyttäytymismuutosmallit ovat osoittautuneet tärkeiksi kehitettäessä onnistuneita terveysratkaisuja, mutta potilaiden osallistaminen kehittämiseen on yhä vaikeaa. Pelillistäminen on mobiilien terveysratkaisujen suunnittelutrendi, ja pelielementeillä pyritään vaikuttamaan ihmisten käyttäytymiseen ja sitoutumiseen. Mobiilien terveyssovellusten suunnittelijoilla ei ole selkeää näkemystä siitä, mitkä sovellustekijät vaikuttavat merkittävimmin kroonisissa sairauksissa sairastavien potilaiden käyttäytymisen muutokseen. Tämä väitöskirja tarkastelee kuluttajille suunnattua terveysteknologiaa, joka hyödyntää lääketieteellistä informatiikkaa ja tietojärjestelmätieteitä. Työn tavoitteena oli selvittää kroonisia sairauksia sairastaville potilaille tarkoitettujen mobiilien terveyssovellusten suunnitteluun liittyviä tekijöitä. Tämän vuoksi lääketieteen tietämyksen, käyttäytymismuutoksien mallien ja pelillistämisen yhdistämistä tutkittiin sulautetun tapaustutkimuksen avulla. Saatuja tietoja temaattisesti analysoimalla luotiin kroonisia sairauksia varten motivoivan mobiilin terveyssovelluksen suunnittelumalli (3MD = Model for Motivational Mobile-health Design). 3MD-malli ohjaa sairauksien hallintaan tarkoitettujen pelillistettyjen ja käyttäytymismuutoksiin tähtäävien mobiilien terveyssovellusten suunnittelua. Mallin pääkomponentit ovat: 1) Sairautta kuvaavat tekijät, jotka kuvaavat tekijöitä, jotka on mukautettava ja sovitettava kullekin krooniselle sairaudelle. 2) Motivaatioon liittyvät tekijät, jotka vaikuttavat innostavasti käyttäytymiseen. 3) Teknologiaan perustuvat tekijät, jotka liittyvät suoraan mobiiliteknologian teknisiin ominaisuuksiin. 3MD tarjoaa myös havainnollisia suunnittelukysymyksiä, joita suunnittelijat voivat käyttää ja pohtia suunnitteluprosessin aikana. Tämä väitöskirja käsittelee yleisesti tunnistettua puutetta tutkimuksessa ja suunnittelukäytännössä ja esittelee ainutlaatuisen mallin, josta voi olla hyötyä uusien ratkaisujen luomisessa ja kroonisia sairauksia sairastavien potilaiden auttamisessa.

In the recent political theory it is ever more common to point out that the liberal theory has had in the modern world a respectable rival called republican theory. This study tries to support the thesis that however fundamentally their distinction be defined it has as its most important element different concepts of freedom. The liberals have so called negative concept of freedom almost without exception as the basis of their political theory whereas the republicans tend to have a different concept of freedom as that. In this study this is called autonomic freedom in its more developed version. The above thesis has been argued by comparing two central modern republicans, Rousseau and Hegel. The arguments of this study firstly show that they both have the autonomic freedom as a basis of their political theories in a much more developed and richer form than anyone else before. The arguments secondly show that their theories of the modern society on the one hand and those of political community on the other hand are very similar. The very same thing can thirdly be said of their accounts of the relationship of these conceptions. Their political theories showed a considerable amount of common features which are different from or contrary to those of liberal theories. Many of them could be connected to Rousseau’s and Hegel’s near-kindred concepts of autonomic freedom. Their characteristic differences can in many cases be accounted for to their historically different perspectives into the development of the modern society. The case in point is Adam Smith’s The Wealth of Nations (1776). It is very unlikely that Rousseau even knew about it whereas studying it was very important for Hegel’s understanding of the modern society. The argumentation for the theses of the study has been based on close and detailed interpretation of the relevant texts of Rousseau and Hegel. Tiivistelmä Viime aikoina on poliittisessa teoriassa yleistynyt käsitys, jonka mukaan liberalistisella poliittisella teoriassa on modernissa maailmassa varteenotettava kilpailija, nimittäin republikanistinen teoria. Tutkimuksessa pyritään esittämään tukea teesille, jonka mukaan liberalismin ja republikanismin eron keskeinen fundamentti tai ainakin yksi aivan keskeisimmistä on niiden erilainen vapauden käsite. Liberalistisella poliittisella teorialla on melkein poikkeuksetta nk. negatiivinen vapauden käsite perusteenaan, kun taas republikanisteilla on yleensä perusteena toisenlainen vapauskäsite, jonka kehittynyttä muotoa nimitetään tässä tutkimuksessa autonomiseksi vapaudeksi. Juuri mainittua teesiä perustellaan tutkimalla kahta keskeistä modernia republikanistia, Rousseauta ja Hegeliä. Ensin osoitetaan, että heillä on autonominen vapaus poliittisen teoriansa perusteena kehittyneemmässä ja rikkaammassa muodossa kuin kenelläkään heitä ennen. Toiseksi osoitetaan heidän poliittisia teorioitaan tutkimalla, että heidän käsityksensä modernista yhteiskunnasta ja poliittisesta yhteisöstä ovat varsin yhteneväiset. Kolmanneksi osoitetaan, että heillä on hyvin yhteneväinen käsitys myös niiden suhteesta. Heidän poliittisissa teorioissaan esiintyi runsaasti liberalistisesta teoriasta poikkeavia tai sille vastakkaisia yhteisiä piirteitä. Monet näistä voitiin asettaa tiiviiseen yhteyteen edellä mainitun heille pitkälti yhteisen vapauskäsitteen kanssa. Heidän luonteenomaiset eronsa voidaan usein yhdistää heidän historiallisesti erilaiseen perspektiiviinsä modernin yhteiskunnan kehitykseen. On esimerkiksi erittäin epätodennäköistä, että Rousseau olisi edes kuullut Adam Smithin Kansojen varallisuudesta, kun taas Hegelin teoria modernista yhteiskunnasta perustuu huomattavassa määrin tämän teoksen tutkimiseen. Tutkimuksen teesien perustelu nojaa Rousseaun ja Hegelin relevanttien tekstien yksityiskohtaiseen lähitulkintaan.