Exploring thermal discomfort amongst lower-limb prosthesis wearers

Amongst lower-limb prosthesis wearers, thermal discomfort is a common problem with an estimated prevalence of more than 50%. Overheating does not just create discomfort to the user, but it has been linked to excessive sweating, skin damage caused by a moist environment and friction. Due to impermeable prosthetic components and a warm moist environment, minor skin damage can result in skin infections that can lead to prosthesis cessation, increased social anxiety, isolation and depression. Despite the seriousness of thermal discomfort, few studies explore the issue, with research predominantly constrained to controlled laboratory scenarios, with only one out of laboratory study. In this thesis, studies investigate how thermal discomfort arises and what are the consequences of thermal discomfort for lower-limb prosthesis wearers. Research studies are designed around the principles of presenting lived experiences of the phenomenon and conducting research in the context of participants' real-life activities. A design exploration chapter investigates modifying liner materials and design to create a passive solution to thermal discomfort. However, this approach was found to be ineffective and unfeasible. Study 1 presents a qualitative study which investigates the user experience of a prosthesis, thermal discomfort and related consequences. Study 2 explores limb temperature of male amputees inside and outside the laboratory, with the latter also collecting perceived thermal comfort (PTC) data. Finally, Study 3 investigates thermal discomfort in the real-world and tracks limb temperature, ambient conditions, activities, and experience sampling of PTC. While there were no apparent relationships presented in sensor data, qualitative data revealed that in situations where prosthesis wearers perceived a lack of control, thermal discomfort seemed to be worse. When combined, the studies create two knowledge contributions. Firstly, the research provides a methodological contribution showing how to conduct mixed-methods research to obtain rich insights into complex prosthesis phenomena. Secondly, the research highlights the need to appreciate psychological and contextual factors when researching prosthesis wearer thermal comfort. The research contributions are also converted into an implication for prosthesis design. The concept of 'regaining control' to psychologically mitigate thermal discomfort could be incorporated into technologies by using 'on-demand' thermal discomfort relief, rather than 'always-on' solutions, as have been created in the past

Evaluating Evidence-Based Content, Features of Exercise Instruction, and Expert Involvement in Physical Activity Apps for Pregnant Women: Systematic Search and Content Analysis

Background: Guidelines for physical activity and exercise during pregnancy recommend that all women without contraindications engage in regular physical activity to improve both their own health and the health of their baby. Many women are uncertain how to safely engage in physical activity and exercise during this life stage and are increasingly using mobile apps to access health-relatedinformation. However, the extent to which apps that provide physical activity and exercise advice align with current evidence-based pregnancy recommendations is unclear. Objective: This study aims to conduct a systematic search and content analysis of apps that promote physical activity and exercise in pregnancy to examine the alignment of the content with current evidence-based recommendations; delivery, format, and features of physical activity and exercise instruction; and credentials of the app developers. Methods: Systematic searches were conducted in the Australian App Store and Google Play Store in October 2020. Apps were identified using combinations of search terms relevant to pregnancy and exercise or physical activity and screened for inclusion (with a primary focus on physical activity and exercise during pregnancy, free to download or did not require immediate paid subscription, and an average user rating of ≥4 out of 5). Apps were then independently reviewed using an author-designed extraction tool. Results: Overall, 27 apps were included in this review (Google Play Store: 16/27, 59%, and App Store: 11/27, 41%). Two-thirds of the apps provided some information relating to the frequency, intensity, time, and type principles of exercise; only 11% (3/27) provided this information in line with current evidence-based guidelines. Approximately one-third of the apps provided information about contraindications to exercise during pregnancy and referenced the supporting evidence. None of the apps actively engaged in screening for potential contraindications. Only 15% (4/27) of the apps collected information about the user\u27s current exercise behaviors, 11% (3/27) allowed users to personalize features relating to their exercise preferences, and a little more than one-third provided information about developer credentials. Conclusions: Few exercise apps designed for pregnancy aligned with current evidence-based physical activity guidelines. None of the apps screened users for contraindications to physical activity and exercise during pregnancy, and most lacked appropriate personalization features to account for an individual\u27s characteristics. Few involved qualified experts during the development of the app. There is a need to improve the quality of apps that promote exercise in pregnancy to ensure that women are appropriately supported to engage in exercise and the potential risk of injury, complications, and adverse pregnancy outcomes for both mother and child is minimized. This could be done by providing expert guidance that aligns with current recommendations, introducing screening measures and features that enable personalization and tailoring to individual users, or by developing a recognized system for regulating apps

Aging in place among home-dwelling older adults in Canton Basel-Landschaft: the INSPIRE Population Survey

Due to medical and technological advancements, many individuals in countries around the world are living longer (1). In Switzerland between 2020 and 2050, a rise from 18% to 26% for those aged 65 years or older and from 5% to 11% for those aged 80 years and older is foreseen (2). The gains in life expectancy, although a positive outcome, are not always enjoyed in full health and free of limitations. As individuals age, many of them may suffer from the presence of multi-morbidity and frailty (3, 4). Functional limitations as well as isolation and loneliness are also frequently reported among this population (3, 5-7). Moreover, these individuals usually receive care from different providers across various settings which can lead to their care being fragmented (8). Fragmentation of care is characterized by gaps in provision of care which could cause confusion and distress for older adults and their caregivers, as well as higher costs associated with unnecessary use of services (9). Despite challenges associated with aging, many older individuals prefer to remain living in their own environments for as long as possible (10, 11), an objective known as aging in place (12). Aging in place is linked to the ability to maintain independence and live a thriving and highly qualitative life within an individual’s own environment (13). It can therefore be fostered by designing environments that facilitate the mobility and engagement in social activities, which are important components for the health and quality of life of older adults (14). There is also an opportunity for countries to exploit existing and new assistive technologies, another pertinent facilitator of aging in place (15). Assistive technologies are an umbrella term including any device, equipment, instrument or software whose purpose is to maintain or improve an individual’s functional status and independence (16). To assist older adults to age in place and address their complex needs, the World Health Organization (WHO) has proposed an integrated care approach to support older adults’ independence and make aging in place possible (8, 17). Integrated care models are complex, dynamic interventions targeting multiple levels of the healthcare system, which often entail behavior change in the way various health and social care providers provide joint care (18, 19). To successfully develop and implement an integrated model of care, not only the perspectives of the healthcare providers, social care professionals or policymakers are essential, but also the needs and preferences of older adults and their informal caregivers (15, 20). Understanding the demographic and social characteristics of a target population, is also fundamental in planning, developing and implementing integrated care for older people (21). In 2018, an opportunity for integrated care for home-dwelling older adults was put forward by a new care law in Canton Basel-Landschaft in Switzerland (22). The INSPIRE project is working together with the local policymakers to support the development, implementation and evaluation of an integrated care model for home-dwelling adults aged 75 and above living in this region (23). The INSPIRE project is an implementation science project, positioned within the three phases (development, feasibility and effectiveness evaluation) of the Medical Research Council (MRC) for developing and implementing complex interventions (18). The project incorporates the recommendations of the MRC framework with several implementation science components such as contextual analysis, stakeholder involvement, as well as using implementation strategies and implementation outcomes to ensure the successful implementation and sustainability of the care model in Canton BL. During the development phase, an understanding of the context aids in ensuring the suitability of the intervention components for the implementation setting (23, 24). Therefore, we conducted the INSPIRE Population Survey (25, 26) as part of the contextual analysis, with the aim to understand the needs and preferences of older adults, as well as the support and services they currently require and anticipate needing in the future to maintain their independence and make aging in place possible. The overall goals of this dissertation are threefold. First, we aimed to describe the development of the INSPIRE Population Survey and the marketing strategy we used to reach as many home-dwelling older adults as possible, a population that is known to be challenging to recruit in research (27). Second, we used an ecological approach to dive deeper into the health-related quality of life of this population, as one of the main goals of aging in place. Finally, we investigated factors associated with openness to use assistive technologies that can facilitate independence among home-dwelling older adults and support them to age in place. Chapter 1 provides a general overview of challenges associated with caring for an aging population as well as the opportunities for integrated care for aging in place among home-dwelling older adults. The current literature on the concepts of quality of life and health-related quality of life, as well as the current state of the art on assistive technologies facilitating the autonomy of older adults is also provided. Chapter 2 follows with the dissertation aims. Chapter 3 chronicles the research conducted to develop the INSPIRE Population Survey, as well as an outline of the variables and measurements used in the survey (25). The work also describes the marketing strategy used for disseminating the survey and briefly reports on the response rate and participant characteristics. This population-based survey achieved a response rate of 30.7%, which is considerably high for postal surveys (28), particularly in those involving older adults (27). This accomplishment can be credited to the ongoing stakeholder involvement strategies we used, including early engagement of all stakeholders during the development of the questionnaire as well as its marketing. In Chapter 4, we evaluated HRQoL and factors related to it using an ecological outlook. The participants of our survey reported a high HRQoL, similar to findings from previous research (29, 30). We specifically looked at multilevel factors at the micro, meso and macro level related to how home-dwelling older adults perceived their HRQoL. This ecological perspective permitted the investigation of variables associated not only with the individual, but also with the environment around the older adult. We confirmed that among home-dwelling older adults, having a higher income, supplementary insurance, better education and generally a greater socio-economic status were associated with a higher HRQoL (31, 32). Our findings also validated previous studies indicating that individuals who report to be more frequently involved in one or more social activities, correspondingly report a higher HRQoL (33, 34). We also confirmed factors that negatively impact home-dwelling older adults’ HRQOL, as previously researched, like being older and female, having multimorbidity and polypharmacy, and being lonely or socially isolated (35-46). Chapter 5 presents the results from our study aiming to describe the current and anticipated use of assistive technologies among our participants, namely telemedicine, phone/SMS, wearables and assistive robots; as well the factors associated with openness to use such assistive technologies. We showcased that the current use of assistive technologies was rather low amid participants, compared to findings from two other surveys conducted on this topic among Swiss older adults (47, 48). Our results highlight a new finding that compared to current use, a higher percentage of home-dwelling older adults were open to using wearables and telemedicine in the future. We also found that openness to use assistive technologies in this population was positively associated with their current use, and also with receiving support from a spouse or a partner. Similar to the two previous surveys in Switzerland, openness to use assistive technologies was negatively associated with older age and with being female (47, 48). Chapter 6 presents a summary of the findings from the three preceding chapters and interprets them in the context of the current literature. Furthermore, methodological strengths and limitations of these studies are discussed. At last, reflections on the implication of this thesis for future research, policy and practice are presented. In conclusion, this dissertation was part of the development phase of an implementation science project aiming to implement and sustain an integrated care model for home-dwelling older adults. Our findings provide some important insight into the areas requiring the attention of care professionals and policymakers. We brought forward the need for considering the role the environment and the social network surrounding home-dwelling older adults play in fostering care that augments their quality of life and supports them in maintaining their desired independence. We also showed the potential assistive technologies have in attaining this goal, possibly also alleviating some of the burden of informal caregivers who are providing care and support for home-dwelling older adults. From a research, practice and policy position, we believe our findings have the prospective to provide a better scientific and policy approach in assuring older adults are reaching their goal to age in place

Designing technology to promote mental health and wellbeing

PhD ThesisMental health and wellbeing are fundamental to our quality of life, enabling us to be resilient against everyday stresses, work productively, to have fulfilling relationships, and experience life as meaningful. While HCI research has recently begun to address important challenges in the treatment of mental illness, approaches to promote and protect mental wellbeing, as positive emotional, psychological and social health, have received far less attention. Besides, the design space for technology innovation for people with severe mental health problems and as hospital inpatients is largely under-explored. The research presented in this thesis investigates how technology can promote the mental health and wellbeing of a group of women, living in the medium secure services of a forensic hospital in the UK. These women present a difficult to treat group due to the complexity of their mental health problems, extremely challenging behaviours, and a mild-tomoderate Learning Disability. Following an Experience-centred Design (ECD) approach in this context, the thesis describes how I worked collaboratively with hospital staff to gain a rich understanding of the women, their treatment regime, and constraints of their secure care; my approach to sensitively engaging this vulnerable group of women into a co-creative process to personalise their technology, and to carefully build up a relationship with them; and how the design of the technology builds upon qualities of creativity, physicality and personal significance for promoting engagement in mental health and wellbeing enhancing activities. In response to the design context I introduce the concept of the Spheres of Wellbeing, a set of three artefacts designed to collectively offer opportunities for engagements that are stimulating, enjoyable and personally meaningful; contribute to the formation of a positive sense of self; assist in tolerating emotional distress; and help familiarise the women with therapeutic concepts of mindfulness. Furthermore, in presenting the findings of a real-world deployment and evaluative study of the Spheres, this thesis contributes to current discourse in HCI on how empathy can be enabled with vulnerable populations, and provides rich insights into the complexities and challenges of conducting design-led research within hospital settings.Microsoft Research through its PhD Scholarship Programme and was partly been funded by the RCUK Digital Economy Hub on Social Inclusion through the Digital Economy (SiDE)

Supporting User Understanding and Engagement in Designing Intelligent Systems for the Home.

With advances in computing, networking and sensing technology, our everyday objects have become more automated, connected, and intelligent. This dissertation aims to inform the design and implementation of future intelligent systems and devices. To do so, this dissertation presents three studies that investigated user interaction with and experience of intelligent systems. In particular, we look at intelligent technologies that employ sensing technology and machine learning algorithm to perceive and respond to user behavior, and that support energy savings in the home. We first investigated how people understand and use an intelligent thermostat in their everyday homes to identify problems and challenges that users encounter. Subsequently, we examined the opportunities and challenges for intelligent systems that aimed to save energy, by comparing how people’s interaction changed between conventional and smart thermostats as well as how interaction with smart thermostats changed over time. These two qualitative studies led us to the third study. In the final study, we evaluated a smart thermostat that offered a new approach to the management of thermostat schedule in a field deployment, exploring effective ways to define roles for intelligent systems and their users in achieving their mutual goals of energy savings. Based on findings from these studies, this dissertation argues that supporting user understanding and user control of intelligent systems for the home is critical allowing users to intervene effectively when the system does not work as desired. In addition, sustaining user engagement with the system over time is essential for the system to obtain necessary user input and feedback that help improve the system performance and achieve user goals. Informed by findings and insights from the studies, we identify design challenges and strategies in designing end-user interaction with intelligent technologies for the home: making system behaviors intuitive and intelligible; maintaining long-term, easy user engagement over time; and balancing interplay between user control and system autonomy to better achieve their mutual goals.PhDInformationUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/133318/1/rayang_1.pd

Aging-in-place: The influence of Covid-19 on smart device acceptance

Covid-19 and the increasing population of older adults in developed countries have increased the need for alternative solutions for preventative health and long-term care. Smart homes and other assistive technology have been proposed as a solution to detect health problems early and prevent major issues later, provide better care access through telemedicine solutions, and support the autonomy of older adults with cognitive or physical issues who wish to continue to live in their homes. Rural older adults' acceptance of assistive technology is understudied compared to other groups, but the few studies available indicated that many tend to reject it. However, Covid-19 may increase interest in the technology, and the goal of this project was to determine if rural Oklahoman older adults' acceptance of the technology has increased enough for it to be implemented. This is a qualitative study that used Grounded Theory coding to determine common themes of participants to determine the level of acceptance. Interviews indicated that acceptance is still low for some devices but that rural older Oklahomans may consider other remote health instruments for specific conditions, fall detection, and home security devices if recommended by a doctor and if their issues with the technology, such as self-image, independence, and financial concerns, were resolved. If the acceptance of these devices is increased in the future, it may be possible to provide better preventative care for rural Oklahomans, detecting problems early and treating the main issues to delay major health complications. This could narrow healthcare disparities between urban and rural older adults, especially during special situations like pandemics