Engagement with Digital Behaviour Change Interventions: Conceptualisation, Measurement and Promotion

Digital behaviour change interventions (DBCIs) can help people change various health behaviours; however, engagement is low on average and there is a positive association of engagement with intervention effectiveness. The extent to which this relationship is confounded or subject to reverse causality is unclear, and evidence-based models of how to promote engagement are lacking. Progress is hindered by the existence of multiple definitions and measures of engagement; this hampers attempts to aggregate data in meta-analyses. Using smartphone applications (apps) for smoking cessation and alcohol reduction as case studies, this thesis investigated how to conceptualise and measure engagement and identified factors that influence engagement with DBCIs in general, and with apps for smoking cessation and alcohol reduction in particular. Six studies using qualitative and quantitative methods were conducted. Study 1 was a systematic, interdisciplinary literature review, which synthesised existing conceptualisations and generated an integrative definition of engagement with behavioural and experiential dimensions, and a conceptual framework of factors that influence engagement with DBCIs. Studies 3 and 4 involved the development and evaluation of a self-report measure of the behavioural and experiential dimensions of engagement. Studies 2, 5 and 6 used mixed-methods to identify factors that influence engagement with apps for smoking cessation and alcohol reduction. Engagement with DBCIs can usefully be defined in both behavioural and experiential terms: the self-report measure demonstrated promising psychometric properties and was underpinned by two distinct factors, labelled ‘Experiential Engagement’ and ‘Behavioural Engagement’. Design features that support users’ motivation to change, foster their beliefs about the perceived usefulness and relevance of the technology, and spark their interest were found to be most important in the promotion of engagement with apps for smoking cessation and alcohol reduction. These findings can be used to inform the design of new, or modification of existing, apps for these behaviours

Mobile Smartphone Applications for Healthcare Practitioners

Mobile Smartphone Applications (apps) have emerged in the last decade as a potentially beneficial tool for doctors. This thesis employs a novel investigative approach based on Realist Evaluation to investigate their prevalence, the outcomes of their use, and uncovers the key causal mechanisms and contexts that influence their use. The first part of the thesis sets the scene for the investigation by explaining the need for this research in an environment where much has been claimed for and against app use, but with a limited evidence base on which to base such claims. A scoping study is used to assess the nature of the extant literature and identify key questions that need to be addressed about app use. The next stage sets the scene for the realist empirical portion of the thesis, by explaining the need to take a theory-based perspective of the issues. The rationale for employing a realist methodology is described in terms of the need to examine causal explanations and contextual elements, with reference to the methodological implications for the rest of the enquiry. The elicitation of initial programme theory is then undertaken to provide a theoretical starting point for the thesis. The final part of the thesis describes an interview study and a mixed-methods study, which in turn develop and then test theories relating to the decision to use an app. The thesis concludes with a discussion of the key findings, presenting an outline theoretical model as well as recommendations designed to enhance the development, implementation and safe use of apps

Analyzing the Impact of Spatio-Temporal Sensor Resolution on Player Experience in Augmented Reality Games

Along with automating everyday tasks of human life, smartphones have become one of the most popular devices to play video games on due to their interactivity. Smartphones are embedded with various sensors which enhance their ability to adopt new new interaction techniques for video games. These integrated sen- sors, such as motion sensors or location sensors, make the device able to adopt new interaction techniques that enhance usability. However, despite their mobility and embedded sensor capacity, smartphones are limited in processing power and display area compared to desktop computer consoles. When it comes to evaluat- ing Player Experience (PX), players might not have as compelling an experience because the rich graphics environments that a desktop computer can provide are absent on a smartphone. A plausible alternative in this regard can be substituting the virtual game world with a real world game board, perceived through the device camera by rendering the digital artifacts over the camera view. This technology is widely known as Augmented Reality (AR). Smartphone sensors (e.g. GPS, accelerometer, gyro-meter, compass) have enhanced the capability for deploying Augmented Reality technology. AR has been applied to a large number of smartphone games including shooters, casual games, or puzzles. Because AR play environments are viewed through the camera, rendering the digital artifacts consistently and accurately is crucial because the digital characters need to move with respect to sensed orientation, then the accelerometer and gyroscope need to provide su ciently accurate and precise readings to make the game playable. In particular, determining the pose of the camera in space is vital as the appropriate angle to view the rendered digital characters are determined by the pose of the camera. This defines how well the players will be able interact with the digital game characters. Depending in the Quality of Service (QoS) of these sensors, the Player Experience (PX) may vary as the rendering of digital characters are affected by noisy sensors causing a loss of registration. Confronting such problem while developing AR games is di cult in general as it requires creating wide variety of game types, narratives, input modalities as well as user-testing. Moreover, current AR games developers do not have any specific guidelines for developing AR games, and concrete guidelines outlining the tradeoffs between QoS and PX for different genres and interaction techniques are required. My dissertation provides a complete view (a taxonomy) of the spatio-temporal sensor resolution depen- dency of the existing AR games. Four user experiments have been conducted and one experiment is proposed to validate the taxonomy and demonstrate the differential impact of sensor noise on gameplay of different genres of AR games in different aspect of PX. This analysis is performed in the context of a novel instru- mentation technology, which allows the controlled manipulation of QoS on position and orientation sensors. The experimental outcome demonstrated how the QoS of input sensor noise impacts the PX differently while playing AR game of different genre and the key elements creating this differential impact are - the input modality, narrative and game mechanics. Later, concrete guidelines are derived to regulate the sensor QoS as complete set of instructions to develop different genres or AR games

Cybersecurity and the Digital Health: An Investigation on the State of the Art and the Position of the Actors

Cybercrime is increasingly exposing the health domain to growing risk. The push towards a strong connection of citizens to health services, through digitalization, has undisputed advantages. Digital health allows remote care, the use of medical devices with a high mechatronic and IT content with strong automation, and a large interconnection of hospital networks with an increasingly effective exchange of data. However, all this requires a great cybersecurity commitment—a commitment that must start with scholars in research and then reach the stakeholders. New devices and technological solutions are increasingly breaking into healthcare, and are able to change the processes of interaction in the health domain. This requires cybersecurity to become a vital part of patient safety through changes in human behaviour, technology, and processes, as part of a complete solution. All professionals involved in cybersecurity in the health domain were invited to contribute with their experiences. This book contains contributions from various experts and different fields. Aspects of cybersecurity in healthcare relating to technological advance and emerging risks were addressed. The new boundaries of this field and the impact of COVID-19 on some sectors, such as mhealth, have also been addressed. We dedicate the book to all those with different roles involved in cybersecurity in the health domain

Ageing with Smartphones in Ireland

There are not many books about how people get younger. It doesn’t happen very often. But Ageing with Smartphones in Ireland documents a radical change in the experience of ageing. Based on two ethnographies, one within Dublin and the other from the Dublin region, the book shows that people, rather than seeing themselves as old, focus on crafting a new life in retirement. Our research participants apply new ideals of sustainability both to themselves and to their environment. They go for long walks, play bridge, do yoga, and keep as healthy as possible. As part of Ireland’s mainstream middle class, they may have more time than the young to embrace green ideals and more money to move to energy-efficient homes, throw out household detritus and protect their environment. The smartphone has become integral to this new trajectory. For some it is an intimidating burden linked to being on the wrong side of a new digital divide. But for most, however, it has brought back the extended family and old friends, and helped resolve intergenerational conflicts though facilitating new forms of grandparenting. It has also become central to health issues, whether by Googling information or looking after frail parents. The smartphone enables this sense of getting younger as people download the music of their youth and develop new interests. This is a book about acknowledging late middle age in contemporary Ireland. How do older people in Ireland experience life today? Praise for Ageing with Smartphones in Ireland 'An innovative and thorough description and analysis of how one small piece of technology has changed the way Irish people live their lives.' Tom Inglis, Professor Emeritus of Sociology in University College Dublin ; 'An innovative and thorough description and analysis of how one small piece of technology has changed the way Irish people live their lives.' Tom Inglis, Professor Emeritus of Sociology in University College Dubli

Ageing with Smartphones in Ireland: When life becomes craft

There are not many books about how people get younger. It doesn’t happen very often. But Ageing with Smartphones in Ireland documents a radical change in the experience of ageing. Based on two ethnographies, one within Dublin and the other from the Dublin region, the book shows that people, rather than seeing themselves as old, focus on crafting a new life in retirement. Our research participants apply new ideals of sustainability both to themselves and to their environment. They go for long walks, play bridge, do yoga and keep as healthy as possible. As part of Ireland’s mainstream middle class, they may have more time than the young to embrace green ideals and more money to move to energy-efficient homes, throw out household detritus and protect their environment. The smartphone has become integral to this new trajectory. For some it is an intimidating burden linked to being on the wrong side of a new digital divide. But for most, however, it has brought back the extended family and old friends, and helped resolve intergenerational conflicts though facilitating new forms of grandparenting. It has also become central to health issues, whether by Googling information or looking after frail parents. The smartphone enables this sense of getting younger as people download the music of their youth and develop new interests. This is a book about acknowledging late middle age in contemporary Ireland. How do older people in Ireland experience life today

Examining the potential for information and communication technology to support patients with cardiovascular disease

The overall goal of this work was to investigate the potential of information and communication technology (ICT) to support patients with cardiovascular disease (CVD). There were two specific aims: (1) to determine access to and willingness to use technology for health-related information in patients with CVD; and (2) to develop and pilot test a text-messaging intervention to support patients with acute coronary syndrome (ACS) following discharge from the hospital. The first aim was done with a cross-sectional survey (n=169). ICT ownership was common, as 98% of participants owned at least one ICT device. Computers were the most commonly owned device (88%), the device most commonly used for health information (74% of computer owners), and the device participants had the most interest in using for health information (72% of computer owners). Participants with lower incomes and education levels were less interested in receiving health information on at least one of their devices. The second aim was done with a mixed-methods, assessor-blinded, pilot randomized controlled trial (n=76). An advisory committee composed of patients, researchers, and clinicians developed 48 one-way text messages to send over 60 days to patients with ACS. There were no statistically significant differences between the intervention and usual care groups for self-management domains, medication adherence, health-related quality of life, self-efficacy, and healthcare resource use except for one self-efficacy domain. The study protocol was feasible, except recruitment took longer than anticipated. Ninety-three percent reported they were satisfied with the text messages. In the semi-structured interviews, many participants reported the program made them feel normal, perceived the program to be a source of social support, reinforced they were on the right track, and reminded them of their condition. However, some participants felt they did not need the messages, wished for a more tailored experience, or did not change their behaviours as a result. Learnings from the pilot study should be addressed prior to proceeding to a larger trial. Overall, these two studies indicate that ICT can be acceptable to patients with CVD. Further work needs to be done to determine how to best use ICT to support patients

MOBILE INTERACTIVE FITNESS TECHNOLOGIES AND THE RECREATIONAL EXPERIENCE OF BICYCLING: A PHENOMENOLOGICAL EXPLORATION OF THE STRAVA COMMUNITY

Technology is now embedded in many aspects of daily life. Over the past few years, fitness related smartphone applications have steadily grown in popularity. Despite the prevalence of technology in recreation and leisure experiences, the topic remains to be thoroughly examined from a qualitative interpretive viewpoint. The purpose of this phenomenological study was to understand and describe how cyclists use and experience Strava--a GPS enabled smartphone application that tracks bicycle rides and uploads the data to an online community of other users. Particular attention was given to user motivations, affordances of the technology, and notions of community. After participant observation and in-depth qualitative interviews with 11 Strava users, the following five theme clusters emerged: (1) King of the Mountain, (2) Ethical Dilemmas, (3) A Social Technology, (4) An Emotion-Laden Experience, and (5) An Augmented Experience. In summary, this thesis offers an accurate portrayal of the lived experience of bicycling as mediated by the interactive fitness technology of Strava. The project concludes with suggestions for areas of future research, as well as implications for health practitioners and technology manufacturers

Investigating how health apps influence college students’ health behavior

Master of ScienceDepartment of Journalism and Mass CommunicationsLouise BenjaminThis study examined how health apps influence college students’ health behavior, because about 50 percent of college students do not comply with physical activity recommendations. Because mobile applications (apps) are popular among college students, they hold promise for promoting behavior change in physical activity. This research was conducted through an online questionnaire distributed to a randomized sample of 18-35 year-old Mid-Western university students. Questionnaire data were analyzed from 237 surveys using Pearson’s Product Moment correlation (r) and Pearson’s chi-square test (χ2). This study showed that college students generally perceived health apps to be useful with slightly over half of the participants using health apps (52.3 percent). Bivariate analysis indicated positive attitudes towards health apps and positive attitudes towards physical activity (p < .001). The amount of experience using health apps yielded a positive relationship with attitudes towards physical activity (p = .008). In addition, having strong beliefs towards physical activity indicated a positive correlation with engaging in physical activity (p < .001). This study provides valuable information regarding attitudes towards health apps and the intention to use health apps for physical activity. While health apps do not trigger an intention to do physical activity, having “belief strength” and positive attitudes towards physical activity increases the likelihood for engaging in physical activity. Health communication intervention strategies and health practitioners can use this information to educate individuals about the advantages for their health that can be associated with using health apps