How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

Investigating the effect of gamification on the adoption of fitness apps on mobile devices in South Africa

Despite the large number of downloads of mobile apps and the growth of the fitness mobile app industry, research shows that fitness mobile apps are faced with the issue of having a low adoption rate. This thesis focusses on fitness mobile apps and attempts to understand this issue of adoption or continuous fitness mobile app usage in a South African context and specifically looks at the role of gamification in fitness mobile app adoption. The research is conducted to better understand how gamification affects and can improve fitness mobile app adoption. Gamification can be defined as the addition of points, badges, leaderboards and other elements found in games to other non-game related areas such as fitness apps. A survey was administered to three cohorts of students at the University of Cape Town in South Africa to assess this. The cohorts focused on MyFitnessPal, Nike+ or Strava gamified fitness mobile apps, respectively, in order to allow for comparisons of survey responses across the three fitness mobile apps. The survey design used an extension of the Technology Acceptance Model (TAM) to quantitatively measure the relationship between gamification in fitness mobile apps and the behavioural intention to adopt the fitness mobile app. User perspectives on how gamification affects adoption of fitness mobile apps was also gathered in the survey. Perceived usefulness (PU), perceived ease of use (PEU) and perceived enjoyment (PE) were found to have a positive relationship to the behavioural intention (BI) to adopt a fitness mobile app in the sample. Across the cohort’s subjective norm didn't significantly contribute to the BI to adopt a fitness mobile app. Interestingly it was found to correlate negatively with the variable BI when analyzing the responses from the Nike+ cohort. In the cohorts for MyFitnessPal and Strava this was not the case as these two variables were found to be positively correlated. The progress bar was perceived to be the most useful gamification element in a fitness mobile app in all three cohorts when compared with leaderboards, badges, levels and points. When looking at how gamification improves adoption motivations the following popular reasons were provided by participants: progress tracking and achievement (encourage improvement). This was followed by the common themes PEU, PE, award/incentive, competitive aspect and goal setting assistance. The findings from this study contribute to better understanding how gamification improves fitness app adoption in a South African context

Smartphone applications for physical activity promotion from physical education

Smartphone applications (apps) are thought to be an adequate instructional strategy not only to improve the quality of the teaching in physical education (PE), but also to efectively promote leisure-time physical activity (PA) of adolescent students in this context. Although the use of smartphone apps has been generalized in PE, little is known about the curricular approach of smartphone apps to be implemented by teacher to teach specifc curricular contents in PE lessons. Therefore, the aim of this research was threefold: a) to conduct a systematic search for smartphone apps focused on PA and sport; b) to assess the features, content and quality of every included smartphone app; and c) to analyze the relationships between every selected app and the secondary PE curriculum. Systematic searches were completed on Google Play Store from January 2021 to March 2021. Apps were included when they met: main goal focused on PA and sport; permitted use by underage; they are free; user scores of at least 4. The app selection process was carried out by several reviewers and concordance measures were estimated. Additionally, an app quality assessment was independently conducted by three reviewers. A total of 18 apps focused on PA were included. Particularly, eight apps were suitable for ftness, health and quality of life curricular content; two for sports content; four for body expression content; and four apps for outdoor PA content. The mean quality score was 4.00. Apps could be helpful for teachers to implement the secondary PE curriculum and efectively promote PA among adolescent students.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. Funding for open access charge: Universidad de Málaga / CBUA. Rafael Burgueño is, specifcally, supported by a “Margarita Salas” postdoctoral fellowship (grant number: RR_A_2021_02) from the Spanish Ministry of Universities. Adriana Nielsen-Rodríguez is supported by “Formación del Profesorado Universitario” grants from the Ministry of Education, Culture and Sport (Spain), grant number FPU17/01554

Interventions for Childhood Obesity: Evaluating Technological Applications Targeting Physical Activity Level and Diet

Overweight and obese children have increased risks for multiple preventable diseases and conditions which can impair their physiological health and significantly increases the overall cost of their healthcare. Free mobile applications and technology for weight loss, dietary tracking, and physical activity may be quite useful for monitoring nutritional intake and exercise to facilitate weight loss. If so, nurses are well positioned to recommend such tools as part of their efforts to prevent childhood obesity and help children and parents better manage childhood obesity when it is present. However, there are no guidelines that nurses can use to determine what applications or technologies are most beneficial to children and their parents. The purpose of this project is to develop such guidelines based on a review of the scientific literature published in the last 5 years. Articles regarding healthy-lifestyle promoting mobile applications and technological approaches to health and fitness interventions were identified by searching articles indexed by CINAHL, Psychinfo, Medline, ERIC, IEEE Xplore, and Academic Search Premier. Identified articles were assessed using Melnyk’s hierarchy of evidence and organized into tables so that implications for research and suggestions for practice could be made

Designing Culture-Tailored Persuasive Technology to Promote Physical Activity

Physical inactivity has been recognized as one of the leading risk factors that account for cardiovascular disease, type-2 diabetes, stroke, hypertension, etc., with the World Health Organization labeling it as the fourth leading risk factor for global mortality. Research has shown that persuasive technology (PT) can be leveraged as a motivational/supportive tool in tackling the physical-inactivity problem. In particular, research shows that persuasive health applications (PHAs) are more likely to be effective if they are theorydriven and tailored to the target audience. Yet, most existing PHAs on the market are neither theory-driven nor tailored to the target audience. Rather, their designers often employ a one-size- fits-all approach. This makes it difficult to know what design decisions are effective or ineffective among a given target audience. To bridge this gap, I proposed a framework, called the "EMVE-DeCK Framework," grounded in Bandura's Triad of Reciprocal Determinism, for designing, implementing and evaluating tailored PT interventions. Basically, the EMVE-DeCK Framework employs "Theory" and "Technology" to explain and change "Behavior." Moreover, research shows that culture can be leveraged as a personalization mechanism for tailoring PHAs to the target users to make them more effective. However, there is limited cross-cultural research|grounded in theory and empirical evidence|on the effectiveness of culture-based tailoring, especially comparative studies involving understudied populations in the PT research landscape. Hence, using the Hofstede's cultural framework (individualism vs. collectivism), Social Cognitive Theory, Technology Acceptance Model and the EMVE-DeCK Framework, I conducted a number of comparative studies to understand the culture-speci c determinants of physical-activity behavior and the acceptance of a proposed PHA. I used the ndings to inform the design, implementation and evaluation of two versions of a tness app called BEN'FIT - personal version (PV) and social version (SV) - aimed to motivate bodyweight exercise at home. In this dissertation, using the EMVE-DeCK Framework and Canada/United States (individualist culture) and Nigeria (collectivist culture) as a case study, I describe: (1) the cross-cultural user studies and empirical f indings that informed the PT intervention; (2) the design and implementation of the culture-tailored PHA; (3) the evaluation of the overall and culture-tailoring e ectiveness of the PHA in a eld setting. Finally, based on empirical evidence, I present a set of validated PT design guidelines in the eld for designing and tailoring PHAs to users in the individualist and collectivist cultures. This dissertation makes three major contributions to PT research in the Human-Computer-Interaction domain. Firstly, it demonstrates how theory and culture can be employed in the design and development of PT interventions to motivate behavior change. Secondly, it reveals and validates in the eld how the individualist and collectivist cultures fundamentally differ in their motivational mechanism of behavior change. Thirdly, it provides an in-the- field validates PT design guidelines for developing tailored PHAs for the two main types of culture. In the physical-activity domain, the dissertation is the rst to conduct a theory-driven, in-the-fi eld cross-cultural PT research that focuses on an understudied population from Africa (Nigeria) and compare its ndings with those of a widely studied population from North America (Canada/United States)

Designing Culture-Tailored Persuasive Technology to Promote Physical Activity

Physical inactivity has been recognized as one of the leading risk factors that account for cardiovascular disease, type-2 diabetes, stroke, hypertension, etc., with the World Health Organization labeling it as the fourth leading risk factor for global mortality. Research has shown that persuasive technology (PT) can be leveraged as a motivational/supportive tool in tackling the physical-inactivity problem. In particular, research shows that persuasive health applications (PHAs) are more likely to be effective if they are theory-driven and tailored to the target audience. Yet, most existing PHAs on the market are neither theory-driven nor tailored to the target audience. Rather, their designers often employ a one-size-fits-all approach. This makes it difficult to know what design decisions are effective or ineffective among a given target audience. To bridge this gap, I proposed a framework, called the “EMVE-DeCK Framework,” grounded in Bandura’s Triad of Reciprocal Determinism, for designing, implementing and evaluating tailored PT interventions. Basically, the EMVE-DeCK Framework employs “Theory” and “Technology” to explain and change “Behavior.” Moreover, research shows that culture can be leveraged as a personalization mechanism for tailoring PHAs to the target users to make them more effective. However, there is limited cross-cultural research—grounded in theory and empirical evidence—on the effectiveness of culture-based tailoring, especially comparative studies involving understudied populations in the PT research landscape. Hence, using the Hofstede’s cultural framework (individualism vs. collectivism), Social Cognitive Theory, Technology Acceptance Model and the EMVE-DeCK Framework, I conducted a number of comparative studies to understand the culture-specific determinants of physical-activity behavior and the acceptance of a proposed PHA. I used the findings to inform the design, implementation and evaluation of two versions of a fitness app called BEN’FIT—personal version (PV) and social version (SV)—aimed to motivate bodyweight exercise at home. In this dissertation, using the EMVE-DeCK Framework and Canada/United States (individualist culture) and Nigeria (collectivist culture) as a case study, I describe: (1) the cross-cultural user studies and empirical findings that informed the PT intervention; (2) the design and implementation of the culture-tailored PHA; and (3) the evaluation of the overall and culture-tailoring effectiveness of the PHA in a field setting. Finally, based on empirical evidence, I present a set of validated PT design guidelines in the field for designing and tailoring PHAs to users in the individualist and collectivist cultures. This dissertation makes three major contributions to PT research in the Human-Computer-Interaction domain. Firstly, it demonstrates how theory and culture can be employed in the design and development of PT interventions to motivate behavior change. Secondly, it reveals and validates in the field how the individualist and collectivist cultures fundamentally differ in their motivational mechanism of behavior change. Thirdly, it provides an in-the-field validated PT design guidelines for developing tailored PHAs for the two main types of culture. In the physical-activity domain, the dissertation is the first to conduct a theory-driven, in-the-field cross-cultural PT research that focuses on an understudied population from Africa (Nigeria) and compare its findings with those of a widely studied population from North America (Canada/United States)

Exploring Consumer Engagement in Gamified Health and Fitness Mobile Apps

This paper explores how Generation Y engages with gamified health and fitness mobile apps focussing on the popular Nike+ and Fitbit apps. An interpretative approach was adopted whereby ten in-depth interviews were carried out to explore this phenomenon from the perspective of the user. Findings suggest that consumers enjoy receiving intrinsic rewards but these only hold value when players understand the behaviour or activity for why they are being rewarded. It was also found that consumers would welcome social media integration in the gamified apps only if a purpose is clearly identified. Finally, competitive elements, such as leaderboards, points and status, are most likely to enhance consumer engagement but brands need to create opportunities for constructive competition

Exploring the Benefits of Using Gamification and Videogames for Physical Exercise: a Review of State of Art

There is a lack of motivation in children and adolescents to do physical exercise and at the same time a worldwide obesity epidemic. Gamification and active videogames can be used to increase the motivation of young people, promoting healthy habits. In this work we explore different studies on active videogames, eSports and gamification applied to physical exercise and health promotion. Main findings include positive effects in a reduction in body weight and in the promotion to continue performing of physical exercise. It also contributes to increase the motivation in children and adolescents to practice exercise. The personalization of user experience and emerging technologies (big data, wearables, smart technologies, etc.) are presented as promising opportunities to keep the engagement in game-based program and gamification of physical exercise

Developing and evaluating MindMax: promoting mental wellbeing through an Australian Football League-themed app incorporating applied games (including gamification), psychoeducation, and social connectedness

Gamification is increasingly being used as a behavioural change strategy to increase engagement with apps and technologies for mental health and wellbeing. While there is promising evidence supporting the effectiveness of individual gamification elements, there remains little evidence for its overall effectiveness. Furthermore, a lack of consistency in how ‘gamification’ and related terms (such as ‘applied games’, an umbrella term of which gamification is one type) are used has been observed within and across multiple academic fields. This contributes to the difficulty of studying gamification and decreases its accessibility to people unfamiliar with applied games. Finally, gamification has also been critiqued by both game developers and by academics for its reliance on extrinsic motivators and for the messages that gamified systems may unintentionally convey. In this context, the aims of this thesis were fourfold: 1) to iteratively co-design and develop a gamified app for mental health and wellbeing, 2) to evaluate the eventuating app, 3) to consolidate literature on gamification for mental health and wellbeing, and 4) to synthesise findings into practical guidelines for implementing gamification for mental health and wellbeing. Chapter 2 reports the first study which addresses the first aim of this thesis. Six participatory design workshops were conducted to support the development of MindMax, an Australian Football League (AFL)-themed mobile phone app aimed at AFL fans (particularly male ones) that incorporates applied games, psychoeducation, and social connectedness. Findings from these workshops were independently knowledge translated and fed back to the software development team, resulting in a MindMax prototype. This prototype was further tested with 15 one-on-one user experience testing interviews at three separate time points to iteratively refine MindMax’s design and delivery of its content. The findings of this study suggest that broadly, participants endorsed a customisable user experience with activities requiring active user participation. These specifications were reflected in the continual software updates made to MindMax. Chapters 3 and 4 report the second and third studies which address the second aim of this thesis. As regular content, performance, and aesthetic updates were applied to MindMax (following the model of the wider tech industry), a naturalistic longitudinal trial, described in Chapter 3, was deemed to be the most appropriate systematic evaluation method. In this study, participants (n=313) were given access to MindMax and asked to use it at their leisure, and surveys were sent out at multiple time points to assess their wellbeing, resilience, and help-seeking intentions. Increases in flourishing (60-day only), sense of connection to MindMax, and impersonal help-seeking intentions were observed over 30 and 60 days, suggesting that Internet-based interventions like MindMax can contribute to their users’ social connectedness and encourage their help-seeking. The third study, described in Chapter 4, reports a secondary analysis of data collected for Chapter 3, and further explores participants’ help-seeking intentions and their links to wellbeing, resilience, gender, and age. An explanatory factor analysis was conducted on Day 1 General Help-Seeking Questionnaire (GHSQ) data (n=530), with the best fitting solution resulting in three factors: personal sources, health professionals, and distal sources. In addition to providing more evidence that younger people aged 16–35 categorise apps and technologies for mental health and wellbeing like MindMax alongside other distal social sources such as phone helplines and work or school, our findings also suggest that the best way to target individuals who are least likely to seek help, particularly men, may be through these distal sources as well. Chapter 5 reports the fourth study, which addresses the third aim. In order to consolidate literature on gamification for mental health and wellbeing, this systematic review identified 70 papers that collectively reported on 50 apps and technologies for improving mental health and wellbeing. These papers were coded for gamification element, mental health and wellbeing domain, and researchers’ justification for applying gamification to improving mental health and wellbeing. This study resulted in two major findings: first, that the current application of gamification for mental health and wellbeing does not resemble the heavily critiqued mainstream application that relies on extrinsic motivators; and second, that many authors of the reviewed papers provided little or no justification for why they applied gamification to their mental health and wellbeing interventions. While the former finding is encouraging, the latter suggests that the gamification of mental health and wellbeing is not theory-driven, and is a cause for concern. Finally, to address the final aim of this thesis, all study learnings were synthesised into practical guidelines for implementing gamification for mental health and wellbeing. First, it is important to assess the suitability of implementing gamification into the intervention. Second, this implementation should ideally be integrated at a deeper, systemic level, with the explicitly qualified intention to support users, evidence-based processes, and user engagement with these processes. Third, it is important to assess the acceptability of this gamified intervention throughout its development, involving all relevant stakeholders (particularly representative end user populations). Fourth, it is important to evaluate the impact of this gamified intervention. Fifth, and finally, comprehensive and detailed documentation of this process should be provided at all stages of this process. This thesis contributes to a growing literature on the increasing importance and relevance of Internet-based resources and apps and technologies for mental health and wellbeing, particularly for young people. Given the dominance of games in society and culture across history, and the increasing contemporary prominence of digital games (also known as video games) in particular, gamification is uniquely positioned to have the potential to make large contributions to mental health and wellbeing research. In this context, this thesis contributes a systematically derived operationalisation of gamification, an evaluation of a gamified app for mental health and wellbeing, and best practice guidelines for implementing gamification for mental health and wellbeing, thereby providing frameworks that future implementations of gamified mental health and wellbeing interventions and initiatives may find useful

HerdHealth: A Mobile Health Data Aggregator for the WPI Community

While many health and fitness smartphone applications exist, not all applications support all data types, which results in fragmented data and reduces the efficacy of BCTs. The purpose of this MQP was to create an application that allows members of the WPI community to aggregate all of their data to get a complete view of their health progress. Consolidating all of one’s health data can help minimize health- related risks, find trends over time, and increase user engagement. Our app includes features that implement several behavioral change mechanisms to help users achieve their health goals. While beta testers found the app useful overall, we also found areas for improvement, which along with ideas for additional features, could serve as the basis for a future project