An Evidence-Based Approach To Digital Inclusion for Health

This report is the first deliverable of the ?Digital Inclusion and Social Knowledge Media for Health: Frameworks and Roadmaps? project. It discusses the concept of social and digital exclusion and suggests that a focus on the digital mediation of social processes may provide more purchase for public service providers. This focus leads to the consideration of the way in which digital services might support a range of health-related factors which are both directly and indirectly linked to specific health outcomes. The report discusses some examples in the light of a consideration of the specific (and spatial) health needs and priorities of Solihull Care Trust. The report concludes with suggestions for directions for future research and development

Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review

Background: The public health impact of health and well-being digital interventions is dependent upon sufficient real-world uptake and engagement. Uptake is currently largely dependent on popularity indicators (eg, ranking and user ratings on app stores), which may not correspond with effectiveness, and rapid disengagement is common. Therefore, there is an urgent need to identify factors that influence uptake and engagement with health and well-being apps to inform new approaches that promote the effective use of such tools. Objective: This review aimed to understand what is known about influences on the uptake of and engagement with health and well-being smartphone apps among adults. Methods: We conducted a systematic review of quantitative, qualitative, and mixed methods studies. Studies conducted on adults were included if they focused on health and well-being smartphone apps reporting on uptake and engagement behavior. Studies identified through a systematic search in Medical Literature Analysis and Retrieval System Online, or MEDLARS Online (MEDLINE), EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, Scopus, Cochrane library databases, DataBase systems and Logic Programming (DBLP), and Association for Computing Machinery (ACM) Digital library were screened, with a proportion screened independently by 2 authors. Data synthesis and interpretation were undertaken using a deductive iterative process. External validity checking was undertaken by an independent researcher. A narrative synthesis of the findings was structured around the components of the capability, opportunity, motivation, behavior change model and the theoretical domains framework (TDF). Results: Of the 7640 identified studies, 41 were included in the review. Factors related to uptake (U), engagement (E), or both (B) were identified. Under capability, the main factors identified were app literacy skills (B), app awareness (U), available user guidance (B), health information (E), statistical information on progress (E), well-designed reminders (E), features to reduce cognitive load (E), and self-monitoring features (E). Availability at low cost (U), positive tone, and personalization (E) were identified as physical opportunity factors, whereas recommendations for health and well-being apps (U), embedded health professional support (E), and social networking (E) possibilities were social opportunity factors. Finally, the motivation factors included positive feedback (E), available rewards (E), goal setting (E), and the perceived utility of the app (E). Conclusions: Across a wide range of populations and behaviors, 26 factors relating to capability, opportunity, and motivation appear to influence the uptake of and engagement with health and well-being smartphone apps. Our recommendations may help app developers, health app portal developers, and policy makers in the optimization of health and well-being apps

Ageing Online : Promoting older persons' subjective wellbeing in a digital everyday life

Background: Digital technology and online services are often seen as one response to many of the challenges that the modern welfare state is expected to face. Evidently, digital technology is an essential part of the society as well as in our daily lives alike. Therefore, the digital context should be taken into consideration when studying subjective wellbeing— also among older persons. Digitalization further entails new ways of working among the multiprofessional personnel groups within the health and social care sector. The importance of meaningful engagement of older persons as part of the development of services is being recognized both within the international policies of active and healthy ageing as well as within the field of innovation studies. In general, more applied research is necessary when moving from evidence to practice in research regarding the promotion of wellbeing among older persons and related working methods and initiatives. Aim: To explore the multidimensionality of older persons’ subjective wellbeing and to deepen the understanding of health promotion practice and participatory approaches together with older persons in an increasingly digital everyday life. Methods: A multi-method design was applied and the thesis consist of four separate studies. Two studies were based on data from a cross-sectional, population-based survey study (the GERDA-project) conducted in 2016 in the Bothnia region (Finland and Sweden, n= ). Study III was a focus-group study with practitioners working with community-level health promotion targeting older persons in two regions in Finland and Sweden in 2019–2020. The last study is based on semi-structured interviews with older persons participating in the @geing online project in 2018–2020. Results: According to the study findings, there is a statistically significant association between subjective well-being and internet use in the studied older population. However, nuanced and multidimensional approaches—simultaneously taking into account the kind of online activities that the older persons engage in, as well as the particular dimensions of subjective wellbeing under study—are needed in order to develop the knowledge field. When it comes to health promotion practice, the findings highlight the importance of seeing the persons among the older people. Digital technology as well as an increased user involvement can support tailored work approaches and initiatives in future health promotion practice by breaking the current perceived barriers related to inflexible organizational routines and the own prejudices. The findings further highlight that being part of the development of an application can be an uplifting experience and increase the interest and confidence in digital technology use among older participants and combat stereotypical beliefs. However, participatory approaches are not linear, rather they are perceived as messy processes— which also can evoke experiences of disappointment among the participants. Conclusion: Digitalization is not only about the technology. Future research endeavours applying various, and preferably mixed methods, simultaneously examining the everyday life both online and offline in later life are warranted. This in order to deepen the understanding regarding the underlying mechanisms between subjective wellbeing and internet use and further answering the remaining question if internet per se actually is the driving component— affecting experienced well-being in later life— or if it is merely a key component of an already rich everyday life. In both design and implementation of technology, the process could entail more value and be facilitated if the user groups (which can be both older persons and practitioners) are actively participating and contributing with their expertise and contextual knowledge. However, advances are needed also regarding the methods for participatory technology design among older persons and especially regarding participatory approaches with diverse groups of older persons (especially more vulnerable groups). The findings highlights the importance of not generalizing the perquisites nor the health promotion actions for experiencing wellbeing an increasingly digital everyday later life.Bakgrund: Digitaliseringen av tjänster är en snabbt växande samhällstrend och ses som en av de viktigaste lösningarna för att göra de omställningar som krävs för att möta många av framtidens utmaningar. I och med att digitala verktyg och tjänster är en stor del av vardagen för en klar majoritet av befolkningen är det följaktligen viktigt att undersöka välbefinnandet i en digital vardagskontext – också bland äldre. Digitaliseringen innebär också ett förändrat arbetssätt inom social-och hälsovårdssektorn. Att på ett meningsfullt sätt inkludera äldre i utvecklingen av tjänster som berör dem är viktig och rekommenderas i såväl riktlinjer för att främja ett aktivt och hälsosamt åldrande som inom innovationsforskning. Överlag behövs mera tillämpad forskning för att kunna göra framsteg inom det gerontekonogiska forskningsfältet och för att kunna utveckla det hälsofrämjande arbetet. Syfte: Att undersöka det mångdimensionella subjektiva välbefinnandet bland äldre och att fördjupa kunskapen om hälsofrämjande arbete och samskapandearbetssätt med äldre personer i en alltmer digital vardag. Metod: Avhandlingen har en multi-metod design och innehåller fyra enskilda studier. De två första baserar sig på material som insamlats genom en enkät inom ramarna för GERDA-projektet år 2016 och är befolkningsbaserade tvärsnittsstudier. Den tredje studien består av fokusgruppintervjuer som gjorts med personal som arbetar med hälsofrämjande arbete i två regioner i Finland och Sverige under 2019–2020. I den fjärde studien analyserades semistrukturerade intervjuer som gjordes med äldre personer som deltog i projektet @geing online under åren 2018–2020. Resultat: Avhandlingen visar på att det finns ett samband mellan subjektivt välbefinnande och internetanvändning och digitala tjänster bland äldre personer i Botnia regionen. För att inte gå miste om viktig information om kopplingen mellan subjektivt välbefinnande och internetanvändning behöver man beakta både vilka digitala tjänster som äldre använder samt hur välbefinnande egentligen mäts. Vad gäller hälsofrämjande arbete riktat till äldre visar avhandlingens resultat på vikten att se de äldre personerna inom den äldre befolkningen. Vidare förslås också att digitala tjänster och samskapande tillvägagångssätt kan möjliggöra personcentrering och skräddarsydda tjänster genom att förändra styva riktlinjer och arbetssätt samt motarbeta de egna fördomarna. Resultaten visar också att det kan vara upplyftande att delta i utvecklingen av en ny applikation och att intresset för digitala verktyg och tilltron till sig själv som teknikanvändare ökade bland äldre deltagare. Samtidigt är samskapande innovationsprocesser inte linjära, utan det rör sig snarare om omständliga processer som också kan väcka olika känslor förknippade med besvikelse bland deltagarna. Slutsatser: Digitaliseringen handlar om mycket mer än bara teknik. För att kunna få svar på frågan om internetanvändning verkligen påverkar välbefinnande bland äldre eller om olika digitala tjänster bara är en del av ett sedan tidigare rikt liv behövs mera forskning. Framtida studier behöver inkludera och kombinera olika metoder samt undersöka båda ”offline” och ”online” aktiviteter samtidigt i en vardagskontext för att kunna titta närmare på för vem och under vilka omständigheter internet potentiellt kan främja välbefinnande. Både utvecklingen och implementeringen av nya digitala verktyg kan underlättas och ge mervärde ifall användare (både äldre och personal i detta fall) aktivt deltar och involveras. Forskning om samskapande innovationsprocesser behöver utökas och metoder för sådana tillvägagångssätt utvecklas – speciellt då det kommer till äldre och de olika grupperna inom den äldre befolkningen. Slutligen är det viktigt att inte generalisera då det kommer till äldres subjektiva välbefinnande, internetanvändning och hälsofrämjande arbete

Eye quietness and quiet eye in expert and novice golf performance: an electrooculographic analysis

Quiet eye (QE) is the final ocular fixation on the target of an action (e.g., the ball in golf putting). Camerabased eye-tracking studies have consistently found longer QE durations in experts than novices; however, mechanisms underlying QE are not known. To offer a new perspective we examined the feasibility of measuring the QE using electrooculography (EOG) and developed an index to assess ocular activity across time: eye quietness (EQ). Ten expert and ten novice golfers putted 60 balls to a 2.4 m distant hole. Horizontal EOG (2ms resolution) was recorded from two electrodes placed on the outer sides of the eyes. QE duration was measured using a EOG voltage threshold and comprised the sum of the pre-movement and post-movement initiation components. EQ was computed as the standard deviation of the EOG in 0.5 s bins from –4 to +2 s, relative to backswing initiation: lower values indicate less movement of the eyes, hence greater quietness. Finally, we measured club-ball address and swing durations. T-tests showed that total QE did not differ between groups (p = .31); however, experts had marginally shorter pre-movement QE (p = .08) and longer post-movement QE (p < .001) than novices. A group × time ANOVA revealed that experts had less EQ before backswing initiation and greater EQ after backswing initiation (p = .002). QE durations were inversely correlated with EQ from –1.5 to 1 s (rs = –.48 - –.90, ps = .03 - .001). Experts had longer swing durations than novices (p = .01) and, importantly, swing durations correlated positively with post-movement QE (r = .52, p = .02) and negatively with EQ from 0.5 to 1s (r = –.63, p = .003). This study demonstrates the feasibility of measuring ocular activity using EOG and validates EQ as an index of ocular activity. Its findings challenge the dominant perspective on QE and provide new evidence that expert-novice differences in ocular activity may reflect differences in the kinematics of how experts and novices execute skills

Cenários comunicacionais baseados em IOT para a promoção do bem-estar físico, psicológico e social dos séniores

The main objective of this research is to design and validate IoT based social hybrid scenario model that has the potential to promote psychological and physical wellbeing among older adults. The main reason to design and validate the model is age growth, older adults face psychological, physical and social well-being problems that increase mild cognitive impairment and frailty among older adults. Thus, to overcome older adults' problems, the study proposes and validates an IoT-based social hybrid scenario model. The model's features contain passive communication in which Drs, caregivers, and family members can monitor older adults' physical data from long distances. The model's features also contained intentional communication in which Older adults can interact online by text, audio, video calls, sharing images, and online activities such as painting, exercises and cooking. Moreover, older adults can do outdoor activities by inviting peers, friends or family members; the activities can be location-based IoT games, city tours, groups gardening and dinners. The outcomes of model validation will indicate how IoT characteristics can promote physical, psychological and social well-being and provide an opportunity for older adults to spend their life independently. The research that embodies this thesis includes 411 senior Portuguese Universities which are located mainland and on the island of Portugal. Using descriptive research methodology, where quantitative results are analysed, the results indicated a holistic scenario of passive and intentional communication in the context of well-being promotion among olderadults. from here, the social hybrid scenario is outlined, a hybrid model that offers passive and intentional communication between olderadults, family and medical doctors in the context of well-being promotion. The design and characteristics of the model are based on the existing knowledg, and needs of older adults, family members and also medical doctors. Such as model is a compound of passive and intentional characteristics that helps to reduce problem-related mental and physical health. The Passive and intentional communication characteristics are capable to create an environment for older adultsto take care of their psychological and physical health without any intervention and also increase their social physical and online activities, these activities help to promote the well-being of olderadults andd improve the daily lifestyle.O principal objetivo desta pesquisa é projetar e validar um modelo de cenário híbrido social baseado em IoT que tenha o potencial de promover o bem-estar psicológico e físico entre os idosos. A principal razão para projetar e validar o modelo é o crescimento da idade, os idosos enfrentam problemas psicológicos, físicos e de bem-estar social que aumentam o comprometimento cognitivo leve e a fragilidade entre os idosos. Assim, para superar os problemas dos idosos, o estudo propõe e valida um modelo de cenário híbrido social baseado em IoT. Os recursos do modelo contêm comunicação passiva na qual médicos, cuidadores e familiares podem monitorar os dados físicos dos idosos a longas distâncias. As características do modelo também contemplam comunicação intencional em que os idosos podem interagir online por meio de texto, áudio, videochamadas, compartilhamento de imagens e atividades online como pintura, exercícios e culinária. Além disso, os idosos podem fazer atividades ao ar livre convidando colegas, amigos ou familiares; as atividades podem ser jogos de IoT baseados em localização, passeios pela cidade, jardinagem em grupo e jantares. Os resultados da validação do modelo indicam como as características da IoT podem promover o bem-estar físico, psicológico e social e fornecer uma oportunidade para os idosos passarem sua vida de forma independente. A investigação que dá corpo a esta tese inclui 411 universidades portuguesas seniores localizadas no continente e na ilha de Portugal. Utilizando metodologia de pesquisa descritiva, onde são analisados resultados quantitativos, os resultados indicaram um cenário holístico de comunicação passiva e intencional no contexto da promoção do bem-estar entre idosos. a partir daqui, delineia-se o cenário social híbrido, um modelo híbrido que oferece comunicação passiva e intencional entre idosos, médicos de família e médicos no contexto da promoção do bem-estar. O desenho e as características do modelo baseiam-se no conhecimento existente e nas necessidades dos idosos, familiares e também médicos. Tal modelo é um composto de características passivas e intencionais que ajuda a reduzir os problemas relacionados com a saúde mental e física. As características de comunicação passiva e intencional são capazes de criar um ambiente para que os idosos cuidem de sua saúde psicológica e física e também aumentem suas atividades sociais físicas e online, essas atividades ajudam a promover o bem-estar dos idosos e melhorar o estilo de vida diário.Programa Doutoral em Informação e Comunicação em Plataformas Digitai

Technologies for Monitoring Lifestyle Habits Related to Brain Health : A Systematic Review

Brain health refers to the preservation of brain integrity and function optimized for an individual's biological age. Several studies have demonstrated that our lifestyles habits impact our brain health and our cognitive and mental wellbeing. Monitoring such lifestyles is thus critical and mobile technologies are essential to enable such a goal. Three databases were selected to carry out the search. Then, a PRISMA and PICOTS based criteria for a more detailed review on the basis of monitoring lifestyle aspects were used to filter the publications. We identified 133 publications after removing duplicates. Fifteen were finally selected from our criteria. Many studies still use questionnaires as the only tool for monitoring and do not apply advanced analytic or AI approaches to fine-tune results. We anticipate a transformative boom in the near future developing and implementing solutions that are able to integrate, in a flexible and adaptable way, data from technologies and devices that users might already use. This will enable continuous monitoring of objective data to guide the personalized definition of lifestyle goals and data-driven coaching to offer the necessary support to ensure adherence and satisfaction