Utilization of Personal Health Informatics Through Intermediary Users

Personal informatics are important tools in health self-management as they support individuals to quantify and self-reflect on their lifestyle. Human-computer interaction researchers have devoted resources on studying how to design such tools. Various motivational strategies have been explored for their capabilities in improving user engagement. However, such strategies are developed with an assumption that the targeted consumer of information is the one directly manipulating user interfaces of the system that has information. This may not always be the case for users in developing regions. As a result, such systems may not scale well in contexts where a targeted consumer (beneficiary) may use technology through the facilitation of another person (intermediary) whom is responsible for manipulating user interfaces, because such facilitators are not recognized as part of the system, hence motivational strategies don't cater for them. In order to uncover design implications for intermediated technology use in the context of personal health informatics (PHI), the researcher started with the theoretical framing of the work followed by a contextual enquiry which led to development of mobile applications' prototypes for tracking nutrition and physical activity. Evaluation of the prototypes revealed that a familial relationship is a prerequisite for such an intervention. The most promising combination involves family members, possibly a child and a parent working together. The study used self-determination theory to understand how a collaborative gamified system can increase engagement. The result revealed that gamification as the source of a significant increase in perceived competence in intermediary users whom also tended to consider themselves as co-owners of the interaction experience. Therefore, gamification was found to be a catalyst for increasing collaboration between an intermediary and beneficiary user of technology, provided that the two users that formed a pair had a prior social relationship. In the absence of gamification, intermediary users tended to be less engaged in the intervention. The study highlights both the positive and negative aspects of gamification in promoting collaboration in intermediated use and its general implications in health settings. Design considerations required in order to improve the overall user experience of both users involved are proposed. In general, this work contributes to both theory and empirical validation of factors for, supporting proximate-enabled intermediated use of personal health informatics

State of Play: A Citation Network Analysis of Healthcare Gamification Studies

Researchers and practitioners alike increasingly recognize gamification as a potential tool to evoke desired behaviours in patients, healthcare professionals, and healthy end-users aiming to live a healthier lifestyle. Thus, the number of scientific publications in healthcare gamification is rapidly increasing and due to the interdisciplinary nature of the research field, knowledge about this topic is being scattered over many research communities. Building on a large number of articles on healthcare gamification and utilizing citation network analysis, this study sheds fur-ther light on the extant knowledge on healthcare gamification. Based on our approach, we were able to (1) evaluate essential articles and authors covering the topic, (2) analyse the recent de-velopment of research on healthcare gamification, and (3) identify past research foci and knowledge gaps in our knowledge on healthcare gamification. By doing so, we call for further research on healthcare gamification and provide researchers with potential avenues for future research projects

Video Consumption Patterns for First Time Smartphone Users: Community Health Workers in Lesotho

There is already strong evidence that mobile videos are a good vehicle for public health information dissemination, but there remain open questions around sustainability, appropriate target users, consumption patterns, content, and usage models. We analyse log and interview data of 42 community health workers (who were first time smartphone users) from a longitudinal 17-month deployment to better understand how the utility of mobile videos played out over time in rural Lesotho. During the study period, videos were viewed at an average of 170 times per month, for a total of 2898 views. Through this data we draw these primary findings: a) pausing is not contextually necessary, b) age is not a barrier to usage, c) the primary predictor of popularity of a given video is topical relevance and national campaigns, d) there is no apparent relationship between video length, popularity and completion rates, and e) new videos have only a short-lived novelty effect. Furthermore, we affirm that regular engagement with CHWs has an impact on continued usage, in addition to being important for reducing attrition due to technical issues

Designing with community health workers: feedback-integrated multimedia learning for rural community health

Community Health Workers (CHWs) are an integral part of the rural health system, and it is imperative that their voices are accommodated in digital health projects. In the mobile health education project discussed in this thesis (The Bophelo Haeso project), we sought to find ways to amplify CHWs' voices, enabling them to directly influence design and research processes as well as technological outcomes. The Bophelo Haeso (BH) project equips CHWs with health videos on their mobile phones to use for educating and counselling the rural public. We investigated how to best co-design, with CHWs, a feedback mechanism atop the basic BH health education model, thus enabling their voices in the design process and in the process of community education. This thesis chronicles this inclusive design and research process - a 30-month process that spanned three sub-studies: an 18-month process to co-design the feedback mechanism with CHWs, a 12-month deployment study of the feedback mechanism and, overlapping with the feedback deployment study, a 17-month study looking at the consumption patterns of the BH educational videos. This work contributes to the field of Human Computer Interaction (HCI) in three distinct ways. First, it contributes to the growing knowledge of co-design practice with participants of limited digital experience by introducing a concept we termed co-design readiness. We designed and deployed explorative artefacts and found that by giving CHWs increased technical, contextual, and linguistic capacity to contribute to the design process, they were empowered to unleash their innate creativity, which in turn led to more appropriate and highly-adopted solutions. Secondly, we demonstrate the efficacy of incorporating an effective village-to-clinic feedback mechanism in digital health education programs. We employed two approaches to feedback - asynchronous voice and roleplaying techniques. Both approaches illustrate the combined benefits of implementing creative methods for effective human-to-technology and human-tohuman communication in ways that enable new forms of expression. Finally, based on our longitudinal study of video consumption, we provide empirical evidence of offline video consumption trends in health education settings. We present qualitative and quantitative analyses of video-use patterns as influenced by the CHWs' ways of being and working. Through these analyses, we describe CHWs and their work practices in depth. In addition to the three main contributions, this thesis concludes with critical reflections from the lessons and experiences of the 30-month study. We discuss the introduction of smartphones in rural villages, especially among elderly, low-literate, and non-English-speaking users, and present guidelines for designing relevant and usable smartphones for these populations. The author also reflects on her position as an African-born qualitative researcher in Africa, and how her positionality affected the outcomes of this research

Implementing data-driven systems for work and health: The role of incentives in the use of physiolytics

Following the recent success of health wearable devices (smartwatches, activity trackers) for personal and leisure activities, organizations have started to build digital occupational health programs and data-driven health insurance around these systems. In this way, firms or health insurance companies seek to both support a new form of health promotion for their workforce/clients and to take advantage of large amounts of collected data for organizational purposes. Still, the success in the implementation of wearable health devices (also known as physiolytics) in organizational settings is entirely dependent on the individual motivation to adopt and use physiolytics over time (since organizations cannot establish a mandated use). Therefore, organizations often use incentives to encourage individuals to participate in such data-driven programs. Yet, little is known about these mechanisms that serve to align the interests of an organization with the interests of a group of individuals. This is an important challenge because these incentives may blunder the frontiers between what is voluntary and what is not. Against this background, this thesis aims, from a critical realist perspective, to build general knowledge regarding incentives in physiolytics-centered organizational programs. By doing so, individuals may be able to recognize challenges linked to participation in such programs; organizations may create sensible incentives; policymakers may identify new social issues that appear with this form of digitalization in organizations; and, finally, researchers may investigate new practical and social challenges regarding digitalization in organizations. In concrete terms, the first explorative phase of the thesis shows that feedback, gamification features and financial incentives are the most implemented incentives in physiolytics-centered organizational programs. There is also an overrepresentation of financial incentives for data-health plans, indicating that health insurance companies are building their strategy on external motivators. A second, more explanatory phase serves to further explore these types of incentives and specify recommendations by taking a higher perspective than normative views, so that it is possible to create more alternative managerial strategies or develop other policy perspectives. This part principally shows that the most influential incentives on user behavior are the ones that are transparent, that stimulate individual empowerment, and that propose defined benefits. In terms of contributions, this thesis allows individuals to evaluate how their autonomy and integrity is impacted by incentives in such data-driven programs. This thesis also outlines the necessity for organizations to invest time and resources to know their audience. Organizations additionally need to develop several strategies, by mixing incentives or gradually introducing them. Policymakers must ensure that regulations permit the clear consent of participants; guarantee a proportionality of incentives, and involve entities that can guide individuals through data-sharing. Finally, this thesis enables researchers to further investigate how organizations can develop appropriate and desirable environments regarding data-driven technology, so that individuals may enhance their decision-making processes and organizations may succeed in their implementation

Designing behavior change support systems in the context of knowledge documentation: development of theory and practical implementation

Although innovation and operating efficiently require creating, transferring, and applying knowledge, successful knowledge documentation remains a challenge for organizations. While knowledge management systems support knowledge management activities, the missing link to applying knowledge management relies on human actions and their behaviors. This dissertation extends prior design knowledge about designing Behavior Change Support Systems in the context of knowledge documentation by developing theory and showing practical implementation. Combining technical and psychological models within information systems frameworks based on the principles of abstraction, originality, justification, and benefit, this dissertation draws on design science to propose prescriptive knowledge, for example, in the form of design principles and a specific artifact

Responsible AI and Analytics for an Ethical and Inclusive Digitized Society

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Designing and evaluating a behaviour change intervention that introduces modification of time perceptions as a solution to promote sustainable behaviours

This research presents the design and evaluation of an intervention that introduces modification of time perceptions as one of the solutions to promote sustainable behaviours. It is demonstrated in this thesis that unnecessary energy use is often caused by temporal tensions, defined as the relation between actions to be performed and available time. This research proposes that it is possible to deliberately reduce temporal tensions, and this can motivate people to behave more sustainably. Persuasive technology and human-computer interaction provided the tools needed to manipulate time perceptions and therefore bring about changes in the specific behaviours that result in unnecessary energy usage. Previous studies indicate that behaviours play an important role in energy consumption. From the different domains of energy use that could be examined, cooking was chosen to be the platform where the studies on behaviour change and energy use would take place. How behaviours influence energy use motivated the design of empirical studies to understand behaviours related to domestic energy use and identify what are the determinants of these behaviours. Each determinant was related to a strategy to be included on a behaviour change intervention. A wider survey was developed to understand students acceptance of a set of proposed energy saving techniques, and resulted in a vast volume of information about user preferences and intentions to perform the suggested energy saving behaviours for cooking. It emerged that participants rushed into the cooking tasks without much deliberation, consequently not following preparation procedures and thus using more energy. Information gathered during the first studies also showed that participants behaviours were partially motivated by the need to speed up the cooking process in order to reduce boredom when they were waiting for the food to cook, consequently resulting in extra energy usage. The knowledge gathered from the preceding steps and a literature review informed the design of strategies to modify the non-sustainable behaviours and promote energy saving. A user-centred design process involving an idea generation session and scenario analysis was used to provide a set of strategies to be embedded in an intervention, containing the specific methods to tackle the correspondent determinants of behaviours. The specific needs of the cooking activity indicated that an electronic intervention was an adequate platform to be implemented and tested. Two high resolution working prototypes of the electronic interventions were developed as mobile phone applications. The final study comprised the evaluation of the proposed interventions in improving aspects of the cooking activity, the acceptance of the interventions and effectiveness in promoting energy saving

Essays on trust and online peer-to-peer markets

The internet has led to the rapid emergence of new organizational forms such as the sharing economy, crowdfunding and crowdlending and those based on the blockchain. Using a variety of methods, this dissertation empirically explores trust and legitimacy in these new markets as they relate to investor decision making