Model-Driven Automatic Question Generation for a Gamified Clinical Guideline Training System

Clinical practice guidelines (CPGs) are a cornerstone of modern medical practice since they summarize the vast medical literature and provide care recommendations based on the current best evidence. However, there are barriers to CPG utilization such as lack of awareness and lack of familiarity of the CPGs by clinicians due to ineffective CPG dissemination and implementation. This calls for research into effective and scalable CPG dissemination strategies that will improve CPG awareness and familiarity. We describe a model-driven approach to design and develop a gamified e-learning system for clinical guidelines where the training questions are generated automatically. We also present the prototype developed using this approach. We use models for different aspects of the system, an entity model for the clinical domain, a workflow model for the clinical processes and a game engine to generate and manage the training sessions. We employ gamification to increase user motivation and engagement in the training of guideline content. We conducted a limited formative evaluation of the prototype system and the users agreed that the system would be a useful addition to their training. Our proposed approach is flexible and adaptive as it allows for easy updates of the guidelines, integration with different device interfaces and representation of any guideline.acceptedVersio

Convergence of Gamification and Machine Learning: A Systematic Literature Review

Recent developments in human–computer interaction technologies raised the attention towards gamification techniques, that can be defined as using game elements in a non-gaming context. Furthermore, advancement in machine learning (ML) methods and its potential to enhance other technologies, resulted in the inception of a new era where ML and gamification are combined. This new direction thrilled us to conduct a systematic literature review in order to investigate the current literature in the field, to explore the convergence of these two technologies, highlighting their influence on one another, and the reported benefits and challenges. The results of the study reflect the various usage of this confluence, mainly in, learning and educational activities, personalizing gamification to the users, behavioral change efforts, adapting the gamification context and optimizing the gamification tasks. Adding to that, data collection for machine learning by gamification technology and teaching machine learning with the help of gamification were identified. Finally, we point out their benefits and challenges towards streamlining future research endeavors.publishedVersio

Exploring barriers to guideline implementation for prescription of surgical antibiotic prophylaxis in Nigeria.

Background: In Nigeria, the prescription of surgical antibiotic prophylaxis for prevention of surgical site infection tends to be driven by local policy rather than by published guidelines (e.g. WHO and Sanford). Objectives: To triangulate three datasets and understand key barriers to implementation using a behavioural science framework. Methods: Surgeons (N = 94) from three teaching hospitals in Nigeria participated in an online survey and in focus group discussions about barriers to implementation. The theoretical domains framework (TDF) was used to structure question items and interview schedules. A subgroup (N = 20) piloted a gamified decision support app over the course of 6 months and reported barriers at the point of care. Results: Knowledge of guidelines and intention to implement them in practice was high. Key barriers to implementation were related to environmental context and resources and concern over potential consequences of implementing recommendations within the Nigerian context applicable for similar settings in low-to-middle-income countries. Conclusions: The environmental context and limited resource setting of Nigerian hospitals currently presents a significant barrier to implementation of WHO and Sanford guidelines. Research and data collected from the local context must directly inform the writing of future international guidelines to increase rates of implementation

Game-Based Learning, Gamification in Education and Serious Games

The aim of this book is to present and discuss new advances in serious games to show how they could enhance the effectiveness and outreach of education, advertising, social awareness, health, policies, etc. We present their use in structured learning activities, not only with a focus on game-based learning, but also on the use of game elements and game design techniques to gamify the learning process. The published contributions really demonstrate the wide scope of application of game-based approaches in terms of purpose, target groups, technologies and domains and one aspect they have in common is that they provide evidence of how effective serious games, game-based learning and gamification can be

Empowering vulnerable people with serious games and gamification

Although many people will associate games with entertainment and leisure, games can also aim more serious purposes, such as training or education. Games with such goals are called serious games. In addition, gamification means that a (serious) task is enhanced with game elements. Examples of serious games and gamification can be seen in many aspects of daily life. Loyalty programs of stores, educational games in schools, fitness wearables and their gamified applications, rehabilitation games, and so on. In this dissertation, the focus is on a specific domain in which serious games and gamification can create societal benefit, namely by using them to empower vulnerable target groups. In the first part of this dissertation, a literature review is performed to understand the domain of serious games and gamification for vulnerable target groups. Based on this review, research gaps can be identified. Moreover, the review resulted in a taxonomy that is used throughout the dissertation to classify different games and applications. In the following parts of the dissertation, projects addressing two different target groups and in total three vulnerabilities are discussed. The first target group is older adults, who are vulnerable in different ways. In this dissertation, safety risks for doorstep scams and health risks through malnutrition are addressed. The first vulnerability is addressed by a serious game using interactive scenarios of doorstep scams. A diet tracking system that was used to support participants in a diet trial addressed the latter vulnerability. The second target group is young adults, which is an age group with a vulnerable mental well-being. The last part of this dissertation aims to study how gamification can be used to enhance self-compassion among young adults via an online 6-weeks training program, to increase their resilience in the face of mental well-being difficulties. Artificial Intelligence (AI) technologies can be used to personalize and adapt the experience of a game to users. Tone of voice analysis was used to influence the progression in scenarios of the serious game about doorstep scams, and it gave players the possibility to assess the assertiveness of their voice. Machine learning algorithms were used to create personalized meal recommendations that can be used to improve the user experience of the diet tracking system for older adults. These algorithms base their recommendations on information about the historical intake of users to suggest meals and to additional items during meal editing. This makes the process of registering a meal less time-consuming. Sentiment analysis is used to adapt responses of the system in an exercise from the self-compassion training program. In addition, a topic detection algorithm was designed to assign one topic from a predefined set of topics to a note by a user of the training program. With this information, users can choose different types of situations to use in the exercises: frequently or rarely discussed topics. Aside from those techniques, knowledge representation is used in all projects, which is important for serious games/gamified applications since they are often based on expert and/or domain knowledge. This dissertation contributes to understanding the domain of serious games and gamification to empower vulnerable groups. The work also contributes to the research on the development of applications within that domain. On top of that, it contributes to understanding how AI techniques can be used to offer (personalized) features that enrich serious games or gamified applications. Finally, for each of the project centered parts, the results that are found in those parts contribute to the research in those specific fields

The Role of Human Knowledge in Explainable AI

As the performance and complexity of machine learning models have grown significantly over the last years, there has been an increasing need to develop methodologies to describe their behaviour. Such a need has mainly arisen due to the widespread use of black-box models, i.e., high-performing models whose internal logic is challenging to describe and understand. Therefore, the machine learning and AI field is facing a new challenge: making models more explainable through appropriate techniques. The final goal of an explainability method is to faithfully describe the behaviour of a (black-box) model to users who can get a better understanding of its logic, thus increasing the trust and acceptance of the system. Unfortunately, state-of-the-art explainability approaches may not be enough to guarantee the full understandability of explanations from a human perspective. For this reason, human-in-the-loop methods have been widely employed to enhance and/or evaluate explanations of machine learning models. These approaches focus on collecting human knowledge that AI systems can then employ or involving humans to achieve their objectives (e.g., evaluating or improving the system). This article aims to present a literature overview on collecting and employing human knowledge to improve and evaluate the understandability of machine learning models through human-in-the-loop approaches. Furthermore, a discussion on the challenges, state-of-the-art, and future trends in explainability is also provided

Sustainable interaction with digital technologies : fostering pro-environmental behavior and maintaining mental health

One of the most essential challenges of the twenty-first century is to realize sustainability in everyday behavior. Daily, partly unconscious decisions influence environmental sustainability. Such everyday choices are increasingly shifted toward digital environments, as digital technologies are ubiquitous in a wide variety of everyday contexts. This yields the great potential to positively influence the users behavior toward more environmental sustainability when interacting with digital technologies, for example, through the use of digital nudging. But besides these benefits, research indicates that interacting with digital technologies can lead to a specific form of stress, also known as technostress, that can cause adverse health outcomes. Individuals increasingly suffer from or are at risk of mental health issues like depression or burnout. This demonstrates that it is essential to ensure a sustainable interaction with digital technologies that is both environmentally friendly and healthy, especially for the mind. Addressing individuals interaction with digital technologies requires a broad understanding from all perspectives. The Human-Computer-Interaction (HCI) framework represents a guiding structure for studying the interaction of humans with digital technologies. Along with the guiding structure of the HCI framework, the seven research articles included in this dissertation aim to contribute to sustainable interaction with digital technologies. The focus is on two outcomes resulting from the interaction: First, fostering pro-environmental behavior and, second, maintaining mental health. After an introductory first chapter, Chapter 2 focuses on the outcome of fostering pro-environmental behavior when interacting with digital technologies using digital nudging. Chapter 2.1 contributes to a deeper understanding of the effectiveness of DNEs in different behavioral contexts (HCI perspective context) that influence the individuals pro-environmental behavior (e.g., e-commerce shopping behavior). Chapters 2.2 and 2.3 zoom in on two of the behavioral contexts described in Chapter 2.1 to investigate and test the design and effectiveness of specific DNEs in an e-commerce shop and a smart home app (HCI perspective technology) through online experiments. While prior research concentrated on the effectiveness of different feedback nudge features (FNFs) (e.g., different update frequencies), Chapter 2.4 investigates the influence of 25 identified FNFs on user satisfaction in a smart home app through a card sorting approach followed by an online survey based on the Kano model (HCI perspective human). Chapter 3 puts focuses on the outcome of maintaining mental health when interacting with digital technologies, thus avoiding technostress. Chapter 3.1 concentrates on the role of the organization in preventing technostress among their employees (HCI perspective context). It introduces and characterizes 24 primary and secondary technostress prevention measures and determines the relevance of primary prevention measures in reducing different sources of technostress (technostress creators). Out of the 24 technostress prevention measures, two specific measures (adopt a stress-sensitive digital workplace design and use gamification) are addressed in Chapters 3.2 and 3.3. Through a large-scale online survey, Chapter 3.2 derives an understanding of the characteristic profiles of technologies used at the digital workplace, their interplay, and how they influence technostress (HCI perspective technology). Chapter 3.3 focuses on the individuals appraisal (HCI perspective human) of a demanding situation when interacting with digital technologies. After conducting an online experiment, Chapter 3.3 finds that the integration of gamification elements (e.g., points or levels) in digital technologies can reduce the individuals threat appraisal. Lastly, Chapter 4 discusses the results of the seven included research articles and provides an outlook for future research. In summary, this dissertation aims to provide research and practice with new insights into creating a sustainable interaction with digital technologies to foster pro-environmental behavior and maintain mental health.Die nachhaltige Gestaltung des Lebens eine der zentralen Herausforderung des einundzwanzigsten Jahrhunderts. Alltägliche, teils unterbewusste Entscheidungen haben Einfluss auf die ökologische Nachhaltigkeit. Diese Entscheidungen werden durch die Allgegenwärtigkeit digitaler Technologien zunehmend in digitalen Umgebungen getroffen. Dies birgt das Potenzial, die Entscheidungen und somit das Verhalten der Nutzer:innen bei der Interaktion mit digitalen Technologien, beispielsweise durch Digital Nudging, positiv in Richtung ökologischer Nachhaltigkeit zu beeinflussen. Doch neben diesen Vorteilen zeigt die Forschung, dass die Interaktion mit digitalen Technologien eine spezifische Form von Stress, bekannt unter dem Begriff Technostress, auslösen kann, die zu negativen gesundheitlichen Folgen führen kann. Immer mehr Menschen leiden unter psychischen Krankheiten wie Depressionen oder Burnout oder sind akut gefährdet, diese zu entwickeln. Das zeigt, dass eine nachhaltige Interaktion mit digitalen Technologien sowohl umweltfreundlich als auch gesund, insbesondere für die Psyche, sein sollte. Das erfordert zunächst ein umfassendes Verständnis für die Problematik und muss deshalb aus allen relevanten Perspektiven betrachtet werden. Das Human-Computer-Interaction (HCI) Framework stellt eine Struktur für die Untersuchung der Interaktion von Menschen mit digitalen Technologien bereit. Das Framework stellt einen ganzheitlichen Ansatz zur Strukturierung und Klassifizierung der Forschung entlang der drei verschiedenen Perspektiven dar. Orientiert an dieser Struktur zielen die sieben Forschungsartikel dieser Dissertation darauf ab, einen Beitrag zur nachhaltigen Interaktion mit digitalen Technologien zu leisten. Dabei liegt der Fokus auf den beiden Ergebnissen der Förderung des umweltfreundlichen Verhaltens und der Aufrechterhaltung der psychischen Gesundheit. Nach dem einleitenden ersten Kapitel fokussiert Kapitel 2 die Förderung eines umweltfreundlichen Verhaltens bei der Interaktion mit digitalen Technologien durch die Verwendung von Digital Nudging. Durch eine strukturierte Literaturanalyse und der anschließenden Entwicklung eines Frameworks trägt Kapitel 2.1 zu einem tieferen Verständnis und einem Überblick der Effektivität von DNEs in verschiedenen Verhaltenskontexten (HCI Perspektive Kontext), die umweltfreundliches Verhalten bestimmen (z.B. Einkaufsverhalten), bei. In den Kapiteln 2.2 und 2.3 werden zwei der in Kapitel 2.1 betrachteten Kontexte vertieft und sowohl das Design als auch die Effektivität spezifischer DNEs in einem E-Commerce-Shop (Kapitel 2.2) und einer Smart Home App (Kapitel 2.3) in Online-Experimenten untersucht (HCI Perspektive Technologie). Kapitel 2.4 konzentriert sich das gut erforschte und wirksame DNE Feedback zur Förderung von energiesparendem Verhalten. Während sich bisherige Forschung auf die Effektivität verschiedener Feedback Nudge Features (FNFs) konzentriert (z.B. unterschiedliche Aktualisierungsfrequenzen), wird in Kapitel 2.4 der Einfluss von 25 identifizierten FNFs auf die Nutzerzufriedenheit mit Hilfe eines Card Sortings und einer Online-Befragung basierend auf dem Kano Modell untersucht (HCI Perspektive Mensch). In Kapitel 3 liegt der Schwerpunkt auf dem Ziel der Aufrechterhaltung der psychischen Gesundheit und somit der Vermeidung von Technostress. Kapitel 3.1 konzentriert sich auf die Rolle der Organisation bei der Prävention von Technostress bei Mitarbeiter:innen (HCI Perspektive Kontext). Basierend auf einer Delphi-Studie werden 24 primäre und sekundäre Technostress-Präventionsmaßnahmen vorgestellt und charakterisiert, sowie deren Relevanz zur Vermeidung von Technostress eingeschätzt. Von den 24 Maßnahmen werden zwei spezifische Maßnahmen (Gestaltung eines stresssensiblen digitalen Arbeitsplatzes" und Einsatz von Gamification) in Kapitel 3.2 und 3.3 behandelt. Kapitel 3.2 trägt durch eine groß angelegte Umfrage zu einem Verständnis für die Charakteristika der am digitalen Arbeitsplatz eingesetzten Technologien und deren Einfluss auf Technostress bei (HCI Perspektive Technologie). Kapitel 3.3 konzentriert sich auf das Individuum und dessen Wahrnehmung einer potenziellen Technostress-Situation bei der Interaktion mit digitalen Technologien (HCI Perspektive Mensch). Durch ein Online-Experiment zeigt sich, dass die Integration von Gamification-Elementen in digitalen Technologien die bedrohende Wahrnehmung der gegebenen Situation des Einzelnen reduzieren kann. Zusammenfassend zielt diese Dissertation darauf ab, Forschung und Praxis mit neuen Erkenntnissen zu einer nachhaltigen Interaktion von Menschen mit digitalen Technologien zu bereichern, die sowohl umweltfreundliches Verhalten fördert als auch die psychische Gesundheit aufrechterhält und somit zu den aktuellen Nachhaltigkeitsbemühungen beiträgt

The Impact of Gamification on Employee Engagement in a Complex System of Human Resource Management Processes

Elektroniskā versija nesatur pielikumusPromocijas darba mērķis ir izpētīt spēļošanu kā rīku, ko izmanto personālvadības procesu kompleksā sistēmā, un tās potenciālu ietekmēt augstāku darbinieku iesaisti šajos procesos, kā arī izstrādāt rekomendācijas spēļotu un iesaisti veicinošu personālvadības procesu dizainam. Pētījums piedāvā hipotēzi, ka, ņemot vērā spēļu vides augsti iesaistošo raksturu, darbinieku iesaiste dažādos personālvadības procesos tiek pozitīvi ietekmēta, izmantojot spēļu elementus, kas veicina izmērāmu šo procesu rādītāju paaugstināšanos. Darba zinātniskā novitāte izpaužas spēļošanas definīcijā ar fokusu uz personālvadības procesiem, kā arī pienesumā vadībzinātņu teorijas attīstībai: izstrādāts 10-soļu modelis iesaisti veicinošai personālvadības procesu spēļošanai. Darba ietvaros izstrādātā metodoloģija spēļošanas ietekmes izpētei uz darbinieku iesaisti var tikt izmantota gan viena uzņēmuma vai uzņēmumu grupas ietvaros, gan pārrobežu pētījumiemThe aim of this study is to explore gamification as a tool used within a complex system of human resource management processes and its potential to achieve higher employee engagement with these processes, as well as to develop recommendations for gamified and engagement-positive design of the said processes. Hypothesis defended throughout the thesis argues that given highly engaging character of the game environment employee engagement with various human resource management processes can be positively influenced through the application of game elements, thus promoting improvement of the process indicators. Scientific novelty of the doctoral thesis lies in developed gamification definition with a focus on human resource management processes, as well as in contribution to the management theory development: thesis offers 10-steps model for the engagement positive gamification of human resource management processes. Methodology for research of the impact of gamification on employee engagement can be used within any business enterprise or group of enterprises, as well as for the crossborder research

Design Principles of Mobile Information Systems in the Digital Transformation of the Workplace - Utilization of Smartwatch-based Information Systems in the Corporate Context

During the last decades, smartwatches emerged as an innovative and promising technology and hit the consumer market due to the accessibility of affordable devices and predominant acceptance caused by the considerable similarity to common wristwatches. With the unique characteristics of permanent availability, unobtrusiveness, and hands-free operation, they can provide additional value in the corporate context. Thus, this thesis analyzes use cases for smartwatches in companies, elaborates on the design of smartwatch-based information systems, and covers the usability of smartwatch applications during the development of smartwatch-based information systems. It is composed of three research complexes. The first research complex focuses on the digital assistance of (mobile) employees who have to execute manual work and have been excluded so far from the benefits of the digitalization since they cannot operate hand-held devices. The objective is to design smartwatch-based information systems to support workflows in the corporate context, facilitate the daily work of numerous employees, and make processes more efficient for companies. During a design science research approach, smartwatch-based software artifacts are designed and evaluated in use cases of production, support, security service, as well as logistics, and a nascent design theory is proposed to complement theory according to mobile information system research. The evaluation shows that, on the one hand, smartwatches have enormous potential to assist employees with a fast and ubiquitous exchange of information, instant notifications, collaboration, and workflow guidance while they can be operated incidentally during manual work. On the other hand, the design of smartwatch-based information systems is a crucial factor for successful long-term deployment in companies, and especially limitations according to the small form-factor, general conditions, acceptance of the employees, and legal regulations have to be addressed appropriately. The second research complex addresses smartwatch-based information systems at the office workplace. This broadens and complements the view on the utilization of smartwatches in the corporate context in addition to the mobile context described in the first research complex. Though smartwatches are devices constructed for mobile use, the utilization in low mobile or stationary scenarios also has benefits due they exhibit the characteristic of a wearable computer and are directly connected to the employee’s body. Various sensors can perceive employee-, environment- and therefore context-related information and demand the employees’ attention with proactive notifications that are accompanied by a vibration. Thus, a smartwatch-based and gamified information system for health promotion at the office workplace is designed and evaluated. Research complex three provides a closer look at the topic of usability concerning applications running on smartwatches since it is a crucial factor during the development cycle. As a supporting element for the studies within the first and second research complex, a framework for the usability analysis of smartwatch applications is developed. For research, this thesis contributes a systemization of the state-of-the-art of smartwatch utilization in the corporate context, enabling and inhibiting influence factors of the smartwatch adoption in companies, and design principles as well as a nascent design theory for smartwatch-based information systems to support mobile employees executing manual work. For practice, this thesis contributes possible use cases for smartwatches in companies, assistance in decision-making for the introduction of smartwatch-based information systems in the corporate context with the Smartwatch Applicability Framework, situated implementations of a smartwatch-based information system for typical use cases, design recommendations for smartwatch-based information systems, an implementation of a smartwatch-based information system for the support of mobile employees executing manual work, and a usability-framework for smartwatches to automatically access usability of existing applications providing suggestions for usability improvement