From persuasion to negotiation in health promoting technology

Over recent years, designing technologies to promote health-related behavioural change has been an area of growing interest in HCI. Given the prevalence of self-monitoring and social facilitation in emerging designs, the assumption appears to be that increasing an individual’s awareness of his or her behaviour and the behaviour of others will promote behavioural change. This thesis argues that while this is true to some extent, this represents a somewhat naive view of how individuals come to make decisions regarding their health-related behaviours. Three qualitative studies within distinct health domains illustrate the complex nature of health-related behavioural change. Weight Management was an inherently social activity, albeit subject to selective disclosure and incremental participation. Individuals were generally motivated by appearance rather than health, implementing change based on exposure and orientation to alternative strategies. In Families at Risk, caregivers were highly motivated by a desire to safeguard the health of their children but were restricted by a lack of financial and strategic resources. Lack of trust and a transient community contributed to social isolation, thus inhibiting opportunities for collaboration. In Cardiac Rehabilitation, behavioural change efforts were prompted by an acute health crisis and guided by health professionals. However, behavioural change efforts were sometimes restricted by a desire to return to normal, tensions arising when what was considered normal was composed of risk behaviours. Family involvement varied greatly, ranging from disregard to facilitating change, and a desire for independence and ownership of the rehabilitation sometimes restricted the active involvement of peers. Informed by the findings of these studies this thesis highlights the strengths and limitations of current technological approaches to promoting behavioural change, provides implications for design, and supported by the sociomedical literature, identifies alternative avenues of technological innovation. The thesis reflects on technology’s role in health-related behavioural change and considers associated ethical implications. Overall, the main contribution of this thesis is a reframing of the problem of promoting health-related behavioural change as more than a matter of behavioural awareness and personal motivation. While it is understandable that technologists would look to the clinical domain to inform initial investigations in this area, this thesis argues that technologists should be cautious about blindly adopting its prescriptive paradigm. As an alternative to persuasion, this thesis offers negotiation as a potential model for future innovations in this area

Tagliatelle: social tagging to encourage healthier eating

This paper describes the design and initial evaluation of Tag-liatelle, a collaborative tagging application for encouraging healthier eating. Users photograph their own meals and upload these photos to a website, where fellow users anonymously tag them for content. Initial results suggest that tagging of food content is a popular activity. However, further work must be done to automate the extraction of valid nutritional information from the tags generated

Children's Health: Evaluating the Impact of Digital Technology. Final Report for Sunderland City Council.

EXECUTIVE SUMMARY The Children’s Health project sponsored by the City of Sunderland Digital Challenge project examined the impact of providing health-focused digital technologies to children aged 11-15 years, in terms of their usage and requirements of such technologies, and their subsequent behavioural changes. The empirical study ran with three groups of six children over a period of seven weeks for each group. A console-based exercise game and an exercise-focused social website were used in the study and the focus was on opportunistic (unstructured/unplanned) exercise. The emergent findings are: • Data collected about physical activity must be more extensive than simple step counts. • Data collection technologies for activities must be ubiquitous but invisible. • Social interaction via technology is expected; positive messages reinforcing attainments of goals are valued; negative feedback is seen as demotivating. • participants were very open to sharing information (privacy was not a concern). • Authority figures have a significant impact on restricting adolescents’ use of technologies. This document reports the how the study was conducted, analyses the findings and draws conclusions from these regarding how to use digital technologies to improve and/or maintain the physical activity levels of children throughout their adolescence and on into adulthood. The appendices provide the detailed (anonymised) data collected during the study and the background literature review

Enhancing physical activity coaching through personalized motivational strategies and self-adaptive goal-setting: development of self-adaptive processes in a monitoring and coaching smartphone application

Dissertação para obtenção do Grau de Mestre em Engenharia BiomédicaThe rising age of the European population brings increased costs in healthcare mainly related to the management of chronic diseases. Regular physical activity has been shown to help in the prevention and control of disease risk. Mobile phones have provided promising and emergent ways of promoting healthy lifestyles, allowing real-time monitoring and coaching to be delivered at any time and any place. The presented work adds new features to the Activity Coach, an ambulatory feedback system that aims to encourage physical activity. The Integral of the Modulus of Body Acceleration (IMA) is the unit used as an estimate for energy expenditure. Although previous research demonstrated the potential of this system, results also showed that adherence drops after a few weeks. The primary goal of this research was to design, implement, and test adaptive goal-setting and personalized feedback strategies in order to encourage physical activity. Regarding the self-adaptive goal-setting feature, the goal for each day is defined automatically based on the physical activity performed at that day of the week since the beginning of the intervention. Hence, the intention is to help the user to increase or maintain his level of physical activity taking his daily routine as a reference. The second element added to the system regards motivational feedback messages, a key factor in interventions aiming at behavior change. Based on the levels of self-efficacy, stage-of-change, and daily activity, the user is assigned to one of the six pre-defined feedback strategies in the system. The content of the motivational cues depends on the selected feedback strategy. The evaluation of the system focused on providing better understandable and more accurate feedback to the user. To do so, we evaluated the challenge and attainability of the goals provided to the user with (1) data acquired during previous studies, and (2) newly gathered data from a single-subject study. As part of the evaluation, we translated IMA counts into ‘steps’, a commonly understandable measure for physical activity, comparing the data acquired from the Activity Coach sensor with a Fitbit, a commercially available pedometer. Although further tests with more subjects and different activities should be performed, we suggest that the default values set to the system are in agreement with the Goal-Setting Theory providing challenging and attainable goals. The results from this research will be used in future experiments using the Activity Coach and can be adapted to other ambulatory feedback systems regarding promotion of physical activity

Best Intentions: Health Monitoring Technology and Children.

In this paper we describe findings from two studies aimed at understanding how health monitoring technology affects the parent-child relationship, examining emotional response and barriers to using this type of technology. We present suggestions for the design of health monitoring technology intended to enhance self-care in children without creating parent-child conflict. Our recommendations integrate the study findings, developmental stage specific concerns, and prior HCI research aimed at children’s health

Reducing meat consumption and following plant-based diets: current evidence and future directions to inform integrated transitions

Background: There is increasing consensus that transitioning towards reduced meat consumption and more plant-based diets is a key feature to address important health and sustainability challenges. However, relevant evidence that may inform these transitions remains fragmented with no overarching rationale or theoretical framework, which limits the ability to design and deliver coordinated efforts to address these challenges. Scope and approach: Eleven databases were systematically searched using sets of keywords referring meat curtailment, meat substitution and plant-based diets, as well as consumer choice, appraisal or behavior (2602 articles selected for title and abstract screening; 161 full-texts assessed for eligibility; 110 articles selected for extraction and coding). Barriers and enablers were identified and integrated into an overarching framework (i.e., COM-B system), which conceptualizes behavior as being influenced by three broad components: capability, opportunity and motivation. Key findings and conclusions: This review mapped potential barriers and enablers in terms of capability, opportunity, and motivation to reduce meat consumption and follow more plant-based diets. These included lack of information for consumers and difficulty to acquire new cooking skills (barrier, capability), changes in service provision in collective meal contexts (enabler, opportunity), and positive taste expectations for plant-based meals (enabler, motivation). Evidence on variables referring to the motivation domain is clearly increasing, but there is a striking need for studies that include capability and opportunity variables as well. The results of this review are relevant to a variety of fields and audiences interested in promoting sustainable living and health improvements through dietary choice.info:eu-repo/semantics/acceptedVersio

Reducing meat consumption and following plant-based diets: current evidence and future directions to inform integrated transitions

Background: There is increasing consensus that transitioning towards reduced meat consumption and more plant-based diets is a key feature to address important health and sustainability challenges. However, relevant evidence that may inform these transitions remains fragmented with no overarching rationale or theoretical framework, which limits the ability to design and deliver coordinated efforts to address these challenges. Scope and approach: Eleven databases were systematically searched using sets of keywords referring meat curtailment, meat substitution and plant-based diets, as well as consumer choice, appraisal or behavior (2602 articles selected for title and abstract screening; 161 full-texts assessed for eligibility; 110 articles selected for extraction and coding). Barriers and enablers were identified and integrated into an overarching framework (i.e., COM-B system), which conceptualizes behavior as being influenced by three broad components: capability, opportunity and motivation. Key findings and conclusions: This review mapped potential barriers and enablers in terms of capability, opportunity, and motivation to reduce meat consumption and follow more plant-based diets. These included lack of information for consumers and difficulty to acquire new cooking skills (barrier, capability), changes in service provision in collective meal contexts (enabler, opportunity), and positive taste expectations for plant-based meals (enabler, motivation). Evidence on variables referring to the motivation domain is clearly increasing, but there is a striking need for studies that include capability and opportunity variables as well. The results of this review are relevant to a variety of fields and audiences interested in promoting sustainable living and health improvements through dietary choice.info:eu-repo/semantics/acceptedVersio

The Future for Fixing

This concluding chapter of _Techno-Fixers: Origins and Implications of Technological Faith_ examines the widespread overconfidence in present-day and proposed 'technological fixes', and provides guidelines - social, ethical and technical - for soberly assessing candidate technological solutions for societal problems

FROM CONSENT TO CHOICE: THE ETHICS OF EMPOWERMENT-BASED REFORMS

The aim of my thesis is twofold. First, I focus on the controversies arising from the renegotiations of patienthood and citizenship entailed in what I call \u2018empowerment-based reforms\u2019 (EBRs). What I define as EBRs will have in fact different implications for the various stakeholders involved in their development and implementation. Empowered citizens within EBRs will have access to (and will be required to manage) an unprecedented amount of information regarding their health conditions. Factors such as genetic and biological makeup, life-style behaviours and environmental exposures will be increasingly used (by both citizens and professionals) to identify treatment options, to target developing diseases, and to adopt preventive measures for future illnesses. Among the effects that this personalising vision of healthcare is likely to foster, it is thus worth emphasizing how the nature and scope of individual responsibility for health will be affected by this paradigm shift, and how this future scenario can be made an ethically desirable one. In my thesis, I therefore identify the range of normative exercises entailed in EBRs, and I present a normative analysis of empowerment aiming at highlighting the distinctive ethical aspects of this approach. Second, the goal of my thesis is to explore how the normative theorization of empowerment proposed above can accommodate one of the most pressing societal implications of epigenomics. Namely, its burdening of individual responsibility for health. On the one hand, I argue that novel approaches to prevention, diagnosis and treatment brought about by epigenomics are a fundamental tenet of the personalization project at the basis of what I call EBRs. In this respect, epigenome-based healthcare is thus likely to foster controversies similar to other epistemic endeavours of personalized medicine (e.g. genomics, metabolomics, pharmacogenomics), which can be addressed from the normative premises of empowerment. On the other, I maintain that concerns arising from the translation of epigenomics into healthcare practice should be poised with its promise to make increasingly visible the \u2018contextual nature\u2019 of health (i.e. tracing the mechanistic interaction between lifestyle, living conditions and individual health). Rather than limiting societal appraisal of epigenomics to the danger of burdening individual responsibility for health, I argue that epigenetic knowledge may become pivotal in fleshing out social and environmental influences inherently affecting individual health. Sufficiently valid, reliable and actionable epigenetic knowledge may in fact orient individual choice across the spectrum of environmental and lifestyle exposures determining health, thus championing epigenomics with the potential of serving the empowering aims fleshed out throughout this work. The road connecting the constitution of an empowered citizenship in healthcare, and the societal appraisal of epigenomics can be regarded as a two-way road. There is in fact a possibility that empowerment and epigenomics may respectively shape their normative and epistemic dimensions in the future of healthcare. It is thus towards the identification of the possible challenges and opportunities that this synergy may bring about that the theoretical attention of this work is devoted