Integrating Taxonomies into Theory-Based Digital Health Interventions for Behavior Change: A Holistic Framework

Digital health interventions have been emerging in the last decade. Due to their interdisciplinary nature, digital health interventions are guided and influenced by theories (e.g., behavioral theories, behavior change technologies, persuasive technology) from different research communities. However, digital health interventions are always coded using various taxonomies and reported in insufficient perspectives. The inconsistency and incomprehensiveness will bring difficulty for conducting systematic reviews and sharing contributions among communities. Based on existing related work, therefore, we propose a holistic framework that embeds behavioral theories, behavior change technique (BCT) taxonomy, and persuasive system design (PSD) principles. Including four development steps, two toolboxes, and one workflow, our framework aims to guide digital health intervention developers to design, evaluate, and report their work in a formative and comprehensive way

Exploring cyclists’ and pedestrians’ personal exposure, wellbeing and protective practices on-the-move

In dieser Doktorarbeit wurde untersucht, welche Faktoren Wohlbefinden, wahrgenommene Gesundheit und Mobilitätspraktiken von Radfahrenden und Fußgänger:innen während des Unterwegsseins beeinflussen. Ziel war es, die persönliche Exposition gegenüber Feinstaub und Lärm unterwegs zu messen und diese der individuell wahrgenommenen Belastung gegenüberzustellen. Zudem wurden weitere Faktoren, die das Wohlbefinden beeinflussen, untersucht. Die Arbeit beleuchtet überdies, wie über gesunde und angenehme Mobilität informiert werden könnte. Zuerst wurden mobile qualitative Interviews (Go-/Ride-Alongs) durchgeführt und mit tragbaren Sensoren zur Messung von Feinstaub und Lärm ergänzt. Der situative Kontext, die sensorische Wahrnehmung und soziale Aspekte beeinflussen, ob das Unterwegsseins in der Stadt als gesund und angenehm empfunden wird. Diese Faktoren können in vergleichsweise als hoch belastend gemessenen Situationen ausgleichend wirken. Weiterhin wurden Informationsmöglichkeiten für eine gesunde Mobilität in der Stadt exploriert. Ein Literaturreview hat aufgezeigt, dass Gesundheitsthemen wenig Berücksichtigung in Forschung zu Mobilitäts-Apps finden. Daran anschließend wurden Fokusgruppen durchgeführt. Es wurde ermittelt, wie gesunde und angenehme Routen kommuniziert werden können. Hier könnendas Vorhandensein von Routenalternativen und Bewältigungsstrategien ein Gefühl von Selbstwirksamkeit geben. Es wurde eine „pleasant routing app“ vorgeschlagen, die angenehme und gesunde Routenaspekte integriert. Um die Attraktivität des Fahrradfahrens und zu Fuß Gehens zu steigern, sollten Erfahrungen, Wahrnehmungen und Praktiken von Radfahrenden und Fußgänger:innen berücksichtigt werden. Letztendlich kann somit aktive Mobilität ihr Potenzial entfalten und zu einer lebenswerten, gesunden und umweltfreundlichen Stadt beitragen.This thesis investigates factors influencing cyclists’ and pedestrians’ health and wellbeing on-the-move. Moreover, the possibilities of smartphone apps for supporting a healthy and pleasant trip are investigated. The scope of this thesis is to combine the topic healthy and pleasant mobility with possibilities of mobility apps. First, the thesis explores how cyclists and pedestrians perceive their personal exposure towards air pollution and noise as well as other factors influencing commuting experience and wellbeing on-the-move. This is contrasted to actual measured particulate matter and noise. Qualitative interviews on-the-move (‘go-/ride-alongs’) are complemented by wearable sensors measuring particulate matter and noise. The results show discrepancies as well as coherences between perceived and measured exposure. The situational context, sensory awareness (e.g. water views) and social cues (e.g. seeing other people) are important for a perceived pleasant commute, even in polluted areas. Second, this thesis identifies how far health impacting factors are considered in research using mobility apps to identify their possibilities for supporting a healthy commute. A literature review reveals that research applying mobility apps is lacking the consideration of health topics and it is proposed to integrate health topics in mobility app development. Following these findings, the thesis investigates communication options to inform about a healthy and pleasant commute. Focus groups were applied showing that information should include feasible coping strategies and increase self-efficacy. Pleasant trip characteristics could be included in a healthy mobility app. If active mode users’ experiences, perceptions and practices are considered, cycling and walking can become more attractive and more people are encouraged to cycle or walk. Hence, active modes can unfold their potential for supporting the transformation towards liveable, healthy and environmentally friendly cities

Validity of a Global Positioning System-Based Algorithm and Consumer Wearables for Classifying Active Trips in Children and Adults

Accepted author manuscript version reprinted, by permission, from [Journal for the Measurement of Physical Behaviour, 2021, Volume 4: Issue 4: pp. 321–332, https://doi.org/10.1123/jmpb.2021-0019. © Human Kinetics, Inc.Objective: To investigate the convergent validity of a global positioning system (GPS)-based and two consumer-based measures with trip logs for classifying pedestrian, cycling, and vehicle trips in children and adults. Methods: Participants (N = 34) wore a Qstarz GPS tracker, Fitbit Alta, and Garmin vivosmart 3 on multiple days and logged their outdoor pedestrian, cycling, and vehicle trips. Logged trips were compared with device-measured trips using the Personal Activity Location Measurement System (PALMS) GPS-based algorithms, Fitbit’s SmartTrack, and Garmin’s Move IQ. Trip- and day-level agreement were tested. Results: The PALMS identified and correctly classified the mode of 75.6%, 94.5%, and 96.9% of pedestrian, cycling, and vehicle trips (84.5% of active trips, F1 = 0.84 and 0.87) as compared with the log. Fitbit and Garmin identified and correctly classified the mode of 26.8% and 17.8% (22.6% of active trips, F1 = 0.40 and 0.30) and 46.3% and 43.8% (45.2% of active trips, F1 = 0.58 and 0.59) of pedestrian and cycling trips. Garmin was more prone to false positives (false trips not logged). Day-level agreement for PALMS and Garmin versus logs was favorable across trip modes, though PALMS performed best. Fitbit significantly underestimated daily cycling. Results were similar but slightly less favorable for children than adults. Conclusions: The PALMS showed good convergent validity in children and adults and were about 50% and 27% more accurate than Fitbit and Garmin (based on F1). Empirically-based recommendations for improving PALMS’ pedestrian classification are provided. Since the consumer devices capture both indoor and outdoor walking/running and cycling, they are less appropriate for trip-based research

Tracking in the wild: exploring the everyday use of physical activity trackers

As the rates of chronical diseases, such as obesity, cardiovascular disease and diabetes continue to increase, the development of tools that support people in achieving healthier habits is becoming ever more important. Personal tracking systems, such as activity trackers, have emerged as a promising class of tools to support people in managing their everyday health. However, for this promise to be fulfilled, these systems need to be well designed, not only in terms of how they implement specific behavior change techniques, but also in how they integrate into people’s daily lives and address their daily needs. My dissertations provides evidence that accounting for people’s daily practices and needs can help to design activity tracking systems that help people get more value from their tracking practices. To understand how people derive value from their activity tracking practices, I have conducted two inquiries into people’s daily uses of activity tracking systems. In a fist attempt, I led a 10-month study of the adoption of Habito, our own activity tracking mobile app. Habito logged not only users’ physical activity, but also their interactions with the app. This data was used to acquire an estimate of the adoption rate of Habito, and understanding of how adoption is affected by users’ ‘readiness’, i.e., their attitude towards behavior change. In a follow-up study, I turned to the use of video methods and direct, in-situ observations of users’ interactions to understand what motivates people to engage with these tools in their everyday life, and how the surrounding environment shapes their use. These studies revealed some of the complexities of tracking, while extending some of the underlying ideas of behavior change. Among key results: (1) people’s use of activity trackers was found to be predominantly impulsive, where they simultaneously reflect, learn and change their behaviors as they collect data; (2) people’s use of trackers is deeply entangled with their daily routines and practices, and; (3) people use of trackers often is not in line with the traditional vision of these tools as mediators of change – trackers are also commonly used to simply learn about behaviors and engage in moments of self-discovery. Examining how to design activity tracking interfaces that best support people’s different needs , my dissertation further describes an inquiry into the design space of behavioral feedback interfaces. Through a iterative process of synthesis and analysis of research on activity tracking, I devise six design qualities for creating feedback that supports people in their interactions with physical activity data. Through the development and field deployment of four concepts in a field study, I show the potential of these displays for highlighting opportunities for action and learning.À medida que a prevalência de doenças crónicas como a obesidade, doenças cardiovasculares e diabetes continua a aumentar, o desenvolvimento de ferramentas que suportam pessoas a atingir mudanças de comportamento tem-se tornado essencial. Ferramentas de monitorização de comportamentos, tais como monitores de atividade física, têm surgido com a promessa de encorajar um dia a dia mais saudável. Contudo, para que essa promessa seja cumprida, torna-se essencial que estas ferramentas sejam bem concebidas, não só na forma como implementam determinadas estratégias de mudança de comportamento, mas também na forma como são integradas no dia-a-dia das pessoas. A minha dissertação demonstra a importância de considerar as necessidades e práticas diárias dos utilizadores destas ferramentas, de forma a ajudá-las a tirar melhor proveito da sua monitorização de atividade física. De modo a entender como é que os utilizadores destas ferramentas derivam valor das suas práticas de monitorização, a minha dissertação começa por explorar as práticas diárias associadas ao uso de monitores de atividade física. A minha dissertação contribui com duas investigações ao uso diário destas ferramentas. Primeiro, é apresentada uma investigação da adoção de Habito, uma aplicação para monitorização de atividade física. Habito não só registou as instâncias de atividade física dos seus utilizadores, mas também as suas interações com a própria aplicação. Estes dados foram utilizados para adquirir uma taxa de adopção de Habito e entender como é que essa adopção é afetada pela “prontidão” dos utilizadores, i.e., a sua atitude em relação à mudança de comportamento. Num segundo estudo, recorrendo a métodos de vídeo e observações diretas e in-situ da utilização de monitores de atividade física, explorei as motivações associadas ao uso diário destas ferramentas. Estes estudos expandiram algumas das ideias subjacentes ao uso das ferramentas para mudanças de comportamento. Entre resultados principais: (1) o uso de monitores de atividade física é predominantemente impulsivo, onde pessoas refletem, aprendem e alteram os seus comportamentos à medida que recolhem dados sobe estes mesmos comportamentos; (2) o uso de monitores de atividade física está profundamente interligado com as rotinas e práticas dos seus utilizadores, e; (3) o uso de monitores de atividade física nem sempre está ligado a mudanças de comportamento – estas ferramentas também são utilizadas para divertimento e aprendizagem. A minha dissertação contribui ainda com uma exploração do design de interfaces para a monitorização de atividade física. Através de um processo iterativo de síntese e análise de literatura, seis qualidades para a criação de interfaces são derivadas. Através de um estudo de campo, a minha dissertação demonstro o potencial dessas interfaces para ajudar pessoas a aprender e gerir a sua saúde diária

Quantifying Quality of Life

Describes technological methods and tools for objective and quantitative assessment of QoL Appraises technology-enabled methods for incorporating QoL measurements in medicine Highlights the success factors for adoption and scaling of technology-enabled methods This open access book presents the rise of technology-enabled methods and tools for objective, quantitative assessment of Quality of Life (QoL), while following the WHOQOL model. It is an in-depth resource describing and examining state-of-the-art, minimally obtrusive, ubiquitous technologies. Highlighting the required factors for adoption and scaling of technology-enabled methods and tools for QoL assessment, it also describes how these technologies can be leveraged for behavior change, disease prevention, health management and long-term QoL enhancement in populations at large. Quantifying Quality of Life: Incorporating Daily Life into Medicine fills a gap in the field of QoL by providing assessment methods, techniques and tools. These assessments differ from the current methods that are now mostly infrequent, subjective, qualitative, memory-based, context-poor and sparse. Therefore, it is an ideal resource for physicians, physicians in training, software and hardware developers, computer scientists, data scientists, behavioural scientists, entrepreneurs, healthcare leaders and administrators who are seeking an up-to-date resource on this subject

The impact of the COVID-19 pandemic on the use of urban green spaces by international youth in Bonn

Throughout the COVID-19 pandemic in Germany, international youth is undergoing manifold negative impacts on their living situation, mobility, mental and physical health and their social life. It is well-known that urban green space (UGS) offers multiple benefits for all age groups, and there are specific advantages for youth in particular, which impact their lifestyle and usage of UGS during COVID-19. In this thesis, usage of urban green spaces in the city of Bonn are being studied, while the study focuses on international youth with specific lifestyle traits, which define their challenges and limitations while living in Bonn during COVID-19. This thesis researches the changes in usage of UGS by international youth during COVID-19, and will study the impacts of these changes on social cohesion, physical activity and mental wellbeing – three pillars derived from a study by Hartig et al. Additionally, the study will briefly highlight how these experiences can lead to more inclusive policy in relation to UGS. To navigate youth’s experiences, ethnographic interviews with several youth have been carried out, of which the results have been analysed and categorized. For this, a systematic method for analysing qualitative interviews (Grounded Theory) has been used. The method uses labelling and tagging of words called ‘open’ and ‘selective coding’. Results showed social interaction and cohesion are one of the main incentives of visiting UGS, which is now severely affected, rendering international youth incapable to perform essential activities related to their specific lifestyles. UGS are often utilized as a tool to become more grounded in youths living environments through exploration, prior and during the COVID-19 pandemic. Conclusively, UGS serve as a green refuge to international youth, offering a space to exercise mental and physical wellbeing, and they have been proven crucial for coping with the effects of the COVID-19 pandemic. As youth is often ill-represented in policymaking in relation to UGS, future policymaking should be addressed to youth’s needs and challenges, which will in its entirety lead to more inclusive and accessible UGS. Youth should occupy a central position while policies on UGS need to be developed, breaking currently existing generational barriers