Current challenges and methods in adherence with mHealth applications used for alcohol use monitoring and reduction

Abstract. Smartphones have become ubiquitous in the modern world; with them business of mobile applications (apps) has risen. Included in these applications are mobile health (mHealth), also referred as electronic health (eHealth), apps that are designed to aid people suffering from a variety of health issues. In this thesis the focus is on apps that aid people with alcohol related issues. Goal for this thesis was to study the current field of existing mobile applications that, deal in people suffering from substance use issues, mainly excessive drinking. Specific focus is on the adherence of those apps and how they plan to maintain it. Using this existing expertise and utilizing a Design Science Research (DSR) approach, MyLimits, a design prototype of mHealth application was designed. MyLimits aims at aiding young adults to self-manage their drinking amounts and habits better, with the purpose of designing an app that is would be able to maintain adherence among its users. Two new features were innovated for MyLimits to improve its adherence and these new features were an unnoticeable mode for widget feature and regular check-up meetings with a chatbot. MyLimits and its new features were evaluated in interview sessions with members of the target age group, along with gathering experiences and thoughts on adherence in behaviour change apps. The research found that existing alcohol related mHealth apps apply a variety of tools for their users. Personal monitoring tools such as self-reporting and goals settings a popular among many others. Social features are also common allowing users to connect with other users, health professionals or people who have experience in reducing their drinking. Gamification and rewarding systems are on the forefront of upcoming apps, but their actual affects still require studying. Findings on adherence show that mHealth app’s adherence benefits from segmenting the progress as behaviour change requires a long-term process. Visits and communication with a health counsellor were a great predictor for adherence. Other key aspect to adherence were tailoring to allow the user to personalize their mHealth tool and reminders have been shown to increase adherence and effectiveness of the interventions. The small number of interviewees was a limitation for this thesis, with five interviewees being interviewed. This was greatly affected by the COVID-19 situation affecting the world during the fall of 2020. Therefore, the interviews were done online, by use of audio call and screen sharing. This removed the possibility for testing the app in a real-world scenario. The interviewees did not have self-reported issues with drinking, and this could affect how sensitively they see the topic. Measuring adherence requires a longer period of monitoring and testing, greatly limiting the potential of evaluating the adherence of MyLimits.Tiivistelmä. Älypuhelimet ovat kaikkialla nykymaailmassa ja niiden yleistyttyä on syntynyt uusia liiketoiminnan aloja, kuten mobiilisovellukset. Näihin lukeutuvat myös mobiiliterveys- eli mHealt-sovellukset sekä muut terveys- eli eHealth-sovellukset, jotka on suunniteltu auttamaan erilaisista terveysongelmista kärsiviä ihmisiä. Tämä tutkielma keskittyy alkoholin käytön ja juomisen seurantaan ja raportointiin liittyviin sovelluksiin. Tutkielmassa tarkkaillaan olemassa olevia alkoholiin liittyviä mobiilisovelluksia. Erityisesti tutkielmassa keskitytään sovellusten antamiin ohjeistuksiin ja niiden noudattamiseen sekä siihen, miten sovellukset parantavat käytön jatkuvuutta. Hyödyntämällä olemassa olevia taustatutkimuksia ja suunnittelutieteellisen (DSR) tutkimuksen lähestymistapaa, tässä tutkielmassa suunniteltiin mHealth-sovellusprototyyppi, MyLimits. MyLimitsin tarkoitus on auttaa nuoria aikuisia hallitsemaan juomismääriään ja -tapojaan paremmin samalla, kun sovelluksen kehityksessä keskitytään ylläpitämään käytön jatkuvuutta. MyLimitsille kehitettiin kaksi täysin uutta ominaisuutta, joiden tarkoituksena on sitouttaa käyttäjiä. Nämä uudet ominaisuudet ovat huomaamaton tila (unnoticiable mode) widget-pienohjelmaominaisuudelle sekä säännölliset tarkastustapaamiset chattibotin kanssa. MyLimitsiä ja sen uusia ominaisuuksia arvioitiin haastattelemalla kohderyhmään sopivia henkilöitä. Haastatteluissa kerättiin myös haastateltavien kokemuksia ja ajatuksia käyttäytymisenmuutossovellusten käytöstä ja niiden antamien ohjeiden noudattamisesta. Tutkimuksessa havaittiin, että nykyiset alkoholin käyttöön liittyvät mHealth-sovellukset tarjoavat useita erilaisia työkaluja käyttäjilleen. Henkilökohtaiset seurantatyökalut, kuten itseraportointi ja tavoitteiden asettaminen, ovat suosittuja. Yleisiä ovat myös sosiaaliset työkalut, joilla käyttäjät voivat olla yhteydessä toisiin käyttäjiin, terveydenhuollon ammattilaisiin tai ihmisiin, joilla on kokemusta juomisen vähentämisestä. Tulevaisuuden sovellusten eturintamassa testataan nykyisin pelillistämis- ja palkitsemisjärjestelmiä, mutta niiden vaikutukset edellyttävät vielä lisätutkimuksia. Käyttäjien sitoutumista testattaessa on huomattu, että mHealth-sovelluksen antamien ohjeiden noudattaminen vahvistuu edistymistä segmentoimalla, sillä pysyvä käytöksen muutos on pitkäaikainen prosessi. Tapaamiset ja viestintä terveydenhuollon henkilökunnan kanssa olivat tutkimuksen mukaan erinomaisia työkaluja sovelluksen antamien ohjeiden noudattamisen kannalta. Muita keskeisiä löytöjä ohjeiden noudattamiseen liittyen olivat sovelluksen mukauttaminen, jotta käyttäjä voi muokata sovelluksen työkaluja mieltymystensä mukaisesti, sekä muistutukset, joiden todettiin myös lisäävän sovellusten ohjeiden noudattamista ja yleistä tehokkuutta. Yksi rajoitus tutkimukselle oli haastateltavien pieni lukumäärä: haastatteluissa haastateltiin vain viittä potentiaalista käyttäjää. Tähän vaikutti suuresti syksyllä 2020 maailmaa kurittanut COVID-19-tilanne, joka poisti mahdollisuuden testata MyLimitsiä tosielämän käyttötilanteissa. Haastattelut suoritettiin verkossa äänipuheluita ja näytön jakoa hyödyntäen. Haastateltavat eivät ilmoittaneet heillä olevan ongelmia alkoholin käytön kanssa, joten he eivät ehkä suhtautuneet aiheeseen niin varautuneesti kuin oikea ongelmakäyttäjä saattaisi suhtautua. Sovellukseen sitoutuminen ja sen antamien ohjeiden noudattamisen tutkiminen vaatisivat pidempää seuranta- ja testausjaksoa, jonka puute rajoitti selvästi MyLimitsin sitouttamiskyvyn arviointia

Promoting Innovation in Albania

This project, based in Tirana, Albania, aims to promote innovation through the creation of a makerspace community, a space where people with creative ideas for new products can find the tools to develop them. A makerspace provides its members with resources such as prototyping tools, and a collaborative working atmosphere. This is much needed in Albania, since we found that students there often mention a lack of hands-on experience in their education. We worked with our local sponsor, Protik ICT Resource Center, to establish the makerspace and to plan future projects. We developed recommendations based on our work mentoring students in the Young Innovators Club and participating in Startup Weekend Tirana

Incomplete Innovation and the Premature Disruption of Legal Services

Article published in the Michigan State Law Review

Going back

The acceleration of social urbanization and education universalization in the past 30 years of China has promoted the popularization of mandarin among the public. Meanwhile, the dialect, as a unique regional language, is gradually dying away. In the city where I grew up, Taizhou, only the elders are likely to speak Taizhou dialect frequently in their life, while others prefer to use mandarin rather than dialect. The truth is the usage rate of dialect has gradually decreased from generation to generation. The primary goal of this thesis is to provide an opportunity for the public to “dialogue with the past” through an immersive language exhibition. The Taizhou Dialect is a local language spoken by residents of Taizhou City, on the southeast coast of China. This language is quite different from Mandarin in terms of pronunciation, words, and grammar. However, due to the acceleration of social urbanization and Mandarin popularization in the past 30 years of China, the usage rate of this local dialect is decreasing from generation to generation. An online questionnaire of 2019 shows that around 70% of the population in Taizhou City is accustomed to using Mandarin in daily communication, but no longer the dialect. Protecting and popularizing the disappearing dialects is critical before they are lost forever. From the perspective of protecting multiculturalism, the dialect is a carrier of local Intangible Cultural, the dying death of the dialect meaning these unique local cultures will also die away when the dialect no longer exists in our daily life. Furthermore,regional languages give people a sense of belonging and prompts emotional communication between neighbors. There is a well known ancient Chinese poem that makes clear the relationship between language, home and belonging: I was young when I went away and came home as an old man. My accent has not changed at all but my hair is now gray. Unlike typical exhibitions that focus more on displayed objects, this project emphasizes and establishes the intimate connection between the audiences and the exhibit information through an immersive and interactive space hosted in Taizhou Contemporary Art Museum. As Taizhou’s first contemporary art center, the recently built Taizhou Contemporary Art Museum plays a significant - 4 - role in Taizhou’s public art education. It is located inside of a cultural and creative center which is a major area of activity for residents nearby and also brings many young local people together. Dialects stories will be staged there and take the audiences to dialogue with the past

The Ironies of Automation Law: Tying Policy Knots with Fair Automation Practices Principles

Rapid developments in sensors, computing, and robotics, including power, kinetics, control, telecommunication, and artificial intelligence have presented opportunities to further integrate sophisticated automation across society. With these opportunities come questions about the ability of current laws and policies to protect important social values new technologies may threaten. As sophisticated automation moves beyond the cages of factories and cockpits, the need for a legal approach suitable to guide an increasingly automated future becomes more pressing. This Article analyzes examples of legal approaches to automation thus far by legislative, administrative, judicial, state, and international bodies. The case studies reveal an interesting irony: while automation regulation is intended to protect and promote human values, by focusing on the capabilities of the automation, this approach results in less protection of human values. The irony is similar to those pointed out by Lisanne Bainbridge in 1983, when she described how designing automation to improve the life of the operator using an automation-centered approach actually made the operator\u27s life worse and more difficult. The ironies that result from automation-centered legal approaches are a product of the neglect of the sociotechnical nature of automation: the relationships between man and machine are situated and interdependent, humans will always be in the loop, and reactive policies ignore the need for general guidance for ethical and accountable automation design and implementation. Like system engineers three decades ago, policymakers must adjust the focus of Meg Leta (Ambrose) Jones, J.D., Ph.D. is an Assistant Professor of Communication, legal treatment of automation to recognize the interdependence of man and machine to avoid the ironies of automation law and meet the goals of ethical integration. The Article proposes that the existing models utilized for safe and actual implementation for automated system design be supplemented with principles to guide ethical and sociotechnical legal approaches to automation

When Players Feel Helpless: Agentic Decay and Participation in Narrative Games

The ergodic (participatory) element of games is often cited as the core barrier to overcoming a perceived divide between good ludic (gaming) design and powerful storytelling. The present study examines two Indie games, Braid and Actual Sunlight, and their nuanced treatment of player participation in service of effective storytelling. These games in particular test the limits of player agency by asking the player to make ethically and morally problematic decisions, such as killing the main character, en route to completing the narrative. Such unusual narrative methods allow Braid and Actual Sunlight‗s game designers to unveil the mechanisms that afford, constrain, and ultimately revitalise the player‘s agency within the bounds of ergodic interaction. Narrative here, rather than restricting gameplay, instead enhances it, offering a tragic moment of cathartic relief as the player is exculpated for his or her decisions during the game. The insights drawn from these two examples and larger-studio offerings like Bioshock and Assassin’s Creed suggest a deeply traditional mode of storytelling at work in many narrative video games, an assertion that allows the ludological/narratological divide to be reknit and sets up ergodic media as a whole (video games, physical roleplaying games, interactive books, and more) for critical reconsideration

Musketeer 1932

Xavier Student Yearbook, published from 1924-2005. Not published: 1943-46, 1972-73, 1988-89, 2006-current.https://www.exhibit.xavier.edu/xavier_yearbook/1008/thumbnail.jp

Digital Storytelling in Field Education: A Model for Critical Consciousness

The dissertation comprises three scholarly work that examine use of digital storytelling (DST) in social work education. The first scholarly work is a conceptual paper that integrates the constructivist framework in presenting DST as a foundational tool for enhancing critical consciousness among social work students. The second scholarly contribution is an exploratory mix-methods study of 10 seniors, who were derived from a convenience sampling method from students enrolled in a field seminar course in partial fulfilment of the requirement of the degree Bachelor of Arts. The participant’s ages ranged from 21 to 40 years (Mage = 23.4, SDage = 5.82), representing different races — Hispanic or Latino (44.1%), White (33%), Asian (7.8%), two or more races (5.5%), Black or African American (4.7%), Native Hawaiian or Other Pacific Islanders (0.39%), and American Indian or Alaska Native (0.34%). The social work students and participants of this study reflected the overall college campus demographics. The quantitative aspect of the study consisted of one-group pre-and posttest design. Findings showed that students’ ratings moved significantly on certain measures at follow-up, compared to the baseline. The qualitative aspect is an analysis of students’ final DST reflection essays within a field seminar course. Data was analyzed using the content analysis methodology. An overall theme emerged demonstrating that DST assignment serves as a mechanism that enhanced the participants’ capacity to empathize with the storyteller’s personal feelings and beliefs as they became motivated to act. The third product is an annotated overview of a peer-reviewed presentation at the European Association of Schools of Social Work Conference Madrid 2019, which took place at the Complutense University of Madrid. The poster presentation highlighted findings from the mix method study (described above) that examined use of digital storytelling using a constructivist framework in field education