Understanding pivotal experiences in behavior change for the design of technologies for personal wellbeing.

Most health technologies are designed to support people who have already decided to work toward better health. Thus, there remains an opportunity to design technologies to help motivate people who have not yet decided to make a change. Understanding the experiences of people who have already started to make a health behavior change and how they made a pivotal decision can be useful in understanding how to design such tools. In this paper, we describe results from data collected in 2 phases. Phase 1 consisted of 127 surveys and 13 interviews with adults who have already accomplished behavior change(s). Phase 2 consisted of 117 surveys and 12 interviews with adults who have either already accomplished their behavior change(s) or are currently working toward them. We identified four factors that lead to pivotal experiences: (1) prolonged discontent and desire to change, (2) significant changes that increase fear or hope of future, (3) increased understanding of one's behavior and personal data, and (4) social accountability. We also describe a design space for designing technology-based interventions for encouraging people to decide to make a change to improve their health. Based on feedback from participants, we discuss opportunities for further exploration of the design space for people who are not yet motivated to change and for ethical considerations for this type of intervention.

Understanding Participant Needs for Engagement and Attitudes towards Passive Sensing in Remote Digital Health Studies.

Digital psychiatry is a rapidly growing area of research. Mobile assessment, including passive sensing, could improve research into human behavior and may afford opportunities for rapid treatment delivery. However, retention is poor in remote studies of depressed populations in which frequent assessment and passive monitoring are required. To improve engagement and understanding participant needs overall, we conducted semi-structured interviews with 20 people representative of a depressed population in a major metropolitan area. These interviews elicited feedback on strategies for long-term remote research engagement and attitudes towards passive data collection. Our results found participants were uncomfortable sharing vocal samples, need researchers to take a more active role in supporting their understanding of passive data collection, and wanted more transparency on how data were to be used in research. Despite these findings, participants trusted researchers with the collection of passive data. They further indicated that long term study retention could be improved with feedback and return of information based on the collected data. We suggest that researchers consider a more educational consent process, giving participants a choice about the types of data they share in the design of digital health apps, and consider supporting feedback in the design to improve engagement.