Home is where the head is: a distributed cognition account of personal health information management in the home among those with chronic illness.

Managing chronic illness requires personal health information management (PHIM) to be performed by lay individuals. Paramount to understanding the PHIM process is understanding the sociotechnical system in which it frequently occurs: the home environment. We combined distributed cognition theory and the patient work system model to investigate how characteristics of the home interact with the cognitive work of PHIM. We used a 3D virtual reality CAVE that enabled participants who had been diagnosed with diabetes (N = 20) to describe how they would perform PHIM in the home context. We found that PHIM is distinctly cognitive work, and rarely performed 'in the head'. Rather, features of the physical environment, tasks, people, and tools and technologies present, continuously shape and are shaped by the PHIM process. We suggest that approaches in which the individual (sans context) is considered the relevant unit of analysis overlook the pivotal role of the environment in shaping PHIM. Practitioner Summary: We examined how Personal Health Information Management (PHIM) is performed in the homes of diabetic patients. We found that approaches to studying cognition that focus on the individual, to the exclusion of their context, overlook the pivotal role of environmental, social, and technological features in shaping PHIM.

Virtualizing living and working spaces: Proof of concept for a biomedical space-replication methodology.

The physical spaces within which the work of health occurs - the home, the intensive care unit, the emergency room, even the bedroom - influence the manner in which behaviors unfold, and may contribute to efficacy and effectiveness of health interventions. Yet the study of such complex workspaces is difficult. Health care environments are complex, chaotic workspaces that do not lend themselves to the typical assessment approaches used in other industrial settings. This paper provides two methodological advances for studying internal health care environments: a strategy to capture salient aspects of the physical environment and a suite of approaches to visualize and analyze that physical environment. We used a Faro™ laser scanner to obtain point cloud data sets of the internal aspects of home environments. The point cloud enables precise measurement, including the location of physical boundaries and object perimeters, color, and light, in an interior space that can be translated later for visualization on a variety of platforms. The work was motivated by vizHOME, a multi-year program to intensively examine the home context of personal health information management in a way that minimizes repeated, intrusive, and potentially disruptive in vivo assessments. Thus, we illustrate how to capture, process, display, and analyze point clouds using the home as a specific example of a health care environment. Our work presages a time when emerging technologies facilitate inexpensive capture and efficient management of point cloud data, thus enabling visual and analytical tools for enhanced discharge planning, new insights for designers of consumer-facing clinical informatics solutions, and a robust approach to context-based studies of health-related work environments.

Quality and Accessibility of Home Assessment mHealth Apps for Community Living: Systematic Review.

BACKGROUND: Home assessment is a critical component of successful home modifications, enabling individuals with functional limitations to age in place comfortably. A high-quality home assessment tool should facilitate a valid and reliable assessment involving health care and housing professionals, while also engaging and empowering consumers and their caregivers who may be dealing with multiple functional limitations. Unlike traditional paper-and-pencil assessments, which require extensive training and expert knowledge and can be alienating to consumers, mobile health (mHealth) apps have the potential to engage all parties involved, empowering and activating consumers to take action. However, little is known about which apps contain all the necessary functionality, quality appraisal, and accessibility. OBJECTIVE: This study aimed to assess the functionality, overall quality, and accessibility of mHealth home assessment apps. METHODS: mHealth apps enabling home assessment for aging in place were identified through a comprehensive search of scholarly articles, the Apple (iOS) and Google Play (Android) stores in the United States, and fnd.io. The search was conducted between November 2022 and January 2023 following a method adapted from PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Reviewers performed a content analysis of the mobile app features to evaluate their functionality, overall quality, and accessibility. The functionality assessment used a home assessment component matrix specifically developed for this study. For overall quality, the Mobile Application Rating Scale (MARS) was used to determine the apps' effectiveness in engaging and activating consumers and their caregivers. Accessibility was assessed using the Web Content Accessibility Guidelines (WCAG) 2.1 (A and AA levels). These 3 assessments were synthesized and visualized to provide a comprehensive evaluation. RESULTS: A total of 698 apps were initially identified. After further screening, only 6 apps remained. Our review revealed that none of the apps used thoroughly tested assessment tools, offered all the functionality required for reliable home assessment, achieved the "good" quality threshold as measured by the MARS, or met the accessibility criteria when evaluated against WCAG 2.1. However, DIYModify received the highest scores in both the overall quality and accessibility assessments. The MapIt apps also showed significant potential due to their ability to measure the 3D environment and the inclusion of a desktop version that extends the app's functionality. CONCLUSIONS: Our review revealed that there are very few apps available within the United States that possess the necessary functionality, engaging qualities, and accessibility to effectively activate consumers and their caregivers for successful home modification. Future app development should prioritize the integration of reliable and thoroughly tested assessment tools as the foundation of the development process. Furthermore, efforts should be made to enhance the overall quality and accessibility of these apps to better engage and empower consumers to take necessary actions to age in place.

Evaluating the Acceptability and Appropriateness of the Augmented Reality Home Assessment Tool (ARHAT): Qualitative Descriptive Study.

Background: The Augmented Reality Home Assessment Tool (ARHAT) is a mobile app developed to provide rapid, highly accurate assessments of the home environment. It uses 3D-capture technologies to help people identify and address functional limitations and environmental barriers. Objective: This study was conducted to gain stakeholder feedback on the acceptability and appropriateness of the ARHAT for identifying and addressing barriers within home environments. Methods: A qualitative descriptive study was conducted because it allows for variability when obtaining data and seeks to understand stakeholders' insights on an understudied phenomenon. Each stakeholder group (occupational therapists, housing professionals, and aging adult and caregiver "dyads") participated in a 60-minute, web-based focus group via a secure Zoom platform. Focus group data were analyzed by 2 trained qualitative research team members using a framework method for analysis. Results: A total of 19 stakeholders, aged from 18 to 85+ years, were included in the study. Of the occupational therapists (n=5, 26%), housing professionals (n=3, 16%), and dyads (n=11, 58%), a total of 32% (n=6) were male and 68% (n=13) were female, with most living in the Midwestern United States (n=10, 53%). The focus group data demonstrate the acceptability and appropriateness of the workflow, style, measurement tools, and impact of the ARHAT. All stakeholders stated that they could see the ARHAT being used at many different levels and by any population. Dyads specifically mentioned that the ARHAT would allow them to do forward planning and made them think of home modifications in a new light. Conclusions: Stakeholders found the ARHAT to be acceptable and appropriate for identifying and addressing functional limitations and barriers in the home environment. This study highlights the importance of considering the workflow, style, measurement tools, and potential impact of home assessment technology early in the developmental process.

Toward Understanding Everyday Lives of Older Adults: A Methodological Exploration.

BACKGROUND AND OBJECTIVES: Emerging trends in aging in place and increasing needs for home health care highlight the importance of researching older adults' daily lives as they unfold within their residential environments. However, studies that examine how older adults interact with their home environments are scarce as homes are fluid and private spaces and do not render themselves easily to the researcher's eyes. This article explores a new investigational method combining 3D-scanning and biomarker tracking technology with in-depth qualitative interviews in situ to explore older adults' daily interactions with their home environments. RESEARCH DESIGN AND METHODS: We employed a unique approach that combined spatial, locational, and physiological tracking technology with in-depth qualitative in-home interviews with older adults aged 62-89 who received home modifications as a means to successfully age in place. We explored multiple data sets both individually and collectively, using various data analysis, visualization, and integration methods to test the feasibility and utility of our approach. RESULTS: A review of individual data sets allowed unique insights into different aspects of the daily lives of this sample of older adults. When combined, the data sets and subsequent analysis allowed an in-depth understanding of participants' well-being and adaptive behaviors. DISCUSSION AND IMPLICATIONS: This study provides a strong methodology for studying the home environment and its impact on the participants' health and well-being. Insights obtained through this method can inform research, policy, and practice at all levels for professionals to continue exploring ways to support older adults aged 65 and older aging at home.

The Effects of Systematic Environmental Manipulation on Gait of Older Adults.

Quantification of gait changes in response to altered environmental stimuli may allow for improved understanding of the mechanisms that influence gait changes and fall occurrence in older adults. This study explored how systematic manipulation of a single dimension of one's environment affects spatiotemporal gait parameters. A total of 20 older adult participants walked at a self-selected pace in a constructed research hallway featuring a mobile wall, which allowed manipulation of the hallway width between three conditions: 1.14 m, 1.31 m, and 1.48 m. Spatiotemporal data from participants' walks were captured using an instrumented GAITRite mat. A repeated measures ANOVA revealed older adults spent significantly more time in double support in the narrowest hallway width compared to the widest, but did not significantly alter other spatiotemporal measures. Small-scale manipulations of a single dimension of the environment led to subtle, yet in some cases significant changes in gait, suggesting that small or even imperceptible environmental changes may contribute to altered gait patterns for older adults.

A Sociotechnical Systems Approach Toward Tailored Design for Personal Health Information Management.

We used a sociotechnical systems approach-which conceptualizes a system of interacting people, technologies, and tasks, to identify individual differences in personal health information management (PHIM) that can inform the design for patient-friendly environments, tools and technologies. We conducted a secondary thematic analysis of data collected as part of a parent project, vizHOME. The goal of vizHOME was to improve health and health outcomes through identifying key features in the environment that will inform the design of consumer health information technology HIT. We analyzed interview data collected from 20 individuals with diabetes. We found seven dimensions of PHIM: (1) level of privacy preferred for PHIM; (2) amount of engagement in PHIM; (3) extent of guidance preferred for PHIM; (4) level of documentation preferred for PHIM; (5) degree of physical distribution of PHIM; (6) amount of flexibility in PHIM routine; and (7) use of external cues to manage PHIM. Our results suggest that each dimension exists as a continuum, which are anchored from low to high. Exploring the interaction between PHIM and the sociotechnical system in which PHIM is performed revealed key dimensions of PHIM as well as individual differences in those PHIM dimensions. Identification of individual differences in PHIM can support the creation of human-centered design considerations for tailored environments, products, processes, and technologies that support PHIM. Future research will seek to validate PHIM dimensions in a larger population and develop a PHIM-typing measure to identify PHIM types toward tailoring processes, products, and to individual needs in context.

The desktop, or the top of the desk? The relative usefulness of household features for personal health information management.

Sixty percent of the US population manages at least one chronic illness. For these patients, personal health information management (PHIM) is an integral part of daily life, and largely occurs within the home. However, the way in which the home supports PHIM has not been systematically investigated. The present study examined how members of the diabetic population use features of the home environment to support PHIM. Participants (N = 60) explored a simulated home environment, the VR CAVE, and identified the most useful features for performing three examples of PHIM tasks. The computer was perceived as the most useful feature for PHIM. However, perceived usefulness of features varied based on the PHIM task performed and the rooms in which features appeared. We conclude that a detailed study of the affordances of features is necessary to ease the burden of managing chronic illness, particularly diabetes mellitus, in the sociotechnical system of the home.

Use of Virtual Reality Feedback for Patients with Chronic Neck Pain and Kinesiophobia.

This study examined how individuals with and without neck pain performed exercises under the influence of altered visual feedback in virtual reality. Chronic neck pain (n=9) and asymptomatic (n=10) individuals were recruited for this cross-sectional study. Participants performed head rotations while receiving programmatically manipulated visual feedback from a head-mounted virtual reality display. The main outcome measure was the control-display gain (ratio between actual head rotation angle and visual rotation angle displayed) recorded at the just-noticeable difference. Actual head rotation angles were measured for different gains. Detection of the manipulated visual feedback was affected by gain. The just-noticeable gain for asymptomatic individuals, below and above unity gain, was 0.903 and 1.159, respectively. Head rotation angle decreased or increased 5.45° for every 0.1 increase or decrease in gain, respectively. The just-noticeable gain for chronic pain individuals, below unity gain, was 0.950. The head rotation angle increased 4.29° for every 0.1 decrease in gain. On average, chronic pain individuals reported that neck rotation was feasible for 84% of the unity gain trials, 66% of the individual just-noticeable difference trials, and 50% of the "nudged" just-noticeable difference trials. This research demonstrated that virtual reality may be useful for promoting the desired outcome of increased range of motion in neck rehabilitation exercises by altering visual feedback.

Use of Virtual Reality Feedback for Patients with Chronic Neck Pain and Kinesiophobia.

This study examined how individuals with and without neck pain performed exercises under the influence of altered visual feedback in virtual reality. Chronic neck pain (n=9) and asymptomatic (n=10) individuals were recruited for this cross-sectional study. Participants performed head rotations while receiving programmatically manipulated visual feedback from a head-mounted virtual reality display. The main outcome measure was the control-display gain (ratio between actual head rotation angle and visual rotation angle displayed) recorded at the just-noticeable difference. Actual head rotation angles were measured for different gains. Detection of the manipulated visual feedback was affected by gain. The just-noticeable gain for asymptomatic individuals, below and above unity gain, was 0.903 and 1.159, respectively. Head rotation angle decreased or increased 5.45° for every 0.1 increase or decrease in gain, respectively. The just-noticeable gain for chronic pain individuals, below unity gain, was 0.950. The head rotation angle increased 4.29° for every 0.1 decrease in gain. On average, chronic pain individuals reported that neck rotation was feasible for 84% of the unity gain trials, 66% of the individual just-noticeable difference trials, and 50% of the "nudged" just-noticeable difference trials. This research demonstrated that virtual reality may be useful for promoting the desired outcome of increased range of motion in neck rehabilitation exercises by altering visual feedback.

SafeHOME: Promoting Safe Transitions to the Home.

This paper introduces the SafeHome Simulator system, a set of immersive Virtual Reality Training tools and display systems to train patients in safe discharge procedures in captured environments of their actual houses. The aim is to lower patient readmission by significantly improving discharge planning and training. The SafeHOME Simulator is a project currently under review.

Virtual exertions: evoking the sense of exerting forces in virtual reality using gestures and muscle activity.

OBJECTIVE: This study was a proof of concept for virtual exertions, a novel method that involves the use of body tracking and electromyography for grasping and moving projections of objects in virtual reality (VR). The user views objects in his or her hands during rehearsed co-contractions of the same agonist-antagonist muscles normally used for the desired activities to suggest exerting forces. BACKGROUND: Unlike physical objects, virtual objects are images and lack mass. There is currently no practical physically demanding way to interact with virtual objects to simulate strenuous activities. METHOD: Eleven participants grasped and lifted similar physical and virtual objects of various weights in an immersive 3-D Cave Automatic Virtual Environment. Muscle activity, localized muscle fatigue, ratings of perceived exertions, and NASA Task Load Index were measured. Additionally, the relationship between levels of immersion (2-D vs. 3-D) was studied. RESULTS: Although the overall magnitude of biceps activity and workload were greater in VR, muscle activity trends and fatigue patterns for varying weights within VR and physical conditions were the same. Perceived exertions for varying weights were not significantly different between VR and physical conditions. CONCLUSIONS: Perceived exertion levels and muscle activity patterns corresponded to the assigned virtual loads, which supported the hypothesis that the method evoked the perception of physical exertions and showed that the method was promising. APPLICATION: Ultimately this approach may offer opportunities for research and training individuals to perform strenuous activities under potentially safer conditions that mimic situations while seeing their own body and hands relative to the scene.

Manually locating physical and virtual reality objects.

OBJECTIVE: In this study, we compared how users locate physical and equivalent three-dimensional images of virtual objects in a cave automatic virtual environment (CAVE) using the hand to examine how human performance (accuracy, time, and approach) is affected by object size, location, and distance. BACKGROUND: Virtual reality (VR) offers the promise to flexibly simulate arbitrary environments for studying human performance. Previously, VR researchers primarily considered differences between virtual and physical distance estimation rather than reaching for close-up objects. METHOD: Fourteen participants completed manual targeting tasks that involved reaching for corners on equivalent physical and virtual boxes of three different sizes. Predicted errors were calculated from a geometric model based on user interpupillary distance, eye location, distance from the eyes to the projector screen, and object. RESULTS: Users were 1.64 times less accurate (p < .001) and spent 1.49 times more time (p = .01) targeting virtual versus physical box corners using the hands. Predicted virtual targeting errors were on average 1.53 times (p < .05) greater than the observed errors for farther virtual targets but not significantly different for close-up virtual targets. CONCLUSION: Target size, location, and distance, in addition to binocular disparity, affected virtual object targeting inaccuracy. Observed virtual box inaccuracy was less than predicted for farther locations, suggesting possible influence of cues other than binocular vision. APPLICATION: Human physical interaction with objects in VR for simulation, training, and prototyping involving reaching and manually handling virtual objects in a CAVE are more accurate than predicted when locating farther objects.

Perceptual calibration for immersive display environments.

The perception of objects, depth, and distance has been repeatedly shown to be divergent between virtual and physical environments. We hypothesize that many of these discrepancies stem from incorrect geometric viewing parameters, specifically that physical measurements of eye position are insufficiently precise to provide proper viewing parameters. In this paper, we introduce a perceptual calibration procedure derived from geometric models. While most research has used geometric models to predict perceptual errors, we instead use these models inversely to determine perceptually correct viewing parameters. We study the advantages of these new psychophysically determined viewing parameters compared to the commonly used measured viewing parameters in an experiment with 20 subjects. The perceptually calibrated viewing parameters for the subjects generally produced new virtual eye positions that were wider and deeper than standard practices would estimate. Our study shows that perceptually calibrated viewing parameters can significantly improve depth acuity, distance estimation, and the perception of shape.

Envisioning the future of home care: applications of immersive virtual reality.

Accelerating the design of technologies to support health in the home requires 1) better understanding of how the household context shapes consumer health behaviors and (2) the opportunity to afford engineers, designers, and health professionals the chance to systematically study the home environment. We developed the Living Environments Laboratory (LEL) with a fully immersive, six-sided virtual reality CAVE to enable recreation of a broad range of household environments. We have successfully developed a virtual apartment, including a kitchen, living space, and bathroom. Over 2000 people have visited the LEL CAVE. Participants use an electronic wand to activate common household affordances such as opening a refrigerator door or lifting a cup. Challenges currently being explored include creating natural gesture to interface with virtual objects, developing robust, simple procedures to capture actual living environments and rendering them in a 3D visualization, and devising systematic stable terminologies to characterize home environments.

Cultivating imagination: development and pilot test of a therapeutic use of an immersive virtual reality CAVE.

As informatics applications grow from being data collection tools to platforms for action, the boundary between what constitutes informatics applications and therapeutic interventions begins to blur. Emerging computer-driven technologies such as virtual reality (VR) and mHealth apps may serve as clinical interventions. As part of a larger project intended to provide complements to cognitive behavioral approaches to health behavior change, an interactive scenario was designed to permit unstructured play inside an immersive 6-sided VR CAVE. In this pilot study we examined the technical and functional performance of the CAVE scenario, human tolerance of immersive CAVE experiences, and explored human imagination and the manner in which activity in the CAVE scenarios varied by an individual's level of imagination. Nine adult volunteers participated in a pilot-and-feasibility study. Participants tolerated 15 minute long exposure to the scenarios, and navigated through the virtual world. Relationship between personal characteristics and behaviors are reported and explored.

Effective replays and summarization of virtual experiences.

Direct replay of the experience of a user in a virtual environment is difficult for others to watch due to unnatural camera motions. We present methods for replaying and summarizing these egocentric experiences that effectively communicate the user's observations while reducing unwanted camera movements. Our approach summarizes the viewpoint path as a concise sequence of viewpoints that cover the same parts of the scene. The core of our approach is a novel content-dependent metric that can be used to identify similarities between viewpoints. This enables viewpoints to be grouped by similar contextual view information and provides a means to generate novel viewpoints that can encapsulate a series of views. These resulting encapsulated viewpoints are used to synthesize new camera paths that convey the content of the original viewer's experience. Projecting the initial movement of the user back on the scene can be used to convey the details of their observations, and the extracted viewpoints can serve as bookmarks for control or analysis. Finally we present performance analysis along with two forms of validation to test whether the extracted viewpoints are representative of the viewer's original observations and to test for the overall effectiveness of the presented replay methods.

Online Real-Time Presentation of Virtual Experiences for External Viewers.

Externally observing the experience of a participant in a virtual environment is generally accomplished by viewing an egocentric perspective. Monitoring this view can often be difficult for others to watch due to unwanted camera motions that appear unnatural and unmotivated. We present a novel method for reducing the unnaturalness of these camera motions by minimizing camera movement while maintaining the context of the participant's observations. For each time-step, we compare the parts of the scene viewed by the virtual participant to the parts of the scene viewed by the camera. Based on the similarity of these two viewpoints we next determine how the camera should be adjusted. We present two means of adjustment, one which continuously adjusts the camera and a second which attempts to stop camera movement when possible. Empirical evaluation shows that our method can produce paths that have substantially shorter travel distances, are easier to watch and maintain the original observations of the participant's virtual experience.

Virtual Exertions: a user interface combining visual information, kinesthetics and biofeedback for virtual object manipulation.

Virtual Reality environments have the ability to present users with rich visual representations of simulated environments. However, means to interact with these types of illusions are generally unnatural in the sense that they do not match the methods humans use to grasp and move objects in the physical world. We demonstrate a system that enables users to interact with virtual objects with natural body movements by combining visual information, kinesthetics and biofeedback from electromyograms (EMG). Our method allows virtual objects to be grasped, moved and dropped through muscle exertion classification based on physical world masses. We show that users can consistently reproduce these calibrated exertions, allowing them to interface with objects in a novel way.