Developing cue-behavior association for habit formation: A qualitative study to explore the role of avatar in hypertension.

Background: Electronic health (eHealth) has been widely adopted in chronic disease management. Prior studies focused on time-based reminders as a cue to facilitate behavior change intentions, ignoring the development of automatic cue-behavior associations via other cue types. Objective: Hence, this study utilized avatar appearance as a visual-based cue to help establish the automatic association between appearance transformation and health behavior to form habits without intention. Methods: To better understand users' attitudes and experiences toward applying changes in avatar appearance to develop cue-behavior associations for hypertensive patients. Fifteen participants were recruited in a 14-day experiment. After excluding one participant who dropped out of the experiment, others were randomly assigned to two groups. One group consisted of a visual-based cue (a virtual plant) and basic behavior change techniques (BCTs). The other group only included basic BCTs. Attitudes and experience outcomes were collected by interview, and qualitative data were analyzed using thematic analysis. Results: 57% of participants had been diagnosed with hypertension for more than five years, and more than 50% of participants have experience using mobile apps or wearables. 66% of participants did physical activity more than three times every week. The result shows that tailored time-based reminders, blood pressure monitoring, and daily dietary intake were the most attractive features. Additionally, hypertensive participants have positive attitudes toward avatar appearance as a visual-based cue to develop cue-behavior association, which enhances self-management motivation. Conclusion: This study proposes a visual-based cue design for habit formation and conducts a qualitative method to explore hypertensive patients' perceptions. The findings offer insights from user's perspectives into hypertensive patients' attitudes toward visual-based cues and perception of the connection between avatar appearance and health behavior for self-management. Subsequent discussions present eHealth design guidelines of habit formation from intention, automatic cue-behavior association, and self-management perspectives.

Detecting subtle yet fast skeletal muscle contractions with ultrasoft and durable graphene-based cellular materials.

Human bodily movements are primarily controlled by the contractions of skeletal muscles. Unlike joint or skeletal movements that are generally performed in the large displacement range, the contractions of the skeletal muscles that underpin these movements are subtle in intensity yet high in frequency. This subtlety of movement makes it a formidable challenge to develop wearable and durable soft materials to electrically monitor such motions with high fidelity for the purpose of, for example, muscle/neuromuscular disease diagnosis. Here we report that an intrinsically fragile ultralow-density graphene-based cellular monolith sandwiched between silicone rubbers can exhibit a highly effective stress and strain transfer mechanism at its interface with the rubber, with a remarkable improvement in stretchability (>100%). In particular, this hybrid also exhibits a highly sensitive, broadband-frequency electrical response (up to 180 Hz) for a wide range of strains. By correlating the mechanical signal of muscle movements obtained from this hybrid material with electromyography, we demonstrate that the strain sensor based on this hybrid material may provide a new, soft and wearable mechanomyography approach for real-time monitoring of complex neuromuscular-skeletal interactions in a broad range of healthcare and human-machine interface applications. This work also provides a new architecture-enabled functional soft material platform for wearable electronics.

Standing Enokitake-like Nanowire Films for Highly Stretchable Elastronics.

Stretchable electronics may enable electronic components to be part of our organs-ideal for future wearable/implantable biodiagnostic systems. One of key challenges is failure of the soft/rigid material interface due to mismatching Young's moduli, which limits stretchability and durability of current systems. Here, we show that standing enokitake-like gold-nanowire-based films chemically bonded to an elastomer can be stretched up to 900% and are highly durable, with >93% conductivity recovery even after 2000 stretching/releasing cycles to 800% strain. Both experimental and modeling reveal that this superior elastic property originates from standing enokitake-like nanowire film structures. The closely packed nanoparticle layer sticks to the top of the nanowires, which easily cracks under strain, whereas the bottom part of the nanowires is compliant with substrate deformation. This leads to tiny V-shaped cracks with a maintained electron transport pathway rather than large U-shaped cracks that are frequently observed for conventional metal films. We further show that our standing nanowire films can serve as current collectors in supercapacitors and second skin-like smart masks for facial expression detection.

Skin inspired fractal strain sensors using a copper nanowire and graphite microflake hybrid conductive network.

This work demonstrates a facile "paint-on" approach to fabricate highly stretchable and highly sensitive strain sensors by combining one-dimensional copper nanowire networks with two-dimensional graphite microflakes. This paint-on approach allows for the fabrication of electronic skin (e-skin) patches which can directly replicate with high fidelity the human skin surface they are on, regardless of the topological complexity. This leads to high accuracy for detecting biometric signals for applications in personalised wearable sensors. The copper nanowires contribute to high stretchability and the graphite flakes offer high sensitivity, and their hybrid coating offers the advantages of both. To understand the topological effects on the sensing performance, we utilized fractal shaped elastomeric substrates and systematically compared their stretchability and sensitivity. We could achieve a high stretchability of up to 600% and a maximum gauge factor of 3000. Our simple yet efficient paint-on approach enabled facile fine-tuning of sensitivity/stretchability simply by adjusting ratios of 1D vs. 2D materials in the hybrid coating, and the topological structural designs. This capability leads to a wide range of biomedical sensors demonstrated here, including pulse sensors, prosthetic hands, and a wireless ankle motion sensor.