User Based Development and Test of the EXOTIC Exoskeleton: Empowering Individuals with Tetraplegia Using a Compact, Versatile, 5-DoF Upper Limb Exoskeleton Controlled through Intelligent Semi-Automated Shared Tongue Control.

This paper presents the EXOTIC- a novel assistive upper limb exoskeleton for individuals with complete functional tetraplegia that provides an unprecedented level of versatility and control. The current literature on exoskeletons mainly focuses on the basic technical aspects of exoskeleton design and control while the context in which these exoskeletons should function is less or not prioritized even though it poses important technical requirements. We considered all sources of design requirements, from the basic technical functions to the real-world practical application. The EXOTIC features: (1) a compact, safe, wheelchair-mountable, easy to don and doff exoskeleton capable of facilitating multiple highly desired activities of daily living for individuals with tetraplegia; (2) a semi-automated computer vision guidance system that can be enabled by the user when relevant; (3) a tongue control interface allowing for full, volitional, and continuous control over all possible motions of the exoskeleton. The EXOTIC was tested on ten able-bodied individuals and three users with tetraplegia caused by spinal cord injury. During the tests the EXOTIC succeeded in fully assisting tasks such as drinking and picking up snacks, even for users with complete functional tetraplegia and the need for a ventilator. The users confirmed the usability of the EXOTIC.

Exploring the barriers and facilitators for supporting adolescents with knee pains adherence to mobile health apps: A think-aloud study.

Background: Mobile health (mHealth) applications have the potential to support adolescents' self-management of knee pain. However, ensuring adherence remains a barrier when designing mHealth concepts for adolescents. Objective: This study aimed to explore barriers and facilitators for adhering to mHealth interventions to inform design principles. Methods: Think-aloud tests were conducted with 12 adolescents (aged 12.5 years median) with knee pain, using a low-fidelity prototype. The prototype was informed by the authors previous work, rapid prototyping sessions with seven health professionals, and synthesis via the Behavioral Intervention Technology Model. The think-aloud tests were video recorded and analyzed thematically to identify design principles. Results: The analysis based on user testing with adolescents with knee pain identified three themes: "user experience and feedback," "contextual challenges," and "new features" and nine subthemes. Adolescents were able to use mHealth behavioral features such as self-tracking, goal setting, education, and data visualization to capture and reflect on their knee pain developments, which facilitated use. However, adolescents struggle with timing interventions, breaking down management behaviors, and biases towards interventions were identified as internal threats to adherence. Competing activities, parental meddling, and privacy concerns were external adherence barriers. Twelve design principles were identified for integrating these insights into mHealth designs. Conclusion: Participants' motivations for adherence were influenced by internal and external factors. While adolescents were able to use mHealth behavioral features to capture and reflect on knee pain developments, understanding how to accommodate adolescents' cognitive abilities, competing activities, and need for independence is quintessential to enhance adherence in everyday contexts.

Exploring User Visions for Modeling mHealth Apps Toward Supporting Patient-Parent-Clinician Collaboration and Shared Decision-making When Treating Adolescent Knee Pain in General Practice: Workshop Study.

BACKGROUND: Long-standing knee pain is one of the most common reasons for adolescents (aged 10-19 years) to consult general practice. Generally, 1 in 2 adolescents will continue to experience pain after 2 years, but exercises and self-management education can improve the prognosis. However, adherence to exercises and self-management education interventions remains poor. Mobile health (mHealth) apps have the potential for supporting adolescents' self-management, enhancing treatment adherence, and fostering patient-centered approaches. However, it remains unclear how mHealth apps should be designed to act as tools for supporting individual and collaborative management of adolescents' knee pain in a general practice setting. OBJECTIVE: The aim of the study was to extract design principles for designing mHealth core features, which were both sufficiently robust to support adolescents' everyday management of their knee pain and sufficiently flexible to act as enablers for enhancing patient-parent collaboration and shared decision-making. METHODS: Overall, 3 future workshops were conducted with young adults with chronic knee pain since adolescence, parents, and general practitioners (GPs). Each workshop followed similar procedures, using case vignettes and design cards to stimulate discussions, shared construction of knowledge and elicit visions for mHealth designs. Young adults and parents were recruited via social media posts targeting individuals in Northern Jutland. GPs were recruited via email and cold calling. Data were transcribed and analyzed thematically using NVivo (QSR International) coding software. Extracted themes were synthesized in a matrix to map tensions in the collaborative space and inform a conceptual model for designing mHealth core-features to support individual and collaborative management of knee pain. RESULTS: Overall, 38% (9/24) young adults with chronic knee pain since adolescence, 25% (6/24) parents, and 38% (9/24) GPs participated in the workshops. Data analysis revealed how adolescents, parents, and clinicians took on different roles within the collaborative space, with different tasks, challenges, and information needs. In total, 5 themes were identified: adolescents as explorers of pain and social rules; parents as supporters, advocates and enforcers of boundaries; and GPs as guides, gatekeepers, and navigators or systemic constraints described participants' roles; collaborative barriers and tensions referred to the contextual elements; and visions for an mHealth app identified beneficial core features. The synthesis informed a conceptual model, outlining 3 principles for consolidating mHealth core features as enablers for supporting role negotiation, limiting collaborative tensions, and facilitating shared decision-making. CONCLUSIONS: An mHealth app for treating adolescents with knee pain should be designed to accommodate multiple users, enable them to shift between individual management decision-making, take charge, and engage in role negotiation to inform shared decision-making. We identified 3 silver-bullet principles for consolidating mHealth core features as enablers for negotiation by supporting patient-GP collaboration, supporting transitions, and cultivating the parent-GP alliance.

The impact of interdisciplinarity and user involvement on the design and usability of an assistive upper limb exoskeleton - a case study on the EXOTIC.

This study describes an interdisciplinary approach to develop a 5 degrees of freedom assistive upper limb exoskeleton (ULE) for users with severe to complete functional tetraplegia. Four different application levels were identified for the ULE ranging from basic technical application to interaction with users, interaction with caregivers and interaction with the society, each level posing requirements for the design and functionality of the ULE. These requirements were addressed through an interdisciplinary collaboration involving users, clinicians and researchers within social sciences and humanities, mechanical engineering, control engineering media technology and biomedical engineering. The results showed that the developed ULE, the EXOTIC, had a high level of usability, safety and adoptability. Further, the results showed that several topics are important to explicitly address in relation to the facilitation of interdisciplinary collaboration including, defining a common language, a joint visualization of the end goal and a physical frame for the collaboration, such as a shared laboratory. The study underlined the importance of interdisciplinarity and we believe that future collaboration amongst interdisciplinary researchers and centres, also at an international level, can strongly facilitate the usefulness and adoption of assistive exoskeletons and similar technologies.

Four principles for user interface design of computerised clinical decision support systems.

The paper presents results from a design research project of a user interface (UI) for a Computerised Clinical Decision Support System (CDSS). The ambition has been to design Human-Computer Interaction (HCI) that can minimise medication errors. Through an iterative design process a digital prototype for prescription of medicine has been developed. This paper presents results from the formative evaluation of the prototype conducted in a simulation laboratory with ten participating physicians. Data from the simulation is analysed by use of theory on how users perceive information. The conclusion is a model, which sum up four principles of interaction for design of CDSS. The four principles for design of user interfaces for CDSS are summarised as four A's: All in one, At a glance, At hand and Attention. The model emphasises integration of all four interaction principles in the design of user interfaces for CDSS, i.e. the model is an integrated model which we suggest as a guide for interaction design when working with preventing medication errors.

How Socio-Technical Factors Can Undermine Expectations of Human-Robot Cooperation in Hospitals.

This research analysed human-robot cooperation and interaction in the basement of a Danish hospital, where kitchen staff and porters conducted their daily routines in an environment shared with mobile service robots. The robots were installed to ease the everyday routines of kitchen staff and carry out physically demanding tasks, such as transporting heavy cargo between destinations in the hospital basement. The cooperation and interaction were studied through ethnographic inspired fieldwork and the results highlighted how robots affect the real-life environments into which they are gradually moving. The analysis revealed how the great human expectations of robots clashed with reality and identified three key elements that influence human-robot cooperation in hospitals: 1) environmental factors, 2) behavioural factors and 3) factors related to human reliance on robots. We emphasise the importance of considering socio-technical factors when deploying robots to cooperate with humans in hospital environments.

Presenting an analytic framework facilitating a situationally oriented analysis of the use of digital technology for engagement in occupation.

BACKGROUND: Digital technology is closely intertwined with and influences people's everyday lives. Within occupational science and occupational therapy, research is therefore warranted into situationally oriented analysis of the use of digital technology for engagement in occupation. OBJECTIVE: To contribute with an analytic framework facilitating a situationally oriented analysis of the use of digital technology for engagement in occupation. MATERIAL AND METHODS: An operationalisation of Dewey's theory of transaction and inquiry in conjunction with an occupational science approach served as the analytical framework for exploring how underprivileged adults use digital technology for engaging in health-related occupation. FINDINGS: The analytical framework proved useful for a situationally oriented analysis of digital technology use for engagement in occupation: by fostering identification and registration of digital technology artefacts used for engagement in occupation, by making transparent the complexity that the situation creates for the participant, by identifying problems with and needs for inquiries in relation to engagement in occupation and, finally, by facilitating a situation-oriented analytical language. CONCLUSION: The analytical framework presented is useful for conducting a situationally oriented analysis of digital technology use for engagement in occupation. Future research and validation of the analytical framework are needed.

IT for learning diabetes.

This paper calls for IT supporting learning of diabetes self-management. Challenges of self-management and traditional IT tools for self-management are outlined--problems with data discipline, motivation of self-management, and learning as only an add-on to existing technologies. There is a call for IT focused on supporting learning in educational settings in an engaging manner. Two central self-management skills are identified: counting of carbohydrates and the understanding of the dynamics of diabetes factors. Three prototypes designed to support the learning of these skills are presented. Results from the prototype explorations emphasize the need for considering social aspects in learning with IT.

Changing Health Behavior with Social Technology? A Pilot Test of a Mobile App Designed for Social Support of Physical Activity.

Mobile applications targeting people engaged in physical activity have increased. However, while research has identified social support as a key factor for people's engagement in physical activity, most mobile health (mHealth) applications are designed for individual use. In this paper, we report on a research study exploring opportunities for designing mHealth to facilitate social support around physical activity. A mHealth application was designed, and pilot tested for eight weeks with healthcare professionals (n = 3) and two groups of citizens (n = 20) who were motivated but challenged physically due to various health conditions. Data was collected via online monitoring of the use of the mHealth application during the pilot test and via qualitative interviews with the participants before and after. The results support the idea that designing for social health support is important but so is identifying key challenges related to (i) the facilitation of technology-mediated social health support, especially to a target group that is living with health challenges, and (ii) finding a balance between social and health agendas that bring social support to the foreground for the participants.

Gaming against medical errors: methods and results from a design game on CPOE.

The paper presents design game as a technique for participatory design for a Computerized Decision Support System (CDSS) for minimizing medical errors. Design game is used as a technique for working with the skills of users, the complexity of the use practice and the negotiation of design here within the challenging domain of medication. The paper presents a developed design game based on game inspiration from a computer game, theoretical inspiration on electronic decision support, and empirical grounding in scenarios of medical errors. The game has been played in a two-hour workshop with six clinicians. The result is presented as a list of central themes for design of CDSS and derived design principles from these themes. These principles are currently under further exploration in follow up prototype based activities.

Breaking barriers to self-management of chronic diseases - the MaXi project.

The purpose of this study is to establish a foundation for participatory design between Information Technology (IT) professionals and people with chronic diseases resulting in IT-supported compensation in daily life. The paper presents the methods applied and results from a qualitative study to understand everyday life with diabetes. The participants are 8 families with one or more diabetic member. Our analysis outlines perspectives, activities, locations and information related to daily life with diabetes. On the basis of the analysis a number of artifacts are designed and tested in a living lab environment in Skagen, Denmark. It is concluded that participatory design and the use of the living lab concept yielded a richness of data adequate for iterative design cycles.

Contradictions in digital health engagement: An activity tracker's ambiguous influence on vulnerable young adults' engagement in own health.

OBJECTIVE: Activity trackers are designed to support individuals in monitoring and increasing their physical activity. The use of activity trackers among individuals diagnosed with depression and anxiety has not yet been examined. This pilot study investigates how this target group engages with an activity tracker during a 10-week health intervention aimed to increase their physical activity level and improve their physical and mental health. METHODS: Two groups of 11 young adults (aged 18-29 years) diagnosed with depression or anxiety participated in the digital health intervention. The study used mixed methods to investigate the research question. Quantitative health data were used to assess the intervention's influence on the participants' health and qualitative data provided insights into the participants' digital health experience. RESULTS: The study demonstrated an ambiguous influence from the use of an activity tracker with positive physical and mental health results, but a fading and even negative digital health engagement and counterproductive competition. CONCLUSIONS: The ambiguous results identify a need for (1) developing strategies for health professionals to provide supervised use of activity trackers and support the target groups' abilities to convert health information about physical activity into positive health strategies, and (2) designing alternatives for health promoting IT targeted users who face challenges and need motivation beyond self-tracking and competition.

User-Innovated eHealth Solutions for Service Delivery to Older Persons With Hearing Impairment.

PURPOSE: The successful design and innovation of eHealth solutions directly involve end users in the process to seek a better understanding of their needs. This article presents user-innovated eHealth solutions targeting older persons with hearing impairment. Our research question was: What are the key users' needs, expectations, and visions within future hearing rehabilitation service delivery? METHOD: We applied a participatory design approach to facilitate the design of future eHealth solutions via focus groups. We involved older persons with hearing impairment (n = 36), significant others (n = 10), and audiologists (n = 8) following 2 methods: (a) human-centered design for interactive systems and (b) user innovation management. Through 3 rounds of focus groups, we facilitated a process progressing from insights and visions for requirements (Phase 1), to app such as paper version wireframes (Phase 2), and to digital prototypes envisioning future eHealth solutions (Phase 3). Each focus group was video-recorded and photographed, resulting in a rich data set that was analyzed through inductive thematic analysis. RESULTS: The results are presented via (a) a storyboard envisioning future client journeys, (b) 3 key themes for future eHealth solutions, (c) 4 levels of interest and willingness to invest time and effort in digital solutions, and (d) 2 technical savviness types and their different preferences for rehabilitation strategies. CONCLUSIONS: Future eHealth solutions must offer personalized rehabilitation strategies that are appropriate for every person with hearing impairment and their level of technical savviness. Thus, a central requirement is anchoring of digital support in the clients' everyday life situations by facilitating easy access to personalized information, communication, and learning milieus. Moreover, the participants' visions for eHealth solutions call for providing both traditional analogue and digital services. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.7310729.

MOVE: A Mobile App Designed for Social Health Relations in Residential Areas.

This paper describes the design of MOVE, a mobile app to support people in forming social relations around exercise in residential areas. MOVE was developed in collaboration with residents and health professionals in a neighbourhood identified as a high-risk health area. The app is targeted to those who are motivated but challenged to do exercise and based on a conceptual model to provide users a social horizon of exercise activities in their residential area. We present the design and first evaluation of MOVE, including usability evaluations in controlled and natural settings. Results from these evaluations indicate that MOVE is a promising platform to support local social health relations once the identified usability problems are resolved.

Designing m-learning for junior registrars--activation of a theoretical model of clinical knowledge.

The MINI-project aims at supporting junior registrars in the learning process of how to utilize their theoretical knowledge from Medical School in everyday clinical reasoning and practice. Due to the nature of the work--concurrent moving, learning and producing--we designed an m-learning application. This paper introduces the possibilities and challenges for design of the m-learning application based on a) analytical findings on learning and mobility as derived from the design case--an emergency medical ward b) theoretical perspectives on medical knowledge, and c) presentation of the design of an m-learning application. The design process was based on user-driven innovation and the paper discusses considerations on how to combine user-drive and generic models.

This Is not Participatory Design - A Critical Analysis of Eight Living Laboratories.

Design of Health Technology for elderly and care personnel has a high priority because of a severe increase of elderly citizens in need of health care combined with a decrease of resources in the health care sector. Desires for maintaining and improving the quality of care while reducing costs has resulted in a search for approaches that support co-operation between technology designers, elderly persons and health care professionals on innovating future care technology. Living laboratories, where areas of a care environment are transformed into a so-called platform for technology innovation, are popular. Expectations for living laboratories are high but examinations of how such laboratories support the intended participatory innovation are few. This paper presents and examines eight living laboratories set up in Danish nursing homes for technology innovation. We present the notion of a living laboratory and explicate the aspirations and expectations of this approach, and discuss why these expectations are hard to meet both on a general level and in the investigated labs. We question the basic assumptions of the possibility of reconciling the different interests of the stakeholders involved. In our analysis we focus on users in the living laboratories. We use guiding principles developed within Participatory Design to reveal the role and participation of the users - the health care professionals and the elderly - in the eight living laboratories. In general, these users played a minor role, in the labs where technical problems turned out to be main activity. We conclude that living laboratories do not nullify different/conflicting interests and that a real-life setting by itself is no guarantee for user participation.

Steps Toward Technology Design to Beat Health Inequality - Participatory Design Walks in a Neighbourhood with High Health Risks.

This paper explores participatory design walks (PD walks) as a first step toward a participatory design of health information technology (HIT) aimed at tackling health inequality in a neighbourhood identified as a high-risk health area. Existing research shows that traditional methods for health promotion, such as campaigns and teaching, have little to no effect in high-risk health areas. Rather, initiatives must be locally anchored - integrated into the local culture, and based on social relationships and group activities. This paper explains how we conducted PD walks with residents and community workers in the neighbourhood and how this participatory approach supported a first step toward HIT design that tackles health inequality. This is important, as people in neighbourhoods with high health risks are not the target audience for the health technology innovation currently taking place despite the fact that this group suffers the most from health inequality and weigh most on the public healthcare services and costs. The study identifies social and cultural aspects that influence everyday health management and presents how a citizen-driven approach like PD walks, can contribute valuable insights for design of HIT. The paper provides concrete methodological recommendations on how to conduct PD walks that are valuable to HIT designers and developers who aim to do PD with neighbourhoods.

Developments in Participatory Design of Health Information Technology - A Review of PDC Publications from 1990-2016.

The landscape of Participatory Design (PD) of Health Information Technology (HIT) is diverse and constantly evolving. This paper reviews the publications in the proceedings from the Participatory Design Conferences (PDCs) that have been held every two years since 1990. We used the Matrix Method to identify, describe and synthesise HIT publications from the proceedings. A total of 47 papers were included in the review and analysed in relation to six themes. The analysis reveals a significant volume of HIT research at PDCs, with a large amount of attention to digitalisation of health information, work procedures, records, secondary healthcare and health professionals. However, the analysis also shows a development from a primary focus on health workers and hospitals to a recent attention on HIT in everyday life and PD with patients, relatives, neighbourhoods and citizens in general. Additionally, the review shows a growing number of PD methods being applied. This paper concludes that research on PD and HIT appears to be maturing and developing with ongoing technological and societal development.

The assumed relation between occupation and inequality in health.

BACKGROUND: Occupational science and therapy scholars have argued that research on inequality in health is needed. Simultaneously, a knowledge gap between how to understand and take action on health inequalities exists in occupational science and therapy. OBJECTIVE: To identify how inequality in health, high-risk areas of health, and engagement in health for low-income adult citizens have been described and conceptualized in contemporary occupational science and therapy literature. MATERIAL AND METHODS: A structured literature review of 37 publications in occupational science and therapy literature, published from 2004 to 2014. FINDINGS: The review revealed several descriptions and conceptualizations based on environmental, social, cultural, historical, and personal perspectives on occupation and already existing occupational science concepts. However, these descriptions were mainly based on assumptions regarding the relation between occupation and inequality in health, and statements on the need to explore this relation. CONCLUSION: Basic theory and reasoning, as well as empirical studies, on inequality in health are missing in occupational science and therapy. Based on the findings and theoretical trends, the authors suggest a transactional perspective on occupation is a possible frame for understanding inequality in health and related issues.

Monitoring Technology Meets Care Work: Challenges of monitoring wet-beds in a nursing home.

Monitoring technology, especially sensor-based technology, is increasingly taken into use in care work. Despite the simplicity of these technologies - aimed to automate what appear as mundane monitoring tasks - recent research has identified major challenges primarily related to the technology's ability to meet the complexity of care work. Understanding intersectional challenges between these care technologies and care work is fundamental to improve design and use of health informatics. In this paper we present an analysis of interaction challenges between a wet-sensor at the task of monitoring wet beds at a nursing home. The analysis identifies the multifaceted nature of monitoring work and the intricacy of integrating sensor technology into the complex knowledge system of monitoring work.