Supporting Remote Social Robot Design Collaboration with Online Canvases: Lessons Learned from Facilitators' and Participants' Experiences.

Social robot design projects typically involve multidisciplinary teamwork and collaboration, adopt a Human-Centred Design (HCD) approach, and deal with physical (tangible) objects, i.e., robots. HCD takes a human to the centre point of the design process. A typical activity in HCD are design workshops where a facilitator is needed to guide and moderate the task-related and interactional activities throughout the session. Facilitation is also usually needed in longer-term design projects or courses to guide participants through the different phases of design during several sessions. Recently, due to the COVID-19 pandemic, most design activities including social robot design were rapidly transferred to online mode. Designing for tangible objects is challenging in online settings because the interaction experience with a physical object is hard to demonstrate online. In this article, we report how we harnessed online canvases to support both short-term social robot design workshops and a long-term design course. Based on participants' feedback and facilitators' experiences, we report lessons learned from utilizing collaborative design canvases for creative social robot design projects that specifically focus on early stages and concept ideation. We propose practical guidelines for canvas-based online facilitation focusing on creative design workshops and projects. In addition, we discuss the lessons learned concerning social robot design activities taking place in online mode. To respond to the challenges of designing tangible robots in a fully online mode, we suggest a Hybrid Robotic Design Model (HRDM), where the participants work in contact with facilitators, other participants and robots at specific points, while the other phases are conducted online.

In the shadow of COVID-19: A randomized controlled online ACT trial promoting adolescent psychological flexibility and self-compassion.

Background: Although some adolescents managed to cope well with the challenges brought on by the COVID-19 pandemic, the well-being of many was adversely affected due to school closures, distance education, restrictions on gathering with friends, and limited access to mental health services. Many adolescents reported increased anxiety and depression as well as decreased psychological wellbeing due to the pandemic. Consequently, there is a need for psychological support that exceeds the strained resources available to schools to support young people during times of crisis and societal pressure. Objective: The present study aimed to explore the effects of an online-delivered ACT intervention to promote adolescent psychological flexibility and self-compassion and decrease psychological distress during the second wave of COVID-19 in the fall of 2020. Methods: A total of 348 adolescents aged 15-16 were randomly divided into three equal groups: 1) the iACT student coach + virtual coach group, n = 116; 2) the iACT virtual coach group, n = 116; and 3) the control group with no intervention, n = 116). Among these adolescents, 234 participated in a pre-measurement (iACT, n = 154; control, n = 80; intent-to-treat) and completed measures of psychological flexibility, self-compassion, anxiety, and depression. Results: An investigation of all the adolescents who participated in the pre-measurement (intent-to-treat analysis, n = 234) revealed no significant differences between the three groups with regard to psychological flexibility, self-compassion, and symptoms of anxiety and depression. However, upon combining the two intervention groups and examining the adolescents who completed at least 30% of the Youth Compass program (per-protocol analysis, n = 137), small but significant differences between the iACT intervention and control groups were found regarding the psychological flexibility subscale valued action, self-compassion, and anxiety in favor of the intervention group. Conclusions: Active use of an ACT-based online intervention under adverse circumstances may decrease symptoms of anxiety and increase psychological flexibility skills in adolescents.

The Roles of Adherence and Usage Activity in Adolescents' Intervention Gains During Brief Guided Online Acceptance and Commitment Therapy.

OBJECTIVE: This study investigated the roles of adherence and usage activity in adolescents' (n = 161) gains during a 5-week web intervention program based on acceptance and commitment therapy (ACT). METHOD: Program adherence was calculated as adherence percentage in relation to intended usage, whereas completion percentage, usage time, and usage weeks were used as indicators for usage activity. Subjective well-being was measured by self-reported life satisfaction and stress before and after the intervention. RESULTS: First, regression analysis results showed that higher adherence predicted an increase in life satisfaction during intervention. Second, three subgroups of adolescents were identified using K-means cluster analysis in regard to adherence, usage activity and intervention gains: (1) "Adhered, committed users with relatively large intervention gains" (35%), (2) "Less committed users with no intervention gains" (42%), and (3) "Non-committed users with no intervention gains" (23%). The results showed that the highest gains from the Youth Compass intervention program are most likely obtained when the program is used as intended in its design. In addition, time investment and engagement in doing exercises seem as important as filling the minimum adherence criterion. CONCLUSIONS: The results support the feasibility of ACT-based web intervention programs in promoting adolescent well-being, although more attention should be paid to motivating adolescents to commit to them and invest enough time in them.

Usage activity, perceived usefulness, and satisfaction in a web-based acceptance and commitment therapy program among Finnish ninth-grade adolescents.

Understanding adolescent usage activity and experiences in web-based psychological intervention programs helps in developing universal programs that can be adopted for promotion of adolescent well-being and prevention of mental health problems. This study examined the usage activity, perceived usefulness (i.e., learning of mindfulness, acceptance and value-related skills), and program satisfaction of 157 Finnish ninth-grade adolescents, who participated in a school-based five-week universal acceptance and commitment therapy web intervention called Youth Compass. Individual and growth environment-related antecedents were measured before the five-week intervention, adolescents' usage activity during the intervention, and perceived usefulness and satisfaction after the intervention. The results showed that female adolescents and adolescents with high self-regulation were more active program users and had more positive experiences of the program. Most of the adolescents used the program on at least a moderate level and perceived it to be moderately or highly useful and satisfactory. Four subgroups of adolescents were identified based on their usage activity, perceived usefulness, and satisfaction: adolescents in the satisfied group (41%) had average activity and high perceived usefulness and intervention satisfaction, the dissatisfied group (18%) had low activity and very low perceived usefulness and intervention satisfaction, the active group (8%) had very high activity and average perceived usefulness and intervention satisfaction, and the moderate group (33%) had average activity, perceived usefulness and intervention satisfaction. Gender, academic achievement, closeness to mother and teacher, and conflict with teacher were significantly related to subgroup membership. The results suggested that adolescent usage activity, perceived usefulness, and satisfaction with the Youth Compass program may to some extent be predicted based on different factors.

Supporting parents of children with chronic conditions: A randomized controlled trial of web-based and self-help ACT interventions.

OBJECTIVE: Many parents of children with chronic conditions and developmental disabilities experience high rates of burnout and psychological distress. The aim of the current study was to examine the effects of two differently delivered interventions based on acceptance and commitment therapy (ACT) on symptoms of burnout, depression, quality of life, psychological flexibility, and mindfulness skills. METHOD: A total of 110 parents of children aged 0.8 to 17 years with chronic conditions and developmental disabilities participated in a randomized controlled trial lasting 13 weeks with two intervention groups: (1) an iACT intervention, including three psychologist-led video conferencing sessions, and (2) a self-help ACT, which received self-help material: an ACT-based booklet with the possibility of using ACT-based online exercises. RESULTS: For the main outcome measure burnout, a similar decrease was found in both groups. The supported iACT intervention produced significantly larger improvements in depressive symptoms (d = 0.49), psychological flexibility (d = 0.64), and mindfulness (d = 0.55) compared to the self-help ACT intervention. For health-related quality of life, only the dimension of role limitations caused by emotional problems showed a significant difference in favor of the supported iACT (d = 0.58). CONCLUSIONS: The results suggest that the iACT intervention including three video conferencing sessions with a psychologist produced broader improvements in parents' psychological well-being than the self-help ACT. Overall, Internet-delivered interventions and video conferencing technology may offer a feasible alternative to psychological support and self-care for parents of children with chronic conditions. Further research is needed to investigate the long-term effects of the current delivery models.

Individual differences in processes of lifestyle changes among people with obesity: an acceptance and commitment therapy (ACT) intervention in a primary health care setting.

AIM: To explore what thoughts, feelings, and learning processes were involved in obese participants' lifestyle change during an acceptance and commitment therapy (ACT) lifestyle intervention delivered in primary health care. BACKGROUND: Previous studies have revealed that lifestyle interventions are effective at promoting initial weight loss, but reduced weight is often difficult to sustain because of the failure to maintain healthy lifestyle changes. Achieving and maintaining lifestyle changes requires to learn self-regulation skills. ACT-based lifestyle interventions combine many self-regulatory skill factors, and the results from previous studies are promising. Research on the individual learning processes of lifestyle change is still needed. METHODS: This study investigated a subset of data from a larger web-based lifestyle intervention. This subset consisted of online logbooks written by 17 obese participants (n = 17, body mass index mean 41.26 kg/m2) during the six-week online module. The logbooks were analyzed via data-driven content analysis. FINDINGS: Four groups were identified based on the participants being at different phases in their lifestyle changes: stuck with barriers, slowly forward, reflective and hardworking, and convincingly forward with the help of concrete goals. Differences between the groups were manifested in personal barriers, goal setting, training of mindfulness and acceptance, and achieving healthy actions. The ACT-based lifestyle intervention offered participants an opportunity to reflect on how their thoughts and feelings may hinder healthy lifestyle changes and provided tools for learning psychological flexibility.

Applicability of acceptance and commitment therapy-based mobile app in depression nursing.

Due to the high burden of depression, new models and methods of mental healthcare need to be developed. Prior research has shown the potential benefits of using technology tools such as mobile apps as self-help or combined with psychological treatment. Therefore, professionals should acquaint themselves with evidence-based apps to be able to use them with clients and guide the clients in their use. The purpose of this study was to explore how an acceptance and commitment therapy-based mobile app was perceived as a self-management tool among nurses, and how it could be applied in the prevention and treatment of depression and other mental health issues. Sixteen Finnish nurses undergoing depression nurse specialist education used the app for 5 weeks and participated in semistructured focus group interviews. Interviews were analyzed by qualitative content analysis. In general, the nurses found the app suitable as a self-management tool and identified three models of using it in clinical practice. Having used the app personally, the nurses were eager to take it into use with various client groups, especially in occupational health but also in the treatment of mental health problems. However, they also raised concerns about the effort needed in familiarizing oneself with the content and pointed out specific client groups for whom the benefits of the app should be carefully weighed against the potential risks. Despite the small sample size, the findings suggest that involving technology tools as part of the nurses' education could ease their adoption in clinical practice. The degree of professional support in the app use should be aligned to the severity of the mental health problems.

Process and Effects Evaluation of a Digital Mental Health Intervention Targeted at Improving Occupational Well-Being: Lessons From an Intervention Study With Failed Adoption.

BACKGROUND: Digital interventions have the potential to serve as cost-effective ways to manage occupational stress and well-being. However, little is known about the adoption of individual-level digital interventions at organizations. OBJECTIVES: The aim of this paper is to study the effects of an unguided digital mental health intervention in occupational well-being and the factors that influence the adoption of the intervention. METHODS: The intervention was based on acceptance and commitment therapy (ACT) and its aim was to teach skills for stress management and mental well-being. It was delivered via a mobile and a Web-based app that were offered to employees of two information and communication technology (ICT) companies. The primary outcome measures were perceived stress and work engagement, measured by a 1-item stress questionnaire (Stress) and the Utrecht Work Engagement Scale (UWES-9). The intervention process was evaluated regarding the change mechanisms and intervention stages using mixed methods. The initial interviews were conducted face-to-face with human resource managers (n=2) of both companies in August 2013. The participants were recruited via information sessions and email invitations. The intervention period took place between November 2013 and March 2014. The participants were asked to complete online questionnaires at baseline, two months, and four months after the baseline measurement. The final phone interviews for the volunteer participants (n=17) and the human resource managers (n=2) were conducted in April to May 2014, five months after the baseline. RESULTS: Of all the employees, only 27 (8.1%, 27/332) took the app into use, with a mean use of 4.8 (SD 4.7) different days. In the beginning, well-being was on good level in both companies and no significant changes in well-being were observed. The activities of the intervention process failed to integrate the intervention into everyday activities at the workplace. Those who took the app into use experienced many benefits such as relief in stressful situations. The app was perceived as a toolkit for personal well-being that gives concrete instructions on how mindfulness can be practiced. However, many barriers to participate in the intervention were identified at the individual level, such as lack of time, lack of perceived need, and lack of perceived benefits. CONCLUSIONS: The findings suggest that neither the setting nor the approach used in this study were successful in adopting new digital interventions at the target organizations. Barriers were faced at both the organizational as well as the individual level. At the organizational level, top management needs to be involved in the intervention planning for fitting into the organization policies, the existing technology infrastructure, and also targeting the organizational goals. At the individual level, concretizing the benefits of the preventive intervention and arranging time for app use at the workplace are likely to increase adoption.

Slim by Design: Kitchen Counter Correlates of Obesity.

Background The home is one place where people can control what foods are available and how the environment is arranged. Given the impact of environments on health, the objective of this study is to determine whether the presence of foods on a person's kitchen counter are associated with their body mass index (BMI). Method In Study 1, a nationwide sample of 500 households was asked to inventory their kitchen and provide their height and weight. In Study 2, researchers photographed and catalogued 210 households in Syracuse, New York, and measured the occupants' height and weight. Main outcome measures for the study were BMI differences between households that had various foods visible on the counter compared with those that did not. Findings The presence of fruit on the counter was associated with lower BMI in both studies, but the presence of foods such as candy, cereal, soft drinks, and dried fruit were associated with weight differences that ranged from 9.4 to 14.4 kg. Interpretations Although correlational, the findings from these two studies suggest that when counseling patients regarding their weight, physicians also suggest they clear their kitchen counter of all food except a fruit bowl.

The use of crowdsourcing for dietary self-monitoring: crowdsourced ratings of food pictures are comparable to ratings by trained observers.

OBJECTIVE: Crowdsourcing dietary ratings for food photographs, which uses the input of several users to provide feedback, has potential to assist with dietary self-monitoring. MATERIALS AND METHODS: This study assessed how closely crowdsourced ratings of foods and beverages contained in 450 pictures from the Eatery mobile app as rated by peer users (fellow Eatery app users) (n = 5006 peers, mean 18.4 peer ratings/photo) using a simple 'healthiness' scale were related to the ratings of the same pictures by trained observers (raters). In addition, the foods and beverages present in each picture were categorized and the impact on the peer rating scale by food/beverage category was examined. Raters were trained to provide a 'healthiness' score using criteria from the 2010 US Dietary Guidelines. RESULTS: The average of all three raters' scores was highly correlated with the peer healthiness score for all photos (r = 0.88, p<0.001). Using a multivariate linear model (R(2) = 0.73) to examine the association of peer healthiness scores with foods and beverages present in photos, peer ratings were in the hypothesized direction for both foods/beverages to increase and ones to limit. Photos with fruit, vegetables, whole grains, and legumes, nuts, and seeds (borderline at p = 0.06) were all associated with higher peer healthiness scores, and processed foods (borderline at p = 0.06), food from fast food restaurants, refined grains, red meat, cheese, savory snacks, sweets/desserts, and sugar-sweetened beverages were associated with lower peer healthiness scores. CONCLUSIONS: The findings suggest that crowdsourcing holds potential to provide basic feedback on overall diet quality to users utilizing a low burden approach.

The effectiveness and applicability of different lifestyle interventions for enhancing wellbeing: the study design for a randomized controlled trial for persons with metabolic syndrome risk factors and psychological distress.

BACKGROUND: Obesity and stress are among the most common lifestyle-related health problems. Most of the current disease prevention and management models are not satisfactorily cost-effective and hardly reach those who need them the most. Therefore, novel evidence-based controlled interventions are necessary to evaluate models for prevention and treatment based on self-management. This randomized controlled trial examines the effectiveness, applicability, and acceptability of different lifestyle interventions with individuals having symptoms of metabolic syndrome and psychological distress. The offered interventions are based on cognitive behavioral approaches, and are designed for enhancing general well-being and supporting personalized lifestyle changes. METHODS/DESIGN: 339 obese individuals reporting stress symptoms were recruited and randomized to either (1) a minimal contact web-guided Cognitive Behavioral Therapy-based (CBT) intervention including an approach of health assessment and coaching methods, (2) a mobile-guided intervention comprising of mindfulness, acceptance and value-based exercises, (3) a face-to-face group intervention using mindfulness, acceptance and value-based approach, or (4) a control group. The participants were measured three times during the study (pre = week 0, post = week 10, and follow-up = week 36). Psychological well-being, lifestyles and habits, eating behaviors, and user experiences were measured using online surveys. Laboratory measurements for physical well-being and general health were performed including e.g. liver function, thyroid glands, kidney function, blood lipids and glucose levels and body composition analysis. In addition, a 3-day ambulatory heart rate and 7-day movement data were collected for analyzing stress, recovery, physical activity, and sleep patterns. Food intake data were collected with a 48 -hour diet recall interview via telephone. Differences in the effects of the interventions would be examined using multiple-group modeling techniques, and effect-size calculations. DISCUSSION: This study will provide additional knowledge about the effects of three low intensity interventions for improving general well-being among individuals with obesity and stress symptoms. The study will show effects of two technology guided self-help interventions as well as effect of an acceptance and value-based brief group intervention. Those who might benefit from the aforesaid interventions will increase knowledge base to better understand what mechanisms facilitate effects of the interventions. TRIAL REGISTRATION: Current Clinical Trials NCT01738256, Registered 17 August, 2012.

Factors related to sustained use of a free mobile app for dietary self-monitoring with photography and peer feedback: retrospective cohort study.

BACKGROUND: Healthy eating interventions that use behavior change techniques such as self-monitoring and feedback have been associated with stronger effects. Mobile apps can make dietary self-monitoring easy with photography and potentially reach huge populations. OBJECTIVE: The aim of the study was to assess the factors related to sustained use of a free mobile app ("The Eatery") that promotes healthy eating through photographic dietary self-monitoring and peer feedback. METHODS: A retrospective analysis was conducted on the sample of 189,770 people who had downloaded the app and used it at least once between October 2011 and April 2012. Adherence was defined based on frequency and duration of self-monitoring. People who had taken more than one picture were classified as "Users" and people with one or no pictures as "Dropouts". Users who had taken at least 10 pictures and used the app for at least one week were classified as "Actives", Users with 2-9 pictures as "Semi-actives", and Dropouts with one picture as "Non-actives". The associations between adherence, registration time, dietary preferences, and peer feedback were examined. Changes in healthiness ratings over time were analyzed among Actives. RESULTS: Overall adherence was low-only 2.58% (4895/189,770) used the app actively. The day of week and time of day the app was initially used was associated with adherence, where 20.28% (5237/25,820) of Users had started using the app during the daytime on weekdays, in comparison to 15.34% (24,718/161,113) of Dropouts. Users with strict diets were more likely to be Active (14.31%, 900/6291) than those who had not defined any diet (3.99%, 742/18,590), said they ate everything (9.47%, 3040/32,090), or reported some other diet (11.85%, 213/1798) (χ(2) 3=826.6, P<.001). The average healthiness rating from peers for the first picture was higher for Active users (0.55) than for Semi-actives (0.52) or Non-actives (0.49) (F2,58167=225.9, P<.001). Actives wrote more often a textual description for the first picture than Semi-actives or Non-actives (χ(2) 2=3515.1, P<.001). Feedback beyond ratings was relatively infrequent: 3.83% (15,247/398,228) of pictures received comments and 15.39% (61,299/398,228) received "likes" from other users. Actives were more likely to have at least one comment or one "like" for their pictures than Semi-actives or Non-actives (χ(2) 2=343.6, P<.001, and χ(2) 2=909.6, P<.001, respectively). Only 9.89% (481/4863) of Active users had a positive trend in their average healthiness ratings. CONCLUSIONS: Most people who tried out this free mobile app for dietary self-monitoring did not continue using it actively and those who did may already have been healthy eaters. Hence, the societal impact of such apps may remain small if they fail to reach those who would be most in need of dietary changes. Incorporating additional self-regulation techniques such as goal-setting and intention formation into the app could potentially increase user engagement and promote sustained use.

Crowdsourcing novel childhood predictors of adult obesity.

Effective and simple screening tools are needed to detect behaviors that are established early in life and have a significant influence on weight gain later in life. Crowdsourcing could be a novel and potentially useful tool to assess childhood predictors of adult obesity. This exploratory study examined whether crowdsourcing could generate well-documented predictors in obesity research and, moreover, whether new directions for future research could be uncovered. Participants were recruited through social media to a question-generation website, on which they answered questions and were able to pose new questions that they thought could predict obesity. During the two weeks of data collection, 532 participants (62% female; age  =  26.5±6.7; BMI  =  29.0±7.0) registered on the website and suggested a total of 56 unique questions. Nineteen of these questions correlated with body mass index (BMI) and covered several themes identified by prior research, such as parenting styles and healthy lifestyle. More importantly, participants were able to identify potential determinants that were related to a lower BMI, but have not been the subject of extensive research, such as parents packing their children's lunch to school or talking to them about nutrition. The findings indicate that crowdsourcing can reproduce already existing hypotheses and also generate ideas that are less well documented. The crowdsourced predictors discovered in this study emphasize the importance of family interventions to fight obesity. The questions generated by participants also suggest new ways to express known predictors.

Public and health professionals' misconceptions about the dynamics of body weight gain/loss.

Human body energy storage operates as a stock-and-flow system with inflow (food intake) and outflow (energy expenditure). In spite of the ubiquity of stock-and-flow structures, evidence suggests that human beings fail to understand stock accumulation and rates of change, a difficulty called the stock-flow failure. This study examines the influence of health care training and cultural background in overcoming stock-flow failure. A standardized protocol assessed lay people's and health care professionals' ability to apply stock-and-flow reasoning to infer the dynamics of weight gain/loss during the holiday season (621 subjects from seven countries). Our results indicate that both types of subjects exhibited systematic errors indicative of use of erroneous heuristics. Stock-flow failure was found across cultures and was not improved by professional health training. The problem of stock-flow failure as a transcultural global issue with education and policy implications is discussed.

Feasibility of a personal health technology-based psychological intervention for men with stress and mood problems: randomized controlled pilot trial.

BACKGROUND: Work-related stress is a significant problem for both people and organizations. It may lead to mental illnesses such as anxiety and depression, resulting in increased work absences and disabilities. Scalable interventions to prevent and manage harmful stress can be delivered with the help of technology tools to support self-observations and skills training. OBJECTIVE: The aim of this study was to assess the feasibility of the P4Well intervention in treatment of stress-related psychological problems. P4Well is a novel intervention which combines modern psychotherapy (the cognitive behavioral therapy and the acceptance and commitment therapy) with personal health technologies to deliver the intervention via multiple channels, includinggroup meetings, Internet/Web portal, mobile phone applications, and personal monitoring devices. METHODS: This pilot study design was a small-scale randomized controlled trial that compared the P4Well intervention with a waiting list control group. In addition to personal health technologies for self-assessment, the intervention consisted of 3 psychologist-assisted group meetings. Self-assessed psychological measures through questionnaires were collected offline pre- and post-intervention, and 6 months after the intervention for the intervention group. Acceptance and usage of technology tools were measured with user experience questionnaires and usage logs. RESULTS: A total of 24 subjects were randomized: 11 participants were followed up in the intervention group (1 was lost to follow-up) and 12 participants did not receive any intervention (control group). Depressive and psychological symptoms decreased and self-rated health and working ability increased. All participants reported they had benefited from the intervention. All technology tools had active users and 10/11 participants used at least 1 tool actively. Physiological measurements with personal feedback were considered the most useful intervention component. CONCLUSIONS: Our results confirm the feasibility of the intervention and suggest that it had positive effects on psychological symptoms, self-rated health, and self-rated working ability. The intervention seemed to have a positive impact on certain aspects of burnout and job strain, such as cynicism and over-commitment. Future studies need to investigate the effectiveness, benefits, and possible problems of psychological interventions which incorporate new technologies. TRIAL REGISTRATION: The Finnish Funding Agency for Technology and Innovation (TEKES), Project number 40011/08.

Mobile mental wellness training for stress management: feasibility and design implications based on a one-month field study.

BACKGROUND: Prevention and management of work-related stress and related mental problems is a great challenge. Mobile applications are a promising way to integrate prevention strategies into the everyday lives of citizens. OBJECTIVE: The objectives of this study was to study the usage, acceptance, and usefulness of a mobile mental wellness training application among working-age individuals, and to derive preliminary design implications for mobile apps for stress management. METHODS: Oiva, a mobile app based on acceptance and commitment therapy (ACT), was designed to support active learning of skills related to mental wellness through brief ACT-based exercises in the daily life. A one-month field study with 15 working-age participants was organized to study the usage, acceptance, and usefulness of Oiva. The usage of Oiva was studied based on the usage log files of the application. Changes in wellness were measured by three validated questionnaires on stress, satisfaction with life (SWLS), and psychological flexibility (AAQ-II) at the beginning and at end of the study and by user experience questionnaires after one week's and one month's use. In-depth user experience interviews were conducted after one month's use to study the acceptance and user experiences of Oiva. RESULTS: Oiva was used actively throughout the study. The average number of usage sessions was 16.8 (SD 2.4) and the total usage time per participant was 3 hours 12 minutes (SD 99 minutes). Significant pre-post improvements were obtained in stress ratings (mean 3.1 SD 0.2 vs mean 2.5 SD 0.1, P=.003) and satisfaction with life scores (mean 23.1 SD 1.3 vs mean 25.9 SD 0.8, P=.02), but not in psychological flexibility. Oiva was perceived easy to use, acceptable, and useful by the participants. A randomized controlled trial is ongoing to evaluate the effectiveness of Oiva on working-age individuals with stress problems. CONCLUSIONS: A feasibility study of Oiva mobile mental wellness training app showed good acceptability, usefulness, and engagement among the working-age participants, and provided increased understanding on the essential features of mobile apps for stress management. Five design implications were derived based on the qualitative findings: (1) provide exercises for everyday life, (2) find proper place and time for challenging content, (3) focus on self-improvement and learning instead of external rewards, (4) guide gently but do not restrict choice, and (5) provide an easy and flexible tool for self-reflection.

Mindless eating challenge: retention, weight outcomes, and barriers for changes in a public web-based healthy eating and weight loss program.

BACKGROUND: Most dietary programs fail to produce lasting outcomes because participants soon return to their old habits. Small behavioral and environmental changes based on simple heuristics may have the best chance to lead to sustainable habit changes over time. OBJECTIVE: To evaluate participant retention, weight outcomes, and barriers for changes in a publicly available web-based healthy eating and weight loss program. METHODS: The National Mindless Eating Challenge (NMEC) was a publicly available, online healthy eating and weight loss program with ongoing recruitment of participants. This volunteer sample consisted of 2053 participants (mean age 39.8 years, 89% female, 90% white/Caucasian, BMI mean 28.14). Participants completed an initial profiling survey and were assigned three targeted habit change suggestions (tips). After each month, participants were asked to complete a follow-up survey and then receive new suggestions for the subsequent month. RESULTS: In terms of overall attrition, 75% (1549/2053) of participants who completed the intake survey never returned to follow up. Overall mean weight loss among returning participants was 0.4% of initial weight (P=.019). Participants who stayed in the program at least three calendar months and completed at least two follow-up surveys (38%, 189/504) lost on average 1.8 lbs (1.0%) of their initial weight over the course of the program (P=.009). Furthermore, participants who reported consistent adherence (25+ days/month) to the suggested changes reported an average monthly weight loss of 2.0 lbs (P<.001). Weight loss was less for those who discontinued after 1-2 months or who did not adhere to the suggested changes. Participants who reported having lost weight reported higher monthly adherence to suggestions (mean 14.9 days, SD 7.92) than participants who maintained (mean 12.4 days, SD 7.63) or gained weight (mean 12.0 days, SD 7.50; F=14.17, P<.001). Common reported barriers for changes included personally unsuitable or inapplicable suggestions, forgetting or being too busy to implement changes, unusual circumstances, and emotional eating. CONCLUSIONS: Because the bulk of the free and commercially available online diet and nutritional tools conduct no evaluation research, it is difficult to determine which aspects of a program are successful and what are reasonable expectations of results. The results of this study suggest that online interventions based on small changes have the potential to gradually lead to clinically significant weight loss, but high attrition from publically available or "free" programs still remains a challenge. Adherence to and effectiveness of small habit changes may be improved through further tailoring to individual circumstances and psychological needs.

Rethinking health: ICT-enabled services to empower people to manage their health.

Lifestyle is a key determinant in the prevention and management of chronic diseases. If we would exercise regularly, eat healthy, control our weight, sleep enough, manage stress, not smoke and use alcohol only moderately, 90% of type II diabetes, 80% of coronary heart disease, and 70% of stroke could be prevented. Health statistics show that lifestyle related diseases are increasing at an alarming rate. Public health promotion campaigns and healthcare together are not effective enough to stop this "tsunami". The solution that is offered is to empower people to manage their health with the assistance of ICT-enabled services. A lot of R&D and engineering effort is being invested in Personal Health Systems. Although some progress has been made, the market for such systems has not yet emerged. The aim of this critical review is to identify the barriers which are holding back the growth of the market. It looks into the theoretical foundations of behavior change support, the maturity of the technologies for behavior change support, and the business context in which behavior change support systems are used.

Personalized behavior change support for disease prevention.

Healthy lifestyle is essential in prevention of chronic diseases. However, people need motivation and support to achieve and to maintain behavior changes. Moreover, effective behavior change support should be personalized to individual's unique characteristics, needs and context. This paper presents a blueprint of an ICT system, which is able to provide holistic, dynamic support for healthy behaviors, engaging also various co-producers in the health journey of a person. Three main concepts in the system are Virtual Individual, which maintains the user's personal profile, PGS-Mall, which collects various health and well-being services into one place, and HealthGuides, which support healthy choices in everyday life and coordinate the interactions between the user, the system, and other co-producers of health.

A concept to empower self-management of psychophysiological wellbeing: preliminary user study experiences.

In prevention of chronic diseases, health promotion and early interventions based on self-management should be emphasized. Mental health problems and stress cause a significant portion of healthcare costs, and also complicate the management of other chronic conditions. In addition to physical health, psychophysiological and social wellbeing should be equally promoted. Thus, we have previously designed and reported the P4Well or Pervasive Personal and PsychoPhysiological management of WELLness concept for working-age citizens. The concept supports the stress and recovery management on a daily basis through improved health management strategies, and combines psychological methods with personal health technologies. In this paper, we discuss the preliminary user study experiences of ongoing evaluations with two different user groups consisting of: 1) middle-aged men who are using the concept for managing their mental wellbeing or mild depression; and 2) entrepreneurs who are using the concept for coping with stress. Our results provide a preliminary assessment of the role and importance of experts, technologies, and peer-support in the concept.