Attrition of older adults in web-based health interventions: Survival analysis within an observational cohort study.

To identify demographics and personal motivation types that predict dropping out of eHealth interventions among older adults. We conducted an observational cohort study. Participants completed a pre-test questionnaire and got access to an eHealth intervention, called Stranded, for 4 weeks.

An experiment on data sharing options designs for eHealth interventions.

Background: With eHealth technology interventions, users' personal health data can be easily shared among different stakeholders. Users should decide with whom they want to share their data. As support, most eHealth technology has data sharing options functionalities.

Optimizing appreciation and persuasion of embodied conversational agents for health behavior change: A design experiment and focus group study.

Embodied Conversational Agents (ECAs) can increase user engagement and involvement and can strengthen the effect of an intervention on health outcomes that is provided via an ECA. However, evidence regarding the effectiveness of ECAs on health outcomes is still limited. In this article, we report on a study that has the goal to identify the effect of a match between a health topic and the ECAs' appearance on ratings of personality characteristics, persuasiveness and intention to use.

Developing an eMental health monitoring module for older mourners using fuzzy cognitive maps.

Objective: Effective internet interventions often combine online self-help with regular professional guidance. In the absence of regularly scheduled contact with a professional, the internet intervention should refer users to professional human care if their condition deteriorates. The current article presents a monitoring module to recommend proactively seeking offline support in an eMental health service to aid older mourners.

Development of an online service for coping with spousal loss by means of human-centered and stakeholder-inclusive design: the case of LEAVES.

To support older mourners after the loss of their partner, LEAVES, an online self-help service that delivers the LIVIA spousal bereavement intervention, was developed. It integrates an embodied conversational agent and an initial risk assessment. Based on an iterative, human-centered, and stakeholder inclusive approach, interviews with older mourners and focus groups with stakeholders were conducted to understand their perspective on grief and on using LEAVES.

How to Prevent the Drop-Out: Understanding Why Adults Participate in Summative eHealth Evaluations.

The aim of this study was to investigate why adults participate in summative eHealth evaluations, and whether their reasons for participating affect their (non-)use of eHealth. A questionnaire was distributed among adults (aged ≥ 18 years) who participated in a summative eHealth evaluation. This questionnaire focused on participants' reason to enroll, their expectations, and on whether the study met their expectations.

A Web-Based Self-help Intervention for Coping With the Loss of a Partner: Protocol for Randomized Controlled Trials in 3 Countries.

Background: The death of a partner is a critical life event in later life, which requires grief work as well as the development of a new perspective for the future. Cognitive behavioral web-based self-help interventions for coping with prolonged grief have established their efficacy in decreasing symptoms of grief, depression, and loneliness. However, no study has tested the efficacy for reducing grief after losses occurring less than 6 months ago and the role of self-tailoring of the content.

The Limitations of User-and Human-Centered Design in an eHealth Context and How to Move Beyond Them.

Human-centered design (HCD) is widely regarded as the best design approach for creating eHealth innovations that align with end users' needs, wishes, and context and has the potential to impact health care. However, critical reflections on applying HCD within the context of eHealth are lacking. Applying a critical eye to the use of HCD approaches within eHealth, we present and discuss 9 limitations that the current practices of HCD in eHealth innovation often carry.

Time to act mature-Gearing eHealth evaluations towards technology readiness levels.

It is challenging to design a proper eHealth evaluation. In our opinion, the evaluation of eHealth should be a continuous process, wherein increasingly mature versions of the technology are put to the test. In this article, we present a model for continuous eHealth evaluation, geared towards technology maturity.

Overcoming Challenges to Inclusive User-based Testing of Health Information Technology with Vulnerable Older Adults: Recommendations from a Human Factors Engineering Expert Inquiry.

Objectives: Involving representative users in usability testing of health information technology (HIT) is central to user-centered design. However, (vulnerable) older adults as representative users have unique requirements. Aging processes may affect physical capabilities and cognitive skills, which can hamper testing with this demographic and may require special attention and revised protocols.

Game not over: Explaining older adults' use and intention to continue using a gamified eHealth service.

Background: Gamification within eHealth services can increase eHealth adoption. However, little is known about factors affecting adoption of gamified eHealth among older adults. In this study, we sought to explain the (continued) use of a gamified eHealth service among older adults (55+).

The First Introduction of Social Robotics in Rehabilitation Care.

Can you imagine to receive treatment through a robot? When talking about the future of healthcare, this is the vision many people have. Currently, the predominant role of social robots in care is entertaining patients. However, this does not have an impact on care process itself.

International eHealth ecosystems and the quest for the winning value proposition: findings from a survey study.

Background: eHealth ecosystems are becoming increasingly important for national and international healthcare. In such ecosystems, different actors are connected and work together to create mutual value. However, it is important to be aware of the goals that each actor pursues within the ecosystem.

Consulting the Oracle: A Delphi study for determining parameters for a mental health user profile and personalization strategy for an online service to aid grieving older adults.

While much effort has been devoted to the development of mental e-health interventions, the tailoring of these applications to user characteristics and needs is a comparatively novel field of research. The premise of personalizing mental e-health interventions is that personalization increases user motivation and (thereby) mitigates intervention dropout and enhances clinical effectiveness. In this study, we selected user profile parameters for personalizing a mental e-health intervention for older adults who lost their spouse.

Use and Effect of Embodied Conversational Agents for Improving Eating Behavior and Decreasing Loneliness Among Community-Dwelling Older Adults: Randomized Controlled Trial.

Background: Embodied conversational agents (ECAs) have been proposed as a promising interaction modality for the delivery of programs focused on promoting lifestyle changes. However, it is not understood what factors influence the health effects of ECAs or their use.

Objective: We aimed to (1) identify whether ECAs could persuade community-dwelling older adults to change their dietary behavior and whether ECA use could decrease loneliness, (2) test the pathways to these effects, and (3) understand factors influencing the use of ECAs.

Improving usability benchmarking for the eHealth domain: The development of the eHealth UsaBility Benchmarking instrument (HUBBI).

Background: Currently, most usability benchmarking tools used within the eHealth domain are based on re-classifications of old usability frameworks or generic usability surveys. This makes them outdated and not well suited for the eHealth domain. Recently, a new ontology of usability factors was developed for the eHealth domain.

Best Practices and Lessons Learned for Action Research in eHealth Design and Implementation: Literature Review.

Background: Action research (AR) is an established research framework to introduce change in a community following a cyclical approach and involving stakeholders as coresearchers in the process. In recent years, it has also been used for eHealth development. However, little is known about the best practices and lessons learned from using AR for eHealth development.

Predictors to Use Mobile Apps for Monitoring COVID-19 Symptoms and Contact Tracing: Survey Among Dutch Citizens.

Background: eHealth apps have been recognized as a valuable tool to reduce COVID-19's effective reproduction number. The factors that determine the acceptance of COVID-19 apps remain unknown. The exception here is privacy.

Supporting eating behaviour of community-dwelling older adults: co-design of an embodied conversational agent.

In order to support community-dwelling older adults with healthy eating behaviours, Embodied Conversational Agents (ECAs) may be an effective and engaging medium. However, ECAs have not yet been found to be capable of engendering behaviour change, which is partly attributed to the absence of a match with users' practices, needs and preferences. Hence, we describe a co-design process with older adults that informs both the content and the appearance of an ECA.

Conceptualizing Usability for the eHealth Context: Content Analysis of Usability Problems of eHealth Applications.

Background: Usability tests can be either formative (where the aim is to detect usability problems) or summative (where the aim is to benchmark usability). There are ample formative methods that consider user characteristics and contexts (ie, cognitive walkthroughs, interviews, and verbal protocols). This is especially valuable for eHealth applications, as health conditions can influence user-system interactions.

Designing a stakeholder-inclusive service model for an eHealth service to support older adults in an active and social life.

Background: Service model design is slowly being recognized among eHealth developers as a valuable method for creating durable implementation strategies. Nonetheless, practical guidelines and case-studies that inform the community on how to design a service model for an eHealth innovation are lacking. This study describes the development of a service model for an eHealth service, titled 'SALSA', which intends to support older adults with a physically active and socially inclusive lifestyle.

The formation of patient trust and its transference to online health services: the case of a Dutch online patient portal for rehabilitation care.

Background: Trust is widely recognized as a crucial factor in successful physician-patient communication and patient engagement in treatment. However, with the rise of eHealth technologies, such as online patient portals, the role of trust and the factors that influence it need to be reconsidered. In this study, we aim to identify the factors that contribute to trust in an eHealth service and we aim to identify the consequences of trust in an eHealth service in terms of use.

Clinician acceptance of complex clinical decision support systems for treatment allocation of patients with chronic low back pain.

Background: The uptake of complex clinical decision support systems (CDSS) in daily practice remains low, despite the proven potential to reduce medical errors and to improve the quality of care. To improve successful implementation of a complex CDSS this study aims to identify the factors that hinder, or alleviate the acceptance of, clinicians toward the use of a complex CDSS for treatment allocation of patients with chronic low back pain.

Methods: We tested a research model in which the intention to use a CDSS by clinicians is influenced by the perceived usefulness; this usefulness, in turn is influenced by the perceived service benefits and perceived service risks.

Use and Effect of Web-Based Embodied Conversational Agents for Improving Eating Behavior and Decreasing Loneliness Among Community-Dwelling Older Adults: Protocol for a Randomized Controlled Trial.

Background: An unhealthy eating pattern and loneliness negatively influence quality of life in older age. Embodied conversational agents (ECAs) are a promising way to address these health behaviors in an engaging manner.

Objective: We aim to (1) identify whether ECAs can persuade community-dwelling older adults to change their dietary behavior and whether ECA use can decrease loneliness, (2) test these pathways to effects, and (3) understand the use of an ECA.

Contextual Health Information Behavior in the Daily Lives of People with Type 2 Diabetes: A Diary Study in Scotland.

Changes in lifestyle can have positive effects on treating type 2 diabetes (T2D), like sporting or healthy eating. Therefore, a person diagnosed with T2D is often advised to make healthy choices throughout the day, in addition to other interventions such as medication. To do this, he or she needs health information to support decision-making.