Just-in-time adaptive intervention (JITAI) has gained attention recently and previous studies have indicated that it is an effective strategy in the field of mobile healthcare intervention. Identifying the right moment for the intervention is a crucial component. In this paper the reinforcement learning (RL) technique has been used in a smartphone exercise application to promote physical activity. This RL model determines the ‘right’ time to deliver a restricted number of notifications adaptively, with respect to users’ temporary context information (i.e., time and calendar). A four-week trial study was conducted to examine the feasibility of our model with real target users. JITAI reminders were sent by the RL model in the fourth week of the intervention, while the participants could only access the app’s other functionalities during the first 3 weeks. Eleven target users registered for this study, and the data from 7 participants using the application for 4 weeks and receiving the intervening reminders were analyzed. Not only were the reaction behaviors of users after receiving the reminders analyzed from the application data, but the user experience with the reminders was also explored in a questionnaire and exit interviews. The results show that 83.3% reminders sent at adaptive moments were able to elicit user reaction within 50 min, and 66.7% of physical activities in the intervention week were performed within 5 h of the delivery of a reminder. Our findings indicated the usability of the RL model, while the timing of the moments to deliver reminders can be further improved based on lessons learned.
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Background: App-based mobile health exercise interventions can motivate individuals to engage in more physical activity (PA). According to the Fogg Behavior Model, it is important that the individual receive prompts at the right time to be successfully persuaded into PA. These are referred to as just-in-time (JIT) interventions. The Playful Active Urban Living (PAUL) app is among the first to include 2 types of JIT prompts: JIT adaptive reminder messages to initiate a run or walk and JIT strength exercise prompts during a walk or run (containing location-based instruction videos). This paper reports on the feasibility of the PAUL app and its JIT prompts.Objective: The main objective of this study was to examine user experience, app engagement, and users' perceptions and opinions regarding the PAUL app and its JIT prompts and to explore changes in the PA behavior, intrinsic motivation, and the perceived capability of the PA behavior of the participants.Methods: In total, 2 versions of the closed-beta version of the PAUL app were evaluated: a basic version (Basic PAUL) and a JIT adaptive version (Smart PAUL). Both apps send JIT exercise prompts, but the versions differ in that the Smart PAUL app sends JIT adaptive reminder messages to initiate running or walking behavior, whereas the Basic PAUL app sends reminder messages at randomized times. A total of 23 participants were randomized into 1 of the 2 intervention arms. PA behavior (accelerometer-measured), intrinsic motivation, and the perceived capability of PA behavior were measured before and after the intervention. After the intervention, participants were also asked to complete a questionnaire on user experience, and they were invited for an exit interview to assess user perceptions and opinions of the app in depth.Results: No differences in PA behavior were observed (Z=-1.433; P=.08), but intrinsic motivation for running and walking and for performing strength exercises significantly increased (Z=-3.342; P<.001 and Z=-1.821; P=.04, respectively). Furthermore, participants increased their perceived capability to perform strength exercises (Z=2.231; P=.01) but not to walk or run (Z=-1.221; P=.12). The interviews indicated that the participants were enthusiastic about the strength exercise prompts. These were perceived as personal, fun, and relevant to their health. The reminders were perceived as important initiators for PA, but participants from both app groups explained that the reminder messages were often not sent at times they could exercise. Although the participants were enthusiastic about the functionalities of the app, technical issues resulted in a low user experience.Conclusions: The preliminary findings suggest that the PAUL apps are promising and innovative interventions for promoting PA. Users perceived the strength exercise prompts as a valuable addition to exercise apps. However, to be a feasible intervention, the app must be more stable.
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Adaptive governance describes the purposeful collective actions to resist, adapt, or transform when faced with shocks. As governments are reluctant to intervene in informal settlements, community based organisations (CBOs) self-organize and take he lead. This study explores under what conditions CBOs in Mathare informal settlement, Nairobi initiate and sustain resilience activities during Covid-19. Study findings show that CBOs engage in multiple resilience activities, varying from maladaptive and unsustainable to adaptive, and transformative. Two conditions enable CBOs to initiate resilience activities: bonding within the community and coordination with other actors. To sustain these activities over 2.5 years of Covid-19, CBOs also require leadership, resources, organisational capacity, and network capacity. The same conditions appear to enable CBOs to engage in transformative activities. How-ever, CBOs cannot transform urban systems on their own. An additional condition, not met in Mathare, is that governments, NGOs, and donor agencies facilitate, support, and build community capacities. This is the peer reviewed version of the following article: Adaptive governance by community-based organisations: Community resilience initiatives during Covid‐19 in Mathare, Nairobi. which has been published in final form at doi/10.1002/sd.2682. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions
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For people with early-dementia (PwD), it can be challenging to remember to eat and drink regularly and maintain a healthy independent living. Existing intelligent home technologies primarily focus on activity recognition but lack adaptive support. This research addresses this gap by developing an AI system inspired by the Just-in-Time Adaptive Intervention (JITAI) concept. It adapts to individual behaviors and provides personalized interventions within the home environment, reminding and encouraging PwD to manage their eating and drinking routines. Considering the cognitive impairment of PwD, we design a human-centered AI system based on healthcare theories and caregivers’ insights. It employs reinforcement learning (RL) techniques to deliver personalized interventions. To avoid overwhelming interaction with PwD, we develop an RL-based simulation protocol. This allows us to evaluate different RL algorithms in various simulation scenarios, not only finding the most effective and efficient approach but also validating the robustness of our system before implementation in real-world human experiments. The simulation experimental results demonstrate the promising potential of the adaptive RL for building a human-centered AI system with perceived expressions of empathy to improve dementia care. To further evaluate the system, we plan to conduct real-world user studies.
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Introduction: Many adults do not reach the recommended physical activity (PA) guidelines, which can lead to serious health problems. A promising method to increase PA is the use of smartphone PA applications. However, despite the development and evaluation of multiple PA apps, it remains unclear how to develop and design engaging and effective PA apps. Furthermore, little is known on ways to harness the potential of artificial intelligence for developing personalized apps. In this paper, we describe the design and development of the Playful data-driven Active Urban Living (PAUL): a personalized PA application.Methods: The two-phased development process of the PAUL apps rests on principles from the behavior change model; the Integrate, Design, Assess, and Share (IDEAS) framework; and the behavioral intervention technology (BIT) model. During the first phase, we explored whether location-specific information on performing PA in the built environment is an enhancement to a PA app. During the second phase, the other modules of the app were developed. To this end, we first build the theoretical foundation for the PAUL intervention by performing a literature study. Next, a focus group study was performed to translate the theoretical foundations and the needs and wishes in a set of user requirements. Since the participants indicated the need for reminders at a for-them-relevant moment, we developed a self-learning module for the timing of the reminders. To initialize this module, a data-mining study was performed with historical running data to determine good situations for running.Results: The results of these studies informed the design of a personalized mobile health (mHealth) application for running, walking, and performing strength exercises. The app is implemented as a set of modules based on the persuasive strategies “monitoring of behavior,” “feedback,” “goal setting,” “reminders,” “rewards,” and “providing instruction.” An architecture was set up consisting of a smartphone app for the user, a back-end server for storage and adaptivity, and a research portal to provide access to the research team.Conclusions: The interdisciplinary research encompassing psychology, human movement sciences, computer science, and artificial intelligence has led to a theoretically and empirically driven leisure time PA application. In the current phase, the feasibility of the PAUL app is being assessed.
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This longitudinal, quantitative study contributes to the debate on technology-based professional development by examining the extent to which a learning (LinkedIn) intervention in a university setting affects an individual’s social media use for professional development, and the extent to which this relates to self-reported employability. In addition, we investigated how this relationship is moderated by an individual’s motivation to communicate through social media (LinkedIn). Based on social capital theory and the conservation of resources theory, we developed a set of hypotheses that were tested based on longitudinal data collected from university employees (N = 101) in middle- and high-level jobs. First, in line with our expectations, social media use for professional development was significantly higher after the learning intervention than before. Second, partially in line with our expectations, social media use for professional development was positively related with the employability dimension anticipation and optimization. Third, contrary to our expectations, motivation to communicate through social media (LinkedIn) did not have a moderating role in this relationship. We concluded that the learning intervention has the potential to foster social media use for professional development, and in turn, can contribute to individuals’ human capital in terms of their employability. Hence, the intervention that forms the core of this empirical research can be a sustainable and promising human resource management (HRM) practice that fits the human capital agenda.
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Objective: To describe the development of a goal-directed movement intervention in two medical wards, including recommendations for implementation and evaluation. Design: Implementation Research. Setting: Pulmonology and nephrology/gastroenterology wards of the University Medical Centre Utrecht, The Netherlands. Participants: Seven focus groups were executed including 28 nurses, 7 physical therapists and 15 medical specialists. Patients' perceptions were repeatedly assessed during the iterative steps of the intervention development. Intervention: Interventions were targeted to each ward's specific character, following an Intervention Mapping approach using literature and research meetings. Main measures: Intervention components were linked to Behavior Change Techniques and implementation strategies will be selected using the Expert Recommendation Implementing Change tool. Evaluation outcomes like number of patients using the movement intervention will be measured, based on the taxonomy of Proctor. Results: The developed intervention consists of: insight in patients movement behavior (monitoring & feedback), goal setting (goals & planning) and adjustments to the environment (associations & antecedents). The following implementation strategies are recommended: to conduct educational meetings, prepare & identify champions and audit & provide feedback. To measure service and client outcomes, the mean level of physical activity per ward can be evaluated and the Net Promoter Score can be used. Conclusion(s): This study shows the development of a goal-directed movement intervention aligned with the needs of healthcare professionals. This resulted in an intervention consisting of feedback & monitoring of movement behavior, goal setting and adjustments in the environment. Using a step-by-step iterative implementation model to guide development and implementation is recommended.
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Abstract Background: Several interventions have been developed to improve physical health and lifestyle behaviour of people with a severe mental illness (SMI). Recently, we conducted a pragmatic cluster-randomised controlled trial which evaluated the efects of the one-year Severe Mental Illness Lifestyle Evaluation (SMILE) lifestyle intervention compared with usual care in clients with SMI. The SMILE intervention is a 12-month group-based lifestyle intervention with a focus on increased physical activity and healthy food intake. The aim of the current study was to explore the experiences of people with SMI and healthcare professionals (HCPs) regarding implementation feasibility of the SMILE intervention and the fdelity to the SMILE intervention. Methods: A process evaluation was conducted alongside the pragmatic randomized controlled trial. The experiences of clients and HCPs in the lifestyle intervention group were studied. First, descriptive data on the implementation of the intervention were collected. Next, semi-structured interviews with clients (n=15) and HCPs (n=13) were performed. Interviews were audiotaped and transcribed verbatim. A thematic analysis of the interview data was performed using MAXQDA software. In addition, observations of group sessions were performed to determine the fdelity to the SMILE intervention using a standardised form. Results: Ten out of 26 HCPs who conducted the group sessions discontinued their involvement with the intervention, primarily due to changing jobs. 98% of all planned group sessions were performed. Four main themes emerged from the interviews: 1) Positive appraisal of the SMILE intervention, 2) Suggestions for improvement of the SMILE intervention 3) Facilitators of implementation and 4) Barriers of implementation. Both clients and HCPs had positive experiences regarding the SMILE intervention. Clients found the intervention useful and informative. The intervention was found suitable and interesting for all people with SMI, though HCPs sometimes had to tailor the intervention to individual characteristics of patients (e.g., with respect to cognitive functioning). The handbook of the SMILE intervention was perceived as user-friendly and helpful by HCPs. Combining SMILE with daily tasks, no support from other team members, and lack of staf and time were experienced as barriers for the delivery of the intervention Conclusion: The SMILE intervention was feasible and well-perceived by clients and HCPs. However, we also identifed some aspects that may have hindered efective implementation and needs to be considered when implementing the SMILE intervention in daily practice
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Background: The environment affects children’s energy balance-related behaviors to a considerable extent. A context-based physical activity and nutrition school- and family-based intervention, named KEIGAAF, is being implemented in low socio-economic neighborhoods in Eindhoven, The Netherlands. The aim of this study was to investigate: 1) the effectiveness of the KEIGAAF intervention on BMI z-score, waist circumference, physical activity, sedentary behavior, nutrition behavior, and physical fitness of primary school children, and 2) the process related to the implementation of the intervention. Methods: A quasi-experimental, controlled study with eight intervention schools and three control schools was conducted. The KEIGAAF intervention consists of a combined top-down and bottom-up school intervention: a steering committee developed the general KEIGAAF principles (top-down), and in accordance with these principles, KEIGAAF working groups subsequently develop and implement the intervention in their local context (bottom-up). Parents are also invited to participate in a family-based parenting program, i.e., Triple P Lifestyle. Children aged 7 to 10 years old (grades 4 to 6 in the Netherlands) are included in the study. Effect evaluation data is collected at baseline, after one year, and after two years by using a child questionnaire, accelerometers, anthropometry, a physical fitness test, and a parent questionnaire. A mixed methods approach is applied for the process evaluation: quantitative (checklists, questionnaires) and qualitative methods (observations, interviews) are used. To analyze intervention effectiveness, multilevel regression analyses will be conducted. Content analyses will be conducted on the qualitative process data. Discussion: Two important environmental settings, the school environment and the family environment, are simultaneously targeted in the KEIGAAF intervention. The combined top-down and bottom-up approach is expected to make the intervention an effective and sustainable version of the Health Promoting Schools framework. An elaborate process evaluation will be conducted alongside an effect evaluation in which multiple data collection sources (both qualitative and quantitative) are used.
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Abstract: Sedentary behaviour in children, four years of age and older, has increased over the last decades. These children become physically less skilled, which demotivates them for regular sports activities. They become susceptible to health risks such as obesity and have a heightened chance to develop depression and a lower self-esteem. Sports professionals acknowledge that these children in time become unable to keep up with the sports education pace, leaving them prone to social exclusion as well.Exergames seem promising in their potential to increase the amount and quality of physical exercise in this group. Moreover, they offer strategies to motivate children to a more active and healthier lifestyle. However, some issues remain unclear regarding their applicability and individual fittingness. For one thing sports professionals have little to no experience using exergames in physical education, let alone understand which games could be appropriate to structurally activate said children. In addition, existing exergames regularly lack a suitable degree of adaptivity regarding what a child is physically capable of, which psychological needs should be addressed, and to what inactive children find appealing in terms of gameplay.The aim of our research project is to build a first prototype of an adaptive platform for exergames to motivate inactive children to structurally engage in physical exercise more, and better. The participative design method we used in our preliminary qualitative research led to a better understanding of the barriers to move and the psychological needs children have when it comes to physical exercise. We made a first global list of requirements for the adaptive platform and an overview of necessary design directions.Future pursuits in this project include a participative design research study amongst both children and sports professionals, and a thorough review of the literature and state of the art knowledge. We will use this knowledge to create a first prototype of an adaptive platform in collaboration with a serious game company and an organisation of sport professionals. After user testing we will use the evaluation findings as a baseline for future measurements regarding the adaptation of suggested exergames and to formalize and disseminate found design guidelines.
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