Study Questions - Persuasive Health Technology

WEEK 1

Chapter 1
● Explain the relationship between technology, psychology and health
Technology is used as a means in the domain of psychology to improve the health, well-being
and healthcare. These technologies are called e-ehealth technologies and aim at supporting or
facilitating the life of the affected individuals. This proves to be extremely useful for the ageing population
the world is encountering and with this ageing population increases the need for healthcare, which is why
It becomes even more necessary to self-manage to maintain an acceptable quality of life.

● State several areas of application of eHealth and provide accompanying examples

Ehealth is applied in several areas such as in a hospital, where the nurses can make use of electronic health or medical
records. Moreover, in a psychiatric setting, ehealth may be used to tackle disorders like ADD, PTSD, OCD etc by
utilising VR in order to bring forth real emotions in a virtual environment.

● Name and explain several benefits and barriers of eHealth in development, implementation,
evaluation and use in practice
There are several benefits ehealth, one of the biggest is probably that healthcare can become available independent
of time and place because people can access it whenever and wherever they need it (access to healthcare).
With easier access, healthcare becomes more equally distributed among people, allowing for an improvement in
Healthcare equity.
Moreover, technology has the ability to empower people by giving them the opportunity to take more control of
their own healthcare. Likewise, patient-centredness can enable people to choose when and where they want to
to access healthcare and also professional can be empowered in their medical decision-making with the help of
E-health technology.
Another important benefit is that new technology opens up a new range of possibilities for healthcare which may
provide the groundwork for more sustainable change by supporting patient-centred and integrated care (innovation).
Furthermore, the quality of care can be improved by reducing human errors with the aid of ehealth technology, for
e.g. an app that supports nurses in prescribing patients antibiotics. Likewise, effectiveness can be improved by
using technology’s available possibilities in improving traditional healthcare. Efficiency can also be improved
because ehealth can require fewer resources to achieve the same quality of care (e.g. Teledermatology, where the
use of audio and video communication can decrease the number of doctor visits, so saving time and costs in the
assessment and treatment of skin conditions.)

However, even though ehealth technologies prove to be beneficial, in practice they don’t prove to be that
successful. Generally you can divide the barriers in three overall categories, namely implementation barriers,
ethical barriers and evidence barriers. A successful ehealth intervention should be embedded in practice and used as
Intended, however there are multiple factors that can negatively influence its uptake in practice. For example, if
people don’t feel the need or motivation to use a technology, it can result in a general resistance to use it. Incentives
to interact with the technology were perceived benefits for one’s health and well-being, as well as financial benefits.
Self-management portals are an example of a technology although proven effective, is not used regularly since the
patients do not recognize the benefits of adhering to the use. This could be due to the lack of human support in
Self-management, because if the user needs are not acknowledged throughout the development process, the
technology can lack commitment and support. Moreover, a lack of skills + confidence to engage with the ehealth
technology can prove to be a further implementation barrier as well as a general lack of motivation by users and
stakeholders to use the technology.

In regards to ethical barriers, privacy and security are obstacles encountered in the use of ehealth services. If we
 consider, for example, a smartwatch and the data that is collected with this watch (steps, locations, hydration, heart
rate etc.) and thus, it provides tailored feedback, but what if the data is misused and distributed to third-parties?
The lack of transparency requires clear policy rules and transparency of the data and what is done with the data.
Another ethical barrier is the quality of information. Is it okay to trust internet sources in regards to health and
well-being ? And in this context, it is unclear how medical professionals handle the data from these devices since
they are not based on medical standards.

Lastly, there are evidence barriers. Since the development of technologies in the last years became so rapid, research
is unable to keep up with it and, therefore, large-scale evidence of cost-effectiveness of ehealth is missing.
Furthermore, ehealth interventions are mostly not evaluated based on the full-picture (outcome-driven focus)
because of the used study designs (for e.g. RCTs, so experimental or quasi-experimental studies use cut-off
measurements at fixed points to determine the effectiveness of an ehealth intervention. Likewise, it is unclear
whether technology is used as intended by developers. Finally, ehealth technology should not be fixed and instead
evaluated and adapted constantly to the needs of the users, so a flexible approach is required.

● Explain what a holistic vision of eHealth entails and why it is required to overcome the barriers and
achieve the benefits
In order to overcome these barriers, a participatory development process, that creates a good fit between
technological, human and contextual factors, is needed. Holism, generally, refers to the notion that individual
elements in a complex system are determined by the relations they bear to other elements. So, all aspects of a
larger whole are interrelated, and separate analysis of its parts should be avoided. An important framework that
supports developers in creating a holistic approach of ehealth is the CeHRes roadmap. It combines human-centred
design, business modelling and persuasive design.

● Describe and explain the importance of the five pillars of holistic eHealth development
The CeHRes roadmap is underpinned by 5 pillars of ehealth development.
1. Ehealth is a participatory development process
This means that stakeholders are identified and involved during the entire development and evaluation process.
Possible stakeholders can include users, organisations etc. Stakeholders aid in creating a technology tailored
to their specific needs, because they are the ones affected by interventions and thus, they are most helpful
in improving the technology based on their input or in identifying critical issues for implementation.

2. Ehealth development creates new ecosystems for improving health and healthcare
This refers to technology not being neutral, so the use is never isolated but influenced by the context in which
it is used. Ehealth development created novel structures and processes for healthcare delivery and thus, an
Ecosystem for healthcare emerges.

3. Ehealth development is intertwined with implementation

In ehealth development, implementation plays an important role from the start since if issues are identified
early in the development process, they can be adapted and changed so they don’t have a negative effect
on the actual implementation.

4. Ehealth development is coupled with persuasive design

Technology provides the opportunity to change people’s behaviour and attitudes. Hence, persuasive technologies
can be used in order to achieve this change, because they support people in improving their health and well-being
by using the system in the intended way.

5. Ehealth development requires continuous evaluation cycles

Ehealth development is an iterative, flexible and dynamic process which aims at continuous evaluation. Every
 activity is followed by a formative evaluation which aids in checking whether the outcomes of the activities match
the context, stakeholders and outcomes of previous phases.

Chapter 7: (p131 - 157)

● Explain the need for a holistic, iterative and multidisciplinary development approach for eHealth technology
Ehealth is not merely a technical development, but a way of thinking or how to improve health and healthcare
with technology supporting this goal. Thus, a holistic approach is necessary because it addresses the
interrelationships between people, technology, health(care) and the environment. The development should
be multidisciplinary since these teams ensure more diversity in skills, perspectives and expertise. Moreover,
the team consists of different stakeholders, either professionals or users. Professionals are more focused on the
actual development, implementation and evaluation, whereas users make sure that the technology fits the
target population.

● Describe and define the 5 phases of the CeHRes Roadmap, state their main objectives and
explain the rationale behind each phase
1. Contextual Inquiry (context is analysed)
- Stakeholder identification
- Stakeholder Analysis
- Describing current situation
- Determining the value of ehealth

2. Value Specification (what is the added value of ehealth)

- Identifying values from stakeholder
- Categorising these values
- Creating a business model
- Translating values into requirements

3. Design (technology is created)

- Development of lo-fi + hi-fi prototype
- Usability tests
- Add persuasive elements + /or BCT’s

4. Operationalisation (technology is implemented)

- Creating plan to ensure introduction and long-term use
- Executing activities to implement the ehealth technology

5. Summative evaluation (influences of the intervention are studied)

- Determining impact of technology
- Analysing uptake of technology

● List several suitable methods for eHealth development, implementation and evaluation and explain
the added value of a multi-method approach for each phase
Contextual inquiry :
- Stakeholder identification
- Stakeholder analysis (stakeholder salience)
 - Desk research
- Focus groups
- Interviews
- Observations
- Log data analysis
- Diary study

Value Specification:
- Interviews
- Business model canvas
- Requirement templates

Design:
- Paper prototyping
- Digital prototyping
- Mock-up’s
- Heuristic evaluation
- Cognitive walkthrough
- Think aloud method
- PSD model
- BCTs

Operationalisation:
- Business modelling
- Implementation activities
- Diffusion of innovation theory
Summative evaluation:
- RCTs
- Interviews
- Usability test
- Formative evaluation

→ the combination of multiple methods creates in-depth understanding

● Explain how the phases of the CeHRes Roadmap are interrelated and connect this to an iterative,
agile development approach
Agile science refers to developments and evaluations occurring parallel and iteratively. This considers the inter-
relationship between context, people and technology as well as it enables rapid iteration and improvement
before the system’s are widely implemented. This is in line with the framework of the CeHRes roadmap, since
the formative evaluation after each phase refers to the iterative process.

● Explain the relationship between formative evaluation, holistic development and the involvement of
stakeholders in eHealth development, implementation and evaluation.
Formative evaluation ensures that the context, outcomes of previous phases and stakeholder needs are in line with
each phase of the CeHRes roadmap. Thus, the CeHRes roadmap is a framework that provides these guidelines
for a holistic approach since stakeholders are involved in every phase of the development, implementation
and evaluation of ehealth technology.
WEEK 2

Chapter 8

● Explain why and in what way the contextual inquiry is essential for the eHealth development process
The goal of the contextual inquiry is to get a thorough understanding of the context before the actual
development of an ehealth technology. It aims at providing the best fit between technology, its users,
other stakeholders and the environment. The outcomes of this phase serve as the basis for the rest of the
development process.

● Provide concrete examples from practice to illustrate the relevance of conducting a good contextual inquiry
for the development of good eHealth development
The results of the contextual inquiry are relevant in multiple ways, for example during the value specification,
the key stakeholders that have been identified should be involved. Moreover, in the design phase it is checked
whether the prototypes are still feasible in context of the analysed environment. Additionally, the
implementation of the technology begins already in the development process. Thus, a good contextual
inquiry is the basis for the entire development process.

● Name and explain the relevance of multiple research methods that are used in the contextual inquiry
Common methods used in the contextual inquiry are for e.g.:
- Desk research, non-systematic collection of already existing material on the topic (videos, literature
(un)scientific, videos, reports)
- Focus groups, where a small group of people discusses about a certain issue
- Scoping review, that enables an overview of the available literature in the field (RQ’s unspecific)
- Interviews
- Observations
- Log-data analysis

→ the combination of multiple methods creates in-depth understanding

● Explain the identification, analysis and added value of stakeholders during the contextual inquiry, and
connect this to the entire eHealth development process
First, a stakeholder identification is conducted where all relevant stakeholders are determined by means
of a scoping review, expert recommendations or snowball sampling. These methods will produce a long
list/map with stakeholders. Thus, the next step is the stakeholder analysis, where key stakeholders are
identified. The stakeholders that have been determined are mapped based on their power, their
legitimacy and their urgency according to a framework by Mitchell et al (1997). This approach is also
called stakeholder salience approach. Finally, after the key stakeholders have been identified,
they can be involved in the whole development process by for e.g. by conducting interviews to assess
their opinions, needs, wishes and views.
 ● Connect the contextual inquiry to holistic development, using the terms user, context and technology
A holistic approach is needed to overcome the barriers of ehealth. The contextual inquiry is essential in
this way because it identifies the users and key stakeholders needed for creating a participatory
development process. Furthermore, it explores the social/physical/environment in which the technology
is supposed to be employed to ensure the best fit between technology, context, creating new infrastructures
in ehealth. Generally, in holistic development, users are part of testing and evaluating the technology.

● Know how stakeholders should be involved in eHealth technology

In a participatory development approach, stakeholders are involved the entire development and evaluation
process , but there should be a balance between expert and user-perspective.

● Know and understand different stakeholder identification and analyses methods

Possible stakeholders (user, researcher, policy maker, funders, designer) can be identified with a literature
review giving insights in stakeholder theories or similar ehealth tech, or experts can nominate other
stakeholder or they can extend the list of stakeholders by means of snowball sampling. But since not every
stakeholder is of the same importance, they are mapped on power, legitimacy and urgency.

Chapter 9

● Know and understand the term Business model

A business model is the rationale of how an organisation delivers, captures and creates value. The business
model includes the resources needed for the actualisation of these values. Moreover, it guides the
implementation process and clarifies the costs and benefits. The way a business model is filled out depends
on the skills and preferences of the development team.

● Know and understand the necessary elements of the definition of a business model
Saebi (2016) described five elements necessary for the definition of a business model:
1. Value proposition → the offering from the organisation to the user
2. Market Segments → customer that benefits from value proposition
3. The infrastructure → activities/resources to create and deliver the value proposition
4. Mechanisms of value capturing → how the organisation is paid by customers (revenue)
5. Firm-specific ways in which these elements are linked → various elements of an organisation
are interrelated and mutually dependent

● Know and understand the components of the Business Model Canvas by Osterwalder and Pigneur (2009)
Business model canvas is a tool for creating business models. It describes the concepts and rules for
creating a business model.
From left to right:
 Key partners, are the organisations offering intermediate products and services to the organisation described
by the business model. These are organisations in the value network forming an ecosystem providing the
Ehealth services to beneficiaries.

Key activities, are the main activities carried out by the organisation itself. Here, how the organisation stands
out from others is described.

Key resources, are the resources needed to conduct the key activities (e.g. people with specific skills,
knowledge , instruments, equipment).

Value propositions, consists of the offerings of an organisation targeted to the needs of specific groups of
customers.

Customer relationships, describes the characteristics of the relationship the organisation strives to achieve
with its customers.

Channels, describe the way products and services are delivered to customers (e.g. face-to-face, media).

Customer segments, sets of customers with common characteristics who are supposed to benefit from
the same set of value propositions

Bottom left of canvas:

Cost Structure, how the costs are distributed across internal + external activities

Bottom right of canvas:

Revenue streams, how the organisation is paid

P1. Woezik, A.F.G. van, et al (2016)

● Understand how a mixed- methods approach can be used to identify, analyse and co-create with stakeholders
Contextual inquiry
1. Step: literature scan on wicked problem of interest
→ get acquainted with problem definitions, solutions, key stakeholders

2. Step: create initial stakeholder list

3. Step: involve (at least) 2 field experts to validate stakeholder list + gain practical insights

4. Step: involve + interview stakeholders from a range of different organisations in order to find
missing stakeholders + get different perspectives on wicked problem

5. Step: if list too long, repeat 1-4

6. Step: stakeholder rank final list

Value Specification:
7. Step: qualitative interviews or focus groups with key stakeholders with different backgrounds
 → to get an understanding of their values, needs + perspectives

8. Step: transcribe + code transcripts and/or focus groups to extract key values

9. Step: validate key stakeholders key values by sending survey to all stakeholder

10. Step: use all generated output to guide the subsequent phases of the process

P2. Limburg, M. van, et al.(2011)

● Know and understand why business modelling supports the development of eHealth technologies
It is interwoven with development to make both design and implementation more value driven.
Ehealth technology needs to fit in existing care infrastructures or, perhaps even more
importantly, be a catalyst for new, innovative care infrastructures. Moreover, business modelling
introduces research activities before the start of the technical design and acts as the basis for
discussion of value drivers with stakeholders.

● Know and understand how co-creation with stakeholders can be performed to create a business model
A bottom-up approach should be employed because it enables a value specification that further than
human-centred design, looks at the intended purpose of the technology and its fit in practice. Patients
are invited to be part of the development process, they are actively involved in their care + feel more
involved and positive towards technology (Patient empowerment). Moreover, OPEN dialogue is very
important in co-creation. An open business mode combines ideas of openness with business models
and that organisations can embed co-creation and collaboration. Furthermore, benefits and value needs
require input from all involved stakeholders. The stakeholder network determines customer segments
and the infrastructure require for value co-creation for ehealth technology. Stakeholder must interact
to co-create value to ehealth technology.

● Understand the difference between a business case and a business model

A business model plays part in implementation and is the basis for discussion of value drivers with
Stakeholders. It's the rationale of how an organisation creates, delivers and captures value. It acts
on a strategic level and provides the basis for more detailed business cases. There is
a strong focus on ideation. Business cases, on the other hand offer concrete info about details of the
operationalisation (necessary activities, resources, costs, financial prognoses). It is based on the
business model but more concrete. It is continuously updated during the development, so operationalisation
is not the endpoint.

WEEK 3

Chapter 10 (p207-216)
- Know and understand why User-Centered design (UCD) is important within design of eHealth
technology
Human-centred design aims to develop solutions to problems by involving the human
perspective in all steps of the process. The key is to keep users and stakeholders in the process
through requirement definition, early feedback, evaluation and field testing. By understanding
 your user, you can create a more relevant and valuable product. It allows understanding of the
true nature of the problem before devising the solution and it reduces the chances of failure and
positively affects user satisfactiionThis also is the reason why it is important within the design of
ehealth technology because users and stakeholders are part of the whole design process.
Human-centred design is composed of 5 specific phases, namely being:
1. Early concept - little idea of design + target group
→ learn more about their requirements + understand the scope of the design project + who the
key user is
2. Early planning - early ideas
→ low-fidelity prototypes or mock-ups + modify + revise
3. Design refinement - work on finer details
→ finished look and feel for the design
4. Mid-design - hi-fi prototype or mock-up
→ do a full evaluation, user experience as realistic as possible
5. Late design/post release - product is implemented
→ continuous evaluation

- Know and understand the importance of using requirements, name different types of
requirements and connect them to different eHealth design issues
A requirement is the technical translation of an attribute. An attribute is the summary of the
needs of the user and a value is an idea or interest of the user/stakeholder. So, requirements are
important because they represent the needs and values of the user + their context and entail
what and how the technology should specifically add. They can be considered as the foundation
of the design process.

Functional + modality requirements

→ technical features, so what kind of technology + operating system are being used?
Service requirements
→ how services surrounding the technology need to be organised (marketing, user support)
Content requirements
→ the content that needs to be communicated via the technology (e.g. language lebel,
persuasive approach, accessibility demands)
User experience requirements
→ the interface and interaction design of the technology and how the user experience factors
should be integrated into the technology (trust, fun)
Organisational requirements
→ how the technology should be integrated in the organisational structure and working routines

- Name and explain several methods and approaches that are suitable for UCD and connect them
to eHealth design.
There are several methods available that suit UCD.
Cognitive work analysis (Vincente, 1999) is a work-centred conceptual framework that aims to
 analyse cognitive work by evaluating the system already in place and developing
recommendations for design. People who interact with information are considered as actors in
work-related situations and human-information is viewed in the context of human work
activities. In order to design good systems that work with humans, one has to understand the
work that actors do, their information behaviour, the context and the reason for the actions.

Participatory design, stresses the importance of involving relevant persons during the
development of technologies. One form of participatory design is informant design, where users
are asked for input and feedback on some but not all choices. They voice only suggestions not
real choices. Another participatory design method is co-design, where users are equal design
partners.

Agil methods, include for example agile development which is a software development method
that tackles perceived limitations of plan-driven methods. Developers quickly develop a small
part of the whole system in order to evaluate and refine it and then move on to another small
part of the system. They don’t design the whole thing at once, so they remain responsive to
changing and new requirements.

Cognitive task analysis, refers to cutting up mental work into more manegeable constructs. It is
the extension of the traditional task analysis techniques by collecting information about the
knowledge, thought processes and goal structures. Observable behaviour and the covert
cognitive functions are seens as the integrated whole.

Persona-based design, provides information about the users to describe their relevant
characteristics. Personas are specific and concrete representations of fictitious persons. They are
useful to communicate the understanding the target group to the whole development team.
They help in identifying what the product needs. Personas have the key user groups
characteristics

P3. LeRouge, C., et al (2013)

- Understand and apply the design process of user profiles and personas for eHealth
development.
User profiles and personas can be a valuable methodological approach in capturing the
conceptual model of aging and informing the design and development decisions of CHT
(consumer health technologies). It is a structured UCD technique typifying a group of users in
text, modeling the end-user. It goes beyond demographics since it attempts to capture the users
mental expectation, prior experiences and anticipated behaviour.

- Know and understand how user profiles and personas can be used to inform requirements,
design and implementation decisions for eHealth development
Personas and user-profiles are conceptual models of the target group and tools of UCD
methodology. An user profile is a dynamic repository used to categorise, characterise and
prioritise a systems target user groups. A persona is a fictional and super-typical user
characterisation of a user created to represent a user group. The foundation of UCD is inquiring
 and analysing the needs, desired and limitations of the users. They can be used to enhance
existing methodology by introducing user-centred thinking into the design and development
process.

P4. Pruitt, J. & Grudin, J. (2008)

- Know and understand the benefits and risks of Personas
Benefits for personas include…
+ the act of creating personas make explicit out assumptions about the target audience.
+ Once created, they help to keep the assumptions and decision-making criteria explicit.
+ Personas are a medium for communication, a conduit for info about users and work setting
+ without personas, the development teams routinely make decisions about features and
implementation without recognising or communicating their underlying assumptions about who
will use the product and how it will be used
+ personas focus attention on a specific target audience. The method helps establish who is and
consequently who is not being designed for.

Risks for personas include..

- designing for any one external person is better than trying to design vaguely for everyone or
specifically for oneself
- in making choices, it becomes clear that choices have consequences
- difficult to avoid overextending their use when it’s time disband one cast of characters and
recruit another one
- marketing + product development have different needs that require different persona
attributes, and sometimes different target audiences
- temptation to overuse personas - at worst they could be used to replace other valid UCD
methods

P5. Van Velsen, L., et al (2012)

- Know and understand how the personas method can be applied in a holistic design approach for
eHealth development
Generally, personas are developed based on a risk analysis to determine the most important
user groups for the new ehealth technology, and interviews with members from the user groups.
These personas, combined with scenarios will be used as input during stakeholder sessions that
have the goal to reflect on the existing care delivery process and to eventually alter this practice.
They also serve as input for the requirements, the actual design and the evaluation of the new
ehealth technology.
The first step in creating a persona is determining the user group, then the primary user group is
interviewed. Afterwards, writing the biographies of the personas marks the end of persona
development. At the moment of writing, the stage of utilising personas in our holistic design
process has entered. Personas can be used to inspire the creation of requirements, as well as
functional, interface & interaction design of prototypical versions of the mobile tick tool. They
then serve as the basis for the creation of scenarios. Personas will influence the design of the
 prototype as well as during formative evaluations, personas will be used when recruiting
evaluation participants.

P6. Van Velsen, et al (2013)

- Know and understand how requirements can be developed and applied for eHealth
development in a holistic design approach
Requirements serve as the foundation of technology design. They describe what a technology
should do, what data it should store/retrieve, what content it should display and what kind of
user experience it should provide. Throughout the development process, formative evaluations
should be conducted to test design assumptions and prototypes.
Generally, there are 5 phases of requirement development:
1. Preparatory phase - here the project team is composed and the overall goal of the ehealth
intervention is decided upon
2. Primary end-user and stakeholder identification phase - in this phase, audience
segmentation techniques are being used (audience segmentation is concerned with identifying
homogeneous sub-populations within a population and their profiling) and the determinants
(knowledge, attitudes, behaviour) are uncovered in a given context
3. Requirement elicitation - here, profile end-user (segments) are mapped on their context of
use in relation to current prevention, opportunities and barriers and implementation. Moreover,
tactic knowledge is assessed. There are multiple methods for requirement elicitation..
- interviews should be used to profile end-users and stakeholders in order to elicit
requirements that will specify the functions, the content and the user experience.
- focus groups establish the context, roles and primary tasks that can be supported by
technology. Current work patterns or daily activities are understood and elicit input for
implementation strategies and business models.
- observations aid in understanding the actual end-user behaviour and their social, physical
and spatial surroundings in order to elicit requirements that specify the functions and modality.
4. requirement analysis - here, stakeholder values and ehealth intervention requirements are
distilled from the output from the requirement elicitation (transcripts). Raw data is translated
into requirements through 3 derivatives. Value, is a summary or interest an end-user or
stakeholder has. An attribute is a summary of the need that is spoken out by the future end-
user/stakeholder. The requirement then is a technical translation of an attribute
5. Communicating requirements to other developers using the requirements notation
template
WEEK 4
Chapter 11
- Explain what persuasive technology is, and in what way domains such as persuasive
communication, health promotion, social marketing, technology acceptance and human-media
interaction are underlying foundations
Persuasive technology is a field that studies any interactive information technologies
intentionally designed to change users' attitudes or behaviour. Persuasive systems are
computerised software or information systems designed to reinforce, change or shape attitudes
or behaviour or both without using coercion or deception. Technology becomes persuasive
through increased engagement of users through modern information and communication
technologies. The foundations of persuasive technology lie, for example, in persuasive
communication. Persuasive technology intends to describe, explain and predict the factors that
contribute to changing attitudes and behaviours. Schulz von Thun describes four layers of
communication that influence the understanding of information:
1. The factual layer, which refers to facts and data
2. The expressive layer, which refers to the relationship between sender and receiver
3. The self-revealing layer, which expresses something about the sender’s emotions and values
4. The appellation layer, which refers to the desire, advice, instructions and effects
This model describes and explains miscommunications. It is part of persuasion since the four
 aspects influence the coding (sending) and decoding (retrieving) of information.

Another foundation can be found in health promotion. The TPB and ELM are dominant in
persuasiveness of communication research. The central hypothesis states that success of a
persuasion attempt depends on the social context, beliefs and norms. The Theory of Planned
Behaviour assumes that intention is the most important predictor of behaviour. Moreover,
intentions are influenced by attitudes, subjective norm and perceived behavioural control. The
Elaboration Likelihood Model states that attitudes are being changed via several pathways of
information processing ranging from the central route (conscious, reason, arguments) to the
peripheral route (less conscious, social cues).

Next to that, social marketing is another foundation. The goal is to influence the target audience
to voluntarily accept, reject, modify or abandon a behaviour for the benefit of individuals,
groups or society as a whole. The basic principles of social marketing include:
- social norms (rules and standards that guide or constrain social behaviour)
- conformity (willingness of people to conform to others because of the social benefit of
being accepted
- compliance (increase people complying with a suggestion or request)
- goal-directed behaviours (behave effectively to build and maintain relationships or to
develop their self-concept
Additionally, Cialdini (2001) described 6 principles of compliance:
- Reciprocity (people feel obligated to return a favour)
- Scarcity (when something is scarce, people value it more)
- Authority (people are more inclined to comply with authorities)
- Commitment + Constancy (people do as they said they would)
- Consensus (people do what others do)
- Liking (people say yes to people they like, and to products which are used by normal
people)

Another foundation lies in two approaches that focus on technological aspects. The first one is
acceptance of technology, which is based on cognitive psychology and investigates and
influences predictors for acceptance or adherence to technology. This is done either through the
technology acceptance model or the unified theory of use and acceptance. Aspects that
influence the acceptance and adherence to technologies are the ease of use, performance and
effort expectations and social influence.
The second approach is human-media interaction & computer-mediated communication. The
goal of this approach is to investigate how people interact with and are influenced by
information technology. Thus, the design of interfaces to interact with technology and how
technology can support people to perform tasks need to be considered.

- Analyze the added value of persuasive technology in the context of improving health
The added value of persuasive technology is the enhanced motivation and engagement of the
users in order to change their attitude or behaviour. Moreover, persuasive technology can
 improve adherence, for e.g. dialogue support + social support increased adherence of web-
based interventions. It can also improve effectiveness, because persuasive systems as a whole
tend to be effective in improving health and well-being.

- Explain the PSD model, name the four categories, and provide examples of accompanying
persuasive features
The Persuasive Systems Design (PSD) model can be used to make technologies more persuasive
via the addition of persuasive features. The PSD model follows 7 principles:
1. Technology is never neutral (always has an intention/influence on you)
2. People like their views to be organised and consistent
3. Persuasion is often incremental (refers to the fact that behaviour change almost never takes
place at once but in small steps)
4. Technology uses direct and indirect routes (refers to ELM)
5. Technology should be open (clear purpose from start)
6. Technology should be unobtrusive (should not interfere with life, instead fit smoothly into
routine)
7. Technology should be user-friendly

Moreover, it consists of 4 categories of software features, being:

Primary Task Support, containing features that help the user in reaching the primary goal
(Reduction, Tunneling, Personalisation, Tailoring, Self-monitoring, Simulation, Rehearsal)
Dialogue Support, focusing on supporting and improving user-technology interaction (Rewards,
Praise, Reminders, Suggestion, Similarity, Liking, Social role etc.)
Credibility Support, where the user should perceive a technology as highly credible (Authority,
Expertise, Trustworthiness, Surface credibility, Real-world feel, Third-party endorsements,
Verifiability)
Social Support, where technology can play a role in providing social support from other human
beings (Social learning, Social comparison, Normative influence, Social facilitation, Cooperation,
Competition, Recognition)

- Explain in what way persuasive technology can be used to develop and evaluate eHealth
technologies
Persuasive technology can be used for the development of an unobtrusive technology that
facilitates the achievement of people’s goals. Within persuasive technology, the interaction
takes place between a system and different users, where the system can be seen as
representative of the designers. Therefore, computer-human persuasion is more complex bc of
an additional influential medium - the technology. Persuasion is not static, but an ongoing
process.
 - Provide examples of how persuasive features can be integrated into and eHealth technology
Dialogue support features provide guidance by suggesting useful exercises based on user goals
and primary task support features guide people through the intervention logic. Reduction and
Tunneling, were two features used to guide the user in the step-by-step registration of
infections.

P7. Oinas-Kukkonen, H. & Harjumaa, M. (2009).

- Know and understand the 7 key issues behind persuasive systems
1. Technology is never neutral (always has an intention/influence on you)
2. People like their views to be organised and consistent
3. Persuasion is often incremental (refers to the fact that behaviour change almost never takes
place at once but in small steps)
4. Technology uses direct and indirect routes (refers to ELM)
5. Technology should be open (clear purpose from start)
→ important to reveal designer bias
6. Technology should be unobtrusive (should not interfere with life, instead fit smoothly into
routine)
7. Technology should be user-friendly

- Describe the 28 design principles for persuasive system content and functionality from the PSD
model.

PRIMARY TASK SUPPORT

Principle Definition

Reduction A system that reduces complex behaviour

into simple tasks helps users perform the
target behaviour and may increase the
benefit/cost ratio of behaviour.

Tunneling Using the system to guide users through a

process of experience provides opportunities
to persuade along the way.

Tailoring Information provided by the system will be

more persuasive if it is tailored to the
potential needs, interests, personality, usage
context, or other factors relevant to a user
group.

Personalisation A system that offers personalised content or

serves has a greater capability for persuasion.

Self-monitoring A system that keeps track of one’s own

performance or status supports the user in
achieving goals.
 Simulation Systems that provide simulations can
persuade by enabling users to observe
immediately the link between cause and
effect.

Rehearsal Systems providing means with which to

rehearse a behaviour can enable people to
change their attitudes or behaviour in the real
world.

DIALOGUE SUPPORT
Principle Definition

Praise By offering praise, a system can users more

open to persuasion.

Rewards Systems that reward target behaviours may

have great persuasive powers.

Reminders If a system reminds users of their target

behavior, the users will more likely achieve
their goals.

Suggestion Systems offering fitting suggestions will have

greater persuasive powers.

Similarity People are more readily persuaded through

systems that remind them of themselves in
some meaningful way.

Liking A system that is visually attractive for its users

is more likely to be more persuasive.

Social role If a system adopts a social role, users will

more likely use it for persuasive purposes.

SOCIAL SUPPORT
Principle Definition

Social learning A person will be more motivated ti perform a

target behaviour if (s)he can use a system to
observe others performing the behaviour

Social comparison System users will have a greater motivation

to perform the target behaviour if they can
compare their performance with others.
 Normative influence A system can leverage normative influence of
peer pressure to increase the likelihood that a
person will adopt a target behaviour.

Social facilitation System users are more likely to perform

target behaviour of they discern via the
system that others are performing the
behaviour with them.

Cooperation A system can motivate users to adopt a target

attitude or behaviour by leveraging human
beings’ natural drive to cooperate.

Competition A system can motivate users to adopt a

target attitude or behaviour by leveraging
human beings’ natural drive to compete.

SYSTEM CREDIBILITY SUPPORT

Principle Definition

Trustworthiness A system that is viewed as trustworthy will

have increased powers of persuasion.

Expertise A system that is viewed as incorporating

expertise will have increased powers of
persuasion.

Surface credibility People make initial assessments of the

system credibility based on first-hand
inspection.

Real-world feel A system that highlights people or

organisation behind its content or serves will
have more credibility.

Authority A system that leverages roles of authority,

will have enhanced powers of persuasion.

Third-party endorsements Third-party endorsements, especially from

well-known and respected sources, boost
perception on system credibility.

Verifiability Credibility perceptions will be enhanced if a

system makes it easy to verify the accuracy of
site content via outside sources.

- Recognize the design principles within an eHealth intervention.

WEEK 5
Chapter 3 (48-62)
- Know, understand and explain the advantages of technology for health and know what
possibilities of technology induce these advantages
Advantages include..
- reduced costs
- increased convenience
- reduced stigma
- increases user + supplier control

According to Fogg, technology proves to a better persuader than human beings because
- Technology is more persistent (humans will get tired of persuading someone at some
point)
- Technology offers greater anonymity
- Technology can manage huge volumes of data
- Technology uses modalities to influence
- Technology is scalable (by using tech, many people can be reached without a large
increase in cost)
- Technology can go where humans cannot go or may not be welcome (importance of
timing)
- Know the evolution of technology, in particular technologies relating to eHealth

1. Early prescriptive systems (G1) were fundamentally human, static one-on-one persuasion
where healthcare providers used technology as telephones and CD’s for extra information
→ no real interaction with the technology itself
2. Second generation technologies, descriptive systems (G2) were mainly web-based systems
where text and later multimedia information was shared with and among users
→ use of sensor started
3. Third generation, environmental (G3) where the data from sensors and other context-aware
technologies are used to learn about the current state of the user
→ ‘just-in-time’-messages to influence behaviour
4. Fourth generation, automated (G4) pervasive sensing and the use of smart algorithms to
automatically personalise feedback and support
→ human intervention minimal

- Know and explain different examples of technologies and their opportunities for health and well-
being
Embodied conversational agents
- provide support
- engage in conversation
- express empathy
- create therapeutic alliance
- responsive or non-responsive
 Cognitive computing
- mimics human brain
- thinking machine
- train system based on data
- useful for clinical decision support, second opinion + adherence to guidelines

Virtual reality
- interact with and be immersed in a computer-generated environment
- can induce real emotions, skills + realistic environment

Wearable technology for self-tracking

- track objective data (e.g. movement, heart rate) and contextual data (e.g. weather)
- Can give user insight in health and well-being
- Many potential advantages, but lacking impact

- Explain the basics of common building blocks of technology (machine learning, natural language
processing, image recognition and neural networks)
The building blocks that make technology with AI possible are ..

Machine learning, which gives computers the ability to learn without being programmed
explicitly. It can be either supervised (when you give a computer a data set which labeled with
the thing you are interested in) or unsupervised (you give the computer an unlabeled data set +
computer tries to find clusters that seem to fit well together)
E.g. in health : predict depression or diagnosis in medical imaging

Natural language processing, which refers to unstructured data being processed in such a way
that it is interpretable to the machine. It connects human language and machine perception and
allows the use of many data sources (e.g. medical records, scientific literature etc.)

Image recognition, refers to the interpretation of images (e.g. MRI). One is able to use images as
data sources and it is often used in combination with NLP and ML.

Neural networks are a computerised approach inspired by biological neural networks. They are
used, for example, as the basis for image recognition

Chapter 10: (p216-222)

- Describe several types of prototypes and connect them to iterative design and the different
phases of HCD
Low-fidelity prototype
- communicate goal and ideas behind the technology to users
- most important features should be present
- doesn’t have to look like the finished product
 - early planning phase + design refinement of HCD

High-fidelity prototype
- higher resemblance to final version of ehealth technology
- for testing specific details
- mid-design + late design phase of HCD

Vertical prototype
- interactive hi-fi prototype of only a subset of the products available function

Horizontal prototype
- high-level functionality but do not contain the lower-level detail of the system

P8. Rudd, J., et al (1996)

- Know and understand the advantages and disadvantages of low- and high-fidelity prototype
Low-fidelity

Advantages Disadvantages

Lower development costs Limited error checking

Easily portable Poor detailed specification to code to

Evaluate multiple design concepts Not good for user evaluation

Does not require programming skills of the designer facilitator-driven

Useful communication medium by which Limited utility after requirements established

requirements can be articulated

Addresses screen layout issues Limited usefulness for usability tests

Useful for identifying market requirements Navigational and flow limitations

Proof-of concept

High-fidelity

Advantages Disadvantages

Complete functionality More expensive to develop

Full interactive Time-consuming to create

user-driven Require programming effort

 Clearly defines navigational scheme Insufficient for proof-of-concept designs

Use for exploration and test Not effective for requirements gathering

Look and feel of final product

Serves as a living specification

Marketing and sales tool

WEEK 6
Chapter 7 (p160-163)
- Explain the relationship between formative evaluation, holistic development and the
involvement of stakeholders in eHealth development, implementation and evaluation.
The Formative evaluation is two-fold, it can be used between development phases or within a
development phase. The objective of the formative evaluation is to check whether the outcomes of the
previous phases have been accounted for in the current phase and that the outcomes of all phases are
related to each other. Moreover, it uses methods to gather information from the stakeholders and the
context to continuously include their perspectives in the activities + outcomes of the development,
implementation and evaluation. It focuses mainly on ensuring that there is a clear relationship between the
content and the output of the phases. The responsibility for this lies with the development team. In the
contextual inquiry phase, snowball sampling is used to ask existing stakeholders to identify missing
stakeholders. In the value specification phase, lists of requirements are often verified by stakeholders once
they are drawn up. In the design phase, a straightforward example of formative evaluation is usability testing
among users via the think aloud method. During the operationalisation phase, the involvement of
stakeholders in finishing up the business model and making a plan on how to implement the model is an
example of formative evaluation. The formative evaluation is iterative and the backbone of the development
of ehealth technology. It aims to monitor whether a project is still on track, detect problems as early as
possible, solve the problems asap and make sure that the relationship between the technology, stakeholders
and context is guaranteed.

Chapter 10 (p222-227)
- Explain the relevance of evaluation for HCD and compare the goals of several common
evaluation techniques for different design stages

P9.Jaspers, M.W.M. (2009).

- Know and understand when and how to apply the different usability methods (the ‘expert-
based’ heuristic evaluation and cognitive walkthrough and ‘user-based’ think aloud method) and
know how these usability methods differ in their results + know the advantages and
disadvantages of the different usability methods

Expert-based methods aim at uncovering potential usability problems by having evaluators inspect a user
interface
Heuristic Evaluation
Experts evaluate an interface to determine conformance to a list of heuristics
→ useful in an early stage of system design

+ Quick and cheap

+ Promotes comparability between alternative designs

- Unstructured approach
- Reveals large numbers of specific, low priority problems
- Heuristics are often very generally described
- Results affected by skills + experience of evaluators

Cognitive Walkthrough
The CW relies on a cognitive model of a novice user (persona!) executing 4 steps in the context of a task the
user is to perform:
Steps
1. The user would set a goal to be accomplished
2. The user would inspect the available actions on the user screen (in the form of menu items, buttons,
etc.)
3. The user would select one of the available actions that seems to make progress toward his goal
4. The user would perform the action and evaluate the system’s feedback for evidence that progress is
being made toward his current goal

How to?
In executing the CW, for each action needed to accomplish a certain task, the evaluator tries to answer four
questions:
1. Will the user try to achieve the correct effect?
2. Will the user notice that the correct action is available?
3. Will the user associate correct action with the desired effect, and, if the user performed the right
action
4. Will the user notice that progress is being made towards the accomplishment of his goal?

Experts simulate new users walking through the interface step by step carrying out tasks
+ Highly structured
+ Detailed analysis of potential and severe problems

- Discourages exploration
- Tedious

→ useful in an early stage of system design

User-based methods
User-based think aloud testing (Jaspers, 2009)
End-users perform a series of tasks in interaction with the system while verbalising their thoughts

+ Rich source of data

+ Detailed insight in WHY of usability problems

- Verbal protocols do not tap all thinking

- Time consuming
- Results affected by evaluator skills

→ representative sample of potential end-users and tasks are crucial