Gamification offers methods for influencing human behaviour that are not available with other approaches to behaviour-change interventions. Its widespread and successful use in business, education, and health care notwithstanding, it has so far not been extensively used for improving sustainability, nor have its underlying psychological principles been studied in depth. This dissertation investigates gamification with a special focus on the role of perspective taking and emotion. A gamified behaviour-change app was compared with a standard app and a webpage for its effect on participants’ sustainable behaviours. During the one month period the participants engaged with the intervention, they kept diaries about their experience with sustainability and the technology. Furthermore, the influence of dramatic elements was tested through an augmented reality approach. Gamification encourages longer engagement with the intervention, thereby influencing behaviour. Specifically, gamification increases knowledge about and willingness to invest effort into sustainable behaviours. Dramatic elements, using the power of narrative persuasion and immersion, are important aspects to consider in gamification. The theory of behavioural choice can fruitfully serve as a psychological model of how gamification affects behaviour. / Graduate

<div>Growing automobile dependency and usage continue to exacerbate traffic congestion, air pollution, and physical inactivity in metropolitan areas. Extensive efforts have been made to leverage advanced technology and related policies to influence short- (within-day and day-to-day) and long-term (mobility and lifestyle) travel decisions to address these issues from the system operator and individual traveler perspectives. However, most studies have yet to address system operator and individual traveler needs together; provide sufficient understanding of the impacts of such technologies on safety and health; and consider the impacts of distinctive regional and political characteristics on responses to different policies among population subgroups.</div><div>This dissertation seeks to facilitate the leveraging of information technologies and related policies to influence short- and long-term travel decisions by: (1) developing a framework for apps that integrate augmented reality, gamification, and social component to influence travel decisions that address multiple user- and system-level goals, (2) understanding the safety and health impacts of these apps, (3) developing strategies to influence residential location decision-making to foster sustainable post-relocation travel behavior, (4) investigating the impacts of economic and legal policies on travel decisions by considering distinctive regional and political characteristics.</div><div>This dissertation can provide insights to system operators for designing a new generation of apps to dynamically manage traffic in real-time, promote long-term mode shifts from single-occupancy driving to carpooling, public transit use, walking and cycling, and address individual traveler needs. The dissertation also presents app mechanisms for providing feedback to legislators and app developers for designing policies and apps geared towards safe usage and promoting the physical and mental health of its users. </div><div>In addition, by considering the impacts of distinctive regional and political characteristics on population subgroups in terms of their responses to information technologies and economic and legal policies, additional measures can be deployed to support and facilitate the implementation of such technologies and policies.</div><div><br></div>

Background: There are naturally occurring health events, such as illness diagnosis, that motivate people to spontaneously adopt healthy behaviours. Such events are often re-ferred to as teachable moments. They have the potential to increase the effectiveness of behaviour change interventions, when people are already motivated to change behaviour. However, it is unclear what makes illness diagnosis a teachable moment for some people but not for others. This project aims to identify the factors determining whether and for whom diagnosis of type 2 diabetes is a teachable moment, and to explore the components of a potential intervention to reduce the risk of type 2 diabetes among high-risk groups. Method: A mixed-methods design, divided into two studies, was employed. The first study was a qualitative study and used semi-structured interviews (n=10 patients and n=13 relatives). It explored the changes occurring in people after diagnosis of type 2 diabetes in oneself or a family member in an effort to identify what factors make diagnosis a teachable moment. The study also explored people's suggestions for a potential diabetes prevention intervention. The second study was a quantitative study and used postal questionnaires (n=85 patients and n=55 relatives). It investigated the relationship between potential teachable moment factors and primary outcomes (physical activity, diet, interest in diabe-tes-related information and education course). Results: This mixed-methods study suggests that the factors that may make diagnosis of type 2 diabetes a teachable moment for patients are outcome expectancy, perceived con-trol, severity, self-concept or social role, gender and time since diagnosis; and for relatives: perceived risk, severity, self-concept or social role, and gender. Although there was lack of complete alignment in factors identified through different methods, this study advances understanding of when interventions may be more (or less) successful. The study makes recommendations for potential interventions to capitalise on the teachable moment crite-ria. Conclusion: The current project highlights the complexity of teachable moment criteria and their relationship with behaviour change. Future research is required to further uncov-er these criteria and their utility for health promotion.

This project aimed to develop a digital web and mobile phone intervention for reducing Estonian adolescent and young adult alcohol and tobacco consumption. A systematic review was conducted, including a meta-analysis based on 32 randomised controlled trials, to investigate the associations with effectiveness of digital interventions in reducing adolescent and young adult alcohol and tobacco consumption. Digital interventions reduced adolescent and young adult weekly drinking (mean difference = -0.55, 95% CI (-1.04, -0.05), I2=93%) and monthly binge drinking (mean difference = -0.30, 95% CI (-0.55, -0.05), I2 = 75%). Digital interventions increased smoking cessation (risk ratio = 1.70, 95% CI (1.37, 2.11), I2= 35%). A qualitative focus group study with Estonian adolescents and young adults (N=22) indicated a lack of knowledge regarding effects of alcohol and tobacco consumption early in life and a recognition of the difficulty to change alcohol and tobacco consumption. A web and mobile phone based intervention programme was appealing to the focus group participants. The development of the first individually tailored web and mobile phone intervention targeting Estonian adolescent and young adult alcohol and tobacco consumption was undertaken. The content of this intervention was informed by the systematic review and meta-analysis, focus group study, psychological theory, and participatory design. The intervention, called MyOwnMe, is a tailored web program linked to a daily mobile phone text-messaging program. A pilot study with Estonian adolescents and young adults (N=22) indicated feasibility of implementation in Estonia and acceptability of intervention content. No difference was found between the intervention and control group in alcohol (mean difference = -0.2 95% CI (-0.9, 0.6), p = 0.62) or tobacco consumption (30-day abstinence from cigarette smoking RR = 1.25, 95% CI (0.81, 1.94)) after the 8-week study period. Results of this pilot study will be used for recommendations in this thesis on the development of individually tailored web and mobile phone interventions for Estonian adolescents and young adults.

Poor diet including inadequate vegetable consumption is among the leading causes of death in the US and UK. Mobile applications (apps) have been heralded as a potentially transformative tool for delivering behavioural nutrition interventions at scale, but most have yet to incorporate theory-based strategies known to drive changes in health behaviours or undergo systematic testing to demonstrate their effectiveness. Moreover, published frameworks to guide the development of such technologies have yet to integrate best practices from academia and industry. The aim of this dissertation was therefore to introduce a process for guiding the development of more effective mobile interventions and to apply that process in the development and evaluation of a mobile application to increase vegetable consumption. This dissertation introduced IDEAS (Integrate, DEsign, Assess, Share), a step-by-step process for integrating behavioural theory, design thinking, and evaluation to guide the development of more effective mobile health interventions. IDEAS was then applied in the iterative development of Vegethon, a mobile app to increase vegetable consumption among overweight adults. Behavioural theory and two stages of qualitative interviews with participants (n=18; n=14) shaped intervention conception and refinement. The final mobile app enabled easy self-monitoring and incorporated 18 behaviour change techniques including goal setting, feedback, social comparison, prompts, framing, and identity. A pilot randomized controlled trial among overweight adults (n=17) was conducted and indicated the initial acceptance, feasibility, and efficacy of the intervention, showing significantly greater consumption of vegetables among the intervention vs. control condition after 12 weeks (adjusted mean difference: 7.4 servings; 95% CI: 1.4, 13.5; p=0.02). A more substantially powered randomized controlled trial among overweight adults (n=135) was conducted and similarly found significantly greater daily vegetable consumption in the intervention vs. control condition (adjusted mean difference: 2.0 servings; 95% CI: 0.2, 3.8, p=0.03). These findings show, for the first time in a rigorous randomized controlled trial, the efficacy of a stand-alone theory-based mobile app to increase vegetable consumption. Given the improved health outcomes associated with greater vegetable consumption, these data indicate the need for longer-term evaluations of Vegethon and similar technologies among overweight adults and other suitable target groups. Theory-based mobile apps may present a low-cost and readily scalable tool for delivering behavioural health interventions. The IDEAS framework may be useful to investigators in the development of their own mobile health interventions.

<p>Abstract</p><p>Title: Network communication for equal opportunities (Nätverkskommunikation för jämställdhet)</p><p>Number of pages: 47 (54 with enclosures)</p><p>Author: Hillevi Good</p><p>Tutor: Ylva Ekström</p><p>Course: Media and Communication Studies D</p><p>Period: Spring Semester 2007</p><p>University: Division of Media and Communication, Department of Information Science, Uppsala University</p><p>Aim: The aim of this essay is to study the possibilities to bring about change by the means of communication in two networks, focusing on the implementation of the Swedish Equal Opportunities Act.</p><p>Material and method: The study draws on data collected in an electronic survey among representatives of two networks consisting of representatives from trade unions and employer’s associations. The material is analyzed using descriptive tools, cross tables and correlation matrices in which general characteristics as well as individual understandings of the network communication are presented and discussed.</p><p>Main results: The general results indicate that the network communication serves important purposes, such as providing support and motivation for the members and changing attitudes towards equal opportunities. The analysis suggests that the network members have good communicative possibilities to serve as agents of change within their organisations. Moreover, there is an observed relation between, on the one hand, organizational context and, on the other hand, the network members’ own communicational behaviour and their experienced possibility to influence their organizations.</p><p>Keywords: network communication, diffusion of innovations, behaviour change, Equal Opportunities Act</p>

Abstract Title: Network communication for equal opportunities (Nätverkskommunikation för jämställdhet) Number of pages: 47 (54 with enclosures) Author: Hillevi Good Tutor: Ylva Ekström Course: Media and Communication Studies D Period: Spring Semester 2007 University: Division of Media and Communication, Department of Information Science, Uppsala University Aim: The aim of this essay is to study the possibilities to bring about change by the means of communication in two networks, focusing on the implementation of the Swedish Equal Opportunities Act. Material and method: The study draws on data collected in an electronic survey among representatives of two networks consisting of representatives from trade unions and employer’s associations. The material is analyzed using descriptive tools, cross tables and correlation matrices in which general characteristics as well as individual understandings of the network communication are presented and discussed. Main results: The general results indicate that the network communication serves important purposes, such as providing support and motivation for the members and changing attitudes towards equal opportunities. The analysis suggests that the network members have good communicative possibilities to serve as agents of change within their organisations. Moreover, there is an observed relation between, on the one hand, organizational context and, on the other hand, the network members’ own communicational behaviour and their experienced possibility to influence their organizations. Keywords: network communication, diffusion of innovations, behaviour change, Equal Opportunities Act

The purpose of the study was to examine what methods and strategies individuals use to maintain their weight loss. Another aim was to explore which factors can complicate or simplify weight loss maintenance. Fifty-four individuals who had maintained their weight loss more than a year, participated by answering a questionnaire. The questionnaire was constructed and distributed through the internet. The answers were registered in the program google docs.  The participants mentioned successful methods and strategies, such as exercising regularly, the majority exercised 30 minutes at least five times per week. Successful methods and strategies regarding diet for weight loss maintenance were to increase the intake of fruits, protein and vegetables and to reduce the intake of carbohydrates and sweets. To maintain the weight loss, social support was considered important, both during the weight loss period but also afterwards, while maintaining it. Other successful strategies were to weigh oneself every week and to exert control over the eating.  The conclusion of useful strategies for weight loss maintenance was according to the participants, to exercise regularly and to eat plenty of vegetables, fruits and protein and at the same time minimize the intake of sweets and carbohydrates. / Syftet med studien var att undersöka vilka metoder och strategier individer använder sig av för hållbar viktnedgång. Vad det är som kan göra att individer bibehåller sin viktnedgång och varför det kan vara svårt, undersöktes också. Femtiofyra personer deltog, varav 33 kvinnor och 21 män i olika åldrar. Kravet för att inkluderas i studien var att de skulle ha bibehållit sin viktnedgång minst ett år, då detta är definitionen på hållbar viktnedgång. Undersökningspersonerna deltog genom att besvara en webbaserad enkät med i huvudsak kvantitativa frågeställningar. En ökad konsumtion av grönsaker, frukt och protein och en minskad konsumtion av kolhydrater, sötsaker och snabbmat bidrog till hållbar viktnedgång. Regelbunden fysisk aktivitet var associerat med hållbar viktnedgång där vardagsmotion, promenader, styrketräning och löpning utgjorde den fysiska aktiviteten. Majoriteten av undersökningspersonerna utövade minst 30 minuters motion fem dagar eller fler i veckan. Att väga sig och ha kontroll över sitt ätande var ytterligare två strategier för hållbar viktnedgång. Socialt stöd under viktnedgången resulterade i att viktminskningsperioden gick snabbare för deltagarna samt att ju mer stöd som de hade, desto högre var sannolikheten att viktnedgången bibehölls. Konklusionen av denna studie är att för att en hållbar viktnedgång ska uppnås, krävs ett ökat intag av grönsaker, frukt och protein och ett minskat intag av kolhydrater och sötsaker. Regelbunden fysisk aktivitet tycks vara ett nödvändigt krav för hållbar viktnedgång, medan socialt stöd kan underlätta en bibehållen viktnedgång.

Many patient-level barriers to more effective post-fracture osteoporosis (OP) management are associated with patients’ perceptions of their bone health and the link between their fracture and OP. These barriers could be addressed by interventions which account for the role of patients’ perceptions, such as those based on theories of behaviour change. This thesis had two objectives: to review the literature and determine whether these theories have been integrated in post-fracture OP management and to examine patients’ awareness of the OP-fracture link. The results showed that theories of behaviour change have not been integrated into post-fracture interventions, that most patients do not perceive the OP-fracture link even after a baseline intervention and that two baseline factors predict who is less likely to make the OP-fracture link at follow up. Based on these findings, modifications to current OP interventions were proposed and guidance that could help create new, patient-centered interventions was provided.

Many patient-level barriers to more effective post-fracture osteoporosis (OP) management are associated with patients’ perceptions of their bone health and the link between their fracture and OP. These barriers could be addressed by interventions which account for the role of patients’ perceptions, such as those based on theories of behaviour change. This thesis had two objectives: to review the literature and determine whether these theories have been integrated in post-fracture OP management and to examine patients’ awareness of the OP-fracture link. The results showed that theories of behaviour change have not been integrated into post-fracture interventions, that most patients do not perceive the OP-fracture link even after a baseline intervention and that two baseline factors predict who is less likely to make the OP-fracture link at follow up. Based on these findings, modifications to current OP interventions were proposed and guidance that could help create new, patient-centered interventions was provided.