People generally want to engage in a healthy lifestyle, to live in harmony with the environment, to contribute to social causes, and to avoid behaviours that are harmful for themselves and others. However, people often find it difficult to motivate themselves to engage in these beneficial behaviours. Even adopting a healthy lifestyle, such as healthy eating, physical activity, or smoking cessation, is hard despite being aware of the benefits. The increasing adoption and integration of technologies into our daily lives present unique opportunities to assist individuals to adopt healthy behaviours using technology. As a result, research on how to use technology to motivate health behaviour change has attracted the attention of both researchers and health practitioners. Technology designed for the purpose of bringing about desirable behaviour and attitude changes is referred to as Persuasive Technology (PT). Over the past decade, several PTs have been developed to motivate healthy behaviour, including helping people with addictive behaviour such as substance abuse, assisting individuals to achieve personal wellness, helping people manage diseases, and engaging people in preventive behaviours. Most of these PTs take a one-size-fits-all design approach. However, people differ in their motivation and beliefs about health and what constitutes a healthy life. A technology that motivates one type of person to change her behaviour may actually deter behaviour change for another type of person. As a result, existing PTs that are based on the one-size-fits-all approach may not be effective for promoting healthy behaviour change for most people. Because of the motivational pull that games offer, many PTs deliver their intervention in the form of games. This type of game-based PTs are referred to as persuasive games. Considering the increasing interest in delivering PT as a game, this dissertation uses persuasive games as a case study to illustrate the danger of applying the one-size-fits-all approach, the value and importance of tailoring PT, and to propose an approach for tailoring PTs to increase their efficacy. To address the problem that most existing PTs employ the one-size-fits-all design approach, I developed the Model-driven Persuasive Technology (MPT) design approach for tailoring PTs to various user types. The MPT is based on studying and modelling user’s behaviour with respect to their motivations. I developed the MPT approach in two preliminary studies (N = 221, N = 554) that model the determinants of healthy eating for people from different cultures, of different ages, and of both genders. I then applied the MPT approach in two large-scale studies to develop models for tailoring persuasive games to various gamer types. In the first study (N = 642), I examine eating behaviours and associated determinants, using the Health Belief Model. Using data from the study, I modelled the determinants of healthy eating behaviour for various gamer types. In the second study (N = 1108), I examined the persuasiveness of PT design strategies and developed models for tailoring the strategies to various gamer types. Behavioural determinants and PT design strategies are the two fundamental building blocks that drive PT interventions. The models revealed that some strategies were more effective for particular gamer types, thus, providing guidelines for tailoring persuasive games to various gamer types. To show the feasibility of the MPT design approach, I applied the model to design and develop two versions of a Model-driven Persuasive Game (MPG) targeting two distinct gamer types. To demonstrate the importance of tailoring persuasive games using the MPG approach, I conducted a large-scale evaluation (N = 802) of the two versions of the game and compared the efficacy of the tailored, contra-tailored, and the one-size-fits-all persuasive games condition with respect to their ability to promote positive changes in attitude, self-efficacy, and intention. To also demonstrate that the tailored MPG games inspire better play experience than the one-size-fits-all and the contra-tailored persuasive games, I measure the gamers’ perceived enjoyment and competence under the different game conditions. The results of the evaluation showed that while PTs can be effective for promoting healthy behaviour in terms of attitude, self-efficacy, and intention, the effectiveness of persuasion depends on using the right choice of persuasive strategy for each gamer type. The results showed that one size does not fit all and answered my overarching research question of whether there is a value in tailoring PT to an individual or group. The answer is that persuasive health interventions are more effective if they are tailored to the user types under consideration and that not tailoring PTs could be detrimental to behaviour change.

Context: The amount of Mobile Health (mHealth) applications to cultivate a healthy lifestyle or rehabilitate patients with physical or mental disabilities are increasingly available on app stores[1]. However, without a validation process, satisfactory results may not be obtained, especially for behaviour change apps.  Objectives: Discover validation tools with high adaptability and design a validation process of mHealth apps for behaviour change involving theoretical frameworks.  Methods: The author conducted a literature review of previous behaviour change theories, validation tools, and research methods to design a validation process for behaviour change apps. A mixed research method of preliminary questionnaire followed by semi-structured interview for limited amount of participants was proposed to empathy with users and evaluate features in the app. Lastly, a case study of a smoking cessation app (Myli) was practiced to examine the feasibility of the designed validation process. Results: A four-step validation process was designed as an instruction to validate mHealth apps step by step, especially behaviour change apps. From the case study, we obtained the knowledge and opinions through the survey and interview such as smoking behaviours, expectations and requirements on user experience, recommendations on features,etc, with five elder smokers and five younger medical students.  Conclusions: This paper contributes a validation study of mHealth apps that applying behaviour change theories and validation tools. Furthermore, the proposed validation process allows app developers or medical professions to adapt their own requirements in validation to meet the app users’ needs. / Sammanhang: Mobile Health (mHealth) applikationer för att bilda hälsosam livsstil eller att rehabilitera patienter med fysiska eller psykiska funktionsnedsättningar är alltmer tillgängliga i appbutiker [1]. Men utan en valideringsprocess kan tillfredsställande resultat inte erhållas, särskilt i appar för beteendeförändringar. Mål: Upptäcka valideringsverktyg med hög anpassningsförmåga och designa en valideringsprocess för mHealth-appar för beteendeförändringar som involverar teoretiska ramverk. Metoder: Författaren genomförde en litteraturgenomgång av tidigare beteendeförändringsteorier, valideringsverktyg och forskningsmetoder för att utforma en valideringsprocess för appar avsedda till beteendeförändringar. En blandad forskningsmetod av ett preliminärt frågeformulär som följs upp med en semistrukturerad intervju med ett begränsat antal deltagare föreslogs för att bättre förstå användare och utvärdera funktioner i appen. Slutligen praktiserades en fallstudie av en rökavvänjningsapp (Myli) för att undersöka genomförbarheten av den designade valideringsprocessen. Resultat: En valideringsprocess i fyra steg utformades som en instruktion för att validera mHealth-appar steg för steg, särskilt appar avsedda för beteendeförändringar. Genom fallstudien fick vi kunskaper och åsikter såsom rökbeteenden, förväntningar och krav på användarupplevelse, rekommendationer om funktioner etc genom enkäten och intervjun med fem äldre rökare och fem yngre läkarstudenter. Slutsatser: Denna artikel bidrar med en valideringsstudie av mHealth-appar som tillämpar teorier för beteendeförändringar och valideringsverktyg. Dessutom möjliggör den föreslagna valideringsprocessen apputvecklare eller de medicinska yrkesverksamma att anpassa sina krav i validering för att möta appanvändarnas behov.

Rapid growth in mobile technologies since the 2000s is reflected in continued smartphone adoption and the expansion of mobile health (mHealth) smartphone applications for pain assessment. Yet there exists a lack of research-based pain assessment apps for endometriosis, a prevalent yet underrepresented disorder where pain management plays a vital role. The predominance of the iOS and Android smartphone operating systems has previously required developers to maintain two separate codebases and development environments in order to access a combined 99% market share. Since 2015, cross-platform development softwares have allowed for maintenance of a single codebase and environment. This thesis explores the development of a cross-platform smartphone app for endometriosis pelvic pain assessment where design decisions are informed by endometriosis and pain assessment research as well as engineering particularities of the React Native framework. The completed prototype along with this thesis’ design discussion indicate that research findings into endometriosis pain assessment can be successfully adapted via React Native into a visual, gesture- guided functionality for the self-assessment of endometriosis related pelvic pain. / Den snabba tillväxten inom mobilteknik sedan 2000-talet återspeglas i en fortsatt ökning av smartphone-användare samt utvidgningen av mobilhälsoapplikationer (mHealth) för smärtbedömning. Ändå finns det en brist på forskningsbaserade smärtbedömningsappar för endometrios, en vanlig men underrepresenterad sjukdom där smärtlindring spelar en viktig roll. Övervägande av operativsystemen iOS och Android har tidigare krävt att utvecklare underhåller två separata kodbaser och utvecklingsmiljöer för att få tillgång 99% av marknaden. Sedan 2015 har mjukvaror för plattformsoberoende utveckling av mobilapplikationer möjliggjort underhåll av en enda kodbas och miljö. Denna avhandling undersöker utvecklingen av en plattformsoberoende applikation för smarttelefoner för utvärdering av bäckenvärk relaterade till endometrios, där designbeslut baseras på forskning om endometrios och smärtbedömning samt tekniska särdrag i React Native-ramverket. Den färdiga prototypen tillsammans med avhandlingens designdiskussion indikerar att forskningsresultat kring bedömning av smärta i endometrios kan anpassas via React Native till en visuell, geststyrd funktionalitet för självbedömning av endometriosrelaterad bäckenvärk.

This study investigates the possibilities for an end-user mobile application that increases access to healthcare in rural communities in Mozambique. The country is facing multiple healthcare-related challenges, including a high prevalence of infectious diseases and a low density of physicians. Improved accessibility to mobile phones opens up the possibility of using mobile health applications to improve health outcomes for people in the country. A literature review, interviews, and questionnaires are conducted to better understand the country, its healthcare system, and its people. Based on the collected data, requirements are developed for a mobile health application that provides healthcare information to patients. The requirements are evaluated based on user testing and the framework tool Dynamics of Social Practice. The perceived usefulness and material prerequisites suggest that the application could get a foothold in Linga Linga and similar rural areas, provided that it’s accompanied by training and redesigned to facilitate ease of use. In the future, the requirements’ technical, operational and economic feasibility could also be investigated. / Denna studie undersöker möjligheterna för en slutanvändarmobilapplikation, som ökar tillgången till sjukvård på landsbygden i Moçambique. Landet står inför flera hälso- och sjukvårdsrelaterade utmaningar, inklusive en hög förekomst av infektionssjukdomar och en låg täthet av läkare. Förbättrad tillgänglighet till mobiltelefoner öppnar för möjligheten att använda mobila hälsoapplikationer för att förbättra hälsopåföljder för människor i landet. En litteraturstudie, intervjuer och enkäter genomförs för att bättre förstå landet, dess sjukvårdssystem och dess folk. Baserat på den insamlade datan utvecklas krav på en mobil hälsoapplikation som ger hälsoinformation till patienter. Kraven utvärderas utifrån användartester och ramverktyget Dynamics of Social Practice. Den upplevda användbarheten och de materiella förutsättningarna tyder på att applikationen kan få fotfäste i Linga Linga och liknande landsbygdsområden förutsatt att den åtföljs av utbildning och omdesignas för att underlätta användarvänligheten. I framtiden kan även kravens tekniska, operativa och ekonomiska genomförbarhet undersökas.

Abstract Background: In Sweden self-harm behaviors among young people have been a difficult area to handle in psychiatric care. From the government's efforts have been made to synchronize the knowledge and experience from the local level aiming to prevent, reduce and faster identify self-harm among young people. M-Health refers to technology such as smartphones, notebooks and mobile phones provide.  These mobile devices have come to revolutionize aspects of health care perhaps mostly among young people, live their digital lives by these electronic media. Aim: To illuminate the use of m-Health in the treatment of mental illness and to present a draft of a mobile application that helps professionals in work with young people active in a mild to moderate self-injury. Method: A literature review based on an analysis of twelve scientific articles with qualitative and quantitative approach. We searched in November 2013-January 2014 Ebsco and PubMed databases.  Results: The literature review is presented as gains and losses in use of m-Health in the treatment of mental illness. The focus has been on what is possible to achieve with a mobile application in this area of concern. It appeared that young people show positive attitudes to using an application in monitoring of psychiatric symptoms and gained more control mental health. The professionals sees advantage in terms of more truthful symptom monitoring in real time in comparison with retrospective self-monitoring, expedited handling processes and better treatment outcomes. Conclusion: We interpret the results of the studies about m-Health as an opportunity for nurses to meet young people, active in a mild to moderate self-harm. An m- Health intervention based on an application for young people could make it easier for nurses to improve their communication and treatment outcomes. Care initiatives and relevant actions can then be tailored to young people's cultural values, beliefs and lifestyle.

Submitted by PPG Comunica??o Social (famecos-pg@pucrs.br) on 2018-04-23T19:28:04Z No. of bitstreams: 1 LUCIELE_COPETTI_DIS.pdf: 2336913 bytes, checksum: 11a44c7d0a0ef6f716884301d9d4e826 (MD5) / Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2018-05-07T17:09:58Z (GMT) No. of bitstreams: 1 LUCIELE_COPETTI_DIS.pdf: 2336913 bytes, checksum: 11a44c7d0a0ef6f716884301d9d4e826 (MD5) / Made available in DSpace on 2018-05-07T17:18:31Z (GMT). No. of bitstreams: 1 LUCIELE_COPETTI_DIS.pdf: 2336913 bytes, checksum: 11a44c7d0a0ef6f716884301d9d4e826 (MD5) Previous issue date: 2018-03-20 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / The Internet is said to be giving rise to a new area of expertise on health communication, increasingly ubiquitous and constantly improving from the huge amount of information that can be easily and quickly retrieved by those concerned with their health. For testing this hypothesis, the researcher conducted a quantitative study with Brazilian women between the ages of 20 and 60 years using wearable apps and devices suitable to monitoring their health, supposedly stimulating in them the development of good preventive habits. The reading of authors like Michel Foucault, Nikolas Rose, Lucien Sfez and David Le Breton gave the study a theoretical scope, drawing relations between health, culture and society. This discussion gives prominence to mobility and digital media, especially those devices developed in the last ten years or so. The researcher then depicts the resources for three case studies: networks, apps and wearables, concentrating on the female public. The quantitative research shows that education and social backgrounds affect the use of technology in personal healthcare. In conclusion, this study confirms the body as an effective network agent embedded in cultural, social and technological practices. / Uma nova ?rea na comunica??o da sa?de est? surgindo via Internet, atrav?s da qual aquela primeira se torna ub?qua e se beneficia de fluxos de informa??o pass?veis de apropria??o cada vez mais ?gil e imediata por parte dos interessados. Com base nessa premissa, realizou-se uma pesquisa quantitativa com brasileiras entre 20 e 60 anos que utilizam aplicativos e dispositivos vest?veis capazes de auxiliar no monitoramento da pr?pria sa?de e, assim, estimular o desenvolvimento de h?bitos preventivos. Para dar sustenta??o ? pesquisa, aborda-se a rela??o entre sa?de, cultura e sociedade, a partir da leitura das obras de Michel Foucault, Nikolas Rose, Lucien Sfez e David Le Breton. Introduz-se o tema da comunica??o na ?rea da sa?de, com destaque para o papel adquirido pela Internet em particular o aspecto da mobilidade, integrado tamb?m pelos dispositivos digitais desenvolvidos no ?ltimo dec?nio. Passo cont?nuo, procede-se ? exemplifica??o destes recursos atrav?s da an?lise de tr?s casos: redes, aplicativos e dispositivos vest?veis. O recorte foi feito com vistas a focar no uso de redes, dispositivos e wearables pelo p?blico feminino. A pesquisa quantitativa concluiu que aparentemente as vari?veis educacionais e de classe social influenciam nos usos dessas tecnologias na sa?de. Dessa forma, o estudo proposto confirmou que o corpo ? agente efetivo nas redes, envolvendo pr?ticas sociais, culturais e tecnol?gicas.

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.

BACKGROUND: In 2009, the Government of the Republic of Vietnam adopted legislation requiring all clinicians to complete continuing medical education (CME) credits in order to maintain licensure. Several CME in-person and distance-based courses have been developed and as of 2015, a national distance-based electronic learning (eLearning) network was being established. However, the uptake of CME courses remained low despite high clinician demand. Vietnam’s high mobile phone ownership rate of 1.4 mobile subscriptions per person presents an opportunity to leverage this for CME. This study investigated how mobile technologies could strengthen delivery of distance-based CME courses and improve national CME program administration. METHODS: A literature and policy review was conducted. Qualitative methods were employed to collect and analyze key informant interviews of 52 global and Vietnamese experts, including selected policy makers. Interviews were supplemented by six focus group discussions with Vietnamese physicians, nurses, midwives and physician assistants. Transcripts were analyzed using an inductive coding methodology. A framework was developed to organize and present results for government consumption. RESULTS: Globally, examples and supporting evidence related to mobile technologies for CME were limited. Experts reported three main use cases for using mobile technology for CME in Vietnam: 1) delivery of CME courses (N=34; 65%); 2) registration and tracking of CME credits (n=28; 54%); and 3) sending alerts and reminders on CME opportunities (n=23; 44%). The national CME policy environment in Vietnam was supportive of introducing mobile technologies within the eLearning network. However, there was a widespread lack of awareness and capacity to design and deliver distance-based CME courses. Mobile phone ownership was high and health workers reported interest in acquiring CME credits via mobile. Financing options to develop and implement distance-based CME courses were limited. CONCLUSION: Despite the paucity of evidence related to mobile technologies for learning, there is potential to innovate and strengthen the evidence base using these technologies for CME in Vietnam. Introducing mobile technologies within the national eLearning network would improve clinicians’ access to CME, particularly in rural areas, and can strengthen national CME program administration. Key recommendations were developed to provide the government with concrete steps for national level adoption.

The thesis addresses mHealth in Uganda and aims to map out how different factors affect the field and what challenges there are in using mobile phones. By using theories the thesis conclude that the organisational structures is unorganised due to lack in communication and communication. The thesis also address many factors that affect the field and to reach development in Uganda the organisations need to target the whole system of components. Coordination from governmental institutions and a will for collaboration between NGO's and government is important if a sustainable organisational structure and development should be attained. ICTs such as mobile phones can be a useful tool in reaching this goal.

mHealth – Mobile phones in HIV prevention in Uganda by Axel Salomonsson Abstract The use of ”new”  interactive media like the Internet and cell phones in health education is not an entirely new phenomenon and studies shows promising results from such information campaigns in developed countries[1]. In the area of HIV/AIDS prevention, however, no scientific studies have been made on the effects of mobile phone-based information campaigns in developing countries. This study can therefore be seen as a pilot study in this area. As mobile phone ownership has multiplied in Africa over the last decade, it has become one of the most reliable mediums for mass communication about health issues. This is a case study of one HIV/AIDS prevention campaign from 2009, where two NGO’s used a multiple choice SMS quiz to ask questions about HIV/AIDS to ten thousand mobile phone owners in the Arua region in North-Western Uganda. The targeted population could send their answers back and win prizes. They were also encouraged to seek out HIV counseling and testing services at a local clinic. By using a qualitative method consisting of a literature study combined with semi-structured interviews with the people who organized the intervention, as well as with respondents to the SMS quiz , the effectiveness and future potential of using mobile phones in HIV prevention in the East African setting are examined. Additional qualitative interviews with a number of experts from the Ugandan telecom sector, the Ugandan Ministry of Health, and an HIV/AIDS researcher from Makerere University in Kampala was also conducted in order to get a better understanding of the context in which this HIV prevention intervention was implemented. The results show that mobile phones are a feasible medium in HIV prevention, and that it offers an additional channel for information dissemination. By allowing two-way communication, the audience is empowered to participate in the exchange of information, which seems to have a positive effect on attitude and behavior change. Further, by receiving answers via SMS from the targeted population, the mobile can at the same time be used as a monitoring and evaluation tool for measuring knowledge levels on different topics. This information can then help to tailor HIV prevention messages in future campaigns. [1] See Bull, S: Internet and other computer technology-based interventions for STD/HIV prevention, in  Communication Perspectives on HIV/AIDS for the 21st Century. Edgar et al. 2008.