Background: Smoking and physical inactivity compromise health, especially in combination. Interventions to promote smoking cessation and increased physical activity (PA) often lack impact, especially in the long term. Digital future-self interventions (FSIs), which prompt individuals to imagine who they do and do not want to become (ie, their desired and undesired future selves), show promise in encouraging sustainable changes in both behaviors. However, knowledge of user experiences with digital FSIs is limited. A deeper understanding of these experiences could help optimize FSIs, enhancing their efficacy in supporting smoking cessation and increased PA sustainably. Objective: This study examined behavioral, cognitive, and affective experiences with digital FSIs focused on smoking, PA, or both. Potential differences in user experiences based on behavior (smoking vs PA), polarity (desired vs undesired future self), and modality (verbal vs visual description of future selves) were explored. Methods: Secondary analyses of quantitative and qualitative survey data from 3 studies using digital FSIs as a means to encourage smoking cessation or increase PA were conducted. In study 1, participants (N=144) thought about how it would be to complete the FSI. In studies 2 (N=447) and 3 (N=87), they completed an FSI. Each study highlighted different aspects of user experiences with FSIs, namely, behavioral (eg, time spent), cognitive (eg, mental effort exerted), or affective (eg, emotions) experiences. Quantitative and qualitative findings were integrated for a comprehensive interpretation. Results: Regarding behavioral experiences, participants completed future-self tasks promptly (mean 6.64, SD 8.30 minutes), spent less time completing the desired- versus undesired-future-self (P<.001; η _p ²=0.227) and verbal versus visual (P=.03; η _p ²=0.060; quantitative) tasks, and integrated the tasks into their lives (qualitative). Despite tasks being preparatory and not actively encouraging behavior change, multiple participants reported implementing changes in their smoking or PA (qualitative). Regarding cognitive experiences, moderate effort (mean 5.85/10, SD 2.56) was exerted on the tasks regardless of behavior (P=.69; η _p ²=0.002), modality (P=.45; η _p ²=0.004), or polarity (P=.69; η _p ²=0.002; quantitative). Experiences of task difficulty were inconsistent across studies, individuals, and tasks, although mental visualization and describing one’s future self using images were consistently reported as challenging (quantitative and qualitative). Future-self tasks were reported to prompt cognitive processes such as contemplating consequences of smoking and PA behavior (qualitative). Regarding affective experiences, desired- and undesired-future-self tasks elicited different emotions (P<.001; η _p ²=0.630; quantitative). Desired-future-self tasks were perceived as enjoyable and happiness inducing, whereas undesired-future-self tasks were perceived as confronting and unpleasant, evoking feelings of sadness, fear, and anger (quantitative and qualitative). Conclusions: Digital FSIs appeared to be a time-efficient, feasible, and acceptable way of strengthening identities as a means to encourage smoking cessation and PA. Findings support continued implementation of digital FSIs, although further research is required to optimize their operationalization. Avenues in that regard are proposed and discussed.

Introduction: eHealth seems promising in addressing challenges in the provision of care for Huntington’s disease (HD) across Europe. By harnessing information and communication technologies, eHealth can partially relocate care from specialized centers to the patients’ home, thereby increasing the availability and accessibility of specialty care services beyond regional borders. Previous research on eHealth (development) in HD is however limited, especially when it comes to including eHealth services specifically designed together with HD gene expansion carriers (HDGECs) and their partners to fit their needs and expectations. Methods: This article describes the qualitative human-centered design process and first evaluations of the Huntington Support App prototype: a web-app aimed to support the quality of life (QoL) of HDGECs and their partners in Europe. Prospective end-users, i.e., HDGECs, their partners, and healthcare providers (HCPs), from different countries were involved throughout the development process. Through interviews, we captured people’s experiences with the disease, quality of life (QoL), and eHealth. We translated their stories into design directions that were further co-designed and subsequently evaluated with the user groups. Results: The resulting prototype centralizes clear and reliable information on the disease, HD-related news and events, as well as direct contact possibilities with HCPs via an online walk-in hour or by scheduling an appointment. The app’s prototype was positively received and rated as (very) appealing, pleasant, easy to use and helpful by both HDGECs and partners. Discussion: By involving end-users in every step, we developed a healthcare app that meets relevant needs of individuals affected by HD and therefore may lead to high adoption and retention rates. As a result, the app provides low-threshold access to reliable information and specialized care for HD in Europe. A description of the Huntington Support App as well as implications for further development of the app’s prototype are provided.

Background: Medical procedures can cause considerable stress and anxiety among children. Current interventions mainly diminish stress and anxiety during procedures, while stress and anxiety often build up at home. Moreover, interventions often focus on either distraction or preparation. eHealth can combine multiple strategies and provide a low-cost solution that can be used outside the hospital. Objective: To develop an eHealth solution to diminish preprocedural stress and anxiety, and to evaluate the app on use, usability and user experience in practice. We also aimed to gain in-depth insights in children's and caregivers' opinions and experiences to inform future improvements. Methods: This is a multi-study report on the development (Study 1) and evaluation (Study 2) of a first version of the developed app. In study 1 we adopted a participatory design approach in which children's experiences were central to the design process. We performed an experience journey session with stakeholders (n = 13) to map the child's outpatient journey, identify pains and gains, and formulate the desired experience journey. Iterative development and testing with children (n = 8) and caregivers (n = 6) resulted in a working prototype. The prototype was tested with children, resulting in a first version of the Hospital Hero app. The app was evaluated on use, user-experience and usability during an eight-week pilot study in practice (Study 2). We triangulated data from online interviews with children and caregivers (n = 21) and online questionnaires (n = 46). Results: Multiple stress and anxiety experience touchpoints were identified. The Hospital Hero app supports children in their hospital journey by facilitating preparation at home and providing distraction at the hospital. The pilot study showed that the app was evaluated positively on usability and user-experience and is considered feasible. Qualitative data showed five themes: (1) user-friendliness, (2) coherence and power of storytelling, (3) motivation and reward, (4) fit with real hospital journey, (5) procedural comfort. Discussion: Using participatory design, we developed a child-centered solution that supports children in the entire hospital journey and may diminish preprocedural stress and anxiety. Future efforts should create a more tailored journey, define an optimal engagement window and formulate implementation strategies.

Background: Current eHealth interventions are poorly adopted by people with low health literacy (LHL) as they often fail to meet their needs, skills, and preferences. A major reason for this poor adoption is the generic, one-size-fits-all approach taken by designers of these interventions, without addressing the needs, skills, and preferences of disadvantaged groups. Participatory design approaches are effective for developing interventions that fit the needs of specific target groups; yet, very little is known about the practical implications of executing a participatory design project for and with people with LHL. Objective: This study aimed to demonstrate the application of participatory design activities specifically selected to fit the needs and skills of people with LHL and how these were manifested within an overarching eHealth design process. In addition, the study aims to present reflections and implications of these activities that could support future designers to engage people with LHL in their design processes. Methods: We used the design process of a smart asthma inhaler for people with asthma and LHL to demonstrate participatory design activities. The study was framed under 5 stages of design thinking: empathize, define, ideate, prototype, and test within 2 major iteration cycles. We integrated 3 participatory design activities deemed specifically appropriate for people with LHL: co-constructing stories, experience prototype exhibition, and video prototype evaluation. Results: Co-constructing stories was found to deepen the understanding of the participant’s motivation to use or not to use maintenance medication. This understanding informed and facilitated the subsequent development of diverse preliminary prototypes of possible interventions. Discussing these prototypes in the experience prototype exhibition helped provoke reactions, thoughts, and feelings about the interventions, and potential scenarios of use. Through the video prototype evaluation, we were able to clearly communicate the goal and functionality of the final version of our intervention and gather appropriate responses from our participants. Conclusions: This study demonstrates a participatory design approach for and with patients with asthma and LHL. We demonstrated that careful consideration and selection of activities can result in participants that are engaged and feel understood. This paper provides insight into the practical implications of participatory activities with people with LHL and supports and inspires future designers to engage with this disadvantaged target group.

Objective: This study aimed to design a persuasive game, using objective adherence data, to motivate people with asthma to adhere to their medication regimen. Methods: A participatory user-centered design approach was employed, involving end-users and other stakeholders throughout the study. The approach consisted of four phases. Semi-structured interviews and a survey were conducted to understand user needs and reasons for poor adherence (Phase 1: define). Key themes were identified, leading to the formulation of behavior change strategies and design and game requirements. Several design directions were ideated, resulting in a concept for a serious game (Phase 2: ideate). Two rounds of user-tests were performed to evaluate a prototype of the serious game in terms of usability, perceived impact on medication adherence and motivation (Phase 3: prototype and Phase 4: evaluate). Results: Findings from semi-structured interviews (n = 6) and the online survey (n = 20) revealed that people’s non-adherence was often attributed to the perception of asthma as an episodic condition, the delayed experienced effect of maintenance inhalers, and lack of knowledge regarding difference of effect between maintenance and reliever inhalers. The study used behavior change strategies to translate these insights into design requirements for the development of the narrative-based persuasive game Ademgenoot. This six-week challenge-based game combines various behavior change strategies, including personal goal setting and continuous visual feedback, as well as persuasive game design elements, such as a narrative and rewards, with the aim of enhancing motivation to adhere to their medication regimen. User-testing (n = 8; round 1 and 2) showed that Ademgenoot is feasible in clinical practice and has the potential to support people with mild asthma in adherence to their maintenance medication. Discussion: Future efforts should be directed towards a larger evaluation to assess the impact on motivation and inhaler use behaviour. Plain Language Summary: The goal of this study was to create a serious game that encourages people with asthma to take their medication regularly. During the study, we worked closely with individuals who have asthma and other stakeholders throughout the study. We conducted interviews and surveys to understand why people have difficulties using their maintenance inhaler as prescribed by their doctor. Based on the feedback we received, we developed a serious game called “Ademgenoot”. The game uses information on inhaler use automatically collected with a device attached to the inhaler. The game includes features like personal goals and visual feedback on inhaler use to motivate users to take their medication consistently. We tested a prototype of the game with users to see if it was easy to use and if it motivated them to use their maintenance inhaler. The results showed that Ademgenoot is a viable option for helping individuals with mild asthma stay on track with their medication.