Aim: As premature replacement of residential appliances drives rising e-waste levels in Europe, analysis of the factors impacting consumer decision-making when faced with opportunities to extend (repair) or reduce appliance lifespans (premature replacement) is needed. This manuscript seeks to explore the impact of environmental and financial literacy on consumer willingness to seek repair of home appliances (over replacement) across owner-occupier and rental properties. The impact of financial salience within the informational frames of these decisions is also explored. Method: An online discrete choice experiment was conducted using the EVIDENT serious game, a life-simulation game in which players manage a virtual home and face energy decisions. Participants (n = 1056) completed a series of 3 choice experiments exploring repair/replace decision-making and willingness to pay for repair. Prior to the game, measures of environmental literacy, financial literacy, household type, and sociodemographic factors were obtained using a pre-game survey. For rental properties, a further stated preference experiment was conducted to determine the impact of financial incentives on willingness to invest in more efficient appliances for both landlords and tenants. Results: While an overall willingness to seek repair for broken home appliances was found, most participants selected to prematurely replace their broken appliance with a more efficient alternative. Participants aged over 51 were significantly less likely to choose a repair (p < .001), while those in non-full-time employment more likely to select a repair (p < .001). Limited impact of environmental and financial literacy on repair/replace decision-making was found, though financial knowledge, environmental knowledge, and environmental skills were associated with willingness to pay for repair. Willingness towards repair in rental properties (landlords and tenants) was found with tenants willing to pay 34-71.3 % more than homeowners for repair and landlords willing to pay 93.3-108.8 % more depending on the appliance. Mixed impacts of financial incentives in rental properties to surmount impacts of split incentives were found. While 86.6 % of landlords were willing to accept a small fee from tenants towards a more efficient appliances, 65.2 % of tenants were unwilling to pay such a fee. Conclusion: Results cast light on the specific impacts of individual financial and environmental literacy, demographic factors, and residence type on early replacement decisions, providing valuable direction for future policy actions.

As efforts to empower consumers to repair home appliances increase, analysis of the behavioural biases driving premature replacement is needed. Serious games, such as the EVIDENT serious game, provide a promising means to explore these biases and aid consumer energy decision making. However, for serious games to be effective, they must be acceptable and usable, and accurately reflect real-world contexts. As such, this manuscript seeks to 1) identify the real-world factors impacting decisions to repair or replace home appliances; and 2) explore the usability and acceptability of the EVIDENT serious game as a means to examine energy decision making. Six interactive workshops were conducted (n = 44) consisting of focus group discussions, questionnaires, and co-located game play. Positive feedback on the use of serious games to explore residential repair or replace decision making was noted. While initial challenges with usability and acceptability of the serious game were identified, significant increases in both arose following iterative incorporation of workshop feedback. Key themes arising from focus group discussions on repair/replace decision making included what does it mean, invisible impacts, shifting cultural values and trust. These findings highlight the uniquely challenging nature of energy decision making, and the resulting need for multi-level interventions to increase repair, with the interconnecting role of individuals, businesses, communities, and policy clearly noted.. Taken together, these results highlight the importance of user inclusion across the energy serious game design and piloting process to support both utility and broader social and ecological validity.

Caring for a child with cancer can place a number of burdens on families, however it is unclear the extent to which health-care professionals (HCPs) and other personnel supporting families are aware of these burdens. This study sought to explore the needs and challenges encountered by families impacted by pediatric cancer in Ireland from the perspectives of both parents and the personnel who support them. Twenty-one participants, comprising seven parents (one male, six females), and 14 supportive personnel (nine hospital-based volunteers and five HCPs) took part in in-depth semi-structured interviews via Microsoft Teams (December 2020 to April 2021) to obtain a perspective of the needs, challenges, and currently available support for families. A reflexive thematic approach to analysis was employed. The need to navigate a new normal, a sense of riding the wave and reliance on others were perceived to be the primary challenges encountered by families. Participants reported a need for community service provision, connectivity across the health-care system and more accessible psychological support. High levels of overlap across themes were found for parents and supportive personnel, particularly HCPs. Results highlight the significant challenges encountered by families impacted by pediatric cancer. Themes voiced by parents were frequently echoed by HCPs, suggesting this group is attuned to broader family needs. As such, they may be capable of providing insight where parent perspectives are unavailable. While further analysis including children's voices is needed, findings highlight key areas toward which support for families should be directed.

The EVIDENT Discrete Choice Experiment seeks to explore the impact of energy related financial literacy, consumer motivation, point-of-sale information and demographic factors on discount rate and willingness to pay for efficient household appliances. Across a series of choice experiments, the impact of factors such as financial information (purchase price, operating cost, salience of financial information), risk reduction (i.e. extended warranty), and financial capacity (i.e. low cost loans) on implicit discount rates for home appliances is examined. Further, the impact of direct rebound rates on efficient appliance selection is examined. The experiment consists of the following sections: 1) demographic information; 2) current home appliance purchasing behaviour; 3) financial literacy; 4) environmental literacy; 5) stated preference experiment consisting of four choice points; 6) discount rates; 7) discrete choice experiment consisting of ten choice points; and 8) questions examining direct rebound rates associated with the novel appliance selected. As noted above, two choice experiments are included within the current use case. The first of these is a stated preference experiment which examines the impact of financial and energy framing on willingness-to-pay for energy efficient appliances. Four choice points are presented within this experiment. Choice 1 presents five identical versions of an appliance which differ only by key feature, and seeks to reduce hypothetical bias across the choice experiment. For example, for a washing machine the key features are cost, capacity, spin speed, quick wash time and pause wash functionality. Choice 2 consists of the participants initial choice (at choice 1) alongside alternatives which differ only in purchase price and energy rating, with purchase price greater for more efficient appliances (I.e. A rated appliances are most expensive; D rated appliances are least expensive). Choice 3 is similar to choice 2, however in this instance operational costs per month are also presented. Again, operational costs are lower for more efficient appliances. Choice 3 is similar to choice 3 however in this instance operational costs per year are presented. The second choice experiment is the DCE which explores the relative impacts of risk reduction (extended warranty), and financial supports (low cost loan, loan term) on willingness to invest in more efficient energy appliances. Attributes were selected based on literature review, focus group analyses, cognitive walk-through and usability analyses. Once final attributes were determined, choice cards were developed using a fractional factorial design. A statistically efficient main-effects design with 10 choice sets was created in R studio using the idefix package. As such, participants are presented with a series of ten choice points, each consisting of two appliances and a ‘no preference’ option. More information on the EVIDENT Discrete Choice Experiment can be found on the public deliverables of the EVIDENT project https://evident-h2020.eu/deliverables/. More specifically, the experiment's theoretical framework and motivation are described in deliverable D1.2 Assessing behavioural biases and financial literacy, in section 5 while the final design is reported in D2.2 Optimised Protocols Design

Within overburdened health care systems and recent transitions towards digital service delivery, parents of children with cancer increasingly turn to technology to support care and psycho-social needs. However, with the rapid acceleration of digital health, tools to support parents in identifying effective technologies are needed. In line with this, this study sought to conduct a content analysis of Connected Health (CH) smartphone applications for families of children with cancer. Systematic searches of Google Play and the Apple App Store were conducted in September 2020. BCTs Taxonomy, Version 1 (BCTv1) was used for content analysis, with additional data on cost, downloads and ratings obtained for each app. Of the 1316 applications found, 26 met inclusion criteria. Common CH features included healthcare tracking and sharing of information with family or health care providers. Common BCTs included feedback and monitoring (n=54), social support (n=19) and goal setting/planning (n=24), with 50 unique BCTs found across applications. Good alignment between CH features and BCT use was found. Statistical analysis found no significant relation between app cost (t(17.8)=-.669, p=.512), downloads (r=-.17, n=23, p<.45) or ratings (r(21)=-.031, p=.894) and BCT volume. While findings suggest a high prevalence of BCTs in CH apps for paediatric cancer, standard measures of quality, such as app rating or download volume, cannot be relied upon when evaluating apps, suggesting a need for more valid accessible metrics of efficacy. While findings suggest a high level of BCTs in CH applications for families affected by paediatric cancer, additional research is needed to determine their efficacy in affecting change in this group.

While the efficacy of serious games for energy efficiency is well established, analysis of how such approaches employ behavioural principles has yet to be considered. This study presents a systematic review and content analysis of the use of behaviour change techniques (BCTs) within serious games for energy efficiency, defined as the use of gamification within interventions. By exploring the use of BCTs, increased understanding of the mechanisms of change underlying serious games for energy efficiency can be obtained. Using search terms relating to (1) serious games and (2) energy efficiency, seven databases were searched. Content analysis was completed using the behaviour change taxonomy v1 (BCTv1; Michie et al., Annals of Behavioral Medicine, 46 (1), 81–95, 2013 ). Twenty-one studies met inclusion criteria. Serious games targeted residential ( n = 10), commercial ( n = 8), educational ( n = 1), and public ( n = 2) settings. Average decreases in energy use of 15.2% in residential settings, 18.4% in commercial settings and 9.9% in educational and public settings were found. Across serious games, 36 individual BCTs were found with an average of 9.45 individual BCTs per game. Common BCTs included monitoring of behaviour by others without feedback ( n = 18), feedback on behaviour ( n = 17) and self-monitoring of behaviour ( n = 12). Results highlight the positive impacts of serious games on energy consumption behaviour and demonstrate the utility of BCTs within such games. Opportunities exist to further enhance the efficacy of serious games through better leveraging behavioural techniques using knowledge from behaviour analysis. Behaviour analysts should consider serious games when developing interventions to support energy behaviour change.

BackgroundWhile Therapeutic Recreation (TR) camp programmes have been extensively analysed, less is known about hospital outreach programmes (HOPs). This study examined parent, volunteer and health care provider (HCP) perceived core features and outcomes of a hospital-based TR programme for children with serious illness.MethodsParticipants were either 1) a HCP within a hospital setting, 2) a volunteer with HOP, or 3) the parent of a child with serious illness. Semi-structured interviews were completed remotely and analysed using a reflexive thematic approach.ResultsNineteen participants (5 parents, 5 HCPs, 9 volunteers) were interviewed. Core features of the HOP included the importance of play as an anchor to the present moment and as a vehicle to challenge and grow, creation of a safe space allowing child and family needs to be met, and meeting families where they are. Perceived outcomes of attending the HOP included changing the focus from being sick to being a child, and developing a sense of solidarity amongst peers for both children and parents.ConclusionsThese results highlight the important contribution of the HOP in supporting children regain a sense of self that is greater than illness, allowing them to reconnect with their values and express themselves, while supporting growth and self-esteem.

Aim As healthcare systems are increasingly burdened, the efficiencies and cost savings offered by connected health (CH, i.e. two-way communicative healthcare technologies such as eHealth or mHealth) present an attractive solution for supporting families impacted by cancer. More research is required, however, to examine attitudes towards CH to better facilitate its use in practice. This study seeks to examine the utility, barriers and facilitators of CH use for families affected by paediatric cancer living in Ireland. Methods Healthcare professionals (n = 5) and parents of children with cancer (n = 7) completed semi-structured interviews on their experiences of and attitudes to CH via Microsoft Teams. A reflexive thematic approach to analysis was employed. Results CH was perceived to provide support for a number of current needs with themes of ‘shifting responsibilities’, ‘individualisation of care’ and ‘knowledge as power’. Through facilitating communication, information sharing and monitoring of child health, CH was perceived to support decreased parental burden and increased parental control, with positive child outcomes thought likely. Perceived barriers and facilitators to the use of CH included the ‘importance of trust’, ‘pace of change’ and ‘access’. Conclusion While results suggest an acceptance of CH across key stakeholders, barriers and facilitators should be considered to support effective implementation. While further analysis of the efficacy of CH to support families impacted by paediatric cancer is needed, these findings highlight key areas where CH may be effectively employed.

Public engagement remains a challenge within energy behaviour change interventions, and serious games appear a promising mechanism to mitigate this. While social factors are commonly employed within such serious games, analysis of their specific impact is outstanding. This paper seeks to examine the social aspects of serious games and explore how they may be leveraged to support and incentivise energy related behaviour change. To demonstrate how social strategies may be used within a serious game to increase impact, the EVIDENT project is presented as a case study. Analysis of the literature suggests positive effects of social strategies within serious games, with peer comparison, collaboration, and competition commonly employed. However, as serious games often include multiple behaviour change strategies, both social and non-social, componential analysis is needed to determine the relative impacts of different approaches. As such, several social factors will be applied within the EVIDENT serious game including 1) stakeholder inclusion in design, 2) shared learning through social groups, 3) social inclusion, 4) social considerations to support maintenance of effects, and 5) social comparison. While positive effects for social factors within serious games are clear, this paper argues that additional analyses of how they may be best applied within serious games is needed.

Emergency evacuation information provided to cruise ship passengers is static and hard to access and understand by some passengers. The SafePASS project is working to provide technology solutions which provide passengers with dynamic, real-time information which they can understand and follow to aid their evacuation from cruise ships in event of an emergency. This paper reports on acceptability and usability analyses of a Passenger Mobile Application, a Smart Lifejacket and a Smart Wristband which were positively rated by passengers and crew in surveys and workshops. Passengers responded positively to the use of a Passenger Mobile Application for directions (suggesting a willingness to use smartphone technologies as support in emergencies), while they responded neutrally to wearable technologies (Smart Lifejacket, Smart Wristband). Crew responded positively to the use of smartphones and wearable technologies in emergency situations. This suggests high acceptability of smartphone-based technologies for use by crew in emergency situations. Workshops with industry experts and passengers highlighted the importance of data protection.

BACKGROUND Caregivers of children may rely on internet sources, health care providers, peers or family for health information. OBJECTIVE To examine the impact of sociodemographic factors on the use of the internet for health information by caregivers of children, and the impact on self-efficacy, effort and frustration. METHODS Using data from the 2019 Health Information National Trends Survey, the effects of information source on self-efficacy, effort and frustration was examined using the complex samples module of SPSS. RESULTS The internet was the most common source of health information for caregivers of children (n = 247), with high confidence, low frustration and effort reported. Younger, higher educated and higher income caregivers were significantly more likely to use the internet for health information. Information from Health Care Providers (HCPs) was associated with greater confidence, and information from peers associated with lesser effort and frustration. No significant effects on self-efficacy, effort or frustration for online health information was noted compared to other sources. CONCLUSIONS Efforts to reduce barriers to online health information may be required for some groups of caregivers, and health care providers may have a role to play in this.

While Connected Health (CH) presents an attractive solution to supporting those with paediatric cancer within a burdened healthcare system, uptake has been limited in practice. This study explored the extent to which attitudes towards CH and the ability to identify evidence-based CH interventions could be predicted by technology usage and eHealth literacy for parents of children with cancer and their Health Care Providers (HCPs). A survey of 85 parents and HCPs was conducted consisting of measures of eHealth literacy, attitude towards online sources, electronic device/internet usage and evaluations of existing CH technologies. While respondents frequently interacted with online supports, CH use was limited (30.8%). Multiple regression and t-test analyses were conducted to determine the relationship between technology usage and eHealth literacy on CH use, attitude and perceived quality. Positive attitudes towards CH and strong eHealth literacy skills were found, however, those who had not used CH had significantly lower eHealth literacy than those who had (t(74)=2.08, p=.04 (two-tailed). Further, eHealth Literacy and device use significantly impacted attitude (F(3,75)=12.01, p<.001) and trust in higher quality CH applications (F (2,58)=3.87, p=.03). This suggests that eHealth literacy and device access play a crucial role in facilitating CH use for stakeholders in paediatric cancer. Consideration of how best to support those with differing eHealth literacy when developing CH technologies is needed to support effective employment in practice.

Objectives Families impacted by paediatric cancer are met with logistical, financial and psychological impacts, with severe acute respiratory syndrome coronavirus two creating additional barriers and stressors for these families. Connected Health (CH) may facilitate cancer care. The objective of the present study was to systematically review CH for families/informal caregivers affected by paediatric cancer. Methods Using search terms relating to: (1) paediatric cancer, (2) family/caregivers and (3) CH, the databases of PsycINFO, Pubmed, EMBASE and Web of Science were searched. Inclusion criteria included an evaluation of CH technologies for supportive care for families/caregivers affected by paediatric cancer at any stage of treatment or survivorship. Results Sixteen studies met inclusion criteria. CH was primarily web-based (n= 6), however smartphone applications (n= 5), telehealth (n= 2) and online groups (n= 3) were utilised. Intervention areas included psycho-social (n= 6), health and information provision (n= 8) and palliative care (n= 2). Conclusions While limited studies have evaluated the impact of CH on families living with paediatric cancer, emerging evidence suggests potential benefits. More evidenced-based interventions are required.

Sleep disorders affect a large portion of those with autism spectrum disorder. Behavioural interventions have been found to increase appropriate sleep behaviours. This study sought to examine the efficacy of two stimulus control interventions (bedtime fading and positive routines) on total sleep duration, sleep onset latency and frequency and duration of night wakings for children with autism using two multiple baseline designs. Secondary dependent variables, namely, educational opportunities, challenging behaviours, parent acceptance and social validity were also analysed. Results suggest some efficacy for both interventions. Increased total sleep duration and decreased sleep onset latency were achieved with bedtime fading. Positive routines showed mixed results with decreased sleep onset latency and increased total sleep duration for two of three participants.