Background Annually, millions of children undergo a magnetic resonance imaging (MRI) examination. Hospitals increasingly aim to scan young children awake, as doing so benefits both patients and health care systems. To help hospitals reduce the need for anesthesia, we have developed solutions to prepare pediatric patients at home and in the hospital. Objective The goal of our project was to design, develop, and test a solution that extends our preparation solutions by guiding and engaging children during their MRI examination. Methods Pediatric In-bore was designed to deliver a familiar experience by reusing design elements from our preparation solutions. It offers child-friendly movies and auditory and visual guidance about examination progress and breath holding. To evaluate children’s liking and understanding of the solution, we conducted a usability study. Ten healthy children participated in a mock MRI examination featuring pediatric In-bore. We observed task compliance (ability to lie still and hold one’s breath) and conducted guided interviews to assess their experience and understanding of the guidance offered. Results Participants (aged 5 to 10 years) were generally positive about pediatric In-bore. They liked the main character (Ollie the elephant) and her movie. Auditory and visual guidance were generally liked and understood. All but one participant successfully managed to lie still during the mock examination, and 6 (60%) out of 10 participants successfully held their breath. Conclusions Pediatric In-bore appears promising for engaging and guiding young children during awake MRI. It completes the Pediatric Coaching solution that now offers guidance throughout the MRI journey. Future research can expand on this work by evaluating the clinical impact of the Pediatric Coaching solution in a larger and more diverse sample of pediatric patients.

Magnetic resonance imaging (MRI) is the diagnostic imaging modality of choice for pediatric patients. However, it can be challenging to scan young children awake while maintaining a high image quality with an efficient, patient-friendly workflow. We investigated if an audio-visual intervention with specially designed pediatric content could reduce MRI-related patient anxiety and workflow-issues in children during an awake MRI. In six European hospitals, children (n = 175; aged 6–12 years) were scanned with child-friendly content (intervention) or without (control). Staff recorded children’s stress levels before, during, and after the MRI on a 6-point Likert scale. Scan issues (i.e., repeat scans and interruptions) were recorded by staff and extracted from the MRI logfiles. The stress level of young children (aged 6–10 years) in the intervention group decreased more strongly from before to after the MRI compared to the control group, F(2,96) = 7.84, P < 0.001. They also had significantly fewer scan issues as reported by staff, F(1,169) = 8.36, P = 0.004, Cohen’s d = 0.58, and as logged by the MRI system, F(1,156) = 8.10, P = 0.005, Cohen’s d = 0.45. The used pediatric content showed no significant effects on older children (aged 10 + years). A child-friendly audio-visual intervention can help reduce stress levels of young children (aged 6–10 years) and support a smooth workflow. NCT05089955, date: 2021–10-22.

Suboptimal self-management with controller inhalation therapy in asthma and COPD is frequently observed with poor treatment outcomes. The developed ‘Respiratory Adherence Care Enhancer’ (RACE) instrument identifies and addresses individual barriers to self-management with a theoretical underpinning. This study investigates the feasibility of pharmaceutical support with this instrument. An implementation trial was conducted with asthma and COPD patients in 5 community pharmacies in the Netherlands. Patients were allocated to standard care or add-on support with the RACE instrument. Patients were invited to complete the RACE questionnaire at baseline, 5-week and 10-week follow-up. Barrier profiles were accessible for the intervention group with subsequent consultations at baseline and 5-weeks. Experiences were collected from patients and consultants with a questionnaire and reported findings. Primary endpoints focused on the acceptability, practicality and implementation process. Secondary endpoints included between-group differences in barrier and disease control outcomes from baseline at 10-weeks follow-up. In total, 84 patients were included; 48 were assigned to intervention and 36 to standard care. Patient satisfaction of support with the RACE instrument was high (71%). Patients felt motivated, reassured and more confident about their disease management. Consultants reported an increase in awareness of patient barriers. Patient recognition of barrier profiles was 83.9% (±12.9%). The barrier inhaler techniques decreased significantly for the intervention group at follow-up with odds ratio 0.30 (95% confidence interval, 0.10–0.91). No significant differences were observed for changes in number of barriers and disease control. Self-management support with the RACE instrument is feasible and appreciated, facilitating behaviour change with patient-centred pharmaceutical care in asthma and COPD.

Aim Suboptimal self‐management with controller inhalation therapy in asthma and COPD is frequently observed with poor treatment outcomes. The developed ‘Respiratory Adherence Care Enhancer’ (RACE) instrument identifies and addresses individual barriers to self‐management with a theoretical underpinning. This study investigates the feasibility of pharmaceutical support with this instrument. Methods An implementation trial was conducted with asthma and COPD patients in 5 community pharmacies in the Netherlands. Patients were allocated to standard care or add‐on support with the RACE instrument. Patients were invited to complete the RACE questionnaire at baseline, 5‐week and 10‐week follow‐up. Barrier profiles were accessible for the intervention group with subsequent consultations at baseline and 5‐weeks. Experiences were collected from patients and consultants with a questionnaire and reported findings. Primary endpoints focused on the acceptability, practicality and implementation process. Secondary endpoints included between‐group differences in barrier and disease control outcomes from baseline at 10‐weeks follow‐up. Results In total, 84 patients were included; 48 were assigned to intervention and 36 to standard care. Patient satisfaction of support with the RACE instrument was high (71%). Patients felt motivated, reassured and more confident about their disease management. Consultants reported an increase in awareness of patient barriers. Patient recognition of barrier profiles was 83.9% (±12.9%). The barrier inhaler techniques decreased significantly for the intervention group at follow‐up with odds ratio 0.30 (95% confidence interval, 0.10–0.91). No significant differences were observed for changes in number of barriers and disease control. Conclusion Self‐management support with the RACE instrument is feasible and appreciated, facilitating behaviour change with patient‐centred pharmaceutical care in asthma and COPD.

Undergoing an awake MRI-scan can be very stressful for young children and bears the risk that image quality is poor due to motion artefacts. Behavioral training by an experienced trainer has shown success in preparing children before a scan, however, this approach is costly and trainer dependent. We have designed a mobile app to prepare children for an upcoming MRI-scan at home. This app was tested by 52 children in four different hospitals. First data show that children and parents appreciate the app very much and that learning goals can be reached with a digital application at home.

The Kitten Scanner is an educational scanner that can be used to playfully prepare children for an MRI or CT scan. The current paper describes a re-design of the Kitten Scanner to increase its educational value and prepare a diverse group of patients for a diverse range of scan types. Learning goals were created that are applicable to both MRI and CT. Based on these learning goals, storylines were developed for 3 different characters, with each character showcasing a different scan and emotional response.

Undergoing an MRI scan can be a stressful experience for young children. For this reason, pediatric patients are often scanned under general anesthesia or sedation, which is costly and may carry health risks. By preparing children for their scan, anesthesia may be avoided; however, existing preparation solutions are generally hospital-specific and not easily scalable. We describe the iterative design process and feasibility test of the Scan Buddy app: a scalable app to prepare children 4–10 for an MRI scan. Interviews and Questionnaire: Interviews with 19 healthcare practitioners (US and EU) revealed a desire to reduce anesthesia for imaging through better patient preparation. A questionnaire administered to 73 caregivers of children who recently had an MRI scan exposed the need for well-designed tools to explain the MRI procedure as well as caregivers’ willingness to invest time in at-home preparation if it could increase the likelihood of an awake scan. Design Rationale: We developed a learning framework based on Informing, Familiarizing and Training children for MRI (FIT-for-MRI), and designed a gamified app with 7 learning goals. Method: Scan Buddy v1 was used in the weeks prior to an MRI examination by 28 children in a feasibility test at Cincinnati Children’s Hospital Medical Center. Results: Scan Buddy prepared the children for their MRI: learning goals were met, children enjoyed playing with the app, awake scanning was successful, and parents felt it supported their child in their preparation. Scan Buddy v2 was subsequently developed, and the rationale for design is detailed.

Parents looking to foster more energy sufficient behaviours in their children struggle to have their child maintain these behaviours unsupervised. Our research indicates that in order for the child to maintain these behaviours, s/he must perceive him/herself as an eco conscious individual. We propose that increasing a child's ability to firstly recognise eco-friendly behaviours and secondly, recollect them, is likely to yield a greater affinity for habitual energy sufficient behaviours. This paper describes a first prototype game, whose interface employs availability heuristics and other persuasive design elements to achieve this goal.

This paper examines the behavioral consequences of individual differences in persuadability in the health promotion domain. We use a 7-item persuadability instrument to determine participants persuadability score. Based on this score two groups are created: the low and high persuadables. Subsequently, we present 2 studies that test the responses to health-related persuasive messages of both low and high persuadables. The results consistently show that high persuadables comply more to messages with a persuasive content as compared to a neutral message than low persuadables. Even more, both studies indicate lower compliance by low persuadables when persuasive messages are employed. Implications of this possible detrimental effect of the use of persuasive messages for low persuadables are discussed.

Introduction Several studies indicate a growing increase in the number of people that are overweight. Along with psychological stigmas, these people have increased risk for heart diseases, high blood pressure, diabetes, arthritis-related disabilities, and some can- cers (1). Sedentary lifestyles and consumption of energy dense foods are the main factors leading to these conditions. A change in lifestyle through an increase of physical activity is common- ly known to aid combating obesity. Additionally, regular physi- cal activities reduce risks and provide therapeutic benefi ts for people that suffer from several health conditions. Motivating an increase in physical activity is a known chal- lenge, as there are several barriers that prevent people from having a healthier lifestyle. The use of persuasive technology has been proven effective in many cases. In the past, most stud- ies relied on self-monitoring, by using, for example, diaries to asses people's physical activity level (2). More recently, how- ever, devices such as pedometers are used to unobtrusively measure physical activity (3). In addition, we see that moti- vational strategies from psychology are employed, to increase persuasiveness of the intervention. In this area, a well-known approach is that of goal setting. These goals are usually deter- mined by a system, and can be altered by the users themselves (4). Goals can be individual or collaborative, in which each user must fulfi ll part of the goal. According to Weldon and Weingart (5), group goals motivate users to improve the personal perfor- mance, because they recognize that group success depends on the performance of the individual users, and because users tend to work together more effectively. As group goals imply, persuasive systems can be built on top of social networks, so users can interact with each other. This allows for the benefi ts provided by social dynamics (6). For our approach, we propose ActivityShare; a service application that combines selfawareness with social goal setting. We provide self-awareness to the user by unobtrusively measuring physi- cal activity through a small accelerometer device, which mea- sures movements in three dimensions. This device is the Philips Activity Monitor, which converts all movements into calorie expenditure. In line with the currently growing trend of shar- ing digital information, we propose a novel approach to goal setting: social goal setting. We enable users to share goals by proposing activity challenges to others. These challenges are posed to all users, and everyone is free to accept/ignore the challenges. Once accepted, the challenge becomes a new goal to achieve. Initial Requirements We performed an extensive literature survey on physical ac- tivity and persuasive technology. This led to an overview of existing technologies and solutions, pointing out their benefi ts and drawbacks. The overview inspired a rough concept. We employed a user-centered design approach to come to a fi nal design. The design approach consisted of several iterations; we involved end-users in each iteration. After the initial concept, we started with interviewing sedentary people about their current lifestyle and about their thoughts on our initial concept. The results of the interview led to a further specifi cation of the concept. This concept was prototyped and put to the test in a real user environment. The results inspired a next iteration of the concept. At this point, we created a video prototype. This prototype was extensively discussed in a focus group. The results of the focus group were used to defi ne the fully functional prototype, which we intend to use in a fi nal user test. Below we describe each design iteration in detail. We report the method as well as a summary of the fi ndings.

Goal setting can be a powerful method for persuading individuals to adopt an active lifestyle. In order for this to be the case, it is important to set concrete and challenging goals, and to strongly commit to them. In this study, we explored how people set goals for physical activity and how these goals were reflected in self-regulatory mechanisms to drive goal attainment. Our approach is novel in two ways: first, we used an unobtrusive wearable sensor to accurately measure physical activity throughout the day rather than rely on self-report, and second, we provided individuals with feedback about the contribution of their common daily activities (e.g., household activities) to their physical activity level. Our results showed that on the basis of this feedback, participants were able to indicate to what degree they intended to change their behavior. Nevertheless, they failed to set concrete goals that matched their intentions precisely. In particular, we observed that overall the set goals were in accordance with intentions (i.e., goals were set in the desired direction), but we saw a strong tendency to focus on enhancing vigorous activity at the cost of moderate intensity activity. This suggests that many individuals have intentions to change and goal setting support is needed to compose goals that accurately reflect these intentions. Technology-mediated interventions might be ideal to support individuals along that path.

This paper discusses the use of social goal setting as a strategy to achieve persuasion through technology. This approach was applied in the design of ActiveShare a system developed to motivate people with sedentary lifestyles to increase their physical activity. In this system, users obtain and share their goals through challenges, which are posted on a social networking website. The paper describes the iterative design process followed, including concept tests, a focus group, and a field test with a fully functional prototype. Preliminary results are promising, although we found no significant increase on physical activity during the one week test. Suggested improvements to the design and plans for a follow up study are outlined.

Andre Fialho¹, Herjan van den Heuvel¹, Qonita Shahab¹, Qing Liu¹, Li Li¹,Privender Saini², Joyca Lacroix², Panos Markopoulos³¹User System Interaction, Stan Ackermans Institute, TU/e²Philips Research Eindhoven, ³Industrial Design, TU/e{a.t.s.fi alho, h.a.c.v.d.heuvel, l.li, q.liu, q.shahab}@tue.nl,{privender.saini, joyca.lacroix}@philips.comp.markopoulos@tue.nl

The growing number of people with an inactive lifestyle emphasizes the need for highly persuasive physical activity interventions. Modern technological developments bring great promise for the realization of such large-scale persuasive behavior change interventions because they allow for user tailored interaction. For the effective tailoring of technology-based interventions, a profound understanding of the main variables underlying physical activity behavior is required. In this paper, we focus on three cognitive variables that have shown to be crucial for the adoption and maintenance of health behaviors: behavioral regulation, types of motives, and self-efficacy. In particular, we explore the relationship of these cognitive variables with actual levels of daily-life physical activity. Our study differs from related studies in two important ways. First, we consider the entire range of physical activities performed throughout the day while many studies focused on sports and or dedicated exercise. Second, we employ a wearable device for the objective measurement of daily physical activity levels rather than rely on self-report measures. Our results show that active individuals feel higher levels of self-determined behavioral regulation, experience stronger motives to be active (in particular for health and well-being related motives), and have higher levels of self-efficacy for daily-life physical activity than inactive individuals. We argue that tailored technology-based activity interventions should accommodate these cognitive variables and for inactive individuals, aim to gradually induce and internalize the cognitions already experienced by active individuals.

This paper addresses the relationship between goal difficulty and performance within the context of an ongoing activity intervention program called New Wellness Solutions (NWS). The NWS program employs a mobile device to enable moment-to-moment monitoring and progress feedback. In order to assess the relationship between goal difficulty and physical performance, we analyzed the data of a recently completed NWS program test. We found a significant positive linear relationship between goal difficulty and performance for individuals with an inactive lifestyle. No significant relationship was found for individuals with an active lifestyle. This may be explained by the active participants' low level of commitment to the assigned goals. We conclude that sufficiently difficult goals combined with timely progress feedback are effective in increasing activity levels of inactive people. Future studies should address the effect of additional mobile persuasion techniques to further improve physical activity patterns of inactive individuals and to enhance goal commitment of active individuals.

14.1 Introduction Current technological and research developments pertaining to Ambient Intelligence, Ubiquitous Computing or Pervasive Computing share an impetus towards embedding computation in our social and physical environments making it an inseparable part of our daily lives. One consequence of embedding technology in this way in our everyday life is that today's user–system interaction paradigm will change substantially. Interaction is expected to be continuous, prolonged, and tied in with the physical spaces that surround us. It will involve a disparate range of interaction devices, affect social interactions and will often bridge physical and virtual worlds. Additionally, technology is expected to become more intelligent and to adapt itself to our needs and the dynamics of the environments we live in. To make this possible, AmI systems will need to be equipped with sensorial and reasoning capabilities. One consequence of confronting users with, for example, home dialog systems that have perceptive and reasoning capabilities is that additional expectations are created. Since people already have a tendency to attribute human like properties to interactive systems (Reeves and Nass 1996), it is expected that implementing human like properties in such home dialog systems will have an important impact on the user–system interaction. Similar observations can be made for other environments, e.g., smart office environments, (virtual) collaborative work or meeting environments and smart educational environments. In this chapter we look at user–system interaction from this particular viewpoint. How can we include aspects of human social interaction in the interface and what difference will it make? We will investigate this in the paradigm of Ambient Intelligence. That is, we assume that there are sensors that perceive the user or inhabitant of a smart environment and that the information that is obtained from the sensors is being processed, fused, and interpreted in order to give useful, acceptable, and effective responses, taking into account characteristics of the user (interests, personality, moods,

new technology does not always have to increase a sense of something “standing in between” two parties in a relationship. Next Steps. Media Lab Europe, which was established in 2000 and housed ten research groups at its height, closed its doors in January 2005 due to unfortunate political circumstances stemming from a lack of an agreement between its stakeholders on how its activities would be funded and managed going forward . Nevertheless, the vision of the Human Connectedness group is still alive and some of the projects discussed above are moving forward on independent tracks of commercialization or further research.