Digital health is the use of technologies to support health, healthcare, and wellbeing. Although technology has potential, it still faces implementation, engagement, and abandonment issues. In this viewpoint, we use Social Practice Theory (SPT) to reflect on these challenges. Particularly, we examine three examples of digital health technologies: Electronic Health Records, Digital Self-Tracking Tools, and Digital Mental Health Interventions. Tensions concerning implementation of and engagement with digital health technologies are discussed through a SPT lens, and reflections for future research are proposed. We argue that concepts such as implementation and engagement should be more broadly interpreted and researched in the context of a social practice of digital health, and that the goal of digital health (implementation and engagement) research should shift from promoting 'desired behaviors', such as using a digital health intervention, to fostering a social practice of digital health. Moreover, the potential of bottom-up approaches to introduce digital health are highlighted. In light of these reflections, we suggest research in digital health should integrate perspectives from neighbouring fields (e.g. sociology and design) to broaden its views on choice, agency, health and responsibility.

Engagement as a concept can explain why Digital Health Interventions (DHIs) produce individual variance in outcomes, and sometimes limited effectiveness, especially in practice. However, previous literature on engagement across different domains (e.g., Psychology, Implementation Science, Human-Computer Interaction) yields disparate conceptualizations, research methods, design strategies, and measurement methods. Therefore, this workshop aims to: bring together a diverse group of researchers within the field of DHIs with an interest in engagement; provide an overview of how engagement has been used, in terms of concept, measures, and strategies; work towards a shared understanding of how engagement, with its diverse measures and strategies, can be leveraged to inform the design, development, and evaluation of meaningful DHIs. We welcome submissions either as a description of a use case that includes: how engagement was defined, measured, designed for by our participants, as well as their lessons learned; or as a short position paper describing their interest in the topic, future plans for measuring/designing for engagement, and current challenges. Our post-workshop plans aim to draw from this transdisciplinary collaboration to document lessons learned on how to employ engagement in DHI development, research and design.

Background:With the growing need of support for informal caregivers (ICs) and care recipients (CRs) during COVID-19, the uptake of digital care collaboration platforms such as Caren increased. Caren is a platform designed to (1) improve communication and coordination between ICs and health care professionals, (2) provide a better overview of the care process, and (3) enhance safe information sharing within the care network. Insights on the impact of COVID-19 on the implementation and use of informal care platforms such as Caren are still lacking. Objective:This study aimed to (1) identify technology developers' lessons learned from the continued implementation of Caren during COVID-19 and (2) examine pre-post COVID-19 changes in usage behavior and support functionality use of Caren. Methods:A focus group with developers of the Caren platform (N=3) was conducted to extract implementation lessons learned. Focus group data were first analyzed deductively, using the Consolidated Framework for Implementation Research domains (ie, individual characteristics, intervention characteristics, inner setting, and outer setting). Later, inductive analysis of overarching themes was performed. Furthermore, survey data were collected in 2019 (N=11,635) and 2022 (N=5573) among Caren platform users for comparing usage behavior and support functionality use. Data were analyzed using descriptive and inferential statistics. Results:Several lessons from the continued implementation of Caren during COVID-19 were identified. Those included, for example, alternative ways to engage with end users, incorporating automated user support and large-scale communication features, considering the fluctuation of user groups, and addressing data transparency concerns in health care. Quantitative results showed that the number of ICs and CRs who used Caren several times per day increased significantly (P<.001 for ICs and CRs) between 2019 (ICs: 23.8%; CRs: 23.2%) and 2022 (ICs: 35.2%; CRs: 37%), as well as the use of certain support functionalities such as a digital agenda to make and view appointments, a messaging function to receive updates and communicate with formal and informal caregivers, and digital notes to store important information. Conclusions:Our study offers insights into the influence of the COVID-19 pandemic on the usage and implementation of the digital informal care support platform Caren. The study shows how platform developers maintained the implementation during COVID-19 and which support functionalities gained relevance among ICs and CRs throughout the pandemic. The findings can be used to improve the design and implementation of current and future digital platforms to support informal care toward the "new digital normal."

Although eMental health interventions are a viable solution to address disparities in access to mental healthcare and increase its efficiency, they still face challenges of implementation. Literature highlights numerous barriers such as diffusion of responsibility and unclear expectations of what implementation entails might hinder this process. While research mostly focuses on analyzing these barriers, there is an urgent need to increase uptake in practice. In turn, commercial companies focus mostly on increasing uptake, while overlooking research outputs. To bridge the gap between research and practice, attention to how implementation occurs in practice is required. This study investigates “Make it Happen” (MiH), the implementation model developed by the eMental Health company Minddistrict, aiming to gain more insight into operationalizing implementation frameworks by 1) describing MiH and its conceptual underpinnings, and 2) gaining lessons learned from the development of MiH. Ultimately, this work aims at improving existing scientific frameworks by extending them with knowledge from practice. First, individual interviews and focus groups with Minddistrict implementation managers were performed. Second, individual interviews with project leads in mental healthcare organizations that were involved in the implementation of Minddistrict were conducted. Within Minddistrict, 7 implementation managers and account managers were involved, in addition to 11 project leads from mental healthcare organizations. Data were elaborated with thematic analysis. A comprehensive description of MiH and its 5 main phases was achieved. During the 1) Onboarding phase, implementing organizations are guided by Minddistrict to build a team responsible for implementation, which then 2) designs patient and client journeys, 3) builds, tailors and configures their offer, 4) trains key-users and, 5) evaluates the success of implementation. All participants had extensive and aligned definitions and articulated expectations on implementation. Points of improvement for the model such as role ambiguity and excessive workload were identified. As strengths, internal motivation and good relationships with the provider were valued. The present study highlights the importance of clear role division and stakeholder engagement in implementation processes, and suggest that a strong collaboration between companies and academia could optimize implementation efforts and ensure a better fit between humans, context, and technologies.

Introduction Informal caregivers offer continuous unpaid support to loved ones who are unable to live independently. Providing care can be a very burdensome commitment, that heavily impacts informal caregivers’ mental health. eMental health is a possible, yet challenging, solution to improve caregivers’ mental health and their overall experience of caregiving. In fact, eMental health technologies often face challenges of implementation. The present work gathers knowledge on how to best deal with these challenges by collecting testimonies of implementation experts of eight eMental health technologies for informal caregivers with the aim of comparing them and extracting lessons learned. Methods For this multiple case study, technologies were selected (through informal suggestions and independent search) according to the following inclusion criteria: they were intended for informal caregivers as main user group, were aimed at improving informal caregivers’ mental wellbeing and caregiving experience and were available and running in real life settings in Europe. Ten interviews were conducted (two pilots and eight included cases). The interviewees were asked to provide a description of the technology and its aims and their implementation approach, method and frameworks used. Finally, determinants of implementation, the influence of the Covid-19 pandemic on implementation processes and lessons learned were investigated. Results The results highlight key differences between technologies developed within academia and the industry regarding efficacy testing and use and use and choice of frameworks. Also, similarities in terms of recognized barriers such as financing are illustrated. Discussion Possible ways to overcome main barriers and examples of best practices, such as structuring a business model and discussing tool maintenance and long-term hosting in advance, are discussed.

Transformation can be deemed as a process composed of specific emotional (e.g., awe) and cognitive components (worldview and mental schema) interacting together to trigger impactful experiences of transformation (TE). Several theories posited that one trigger of transformation can be something able to violate people's current worldview. In Italy, the lockdown - requested by the Government to limit the consequences of pandemic - represented an unprecedented experience for Italian citizens. Although COVID-19 home confinement significantly impacted psychosocial wellbeing and encouraged the adoption of new communication technologies to overcome lockdown loneliness, no difference emerged in relation to lockdown intensity. However, the potential transformative impact of this event has not been tested yet. In this study, we measured fluctuations of nine healthy Italian people's cognitive worldview and personality traits, as well as their disposition to live the complex emotion of awe in three timeframes (i.e., at the beginning of Italian Lockdown period, at the end, and one month after the end of the lockdown). No significant changes emerged from data analyses, thus suggesting that, despite the potential impact of this worldwide event, people's stable worldview, personality factors, and complex emotion dispositions persisted, at least, immediately after the first lockdown period.

BACKGROUND The worldwide increase in community-dwelling people with dementia underscores the need for innovative eHealth technologies that aim to provide support to both patients and their informal caregivers in the home setting. However, sustainable implementation of eHealth technologies within this target group can be difficult. OBJECTIVE The goal of this study was to gain a thorough understanding of why it is often difficult to implement eHealth technologies in practice, even though numerous technologies are designed to support people with dementia and their informal caregivers at home. In particular, our study aimed to (1) provide an overview of technologies that have been used and studied in the context of informal dementia care and (2) explore factors influencing the implementation of these technologies. METHODS Following an umbrella review design, five different databases were searched (PubMed, PsycINFO, Medline, Scopus, and Cochrane) for (systematic) reviews. Among 2205 reviews retrieved, 21 were included in our analysis based on our screening and selection procedure. A combination of deductive and inductive thematic analyses was performed, using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework for organizing the findings. RESULTS We identified technologies designed to be used “by informal caregivers,” “by people with dementia,” and “with people with dementia.” Within those groups, most of the represented technologies included, respectively: (i) devices for in-home monitoring of lifestyle, health, and safety; (ii) technologies for supporting memory, orientation, and day structure; and (iii) technologies to facilitate communication between the informal caregiver and person with dementia. Most of the identified factors influencing implementation related to the condition of dementia, characteristics of the technology, expected/perceived value of users, and characteristics of the informal caregiver. Considerably less information has been reported on factors related to the implementing organization and technology supplier, wider institutional and sociocultural context of policy and regulations, and continued adaptation of technology over time. CONCLUSIONS Our study offers a comprehensive overview of eHealth technologies in the context of informal dementia care and contributes to gaining a better understanding of a broad range of factors influencing their implementation. Our results uncovered a knowledge gap regarding success factors for implementation related to the organizational and broader context and continuous adaptation over the long term. Although future research is needed, the current findings can help researchers and stakeholders in improving the development and implementation of eHealth technologies to support informal dementia care.

Background. The COVID-19 lockdown could engender disruption to lifestyle behaviors, thus impairing mental wellbeing in the general population. This study investigated whether sociodemographic variables, changes in physical activity, and sleep quality from pre- to during lockdown were predictors of change in mental wellbeing in quarantined older adults. Methods. A 12-week international online survey was launched in 14 languages on 6 April 2020. Forty-one research institutions from Europe, Western-Asia, North-Africa, and the Americas, promoted the survey. The survey was presented in a differential format with questions related to responses “pre” and “during” the lockdown period. Participants responded to the Short Warwick–Edinburgh Mental Wellbeing Scale, the Pittsburgh Sleep Quality Index (PSQI) questionnaire, and the short form of the International Physical Activity Questionnaire. Results. Replies from older adults (aged >55 years, n = 517), mainly from Europe (50.1%), Western-Asia (6.8%), America (30%), and North-Africa (9.3%) were analyzed. The COVID-19 lockdown led to significantly decreased mental wellbeing, sleep quality, and total physical activity energy expenditure levels (all p < 0.001). Regression analysis showed that the change in total PSQI score and total physical activity energy expenditure (F(2, 514) = 66.41 p < 0.001) were significant predictors of the decrease in mental wellbeing from pre- to during lockdown (p < 0.001, R2: 0.20). Conclusion. COVID-19 lockdown deleteriously affected physical activity and sleep patterns. Furthermore, change in the total PSQI score and total physical activity energy expenditure were significant predictors for the decrease in mental wellbeing.

(1) Background: The COVID-19 pandemic forced people from all around the globe to strongly modify their daily routines, putting a significant strain on the social aspects of daily lives. While the first wave of the pandemic was a very challenging time in all countries, it is still uncertain whether various lockdown intensities and infection rates differed regarding their psychosocial impact. This work therefore aimed to investigate (i) the psychosocial effects of home confinement in two European countries that underwent different lockdown intensities: Italy and the Netherlands and (ii) the role of communication technology in relation to feelings of loneliness. (2) Methods: A cross-sectional online survey inquiring about different psychosocial variables and the use of and satisfaction towards communication technology was circulated among the general public during the first wave of the COVID-19 pandemic. In total, 629 participants (66% female, 68% from the Netherlands) answered each question twice, referring to “before” and “during” the pandemic. (3) Results: We found significant negative effects of COVID-19 home confinement on depressive feelings (p < 0.001, %∆ = +54%), loneliness (p < 0.001, %∆ = +37.3%), life satisfaction (p < 0.001, %∆ = −19.8%) and mental wellbeing (p < 0.001, %∆ = −10.6%) which were accompanied with a significantly increased need for psychosocial support (p < 0.001, %∆ = +17.3%). However, the magnitude of psychosocial impact did not significantly differ between residents undergoing a more intense (Italy) versus a less intense (Netherlands) lockdown, although the decrease in social participation was found to be significantly different for both countries (z = −7.714, p < 0.001). Furthermore, our findings demonstrate that the increase in loneliness was associated with the adoption of new digital communication tools (r = 0.21, p < 0.001), and significantly higher for individuals who started to adopt at least one new digital communication tool during confinement than for those who did not (z = −4.252, p < 0.001). (4) Conclusions: This study highlights that, although COVID-19 home confinement significantly impacted psychosocial wellbeing during the first wave of the pandemic, this impact did not differ based on lockdown intensity. Recognizing the increasing adoption of digital communication technology in an attempt to reduce lockdown loneliness, future studies should investigate what is needed from the technology to achieve this effect.

Abstract The increase of People with Dementia (PwD) living at home underscores the need for innovative eHealth technologies that support both patients and informal caregivers (IC). Sustainable implementation of eHealth technologies within this target group can, however, be difficult. Our study aims at providing an overview of (1) technologies employed in the context of informal dementia care (IDC) and (2) factors influencing the implementation of these technologies. Five databases were searched for (systematic) reviews. 21 reviews were included. A combination of deductive and inductive thematic analysis was performed, using the NASSS Framework to organize the findings. We identified technologies used “by IC”, “by PwD” and “with PwD”. Most represented technologies included: (i) devices for in-home monitoring (ii) technologies for supporting memory, orientation, and day structure, and (iii) communication technologies. Most factors influencing implementation related to the condition of dementia, characteristics of the technology, the expected/perceived value by users, and the characteristics of the IC. Considerably less has been reported on factors related to the implementing organization, the technology supplier, the wider institutional and sociocultural context of policy and regulations, and the adaptation of technology over time. Our study 1) created a comprehensive overview of eHealth technologies employed in the context of IDC and contributes to a better understanding of factors influencing their implementation, and 2) uncovered a knowledge gap regarding success factors for implementation related to the wider context. Although future research is needed, these findings can help researchers improving the development and implementation of eHealth technologies to support IDC.

Physiological and self-report correlates for subjective wellbeing have been widely investigated in aesthetic psychology. Specifically, some of the features of visual stimuli that seem to have a great impact on wellbeing and appreciation are: (i) complexity, (ii) recursion and a certain amount of (iii) randomness. Fractals are examples of visual stimuli that were proven able to promote subjective wellbeing by acting on physiological parameters, determining higher appreciation in self-report measures, and happen to own those three peculiarities. Fractals can be artificially designed- i.e. exact fractals-, resulting in more recursive pattern, or found in nature-i.e. statistical fractals-, introducing higher levels of randomness into the pattern, that seem to elicit greater appreciation, probably due to their lower predictability. Fractals' ability to exhibit the same pattern at every scale is what Mandelbrot first defined as self-similarity or unfolding symmetry, measured with "Fractal Dimension", also known as "D" (1<D<2). These studies suggest that visual complex stimuli with a certain amount of randomness have a positive impact on people's wellbeing and gratitude and are preferred to their more recursive counterparts. This study aims to investigate the impact of a specific and highly accessible type of natural statistical fractals, namely clouds, on subjective wellbeing (using SAM), as gratitude (using the Italian Version of the Gratitude Questionnaire) using ecological images of clouds, with different D values. D values were measured using ImageJ, a Java-based image processing program.

Sometimes, life houses rare and unexpected events, such as moving abroad or meeting a special person unexpectedly. Recently, these situations have been indicated as "diversifying experiences" (DEs), defined as unusual and unexpected events that drag people outside their daily routine and accustomed schemas. The core mechanism of DEs would entail the disruption of our mental schema, which can facilitate unexpected connections among even distant ideas, thus enhancing people's cognitive flexibility, that is, a key component of creative thinking. Despite both qualitative and lab-based studies have investigated the features of these experiences, an ecological assessment of their properties also in relation with creativity is still an open issue. The aim of this research is to study the DE-creativity link in a more ecological way, on the basis of a real-life disruptive experience of light deprivation. Specifically, we compared an ecological DE artistic established entertainment format (i.e., "dialogue in the dark," which is seeing people perform several daily life activities but in the absence of light) with an equivalent experience in which the same activities were acted in the sunlight. The absence of light played the role of violating mechanism, framed within the ecological experiential format of the "dialogue in the dark." We compared visitors' emotional profile [Positive and Negative Affect Schedule (PANAS),ad hocAdjective Checklist], perceived impact of the experience [Centrality of Event Scale (CES)], and creative performance [Torrance Tests of Creative Thinking (TTCT)] in both groups of sighted people (in absence of light vs. in presence of light); and we also controlled for people's openness to experience and need for cognitive closure, as dispositions. Results showed that (vs. control group) "dialogue in the dark" (i) led to worse creative performances, (ii) produced more intense positive affect, and (iii) resulted as a more impacting experience. Intense short-term impact of DE could have been detrimental for participants' creativity. People may need more time to elaborate the DE and accommodate existing schema to generate more creative ideas. This is the first study proposing and succeeding in demonstrating the feasibility to investigate even real complex DEs in a controlled way, thus outlining how their link with creativity can take place in real life.

A lunar eclipse is an extraordinary natural event and a potential elicitor of complex emotional experiences. Preliminary scientific evidence investigated the impacts of the moon on human behavior, but without deepen its effects on emotions, which are essential to understand our cognitive evaluations and actions. Here, we tested whether specific dispositional emotions and emotional regulation strategies can be predictive of specific discrete state emotions including awe, anxiety, general positive and negative affect lived by participants during the Total Lunar eclipse (TLE) occurred in July 2018. 401 participants compiled validated questionnaires measuring state and dispositional emotions and affect: Awe-experience Scale (Awe-S), the Dispositional Positive Emotions Scale (DPES), the Emotion Regulation Questionnaire (ERQ), the Positive and Negative Affect Scale (PANAS) and the State-Traits Anxiety Inventory (STAI). DPES factors compassion, love, pride and awe, and ERQ factor reappraisal predicted state positive affect, state anxiety and awe. Negative affect was predicted only by the DPES factor compassion. Specifically, a higher predisposition to live pride and love predicted respectively lower state awe and anxiety, while higher levels of dispositional compassion and awe led to higher state awe and anxiety. Dispositional awe with a reappraisal strategy led to experience more intense state positive emotions, while dispositional compassion alone led to more state negative emotions during TLE. Therefore, it was the combination of dispositional emotions and regulation strategies that significantly impacted on contingent emotions lived during the lunar eclipse.

Background: Public health recommendations and governmental measures during the COVID-19 pandemic have resulted in numerous restrictions on daily living including social distancing, isolation and home confinement. While these measures are imperative to abate the spreading of COVID-19, the impact of these restrictions on health behaviours and lifestyles at home is undefined. Therefore, an international online survey was launched in April 2020, in seven languages, to elucidate the behavioural and lifestyle consequences of COVID-19 restrictions. This report presents the results from the first thousand responders on physical activity (PA) and nutrition behaviours. Methods: Following a structured review of the literature, the "Effects of homeConfinement on multipleLifestyleBehaviours during the COVID-19 outbreak (ECLB-COVID19)" Electronic survey was designed by a steering group of multidisciplinary scientists and academics. The survey was uploaded and shared on the Google online survey platform. Thirty-five research organisations from Europe, North-Africa, Western Asia and the Americas promoted the survey in English, German, French, Arabic, Spanish, Portuguese and Slovenian languages. Questions were presented in a differential format, with questions related to responses "before" and "during" confinement conditions. Results: 1047 replies (54% women) from Asia (36%), Africa (40%), Europe (21%) and other (3%) were included in the analysis. The COVID-19 home confinement had a negative effect on all PA intensity levels (vigorous, moderate, walking and overall). Additionally, daily sitting time increased from 5 to 8 h per day. Food consumption and meal patterns (the type of food, eating out of control, snacks between meals, number of main meals) were more unhealthy during confinement, with only alcohol binge drinking decreasing significantly. Conclusion: While isolation is a necessary measure to protect public health, results indicate that it alters physical activity and eating behaviours in a health compromising direction. A more detailed analysis of survey data will allow for a segregation of these responses in different age groups, countries and other subgroups, which will help develop interventions to mitigate the negative lifestyle behaviours that have manifested during the COVID-19 confinement.