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Introduction: Spinal surgery patients often experience pain as well as stress, anxiety or even depression before surgery, highlighting the need for better mental preparation before undergoing surgery. Acceptance and Commitment Therapy and positive psychology have proven effective in coping with chronic pain and providing long-term skills that enhance psychological flexibility and mental wellbeing. The aim of this study is to develop a digital intervention (app) based on Acceptance and Commitment Therapy and positive psychology in co-creation with all stakeholders, including patients and professionals. The aim of the intervention is to increase psychological flexibility and positive skills of spinal surgery patients to promote long-term resilience. Materials and methods: In this qualitative study, individual, semi-structured interviews were held with healthcare professionals (N = 9) and spinal surgery patients (N = 12) to identify contextual factors and needs for the app. Subsequently, three focus-group sessions were held with healthcare professionals and newly recruited patients to specify relevant values. Also, a first version of the app, named Strength Back, was developed using a participatory design. Results: The interviews confirmed the need for information and digital support to cope with insecurity, anxiety and pain, both before and after surgery. Based on iterative steps in the focus-group sessions, thirteen modules were developed focusing on procedural information, pain education, psychological flexibility and mental well-being. Discussion: The intervention Strength Back, containing information as well as Acceptance and Commitment Therapy and positive psychology exercises, has the potential to increase psychological flexibility, enhance well-being and improve postoperative recovery after spinal surgery. [ABSTRACT FROM AUTHOR]

IntroductionSpinal surgery patients often experience pain as well as stress, anxiety or even depression before surgery, highlighting the need for better mental preparation before undergoing surgery. Acceptance and Commitment Therapy and positive psychology have proven effective in coping with chronic pain and providing long-term skills that enhance psychological flexibility and mental well-being.The aim of this study is to develop a digital intervention (app) based on Acceptance and Commitment Therapy and positive psychology in co-creation with all stakeholders, including patients and professionals. The aim of the intervention is to increase psychological flexibility and positive skills of spinal surgery patients to promote long-term resilience.Materials and methodsIn this qualitative study, individual, semi-structured interviews were held with healthcare professionals (N = 9) and spinal surgery patients (N = 12) to identify contextual factors and needs for the app. Subsequently, three focus-group sessions were held with healthcare professionals and newly recruited patients to specify relevant values. Also, a first version of the app, named Strength Back, was developed using a participatory design.ResultsThe interviews confirmed the need for information and digital support to cope with insecurity, anxiety and pain, both before and after surgery. Based on iterative steps in the focus-group sessions, thirteen modules were developed focusing on procedural information, pain education, psychological flexibility and mental well-being.DiscussionThe intervention Strength Back, containing information as well as Acceptance and Commitment Therapy and positive psychology exercises, has the potential to increase psychological flexibility, enhance well-being and improve postoperative recovery after spinal surgery.

Background: Co-creation allows to develop tailored interventions in chronicity and to increase patients' engagement. Considering the interacting nature of physical, psychological, and social domains in multiple sclerosis (MS), a biopsychosocial approach to care is crucial. Aims: This paper aims to present (i) an example of a co-creation process in the context of chronic diseases (ii) preferences and perspectives of young adults with multiple sclerosis (YawMS; aged 18-45) and healthcare professionals (HCPs) on the relevance, objectives, and modalities of a biopsychosocial intervention (named ESPRIMO) and on strategies/barriers to participation. Methods: A participatory mixed-method approach in three consecutive steps was implemented: online surveys with YawMS (n = 121) and HCPs (n = 43), online focus groups (FGs) with YawMS, consultation with an advisory board (AB) composed by YawMS, HCPs and researchers. For the survey, descriptive statistics and inductive content analysis have been used for quantitative and qualitative analysis, respectively. FGs and AB were used to deepen the understanding of the survey's results. Results: An integrated intervention is extremely relevant according to the perspectives of the main stakeholders. Helping disease acceptance, providing stress management strategies, and supporting emotional expression emerged as the most relevant psychological objectives according to participants. Having tangible benefits, being tailored, and fostering interpersonal relationships emerged as the main preferred characteristics of physical activity. Preferences emerged on the modalities and timing of the intervention, with a venue unrelated to the disease strongly supported. Both HCPs and YawMS highlighted as the most valuable advantages of conducting the intervention online the increased accessibility, while the main limit was the restriction to social interaction (recognized as already limited during the COVID-19 pandemic). Accessibility and lack of time resulted as the main barriers to participation. Conclusion: The co-creation process gave valuable information on preferences and perspectives of main stakeholders on objectives, modalities, and strategies to improve participation which has been used in the design of the ESPRIMO biopsychosocial intervention. Those results might inform future intervention development in the field of chronicity. The current paper outlined a co-creation methodology which might be replicated in future research on other conditions of vulnerability. [ABSTRACT FROM AUTHOR]

BackgroundCo-creation allows to develop tailored interventions in chronicity and to increase patients’ engagement. Considering the interacting nature of physical, psychological, and social domains in multiple sclerosis (MS), a biopsychosocial approach to care is crucial.AimsThis paper aims to present (i) an example of a co-creation process in the context of chronic diseases (ii) preferences and perspectives of young adults with multiple sclerosis (YawMS; aged 18–45) and healthcare professionals (HCPs) on the relevance, objectives, and modalities of a biopsychosocial intervention (named ESPRIMO) and on strategies/barriers to participation.MethodsA participatory mixed-method approach in three consecutive steps was implemented: online surveys with YawMS (n = 121) and HCPs (n = 43), online focus groups (FGs) with YawMS, consultation with an advisory board (AB) composed by YawMS, HCPs and researchers. For the survey, descriptive statistics and inductive content analysis have been used for quantitative and qualitative analysis, respectively. FGs and AB were used to deepen the understanding of the survey’s results.ResultsAn integrated intervention is extremely relevant according to the perspectives of the main stakeholders. Helping disease acceptance, providing stress management strategies, and supporting emotional expression emerged as the most relevant psychological objectives according to participants. Having tangible benefits, being tailored, and fostering interpersonal relationships emerged as the main preferred characteristics of physical activity. Preferences emerged on the modalities and timing of the intervention, with a venue unrelated to the disease strongly supported. Both HCPs and YawMS highlighted as the most valuable advantages of conducting the intervention online the increased accessibility, while the main limit was the restriction to social interaction (recognized as already limited during the COVID-19 pandemic). Accessibility and lack of time resulted as the main barriers to participation.ConclusionThe co-creation process gave valuable information on preferences and perspectives of main stakeholders on objectives, modalities, and strategies to improve participation which has been used in the design of the ESPRIMO biopsychosocial intervention. Those results might inform future intervention development in the field of chronicity. The current paper outlined a co-creation methodology which might be replicated in future research on other conditions of vulnerability.

Service-dominant logic established that for the success of service industries, it is vital to acknowledge the customer as an active agent in the commercial ecosystem. To carry it out, the consumer must participate in value creation. The resource integration theory exposes the importance of recognizing the customer as an agent capable of improving the company’s competitive advantage. It is only necessary for the participants to perceive benefits to make their resources available and integrate them into the co-creation process. This study aims to find the key customer-based factors that influence the brand value co-creation (VCC) process in the banking sector, analyzing the dynamics in different customers across national cultures and idiosyncrasies. In this paper, we analyze the potential heterogeneous idiosyncrasy of customers and how it leads to becoming more engaged in the co-creation process. Quantitative research was performed in five countries, obtaining a total of 2,029 valid questionnaires where latent profile analyses and ANOVAs were performed to identify and describe the latent profiles (LPA) of consumer cocreators of brand value. Afterward, a PLS-SEM was performed to test the research model in each segment. The results show four different profiles of customer co-creators of brand value, from non-co-creators (detractors), skeptical and neutral, to customers committed to co-creating brand value with their banks. The results indicate that detractor customers lack the motivations and resources to carry out co-creation behaviors. On the other hand, creativity and connectedness were crucial for customers cocreators of value. To the authors’ understanding, no studies have used latent segmentation to find the profiles of customer co-creators of brand value. [ABSTRACT FROM AUTHOR]

Service-dominant logic established that for the success of service industries, it is vital to acknowledge the customer as an active agent in the commercial ecosystem. To carry it out, the consumer must participate in value creation. The resource integration theory exposes the importance of recognizing the customer as an agent capable of improving the company’s competitive advantage. It is only necessary for the participants to perceive benefits to make their resources available and integrate them into the co-creation process. This study aims to find the key customer-based factors that influence the brand value co-creation (VCC) process in the banking sector, analyzing the dynamics in different customers across national cultures and idiosyncrasies. In this paper, we analyze the potential heterogeneous idiosyncrasy of customers and how it leads to becoming more engaged in the co-creation process. Quantitative research was performed in five countries, obtaining a total of 2,029 valid questionnaires where latent profile analyses and ANOVAs were performed to identify and describe the latent profiles (LPA) of consumer co-creators of brand value. Afterward, a PLS-SEM was performed to test the research model in each segment. The results show four different profiles of customer co-creators of brand value, from non-co-creators (detractors), skeptical and neutral, to customers committed to co-creating brand value with their banks. The results indicate that detractor customers lack the motivations and resources to carry out co-creation behaviors. On the other hand, creativity and connectedness were crucial for customers co-creators of value. To the authors’ understanding, no studies have used latent segmentation to find the profiles of customer co-creators of brand value.

Local development enhances the economic capacity and quality of life of the residents and, in particular, attracts tourism to the area. The co-creative value of the residents and the tourists can improve the consensus of the residents on the sustainable development of the place. This study focuses on the factors influencing the co-creation of value between residents and visitors in the Tamsui area near Taipei. The research hypothesis is based on the components of local attachment, economic benefits brought by tourists, environmental costs, social and cultural welfare of the place, life satisfaction of the residents, and the value of co-creation between residents and tourists. A total of 430 questionnaires were collected through a questionnaire survey and statistical data were analyzed using a structural equation model, including descriptive statistical analysis, measurement reliability and validity verification, model fit, and structural model analysis to validate the research hypotheses. The study found that place attachment positively and significantly affects the economic benefits, environmental costs, and socio-cultural welfare of residents about tourists. Resident satisfaction is positively and significantly affected by the environmental costs from visitors and by socio-cultural welfare, but there is no significant impact from economic benefits. Finally, based on the findings of the study, practical recommendations were made for enhancing co-creation value between Tamsui residents and visitors, including enhancing residents' feelings of place attachment and construction of local social culture and welfare. For the residents of Tamsui, unlike the local government and enterprises, need to be able to create value with tourists in order to have a friendly relationship with them and develop regional tourism in a sustainable manner. [ABSTRACT FROM AUTHOR]

Local development enhances the economic capacity and quality of life of the residents and, in particular, attracts tourism to the area. The co-creative value of the residents and the tourists can improve the consensus of the residents on the sustainable development of the place. This study focuses on the factors influencing the co-creation of value between residents and visitors in the Tamsui area near Taipei. The research hypothesis is based on the components of local attachment, economic benefits brought by tourists, environmental costs, social and cultural welfare of the place, life satisfaction of the residents, and the value of co-creation between residents and tourists. A total of 430 questionnaires were collected through a questionnaire survey and statistical data were analyzed using a structural equation model, including descriptive statistical analysis, measurement reliability and validity verification, model fit, and structural model analysis to validate the research hypotheses. The study found that place attachment positively and significantly affects the economic benefits, environmental costs, and socio-cultural welfare of residents about tourists. Resident satisfaction is positively and significantly affected by the environmental costs from visitors and by socio-cultural welfare, but there is no significant impact from economic benefits. Finally, based on the findings of the study, practical recommendations were made for enhancing co-creation value between Tamsui residents and visitors, including enhancing residents’ feelings of place attachment and construction of local social culture and welfare. For the residents of Tamsui, unlike the local government and enterprises, need to be able to create value with tourists in order to have a friendly relationship with them and develop regional tourism in a sustainable manner.

Scenarios can be used to communicate potential future changes and engage and connect different audiences in exploring sustainable solutions. Communicating scenarios using creative visualisation, co-creation and a focus on local contexts are especially promising. This research is conducted on the island of Palawan in the Philippines as part of the GCRF Blue Communities project. With a quasi-experimental design, we investigate the psychological and emotional effects of the engagement with future scenarios as a tool for communicating sustainability. Together with local stakeholders and community members, three distinct, locally relevant scenario narratives (Business as Usual, Best Case, and Worst Case) have been co-created. Subsequently, a sample of N = 109 local high school students was asked to creatively engage with these scenario narratives. Intentions to engage in sustainable behaviour, perceived behavioural control, ascription of responsibility, consideration of future consequences, six basic emotions and connectedness to place were assessed before and after the activity via paper-pencil administrated questionnaires. A mixed-model analysis showed significant increases in intentions to engage in sustainable behaviour, however, this increase disappeared when consideration of future consequences was added as a covariate, suggesting a mediating effect. The level of consideration of future consequences also increased significantly after engaging with any of the future scenarios, which questions the common interpretation of consideration of future consequences as a trait variable. Perceived behavioural control significantly increased following the engagement with each of the scenarios whereas ascription of responsibility and connectedness to place did not show any changes. Overall, the two most emotion-evoking scenarios, Best Case Scenario and Worst Case Scenario, turn out as superior over the Business as Usual Scenario, which points to the relevance of emotional framing for effective messaging in our sample. This is the first systematic, quantitative assessment of the effects of future scenarios as a communication tool. [ABSTRACT FROM AUTHOR]

Entrepreneurs are considered an important source of innovation, acting as agents of change in developed societies. For entrepreneurs to develop, entrepreneurial ecosystems are required. These environments are complex heterogeneous systems. However, the atomization of the subsystem of agencies and organisms supporting entrepreneurial activity can cause problems. To solve this governance problem, a social experiment was designed to test the value of a solution based on a technological platform. The methodology is based on a dynamic scheme, seeking the involvement and collaboration of all the stakeholders. This method uses a co-creative process inspired by design thinking. The theoretical framework included literature on entrepreneurial ecosystems and governance theory and took into account the need to involve all the stakeholders to improve the previous situation and achieve sustainable development goals. Based on the application and an ad-hoc methodology seeking the involvement and collaboration of all stakeholders, a social network supported by an ICT-based platform was formally created, contributing to alleviate the atomization problem and generating social value at the same time. This social experiment, carried out in the Spanish province of Biscay in the Basque Country, was a pilot test and could be extended to other entrepreneurial ecosystems with similar casuistic frameworks. [ABSTRACT FROM AUTHOR]

Scenarios can be used to communicate potential future changes and engage and connect different audiences in exploring sustainable solutions. Communicating scenarios using creative visualisation, co-creation and a focus on local contexts are especially promising. This research is conducted on the island of Palawan in the Philippines as part of the GCRF Blue Communities project. With a quasi-experimental design, we investigate the psychological and emotional effects of the engagement with future scenarios as a tool for communicating sustainability. Together with local stakeholders and community members, three distinct, locally relevant scenario narratives (Business as Usual, Best Case, and Worst Case) have been co-created. Subsequently, a sample of N = 109 local high school students was asked to creatively engage with these scenario narratives. Intentions to engage in sustainable behaviour, perceived behavioural control, ascription of responsibility, consideration of future consequences, six basic emotions and connectedness to place were assessed before and after the activity via paper-pencil administrated questionnaires. A mixed-model analysis showed significant increases in intentions to engage in sustainable behaviour, however, this increase disappeared when consideration of future consequences was added as a covariate, suggesting a mediating effect. The level of consideration of future consequences also increased significantly after engaging with any of the future scenarios, which questions the common interpretation of consideration of future consequences as a trait variable. Perceived behavioural control significantly increased following the engagement with each of the scenarios whereas ascription of responsibility and connectedness to place did not show any changes. Overall, the two most emotion-evoking scenarios, Best Case Scenario and Worst Case Scenario, turn out as superior over the Business as Usual Scenario, which points to the relevance of emotional framing for effective messaging in our sample. This is the first systematic, quantitative assessment of the effects of future scenarios as a communication tool.

Entrepreneurs are considered an important source of innovation, acting as agents of change in developed societies. For entrepreneurs to develop, entrepreneurial ecosystems are required. These environments are complex heterogeneous systems. However, the atomization of the subsystem of agencies and organisms supporting entrepreneurial activity can cause problems. To solve this governance problem, a social experiment was designed to test the value of a solution based on a technological platform. The methodology is based on a dynamic scheme, seeking the involvement and collaboration of all the stakeholders. This method uses a co-creative process inspired by design thinking. The theoretical framework included literature on entrepreneurial ecosystems and governance theory and took into account the need to involve all the stakeholders to improve the previous situation and achieve sustainable development goals. Based on the application and an ad-hoc methodology seeking the involvement and collaboration of all stakeholders, a social network supported by an ICT-based platform was formally created, contributing to alleviate the atomization problem and generating social value at the same time. This social experiment, carried out in the Spanish province of Biscay in the Basque Country, was a pilot test and could be extended to other entrepreneurial ecosystems with similar casuistic frameworks.

Human-Computer Interaction (HCI) and games set a new domain in understanding people’s motivations in gaming, behavioral implications of game play, game adaptation to player preferences and needs for increased engaging experiences in the context of HCI serious games (HCI-SGs). When the latter relate with people’s health status, they can become a part of their daily life as assistive health status monitoring/enhancement systems. Co-designing HCI-SGs can be seen as a combination of art and science that involves a meticulous collaborative process. The design elements in assistive HCI-SGs for Parkinson’s Disease (PD) patients, in particular, are explored in the present work. Within this context, the Game-Based Learning (GBL) design framework is adopted here and its main game-design parameters are explored for the Exergames, Dietarygames, Emotional games, Handwriting games, and Voice games design, drawn from the PD-related i-PROGNOSIS Personalized Game Suite (PGS) (www.i-prognosis.eu) holistic approach. Two main data sources were involved in the study. In particular, the first one includes qualitative data from semi-structured interviews, involving 10 PD patients and four clinicians in the co-creation process of the game design, whereas the second one relates with data from an online questionnaire addressed by 104 participants spanning the whole related spectrum, i.e., PD patients, physicians, software/game developers. Linear regression analysis was employed to identify an adapted GBL framework with the most significant game-design parameters, which efficiently predict the transferability of the PGS beneficial effect to real-life, addressing functional PD symptoms. The findings of this work can assist HCI-SG designers for designing PD-related HCI-SGs, as the most significant game-design factors were identified, in terms of adding value to the role of HCI-SGs in increasing PD patients’ quality of life, optimizing the interaction with personalized HCI-SGs and, hence, fostering a collaborative human-computer symbiosis.

The paper describes an innovative structured workshop methodology in garden-based-learning (GBL) called “Nature in Your Face” (NiYF) aimed at provoking a change in citizens behavior and engagement as a consequence of the emotional activation in response to disruptive artistic messages. The methodology challenges the assumption that the change needed to meet the carbon targets can be reached with incremental, non-invasive behavior engineering techniques such as nudging or gamification. Instead, it explores the potential of disruptive communication to push citizens out of their comfort zones and into creative modes of re-creating futures. This is done by confronting us with consequences of consumption by means of art and eco-visualizations. The aim being to achieve awareness, mental flexibility, and spurring debate. Thus, we invite them to react – and act upon these reactions by communicating their feelings or thoughts. This is used as an entrance point for broader and/or deeper engagement in a structured three-step methodology; (1) Framing: A disruptive element is introduced into the local environment. This triggers an emotional reaction, which then is taken up in a process of framing the problem and working with solutions. (2) Twisting: in a guided process, the initial energy from the emotional confrontation is twisted into a creative exploration of innovative solutions, from the perspective of the children. (3) Using: The last stage is using the developed solutions in the local social system (or refining them further). The methodology is being applied in cooperation with a primary school, and is iteratively adjusted and evaluated in a formative, action-research based approach scenario. NiYF is to stimulate societal engagement through deliberately confronting stakeholders with unexpected and potentially upsetting appearances of nature, climate effects, or carbon-neutral lifestyle scenarios. We have verified the practical usefulness and potential of the methodology and found that NiYF triggers societal engagement and transition, negotiating responsibilities and unlocking action potentials. We also found that eco-anxiety, denial, self-efficacy and cognitive dissonance form children’s understanding of plastic. The project marks a paradigm shift from creating knowledge to using knowledge to create action, and a focus on learning from evaluating and adapting the approach in the field.

The paper describes an innovative structured workshop methodology in garden-based-learning (GBL) called "Nature in Your Face" (NiYF) aimed at provoking a change in citizens behavior and engagement as a consequence of the emotional activation in response to disruptive artistic messages. The methodology challenges the assumption that the change needed to meet the carbon targets can be reached with incremental, non-invasive behavior engineering techniques such as nudging or gamification. Instead, it explores the potential of disruptive communication to push citizens out of their comfort zones and into creative modes of re-creating futures. This is done by confronting us with consequences of consumption by means of art and eco-visualizations. The aim being to achieve awareness, mental flexibility, and spurring debate. Thus, we invite them to react – and act upon these reactions by communicating their feelings or thoughts. This is used as an entrance point for broader and/or deeper engagement in a structured three-step methodology; (1) Framing: A disruptive element is introduced into the local environment. This triggers an emotional reaction, which then is taken up in a process of framing the problem and working with solutions. (2) Twisting: in a guided process, the initial energy from the emotional confrontation is twisted into a creative exploration of innovative solutions, from the perspective of the children. (3) Using: The last stage is using the developed solutions in the local social system (or refining them further). The methodology is being applied in cooperation with a primary school, and is iteratively adjusted and evaluated in a formative, action-research based approach scenario. NiYF is to stimulate societal engagement through deliberately confronting stakeholders with unexpected and potentially upsetting appearances of nature, climate effects, or carbon-neutral lifestyle scenarios. We have verified the practical usefulness and potential of the methodology and found that NiYF triggers societal engagement and transition, negotiating responsibilities and unlocking action potentials. We also found that eco-anxiety, denial, self-efficacy and cognitive dissonance form children's understanding of plastic. The project marks a paradigm shift from creating knowledge to using knowledge to create action, and a focus on learning from evaluating and adapting the approach in the field. [ABSTRACT FROM AUTHOR]

Digital transformation has allowed to offer additional services—which complement the main product—both in terms of use, emotional, and relationship terms. Focusing on a traditionally rational insurance customer offering a value that explores the customer's emotions, from co-creating with the user, allows brand differentiation. Given this idea, this document has three purposes. First is identify the true role of expectations and the perceived quality of the customer's digital experience. Second is to identify the relationship between customer experience and satisfaction gained in private insurance web areas. Third is to identify the most valued digital attributes by the user. A sample of 4,178 customers registered was analyzed using the partial least-squares technique. The model is highly predictive to customer experience and evidence the important relationship between the WOW effect and satisfaction, as well as the weak but double role that expectations play on insurance digital self-service. The model demonstrates that expectations are only relevant before web consumption, because during the process it is the perceived digital quality, in particular the usefulness, information, and technology, that offers a true customer experience. This article offers high academic value because it more accurately defines the determinants of the digital insurance customer experience and its effect on customer satisfaction in digital services. While expectations influence attitude before service, this research reveals that perceived digital quality is what delivers a true customer experience. Strategically, the implications are immediate in the field of business as it shows the importance of co-creation in digital design, not only because of the significant savings in implementation costs but also because it guarantees a greater experience, essential in the loyalty of its customers. This ensures the sustainable growth of the company. [ABSTRACT FROM AUTHOR]

Value co-creation continues to be a key issue in the era of marketing 4.0. Despite an increasing amount of research on value co-creation, there is still a lot of ambiguity in the use of certain terms. For example, different names are used to refer to the same concept. Even though the concept of co-innovation or co-production has nearly the same meaning as co-creation, there are certain differences between them that must be clarified. In addition, another difficulty found in the literature is that the co-creation concept is frequently applied to different objects of study, such that it might be dealing with brand value co-creation, co-creation of experience, co-creation attitude, etc. In order to clarify these issues, this paper presents a brief review of the relevant literature on value co-creation.

Value co-creation continues to be a key issue in the era of marketing 4.0. Despite an increasing amount of research on value co-creation, there is still a lot of ambiguity in the use of certain terms. For example, different names are used to refer to the same concept. Even though the concept of co-innovation or co-production has nearly the same meaning as co-creation, there are certain differences between them that must be clarified. In addition, another difficulty found in the literature is that the co-creation concept is frequently applied to different objects of study, such that it might be dealing with brand value co-creation, co-creation of experience, co-creation attitude, etc. In order to clarify these issues, this paper presents a brief review of the relevant literature on value co-creation. [ABSTRACT FROM AUTHOR]

Human-Computer Interaction (HCI) and games set a new domain in understanding people's motivations in gaming, behavioral implications of game play, game adaptation to player preferences and needs for increased engaging experiences in the context of HCI serious games (HCI-SGs). When the latter relate with people's health status, they can become a part of their daily life as assistive health status monitoring/enhancement systems. Co-designing HCI-SGs can be seen as a combination of art and science that involves a meticulous collaborative process. The design elements in assistive HCI-SGs for Parkinson's Disease (PD) patients, in particular, are explored in the present work. Within this context, the Game-Based Learning (GBL) design framework is adopted here and its main game-design parameters are explored for the Exergames, Dietarygames, Emotional games, Handwriting games, and Voice games design, drawn from the PD-related i-PROGNOSIS Personalized Game Suite (PGS) (www.i-prognosis.eu) holistic approach. Two main data sources were involved in the study. In particular, the first one includes qualitative data from semi-structured interviews, involving 10 PD patients and four clinicians in the co-creation process of the game design, whereas the second one relates with data from an online questionnaire addressed by 104 participants spanning the whole related spectrum, i.e., PD patients, physicians, software/game developers. Linear regression analysis was employed to identify an adapted GBL framework with the most significant game-design parameters, which efficiently predict the transferability of the PGS beneficial effect to real-life, addressing functional PD symptoms. The findings of this work can assist HCI-SG designers for designing PD-related HCI-SGs, as the most significant game-design factors were identified, in terms of adding value to the role of HCI-SGs in increasing PD patients' quality of life, optimizing the interaction with personalized HCI-SGs and, hence, fostering a collaborative human-computer symbiosis., Competing Interests: Authors Hugo Silva and Gonçalo Telo were employed by the company PLUX, Wireless Biosignals. Moreover, Konstantinos Filis, Elina Theodoropoulou, and George Lyberopoulos were employed by the company COSMOTE Kinites Tilepekoinonies AE. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Dias, Diniz, Konstantinidis, Savvidis, Zilidou, Bamidis, Grammatikopoulou, Dimitropoulos, Grammalidis, Jaeger, Stadtschnitzer, Silva, Telo, Ioakeimidis, Ntakakis, Karayiannis, Huchet, Hoermann, Filis, Theodoropoulou, Lyberopoulos, Kyritsis, Papadopoulos, Depoulos, Trivedi, Chaudhuri, Klingelhoefer, Reichmann, Bostantzopoulou, Katsarou, Iakovakis, Hadjidimitriou, Charisis, Apostolidis and Hadjileontiadis.)

In this paper we connect open-ended development, authority, agency, and motivation through (1) an analysis of the demands of existing in a complex world and (2) environmental appraisal in terms of affordance content and the complexity to select appropriate behavior. We do this by identifying a coherent core from a wide range of contributing fields. Open-ended development is a structured three-step process in which the agent first learns to master the body and then aims to make the mind into a reliable tool. Preconditioned on success in step two, step three aims to effectively co-create an optimal living environment. We argue that these steps correspond to right-left-right hemispheric dominance, where the left hemisphere specializes in control and the right hemisphere in exploration. Control (e.g., problem solving) requires a closed and stable world that must be maintained by external authorities or, in step three, by the right hemisphere acting as internal authority. The three-step progression therefore corresponds to increasing autonomy and agency. Depending on how we appraise the environment, we formulate four qualitatively different motivational states: submission, control, exploration, and consolidation. Each of these four motivational states has associated reward signals of which the last three-successful control, discovery of novelty, and establishing new relations-form an open-ended development loop that, the more it is executed, helps the agent to become progressively more agentic and more able to co-create a pleasant-to-live-in world. We conclude that for autonomy to arise, the agent must exist in a (broad) transition region between order and disorder in which both danger and opportunity (and with that open-ended development and motivation) are defined. We conclude that a research agenda for artificial cognitive system research should include open-ended development through intrinsic motivations and ascribing more prominence to right hemispheric strengths.