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BACKGROUND Smart bathroom technology offers unrivalled opportunities for automated measurement of a range of biomarkers and other data. Unfortunately, efforts in this area are mostly driven by a ‘technology push’ rather than ‘market pull’ approach, which decreases the chances of successful adoption. As of yet, little is known about the perceived use cases that potential users of smart bathrooms see, nor about their perceived barriers and desires. OBJECTIVE This study aims to investigate how participants from the general population experience using a ‘smart’ sensor-equipped toilet seat, installed in their home. The study contributes to answering the question what use cases citizens see for this innovation, and what limitations and barriers to use in everyday life they see, including privacy concerns, fit with everyday practices, and expectations for user experience. METHODS 31 Participants of 30 households took part in a study consisting of three (partially overlapping) stages: sensitising, in which participants filled out questionnaires to trigger their thinking of ideas about smart bathroom use and personal health; provotyping, in which participants received a gentle provocation in the form of a smart toilet seat which they used for two weeks; and discussion, in which participants took part in an online focus group session to discuss their experiences. RESULTS Participants found the everyday use of the toilet, including installation and dismantling when necessary, easy and without complications. Where complications occurred, participants mentioned issues with using the smart toilet seat, either related to the design of the prototype, related to the technology, and related to mismatches with normal practices in using toilets and hygiene. A broad range of use cases were mentioned, ranging from signalling potentially detrimental health conditions or exacerbations of existing conditions, documenting physical data, to measuring biomarkers to inform a diagnosis and behaviour change. Participants differed greatly in whether they let others know about, or even use, the seat. Ownership and control over their own data was essential for most participants. CONCLUSIONS This study shows that participants felt a smart toilet seat could be acceptable and effective, as long as it fits everyday practices concerning toilet use and hygiene. The range of potential uses for a smart toilet seat are broad, as long as privacy and control over disclosure and data are warranted. CLINICALTRIAL

BACKGROUND Although digital tools for healthy nutrition have shown great potential, their actual impact remains variable, because digital solutions often do not fit users’ needs and barriers. This is especially poignant for priority communities in society. Involving these groups in Citizen Science may have great benefits, even beyond the increase of knowledge about the lives and experiences of these groups. However, this requires specialised skills. Participants from priority groups could benefit from an approach that offers sensitization, gentle and safe provocation, and discussion, to help them voice their needs regarding (digital technology for) healthy nutrition. OBJECTIVE The study aims to gather insights on people’s thoughts on (applying technological innovations for) everyday eating practices, in self-regulation (for instance of snacking), and skill acquisition. METHODS Participants answered three daily questionnaires, to garner their current practices regarding habits, self-regulation, skills, and technology use surrounding healthy eating, and to make it easier for them to collect their thoughts and experiences (sensitisation). Within a week after filling out the three questionnaires, participants took part in an online focus group discussion session. Part of this discussion was a brief ‘provotyping’ exercise in which participants were presented with digital solutions for measuring health determinants. All sessions were transcribed and analysed using a thematic qualitative approach. RESULTS 42 people took part in 7 focus group interviews of six people each. The analysis showed that participants would like to receive support from technology for a broad range of aspects of nutrition, such as in measuring the effect their personal nutrition has on their individual health; providing them with reliable product information; giving them practical guidance for healthy eating and snacking; and reducing the burden of registering food intake. Technology should be easy to use, reduce burdens, and be tailored to personal situations. Privacy and cost are major concerns to the participants. CONCLUSIONS The present study shows that people from low and medium-socioeconomic status groups have a need for specific support in tailoring their knowledge of healthy nutrition to their own situation, and see technology as a means to achieve this.

BACKGROUND Many intervention development projects fail to bridge the gap from basic research to clinical practice. Instead of theory-based approaches to intervention development, co-design prioritizes the end users’ perspective as well as continuous collaboration between stakeholders, designers, and researchers throughout the project. This alternative approach to the development of interventions is expected to promote the adaptation to existing treatment activities and to be responsive to the requirements of end users. OBJECTIVE The first objective was to provide an overview of all activities that were employed during the course of a research project to develop a relapse prevention intervention for interdisciplinary pain treatment programs. The second objective was to examine how co-design may contribute to stakeholder involvement, generation of relevant insights and ideas, and incorporation of stakeholder input into the intervention design. METHODS We performed an embedded single case study and used the double diamond model to describe the process of intervention development. Using all available data sources, we also performed deductive content analysis to reflect on this process. RESULTS By critically reviewing the value and function of a co-design project with respect to idea generation, stakeholder involvement, and incorporation of stakeholder input into the intervention design, we demonstrated how co-design shaped the transition from ideas, via concepts, to a prototype for a relapse prevention intervention. CONCLUSIONS Structural use of co-design throughout the project resulted in many different participating stakeholders and stimulating design activities. As a consequence, the majority of the components of the final prototype can be traced back to the information that stakeholders provided during the project. Although this illustrates how co-design facilitates the integration of contextual information into the intervention design, further experimental testing is required to evaluate to what extent this approach ultimately leads to improved usability as well as patient outcomes in the context of clinical practice.

BACKGROUND Adequate self-management skills are of great importance for patients with chronic obstructive pulmonary disease (COPD) to reduce the impact of COPD exacerbations. Using mobile health (mHealth) to support exacerbation-related self-management could be promising in engaging patients in their own health and changing health behaviors. However, there is limited knowledge on how to design mHealth interventions that are effective, meet the needs of end users, and are perceived as useful. By following an iterative user-centered design (UCD) process, an evidence-driven and usable mHealth intervention was developed to enhance exacerbation-related self-management in patients with COPD. OBJECTIVE This study aimed to describe in detail the full UCD and development process of an evidence-driven and usable mHealth intervention to enhance exacerbation-related self-management in patients with COPD. METHODS The UCD process consisted of four iterative phases: (1) background analysis and design conceptualization, (2) alpha usability testing, (3) iterative software development, and (4) field usability testing. Patients with COPD, health care providers, COPD experts, designers, software developers, and a behavioral scientist were involved throughout the design and development process. The intervention was developed using the behavior change wheel (BCW), a theoretically based approach for designing behavior change interventions, and logic modeling was used to map out the potential working mechanism of the intervention. Furthermore, the principles of design thinking were used for the creative design of the intervention. Qualitative and quantitative research methods were used throughout the design and development process. RESULTS The background analysis and design conceptualization phase resulted in final guiding principles for the intervention, a logic model to underpin the working mechanism of the intervention, and design requirements. Usability requirements were obtained from the usability testing phases. The iterative software development resulted in an evidence-driven and usable mHealth intervention—Copilot, a mobile app consisting of a symptom-monitoring module, and a personalized COPD action plan. CONCLUSIONS By following a UCD process, an mHealth intervention was developed that meets the needs and preferences of patients with COPD, is likely to be used by patients with COPD, and has a high potential to be effective in reducing exacerbation impact. This extensive report of the intervention development process contributes to more transparency in the development of complex interventions in health care and can be used by researchers and designers as guidance for the development of future mHealth interventions.

BACKGROUND A lack of physical activity is considered to cause 6% of deaths globally. Feedback from wearables such as activity trackers has the potential to encourage daily physical activity. To date, little research is available on the natural development of adherence to activity trackers or on potential factors that predict which users manage to keep using their activity tracker during the first year (and thereby increasing the chance of healthy behavior change) and which users discontinue using their trackers after a short time. OBJECTIVE The aim of this study was to identify the determinants for sustained use in the first year after purchase. Specifically, we look at the relative importance of demographic and socioeconomic, psychological, health-related, goal-related, technological, user experience–related, and social predictors of feedback device use. Furthermore, this study tests the effect of these predictors on physical activity. METHODS A total of 711 participants from four urban areas in France received an activity tracker (Fitbit Zip) and gave permission to use their logged data. Participants filled out three Web-based questionnaires: at start, after 98 days, and after 232 days to measure the aforementioned determinants. Furthermore, for each participant, we collected activity data tracked by their Fitbit tracker for 320 days. We determined the relative importance of all included predictors by using Random Forest, a machine learning analysis technique. RESULTS The data showed a slow exponential decay in Fitbit use, with 73.9% (526/711) of participants still tracking after 100 days and 16.0% (114/711) of participants tracking after 320 days. On average, participants used the tracker for 129 days. Most important reasons to quit tracking were technical issues such as empty batteries and broken trackers or lost trackers (21.5% of all Q3 respondents, 130/601). Random Forest analysis of predictors revealed that the most influential determinants were age, user experience–related factors, mobile phone type, household type, perceived effect of the Fitbit tracker, and goal-related factors. We explore the role of those predictors that show meaningful differences in the number of days the tracker was worn. CONCLUSIONS This study offers an overview of the natural development of the use of an activity tracker, as well as the relative importance of a range of determinants from literature. Decay is exponential but slower than may be expected from existing literature. Many factors have a small contribution to sustained use. The most important determinants are technical condition, age, user experience, and goal-related factors. This finding suggests that activity tracking is potentially beneficial for a broad range of target groups, but more attention should be paid to technical and user experience–related aspects of activity trackers.