NUDGE: IMPROVING DECISIONS ABOUT HEALTH, WEALTH, AND HAPPINESS by Richard H. Thaler and Cass R. Sunstein Penguin Books, 2009, 312 pp, ISBN 978-0-14-311526-7This book is best described formally as a general explanation of and advocacy for libertarian paternalism, a term coined by the authors in earlier publications. Informally, it is about how leaders, systems, organizations, and governments can nudge people to do the things the nudgers want and need done for the betterment of the nudgees, or of society. It is paternalism in the sense that "it is legitimate for choice architects to try to influence people's behavior in order to make their lives longer, healthier, and better", (p. 5) It is libertarian in that "people should be free to do what they like - and to opt out of undesirable arrangements if they want to do so", (p. 5) The built-in possibility of opting out or making a different choice preserves freedom of choice even though people's behavior has been influenced by the nature of the presentation of the information or by the structure of the decisionmaking system. I had never heard of libertarian paternalism before reading this book, and I now find it fascinating.Written for a general audience, this book contains mostly social and behavioral science theory and models, but there is considerable discussion of structure and process that has roots in mathematical and quantitative modeling. One of the main applications of this social system is economic choice in investing, selecting and purchasing products and services, systems of taxes, banking (mortgages, borrowing, savings), and retirement systems. Other quantitative social choice systems discussed include environmental effects, health care plans, gambling, and organ donations. Softer issues that are also subject to a nudge-based approach are marriage, education, eating, drinking, smoking, influence, spread of information, and politics. There is something in this book for everyone.The basis for this libertarian paternalism concept is in the social theory called "science of choice", the study of the design and implementation of influence systems on various kinds of people. The terms Econs and Humans, are used to refer to people with either considerable or little rational decision-making talent, respectively. The various libertarian paternalism concepts and systems presented are tested and compared in light of these two types of people. Two foundational issues that this book has in common with another book, Network of Echoes: Imitation, Innovation and Invisible Leaders, that was also reviewed for this issue of the Journal are that 1 ) there are two modes of thinking (or components of the brain) - an automatic (intuitive) process and a reflective (rational) process and 2) the need for conformity and the desire for imitation are powerful forces in human behavior. …

Nudge: Improving Decisions about Health, Wealth, and Happiness

[서평]「The Unified Modeling Language User Guide」

The just-in-time adaptive intervention (JITAI) is an intervention design aiming to provide the right type/amount of support, at the right time, by adapting to an individual’s changing internal and contextual state. The availability of increasingly powerful mobile and sensing technologies underpins the use of JITAIs to support health behavior, as in such a setting an individual’s state can change rapidly, unexpectedly, and in his/her natural environment. Despite the increasing use and appeal of JITAIs, a major gap exists between the growing technological capabilities for delivering JITAIs and research on the development and evaluation of these interventions. Many JITAIs have been developed with minimal use of empirical evidence, theory, or accepted treatment guidelines. Here, we take an essential first step towards bridging this gap. Building on health behavior theories and the extant literature on JITAIs, we clarify the scientific motivation for JITAIs, define their fundamental components, and highlight design principles related to these components. Examples of JITAIs from various domains of health behavior research are used for illustration. As we enter a new era of technological capacity for delivering JITAIs, it is critical that researchers develop sophisticated and nuanced health behavior theories capable of guiding the construction of such interventions. Particular attention has to be given to better understanding the implications of providing timely and ecologically sound support for intervention adherence and retention.

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Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health: Key Components and Design Principles for Ongoing Health Behavior Support

The increasing use of wireless networks and the constant miniaturization of electrical devices has empowered the development of Wireless Body Area Networks (WBANs). In these networks various sensors are attached on clothing or on the body or even implanted under the skin. The wireless nature of the network and the wide variety of sensors offer numerous new, practical and innovative applications to improve health care and the Quality of Life. The sensors of a WBAN measure for example the heartbeat, the body temperature or record a prolonged electrocardiogram. Using a WBAN, the patient experiences a greater physical mobility and is no longer compelled to stay in the hospital. This paper offers a survey of the concept of Wireless Body Area Networks. First, we focus on some applications with special interest in patient monitoring. Then the communication in a WBAN and its positioning between the different technologies is discussed. An overview of the current research on the physical layer, existing MAC and network protocols is given. Further, cross layer and quality of service is discussed. As WBANs are placed on the human body and often transport private data, security is also considered. An overview of current and past projects is given. Finally, the open research issues and challenges are pointed out.

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A survey on wireless body area networks

A review of smart homes-Present state and future challenges

Telemedicine implementations often remain in the pilot phase and do not succeed in scaling-up to robust products that are used in daily practice. We conducted a qualitative literature review of 45 conference papers describing telemedicine interventions in order to identify determinants that had influenced their implementation. The identified determinants, which would influence the future implementation of telemedicine interventions, can be classified into five major categories: (i) Technology, (ii) Acceptance (iii) Financing, (iv) Organization and (v) Policy and Legislation. Each category contains determinants that are relevant to different stakeholders in different domains. We propose a layered implementation model in which the primary focus on individual determinants changes throughout the development life cycle of the telemedicine implementation. For success, a visionary approach is required from the multidisciplinary stakeholders, which goes beyond tackling specific issues in a particular development phase. Thus the right philosophy is: ‘start small, think big’.

Determinants of successful telemedicine implementations: a literature study

The forthcoming wide availability of high bandwidth public wireless networks will give rise to new mobile health care services. Towards this direction the MobiHealth project has developed and trialed a highly customisable vital signals' monitoring system based on a Body Area Network (BAN) and an m-health service platform utilizing next generation public wireless networks. The developed system allows the incorporation of diverse medical sensors via wireless connections, and the live transmission of the measured vital signals over public wireless networks to healthcare providers. Nine trials with different health care cases and patient groups in four different European countries have been conducted to test and verify the system, the service and the network infrastructure for its suitability and the restrictions it imposes to mobile health care applications.

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Mobile Patient Monitoring: The MobiHealth System

Prolonged sitting is a potential health risk, not only for people with an inactive lifestyle but also for those who meet the daily physical activity recommendations. Mobile applications that trigger people to take regular breaks from sitting seem promising. In this paper, we present the results of our quest to create effective persuasive mobile applications aimed at reducing sedentary behavior. First, we developed SitCoach, a mobile application to nudge office workers from their seats. SitCoach monitors physical activity and sedentary behavior and provides timely persuasive messages suggesting active breaks. A user test showed that users had little awareness of the risks of prolonged sitting and considered their ability to take active breaks to be highly dependent on external factors. The results from this study formed the basis for a second experiment, which was more extensive in duration and number of participants. In this 6-week experiment, office workers received timely persuasive messages on their smart phones, advising them to take an active break whenever they were sitting behind their computer for too long. Compared to a Control group who did not receive these messages, a significant decrease in computer activity was achieved. The studies show the potential and limitations of using a smart phone as a platform for reducing sedentary behavior. We conclude with recommendations to create effective mobile applications that motivate people to take regular breaks from sitting.

Toward a persuasive mobile application to reduce sedentary behavior

Several social-economical developments, like the ageing society, stimulate the use of ICT applications for mobile healthcare (e.g., tele-monitoring). To support novel m-health applications, the consequences of developing these applications should be considered in the scope of a comprehensive architecture. Additionally, contextual information plays an important role for personalised healthcare and should be considered in such architectures. This paper describes ongoing research that focuses on developing an application framework for supporting the development of context-aware m-health applications. It gives initial requirements for such a framework and it gives a first attempt for a functional decomposition. The use of the framework is illustrated by means of an epilepsy tele-monitoring scenario.

https://archive-ouverte.unige.ch/unige:55835/ATTACHMENT01

Towards an application framework for context-aware m-health applications

Background: Research on digital technology to change health behavior has increased enormously in recent decades. Due to the interdisciplinary nature of this topic, knowledge and technologies from different research areas are required. Up to now, it is not clear how the knowledge from those fields is combined in actual applications. A comprehensive analysis that systematically maps and explores the use of knowledge within this emerging interdisciplinary field is required.
Objective: This study aims to provide an overview of the research area around the design and development of digital technologies for health behavior change and to explore trends and patterns.
Methods: A bibliometric analysis is used to provide an overview of the field, and a scoping review is presented to identify the trends and possible gaps. The study is based on the publications related to persuasive technologies and health behavior change in the last 18 years, as indexed by the Web of Science and Scopus (317 and 314 articles, respectively). In the first part, regional and time-based publishing trends; research fields and keyword co-occurrence networks; influential journals; and collaboration network between influential authors, countries, and institutions are examined. In the second part, the behavioral domains, technological means and theoretical foundations are investigated via a scoping review.
Results: The literature reviewed shows a clear and emerging trend after 2001 in technology-based behavior change, which grew exponentially after the introduction of the smartphone around 2009. Authors from the United States, Europe, and Australia have the highest number of publications in the field. The three most active research areas are computer science, public and occupational health, and psychology. The keyword “mhealth” was the dominant term and predominantly used together with the term “physical activity” and “ehealth”. A total of three strong clusters of coauthors have been found. Nearly half of the total reported papers were published in three journals. The United States, the United Kingdom, and the Netherlands have the highest degree of author collaboration and a strong institutional network. Mobile phones were most often used as a technology platform, regardless of the targeted behavioral domain. Physical activity and healthy eating were the most frequently targeted behavioral domains. Most articles did not report about the behavior change techniques that were applied. Among the reported behavior change techniques, goal setting and self-management were the most frequently reported.
Conclusions: Closer cooperation and interaction between behavioral sciences and technological areas is needed, so that theoretical knowledge and new technological advancements are better connected in actual applications. Eventually, this could result in a larger societal impact, an increase of the effectiveness of digital technologies for health behavioral change, and more insight in the relationship between behavioral change strategies and persuasive technologies' effectiveness.

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Aart van Halteren

Papers

Determinants of successful telemedicine implementations: a literature study

Mobile Patient Monitoring: The MobiHealth System

Toward a persuasive mobile application to reduce sedentary behavior

Towards an application framework for context-aware m-health applications

Digital health behavior change technology: Bibliometric and scoping review of two decades of research