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Designing online social networks to motivate health behaviour change Kamal, Noreen 2013

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Designing Online Social Networks toMotivate Health Behaviour ChangebyNoreen KamalB.Sc., The University of Calgary, 1994M.A.Sc., The University of British Columbia, 1997A THESIS SUBMITTED IN PARTIAL FULFILLMENT OFTHE REQUIREMENTS FOR THE DEGREE OFDOCTOR OF PHILOSOPHYinThe Faculty of Graduate Studies and Postdoctoral Studies(Electrical and Computer Engineering)THE UNIVERSITY OF BRITISH COLUMBIA(Vancouver)October 2013c? Noreen Kamal 2013AbstractEating nutritious foods and being more physically active prevents signifi-cant illnesses such as cardiac disease, stroke, and diabetes. However, leadinga healthy lifestyle remains elusive and obesity continues to increase in NorthAmerica. We investigate how online social networks (OSN) can change healthbehaviour by blending theories from health behaviour and participation inOSNs, which allow us to design and evaluate an OSN through a user-centreddesign (UCD) process.We begin this research by reviewing existing theoretical models to obtainthe determining factors for participation in OSNs and changing personalhealth behaviour. Through this review, we develop a conceptual framework,Appeal Belonging Commitment (ABC) Framework, which providesindividual determinants (Appeal), social determinants (Belonging), andtemporal consideration (Commitment) for participation in OSNs for healthbehaviour change.The ABC Framework is used in a UCD process to develop an OSNcalled VivoSpace. The framework is then utilized to evaluate each designto determine if VivoSpace is able to change the determinants for healthbehaviour change. The UCD process begins with an initial user inquiry usingquestionnaires to validate the determinants from the framework (n=104).These results are used to develop a paper prototype of VivoSpace, whichis evaluated through interviews (N=11). These results are used to designa medium fidelity prototype for VivoSpace, which is tested in a laboratorythrough both direct and indirect methods (n=36).The final iteration of VivoSpace is a high fidelity prototype, which isevaluated in a field experiment with clinical and non-clinical participantsfrom Canada and USA (n=32). The results reveal positive changes for theparticipants associated with a clinic in self-efficacy for eating healthy foodand leading an active lifestyle, attitudes towards healthy behaviour, and iniiAbstractthe stages of change for health behaviour. These results are further validatedby evaluating changes in health behaviour, which reveal a positive change forthe clinical group in physical activity and an increase in patient activation.The evaluation of the high fidelity prototype allow for a final iteration of theABC Framework, and the development of design principles for an OSNfor positive health behaviour change.iiiPrefaceAll of the work presented henceforth was conducted in the Media andGraphics Interdisciplinary Centre (MAGIC) at the University of BritishColumbia, Point Grey campus. All experiments and associated methodswere approved by the University of British Columbias Behavioural ResearchEthics Board [certificate #H10-02050].An earlier version of Chapter 3, Sections 3.1 and 3.2 has been published [N.Kamal, S. Fels, K. Ho. (2010) Online social networks for personal informaticsto promote positive health behavior. In The Second ACM SIGMM Workshopon Social Media (WSM2010). Oct 25-29, 2010. Firenze, Italy. 47-52.]. I wasthe lead investigator, responsible for all major areas of concept formation,literature review, literature consolidation, as well as manuscript composition.K. Ho was involved in the early stages of concept formation. S. Fels was thesupervisory author on this project and was involved throughout the projectin concept formation and manuscript composition.An earlier version of Chapter 3 and portion of Chapter 7 (Section 7.3)has been published as a book chapter [N. Kamal, S. Fels, M. Blackstock, K.Ho. (2013). The ABC?s of Designing Social Networks for Health BehaviourChange: The VivoSpace Social Network. In E. Kranakis (ed.), Advances inNetwork Analysis and its Applications. Volume 18, 232-248. Springer Berlin/ Heidelberg]. I was the lead investigator, responsible for all major areas ofconcept formation, literature review, experimental design, data collectionand analysis, as well as manuscript composition. K. Ho was involved in theearly stages of concept formation. S. Fels was the supervisory author on thisproject and was involved throughout the project in concept formation andmanuscript composition. M. Blackstock provided edits to the manuscript.A version of Chapter 7 (Sections 7.1 and 7.2) has been published [N.Kamal, S. Fels, M. Blackstock, K. Ho. (2011). VivoSpace: Towards BehaviorChange Using Social Gaming. In J. C. Anacleto, S. Fels, N. Graham, B.ivPrefaceKapralos, M. S. El Nasr, and K. Stanley (Eds.), Entertainment ComputingICEC 2011, Lecture Notes in Computer Science, Volume 6972. Pages 319-330.Springer Berlin / Heidelberg]. I was the lead investigator, responsible forall major areas of concept formation, literature review, experimental design,data collection and analysis, as well as manuscript composition. K. Ho wasinvolved in the early stages of concept formation. S. Fels was the supervisoryauthor on this project and was involved throughout the project in conceptformation and manuscript composition. M. Blackstock provided edits to themanuscript.A version of Chapter 7 and Section 7.3 has been published [N. Kamal, S.Fels. (2012). Determining the Determinants of Health Behaviour ChangeThrough Online Social Networks. In M. Bang, E.L. Ragnemalm (Eds),Persuasive 2012, Lecture Notes in Computer Science, Volume 7284. 1-12.Springer Berlin / Heidelberg]. I was the lead investigator, responsible forall major areas of concept formation, literature review, experimental design,data collection and analysis, as well as manuscript composition. S. Felswas the supervisory author on this project and was involved throughout theproject in concept formation and manuscript composition.Portions of Chapter 4 have been accepted for publication and is expectedto appear in September 2013 [N. Kamal, S. Fels, J. McGrenere, K. Nance.(2013). Helping me helping you: designing to influence health behaviourthrough social connections. INTERACT 2013, Cape Town, South Africa]. Iwas the lead investigator, responsible for all major areas of concept forma-tion, literature review, experimental design, data collection and analysis, aswell as manuscript composition. J. McGrenere provided assistance on themanuscript revisions. K. Nance assisted with the participant recruitment andexperimental design. S. Fels was the supervisory author on this project andwas involved throughout the project in concept formation and manuscriptcomposition.vTable of ContentsAbstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iiPreface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ivTable of Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . viList of Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiList of Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xivAcknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . xviiiDedication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xx1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.1 Motivation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.2 Research Goals . . . . . . . . . . . . . . . . . . . . . . . . . . 31.3 Research Approach . . . . . . . . . . . . . . . . . . . . . . . . 51.3.1 Literature Review of Theoretical Models . . . . . . . . 51.3.2 Development of a Conceptual Framework . . . . . . . 61.3.3 Initial User Inquiry . . . . . . . . . . . . . . . . . . . . 71.3.4 Development and Evaluation of Paper Prototypes . . 71.3.5 Development and Evaluation of a Medium FidelityPrototype . . . . . . . . . . . . . . . . . . . . . . . . . 81.3.6 Development and Evaluation of a High Fidelity Prototype 81.4 Summary of Contributions . . . . . . . . . . . . . . . . . . . . 91.5 Thesis Outline . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Related Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122.1 Persuasive Technology . . . . . . . . . . . . . . . . . . . . . . 13viTABLE OF CONTENTS2.2 Health Behaviour Change in HCI . . . . . . . . . . . . . . . . 142.2.1 Research for Increased Physical Activity . . . . . . . . 142.2.2 Research for Improving Dietary Intake . . . . . . . . . 212.2.3 Research on Health Behaviour Generally . . . . . . . . 232.2.4 Personal Health Informatics . . . . . . . . . . . . . . . 262.3 Commercial Applications . . . . . . . . . . . . . . . . . . . . 282.4 Gamification . . . . . . . . . . . . . . . . . . . . . . . . . . . 302.5 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313 The ABC Conceptual Framework . . . . . . . . . . . . . . . . 333.1 Theories for Use of OSNs . . . . . . . . . . . . . . . . . . . . 333.1.1 Uses and Gratification Theory (UGT) . . . . . . . . . 343.1.2 Social Influence Model . . . . . . . . . . . . . . . . . . 353.1.3 Social Identity Theory . . . . . . . . . . . . . . . . . . 363.1.4 Common Bond Theory . . . . . . . . . . . . . . . . . . 373.1.5 Common Identity Theory . . . . . . . . . . . . . . . . 383.1.6 Theory of Organizational Commitment . . . . . . . . 393.1.7 Behaviour Chain for Online Participation . . . . . . . 403.1.8 Social Network Threshold . . . . . . . . . . . . . . . . 403.2 Theories for Health Behaviour Change . . . . . . . . . . . . . 413.2.1 The Health Belief Model (HBM) . . . . . . . . . . . . 413.2.2 The Social Cognitive Theory . . . . . . . . . . . . . . 423.2.3 The Theory of Reasoned Action (TRA) . . . . . . . . 443.2.4 The Theory of Planned Behaviour . . . . . . . . . . . 453.2.5 The Common Sense Model . . . . . . . . . . . . . . . 463.2.6 The Transtheoretical Model (TTM) . . . . . . . . . . 463.3 The Appeal Belonging Commitment (ABC)Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . 483.3.1 Appeal . . . . . . . . . . . . . . . . . . . . . . . . . . 493.3.2 Belonging . . . . . . . . . . . . . . . . . . . . . . . . . 523.3.3 Commitment . . . . . . . . . . . . . . . . . . . . . . . 533.3.4 Using the ABC Framework . . . . . . . . . . . . . . . 54viiTABLE OF CONTENTS4 The VivoSpace Prototype: An OSN for Health BehaviourChange . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574.1 Design of High Fidelity Prototype . . . . . . . . . . . . . . . 604.1.1 Mapping Design Elements to the ABC Framework . . 624.2 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 654.2.1 Methods . . . . . . . . . . . . . . . . . . . . . . . . . . 664.2.2 Results . . . . . . . . . . . . . . . . . . . . . . . . . . 704.2.3 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . 875 Final ABC Framework . . . . . . . . . . . . . . . . . . . . . . . 896 Design Principles . . . . . . . . . . . . . . . . . . . . . . . . . . 936.1 Provide Information . . . . . . . . . . . . . . . . . . . . . . . 956.2 Get Information . . . . . . . . . . . . . . . . . . . . . . . . . 966.3 Self-Discovery . . . . . . . . . . . . . . . . . . . . . . . . . . . 986.4 Maintain Interpersonal Connectivity . . . . . . . . . . . . . . 986.5 Social Enhancement . . . . . . . . . . . . . . . . . . . . . . . 996.6 Entertainment . . . . . . . . . . . . . . . . . . . . . . . . . . 1006.7 Convenience . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1016.8 Sense of Belonging . . . . . . . . . . . . . . . . . . . . . . . . 1026.9 Group Norms . . . . . . . . . . . . . . . . . . . . . . . . . . . 1026.10 Social Categorization . . . . . . . . . . . . . . . . . . . . . . . 1036.11 Shared Identity . . . . . . . . . . . . . . . . . . . . . . . . . . 1036.12 Social Comparison . . . . . . . . . . . . . . . . . . . . . . . . 1046.13 Interdependence . . . . . . . . . . . . . . . . . . . . . . . . . 1056.14 Social Interaction . . . . . . . . . . . . . . . . . . . . . . . . . 1066.15 Personal Knowledge of Others . . . . . . . . . . . . . . . . . . 1066.16 Habitual Use . . . . . . . . . . . . . . . . . . . . . . . . . . . 1076.17 Consideration of the Target Users . . . . . . . . . . . . . . . . 1076.18 Summary of Design Principles . . . . . . . . . . . . . . . . . . 1087 User-Centred Design (UCD) Process . . . . . . . . . . . . . . 1107.1 Initial User Inquiry . . . . . . . . . . . . . . . . . . . . . . . . 1107.1.1 Questionnaires . . . . . . . . . . . . . . . . . . . . . . 111viiiTABLE OF CONTENTS7.1.2 Interviews . . . . . . . . . . . . . . . . . . . . . . . . . 1177.1.3 Discussion and Iteration of the Framework . . . . . . 1217.2 Paper Prototypes for VivoSpace . . . . . . . . . . . . . . . . . 1227.2.1 Paper Prototype Design . . . . . . . . . . . . . . . . . 1227.2.2 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . 1277.2.3 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . 1317.3 Medium Fidelity Prototype for VivoSpace . . . . . . . . . . . 1327.3.1 Key Functions of Medium Fidelity Prototype . . . . . 1347.3.2 Evaluation Methods . . . . . . . . . . . . . . . . . . . 1367.3.3 Results . . . . . . . . . . . . . . . . . . . . . . . . . . 1427.3.4 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . 1508 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1538.1 Primary Contribution . . . . . . . . . . . . . . . . . . . . . . 1538.1.1 Appeal Belonging Commitment Framework . . . . . . 1538.1.2 Design Principles . . . . . . . . . . . . . . . . . . . . . 1568.1.3 The VivoSpace Prototype . . . . . . . . . . . . . . . . 1578.2 Secondary Contributions . . . . . . . . . . . . . . . . . . . . . 1588.2.1 Target User Groups . . . . . . . . . . . . . . . . . . . 1588.2.2 Maintained Health Behaviour Beyond Use . . . . . . . 1598.3 Relevant Publications . . . . . . . . . . . . . . . . . . . . . . 1598.4 Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1628.5 Directions for Future Research . . . . . . . . . . . . . . . . . 1638.6 Lessons Learned . . . . . . . . . . . . . . . . . . . . . . . . . 1648.7 Concluding Comments . . . . . . . . . . . . . . . . . . . . . . 165Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166AppendicesFirst Appendix: Screen Captures of High-Fidelity Prototype 181Second Appendix: Questionnaires for Field Experiment ofHigh-Fidelity Prototype . . . . . . . . . . . . . . . . . . . . . . 190ixTABLE OF CONTENTSThird Appendix: Initial User Inquiry Questionnaire and In-terview Questions . . . . . . . . . . . . . . . . . . . . . . . . . . 214Fourth Appendix: Paper Prototypes . . . . . . . . . . . . . . . . 226Fifth Appendix: Screen Captures of Medium Fidelity Proto-types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240Sixth Appendix: Laboratory Evaluation of Medium-FidelityPrototype . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265xList of Tables2.1 A summary of studies on design of technologies for healthbehaviour change. This table lists the name of the application,a brief description of the application, whether social designfeatures were included, the evaluation including the numberof participants (p) and length of the study, and the outcomesof the evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . 162.2 A summary of commercial applications for health behaviourchange that includes nutritional intake and physical activity. 283.1 The collation of the determinants from various sources of theUses and Gratification Theory into a common terminology. . 353.2 Definition of the common terminology for the determinantscollated from the Uses and Gratification Theory . . . . . . . 363.3 The collation of the socially based determinants for usingOSNs into a common terminology. . . . . . . . . . . . . . . . 383.4 Definition of the common terminology for the socially baseddeterminants for use of OSNs. . . . . . . . . . . . . . . . . . . 393.5 The collation of the individually based determinants for healthbehaviour change into a common terminology . . . . . . . . . 443.6 Definition of the common terminology for the individuallybased determinants for health behaviour change . . . . . . . . 453.7 The collation of the socially based determinants for healthbehaviour change into a common terminology . . . . . . . . . 473.8 Definition of the common terminology for the socially baseddeterminants for health behaviour change . . . . . . . . . . . 48xiLIST OF TABLES4.1 Mapping of the determinants for use of OSNs from the ABCFramework to the design elements in VivoSpace?s high fi-delity prototype. . . . . . . . . . . . . . . . . . . . . . . . . . 624.2 Mapping of the determinants for health behaviour change fromthe ABC Framework to the design elements in VivoSpace?shigh fidelity prototype. . . . . . . . . . . . . . . . . . . . . . . 644.3 An overview of the participants recruited for the field exper-iment showing gender distribution, age, obesity, and theirrank of their healthiness (1-6 Likert Scale, 1=very unhealthy,6=very healthy). . . . . . . . . . . . . . . . . . . . . . . . . . 684.4 Overview for usage of VivoSpace for all three groups, includesthe mean and range of log entries made, disclosure of logentries, and total comments made for each group. . . . . . . . 714.5 Mean values for results from the mid- and post-questionnaires?5-point Likert scale responses for Appeal determinants foruse of OSNs, based on their motivations for using VivoSpace. 734.6 Mean values for results from the mid- and post-questionnaires?5-point Likert scale responses for Shared Identity determinantfor use of VivoSpace. . . . . . . . . . . . . . . . . . . . . . . . 744.7 Post-hoc analysis results for each group showing the maineffects for self efficacy in eating healthy foods. . . . . . . . . . 784.8 Statistical significance p values (post hoc analysis shown inbrackets) for all determinants for health behaviour changefrom the ABC Framework for each group. . . . . . . . . . . 846.1 Final design principles for OSNs for health behaviour changeshown by each determinant for use of OSNs. . . . . . . . . . . 937.1 The theme and the associated number of comments thatemerged from interview inquiry of participants? use of OSNs . 1187.2 The theme and the associated number of comments thatemerged from interview inquiry of participants? thought onliving healthy . . . . . . . . . . . . . . . . . . . . . . . . . . . 120xiiLIST OF TABLES7.3 Mapping of the behavioural determinants from the ABCFramework to the design elements in the Paper Prototype . 1267.4 Qualitative analysis of feedback of VivoSpace showing thecategories, number of comments in each category and numberof themes that emerged for each category. . . . . . . . . . . . 1287.5 Themes emerging from ?Difficulties with VivoSpace? category. 1297.6 Themes emerging from ?Likes about VivoSpace? category. . 1307.7 Themes emerging from ?Recommendations for VivoSpace?category. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131xiiiList of Figures1.1 The research approach is a user-centred design process thatis modified with a theoretical foundation. The conceptualframework is used for the design as well as the evaluation ofthe OSN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63.1 ABC Framework showing the Appeal dimension in red andBelonging dimension in green. The determinants for use ofOSNs is shown in the boxes with no fill and the determi-nants for health behaviour change is shown in the filled boxes.The interplay between these two domains is shown by linesconnecting the boxes. . . . . . . . . . . . . . . . . . . . . . . 513.2 The Commitment dimension of the ABC Frameworkshowing the stages and attachment categories showing thestages of health behaviour change, the attachments categoriesof OSN, and the stages for use of OSN. The orange line in-dicates an example journey for a user through the temporalstages and attachment categories. . . . . . . . . . . . . . . . . 543.3 A graphical representation for the use of the ABC Frame-work, which includes the design and evaluation of the OSNfor health behaviour change and the validation of the framework. 564.1 Main home page of VivoSpace showing the Dashboard on theleft; the goals summary, log entry, and news feed in the middle;and friends with game progress on the right. . . . . . . . . . . 594.2 Left: the nutritional content of a meal is displayed when thelogged meal is clicked. Right: goal details show the users andparticipating friends progress towards the goal target. . . . . 60xivLIST OF FIGURES4.3 The user?s progression through the 10-level game showing thecharacters that have been revealed at each level and how muchthey have progressed through the current level. . . . . . . . . 614.4 The mean values from the results of the 5-point Likert re-sponses for attitude towards physical activity ; the error barsindicate standard deviation, and the statistical significancefor repeated measure ANOVA is shown on the x-axis. . . . . 764.5 The mean values from the results of the 5-point Likert re-sponses for self efficacy in eating healthy foods; the error barsindicate standard deviation, and the statistical significancefor repeated measure ANOVA is shown on the x-axis. . . . . 774.6 The mean values from the results of the 5-point Likert re-sponses for self efficacy in performing physical activity ; theerror bars indicate standard deviation, and the statisticalsignificance for repeated measure ANOVA is shown on thex-axis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 794.7 The percent of respondents from the all-clinical group (Van-couver clinic and Chicago Clinic) that were in each of the 5stages of change from the Transtheoretical Model before (pre)and after (post) using VivoSpace. . . . . . . . . . . . . . . . . 824.8 The mean values from the results of the PAM R?-22 question-naire; the error bars indicate standard deviation, and thestatistical significance for repeated measure ANOVA is shownon the x-axis. . . . . . . . . . . . . . . . . . . . . . . . . . . . 865.1 The final ABC Framework with the interplay between thedeterminants for use of OSN and health behaviour changeshown in red for the Appeal dimension and in green forthe Belonging dimension. The the interplay shown by thered and green arrows are based on evidence from the fieldexperiments. Compare with initial framework in figure 3.1 . . 90xvLIST OF FIGURES6.1 A 2x2 Matrix showing simplified design principles for OSNsfor health behaviour change. . . . . . . . . . . . . . . . . . . . 1097.1 Questionnaire responses (n=85) to agreement about moti-vation to use online social networks for individually-baseddeterminants. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1137.2 Questionnaire responses (n=85) to agreement about moti-vation to use online social networks for individually-baseddeterminants. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1147.3 Questionnaire responses (n=85) to agreement about moti-vation to use online social networks for individually-baseddeterminants. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1157.4 Questionnaire responses (n=85) to agreement about moti-vation to use online social networks for individually-baseddeterminants. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1167.5 Timeline page for the VivoSpace paper prototype. Timelinepage is where users are able to log their daily activity andshare with any portion of their social network or not share it. 1237.6 Dashboard page for the VivoSpace paper prototype. Dash-board of weekly performance with flags displayed on the graphto show what activities that were logged on that day. . . . . . 1247.7 Photograph of all 14 pages of the paper prototype laid outduring the interviews. . . . . . . . . . . . . . . . . . . . . . . 1277.8 A screenshot of the Medium Fidelity Prototype for VivoSpaceshowing the main activity page. . . . . . . . . . . . . . . . . . 1337.9 A screenshot of the Dashboard page of the medium fidelityprototype for VivoSpace showing the calories icon selected fromthe dashboard summary table, which displays the historicalchart for Calories consumed. . . . . . . . . . . . . . . . . . . . 1367.10 Mean 7-point Likert responses for Entering Activity task groupshowing the relevant Appeal determinants. The error barsrepresent the standard deviation. . . . . . . . . . . . . . . . . 143xviLIST OF FIGURES7.11 Mean 7-point Likert responses for Newsfeed task group show-ing the relevant Appeal and Belonging determinants. Theerror bars represent the standard deviation. . . . . . . . . . . 1447.12 Mean 7-point Likert responses for Dashboard task group show-ing the relevant Appeal determinants. The error bars repre-sent the standard deviation. . . . . . . . . . . . . . . . . . . . 1457.13 Mean 7-point Likert responses for Goals task group showingthe relevant Appeal determinants. The error bars representthe standard deviation. . . . . . . . . . . . . . . . . . . . . . 1467.14 Mean 7-point Likert responses for Clubs and Challenges taskgroup showing the relevant Appeal and Belonging determi-nants. The error bars represent the standard deviation. . . . 1477.15 Estimated marginal mean values and standard deviation forpercent of tasks helped during helping game experiment (n=9for each condition). . . . . . . . . . . . . . . . . . . . . . . . . 1487.16 Percent willing to stay or leave in the group commitmentexperiment (n=18 for each condition). . . . . . . . . . . . . . 149xviiAcknowledgementsThe process of completing this work was a completely transformative one.I could have predicted how this experience has made me a better scholar, butnot how this process has made me a better human. For this transformation,I have many people to acknowledge.First and foremost, I am grateful to Sidney Fels, who was not only mysupervisor, but a wonderful mentor. Thank you for allowing me the freedomto explore, ask the right (and wrong) questions, and succeed (and fail). Youprovided the right amount of guidance to allow me to develop the skills tobecome a researcher and academic.I am also grateful to Joanna McGrenere, who provided me with the idealmodel to follow in teaching, mentoring, and researching. Thank you foralways being available to assist me in my research and writing despite yourbusy schedule.There are also a multitude of people that I met along this journey thatcontributed to this research and my personal development in many ways:Michael Fergusson, who was a wonderful supporter and industry collaborator,thank you for all your support; Lawrence Cheng, who is a visionary for thehealth of individuals, thank you for your collaboration and support; KaraNance, who found me in the sea of people at SXSW and saw potential inmy research, thank you for your collaboration and support. I also want toacknowledge Michelle Aragon for all her assistance in the recruitment andcoordination of participants from Dr. Nance?s clinic.I also want to thank the undergraduate students, who assisted with thedevelopment of the high-fidelity prototype: Raymond Huang and VincentTsui. Thank you both for your hard work and enthusiasm.Most significantly, I thank all the participants from those that completedthe initial-user inquiry to those that participated in the 3-month field experi-ment. Without your honesty and contribution, none of this research wouldxviiiAcknowledgementsbe be possible. I am forever grateful to you.I am very grateful to the Stroke Services BC and in particular, PamAikman, for your allowances and support through my studies and in particularwhile I was in Victoria completing my CIHR Science Policy Fellowship. Iam very thankful to have such a great employer.Last but not least, I thank my parents. You are my biggest fans. I amvery indebted to your interest, support and encouragement.xixDedicationFor Douglas, thank you for your support, generosity and patience throughthe years.xxChapter 1Introduction1.1 MotivationThe importance of a nutritious diet and an active lifestyle has been foundto be central to a healthy population, which contributes to lower healthcarecosts for a nation and better quality of life for its citizens. Specifically, eatingnutritious foods can reduce advancement of and prevent the occurrence ofchronic diseases [6]. Being more physically active for as little as 30 minutesevery day has been found to result in overall better health and preventillness [86]. Diet and physical activity can also help prevent vascular diseasessuch as cardiac disease and stroke, which are the leading causes of death anddisability respectively [65]. Cardiac disease such as myocardial infarction(heart attack) has been linked to diets that have high caloric value and containhigh saturated and trans fat in combination with low physical activity [14].Similarly, preventable causes of stroke have been linked to obesity, physicalinactivity, and diets high in cholesterol and trans fat [41]. Furthermore,obesity has shown a marked increase over the past generation [34], andrelated chronic diseases such as type 2 diabetes is reaching epidemic numbersin some populations [124].The current delivery of healthcare focuses on symptom managementrather than prevention and self-management, and calls are being made toreframe health to include self-management [28]. Self-management of personalhealth has been shown to achieve positive health outcomes in both healthypeople and those with chronic conditions [15, 32, 117]. Not surprising, govern-ments have invested significant resources to promote healthy lifestyle amongits population. Governments around the world have adopted mandatory1Chapter 1. Introductionnutritional labelling to help their citizens understand the nutritional valuefor the packaged foods. However, there are limitations with this approach, aslabels are not available on all foods such as fruits and vegetables and oftenthey are difficult to understand [108].Despite greater medical and scientific knowledge, North Americans con-tinue to be more obese due to poor diet and a sedentary lifestyle. A significantfactor in health outcomes is one?s close and distant social networks [18, 68].One?s social networks can be used to improve health behaviour throughfacilitating social integration and social support [18]. Further, mortality andmorbidity is reduced by being more socially connected, and social supportscan promote better health by providing a sense of belonging and buildingself-efficacy [12].Studies have realized the benefits of social connection by designing socialtechnologies for health and weight management. Social technology has beenshown to increase social support for individuals afflicted with a particularcondition. The conditions studied include diabetes [71?73], ACL (AnteriorCruciate Ligament) [70], ALS (Amyotrophic Lateral Sclerosis) [37], can-cer [17, 109], HIV [45] , and menopause [107]. Furthermore, the dynamicsof social activity for weight management was ?unpacked? by finding thetaxonomy of peer involvement including supportive involvement and passiveinvolvement (such as social norms) and observed patterns of interaction suchas (un)disclosure [69].We have also seen social connection through websites and other webenabled technology have had an explosion of engagement and use, namelyin use of Online Social Network (OSN) services such as Facebook R?. OSNsare the most popular activity on the internet with 82% of the world?s onlinepopulation using OSNs, and users of the internet use OSNs more than anyother website category, as it accounts for 19% of all time spent online [19].Additionally, social (network) games delivered through OSNs have had asurge in popularity with Zynga?s R? Mafia Wars, FarmVille and CityVillehaving 60 million daily active users; furthermore, the user demographics forthese social (network) games are changing to include more women than menand users over 40 years old rather than teenagers [1]. However, we need to2Chapter 1. Introductionbe cautious in using these large OSN services for our health needs, as issuesof sharing private health information on such a large social network servicedoes not make sense [78].We design an OSN for positive health behaviour change to address theissues with increasing obesity and sedentary lifestyle in an effort to developnew technical solutions for prevention of illness and self-management of one?spersonal health. By using the OSN as a basis for design we hope to harnessthe engaging potential of OSNs to ensure use of the technology. However, weconsider the audience by designing an OSN for small social network groupsto change health behaviour.1.2 Research GoalsThe overarching purpose of this research is to use a theoretical foundationto design and evaluate an OSN for positive health behaviour change. Toachieve this, we develop a conceptual framework that guides the design andevaluation of OSNs for health behaviour change. The conceptual frameworktakes into consideration participation in OSNs and motivation for changinghealth behaviour. The importance of engaging users to use a system iscritical to ensure participation; for this reason, we analyze and make use ofexisting theoretical models for use of OSNs. Similarly, there has been decadesof research in health psychology and social psychology, which has yieldednumerous theoretical models for health behaviour change. We distill thesetheoretical models into a conceptual framework that guide a user-centreddesign process (UCD) for designing an OSN to change health behaviour.The conceptual framework also guides the evaluation of the prototypesto determine if the factors from the theories are being influenced by theOSN, which yields the final design principles. In our theoretical approachto designing an OSN for health behaviour change, we will refer to thedeterminants of health behaviour, which refers to the many factors thatcombine to affect the health behaviour of individuals, and in particular weare referring to the social environment as well as individual characteristicsand behaviours [121].3Chapter 1. IntroductionThesis Goal 1: Distill existing theoretical models for participationin OSNs and health behaviour change into a conceptual framework.We review the literature for existing theoretical models that provide thefactors that influence users to participate in OSNs, which includes use of othersocial media since OSNs are relatively new. Similarly, we review existingtheoretical models for health behaviour. Through the distillation of thesetheoretical models, we develop a conceptual framework that collates similarthemes in a manner that can be translated into the design of OSNs for healthbehaviour change.Thesis Goal 2: Design a series of prototypes and evaluate the de-sign that is interpreted from the theoretical conceptual framework.A series of prototypes are developed through a UCD process to evaluate theinterpretation of the design features that are abstracted from the conceptualframework. All the prototypes are evaluated using the theoretical deter-minants from the conceptual framework: paper prototypes are evaluatedthrough interviews; medium fidelity prototypes are evaluated through labexperiments; and the high-fidelity prototype is evaluated using field experi-ments. The purpose of the prototypes is to test the validity and effectivenessof the interpretation of the framework to the design of these prototypes.Furthermore, the conceptual framework will be iterated based on the resultsof the evaluation of these prototypes.Thesis Goal 3: Develop design principles for OSNs to motivatehealth behaviour change. Finally, design principles are developed forOSNs to motivate positive health behaviour change. The design principlesare developed iteratively through the evaluation of the prototypes with theoverall objective to influence the determinants that promote use of OSNsand promote positive health behaviour change.4Chapter 1. Introduction1.3 Research ApproachThe goals of the research are met through a modified UCD approach. AUCD process typically takes into consideration initial user inquiry anditerative prototyping with increasing fidelity for a particular design [105].We modify this design process by embedding a theoretical grounding to theinquiry. The conceptual framework that is developed through a distillationof theoretical models informs both the design as well as the points of inquiryfor the evaluation of each phase of the UCD process. The cyclical nature ofthis approach links the disconnect that occurs between the interpretationof the conceptual framework into a design, and the evaluation allows fora comprehensive evaluation of the ability for the OSN to change healthbehaviour by evaluating the effects articulated by the conceptual framework.Figure 1.1 shows a pictorial representation of the research approach. Thisfigure shows how the conceptual framework interacts with the traditionalUCD process [54].1.3.1 Literature Review of Theoretical ModelsThe research begins with a literature review of existing theoretical models.Two domain of theoretical knowledge are reviewed. First, the literature fromHuman-Computer Interaction (HCI), communications, and social psychologyare reviewed to find theories that explicate the determining factors forparticipation in OSNs. Designing an engaging OSN that encourages use isthe main reason for obtaining an understanding of the determinants thatinfluence use of OSNs. Therefore, the engaging aspect of OSNs can beharnessed to ensure use and lead to health behaviour change. Second, theliterature from health psychology and social psychology are reviewed forexisting theories on health behaviour change. The determinants for healthbehaviour change are taken from the review of theoretical models.5Chapter 1. IntroductionLiterature Review  Conceptual Framework User Inquiry Questionnaires  & Interviews Low-Fidelity Interviews On Paper  Prototypes Medium-Fidelity Usability Studies On Medium Fidelity  Prototypes High-Fidelity Field Tests On High Fidelity  Prototypes Final Framework Figure 1.1: The research approach is a user-centred design process that ismodified with a theoretical foundation. The conceptual framework is used forthe design as well as the evaluation of the OSN.1.3.2 Development of a Conceptual FrameworkFollowing the literature review of the existing theoretical models, the determi-nants for both use of (or participation in) OSNs and health behaviour changeare distilled to create a conceptual framework. This framework combinesthese determinants to unpack how OSNs can be designed to motivate healthbehaviour change. Interaction between the determinants for use of OSNsand health behaviour change are hypothesized in the initial development ofthe conceptual framework. These interactions help to define the design ofOSNs, as certain design features of the OSN can possibly lead to change ofhealth behaviours. The conceptual framework is applied to the design ofan OSN system, and the evaluation allows the conceptual framework to beiterated so that the interactions between the determinants for use and thedeterminants for health behaviour change can be validated.6Chapter 1. Introduction1.3.3 Initial User InquiryInitial user inquiry is conducted through both questionnaires and interviewsto obtain a better understanding of people?s motivations to use OSNs andchange health behaviour. The points of inquiry for the questionnaire and in-terviews are from the conceptual framework. The purpose of this initial userinquiry is to understand the strength of determinants from the conceptualframework, and how each determinant can be operationalized in the designof an OSN. Furthermore, the user inquiry provides a better understandingof the determinants when specifically applied to OSNs, as this technology isrelatively new, and the theories that are reviewed are more broadly applicableto different social medias such a online communities. The questionnaire ob-tains responses from a broad population to better understand the differencesbetween gender, age groups, and ethnic groups, so that the design principlesthat are developed can focus on those determinants that are more generallyapplicable. The purpose of the interviews is to obtain a richer understandingof the determinants from the conceptual framework.1.3.4 Development and Evaluation of Paper PrototypesPaper prototypes are developed based on the results of the initial userinquiry and the conceptual framework. The paper prototypes are designedby developing initial design interpretations of the conceptual framework.They are evaluated through one-on-one interviews. The point of inquiry areonce again the determinants for use of OSNs and health behaviour changefrom the conceptual framework, as well as inquiry into the usability andgeneral thoughts on the prototype. The results from the evaluation providea rich interpretation of how well the prototype meet the determinants foruse of the OSN and health behaviour change; furthermore, the results alsoprovide thoughts for how the prototype can be improved.7Chapter 1. Introduction1.3.5 Development and Evaluation of a Medium Fidelity Pro-totypeA medium fidelity prototype is developed from the results of the evaluationof the paper prototypes. The medium fidelity prototype provides the keyinteractions, which allows the prototype to be tested in a laboratory. Theprototype is evaluated for usability and for its ability to engage user of theOSN as well as for its ability to change health behaviour. Once again thepoints of inquiry are based on the conceptual framework, and both directand indirect methods is used to extrapolate the ability for the design to gainan engaged user base and change health behaviour. Direct self-reports areused for certain determinants that can be reliably evaluated in this manner;however, indirect methods of inquiry are utilized for those determinantsthat cannot be reliably collected through self-reports. The results fromthe laboratory evaluation is used to develop a fully functional high fidelityprototype.1.3.6 Development and Evaluation of a High Fidelity Proto-typeA fully functional high fidelity prototype is developed by iterating the designof the medium fidelity prototype based on the results of the evaluation. Thepurpose of the high-fidelity prototype is to evaluate the prototype in a fieldexperiment to determine actual engagement in the OSN determined throughuse of the prototype and its ability to change health behaviour. The fieldevaluation also uses the conceptual framework to directly determine if theprototype was able to influence any of the determinants from the conceptualframework, as this theoretical foundation can infer that by changing thesedeterminants, health behaviour will also change. The field experiment isconducted with a number of socially connected groups, which are both clinicaland non-clinical as well as loosely connected and tightly connected. Theclinical groups are from clinics that promote wellness and healthy lifestyles,and efforts are made to include control groups, so that the efficacy of theprototype beyond the interactions with the clinic can be evaluated. Pre-,8Chapter 1. Introductionmid-, and post-questionnaires are developed from the conceptual framework.Pre-questionnaires are used to assess current health behaviours. Mid- andpost-questionnaires are used to understand how specific design features of theprototype influenced health behaviours. The evaluation yields: 1) an overallunderstanding of the prototype?s ability to change health behaviour; 2) howdifferent social groups used the prototype; and 3) to what extent the prototypeinfluenced the determinants from the conceptual framework. Furthermore,the results allow for the conceptual framework to be iterated. The interactionsbetween the determinants for use of OSNs and the determinants for healthbehaviour change are validated through the evaluation of the high fidelityprototype.1.4 Summary of ContributionsThis thesis provides three main contributions to the research domain ofHuman-Computer Interaction (HCI). An overview of each contribution isprovided below, and a detailed discussion of each contribution is provided inin the final conclusions in Chapter 8.Contribution 1: An evaluated conceptual framework that providesthe determinants for individuals to use OSNs and change healthbehaviour. A conceptual framework is derived from theoretical models foruse of OSNs and health behaviour change, which provides the determinantsfor both of these domains. This contribution included a synthesis of thetheoretical models to broadly develop the behavioural determinants for useof online social network and health behaviour change that were described inthe theoretical models reviewed. For use of OSNs, the theoretical modelsreviewed were: the Uses and Gratification Theory, Social Influence Model ;Social Identity Theory ; Common Bond Theory ; Common Identity Theory ;Theory of Organizational Commitment ; and Behaviour Chain for OnlineParticipation. For health behaviour change, the theoretical models reviewedwere the Health Belief Model ; Social Cognitive Theory ; Theory of ReasonedAction; Theory of Planned Behaviour ; Common Sense Model ; and the9Chapter 1. IntroductionTranstheoretical Model. Interactions between the determinants for use thatwill lead to health behaviour change are incorporated into the framework.The conceptual framework is evaluated through the experimental evaluationof each of the prototypes. [55, 56]Contribution 2: Design principles for OSNs to motivate health be-haviour change. Design principles are developed for OSNs that motivatepositive health behaviour change. These design principles are developedthrough the evaluation of prototypes using user studies where the points ofinquiry are defined by the conceptual framework to determine if the designwas able to influence the determinants defined by the framework. This evalu-ation methodology provides us with an understanding of the design principlesthat were able to change the determinants that influence health behaviourchange, and to iterate design principles that were less effective. [53, 57]Contribution 3: An evaluated OSN that is able to change healthbehaviour of users. A working high-fidelity OSN called VivoSpace isdeveloped using a UCD process, which is able to change some of the deter-minants for health behaviour change in its users that are associated with aclinic. [57]1.5 Thesis OutlineThe thesis is organized so that the main contributions are presented up front;however, we begin by first reviewing related works and existing commercialapplications in this field of study (Chapter 2). Following the review of therelated works, the development of the conceptual framework is describedin Chapter 3. We then describe the high fidelity prototype in Chapter 4,which is developed using the UCD process and the conceptual framework;readers can choose to read Chapter 7 prior to Chapter 4 for a chronologicalflow. Chapter 4 also describes the field experiments that are conducted toevaluate the prototypes. From the results of the evaluation of the high-fidelityprototype, Chapter 5 describes the final iteration of the conceptual framework.10Chapter 1. IntroductionChapter 6 details the design principles for OSNs for health behaviour change.The full UCD process is described in Chapter 7, which begins with theinitial user inquiry in Section 7.1. The Chapter then describes the paperprototypes in Section 7.2 and medium fidelity prototypes in Section 7.3,where we describe the prototypes, evaluation methods, and results for bothof these prototypes. Chapter 8 summarizes the work in the thesis andprovides detailed descriptions of the contributions. There are also a numberof appendices that provide screen captures of the prototypes and evaluationmaterials that are used in the research.The conceptual framework and the results from the study of each proto-types have been published as peer-reviewed publications as described in thePreface with details of co-authorship.11Chapter 2Related WorksTechnologies for health behaviour change has had significant interest inboth the research community and in industry. In particular, technologiesthat aim to promote physical activity and/or healthy eating behaviour havebeen designed and evaluated by the research community, and they are beingdeveloped by industry.This chapter will review the research that has been conducted in this area,and do a review of a sample of available commercial applications designedto change health behaviour. We will review the research in PersuasiveTechnologies and HCI communities that have developed prototypes forhealth behaviour change; a large portion of this research has considered socialaspects. We will also conduct a literature review of personal informaticsbecause much of the research and the commercial applications in this fieldinvolve the collection and visualization of personal health information suchas step counts, calories consumed, and calories expended; therefore, thedomain of personal informatics comes into play. Finally, we also reviewthe growing number of commercial applications that are available, and wedescribe some of the key features of these applications. There is also abrief discussion about gamification, as some of the research prototypes andcommercial application have some gaming features. While we review thisresearch, we will look at whether the design and/or the evaluation of thetechnology took into consideration theoretical models. In particular, we areaddressing the call-to-action that was recently put out by the HCI communityfor greater theoretical foundation and frameworks in designing and evaluatingtechnology for behaviour change [47].12Chapter 2. Related Works2.1 Persuasive TechnologyThe design of technologies for behaviour change has been the primary focus ofPersuasive Technologies, and it was first studied by B.J. Fogg [35]. PersuasiveTechnologies is defined as technology that is designed to change attitudesor behaviours of users through persuasion and social influence, but notthrough coercion. Persuasive Technologies include many concepts including:principle of reduction, which is to reduce complex behaviour to simpletasks; principle of tunnelling to guide users through a process or experience;principle of tailoring to the individual?s need, interests, and personality usagecontext; principle of suggestion to offer suggestions at opportune moments;principle of self-monitoring to eliminate the tedium of tracking performanceor status to help people achieve predetermined goals/outcomes; principleof surveillance to observe other?s behaviour; and principle of conditioning,which is the use of positive reinforcement to shape complex behaviour orchange behaviour into habit [35]. The Persuasive Technology communityalso uses the Persuasive System Design (PSD) model in their research, whichhas three layers: postulates, persuasive context, and design qualities [82].The postulates are key issues behind the design and they include issues suchas: Information Technology is always ?on?; people like their views about theworld to be organized and consistent; and persuasion is often incremental.The persuasion context includes the intent, the event and the strategy. Thedesign qualities include: primary task support (which includes conceptsfrom [35]), dialogue support, and system credibility.Persuasive Technology provides a foundation for the design of technolo-gies for behaviour change from the perspective of persuading users to change.However, the research from this community has had little consideration oftheories from social science that define behaviour change to address the theo-retical gap that Hekler et al. refers to [47]. Furthermore, the community hascome under some criticism from the HCI community for not considering theethical and sociocultural consideration in their models [91]. The perspectiveof Persuasive Technology research has been considered modernist, whichhas also opened discourse on the acceptance of this approach [123]. Our13Chapter 2. Related Worksapproach is not to take sides on this debate, but rather to contribute to bothHCI and Persuasive Technology areas through a theoretical perspective bydeveloping a conceptual framework for the design and evaluation of OSNsfor health behaviour change.2.2 Health Behaviour Change in HCIA number of studies have explored technologies from an HCI perspective.Some have looked at technologies from an individual use perspective whileothers have considered social aspects. Furthermore, some have consideredtheoretical models for health behaviour change. We will review all of thesestudies, describe the technical intervention, outline the evaluation methods,and summarize their outcomes. A summary of the related works is shownin Table 2.1, which shows the name of the project or technology developed(listed in alphabetic order), a brief description of its functionality, if there wasa social component to the technology, the number of participants and lengthof the field experiment, and the key outcomes from the evaluation. Overall,this review shows that there has been significant work in this area since2006 by the HCI research community. Most of the studies considered socialaspects and were evaluated in a field experiment with variable outcomes.Furthermore, a handful of these studies considered health behaviour theoriesto variable extent. We will review these studies in more detail.2.2.1 Research for Increased Physical ActivityWe will first review the works that looked at step count or physical activitygenerally. The Fish?n?Steps system [64] utilized users? step count with asoftware application where the growth and happiness of the fish is linked tothe step counts; it has a personal version and a shared version, where the sizeand ?mood? of others? fish was anonymously shared. There was no statisticallysignificant difference in step count between the personal and shared version,but those in the shared group had a better attitude towards exercise. Theauthors considered the Transtheoretical Model [90] for health behaviour14Chapter 2. Related Workschange to evaluate progression through the stages of change; however, healthbehaviour theories were not taken into consideration when designing thesystem. Another important consideration for the Fish?n?Steps? shared versionwas that the information that was being shared was kept anonymous, soeven though the participants knew each other, they did not know who wasperforming better (or worse) than them. On a final note, the design of thissystem abstracts the actual personal health information into the growth andhappiness of a fish rather than providing direct information.Similarly, the IMPACT and IMPACT 2.0 system [63] also looked atstep count, and it was designed to study the effect of context on personalhealth information through the design of several prototypes: 1) a paper diary,where users logged their activities, location and people they were with, andthey wore an arm band that logs their movement and also a pedometer thatdisplays their step count; 2) the IMPACT 1.0 system, which has a website andpedometer, and the website allowed users to enter contextual information andshowed their step counts along with their contextual information; and 3) theIMPACT 2.0 system was a mobile phone with a GPS, which automaticallymonitors steps and location and this information is displayed on a website.Overall, there was no increase in steps in any of the versions, but userswere more engaged in the data through manual entry of context rather thanautomatic data collection. Behaviour theories were not used in the designand evaluation of this technology.The Houston system [20] used a pedometer to track step count andshare progress towards a goal. The system was evaluated with an individualversion and a shared version with a small group of friends. The sharedversion included seeing progress towards a goal with the ability to commentand send messages. The results revealed a statistically significant differencebetween the shared version and the individual version for increased stepcount. Contributing to this result was that the data was not anonymized andthe participants in this small group knew each other. Theoretical modelswere not considered in the design of Houston.15Chapter2.RelatedWorksTable 2.1: A summary of studies on design of technologies for health behaviour change. This table lists the name of theapplication, a brief description of the application, whether social design features were included, the evaluation includingthe number of participants (p) and length of the study, and the outcomes of the evaluation.Name Description Social Evaluation OutcomeAHPCevaluated by[88]Pedometer and website for school aged childrenwith collated data compared between schools.yes 1400 chil-dren over 3semestersEvaluation allowed to betterunderstand introducing ubiq-uitous technology in schoolsettings.Chick-Clique[114]Mobile application provides sharing of step counts,visibility of group averages, and text messagingcapability.yes 7 girls for 4daysShowed difference but due toconfounding factors.CommunityMosaic [85]Mobile and community display for sharing photosand text about food to promote better health.yes 43 p for 12wksAllowed for an understandingof health promotion throughcollective action.EatWell [42] Social mobile phone application to assist AfricanAmerican communities make better food choices,where users share audio recordings of experiencesrelated to food.yes 12 p for 4wksAllowed for an understandingof promoting health throughcollective action.Fish?n?Steps [64]Links participants? step counts to the growth andhappiness of a virtual fish.yes 19 p for 14wksBetter attitude towards exer-cise but no difference in stepcount.Continued on next page16Chapter2.RelatedWorksTable 2.1 ? continued from previous pageName Description Social Evaluation OutcomeFit4Life [91] A satirical design of a health system that collectsdietary and activity level, shares on social networksites, and provides advice.yes N/A N/A.IMPACT(2.0) [63]A step count personal informatics system thattests for the influence of context on step count.no 49 p for 8weeksNo difference in step countwhen context was included ornot included.Houston [20] Pedometer and mobile phone application that hasa sharing version and a personal version.yes 28 p for 3moSuccessful in helping partici-pants maintain physical activ-ity.LifestyleCoachingApp. [38]Smart phone and website version where users logtheir food and physical activity, set goals andprovide a points system for a game experience.yes 40 p for 4wksNo difference.MAHI[71?73]Mobile application to communicate with one?sdiabetic educator.yes 49 p for 6moSocial support for newly di-agnosed [73] else a means tobuild self-identity [71].OrderUP![43, 44]Casual game where the user is the restaurantowner and they must serve nutritious meals.no 12 p for 3wksUsers become more aware ofwhat foods were healthy.Continued on next page17Chapter2.RelatedWorksTable 2.1 ? continued from previous pageName Description Social Evaluation OutcomeShakra [5] Mobile phone application infers whether user isstill, walking or traveling in a car, and providesand shares the amount of time that the user wasactive with some competition.yes 9 p for 10daysNo increase in activity but so-cial and competition aspectswere enjoyed.Stepping Upfor Health(SUH) [97]Internet mediated walking program thatmeasures the impact of adding an onlinecommunity on the walking habits of individualsyes 324 p for16 wksSocial group was more en-gaged and had less attrition.UbiFit [21,22]Wallpaper of the users cell phone shows a gar-den as more physical activity is performed andbutterflies as goals are met.yes 12 p for 3wk and 28p for 3 moSharing group met goals moreoften.VERA [11] Users take pictures at moments where they makehealth decisions and provide annotation about thepicture?s relation to health.yes 45 p for 2wks & 44 pfor 4 wksBuilt group identity andgreater accountability.18Chapter 2. Related WorksThe UbiFit Garden system [21, 22] system was also a mobile phoneapplication. UbiFit included: an automatic sensing device that inferredphysical activity such as walking, cycling, running, and eliptical trainer; aglanceable wallpaper showed a garden that depicted physical activity andprogress towards goals; and an interactive application that allowed for entry,editing and deleting of log entries about the user?s physical activity. Key tothe altering garden on the wallpaper was the user?s progress towards weeklygoals. This system was based on the Goal-Setting Theory [66], which comesfrom workplace research, and the model defined motivation through intentionsto complete goals. This theory was used throughout the design of UbiFitand its evaluation. The system was evaluated by having conditions thatincluded the source of the goals: self-set, assigned (i.e. by a fitness or medicalexpert, or national standards), guided (by a medical or fitness expert), andgroup-set (strangers or social network connected). The other condition wasthe time frames: fixed week, customizable week, or rolling seven-day window.The qualitative evaluation showed that self-set and group-set goals weremost popular, and that variable timeframe had different benefits for differentparticipants [21]. The UbiFit Garden was also designed using additionaltheories of Presentation of Self in Everyday Life [40] and the CognitiveDissonance Theory [31] along with the Transtheoretical Model [90] and theGoal-Setting Theory [66]. Four design strategies are revealed: abstract asthe garden wall paper on the mobile phone; non-instrusive access to thedata through an easy way that does not obstruct one?s day-to-day tasks;public so that it is appropriate to be displayed publicly; aesthetic so it looksnice; positive to be reinforcing to the user; controllable to allow the user toadd, edit and delete; and trending and historical access to information. Thequalitative evaluation linked the theories? design strategies to the UbiFitGarden [22]. We expand their approach of using theoretical models in thedesign and evaluation of technology for health behaviour change to the designof OSNs for health behaviour change, and deviate from their methodologyby clearly using health behaviour theories to define health behaviour change,and we address the modality (OSNs in our case) through separate theories,which are combined in our conceptual framework.19Chapter 2. Related WorksStepping Up for Health (SUH) was a large medical trial using a websitethat provided visualization of ones uploaded pedometer reading, whichwas studied with and without an online community [97]. The system hadparticipants wear pedometers, whose reading were uploaded to a serverand accessed through a website, where they could view their readings, viewindividualized motivational messages, and set goals. The study involved 324overweight sedentary individuals with type II diabetes, who used email atleast once a day. They were randomized to a group with or without an onlinecommunity, and the study lasted 16 weeks. The results showed that therewas no increase in step-count between the two communities; however, therate of attrition was lower in the group that had an online community. Thesecond part of this study investigated strategies to increase participationin an online community for studies such as the one described previously,where the number of participants was small and a large portion need tobe active contributors rather than ?lurkers? [96]. The strategies includedhaving contests for posting and having staff respond to posts to ensureresponsiveness. The overall simplicity in the design of this study did notinvolve the use of theoretical models; however, the contribution of the resultsinformed the benefits of an online community for personal health managementto the medical community is an important milestone.The Shakra system [5] measured physical activity, and it was a mobilephone application that inferred whether the user was active or inactive andfacilitated sharing and comparison of the user?s activity level with peers.The study involved 9 participants over 10 days, which included an initial3 days where the participants enter their current level of activity througha diary type entry. For the week following the initial 3 days, they trainedthe system for 2 days and used it for the 5-day work week. They weredivided into 3 groups with 2, 3 and 4 people in each group, and their activityinformation was shared within each group. The results of the study foundthat participants enjoyed seeing their activity level and different participantsused it as an awareness tool, a self-monitoring device, and as a competitivegame. Theoretical models were not considered in the design and evaluationof Shakra.20Chapter 2. Related WorksThe AHPC (American Horsepower Challenge) was an large scale Amer-ican project, whose aim was to increase physical activity of school agedchildren aged 9 to 13 years old. AHPC deployed 20 pedometers to 61 schoolswith over 1400 children using the system over 3 semesters. Each school had abase station, which automatically uploaded step counts, and a website wherea school versus school game was displayed using the horserace metaphor.The system was deployed by the Humana Project, and HCI researchers [88]were invited to evaluate it. Their findings provide guidance on introducingubiquitous computer systems to school settings. No theoretical models wereused to design or evaluate AHPC.The Chick-Clique system [114] was developed to encourage greater activityfor teenage girls. This system was a mobile phone application that had groupsof 3 or 4 people, where the steps were tracked for each individual and theprogress of the group was communicated through text messages. The systemwas evaluated with 7 teenage girls over 4 days. The questionnaire resultsrevealed that group performance was rated as the highest motivation toincrease walking. There were mixed results with respect to increased step-count, which was contributed to external factors and the short length ofthe study. Once again, no theoretical models were used in the design andevaluation of the system.2.2.2 Research for Improving Dietary IntakeThere have also been many studies that explored technologies to encouragehealthy eating behaviour. We start with the EatWell system [42], whichwas designed for the African American community. It was a mobile audioapplication, where users created recordings of their thoughts on healthy eatingin their communities, and they listened to voice recording of others in theircommunity. They recorded these ?voice memories? in one of the followingcategories: fast food, restaurants, eating at home, grocery stores & markets,and ?other?. Critical to this research was that the community being connectedwere from the same geographic location and the same socioeconomic group.Their evaluation involved 12 participants, who used EatWell for 4 weeks.21Chapter 2. Related WorksThe results show that EatWell empowered the community to eat morenutritious meals, and the participants shared their experiences throughstories. Theoretical models were not used in the design and evaluation ofEatWell. However, we used the design of this study to have connected groupsfrom the same geographic location in our selection of participant groups forour field experiment (described in Section 4.2) because of the importancethat it played to the development of community empowerment that resultedfrom this work.Building from her work in EatWell, the Community Mosaic system wasimplemented for the same African American community [85]. CommunityMosaic allow for the sharing of photos and texts through a community displayat the local YMCA. Although the system was available to anyone enteringthe YMCA, the study was conducted with 43 participants over 12 weeks.The main finding from this work was to provide a shift in thinking aroundcontext in health management and health behaviour change to one of healthpromotion through collective action. Theoretical models were not used inthe design of Community Mosaic, but the the Transtheoretical Model [90]was used to evaluate if any health behaviour change was observed and alsoto assess the participants? current stage in health behaviour change.OrderUP!, an other application, was a casual game designed to educateusers on the nutrition of meals with a focus on meals for low income AfricanAmericans [43, 44]. This work spoke to the importance of cultural relevancywhen designing for behaviour change. OrderUP! was a casual game on amobile phone, where the user was a server in a restaurant, and the goal wasto make meal recommendations to customers as quickly and healthfully aspossible. The meals were relevant to African American community. Thedesign took into consideration three theoretical models: the TranstheoreticalModel [90], the Health Belief Model [94], and the Social Cognitive Theory [10].OrderUP! was evaluated with 12 participants over 3 weeks, and the qualitativeresults revealed that the participants gained knowledge about the nutritionalvalue of foods.The MAHI system was a mobile and website application designed fordiabetics [71?73]. The system was a health monitoring application that22Chapter 2. Related Worksprovided social interactions with diabetes educators; it included a blood-glucose monitor that was linked to a mobile phone, and it provided theability to record text notes or questions, take pictures, and make audio notes.These records were linked to their blood-glucose levels, and allowed forasynchronous communication with their diabetes educator. I have includedthis work in my related works, as much of the records were related to eatingnutritious foods that were low in sugar and carbohydrates. The initial studywas done with 49 subjects that were recently diagnosed with diabetes, whoused MAHI for 4 weeks. MAHI was given to 25 subjects, and the others wereassigned to the control group, who also had access to a diabetes educator.The results show that those that used MAHI achieved their diet goals morethan those that did not use it; furthermore, by sharing records with theirdiabetes educators, the users were able to reflect on their diet and be moreaware of eating habits [73]. In a second study, MAHI was deployed to 8subjects (for 12 weeks) who had been diagnosed for five or more years, andthe results were very different. There was no behaviour change observed;however, MAHI became a means to construct identities through the entryof records [71]. Theoretical models were not used to design or evaluate theMAHI system.2.2.3 Research on Health Behaviour GenerallyThere are several research studies that look at designing technology for healthbehaviour change more broadly. The Lifestyle Coaching Application wasdesigned to promote both nutritious eating habits and physical activity [38].This application was deployed as both a mobile and a web version, and it hadan individual version and a team version, where the health information wasshared between team members and between teams. The Lifestyle CoachingApplication allowed users to log their meals and physical activity, set goals andearn points. The results of their study with 40 participants over 4 conditionsfound that there was no difference in achieving goals and health behaviour;however, the mobile version afforded more consistent usage patterns. TheTranstheoretical Model [90] was used in the evaluation to determine the23Chapter 2. Related Workscurrent stage of behaviour change for the participants; however, healthbehaviour theory was not used to ground the design in the factors for healthbehaviour change or to determine if any of the theoretically-based factorschanged over the course of the study.The VERA system was not specifically designed for diet or physical activ-ity, but VERA?s central design principle was ?open-ended social awareness? asapposed to prescriptive persuasion to promote positive health behaviour [11].The authors argue for a theoretical foundation for ?open-ended social aware-ness? based on the Social Cognitive Theory and Presentation of Self Theory.Although all the aspects of the Social Cognitive Theory were not explored,they have taken the modelling behaviour of others from the theory as acentral guiding principle for their design, and all other aspects of this theorywere not considered such as self-efficacy and they also did not use the SocialCognitive Theory to design specific features of VERA. The second theory,Presentation of Self, which is not from health behaviour, and it explainshow individuals see themselves as actors in social interaction with others.The VERA system was a collaborative photo sharing site, where users tookpictures and provided annotations at moments when a user needs to choosebetween options that had health implications. It was evaluated with a totalof 89 participants over two separate deployments. The first deployment had45 participants recruited with 36 completing the final questionnaire, whoused it for 2 weeks. The second deployment had 44 participants with 21assigned to the control group, and they used it for 4 weeks. The resultsfound that VERA built group identity and individual accountability, butthere was confusion among the participants on what was healthy due tothe ?open-ended? (rather than prescriptive) nature of the system. Theseresults can be attributed to the exclusion of some of the determinants ofhealth behaviour change from the Social Cognitive Theory; for example,determinants such as knowledge and goals were not considered in the design.Fit4Life was not an actual system that was deployed, but rather a satiricalconcept design, which was meant to be a critical review of the direction ofpersuasive technologies [91]. The Fit4Life?s design was based on PersuasiveSystem Design (PSD) model from the persuasive technology community [82],24Chapter 2. Related Workswhich is not based on theories from health behaviour. The work presentedthree issues in particular: the extent that persuasion can become coercion;the relationship between persuasive computing and cultural trends towardsscientific rationalization; and issues around surveillance and the power of datacollection over personal experience. From these three issues, Purpura et al.also described the issues with sharing personal health data over large socialnetworks such as Facebook R?especially if it was automatically posted. Theissues that were described with the satirical Fit4Life design could perhapsbe overcome by looking at the foundational theories from health behaviour,as we will do in applying our theoretically-based conceptual framework tothe design and evaluation of our OSN.Three other works are important to the design and evaluation of tech-nology for health behaviour change, which do not focus on the design ofa particular system, but rather provide insight into the evaluation of suchsystems [59], provide taxonomy for weight loss to assist with the design ofsuch technologies [69], and use the Health Belief Model to provide designstrategies for developing games for health [83]. The first work by Klasna etal. explores how to evaluate technologies for health behaviour change due tothe complexity of conducting full randomized control trials and their lackof value to HCI research, so in response to these difficulties, they presentefficacy evaluations [59]. They discuss the need to do smaller field studiesprior to jumping to a large evaluation, which can better uncover design flawsthrough qualitative data, and tailoring the evaluation to the strategy ratherthan the end-point of behaviour change; for example, an evaluation can focuson monitoring if the technology is monitoring step-count. This approachdoes not take health behaviour theories into consideration as we are doingin our approach, but the approach to evaluate the strategy does have somesimilarity. Specifically, we are using the determinants of health behaviourfrom the theories in the evaluation of our design to determine if our design isable to change these determinants. Therefore, we can reframe this approachto say that we are evaluating the system based on the overall design strategy,which is the determinants from existing theories.The second work provides a taxonomy of peer-involvement for weight25Chapter 2. Related Worksmanagement, and its implication for designing social technology throughqualitative interviews [69]. This work provides insight into the types ofsocial involvement, which include: passive involvement that is shown to besocial norms; proactive involvement, where one takes the lead; supportiveinvolvement; and cooperative involvement. Also of key importance was thediscussion around secrecy and disclosure of health information. This workprovides significant insight into the design of an OSNs for health, as it showsthe importance of passive involvement; in other words, social norms candevelop by viewing and sharing data of other people. However, this needsto be balanced by the function to allow the user to have control over whatinformation is disclosed.Finally, Orji et al. correlated gamer types to determinants of healthbehaviour from the Health Belief Model through a large-scale questionnaireevaluation [83]. This work does not design or evaluate a digital game forhealth; however, the methodologies are based on the determinants for healthbehaviour change from the Health Belief Model. This strategy of lookingat the determinants from health behaviour theory shows the recent movein HCI research towards this methodology, which shows the value in theapproach that we are taking.2.2.4 Personal Health InformaticsMuch of the related works and commercial applications are collecting personalhealth information in some manner. This includes collecting daily step counts,calories burned through various physical activities, calories consumed, andother nutrients. The field of personal informatics is growing both froma research lens and also through a commercial lens, and the QuantifiedSelf community is growing [92]. Understanding and reflecting upon one?sbehaviour through personal informatics is one way to understand that one?shealth behaviour needs to change. However, the motivation to enter one?shealth information is often a challenge. For this reason, an exploration ofrelated works in HCI on personal informatics deserves a review, as this willprovide an understanding of some of the key challenges and facilitators in26Chapter 2. Related Worksthe study of personal informatics.Understanding personal information especially if it does not fit intoexisting personal information management systems has been explored, andit was found that the information often is stored in temporary and dispersedlocations such as notepad, Post-it R? notes and temporary text files [13].Similar work has been done to understand how mobile applications canbetter support note-taking [23].The move beyond simply logging personal information into personalinformatics was modelled through a stage-based model [62]. This researchproposed a 5-stage model for the life-cycle of personal informatics: prepa-ration stage is where people motivate to collect data about themselves;collection stage is where data is collected; integration stage is where infor-mation is prepared, combined and transformed; reflection stage is wherethe user reflects on her/his personal information; and action stage is wherepeople choose what they are going to do with the information.From these previously mentioned studies it is evident that there arenumerous amounts of personal information that are stored in ad-hoc areasand they do not fit into existing personal information management systems.Furthermore, the life logging systems that have been developed require a highlevel of motivation to use. The lack of motivation to use the systems makethem much less useful. None of these studies has combined OSNs, whichcan provide a method to gain information from others, promote continuoususe, and increase the overall usefulness of the system. Furthermore, recentresearch has found that existing OSNs such as Facebook R?are being used asan archive of personal information [125].Other related works include personal informatics and life logging appliedto the health domain. The challenge of managing personal health informationfrom health clinics, insurance information, and home information has beenexplored in [89]. Further work was done to understand the types of unan-chored information that needed to be managed by cancer patients [58], whichfound the large diversity in the information that was required to be handledfrom various locations, cognitive capacities and comprehension limitations.Additionally, the visualization of clinical information was explored using a27Chapter 2. Related Workshorizontal timeline to review personal histories [7, 87].These health related studies of personal informatics reveals some of thechallenges with storing and retrieving information. The studies again didnot take the modality of OSNs into consideration; however, it was foundthat connection with social ties was a key component of managing theirdisease [58].2.3 Commercial ApplicationsThe number of commercial applications in the domain of tracking, monitoringand potentially changing one?s health behaviour has increased significantlysince I started my doctoral work. Due to the large interest by industryin this domain, a review of the types of commercial applications in thisdomain deserves some discussion. An overview of a sample of commercialapplications is listed in Table 2.2, which provides an overview of whether thelisted application includes: automatic sensing such as step-counts; featuresfor encouraging increased physical activity; features for better diet; and anysocial features.Table 2.2: A summary of commercial applications for health behaviour changethat includes nutritional intake and physical activity.Name Auto Sensing Physical Activity Diet SocialFitBit R? [33] Step-counting,sleep qualityAuto sensing anduser logs entriesUser logsentriesFacebook R?integrationand an onlinecommunity fordiscussionsNike+ R?FuelBand [79]MeasuresmovementusingaccelerometerThrough automaticsensingNo Share onFacebook R?,Twitter R?and PathContinued on next page28Chapter 2. Related WorksTable 2.2 ? continued from previous pageName Auto Sensing Physical Activity Diet SocialWithings [119] Step-count,track activities,sleep qualityand monitorheart rateThrough automaticsensingNo NoLose It! [67] Integrateswith Fitbit R?,Nike R?+ Fu-elBand, andothersThrough integra-tion with 3rd partydevicesUser logs foodand barcodescanningShare entries withfriendsSparkPeople[110]No My Fitness tracksactivity throughuser logsMy Nutritiontracks dietintake throughuser logsOnline communityallows for discussionbetween usersMyFitnessPal[76]No Log physical ac-tivity (caloriescalculated fromdatabase)Log meals(nutritionalinformationfrom database)Facebook R?integration,online community,friending andpersonal messagingTap and Track[113]No No Log meals(databasesearch)NoDailyBurn [24] No Compilation of nu-merous workoutsStepwise dietprogramsTrainersRunKeeper[102]No Track running andset goalsNo Sharing posts andcommenting onpostsCalorie Count[16]No Log activities Log food Sharing daily calo-rie reports with com-mentingDailyMile [25] Integrates withNike+Log various activi-tiesNo Sharing and com-menting29Chapter 2. Related WorksAs shown in this sample of applications, different applications offerdifferent features. There are a handful of applications that have hardwarethat allows for automatic sensing of physical activity; further, many of theseapplications integrate with other systems that provide other features suchas social features. Most of these applications provide a personal healthinformatics feature with other features such a goal setting and rewards suchas badges. Generally, the number of applications that are available showsthe potential that information and communication technologies offer to thepromotion of healthy lifestyle. Furthermore, it signals the importance for HCIresearchers to evaluate the design principles that lead to health behaviourchange, and my work takes a theoretical approach for grounding the designprinciples back to the determinants for behaviour change. We also makeOSNs central to the design, and expand the theoretical foundation to includethe factors that encourage individuals to use OSNs to ensure engagement.Clearly, there is a need for more research into designing these web andmobile technologies for health behaviour change. We need to be able toassess the ability for a system to affect health behaviour from the theoreticalbasis, and without doing a large randomized control trials (RCT) that aredone to determine the efficacy of a new medical therapy. This same call fornew theoretical evaluation methods was also made by Klasna et al. [59] andHekler et al. [47].2.4 GamificationMany of the systems developed for research and for commercial purposes alsohave some gaming elements to them. For example, the Lifestyle Coaching Apphas a points system that are visible to the group of user [38], the OrderUP!system is a casual game [44], and the Shakra system also provides competitionbetween its users to encourage more physical activity [5]. Similarly, manyof the commercial applications also have gaming features associated withthem; for example, FitBit R? [33] has a points system and users earn badgeswhen they reach specific point thresholds, and RunKeeper [102] encouragescompetition by showing how the user is performing against others. Gaming30Chapter 2. Related Worksfeatures appear to be used as a component in the design of technologies forpositive health behaviour. For this reason, we will briefly look at gamification.Gamification is defined as the use of game design elements in non-gamecontexts, and it includes reward features such as points, badges, levels andleader boards [26]. Within this definition, gamification relates to gamesrather than play : where a video game?s main purpose is to play it, anapplication with gamification refers to games in the sense of having rulesand competition towards a goal. Another feature of gamification is thatgames is not the central purpose, but rather includes elements of games.Finally, gamification uses elements of games in applications that are non-game contexts, and they are used to increase engagement and improve userexperience. However, gamification is distinct from serious games in that itsgaming features are only part of the design of the application, where seriousgames? entire purpose is the game but for a serious purpose [51]. The useof gamification in health is also not novel. Gamification and serious gameshave been used for physical health, cognitive health, social and emotionalhealth [74].2.5 SummaryThe field of HCI research has yielded significant research on the designof technologies for health behaviour change. Many of these works haveconsidered theories [11, 22, 43, 44], and have social features [5, 11, 20,21, 38, 42, 63, 64, 73, 97, 114]. Additionally, the explosion of commercialapplications for health monitoring and health behaviour change are alsoshowing the need to better understand the design principles that lead tohealth behaviour change.The related works show the promise of using theoretical models in thedesign and evaluation of technologies for health behaviour change, and theimportance of social aspects in the design. We expand this by developinga comprehensive theoretical approach to both the design and evaluationof an OSN for health behaviour change. In order to better understandengagement, in the next chapter, we review theories that help us to better31Chapter 2. Related Worksunderstand motivations for using OSNs thus ensuring that the system isused, and secondly, we comprehensively review theories related to healthbehaviour change to better understand the determining factors that changehealth behaviour. So the overall approach is that we design for engagementto ensure use, which then can lead to health behaviour change, as the factorsfor use can interplay with determinants for health behaviour change. Some ofthe related works used theories from domains outside of health behaviour todesign for health behaviour change; however, we will review several theoriessimilar to [11, 22], but we will only use theories related to health behaviour.This will ensure that the factors distilled from the theories are related tospecifically health behaviour. By using this theoretical approach, we canbegin to address the ?Theoretical Gap? in HCI research that was describedby Hekler et al. [47], and heed the call for a theoretical basis to the design oftechnologies for health behaviour change from the medical literature [118].Our approach will look at changes in the determinants for health behaviourin addition to change in health behaviour because it is difficult to see changesin health behaviour, as was found in most of the works described in thischapter.32Chapter 3The ABC ConceptualFrameworkWe review both theories for using OSNs and theories for health behaviourchange. The theoretical models for use of OSNs are presented in Section 3.1and the theoretical models for health behaviour change are presented inSection 3.2. Each theoretical model is summarized, and the determinants formotivation are collated and categorized from all the models in each of thesetwo domains into the conceptual framework that is described in Section 3.3.Our work in the development of the conceptual framework includes thecollation of the determinants from the theories into common determinants.3.1 Theories for Use of OSNsSeveral theoretical models can be applied to understanding the motivationsfor participation in OSNs: Uses and Gratification Theory, Social InfluenceModel, Common Identity Theory, Common Bond Theory, Social IdentityTheory, Organizational Commitment Theory, Behavior Chain for OnlineParticipation, and social network threshold. Many of these theories are rootedin social psychology or occupational psychology; however, they were selectedfor inclusion because they have been applied to understanding participationin online communities and in some cases OSNs. Since OSNs are a relativelynew phenomenon, theoretical models for motivations for use of OSNs have notyet been extensively developed. Therefore, we include theories that have beenapplied to participation in online communities to define the determinants ofuse; however, the user inquiry evaluation described in Section 7.1 of Chapter 733Chapter 3. The ABC Conceptual Frameworkwill evaluate the efficacy of these determinants when applied to OSNs.3.1.1 Uses and Gratification Theory (UGT)The UGT originates from communications research. Initially, this theory pro-vided a theoretical approach in defining the motivations for using traditionalmass media such as newspapers, radio and television [101], and generallyis recognized to be a sub-tradition of media effects research [75]. It hasreceived renewed interest because of its applicability to telecommunications,computer-mediated-communication [27, 101] and the internet [84]. It hasalso been applied to online communities [27, 60], and more recently usesand gratification was also studied to understand the motivations for usingFacebook R? [52, 111]. The UGT aims to understand why people use a specificmedia and the gratification that they receive from it. Table 3.1 shows asynthesis of the literature from 6 key studies [27, 52, 60, 84, 101, 111]. Thesestudies were chosen because they applied the UGT to computer-mediatedcommunications, internet, online communities, and OSNs. The left columnon Table 3.1 shows the common terminology that we have assigned based onthe original term from the various sources that have overlap with this term.The common term was collated from all 6 studies. The right column showsthe original term used in the source study and the citation from the study orstudies that used that terminology. For example, the first row in Table 3.1shows that three papers [27, 60, 84] used the term Entertainment, and otherpapers had similar determinants such as Diversion and Pass time; therefore,our common terminology of Entertainment includes a broader interpretationthat includes Diversion and Pass time. The first determinant listed is Enter-tainment, which stems from enjoyment of playing or interacting with others.The second determinant is Social Enhancement, which is a value that oneties to one?s status within social peers. Next is Maintaining InterpersonalConnectivity, which refers to a user?s desire to use OSNs to sustain contactwith their friends and family. Self-discovery occurs when self-knowledge is ob-tained through social interaction. The next determinant is Get Information,which is an instrumental purpose like receiving information, and the flip-side34Chapter 3. The ABC Conceptual FrameworkTable 3.1: The collation of the determinants from various sources of the Usesand Gratification Theory into a common terminology.Determinant Determinant from LiteratureEntertainment Diversion [101], Pass time [84], Entertainment [27,60, 84]Social Enhancement Social utility [101], Interpersonal utility [84], Socialenhancement [27, 60]Maintaining InterpersonalConnectivitySocial utility [101], Interpersonal utility [84], Main-taining interpersonal utility [27, 60], Social connection[52, 111]Self-discovery Personal identity [101], Self-discovery [27, 60]Get Information Surveillance [101], Information seeking [84], Purpo-sive value [27], Get information [60], Content [52, 111],Social network surfing [52, 111], Social investigation[52, 111]Provide Information Purposive value [27], Provide information [60], Statusupdating [52, 111]Convenience Convenience [84]Shared Identities Shared Identities [52, 111]of this is the determinant to Provide Information, which is democratized withonline communities and OSNs compared to previous media. Convenience isanother determinant, which provides an understanding of why people wouldchoose to use the Internet as opposed to read the newspaper, or socializevia an OSN service as opposed to meet in person. The final determinantlisted on Table 3.1 is Shared Identities, which was referred to by [52, 111], asthese studies were directly based on the uses and gratification of Facebook R?.Shared Identities occurs as one constructs one?s identities through the useof an OSN and relates to others through shared interests and values. Forease of reference to the definition of the determinants, Table 3.2 defines thecommon terminology for the determinants from the UGT.3.1.2 Social Influence ModelThe Social Influence Model was developed by [27], and it expands on theUGT determinants that are described above to include the variables relatedto social influence. This theory includes the individual value perceptions35Chapter 3. The ABC Conceptual FrameworkTable 3.2: Definition of the common terminology for the determinants collatedfrom the Uses and Gratification TheoryDeterminant Definition of DeterminantEntertainment Enjoyment from playing or interacting with othersincluding the desire to pass time or diversion fromother activitiesSocial Enhancement Value tied to status among social peersMaintaining InterpersonalConnectivitySustain contact with friends and familySelf-discovery Self-knowledge obtained through information receivedand social interactionGet Information Obtaining any information, content, and knowledgeincluding information about their social connectionsProvide Information Any information that is shared on an OSN; for exam-ple, through status updatingConvenience Ease of access to friends and informationShared Identities Construction of one?s identity and relating to othersthrough shared interests and valuesthat are derived from the UGT (purposive value, self-discovery, maintaininginterpersonal connectivity, social enhancement, and entertainment value);however, it goes further to explain the social influence variables that comefrom the individual value perceptions. These social influence variables include:Group Norms, mutual agreement, mutual accommodation and social identity.The Group Norms is the main determinant is the Social Influence Model thatleads to Mutual Agreement and Mutual Accommodation. In a similar manner,Social Identity is the main determinant that eventually leads to Sense ofBelonging. These socially-based determinants are listed in Table 3.3, whichalso shows the determinants for other theoretical models that are describedbelow.3.1.3 Social Identity TheoryThe Social Identity Theory [112] does not specifically describe the deter-minants for use of OSNs or online communities; however, this theory wasfoundational to the Social Influence Model [27]. Therefore, we will describeit in more detail. The Social Identity Theory is rooted in social science and36Chapter 3. The ABC Conceptual Frameworksocial psychology in particular, and it describes behaviour within a group andbetween groups. When two or more groups exist, individuals within a groupfind, create and define their place in these networks. The behaviour is de-scribed by the Social Identity Theory by four concepts: Social Categorization,Social Identity, Social Comparison, and Psychological Distinctiveness. SocialCategorization is the ordering of social environment in groupings of personsin a manner that is meaningful to the subject. Social identity is part of anindividual?s self-concept which derives from his knowledge of his membershipof a social group(s) together with the emotional significance attached tothat membership. Social Comparison describes individuals within a groupcomparing themselves to those of another group through both similaritiesand differences, which leads to Psychological Distinctiveness, where thoseof one group feel that they are unique to those of another group. Thesesocially-based determinants are also listed in Table 3.3. The definition ofthe common terminology that we have collated from the theories for use ofOSNs is shown in Table 3.4.3.1.4 Common Bond TheoryThe Common Bond Theory was applied to the design of online communitiesby [95]. This theory describes when individuals within a group feel a bond-based attachment, which is a connection to the individuals within the grouprather than to the group as a whole. The main behavioural determinantsfrom the Common Bond Theory are the following: 1) Social Interactionwith Others provides opportunities for people to get acquainted, to becomefamiliar with one another and to build trust; 2) Personal Knowledge ofOthers allows opportunities for self-disclosure that are both a cause and aconsequence of interpersonal bonds; and 3) Personal Attraction ThroughSimilarities is when people like others who are similar to them in preferences,attitudes, and values.37Chapter 3. The ABC Conceptual FrameworkTable 3.3: The collation of the socially based determinants for using OSNsinto a common terminology.Determinant Determinant from LiteratureSocial Categorization Social Categorization: Common Identity Theory[95], Social Identity Theory [112], Social InfluenceModel [27]Interdependence Interdependence: Common Identity Theory [95]Social Comparison Intergroup Comparisons: Common Identity Theory[95]; Social Comparisons: Social Identity Theory[112], Social Influence Model [27]; Psychological Dis-tinction: Social Identity Theory [27, 112]Social Interaction withOthersSocial Interaction with Others: Common Bond The-ory [95]Personal Knowledge ofOthersPersonal Knowledge of Others: Common Bond The-ory [95]Personal Attraction toOthers Through Similari-tiesPersonal Attraction to Others Through Similarities:Common Bond Theory [95]Social Identity Social Identity : Social Identity Theory [112], SocialInfluence Model [27]Sense of Belonging Sense of Belonging : Social Influence Model [27, 112]Group Norms Group Norms, Mutual Agreement, Mutual Accommo-dation: Social Influence Model [27]3.1.5 Common Identity TheoryThe Common Identity Theory is the other side of the coin for the CommonBond Theory, and it too was applied to the design of online communitiesby [95]. This theory describes when individuals within a group feel anidentity-based attachment, which is when individuals identify with a group asa whole, and people in the group are interchangeable. The main behaviouraldeterminants from the Common Identity Theory are the following: 1) SocialCategorization creates group identity merely by defining a collection of peopleas members of the same social category; 2) Interdependence is when groupmembers are cooperatively interdependent; and 3) Intergroup Comparisons iswhen individuals define and categorize themselves as members of a group andcompare themselves with other groups. These socially-based determinantsfrom both the Common Bond and Common identity theory are shown in38Chapter 3. The ABC Conceptual FrameworkTable 3.4: Definition of the common terminology for the socially baseddeterminants for use of OSNs.Determinant Definition of DeterminantSocial Categorization Ordering of social environment in groupings of per-sons in a manner that is meaningful to the subjectsuch as a shared interestInterdependence Group members are cooperatively interdependentSocial Comparison Individuals define and categorize themselves as mem-bers of a group, and compare themselves with othergroupsSocial Interaction withOthersOpportunities for people to get acquainted, becomefamiliar, and build trustPersonal Knowledge ofOthersOpportunities for self-disclosure that are both a causeand a consequence of interpersonal bondsPersonal Attraction toOthers Through Similari-tiesOccurs when people like others who are similar tothem in preferences, attitudes, and valuesSocial Identity Individual?s self-concept which derives from his knowl-edge of his membership of a social groupSense of Belonging An individual?s feeling that she/he have a place withina groupGroup Norms The ability for behaviours of individuals in a groupto be adopted by others in the groupTable 3.3. Once again, the definition of the common terminology that wehave collated from the theories for use of OSNs is shown in Table 3.4 forease of access to the definition for the socially based determinants.3.1.6 Theory of Organizational CommitmentThe Theory of Organizational Commitment originates from the domain ofoccupational psychology [4], and it has been applied to online communitiesby [60]. This theory describes the types of attachment that individuals wouldhave to an organization (or an online community), which then explains thereasons that they continue to stay within that group. These attachmentsdescribe the behavioural motivations for commitment. The first attachmentis called Affective, which refers to when individuals stay in an organizationbecause they want to. Individual?s have an emotional attachment, where39Chapter 3. The ABC Conceptual Frameworkthey identify with the organization or online group. The second attachmentis called Continuance, which refers to when individuals need to stay becausethey perceive a lack of alternatives and cost of leaving. The final attachmentis Normative, which refers to when individual stay because they feel a senseof obligation to remain. Normative Attachment can occur when individualsjoin an online community or OSN because everyone else is on the system.3.1.7 Behaviour Chain for Online ParticipationThe Behaviour Chain for Online Participation describes the temporal stagesfor use of online communities [36]. The model has three stages of use. First,the user needs to discover or find the site, Discovery Stage. The second stageis Superficial Involvement, where the user decides to try the site and she/hegets started. The final stage is True Commitment, which is when new habitsare created through frequent use of the site and contribution to its content.3.1.8 Social Network ThresholdThe final theoretical model that is important to describe is Social NetworkThreshold [98, 116], which describes the adoption of innovations throughinfluence of one?s social networks. Indeed, these innovations can be healthhabits. The adopter categories include: early adopters, early majority, latemajority and laggards. This theory will not be incorporated directly intothe conceptual framework; however, the adoption categories should be keptin mind when creating OSN for health behaviour change, as it can providea good means to understand individual?s adoption of the OSN. The reasonfor not incorporating the adoption categories into the conceptual frameworkis because they do not explain motivation for adoption, but rather thatadoption of innovation and technology occurs at different times for differentpeople; the motivations for which are defined by the other theoretical modelsdescribed in this chapter. For this reason, we felt that the adoption categoriesdid not add any motivational factors, which is the basis of the conceptualframework.40Chapter 3. The ABC Conceptual Framework3.2 Theories for Health Behaviour ChangeThe theoretical models reviewed for understanding health behavior change are:The Health Belief Model, Social Cognitive Theory, Theory of Reasoned Action,Theory of Planned Behavior, Common Sense Model, and The TranstheoreticalModel. Although there are other models for health behaviour change, we feelthat the theoretical models we used are most widely accepted and used. Forexample, these theoretical models with the exception of the Health BeliefModel have been reviewed and comprehensively compiled by [104]. Further,the Health Belief Model has been used by [43] for designing persuasivetechnologies for health behaviour change. As we review these models, wewill refer to the determinants of health behaviour, which refers to the manyfactors that combine to affect the health behaviour of individuals, and inparticular we are referring to the social environment as well as individualcharacteristics and behaviours [121].3.2.1 The Health Belief Model (HBM)HBM originates from the 1950?s by a group of social psychologists at theUS Public Health Service to understand disease prevention through inoc-ulations and uptake of screening tests, and it has been used extensivelyto understand health behaviour in numerous studies [99]. HBM is basedon understanding health behaviour change from the perspective of preven-tative health behaviour to self-management of chronic diseases [50]. Thismodel has 4 key determinants for health behaviour change. The first isPerceived Susceptibility, which refers to personal feeling of vulnerability toa condition and perceptions of the risk of contracting a condition. Thesecond determinant is Perceived Severity, which relates to feelings concern-ing the seriousness of contracting an illness, and it includes evaluations ofboth medical/clinical consequences and possible social consequences. Thethird determinant is Perceived Benefits, which relates to the effectiveness ofvarious actions available in reducing the disease threat, so the willingnessto accept the recommended health action only if it is perceived as feasible41Chapter 3. The ABC Conceptual Frameworkand efficacious. The final determinant from the HBM is Perceived Barriers,which refers to an individual?s perceived ?cost? of the treatment, which caninclude expense, danger, discomfort, inconvenience, and time consumption.These 4 determinants are individually-based determinants that relate toan individual?s perception of a certain health behaviour. The individuallybased determinants for the HBM and the other theoretical models describedbelow are listed on Table 3.5. HBM also has a socially-based determinant,Cues to Action, which is external stimulus that can include media awarenesscampaigns and reminders [50]. Socially-based determinants such as Cues toAction are listed in Table 3.7. The definition of the common terminology forthe individually based and socially based determinants that we developedthrough the collation of all the theories for health behaviour change is listedin Tables 3.6 and 3.7 and 3.8 respectively. However, there are limitationsto this theory due to its origins in the uptake of immunizations, as thedeterminants from this theory are most applicable to these examples. Whenwe combine the determinants with other the other theories in Table 3.5,these limitations are minimized as the determinants are linked to broaderdefinitions from theories that are more focused on diet and physical activitybehaviours.3.2.2 The Social Cognitive TheoryThe Social Cognitive Theory holds that behaviour is determined throughexpectancies and incentives, and of key importance is self-efficacy to changinghealth behaviour [10, 100]. The Social Cognitive Theory was first drawnfrom the Social Learning Theory by [100], which describes 4 determinantsfor health behaviour change. The first determinant is Expectancies AboutEnvironmental Cues, which is an individual?s beliefs about how events areconnected. The second determinant is Expectancies About Outcomes, whichis the consequences of one?s own actions, opinion about how individual be-haviour is likely to influence outcomes. The third determinant is ExpectanciesAbout Self-Efficacy, which is an individual?s own competence to perform thebehaviour needed to influence outcomes. The fourth determinant is Incen-42Chapter 3. The ABC Conceptual Frameworktives, which is the value of the outcome of health behaviour change, whichcan be health, appearance, approval, economic gain or other consequences.The Social Cognitive Theory was studied by Bandura et al. [10], whofurther developed the Social Learning Theory and found 6 core determinantsfor health behaviour change:1. Knowledge is an individual?s need to know the health risks and benefits ofdifferent health practices.2. Perceived Self-Efficacy is an individual?s own competence to perform thebehaviour needed to influence outcomes and the individual?s ability to exercisecontrol over one?s health habits. Perceived Self-Efficacy can be influencedvicariously through others, which allows for social modelling and building ofsocial norms.3. Outcome Expectation is about the expected cost and benefit for certainbehaviour. There are three forms of this: physical outcome expectation is thepleasurable and aversive effects of the behaviour and any losses or benefitsfrom it; social outcome expectations is the social approval or disapprovalsof the behaviour from one?s social connections; and self-evaluative outcomeexpectations is ones own reaction to the behaviour and health status.4. Goals include proximal and distal goals, and they need to be concrete plansand include strategies to realize them. This factor builds accountability.5. Perceived Facilitators include social and structural factors, and social ap-provals and social supports can be facilitators. They incorporate the valueof the outcome of health behaviour change, which can be health, appearance,social approval, or economic gain.6. Perceived Impediments is the opposite of perceived facilitators, and they alsoinclude both social and structural factors.The individual and social determinants are listed on Tables 3.5 and 3.7respectively, with the definition for the determinant shown in Tables 3.6and 3.8 respectively.43Chapter 3. The ABC Conceptual FrameworkTable 3.5: The collation of the individually based determinants for healthbehaviour change into a common terminologyDeterminant Determinant from LiteratureKnowledge Perceived susceptibility to adverse health outcomesand Perceived severity of current health behavior:Health Belief Model [50]; Knowledge of health risksand alternative health behaviour : Social CognitiveTheory [10, 100]Expectations about out-comesPerceived benefit of specific health behaviours: HealthBelief Model [50]; Expectations about outcomes: So-cial Cognitive Theory [10, 100]Expectations about self-efficacyExpectations about self-efficacy : Social Cognitive The-ory [10, 100]; Perceived behavioural controls: Theoryof Reasoned Action [2]Goals Distal and proximal goals: Social Cognitive Theory[10, 100]; Proximal goals as targets: Common SenseModel [61]Perceived facilitators Sociostructural factors (facilitators): Social Cogni-tive Theory [10, 100]; Individual incentives: SocialLearning Theory [100];Perceived barriers Perceived barriers: Health Belief Model [50]; So-ciostructural factors (barriers): Social Cognitive The-ory [10, 100]Attitude Attitude: Theory of Reasoned Action [3, 106] andTheory of Planned Behaviour [2]; self-evaluative out-come expectations: Social Cognitive Theory [10, 100]Interaction between emo-tion and cognitionInteraction between emotion and cognition [61]3.2.3 The Theory of Reasoned Action (TRA)TRA is rooted in social psychology, and it suggests that a person?s be-havioural intention depends on the person?s Attitude about that behaviourand Subjective Norms [3, 106]. Subjective Norms refer to one?s perceivedexpectations from their social connections along with intention to followwith these expectations. Attitude is much more dependent on one?s personalfeelings towards the behaviour. The combination of these two determinants,Attitude and Subjective Norms, make up TRA. The individually-based deter-minant (Attitude) can be found in Table 3.5 (definitions listed in Table 3.6),and the socially-based determinant (Subjective Norms) can be found in44Chapter 3. The ABC Conceptual FrameworkTable 3.6: Definition of the common terminology for the individually baseddeterminants for health behaviour changeDeterminant Definition of DeterminantKnowledge The necessity to know the health risks and benefitsof different health practices including an individual?sperceived susceptibility to poor health outcomes andthe perceived severity of the outcomesExpectations about out-comesThe expected cost and benefit for certain behaviourExpectations about self-efficacyAn individual?s own competence to perform the be-haviour needed to influence outcomes and the indi-vidual?s ability to exercise control over one?s healthhabitsGoals Includes both proximal and distal goals, and theyneed to be concrete plans that include strategies torealize themPerceived facilitators Structural factors that assist health behaviour, andit incorporates the value of positive health behavioursuch as health, appearance and other individual in-centivesPerceived barriers Structural factors that impede positive health be-haviour such as lack of timeAttitude An individual?s feelings towards specific health be-havioursInteraction between emo-tion and cognitionAn individual?s emotional reaction to illness combinedwith their knowledge about that illnessTable 3.7 (definitions listed in Table 3.8) along with determinants from othertheoretical models.3.2.4 The Theory of Planned BehaviourThe Theory of Planned Behaviour [2] is an extension of TRA [3, 106], whichwas iterated to incorporate will power. The need for a new theory was madenecessary by TRA?s limitation in dealing with behaviours over which peoplehave incomplete volitional control. Therefore, the three main determinantsfor health behaviour change based on the Theory of Planned Behaviour arethe following: 1) Attitude Towards Behaviour is similar to the determinant inTRA, and it includes one?s salient beliefs towards the behaviour and subjective45Chapter 3. The ABC Conceptual Frameworkevaluation of the behaviour; 2) Subjective Norms refers to normative beliefsabout whether groups approve or disapprove of a certain behaviour againsimilar to TRA; and 3) Perceived Behavioural Controls deals with the presenceor absence of requisite resources and opportunities, and these beliefs areoften based on past experiences. The Theory of Planned Behaviour alsohas another determinant, Moral Norms, which is different from subjectivenorms or normative pressures. Moral Norms refers to personal feelings ofmoral obligation or responsibility to perform, or refuse to perform, a certainbehaviour. These determinants are lists in Tables 3.5 and 3.7. Once again foreasy reference, the definition of the common terminology for the individuallybased and socially based determinants for health behaviour change are listedin Tables 3.6 and 3.8 respectively.3.2.5 The Common Sense ModelThe Common Sense Model is a framework that describes behavioural pro-cesses involved in adaptation to episodes of physical and psychological disor-ders, and integrates both individual (cognition and affect/emotion) and social(and contextual) factors [61]. The Common Sense Model has three maindeterminants: 1) importance of Proximal Goals as Targets for self-regulation;2) Coherence and Maintenance, which is influenced by the individual, theirculture and support from their social network; and 3) Interaction betweenEmotion and Cognition, which refers to one?s emotional reaction to illnesscombined with their knowledge about that illness. The first and third deter-minant are listed in Table 3.5; however, the second determinant is a temporaldeterminant that fits with the stages of change that is described by the TTMbelow.3.2.6 The Transtheoretical Model (TTM)TTM shows the stages of health behavior change, and the determinants tomove between the stages [90]. TTM has been used in the HCI literaturefor the design of persuasive technologies (e.g. [22, 43, 46]). TTM is basedon temporal factors that describe health behaviour change. TTM presents46Chapter 3. The ABC Conceptual FrameworkTable 3.7: The collation of the socially based determinants for health behaviourchange into a common terminologyDeterminant Determinant from LiteratureEnvironmental cues Cues to action: Health Belief Model [50]; Environ-mental cues: Social Learning Theory [9, 100]; En-vironmental re-evaluation: Transtheoretical model[90]Subjective norms Social outcome expectation: Social Cognitive The-ory [10, 100]Subjective norms: Theory of PlannedBehaviour [2]; Moral norms: Theory of Planned Be-havior [2]Self-efficacy (vicariouslythrough others)Self-efficacy vicariously through others: Social Cog-nitive Theory [10, 100]Sociostructural facilitators Sociostructural facilitators: Social Cognitive Theory[10]; Helping relationships: Transtheoretical Model[90]Sociostructural barriers Sociostructural barriers : Social Cognitive Theory [10]the stages of change: Pre-Contemplation, Contemplation, Peparation, Actionand Maintenance. The model also states that individuals can revert backto a previous stage at any time. TTM also provides processes by whichone moves from one stage to another; the processes to move from Pre-Contemplation to Contemplation are Consciousness Raising, Dramatic Reliefand Environmental Reevaluation; the process to move from Contemplationto Preparation is Self Reevaluation; the process to move from Preparationto Action is Self Liberation; and the processes to move from Action toMaintenance are Contingency Management, Helping Relationships, CounterConditioning and Stimulus Control. There are also limitation to the TTM,as its origins are from smoking cessation, which has clearly defined stagesof change; however, it has been applied more broadly to diet and physicalactivity by health and HCI researchers, but it is understood that the stagesof change are less clear in changing one?s diet and activity level.47Chapter 3. The ABC Conceptual FrameworkTable 3.8: Definition of the common terminology for the socially baseddeterminants for health behaviour changeDeterminant Determinant from LiteratureEnvironmental cues External stimulus that raises awareness of poor healthbehaviourSubjective norms One?s perceived expectation of health behaviour fromtheir social connections along with intention to followthese expectations, which includes the need to receivesocial approvalsSelf-efficacy (vicariouslythrough others)One builds their perceptions of their own ability tochange their health behaviour through social mod-ellingSociostructural facilitators Social facilitators such as obtaining help and encour-agement from others, as well as receiving social ap-proval from othersSociostructural barriers Social barriers to good health occurs due to poorhealth influencers3.3 The Appeal Belonging Commitment (ABC)FrameworkThe literature review as described in Sections 3.1 and 3.2 reveals 14theoretical models: 8 describe the motivations for using OSNs and 6 describethe motivations for changing health behaviour. Three dimensions emergedwhen we reviewed and collated the determinants from the theories for useof OSNs and health behaviour change. The first dimension includes all theindividually based determinants for both use of OSNs and health behaviourchange that are listed in Tables 3.1 and 3.5 respectively, which we callAppeal. The second dimension includes all the socially based determinantsfor both use of OSNs and health behaviour change that are listed in Tables 3.3and 3.7 respectively, which we call Belonging. The third dimension islabelled Commitment and includes the following: 1) temporal stages foruse of OSNs from the Behaviour Chain for Online Participation model(described in Section 3.1.7) and for health behaviour change from TTM(described in Section 3.2.6), and 2) attachments for use of OSNs from theTheory of Organizational Commitment described in Section 3.1.6.48Chapter 3. The ABC Conceptual FrameworkTogether these dimensions provide the foundation for the Appeal Be-longing Commitment (ABC) Framework illustrated in Figures 3.1 and3.2, which fully describes how OSNs can be used to motivate health behaviourchange. The ABC Framework is a synthesis of the determinants fromthese two domains into three dimensions. It shows that health behaviourchange and use of OSNs are complex and are defined by a multitude offactors that have significant interplay between the determinants for the use ofOSNs and motivating health behaviour change. The only theoretical modelfrom Section 3.1 that has not been included in the ABC Framework is theadoption categories described by the Social Network Threshold. Even thoughthe adoption of OSN and new health behaviours can likely be described bythe adoption categories of the Social Network Threshold, this theory does notshow how an individual would use the OSN, but rather shows how an OSNwould be adopted through a population group. The ABC Frameworkexplains how the determinants for use of OSNs interplay to influence thedeterminants for health behaviour change. The interplay connections arebased on the face value of the definition of the determinant, and it willbe evaluated through the design of the OSN as described in the researchapproach, Section 1.3.3.3.1 AppealThe individually based determinants for both the use of OSNs and healthbehaviour change make up the Appeal dimension of the framework. TheAppeal dimension is shown in Figure 3.1 in red. The individually baseddeterminants for use of OSNs is shown in the boxes outlined in red (the firstseven determinants from the Uses and Gratification Theory), and the indi-vidually based determinants for health behaviour change (listed in Table 3.5)are shown in the solid red boxes. The interplay between the determinantsis shown by the lines that connect the determinants of these two domains,which is based on the face value of the definition of the determinants. Theapplication of the individually based determinants for use of OSNs and theinterplay with the individually based determinants for health behaviour49Chapter 3. The ABC Conceptual Frameworkchange is described below:1. Get Information can include information about the nutritional content ofmeals and the energy expenditure of physical activity. Furthermore, the in-formation can include the definitions for nutrients and information about theoutcomes of consuming certain nutrients. This information can be obtainedby first Providing Information about what an individual ate and physicalactivity completed. By obtaining information about nutritional content ofmeals and energy expenditure of physical activity, it allows an individualto build their health Knowledge, which provides motivation to understandher/his health behaviour and also provides the ability to understand whathealthy choices exist. Get Information can also change their attitude aboutgood health behaviour, as seeing information about specific behaviour mayshow that certain behaviour is beneficial to her/his health, which is a mealor activity that she/he enjoys.2. Self-Discovery can be facilitated by the information that is provided, as de-scribed above. An individual obtains a better of understanding of her/himselfthrough providing health information and reviewing the nutritional informa-tion that is obtained through the OSN. This in turn then can also changeher/his attitude about a specific behaviour (as described in item 1), and alsochange her/his Expectations about their Self-Efficacy, as she/he builds her/hisconfidence in being healthy by allowing her/him to see the nutritional valueof certain meals consumed or physical activity that they have completed.3. Maintain Interpersonal Connectivity can facilitate the Belonging determi-nant of increasing an individual?s Expectations about Self-Efficacy vicariouslythrough others. By viewing the capabilities of her/his social connections,she/he can also increase their own confidence in her/his own capabilities.4. Social Enhancement determinant interplays initially with the determinantto Provide Information, as individuals would be motivated to provide theirhealth information to increase their social standing among their friends orsocial connections on the OSN. Subsequently, Social Enhancement will alsointerplay with the health behaviour determinant of Goals, as individualswill be motivated to complete health goals and share this achievement toenhance their social standing within the OSN. Finally, Social Enhancement50Chapter 3. The ABC Conceptual Framework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igure 3.1: ABC Framework showing the Appeal dimension in red andBelonging dimension in green. The determinants for use of OSNs is shownin the boxes with no fill and the determinants for health behaviour change isshown in the filled boxes. The interplay between these two domains is shownby lines connecting the boxes.also provides Individual Incentives to share healthy behaviour, so individualsappear in good standing with their OSN connections.5. Entertainment determinant can be designed into an OSN by adding gami-fication elements to one?s health goals, so that individual?s earn points orbadges for successful completion of their goals. Furthermore, these featuresprovide incentives for healthy behaviour, which builds Perceived Facilitators.6. Convenience of an OSN is provided by storing health information rather thanan individual having to read nutritional labels and keep track of nutritionalintake and energy expenditure, which can reduce Perceived Barriers tochanging health behaviour.51Chapter 3. The ABC Conceptual Framework3.3.2 BelongingThe Belonging dimension of the ABC Framework consists of the socially-based determinants for use of OSNs and health behaviour change that arelisted on Tables 3.3 and 3.7 respectively. The Belonging dimension is shownin Figure 3.1 in green. The socially-based determinants for use of OSNs isshown in the boxes outlined in green, and the socially-based determinantsfor health behaviour change is shown in the solid green boxes. The interplaybetween the determinants is shown by the lines that connect the determinantsof these two domains. The application of the socially-based determinantsfor use of OSNs and the interplay with the socially-based determinants forhealth behaviour change is described below:1. As users in an OSN start to develop a Sense of Belonging with their onlinegroup, their health behaviours will normalize to that of their social connection;in other words, Subjective Norms in health behaviour will develop.2. Group Norms will build within an OSN, and this will also build SubjectiveNorms in health behaviour if the OSN displays the health behaviour of theirsocial connection. This includes moral norms where poor health behaviourswill be frowned upon by one?s social networks.3. Social Categorization will allow users of the OSN to feel that they are a partof a group, which will build Subjective Norms in health behaviour withinthe group.4. For the same reasons as items 1, 2 and 3, Shared Identity will also developSubjective Norms.5. Social Comparisons will allow one to see what others are capable of withrespect to their health, which will allow one to build Self-Efficacy VicariouslyThrough Others, which is also promoted through Maintaining InterpersonalRelationships as described by in Section 3.3.1?s item 3. Additionally, SocialComparison builds Perceived Facilitators by individuals wishing to obtainSocial Approvals from their peers for good health behaviour.6. Interdependence will also allow social supports to develop, which will buildone?s Perceived Facilitators, where one?s social connections provide supportto the individual to continue to maintain healthy behaviour.52Chapter 3. The ABC Conceptual Framework7. Social Interaction can allow a multitude of changes to occur through dialogueand shared experiences:(a) Environmental Cues can be discussed and acted upon;(b) Self-Efficacy Vicariously Through Others explains one?s confidencethat is built;(c) developing methods to overcome Perceived Barriers;(d) adoption of others? strategies and encouragement builds PerceivedFacilitators.8. Personal Attraction to Others will also allow individuals to see their ownbehaviour in comparison to others, which may allow Environmental Cues toaction to happen.3.3.3 CommitmentThe third dimension of the ABC Framework is Commitment, whichincludes temporal stages for both use of OSN and health behaviour change,and attachment categories for use of OSN. Commitment dimension isshown by Figure 3.2, which shows the stages of health behaviour changefrom the TTM as described in Section 3.2.6, the stages of use for OSN arefrom the Behaviour Chain for Online Participation as described in Section3.1.7 , and the attachment categories are from the Theory of OrganizationalCommitment as described by Section 3.1.6. This dimension does not haveinterplay, as we saw in the Appeal and Belonging dimensions, but ratherthe Commitment dimension describes a user?s commitment and journeywhile using an OSN for health behaviour change. The orange line shown onFigure 3.2 depicts an example journey through the use of an OSN for healthyliving: this user discovered the OSN and started using it for normativemotivations, perhaps her/his friends were using it, and she/he is in thepre-contemplative stage of changing her/his health behaviour, but as she/heuses the system more, she/he moves from continuance attachment to affectiveattachment to the system and starts to contemplate, prepare and take actionon her/his health behaviour. This example is by no means the ideal state. Auser?s motivation for commitment (the attachment) may remain static unless53Chapter 3. The ABC Conceptual FrameworkFigure 3.2: The Commitment dimension of the ABC Framework showingthe stages and attachment categories showing the stages of health behaviourchange, the attachments categories of OSN, and the stages for use of OSN. Theorange line indicates an example journey for a user through the temporal stagesand attachment categories.there are changes to the design that would allow more Affective Attachmentto develop. Furthermore, a user may not require the use for the OSN tomaintain acquired positive health behaviour, and may choose to stop usingthe system, but remain committed to healthy living.The Commitment dimension of the ABC Framework allows an un-derstanding of why users would be committed to the use of an OSN, and itdescribes the temporal stages of use and health behaviour change. The Com-mitment dimension allows a designer of an OSN to better understand thatstages do exist and design elements can be developed to lead to committedbehaviour.3.3.4 Using the ABC FrameworkThe ABC Framework provides the behavioural determinants for usingOSNs and how they can influence health behaviour change. This frameworkcan now be used to extrapolate design guidelines for OSNs for health be-54Chapter 3. The ABC Conceptual Frameworkhaviour change. Specifically, each of the determinants for use of OSNs andhealth behaviour change can be abstracted into design guidelines for OSNsdesigned to change health behaviour.The ABC Framework can then be used to evaluate the OSN. Thedeterminants from the framework form the points of inquiry for evaluatingthe design of the OSN. For example, users of the OSN are asked about theirself-efficacy or capability of eating nutritious foods and being physicallyactive. Similarly, users are asked about their motivation for using the OSNsuch as to get information. This evaluation allows for clarity on whichdeterminants of the ABC Framework were adequately met in the design,and which design principles need to be iterated to obtain better alignmentwith the framework.Finally, the ABC Framework can also be validated through the eval-uation of the OSN. The users are asked which design features contributedto specific determinants for health behaviour change, which evaluates theinterplay between the determinants for use of OSN and the determinants forhealth behaviour change. The evaluation of actual health behaviour changefrom clinical measures is used against the ABC Framework to validatethe framework. This validation should yield change in health behaviour ifthere are changes in the determinants for health behaviour change from theframework. The use of the ABC Framework is summarized in Figure 3.3,and it includes the design and evaluation of the OSN for health behaviourchange and the validation of the framework.55Chapter 3. The ABC Conceptual FrameworkABC Framework OSN for Health Behaviour Change Design Evaluate Validate Figure 3.3: A graphical representation for the use of the ABC Framework,which includes the design and evaluation of the OSN for health behaviourchange and the validation of the framework.56Chapter 4The VivoSpace Prototype:An OSN for HealthBehaviour ChangeWe designed a high-fidelity prototype of an OSN designed to change healthbehaviour through a UCD process augmented by the ABC Framework.This methodology, as described in Section 1.3, is deployed to design the OSNcalled VivoSpace. The full UCD process is described in Chapter 7, whichdescribes in chronological order details for how the high-fidelity prototype wasdesigned. Chapter 7 can be read prior to reading this chapter to obtain a fullchronological understanding of the design iterations of VivoSpace. However,the main contributions for this research were obtained from the high-fidelityprototype, so the design and evaluation of the high-fidelity prototype ispresented in this chapter with details of the UCD design and evaluationpresented in Chapter 7.The UCD process began with an initial user inquiry (Section 7.1), whichwas done through online and paper questionnaires with 104 adults fromdiverse age and ethnic groups and through in-person interviews with 11 adults.The main purpose of the initial user inquiry was to validate the determinantsfor use of OSNs in the ABC Framework because the determinants werederived from theories that were mostly applied to user participation inonline communities and are rooted in social psychology, communicationand organizational psychology as described in Section 3.1. The initial userinquiry also inquired about the respondents? thoughts on their health. Theresults of the initial user inquiry showed strong agreement with the ABC57Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour ChangeFramework, and it showed that different populations groups have differentmotivations for using OSNs, which allowed us to design the initial paperprototype to exploit the determinants with the most overlap between thevarious groups.The paper prototypes were designed using the ABC Framework, andthe information obtained from the initial user inquiry about the determinantsthat had the strongest agreement across age and ethnic groups. Section 7.2describes the design and evaluation of the paper prototypes. The paperprototypes were evaluated through in-person one-on-one interviews with 11adults. The results revealed that the personal health informatics featureand the dashboard resonated the most with the users; however, the designneeded to provide better gamification features.The results from the evaluation of the paper prototypes was used todevelop the medium fidelity prototype for VivoSpace. The design and evalua-tion of the medium fidelity prototype is described in detail in Section 7.3. Themedium fidelity prototype was an interactive prototype that was evaluated inmultiple laboratory experiments using both direct and indirect methods with36 adults. The evaluation of the medium fidelity prototype for VivoSpaceprovided significant information on how the design should be iterated toensure engagement and health behaviour change. The weakest aspect of thedesign was that it did not provide enough motivation to provide information.Additionally, the gaming features of the medium fidelity prototype were toocomplicated, so the design was simplified by providing a points systems,where users are rewarded with minor points for using the system and majorpoints for completing goals.The results from the evaluation of the medium fidelity prototype allowedus to design the high-fidelity prototype for VivoSpace. The design was modi-fied so that users are rewarded for using the system as well as for completinggoals as part of the gaming features. Furthermore, the gamification featureswere modified, so that users level-up through a 10-level game with eachlevel revealing a new character. This simplifies the gaming features thatadd to the entertainment motivation to use VivoSpace as well as allows forperceived facilitators toward health behaviour change. Users are able to see58Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour ChangeFigure 4.1: Main home page of VivoSpace showing the Dashboard on the left;the goals summary, log entry, and news feed in the middle; and friends withgame progress on the right.the level of their friends providing motivation to use the system for socialenhancement and group norms, which potentially builds perceived facilitatorsthrough individual incentives and builds subjective norms to make positivehealth behaviour changes. Goals are central, and users are rewarded withpoints for successfully completing their goals. Further simplifications weremade to the design, and the number of pages were be reduced to just a few.The main home page (shown in Figure 4.1) includes the dashboard on theleft side; the goals summary at the top; the status update entry and thenewsfeed is in the middle; and the game points and levels is displayed onthe right. The other pages include the goals page that allow the user to seedetails about each goal and create new goals, and the profile page whereusers can change their profile picture, update the visibility of charts on theirdashboard and set nutrient targets, and control personal security such asallowance to change their password.59Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour ChangeFigure 4.2: Left: the nutritional content of a meal is displayed when thelogged meal is clicked. Right: goal details show the users and participatingfriends progress towards the goal target.4.1 Design of High Fidelity PrototypeThe high fidelity prototype was developed using PHP and MySQL withinthe CodeIgniter application framework. Twitter R??s Bootstrap [115] wasused for the user interface elements and Doctrine PHP libraries were usedfor the database abstraction layer. Furthermore, VivoSpace incorporatedWolfram?Alpha R??s application programming interface (API) [120] to ob-tain nutritional information for meals and caloric expenditure for physicalactivities logged. When the API could not return the nutritional information,a site administrator entered the correct information based on web searches,which can eventually be crowd-sourced. The high-fidelity prototype wastested with seven individuals using a cognitive walk-through prior to thefield experiment described in this chapter.VivoSpace has three main components: logging, goals, and a personaldashboard. The main home page of VivoSpace is shown in Figure 4.1. Usershave the ability to log their meals, physical activity and weight. After userslog their meals, the nutritional content of the meals is available when theyclick on the name of the food (Figure 4.2 left). Similarly, when they log aphysical activity, the calories burned information is available. Users havethe ability to make a log private or to share it with their social network.The newsfeed shows the log entries for themselves and their friends. Theshared log entries allow for commenting between the individuals in the user?s60Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour ChangeFigure 4.3: The user?s progression through the 10-level game showing thecharacters that have been revealed at each level and how much they haveprogressed through the current level.social network. The historical trends for calories consumed, calories burned,and each nutrient is charted on the dashboard, which is always visible onthe left side of the home page. Users can customize their targets for eachof the nutrients or use the defaults, which are based on US and Canadiannational standards. Users also have the ability to create concrete proximalgoals from a library of goals such as walk for 60 minutes over 2 days, oreat 35 g of fibre over 3 days. Users can invite friends to participate in theirgoals with them. The goal progress is shown on the home page, and detailsfor the goal are shown when the user clicks on the goal (Figure 4.2 right).VivoSpace also provides the following gamification features: users earn smallexperience points (XP) by using VivoSpace and major experience points forsuccessfully completing goals. Users progress through 10 levels with eachlevel requiring more points to advance to the next level. Furthermore, eachlevel reveals a new character. Users can view their progression through thelevel and the characters that have been revealed by clicking on their name61Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour Changeon the scoreboard that is on the right side of the main screen. Figure 4.3shows the pop-up that appears when the user click on their name on thescoreboard that shows all the characters that have been revealed for eachlevel achieved. The gamification design was based on personal conversationswith Ayogo Games [8]; however, they did link well with the determinantsfrom the ABC Framewok ; specifically, they linked with Social Enhancementand Social Comparison. Screen captures of the high-fidelity prototype canbe found in the First Appendix.4.1.1 Mapping Design Elements to the ABC FrameworkThe design element of the high fidelity prototype can be mapped to thedeterminants of the ABC Framework. The UCD process (as describedin Chapter 7) where the points of inquiry are based on the theoreticalfoundations of the ABC Framework have allowed to better interpretthe translation of the determinants from the framework into the designelements for this high fidelity prototype. Table 4.1 maps the determinantsfor use of OSNs from the Appeal and Belonging dimensions of the ABCFramework to design elements of the high fidelity prototype for VivoSpace.Table 4.1: Mapping of the determinants for use of OSNs from the ABCFramework to the design elements in VivoSpace?s high fidelity prototype.Determinant Design ElementsProvideInformationInformation is provided through logging of meals, physical activity,and weight, and through commenting on friends? entries.Get Information Nutritional information is obtained for each log entry, and historicalinformation is available on the dashboard.Self-Discovery Ability to see the nutritional value of foods eaten and caloricexpenditure for physical activity combined with the historicaltrends on the dashboard allow the user to discover their healthbehaviour.Continued on next page62Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour ChangeTable 4.1 ? continued from previous pageDeterminant Design ElementsMaintainingInterpersonalConnectivitySocial connection is provided through the ability to comment onfriends? log entries and participate with friends on goals.SocialEnhancementSocial enhancement is provided by: 1) visibility into the levelachieved by one?s friends; 2) visibility into the shared meals ofone?s friends; and 3) participating with a friend on a goal andseeing their progress towards the target.Entertainment The gaming features include the accumulation of experience pointsand advancement through 10 levels.Convenience Obtaining the nutritional value of foods and caloric expenditureof physical activity, and also having a historical storage of one?snutritional information provide convenience of access to personalhealth information.Sense of Belonging Viewing the newsfeed of others? activities, commenting on others?activities, and participating in group goals.Group Norms Participating in goals with others allow users to see what othersare doing to mimic behaviour.SocialCategorizationGroup goals will allow users to categorize themselves based onactivities.Shared Identities Through the sharing of one?s meals and physical activity, andallowing friends to comment on these entries can provide theability to learn about others with similar interests.Social Comparison Viewing friends? meals and physical activity allows user?s to com-pare themselves to them, and also seeing friends?s progressionthrough the 10 levels.Interdependence Building helping relationships through commenting features andgroup goals.Social Interaction Commenting on shared activity posts (meals, physical activity,and weight).PersonalKnowledge ofOthersDeveloped by viewing the shared activity posts of friends, partici-pating with friends on goals, and interacting through commentson the shared posts.63Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour ChangeIn a similar manner, the determinants for health behaviour changefrom the Appeal and Belonging dimensions of the ABC Frameworkare mapped to design elements in the high fidelity prototype of VivoSpaceas shown in Table 4.2. The Commitment dimension of the ABC Frame-work does not have determinants, and there are no design elements thatreflect the temporal aspect of use and health behaviour change; however,this will be evaluated in the field experiment evaluation of the high fidelityprototype.Table 4.2: Mapping of the determinants for health behaviour change fromthe ABC Framework to the design elements in VivoSpace?s high fidelityprototype.Determinant Design ElementsKnowledge Knowledge is obtained through the nutritional value for loggedmeals and caloric expenditure for logged physical activity. Infor-mation about the definition of each nutrient is available through ahelp link beside the name of the nutrient.Attitude TowardsBehaviourRewards through points and game levels can allow users to havenew motivations for healthy behaviour and change attitude towardit, and conversation about activities through the commentingfeature can allow users to develop new attitudes.Expectations aboutSelf-EfficacySeeing historical log entries and charts of nutrients consumed on thedashboard shows one?s capability to eat healthy and be physicallyactive. Also seeing the log entries of others builds self-efficacyvicariously through others by social modelling.Goals Proximal goals can be created and they are always visible at thetop of the homepage. Distal goals are achieved through the charts(on dashboard) displaying historical trends and targets.PerceivedFacilitatorsVisibility of foods and physical activities of others provide theability to mimic others behaviour, and the commenting feature onshared entries provides dialogue for encouragement. The gamingfeatures provide motivation to complete the goals.Continued on next page64Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour ChangeTable 4.2 ? continued from previous pageDeterminant Design ElementsPerceived Barriers The commenting feature on shared log entries can provide dialoguewith one?s friends to overcome barriers.Subjective Norms Built by viewing others activities, participating in goals with others,and viewing the game level of others.Expectation aboutEnvironmentalCuesThe environmental cues can change health behaviour by seeingwhat others are doing for their health.4.2 EvaluationThe high fidelity prototype of VivoSpace was evaluated through field experi-ments with small social network groups. We chose to evaluate this prototypewith small social network groups to build on previous work that suggest thatsharing personal health information on a large social network does not makesense due to privacy concerns [78, 91]. Large OSNs such as Facebook R?canprevent people from sharing posts, as the connections are diverse, and a per-son may not feel comfortable disclosing their health information to everyoneon a large OSN; furthermore, the design of VivoSpace is based on postingcomprehensive meal and physical activity information, which can easily growlarge, so if one?s OSN is large the newsfeed would become unmanageable.We also evaluated different types of groups, and we focused on clinicaland non-clinical groups. By clinical groups, we looked at patients associatedwith the same primary care clinic that focuses on wellness. The non clinicalgroup is not associated with any clinic but is closely tied; in other words,they have good knowledge of each other. We review the study methods next,which include a description of recruitment methods, details of the studyparticipants, and a description of the measures used in the evaluation.65Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour Change4.2.1 MethodsRecruitment and Participant OverviewWe recruited a total of 35 participants from three different settings includingclinical and non-clinical settings. For the clinical groups, we consideredpatients that are associated with the same clinic, share the same geographiclocation, and are generally from the same socioeconomic status, as was foundto be important by Grimes et al. [42].The first group of participants from a clinical setting was recruited froma primary care clinic in suburban Chicago, which has a focus on wellness andweight loss. A total of 22 participants were recruited by sending an emailthrough the clinic?s patient portal. Half of the participants were randomlyassigned to the control group and the other half to the experimental group.The participants in the experimental group used VivoSpace during the 3-month study period, while participants in the control group did not useVivoSpace. The reason for having a control group was to mitigate newlyacquired health behaviours from association with the clinic.The second group of participants from a clinical setting was recruitedfrom an integrative medical centre in Vancouver, Canada. This clinic pro-vides a focus on prevention and partnership between physician and patient.Participants were recruited from their medical-group-visit patients, wherepatients meet with a physician as a group, so they already take advantage ofsocial aspects to good health. A total of 3 participants were recruited fromthis clinic. The small number reflects the limited number of patients thattake part in the medical group visits, and it means that we could not have acontrol group for this clinic. The participants were recruited through directemail contact from the clinic.The non-clinical group of participants was a close-knit group of colleaguesat a small software gaming company in Vancouver Canada, where all theemployees have good knowledge of each other. A total of 10 participants wererecruited by directly asking the employees of the company. The companyhas a total of 35 employees. A control group would have been ideal for thenon-clinical group to ensure that any changes that were found was not due66Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour Changeto being involved in an experiment; however, this group was not associatedwith a wellness or integrative medical clinic, so the effects of that associationdoes not need to be determined through a control group. For this group, theresults from the pre-questionnaire (see Section 4.2.1) provide evaluation oftheir health without VivoSpace.A total of 35 participants were recruited from three groups: Chicagoclinic (11 in experimental group and 11 in control group), Vancouver clinic(3), and the non-clinical group from the Vancouver gaming company (10).Out of the 22 participants recruited from the Chicago clinic 3 dropped outprior to the end of the study. One was in the experimental group, andthe other two were in the control group. Table 4.3 shows an overview ofthe remaining participants from all three groups. Overall, there is a biastowards women. Furthermore, the participants from the non-clinical groupwere younger than those from the clinics, and this group ranked their healthbetter than those from the clinics. The determination of whether individualswere of normal weight, overweight, or obese was done by calculating thebody-mass index from the weight and height information that the usersprovided, and using standard definition of these weight categories from thebody-mass index [77]. Furthermore, there was not enough variability amongthe participants in ethnic identity and the overall sample size was too smallto conduct any analysis based on age, gender and ethnic identity, as was doneduring the UCD process as described in Chapter 7, and in particular duringthe initial user inquiry (described in Section 7.1). Therefore, we will evaluatethe results based on clinical and non-clinical groups, and not conduct anyfurther analysis on gender, age, and ethnic identity.Participants from each group were asked to friend each other, but therewas no friending across the groups, so that we could evaluate the socialdynamic within each group. All participants received a $50 honorarium.MeasuresAll participants completed a pre-questionnaire prior to the start of the study,a mid-questionnaire after 4 weeks, and a post-questionnaire after the 3-month67Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour ChangeTable 4.3: An overview of the participants recruited for the field experimentshowing gender distribution, age, obesity, and their rank of their healthiness(1-6 Likert Scale, 1=very unhealthy, 6=very healthy).Group Male(n)Female(n)Mean Age(range)SDageOver-weight(n)Obese(n)MeanHealthRankChicago Clinic (exp) 2 8 48.15 (24-76) 17.3 2 5 2.9 (SD=1.3)Chicago Clinic (cntl) 0 9 58.22 (29-68) 11.8 4 3 3.9 (SD=1.0)Vancouver Clinic 0 3 48.00 (44-57) - 1 0 3.0Non-Clinical 4 6 32.60 (20-46) 7.4 3 0 4.6 (SD=0.9)study period. The questionnaires had the following measures: 1) currenthealth behaviour; 2) Patient Activation Measure (PAM R?); 3) determinantsfrom the ABC Framework for health behaviour change; 4) determinantsfor use of VivoSpace from the ABC Framework; 5) linkage between designelements and determinants for health behaviour change; 6) usage data forVivoSpace; and 7) thoughts on the design of VivoSpace. Details about eachof these measure is described below:1. All questionnaires (pre-, mid-, and post-questionnaires) for both the exper-imental and control groups include the first set of questions that inquiredabout health behaviour. These questions included: inquiry into the heightand weight to obtain a body-mass-index to assess if the participant wasoverweight or obese; the number of salads, vegetables, fruits, French fries, andpotato chips that they ate in the past week; and the number of times theywalked, performed cardio exercise, and other physical activity in the pastweek. The current stage in health behaviour change from the TranstheoreticalModel was also inquired, as was done by [20, 64, 68]. The TranstheoreticalModel defines the stages of change as pre-contemplation, contemplation,preparation, action, and maintenance [90].2. Similarly, all questionnaires included the Patient Activation Measure (PAM R?)[48, 49]. The PAM R?is a validated clinical measure to assess an individual?sknowledge, skill, and confidence in managing one?s health. PAM R?is a unidi-mensional, probabilistic Guttman-like scale developed using Rasch methodol-ogy [93, 122]. PAM R?is measured through a 22-item questionnaire [49], and68Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour Changelater into a short form 13-item questionnaire [48]. We have used the full22-item questionnaire in this experiment because the long-form questionnaireis more comprehensive.3. Third, we inquired about the determinants for health behaviour from theABC Framework in all the questionnaires and for all the groups. Knowledgewas evaluated through a 10-question multiple-choice test on the meaningof nutrients to assess knowledge. They included questions such as, ?Whatfoods have the highest fiber content?? The answers included: a) whole wheatbreads, beans, and vegetables; b) any breads and cereal grains; c) wholewheat bread and meats; and d) all of the above. The determinants for healthbehaviour was also inquired through 5-point Likert style questions that askedfor the level of concurrence on statements that mapped to the factors from theABC Framework. For example, the statement for perceived self-efficacyfor eating nutritious foods stated, ?I am capable of eating highly nutritiousfoods and resisting unhealthy foods.? The 5-point Likert questions rangedfrom ?strongly disagree? (1) to ?strongly agree? (5). All questionnaires andboth the experimental and control group was given these questions with theobjective to determine if there was any change in these determinants after 4weeks and after 3 months.4. Fourth, the mid- and post-questionnaires for those participants in the ex-perimental groups (those participants using VivoSpace) had 5-point Likertquestions for the determinants for use of OSNs from the ABC Framework.These questions objective was to determine, which determinants for use ofOSNs correlated most strongly and least with the user?s motivation to useVivoSpace.5. Next, the mid- and post-questionnaire for the experimental group alsoinquired about which design features of VivoSpace contributed to the de-terminants for health behaviour change from the ABC Framework. Forexample, after the afore mentioned Likert question on perceived self-efficacy,other 5-point Likert statements inquired concurrence with, ?I was able tolearn about my capabilities by logging my meals on VivoSpace.?6. Usage data was automatically collected via the VivoSpace system. The usagedata for each user included the number of log entries made, the number of69Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour Changeentries that were shared, and the number of comments made.7. Finally, the mid- and post- questionnaires for the experimental group includedopen-ended qualitative questions to obtain general thoughts on VivoSpaceand how it can be improved to motivate use and health behaviour change,and specific responses for how it can promote the determinants from boththeories more effectively.All questionnaires can be found in the Second Appendix.4.2.2 ResultsThe results cover the following: 1) whether the incorporation of the ABCFramework into the design encouraged use of VivoSpace; 2) whether theincorporation of the ABC Framework led to an increase in the self-reportsof the determinants for health behaviour change from the framework; 3) andif there was any observed change in health behaviour at the end of the 4weeks and at the end of 3 months. Analysis includes statistical comparisonof pre-, mid- and post questions as well as qualitative analysis of open-endedfree form questions.Use of VivoSpaceThe use of VivoSpace varied substantially over the first 4-week period, andthen dropped off considerably by the end of the 3-month study period. All23 participants that were using VivoSpace created an account and friendedothers from their network group. The participants from the non-clinical group(Vancouver gaming company) used it more than those from the Chicago clinic,which can likely be attributed to this group?s ease with technology. Oneparticipant from the Vancouver clinic used the system the most. Table 4.4shows an overview for usage of VivoSpace for all three groups for the first4-week period and for the entire 3-month study period. The non-clinicalgroup was less inclined to share their entries than those from the clinicalgroups. The comments included: encouragement about the post, ?goodjob!? and ?Woot!?; additional information about the food or activity entered,70Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour ChangeTable 4.4: Overview for usage of VivoSpace for all three groups, includesthe mean and range of log entries made, disclosure of log entries, and totalcomments made for each group.Group Mean # of logentriesMin-max # oflog entries% privatelog entriesTotal # ofcommentsChicago Clinic @ 4wks 18.3 (SD=27.4) 0-83 2.2% 20Chicago Clinic @ 3mo 18.9 (SD=27.09) 0-83 2.6% 20Vancvr.Clinic @ 4wks 93 (SD=161) 0-279 1.1% 19Vancvr. Clinic @ 3mo 101 (SD=174) 0-302 0.9% 22Non-Clinical @ 4wks 54.6 (SD=63.3) 2-184 59.2% 24Non-Clinical @ 3mo 63.9 (SD=78.5) 2-210 63.4% 24?Santa Cruz organic added to Perrier?; or their feeling about the activity, ?Ilove Thai food, yum?.The usage data reveals that after the first 4 weeks participants eitherstopped using VivoSpace or they reduced their usage considerably. The dropin usage of Vivospace from when usage was collected at 4 weeks and then at 3months varied between the groups. The non-clinical group had 4 participants,who used the system after the initial 4-week period. The number of additionallog entries after the initial 4-week period for the 4 participants from thenon-clinical group were 2, 51, 14, and 26. Only one participant from theChicago clinic used it after the initial 4-week period, and this participantmade an additional 3 log entries. Finally, one participant from the Vancouverclinic used it after the initial 4-week period, and this participant made anadditional 23 entries. In summary, most of the participants did not useVivoSpace after the initial 4-week period, and those who did use it reducedtheir entries to 8% - 50% of the log entries they made in the initial 4-weekperiod. Furthermore, all the participants stopped using VivoSpace after the3-month study period. This speaks to the level of engagement that the designof VivoSpace afforded. There was initial engagement in the use of VivoSpace;however, that engagement did not last beyond 4 weeks. We investigate thisfurther by reviewing the questionnaire responses of the determinants for useof OSNs based on their motivation to use (or not use) VivoSpace. Theseresponses will inform the strengths and weaknesses in the design of VivoSpace71Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour Changebased on the ABC Framework.Determinants from ABC Framework for Use of OSNsAppeal We will first evaluate the results for the Appeal determinants foruse of OSNs from the mid- and post-questionnaires. These results show theparticipant?s perception of VivoSpace based on the Appeal determinantsfrom the ABC Framework. The results of the 5-point Likert responses forall three groups are shown in Table 4.5. The strongest factors for motivatinguse were to Provide Information and Self-Discovery for all groups. Althoughthe Likert response for to Get Information was a bit lower with mean of2.88 in the post-questionnaire, the qualitative responses showed that theydid use it to receive information; for example, ?I liked watching my vitaminconsumption over time? (P9). The motive, Maintain Connectivity, rated lowamongst participants. This is likely due to usability issues with the design,as the newsfeed would easily fill up, and it was difficult to find commentsthat were made. This is evident in the following qualitative response, ?therewas no way to tell you that a user commented on your news item so often itwould require a ton of scrolling to discover that this is the case.?(P10). TheVancouver clinic had one active user, who was the heaviest user of VivoSpace.She continued to use it on a daily basis despite the fact that the she did nothave the full social experience of VivoSpace. This user had some mistrustin the nutritional and energy expenditure information that was provided byVivoSpace, ?I?m not sure how accurate the nutritional and calorie burninginfo was, and I think that more detailed information would need to be madeavailable for it to be useful? (P31). With respect to Self Discovery, she said,?It was interesting to be accountable; it made me think more about it? (P31).Interestingly, the Chicago Clinic rated higher in all the determinants after3 months, as compared to the 4-week point. Since use after 4 weeks wasvery minimal, these answers were likely based on reflection of the VivoSpacesystem. In contrast, the non-clinical group rated lower on most determinantsexcept Self Discovery.72Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour ChangeTable 4.5: Mean values for results from the mid- and post-questionnaires?5-point Likert scale responses for Appeal determinants for use of OSNs, basedon their motivations for using VivoSpace.ProvideInforma-tionGetInforma-tionSelf Dis-coveryMaintainConnec-tivitySocialEnhance-mentEntertain-mentConvenienceGroup mid post mid post mid post mid post mid post mid post mid postChicagoClinic2.86 3.33 1.57 3.17 2.43 3.33 2.00 2.67 1.71 2.5 2.14 2.83 2.17 3.5VancouverClinic3.50 2.50 2.50 2.00 3.50 2.50 2.00 1.00 3.00 2.50 3.50 2.50 2.50 2.00Non-clinical 3.00 2.38 2.67 2.88 3.11 3.86 2.67 2.57 2.78 2.00 2.44 2.38 2.33 2.50OverallMean3.00 2.75 2.22 2.88 2.89 3.47 2.33 2.40 2.39 2.25 2.44 2.56 2.29 2.81Belonging The Belonging determinant from the ABC Framework foruse of OSNs were also inquired in the mid- and post-questionnaires wasShared Identity to show the participant?s perception of VivoSpace?s ability tobuild social motivations to use VivoSpace. The results of the 5-point Likertresponses is shown in Table 4.6. Interestingly, Shared Identity was strong onlyfor the loose social connections of the clinical groups, and especially strongfor the Chicago clinical group. The qualitative responses for the Chicagoclinic revealed sentiment for the Shared Identity motivational factor; such as,?I liked being supportive to like minded people achieving goals? (P32). Theother Belonging determinants were not inquired through the 5-point Likertself-report questions because they are determinants that cannot be accuratelycollect through self-report; for example, Sense of Belonging is an emotionthat is hard for an individual to be aware of; similarly, Social Categorization,Social Comparison, and Group Norms are determinants that individuals maynot be aware of. They can, however, be observed through usage patterns onVivoSpace, and generally the social features such as commenting and groupgoals were not used extensively, so additional motivators need to be addedto the design to promote the Belonging determinants for use of OSNs.73Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour ChangeTable 4.6: Mean values for results from the mid- and post-questionnaires? 5-point Likert scale responses for Shared Identity determinant for use of VivoSpace.Group mid postChicago Clinic 2.86 3.33Vancouver Clinic 3.00 2.50Non-Clinical 2.22 2.14Overall Mean 2.55 2.67Commitment The temporal attachments and usage of VivoSpace basedon the Commitment dimension of the ABC Framework can be observedthrough the usage patterns. Only 3 users of VivoSpace developed habitualuse, and this only lasted for the first 4 weeks of the study. The bulk of theusers (12) were superficial users of VivoSpace, and the remaining 7 usersdid not get past the discovery phase. The attachments to VivoSpace can beinferred as being Normative especially as the users were participating in aresearch study. For the few users who were initially heavy users of VivoSpace,the initial attachment may have been Affective; however, this did not lastfor the entire 3-month study period.Change in Determinants from ABC Framework for Health Be-haviourAll the determinants in the ABC Framework for health behaviour changewere enquired through the pre-, mid-, and post-questionnaires using 5-point Likert scale questions. The responses from these questionnaires werecompared through repeated measures ANOVA statistical analysis for thefollowing groups: Chicago clinic experimental, all-clinical experimental,Chicago clinic control, and non-clinical. By experimental, we mean thoseparticipants that were using VivoSpace and not assigned to the controlgroup. The ?all-clinical? experimental group includes the responses fromboth the Chicago clinic and the Vancouver clinic. The responses from theVancouver clinic could not be compared on its own due to the small ofnumber of participants in this group. The responses from the Chicago clinic74Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour Changeexperimental group and the all-clinical experiment group were comparedwith the Chicago clinic control group to determine if there were changesassociated with use of VivoSpace beyond association with the clinic.Knowledge The first Appeal determinant for health behaviour change inthe framework is Knowledge. This determinant was quantitatively inquiredthrough several means. The first way was 10 multiple choice questions thattested knowledge about nutrition and benefits of being physically active.There was no statistically significant difference found between the pre-, mid-,and post-questionnaires. Self-reports on knowledge was also inquired through5-point Likert questions on perception of knowledge of nutritional value offoods, outcome expectation of diet, outcome expectation of physical activity,perceived susceptibility of healthy behaviour to avoid illness, and perceivedsusceptibility of healthy behaviour to live longer. None of these yielded statis-tically significant difference between the pre-, mid-, and post-questionnairesfor all study groups including the control group. All participants generallyscored well on the 10-question multiple choice test as well as the self-reportson the 5-point Likert questions, which likely contributed to not seeing anychange in this determinant. The additional inquiry on which aspects ofthe VivoSpace design contributed to an increase in knowledge, outcomeexpectation, and perceived susceptibility yielded strong agreement that thedesign features that mapped to the get information determinant for use ofOSNs with the mean Likert responses of 3.2 in the post questionnaire. Theopen-ended qualitative responses showed that some participants felt thatproviding information also contributed to increasing knowledge.Attitude Towards Behaviour The second Appeal determinant forhealth behaviour change is Attitude Towards Behaviour. The results fromthe 5-point Likert questions that asked for agreement on enjoyment in eatinghealthy food and participating in physical activity. The results reveal nostatistical significance for change in attitude between the pre-, mid-, andpost-questionnaire for eating healthy food, but does show statistical sig-nificance in a change in attitude for participating in physical activity for75Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour Change!"#"$"%"&"'"()*+,-.*./0-"123!4&&5"6--",-.*./0-"123!4!&&5",7./08)",-.*./"123!4!'95",)*:;)-"123!4<=5">;?"@.A">)B:"Figure 4.4: The mean values from the results of the 5-point Likert responsesfor attitude towards physical activity ; the error bars indicate standard deviation,and the statistical significance for repeated measure ANOVA is shown on thex-axis.the clinical group and not the control group. Figure 4.4 shows the resultsfrom the 5-point Likert responses for attitude towards physical activity withthe statistical significance for each group shown on the x-axis. The non-clinical group did not see any significant change in attitude for physicalactivity either. The statistical significance for all the participants that wereassociated with a clinic is 0.044 with the main effects being between thepre- and mid-questionnaire results (p=0.031) using the Bonferroni post-hocanalysis. Although the results from the Chicago clinical group did not revealstatistically significant results, the mean difference between the mid- andpre-questionnaire results of 1.75 for the Chicago group is greater than themid- and pre-questionnaire results of 1.33 from the All Clinical group. Thereason for not reaching statistical significance is likely due to the smallsample size. Post-hoc analysis of main effects for the Chicago clinical groupshow a strong significant effect between the pre- and mid-results of 0.018.The attitude towards physical activity for these two group did drop slightlyfrom the mid- to post-questionnaire results; however, it did not drop to as76Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour Change!"#"$"%"&"'"()*+,-.*.,/-"012!3!'&4"5--"6-.*.,/-"012!3!&&4"67.,/8)",-.*.,"012!3!'94"6)*:;)-"012!3#%'4"<;=">.?"<)@:"Figure 4.5: The mean values from the results of the 5-point Likert responsesfor self efficacy in eating healthy foods ; the error bars indicate standard deviation,and the statistical significance for repeated measure ANOVA is shown on thex-axis.low as the pre-questionnaire results (before using VivoSpace), which showsthat some of the possible benefits of use were maintained after use of thetool. These results show that a tool such as VivoSpace holds benefit towardschanging attitude toward physical activity for patients associated with aclinic, but not for those not associated with a clinic. Further, the use ofVivoSpace augments the benefits of being associated with the clinic, butassociation with the clinic alone does not affect attitude towards physicalactivity, because the control group did not see the same benefit. The designfeatures that contributed to this change in attitude was also inquired, andthere was only mild agreement that getting information from VivoSpacecontributed to a change in attitude (mean value from the 5-point Likertquestion was only 2.7), and the qualitative responses did not reveal anyother design feature or determinants for use that contributed to a change inattitude.77Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour ChangeSelf-Efficacy The next Appeal determinant for health behaviour changeis Self-Efficacy. The results from the 5-point Likert questions that inquiredabout one?s self-efficacy to eat healthy foods showed a statistically significantdifference for the all clinical group (p-0.044) with the main effects beingonce again between the pre- and mid-questionnaire results. There was also astrong trend towards significant results for the non-clinical group (p=0.054)and the Chicago clinic group (p=0.056) with the large mean difference beingthe Chicago clinic group of 1.75 between the mid- and pre-results comparedto 1.33 (between mid- and pre-) for the all clinical group and 1.0 (betweenpost- and pre-) for the non-clinical group. Once again the reason for notshowing statistical significance for the Chicago clinic group may be dueto the small sample. Figure 4.5 shows the mean Likert responses for eachgroup for the pre-, mid-, and post-questionnaire results for self-efficacy toeat healthy food. The results of the main effects in the post-hoc analysisfor each group is shown in Table 4.7. For the clinical groups, we are seeingsome reversion back after use of VivoSpace ended; however, self-efficacydoes not return to as low as the results from the pre-questionnaire results.In addition to self-efficacy in eating healthy food, the questionnaires alsoinquired about the participant?s self-efficacy in performing physical activity.The results are shown in Figure 4.6. Statistically significant results wererevealed for the all participants associated with a clinic (p=0.035) withthe main effects having a significance of 0.018 between the pre- and post-questionnaire results. Similar trends can be seen in the Chicago clinic, butstatistical significance was not reached due to the small sample size. TheTable 4.7: Post-hoc analysis results for each group showing the main effectsfor self efficacy in eating healthy foods.Group Significance Observed effectNon-Clinical 0.035 pre- and post-All Clinical 0.031 pre- and mid-Chicago Clinic 0.018 pre- and mid-Control none N/A78Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour Change!"#"$"%"&"'"()*+,-.*./0-"123!4%567"8--",-.*./0-"123!4!%57",9./0:)"123!4$'7" ,)*;<)-"123!4#&&7"=<>"?.@"=)A;"Figure 4.6: The mean values from the results of the 5-point Likert responsesfor self efficacy in performing physical activity ; the error bars indicate standarddeviation, and the statistical significance for repeated measure ANOVA is shownon the x-axis.design features that contributed to these effects based on the qualitativeresponses showed that getting information from VivoSpace allowed one tounderstand their capabilities, which is shown in this qualitative response,?nice to have this information compiled and referenced on VivoSpace? [P16].The Likert-scale responses into which design features contributed to increasingSelf-Efficacy showed mild support for Providing Information (average Likertresponse 2.83) and Self-Discovery (average Likert response 2.91).Goals Both distal and proximal goals were inquired through 5-point Likertquestions, and the results revealed no statistically significant results for anyof the groups. The only group that was trending towards significance was AllClinical for distal goals (p=0.076). The goals feature for VivoSpace was notwell extensively, which likely is linked to the poor results for this determinantfor health behaviour change. Participants felt that the goals that it providedwere too rigid and did not represent their personal health goals.79Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour ChangePerceived Facilitators and Barriers The next Appeal determinantsfor health behaviour change are Perceived Facilitators and Perceived Barriers.Perceived Facilitators were inquired through two 5-point Likert questions.Both facilitators and individual incentives were inquired; however, neitherof these showed any significant increase between the pre-, mid-, and post-questionnaire responses. Similarly, the inquiry about barriers did not signifi-cantly decrease between the questionnaires. The use of VivoSpace did not inanyway change the users? perceptions of facilitators and barriers. The secondarea of inquiry was around, which design features (and determinants for useof OSNs) linked to the Perceived Facilitators and Barriers determinants forhealth behaviour. The results around the inquiry into which determinantsfor use of OSN allowed one to overcome barriers revealed that getting infor-mation through viewing one?s health information (Average 5-point Likertresponse was 3.0), and the convenience of having the information allowed oneto overcome barriers and build facilitators (average 5-point Likert responsewas 2.64). The qualitative responses also revealed that providing informationand the goals feature also increased perception of facilitators.Subjective Norms The first Belonging determinant for health behaviourchange is Subjective Norms. The pre-, mid-, and post-questionnaires inquiredabout Social Norms through 4 separate 5-point Likert scale questions: 1)social norms and influence of family; 2) social norms and influence of friends;3) moral norms or obligation from family or friends towards eating healthyfoods; and 4) moral norms or obligation from family or friends towardsleading an active lifestyle. However, there were no statistically significantdifference in the results. Furthermore, there was a great deal of variabilityin how the participants felt they were influenced by their family and friends.I would also be wary of trying to understand how VivoSpace influenced thisdeterminant through the self-reported Likert scale responses, as VivoSpacewas not building social norms of family and friends, but rather the partici-pant?s social connections or friends on VivoSpace. There was mild agreementthat Shared Identity, Sense of Belonging, and Group Norms contributed todeveloping Social Norms with mean responses to agreement on a 5-point80Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour ChangeLikert scate of 2.77, 2.69, and 2.85 respectively.Self-Efficacy Vicariously Through Others The next Belonging de-terminant is Self-Efficacy experienced vicariously through others, which wasinquired through one 5-point Likert scale questions. The results showed no sta-tistically significant difference between the pre-, mid-, and post-questionnaires.The potential reasons for this could be evaluating self-efficacy that is achievedvicariously through others using a self-report Likert question, and that thesocial aspects of VivoSpace were not used as much as the personal healthinformatics features. The respondents had mild support for the followingdeterminants for use of OSNs supported Self-Efficacy experienced vicariouslythrough others: Social Comparison and Personal Knowledge of Others witheach of these having a mean value of 2.84 on a 5-point Likert scale.Social Facilitators and Barriers In addition to individual facilitatorsand barriers, Social Facilitators (includes both Social Supports and SocialApprovals) and Social Barriers were also inquired through 5-point Likertscale questions. There were no statistically significant results found forthis. Upon inquiry into which determinants for use of OSNs can lead tomore Social Facilitators, there was mild agreement to Group Norms, SocialInteraction, and Social Comparison with mean results of the 5-point Likertscale inquiry of 2.85, 2.77, and 2.83 respectively. A qualitative responsealso indicated ?awareness? [P43], which can tie to Self-Discovery, but is nota social facilitator, but more likely an individual facilitator. The inquirydid not reveal any determinants or aspects of the design that can lead to adecrease in Social Barriers.Environmental Cues The final Belonging determinant is EnvironmentalCues, or external stimulus that motivate healthy behaviour. The results fromthe 5-point Likert scale question for Environmental Cues indicated that therewas no statistically significant difference between the pre-, mid-, and post-questionnaire results for each of four groups. Furthermore, there was onlymild agreement that social identity contributed to assisting Environmental81Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour Change!"!#$%!"!#$&!"!#$'!"!#$(!"!#$)!"!#$*!"!#$+,-./012-3456701$/012-3456701$+,-46,6701$89701$:6;12-1619-$!"#$"%&'()'*"+,(%-"%&+'+,-$+0<2$Figure 4.7: The percent of respondents from the all-clinical group (Vancouverclinic and Chicago Clinic) that were in each of the 5 stages of change from theTranstheoretical Model before (pre) and after (post) using VivoSpace.Cues to change health behaviour with a mean 5-point Likert scale responseof 2.61. The qualitative responses showed the getting information assistedwith building environmental cues.Stages of Change The Transtheoretical Model provides the Stages ofChange for health behaviour within the Commitment dimension of theframework. Freidman?s test for related samples was used to determine ifthere was any statistically significant difference between the pre-, mid-, andpost-results for the Stages of Change, which revealed a significant differencefor the all-clinical group (p=0.035), and the post-hoc analysis showed thatthe significant difference between pre- and post-results (p=0.045). Figure 4.7shows the percent of respondents from the all-clinical group that were ineach of the 5 stages of change; the figure shows that participants movedfrom contemplation and preparation to action and maintenance. None of theother groups had any statistically significant difference including the controlgroup.82Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour ChangeSummary Table 4.8 shows the summary of the statistical significance forall the determinants for health behaviour change from the ABC Framework;any statistically significant post hoc analysis is shown in parenthesis afterthe statistical significant p values. Through this evaluation, it is evidentthat the design of VivoSpace was able to change attitude and self-efficacyfor the participants from the clinic, as well as assist with moving themthrough the stages of change. However, the design was not effective in seeingany change in the non-clinical group. Furthermore, none of the Belongingdeterminants or the goals determinants changed from the use of VivoSpace.These results are consistent with the usage of VivoSpace since the social andgoals features were under utilized. Furthermore, the difficulties in evaluatingchange in the socially-based determinants for health behaviour change aredue to problems with inquiring through self-reports of 5-point Likert scalequestions. Generally, individuals are not actively aware of the influenceof others on their health behaviour, and they are reluctant to admit theinfluence if they are aware of it. Future use of the ABC Framework shouldlook at other methods of inquiry to better understand how to evaluate thesocially-based determinants.Change in Health BehaviourThe ultimate endpoint of this research is to see positive change in healthbehaviour. We enquired about health behaviour through multiple methodsin the pre-, mid-, and post-questionnaires: 1) we looked at the body massindex (BMI) by asking the participants for their weight and height; 2) weasked the participants about their eating habits in the past 7 days by askinghow many servings of salads, fruits, vegetables, french fries, and potato chipsor similar products they consumed; 3) we asked the participants about theirphysical activity in the past week by asking how many times they walked formore than 30 minutes; performed cardio or aerobic exercise, and performedother physical activity such as gardening; and 4) we had each participantcomplete the 22-question Patient Activation Measure (PAM R?), which is avalidated and rigorous method for quantifying a patient?s knowledge and83Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour ChangeTable 4.8: Statistical significance p values (post hoc analysis shown in brackets)for all determinants for health behaviour change from the ABC Frameworkfor each group.Determinant Control All Clinical ChicagoClinicNon ClinicalKnowledge (from 10 ques-tion test)0.437 0.863 0.465 0.136Knowledge 0.164 0.175 0.182 0.444Outcome expectation forhealthy diet0.199 0.302 0.319 0.247Outcome expectation forphysical activity0.128 0.302 0.465 0.12Perceived susceptibility toillness0.401 0.302 0.192 0.694Attitude towards healthydiet0.156 0.471 0.465 0.151Attitude towards physicalactivity0.78 0.044 (p=0.031between pre andmid)0.056 (p=0.018between pre andmid)0.44Self-Efficacy healthy diet 0.135 0.044 (p=0.031between pre andmid)0.056 (p=0.018between pre andmid)0.054 (p=0.035between pre andpost)Self-Efficacy physical activ-ity0.144 0.036 (p=0.018between pre andpost)0.25 0.367Distal Goals 0.422 0.076 0.31 0.259Proximal Goals 0.129 0.59 1.0 0.79Facilitators 0.547 0.145 0.253 0.792Individual Incentives 0.215 0.68 0.465 0.655Barriers 0.431 0.573 0.815 0.304Subjective Norms 0.252 0.17 0.486 0.151Moral Norms 0.208 0.147 0.089 (p=0.048between midand post)0.256Self-Efficacy through oth-ers0.448 0.854 0.92 0.59Social facilitators 0.12 0.863 1.0 0.716Social Barriers 0.312 0.431 0.253 0.454Environmental Cues 0.522 0.541 0.483 0.301Stages of Change 0.178 0.035 (p=0.045between pre andpost)0.148 0.09784Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour Changeconfidence in managing their health.The results of the BMI revealed no statistically significant differencebetween the pre-, mid-, and post-questionnaire results. This is not surprisingas weight loss was not a target for this study.The results into the eating habits also did not reveal any statisticallysignificant results in the repeated measures ANOVA for any of the fooditems: salads, fruits, vegetables, french fries, and potato chips. However,upon post-hoc analysis, there was a trend found for the Chicago clinic inthe number of salad consumed between the mid and post results (p=0.098).The mean number of salads consumed in the last week for this group wentfrom 4.2 in the pre-questionnaire to 5.2 in the mid-questionnaire, and thendropped drastically to 4 in the post-questionnaire. Furthermore, the numberof french fries and potato chips that all of the groups consumed in all thequestionnaires was very low each with averages (means) of less than 1 servingper week, which makes any improvement in this category difficult.The results for the number of times a particular physical activity suchas walking and cardiovascular exercise performed in the past week revealedstatistically significant results for walking for the participants associatedwith a clinic (experimental group). The repeated measures ANOVA showeda statistically significant result (p=0.025); however, the post-hoc analysisdid not show reveal any statistical significance due to the small sample size.When we use Least Significant Difference (LSD) for pairwise comparison, weobtained a trend level statistical significance of 0.078 between the pre andpost results. The mean number of walks in the pre-, mid-, and post-resultswere 3.14, 3.29, and 3.57 respectively, which shows a progressive increase inwalking activity for the participants associated with a clinic, and it also showsthat the progression continued even after they stopped using VivoSpace.The PAM R?-22 measure showed the most significant change in healthbehaviour for both the participants associated with a clinic (All Clinic exper-imental group) and for those associated with the Chicago clinic experimentalgroup. The statistical significance for the all clinical experimental group is0.026, and the statistical significance for the Chicago clinic experimentalgroup is 0.013. There was no statistically significant results for the control85Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour Change!"#!"$!"%!"&!"'!"(!")!"*!"+!"#!!",-./012.2031"456!7(%)8"911"012.2031"456!7!$(8":;203<-"456!7!#%8":-.=>-1"456!7#!$8"?>@"A2B"?-C="Figure 4.8: The mean values from the results of the PAM R?-22 questionnaire;the error bars indicate standard deviation, and the statistical significance forrepeated measure ANOVA is shown on the x-axis.group or the non-clinical experimental group. Figure 4.8 shows the meanvalue for the PAM R?-22 results; the measure?s range is 0 to 100 with 100indicated full activation in managing one?s health. The post-hoc analysis ofthe two significant results show that for the all-clinical group the main effectswere between the pre- and post-results (p=0.073), which was once againobtained using Least Significant Difference (LSD) for pairwise comparisondue to the lack of power from the small sample size, and for the Chicagoclinic, the main effects were between the pre- and mid- results (p=0.013)using the Bonferroni correction for multiple comparisons. When we lookat the these results with all participants associated with a clinic with seea progression in the patient activation; however, this progression does notexist when we look at the participants from the Chicago clinic. This showsthat there was perhaps a reversion back to previous activation levels whenthe participants stopped using VivoSpace.86Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour Change4.2.3 DiscussionThe results of the evaluation of the high-fidelity prototype for VivoSpaceshows that there is an overall benefit towards health behaviour changefor those participants associated with a clinic by using VivoSpace. Thechange occurred in the determinants for health behaviour change; specifically,a change in self-efficacy for eating healthy food, self-efficacy for physicalactivity, and attitude towards physical activity. Furthermore, there waschange observed in health behaviour; specifically, the change was observed inwalking for 30 minutes every day, and in patient activation as measured usingthe validated PAM R?-22 measure. Additionally, the Chicago clinic group feltthat VivoSpace contributed to the social determinants for use more thanthe non-clinical group, and they were more inclined to share their healthinformation with others from their clinic. These results show that a systemsuch as VivoSpace that is designed using a theoretical foundation formedby the ABC Framework can change health behaviour for individualsassociated with the same primary care clinic. However, there are manyaspects of the design that can be improved, which can potentially furthercontribute to additional benefit.Logging meals and physical activities to reveal the nutritional value ofmeals and caloric expenditure of activities combined with charts showingtrends of calories and nutrients consumed build perceived self-efficacy.The greatest increase in self-efficacy for both healthy diet and physical activitywas observed in the all clinical experimental group, which suggests that theprocess of logging meals and physical activity does build self-awareness. Bylogging health information, users become more accountable and aware oftheir capabilities.The design can be improved by also providing nutritional informationfor foods not eaten and having tailored messages for how to improve healthbehaviour to build knowledge. The qualitative results show that the designcan be modified to promote an increase in knowledge of nutritional valueof food and energy expenditure of physical activities. The participantssuggested that VivoSpace could assist them to make decisions about food,87Chapter 4. The VivoSpace Prototype: An OSN for Health Behaviour Changeso it should have the ability to obtain nutritional information for foods thatwere not eaten. Further, VivoSpace can be more prescriptive and providetailored messages for how the user can make healthier choices.Providing reminders for goals and allowing for customizable goals willincrease user engagement. The goals feature on VivoSpace should providereminders to the users after they are set, and goals should be more central inthe design. A key change to the goals feature would be to allow users to createcustomized goals, as the rigidity of the goals provided on VivoSpace led tofewer people creating goals. These changes will increase Social Enhancementand make the system more Entertaining ; both of which are determinants foruse of OSNs.Email notifications should be provided when comments are made to one?slog entries, and a link should be provided to the log entry and the comment.VivoSpace should provide notifications when comments are made to one?sposts, or when one responds to one?s existing comment. This will increasedialogue between participants, which will build social supports to allow foran increase in the motivation to Maintain Connectivity a determinant foruse of OSNs and Perceived Facilitators a determinant for health behaviourchange.Design should include a mobile version and other conveniences suchas automatic sensing to ease the time required to use it. The time that wasrequired to enter the data was a contributing factor for some participantsto ask for easier means of entering their data. A mobile version and linkingto devices such as fitbit R?to automatically sense steps taken can ease theburden of data entry.Based on the results of the field experiment, we are able to iterate theABC Framework. Specifically, we use the results that inquired aboutwhich design features of VivoSpace contributed to the determinants forhealth behaviour change. The final ABC Framework is presented in thenext chapter.88Chapter 5Final ABC FrameworkThe results of the field experiment for the high fidelity prototype ofVivoSpace provides us with a better understanding of the interplay betweenthe determinants for use of OSNs and the determinants for health behaviourchange. The overall revised ABC Framework is shown in Figure 5.1, andwe will review the interplay below that is depicted on the figure by thelines with arrows. Evidence of the interplay through the field evaluation ofVivoSpace is shown using the red (for Appeal) and green (for Belonging)solid lines with arrows. Evidence of the interplay that showed only mildagreement is shown with a dashed line. Finally the interplay that wasnot evaluated, but still has strong merit is shown with the black line andarrow. ?Merit? was determined based on the qualitative results of the fieldexperiment, as well as, by reducing the weight of those determinants thatthe design failed to meet.We will first review the determinants in the Appeal dimension. Knowl-edge is a core determinant for health behaviour change, and ProvidingInformation and Getting Information both contributed to building one?sKnowledge of healthy behaviour and outcomes. The evaluation providedadditional insight to the original ABC Framework that Getting Informa-tion also interplayed with the health behaviour determinant of Knowledge.Attitude Toward Behaviour was only mildly influenced by Getting Infor-mation, which we have noted with a dashed line in Figure 5.1. We haveleft the interplay with Self Discovery for Attitude Towards Behaviour, asone?s attitude is likely being changed by learning more about one?s healthbehaviours. Expectations About Self-Efficacy was also affected by GettingInformation, and we have also maintained that there is interplay with Self89Chapter 5. Final ABC Framework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igure 5.1: The final ABC Framework with the interplay between the determi-nants for use of OSN and health behaviour change shown in red for the Appealdimension and in green for the Belonging dimension. The the interplay shownby the red and green arrows are based on evidence from the field experiments.Compare with initial framework in figure 3.1Discovery, as one better understands one?s capability through Self-Discovery.The interplay of determinants for use of OSNs with the Goals determinantfor health behaviour change could not be adequately inquired during the fieldexperiment, as the feature was not well used; however, with more flexiblegoals and more gaming features that clearly indicate how many points will beearned by successfully completing a goal, Entertainment can play a greaterrole in having users create and successfully complete Goals. To furtherenhance Goals, Social Enhancement features that show what others in theirsocial network have completed can also provide interplay between Social90Chapter 5. Final ABC FrameworkEnhancement and Goals. Therefore, we have left Entertainment and SocialEnhancement as providing interplay for Goals. For Perceived Facilitators andBarriers, the field experiment showed that Getting Information facilitatedhealthy behaviour, so we have added this interplay. The results of the fieldexperiment also confirmed that the Convenience of having personal healthinformation allowed users to overcome existing barriers. We have also leftEntertainment and Social Enhancement as affecting Perceived Facilitators be-cause social gaming features and wishing to perform for one?s social networkconnections can also serve as a facilitator.Next we will review the interplay in the Belonging dimension of theABC Framework. The Subjective Norms determinant for health behaviourchange was found to be mildly influenced by Sense of Belonging, SharedIdentity, and Group Norms. We feel that this mild agreement is sufficient, associal determinants did not significantly change in the field experiment, soeven this mild agreement shows that users of the OSN, VivoSpace, found someinterplay for these determinants of use. We have also left the Social Compari-son determinant as affecting Social Norms, as better design of social goals canallow Social Comparisons to develop, which may lead to the development ofSocial Norms. For Self-Efficacy Vicariously Experienced through Others wasfound to be influenced by having Personal Knowledge of Others, so we haveadded this interplay. There was agreement that Social Comparison effectedthe determinant Self-Efficacy Vicariously Experienced through Others. Wehave left Social Interaction and Maintaining Interpersonal Connectivity asinfluencing Self-Efficacy Vicariously Experienced through Others determi-nant, as interacting with one?s social network connections will allow thisdeterminant to develop by allowing the user to alter their own perceptionsof their capability by expanding their knowledge of other?s capability. Sincethe commenting and other social features were under utilized, this interplaycould not be validated in the field experiment. For the social aspects ofPerceived Facilitators and Barriers, an additional determinant of GroupNorms was found to be a facilitator. The field experiment found agreementthat Social Comparisons and Social Interaction provided facilitators andreduced barriers. We have left Interdepedence as a factor that can be a91Chapter 5. Final ABC Frameworkfacilitator if it is positive; however, can potentially be a barrier as well ifone becomes too dependent on another. For Environmental Cues, the fieldexperiment showed no interplay with Personal Knowledge of Others, as thequalitative results showed that they would want external cues based onnational standards rather than other?s (peers) thoughts on health, so it hasbeen removed; however, future iteration of the framework may show that thisinterplay does exist. The field experiment also showed that there was mildagreement that Social Identity contributed to providing Environmental Cuesto change health behaviour, so a dotted line has been added; furthermore,Getting Information was also found to affect Environmental Cues, so this linehas been added. Although the results did not show any interplay betweenSocial Interaction and Environmental Cues, we have left this in, becausecommunication with others may reveal Environmental Cues leading to healthbehaviour change; for example, commenting with others on specific behaviourmay point the user to better understand nutritional criteria and their healthbenefits.The Commitment dimension of the ABC Framework does not re-quire iteration at this time, as the temporal factors for use of OSN, stagesof change in health behaviour, and the type of attachment to the OSNthat was explained in Chapter 3 represents the temporal behaviour of ourfield experiment; however, future iteration and inquiry can possibly showadditional temporal stages and attachment categories.92Chapter 6Design PrinciplesThe iterated ABC Framework that is described in Chapter 5 providesus with the individually- and socially-based determinants for use of OSNs,the determinants for health behaviour change, and the interplay betweenthem, and also temporal stages and attachments for use and health behaviourchange. Furthermore, the field evaluation of the high-fidelity prototype ofVivoSpace provided qualitative and quantitative results for how the designcan be improved to promote more usage and health behaviour change. Weuse these results to provide design principles for OSNs for health behaviourchange. These design principles can inform the design of the multitudeof websites and mobile applications for health behaviour change that areincreasingly coming to market. In this section, I will introduce the designguidelines by each determinant for use of OSNs from the ABC Framework,and through the description of the design principles for each determinant foruse, provide details for how the guidelines contribute to the determinantsfor health behaviour change. An overview of the design principles is alsopresented in Table 6.1.Table 6.1: Final design principles for OSNs for health behaviour changeshown by each determinant for use of OSNs.Use of OSNs Health Behaviour Design PrincipleProvideInformationKnowledge and SocialEnhancementEnter dietary information, physical activity infor-mation, and other information such as weight.Continued on next page93Chapter 6. Design PrinciplesTable 6.1 ? continued from previous pageUse of OSNs Health Behaviour Design PrincipleGet Information Knowledge, PerceivedSelf-Efficacy, andAttitude TowardsBehaviourObtain the nutritional information for meals andenergy expenditure with definitions for nutrients.Provide time series charts for nutrients. Abilityto obtain nutritional information for foods noteaten and physical activity not competed. Providetailored messages about how to improve one?s dietand physical activity.Self-Discovery Attitude TowardsBehaviour andPerceived Self-EfficacyAll principles for Get Information. Provide theuser with information about which activity thatthey logged is ?healthy?.MaintainInterpersonalConnectivityPerceived Self-EfficacyExperienced Vicari-ously Through OthersProvide the ability to connect with specific socialconnections through a friending feature, whichallows visibility of friends? shared activities. Pro-vide a means to communicate with friends throughcommenting on their shared activities. Providenotifications and direct links when a friend com-ments on their posts.SocialEnhancementGoals and PerceivedFacilitatorsAllow for the creation of health goals with adeadline with ability to complete the goals withtheir friends. Game mechanics with a points sys-tem and levelling-up when pre-set point thresholdare reached and allowing visibility of the level offriends.Entertainment Goals and PerceivedFacilitatorsThe goals feature can include the percent comple-tion of the active goals highly visible, and showthe days remaining until deadline. The points andlevelling-up game features described for Social En-hancement can include revealing a new characteror badge when a new level is reached. Additionalpoints or bonus points should be given for thesuccessful completion of goals with clarity on howpoints are earned.Continued on next page94Chapter 6. Design PrinciplesTable 6.1 ? continued from previous pageUse of OSNs Health Behaviour Design PrincipleConvenience Perceived Barriers Provide a store and collation of user?s personalhealth data. Provide the ability to automaticallysense steps and scan barcodes for packaged foods.Sense of Belonging Subjective Norms Provide a newsfeed that shows the shared mealsand physical activities completed by the user?sfriends.Group Norms Subjective Norms andPerceived FacilitatorsNewsfeed shows when a friend has joined a goal,completed a goal, and levelled-up. All principlesdescribed for Sense of Belonging.SocialCategorizationSubjective Norms All principles described for Sense of Belonging.Shared Identity Expectations aboutEnvironmental CuesCommenting between friends on the log entries.Displaying seals when meals meet specific guide-lines.Social Comparison Perceived Facilitatorsand Self-EfficacyVicariously ThroughOthersProviding group goals. Displaying the level thatfriends have achieved. Newsfeed feature.Interdependence Perceived Facilitators All principles for Shared IdenditySocial Interaction Perceived Barriers Commenting features as described for Shared Iden-tity. Organize the Newsfeed to encourage com-menting. Provide notification for new comments.PersonalKnowledge ofOthersPerceived Self-EfficacyVicariously ThroughOthersNewsfeed features as described for Sense of Be-longing and Group Norms; commenting as de-scribed for Shared Identity ; and goals feature asin Entertainment and Social Comparison.6.1 Provide InformationAn OSN for health behaviour change should provide a means for individualsto enter their dietary information, physical activity information, and other95Chapter 6. Design Principlesrelevant information such as weight. This will provide a way to diary orlog their information, which will provide a means to build Knowledge ofhealthy behaviour. Once the information has been logged by the individual,the data can be further refined to include detailed information that will beexplained further in Section 6.2. Since this is an OSN, the user should havethe option to share the information with her/his social network connections.Allowing the user to choose what information they wish to keep private, givingher/him control over what personal health data is shared. The shared healthinformation then promotes use through the Social Enhancement determinant.In other words, users will be more motivated to use the OSN and log theirhealth data because they see other connections doing the same. The SocialEnhancement determinant is discussed further in Section 6.5.6.2 Get InformationOSNs should provide users with the nutritional information for meals loggedand energy expenditure information for physical activities. The dietary andphysical activity information that is logged can be used to calculate or obtainthe specific nutritional information or energy expenditure from it. This willprovide individuals with Knowledge about the actual nutritional value forthe meals they are consuming and the energy expenditure for the activitiesthey are taking part in. Furthermore, the users build their Perceived Self-Efficacy by understanding that certain behaviours (i.e. meals or physicalactivity) were very beneficial to their health. When the nutritional detailsare provided, definitions for the nutrients should be provided with informationfor the beneficial or negative effects that the nutrient has on one?s health,which will allow the user to have a better understanding of how specifichealth behaviour can lead to poor health outcomes.The detailed nutritional information should be graphed on time-seriescharts for individuals to provide a historical view of the consumption of eachnutrient. By providing a historical chart of each nutrient, users can buildtheir Perceived Self-Efficacy, as they can see their own capabilities throughpast behaviour. Furthermore, the charted information provides users with96Chapter 6. Design Principlesa Facilitator for improved health behaviour, as they use the chart to setpersonal targets for consumption of specific nutrients and energy expenditure.Getting information including detailed nutritional information from thelogging of meals and energy expenditure for physical activity combined withthe charting of this detailed information allows the user to formulate newattitudes towards the behaviour. For example, a user may like certain foods,but is unaware of their nutritional value until the information is made expliciton the OSN, which will allow them to redefine what types of food makeup ?healthy? foods. Similarly, as they start to log their meals and physicalactivity and change their health behaviour, they may realize that they enjoyeating healthy foods and being more physically active.Allow users to obtain nutritional information for foods not eaten andenergy expenditure for physical activities not completed. The OSN cansupport decisions about what foods to consume by allowing users to explorethe nutritional value for various foods not just the foods that are consumed.This will allow the user to build Knowledge about nutritional value for alarge variety of foods. This will build Expectations about their Self-Efficacy,as they become more knowledgable about the nutritional value of the foods.Provide tailored messages to the user for how they can improve their dietand physical activity level. By providing tailored information to the userabout their health behaviour based on the information that they have logged,the user is provided with tips and hints about how to improve their healthbehaviour. For example, the system can inform the user that a specific mealthat she/he consumed was high in saturated fats, and provide suggestionsfor alternative ingredients such as ?turkey bacon? instead of ?regular bacon?.Or it can suggest foods that are high in Vitamin C such as oranges andlemons if the user?s Vitamin C intake is low. Users should have the abilityto turn-off these message or ask for suggestions, so that these prescriptivemessages do not intrude on the user. This will build Knowledge of how tochange health behaviour, contribute to changing the users? Attitude towardsthe Behaviour, and build their Self-Efficacy for living in a healthier manner.97Chapter 6. Design Principles6.3 Self-DiscoveryAll of the features described in Section 6.2 also contribute to the motivationto use the OSN for Self-Discovery. As users are given detailed nutritionaland energy expenditure information about their meals and physical activities,they start to discovery their own health behaviours. It is through this Self-Discovery that the user can start to change their Attitude towards specifichealth behaviours by understanding that certain foods that they eat arebeneficial to their health thus their attitude towards healthy eating improves.Similarly, users may come to understand that being physically active doesnot require as much effort as they originally thought through both providingtheir information, and the information that is obtained. In a similar manner,user?s Perceived Self-Efficacy or understanding of their own capabilities inchanging and maintaining positive health behaviour can also improve throughGetting Information that is provided through the design features describedin Section 6.2.The system should provide an indication when a user logs a meal orphysical activity that is healthy. This will provide user?s with an immediateindication of when the user has eaten a healthy meal or completed physicalactivity where a threshold of energy is expended, which will allow the userto discover their potential to allow them to improve their Attitude andSelf-Efficacy towards healthy behaviour.6.4 Maintain Interpersonal ConnectivityOSNs for health behaviour change should provide the ability to connect withspecific social connections through a friending feature, which allows forthe user to view friends? shared activities. By allowing users to see whattheir friends are eating and their physical activities, they can improve theirPerceived Self-Efficacy Experienced Vicariously Through Others. Users areable to formulate improved opinions about their ability by viewing theirfriends health behaviour, as they have visibility into the ability of theirfriends.98Chapter 6. Design PrinciplesThe OSN for health behaviour change should provide a means to com-municate with friends through commenting on their shared activities. Bydesigning an OSN for health behaviour change that allows for dialogue aboutcertain meals consumed and physical activity, users are able to learn moreabout the activity such as the total effort required, which will allow the userto improve their Self Efficacy Vicariously through Others.Notifications and direct links should be provided to users when one oftheir friends comments on their posts. Due to the large number of posts inan OSN for health behaviour change, the newsfeed fills very quickly evenwith a small social network group, notifications are required to alert theuser to comments on their posts, and also link to additional comments thathave been made to posts that the user has commented on. By providingnotification and a direct link to comments, additional dialogue is encouraged.6.5 Social EnhancementAn OSN for health behaviour change should allow users to create health goalswith a deadline that allow the user to complete the goals with their friends.The OSN should allow the user to create goals that are flexible and alsoprovide a library of existing goals that are static. By allowing users to createtheir own goals, they have the ability to customize the goals according totheir needs. Conversely, users should also be able to select goals from alibrary of goals for ease of creation. The goals available in the library shouldbe those goals that individuals are most likely to participate in. For example,individuals may wish to lose two pounds over one month, or walk for onehour for two weeks. Successful completion of goals is posted on the newsfeedbuilding Social Enhancement because users want to make a good impressionto their friends, which also encourages them to reach their goal.Game mechanics should be provided with a points system and levelling-upwhen pre-set point thresholds are reached and allowing users to see the levelof their friends. A unique and fun character or badge should be revealed,when the user reaches a new level. Points can be earned by successfullycompleting the goals, where the number of points are based on the difficulty99Chapter 6. Design Principlesof the goal. Minor points or a small number of points should also be earnedfor logging meals and physical activity. By making the level that their friendshave reached visible to the user, builds Social Enhancement, as users areencouraged to keep-up with their friends.Providing Information that includes meals and physical activity andsharing this information as described in Section 6.1 also allows Social En-hancement to develop. Users would be inclined to eat healthier foods and bemore physical active as they would want to look good to their friends andshare it, which is encouraged through Providing Information.All of these design principles that promote Social Enhancement providea means for the individual to develop Perceived Facilitators by buildingIndividual Incentives. These incentives include indirect incentives to healthbehaviour change such as the acquisition of points and levelling up that isprovided in the game mechanics. More direct incentives include showingfriends good health behaviour through posts on the newsfeed such as thecompletion of health goals and the logs of healthy foods eaten and physicalactivity completed.6.6 EntertainmentThe design principles that promote use through Entertainment are the sameas those for Social Enhancement described in Section 6.5. More specifically,the design principle of creating goals can be augmented by making thepercent completion of the active goals visible at the top of the page througha horizontal bar that fills to 100% as the user progresses towards the target,and the number of days left to complete the goals also needs to be visible. Byviewing the progression towards the target in a goal as well as the days leftto reach the target, build Individual Incentives to complete the proximalGoals.The accumulation of points and levelling-up game mechanics can provideEntertaining motivation to continue to use the system. The user can beencouraged to change health behaviour as they have Individual Incentives toaccumulate more points, and see the character (or badge) that is revealed100Chapter 6. Design Principlesin the next level. Although using the system should allow the user theearn points, the largest number of points (or bonus points) should be earnedthrough the successful completion of goals. There needs to be clear indicationprovided to the user when points are earned and how they earned the points,so that they can understand how to earn more points and have a moreentertaining experience.6.7 ConvenienceThe OSN can provide Conveniences by providing a store and collation ofthe user?s personal health data, which includes the consumption of specificnutrients and energy expenditure. This is provided on the user?s newsfeedwith the detailed information displayed when the user clicks on the food oractivity logged, and a chart of each nutrient on the dashboard showing thechange in consumption or expenditure over time. All of these design principlesare described in detail in Section 6.2. These design principles provideConvenience by reducing the Perceived Barriers to having to rememberdetails of the nutritional content of foods consumed and energy expenditurefor physical activity. Furthermore, the charts provide the consumption of allthe nutrients and expenditure of energy over time, which conveniently showsthe change in health behaviour over time.Other Conveniences should also be designed to afford ease of data entry.These can include the automatic sensing of steps, which can be provided bylinking the OSN to existing commercial hardware such as the fitbit R?or Nike?sFeulBand R?. This can ease the effort required to enter the distance that auser walked, and also reduce the error that may be incurred due to lapses inmemory and not knowing the speed or distance that the user walked. Otherlinkages can also be made through barcode scanning of packaged meals foundin the supermarket. This will also reduce the effort required to enter theinformation and increase accuracy. Generally, this will reduce the barriersto using the OSN and entering one?s personal health data, which is centralto the system.101Chapter 6. Design Principles6.8 Sense of BelongingSense of Belonging can be designed into the system by first taking intoconsideration the users and the groups that will connect through it. TheOSN for health behaviour change should be for small social network groupswith approximately 10 people in each group based on the size of the socialnetworks in the field experiment. The people in the groups should beconnected through either close or loose ties. The most significant healthbehaviour change that has been observed is when an OSN is used by clinicalgroups, where the people within the group share the same clinic, live thein same geographic area, and come from similar socio-economic strata. Byhaving a small number of users in each social network group and sharing thesame connection such as a clinic, greater Sense of Belonging to the groupcan develop between the users because they share the same goal of livinghealthy. Furthermore, it is easier to see the activities of the other users sincethere is a limited number of users in each group.The OSN should provide a newsfeed that shows the shared meals andphysical activities completed by the user?s friends. By having the ability toview the meals and physical activity of one?s social network connections, theuser can feel a part of a group and know that they are not alone in their wishto be healthy; in other words, they feel that they belong. This knowledge ofothers? eating behaviour and physical activity can allow the user to modeltheir behaviour to that of the group, which can allow for the development ofSubjective Norms.6.9 Group NormsGroup Norms determinant for use of OSNs is similar to Sense of Belonging,and the design principles that contributes to the development of it includesthe newsfeed design principle described in Section 6.8. However, additionaldesign features can also contribute the development of Group Norms. Thenewsfeed should display when the user?s friends have joined a goal, completeda goal, and levelled-up or earned enough points to proceed to the next level.102Chapter 6. Design PrinciplesThese design features will contribute to building awareness of what theirfriends are doing, which encourages the user to also participate in theseactivities through visibility of group norms.These design features provide awareness of the health behaviour for theuser?s friends, which will lead to the development of Subjective Norms. Inother words, the users will adopt the health behaviours of their friendsby seeing what they are eating, their physical activity, and the goals thatthey are participating in and have completed. There is an overall tendencyto share positive health behaviours over negative behaviours, which willallow for the sharing of good health behaviour, and lead to subjective normsof good behaviour over poor health behaviour. Additionally, these designfeatures also builds Perceived Facilitators through the user?s desire for SocialApprovals. The user?s desire to receive approvals from their friends willmotivate them to share healthy choices through the newsfeed.6.10 Social CategorizationSocial Categorization is similar to Sense of Belonging except that it is theactual relation to a group, and the design features that contribute to SocialCategorization is the same as the features for Sense of Belonging, which aredescribed in Section 6.8. Therefore, it is no surprise that the determinantsfor health behaviour that are influenced by Social Categorization is the same,namely Subjective Norms are influenced by these design features.6.11 Shared IdentityThe OSN can build Shared Identity by allowing for dialogue between thesocial network connections (between the user and her/his friends). This isdesigned by allowing for commenting between the users and her/his friendson the log entries. The user is able to develop relationships and identifywith others through dialogue about specific meals and physical activities.It is through this dialogue that users are able to change their Expectationsabout Environmental Cues for health behaviour. The commenting feature103Chapter 6. Design Principleswill allow for dialogue about particular foods and their associated nutritionalvalue, and physical activity and their associated energy expenditure, whichwill provide the user the cue to change health behaviour based on societalexpectations.Additional design features can be incorporated to show EnvironmentalCues, which were not incorporated into the high-fidelity design of VivoSpace,such as displaying seals from credible organizations such the Heart andStroke Foundation, when logged meals and physical activity meet specificguidelines. This design guideline was incorporated into the Medium-Fidelityprototype, but could not be incorporated into the High-Fidelity prototypedue to the limitations on the development of features that the prototypewould allow in the time available and resources required to connect withexternal organizations and develop the formulas and programming required toincorporate the seal. However, the use of a ?seal of approval? from particularorganization would allow the user to see, which meals that she/he ate meetexternal approval, which would allow her/him to change her/his Expectationsof Environmental Cues.6.12 Social ComparisonSocial Comparisons can be designed into an OSN by extending the goalsfeature described in Section 6.5 by having groups goals, or goals which theuser can complete with her/his friends through direct invitation. In additionto the selection or creation goals towards a health targets with a deadline,the user should also be able to invite specific friends to complete the samegoal with them. As the user progresses towards the goal target, their progressas well as the progress of their friends? that are completing the goals withthem are clearly visible through a fill bar that shows the percent complete.By allowing users to complete their goals with their friends, Facilitators aredesigned into the OSN, as Social Supports and Social Approvals for the goalare motivators to complete the goal. In other words, the user?s friends, whoare completing the goal with her/him, provide both support to complete thegoal as well as the desire to seek approval from her/his friend(s).104Chapter 6. Design PrinciplesThe OSN should show the level that all of the user?s friends have achieved.This will allow the user to see how far their friends are progressing with theirhealth, and encourage her/him to perform better because they seek SocialApprovals from them. Generally, the visibility of the user?s friends? levelsbuild Perceived Facilitators towards positive health behaviour change.Social Comparisons is also enabled through the newsfeed design featurethat was described Section 6.8. Users are able to compare their healthbehaviour to those of their friends through this feature, which allows healthbehaviour change to occur as the users can change their expectations of theirself-efficacy vicariously through others. As they see others? capabilities, theybecome aware of their own capabilities.6.13 InterdependenceInterdependence is similar to Shared Identity except that the relationship thatdevelops is one more of dependence than simply a sharing of identities. Thedesign principles for Shared Identity are described in Section 6.11. Similarly,these design features influence the same determinants for health behaviourchange, Perceived Facilitators with both Social Supports and Social Approvalsbeing facilitators for health behaviour change. However, Social Supports aremuch stronger when the determinant for use is Interdependence, as the userrelies on her/his friends to provide the support necessary to change theirhealth behaviour.Although Interdependence is a determinant for use that can ensurehabitual use, we need to be careful in creating dependency on an OSNwhen maintained health behaviour change can be possible through use of anOSN for only a few months with design features such as those described inthis chapter. There should be an ethical understanding with the design ofOSNs that the end goal is health behaviour change, and not sustained useof the OSN. However, different users may have different levels of supportsthat are necessary for sustained healthy behaviour, and they may requireinterdependence of their social network connections to see them throughtimes when they may revert to poor behaviour.105Chapter 6. Design Principles6.14 Social InteractionThe commenting feature on the newsfeed that is described in Section 6.11allows for Social Interaction. However, the design needs to consider howto increase socialization. The high-fidelity prototype of VivoSpace had alimited number of comments because the newsfeed filled up very quickly,which made it difficult to see when comments had been made. Therefore, thedesign needs to organize the newsfeed to encourage social interaction throughthe commenting feature. This can be achieved by displaying newsfeed itemsthat others have commented at the top. Similarly, the items that have receivedcomments from others should be displayed in the notifications menu at thetop, which has a direct link to the newsfeed item. The user should also receiveemail notification for the same. Finally, the newsfeed should be organized in amanner that encourages Social Interaction through commenting by reducingthe potential clutter of the newsfeed, which can be done by collapsing theusers meals and physical activity into daily summaries, which can be expandedto view the details for the day.An OSN for health behaviour change that is easy to navigate and encour-ages Social Interaction can allow for dialogue that will provide the user withstrategies to reduce her/his Perceived Barriers, which is a determinant forhealth behaviour change.6.15 Personal Knowledge of OthersPersonal Knowledge of Others in the OSN is provided through multipledesign principles that have already been described. The newsfeed designfeature that was described in Section 6.8 allows users to gain knowledgeof their friends? personal nutrition and physical activity. The commentingfeature that was described in Section 6.11 allows for dialogue and socialinteraction, which permits users to learn about each other. Finally, thegroup goals feature that was described in Sections 6.5 and 6.12 allows usersto be exposed to what types of goals their friends participate in and howquickly their friends achieve their goals. By having Personal Knowledge of106Chapter 6. Design PrinciplesOthers, the users are able to change their understanding of their capabilitiesto change their health behaviour; in other words, they change their PerceivedSelf-Efficacy Vicariously Through Others.6.16 Habitual UseAs for the Commitment dimension of the ABC Framework, there areseveral design principles that can encourage sustained use. The use ofemail reminders and notifications of comments on the users log entries canencourage sustained use. Furthermore, the use of game mechanics such asrevealing a new characters when the user levels up otherwise the level islocked and the character for that level cannot be seen, as was described inSection 6.6. These game mechanics need to be continuously revised, so thatif a user reached the last level, their motivation to continue to use the systemdoes not diminish.It should be noted, however, that sustained use of the OSN in itselfdoes guarantee a progression towards health behaviour change. The specificdesign principles described in this section can lead to changes in the specificdeterminants for health behaviour change. Furthermore, habitual use of theOSN should not be the end goal in the design of an OSN for health behaviourchange, but rather positive health behaviour change, so if maintained healthbehaviour change is achieved after a few months of use, we should not expecthabitual use of the OSN (as explained in Section 6.13).6.17 Consideration of the Target UsersThis work showed that the design of an OSN for health behaviour changeshould consider the target user. The literature shows us that a large scaleOSN for one?s entire social network including close and distant ties such asFacebook R?is not ideal for an OSN designed to change health behaviour. Ourfield experiment showed that the number of people connected on the OSNshould be small, as the number of log entries can grow large very quickly.We suggest that ideally the number of connections in the OSN designed for107Chapter 6. Design Principleshealth behaviour change should be around 10 people.Further consideration needs to be given to who would benefit from thisOSN. Our field experiment revealed that loose social network connectionsfrom the same geographic and socioeconomic strata, who shared the sameprimary health clinic that was focused on wellness showed significant changesin the determinants for health behaviour change, as well as increased patientactivation. The number of groups that were studied was limited due to thelogistics in finding such groups, so there may be other social networks thatmay also benefit from an OSN for health behaviour change.6.18 Summary of Design PrinciplesThe design principles have been described by listing each determinant foruse of OSNs from the ABC Framework. In doing so, there is significantoverlap; specifically, a single design feature maps to multiple determinantsfor use of OSNs. Much of this occurred through the UCD process, whereinitially the design was much more complex, so that there was a one-to-onemapping of the design features to the determinants for use of OSNs. However,the evaluation of the paper prototype and medium fidelity prototype showedthat users wanted simpler designs.We can simplify the design features by creating a 2x2 matrix, wherewe have two columns, Individual and Social, and two rows for Give andObtain. There are design principles that can be provided in each of the fourquadrants. This is shown in Figure 6.1. The top left quadrant shows theindividual design features where the user provides (or Gives) informationsuch as their personal health information. The top right quadrant shows whatinformation others would provide to the user such as encouragement andtheir own personal health information. The bottom left quadrant shows whatthe user obtains from the OSN such as nutritional value for the foods eaten, ahistorical chart of their personal health data, entertaining gaming experience,and visibility into their goals. The bottom right quadrant shows the designprinciples where the user obtain value through their peers on the OSN suchas advice and encouragement, visibility into their health information and108Chapter 6. Design Principles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igure 6.1: A 2x2 Matrix showing simplified design principles for OSNs forhealth behaviour change.gaming levels, and peers to complete their goals with.The simplified 2x2 matrix allows this work to be adopted more broadlyby industry without getting bogged down in definition of determinantsfrom the ABC Framework. However, further research from this workshould consider the ABC Framework when applying the design principlesdescribed in this chapter.109Chapter 7User-Centred Design (UCD)ProcessThe high fidelity prototype of VivoSpace that was described in Chapter 4was designed through a UCD process that is described in this chapter. Thedeterminants that make up the ABC Framework form the points of inquirythroughout the UCD process. The end-point of this approach as describedin Section 1.3 is to design a system that will change health behaviour.7.1 Initial User InquiryWe begin with the UCD process with initial user inquiry. Questionnaires andinterviews are conducted to better understand motivations for using OSNsand thoughts on one?s health behaviour. The initial user inquiry allows us toformulate the motivations for use of existing OSNs such as Facebook R?andTwitter R?. The determinants for use of OSN from the ABC Frameworkwere derived from theories that were mostly applied to user participationin online communities and are rooted in social psychology, communicationand organizational psychology as described in Section 3.1. For example, theTheory of Organizational Commitment [4] was developed to understand em-ployees commitment to their employer, and it was later applied to attachmentto online communities [60]. The Common Identity Theory and CommonBond Theory [95], is used to describe motivation to participate in onlinecommunities. Furthermore, the Social Identity Theory [112] describes thebasis of group dynamics, and it was only later applied to online communities[27]. Since the evaluation of most of these theoretical models have not been110Chapter 7. User-Centred Design (UCD) Processapplied to OSNs, we conducted a questionnaire and interview evaluation ofthe determinants of the ABC Framework to determine their true validityin the motivations to use OSNs. We also evaluated the determinants forhealth behaviour change to better understand the validity of our synthesis;in other words, the evaluation provides a determination of whether we canextract determinants from multiple theoretical models for health behaviourchange into a single framework. An initial evaluation was done throughquestionnaire inquiry for the key determinants of the ABC Framework.Additional interviews were also conducted to obtain a richer understandingof individuals? thoughts on the use of online social networks and health.The full questionnaire and interview questions can be found in the ThirdAppendix.7.1.1 QuestionnairesOnline and paper questionnaires were created and distributed to a diverse par-ticipant group: across gender, age (adult only) and ethnics groups. Healthyliving should not be limited to young adults, who are active users of tech-nology, nor should it be for particular ethnicities. The actual validity of thetheoretical models used in the ABC Framework across age, gender andethnic boundaries is unknown. Therefore, we have endeavoured to obtainadult participants in our evaluation that cross various age and ethnic groups.The evaluation also looks further at the differences within these groups, sothat the design of an OSNs can focus on aspects that are similar across thesegroups.Recruitment and RespondentsParticipants were recruited from university listservs, the authors? personalsocial networks, OSNs, direct outreach to the First Nations community, andhaving a table at a Punjabi Diabetes forum in the Surrey BC. We obtained 104responses to our online and paper questionnaire. 26 respondents completeda paper survey and the balance completed the questionnaires online.Of the 104 respondents that completed the questionnaire, 52% were111Chapter 7. User-Centred Design (UCD) Processwomen and 48% were men; 15% 19-24 years old, 29% 25-34 years old, 29%35-49 years old, 12% 50-64 years old, 12% 65-74 years old and 3% wereover 75 years old; 26% identified as Canadian, 24% as South Asian, 18%as First Nations, 14% as Chinese, 7% as European, and there were 8 otherethnic groups that represented the remaining 11%; 33% of the respondentsidentified as having health problems.The respondents were users of technology and OSNs to varying degrees;95% of the respondents used a computer at least once a day; 24% had neverused Facebook R?; and 9% had never used any OSN or online community. Therespondents to this survey were high users of technology and OSNs, which waslikely due to our recruitment methods. This will create a general bias towardstechnology; however, it will allow us to better understand the motivations touse OSNs to best evaluate the ABC Framework?s determinants of for useof OSNs.ResultsThe results from the questionnaire showed strong agreement with the ABCFramework and also revealed some motivational differences between ageand ethnic groups. 85 of the 104 respondents answered questions inquiringabout their motivation for using OSNs. Respondents were asked to rank theiragreement to statements that are reflected by the ABC Framework. For ex-ample, respondents were asked for their degree of agreement or disagreementon a 5-point likert scale to statements such as, I use online social networksto get information, which reflects the to get information determinant in theAppeal dimension of the framework.The results to the responses around individually based (Appeal) determi-nants for motivation to use OSNs revealed that the strongest agreement wasto maintain connection with people and convenience. The weakest agreementwas to learn about oneself and social enhancement. This is shown on Figure7.1. The Belonging dimension for using OSNs was not fully incorporatedinto the questionnaire due to the complexity in obtaining responses aroundgroup behaviour; however, it is interesting to note that?belonging to a group?112Chapter 7. User-Centred Design (UCD) Processdid solicit positive and negative responses. This does suggest that evaluatingsocial motivation requires alternate inquiry methods. This is shown on Figure7.2. The results also revealed that the strongest Commitment attachmentis affective rather than continuance or normative (attachment categories aredescribed in Section 3.1.6).Figure 7.1: Questionnaire responses (n=85) to agreement about motivationto use online social networks for individually-based determinants.We also looked more deeply into respondents? motivation by understand-ing the differences between gender, age group and ethnic group. For thisreason, factorial ANOVA was run on the data to better understand anysignificant difference between these groups, the main effects and the in-teraction effects. All post hoc test was done using Tukey HSD. All meandifferences are in the direction indicated in the text, so the difference betweenx and y will have a mean difference x-y. The factorial ANOVA revealedsignificant differences in the Appeal dimension. The motivation to useOSNs for entertainment (F(4, 70)=2.89, p=0.031) was significantly differ-ent for different age groups. The greatest difference in the entertainmentdeterminant occurred between the 19-24 years old and 50-64 years old age113Chapter 7. User-Centred Design (UCD) ProcessFigure 7.2: Questionnaire responses (n=85) to agreement about motivationto use online social networks for individually-based determinants.group (mean difference=1.68, p=0.017). Similarly, social enhancement (F(2,66)=3.14, p=0.05) was significantly different for different ethnic groups. Thedifference between the Canadian and Chinese/South Asian ethnic groupsare statistically significant (mean difference=-1.39, p=0.001). The analysisalso revealed a significant difference in the Commitment dimension, asage groups showed significant difference in continuing to use online socialnetworks for their fondness (affective attachment) of them (F(4, 55)=2.81,p=0.034). The significant difference is between the 19-24 years old and 50-64years old age group (mean difference=2.17, p=0.024).Respondents were also asked about their thoughts on their health forvalidation of the ABC Framework, and the results show a strong agreementwith the framework. 102 of our 104 respondents answered questions inquiringabout their health. Generally, respondents seemed to have agreement withunderstanding how to live healthy with the greatest concern around exercise.The Appeal determinants for health behaviour is shown on Figure 7.3.Further, the responses to the Belonging and Commitment dimensions114Chapter 7. User-Centred Design (UCD) Processshow good support. Although there is somewhat mixed agreement to socialinfluence on health behaviour, and they are mixed about commitment, sincemany agree that they can live healthier. This is shown on Figure 7.4.We realize that this method of inquiry and the value of responses to thisinquiry are limited because asking a person if she/he understands how tolive healthily does not mean she/he understands. However, the answers doreveal respondents? perceptions about their understanding of healthy living.Figure 7.3: Questionnaire responses (n=85) to agreement about motivationto use online social networks for individually-based determinants.Similar to the analysis on OSN, the data on the respondents? thoughtson health was also analyzed using factorial ANOVA to better understandthe difference between gender, health status (healthy or not), age and eth-nicity. The results reveal that the Appeal dimension does show significantdifferences in some of the determinants. Knowledge was one such determi-nant, as the questionnaire inquiry on ?understanding the nutritional valueof food? showed statistical difference. The age groups show a statisticallysignificant difference for this determinant (F(4, 43)=3.29, p=0.019). This115Chapter 7. User-Centred Design (UCD) ProcessFigure 7.4: Questionnaire responses (n=85) to agreement about motivationto use online social networks for individually-based determinants.difference is between the following age groups: 19-24 years old and 25-34 yearsold (mean difference=-0.59, p=0.033), 19-24 years old and 50-64 years old(mean difference=-0.70, p=0.026), 19-24 years old and 65-74 years old (meandifference=-0.97, p=0.003), and 35-49 years old and 50-64 years old (meandifference=-0.75, p=0.009). This analysis also revealed interaction betweenage and health status for understanding nutritional content (F(4,43)=2.81,p=0.037). Concern for one?s health in the Appeal dimension shows a signif-icant difference between healthy and those that have health problems (F(1,43)=13.81, p=0.001) with a mean difference of -0.76 with the those withhealth problems being more concerned.The Belonging dimension showed significant difference, especially whenthey were asked about friends and family influence on their diet. There weresignificant differences between age groups (F(4,43)=2.88, p=0.034), healthstatus (F(1,43)=6.10, p=0.018), interaction between gender and age (F(4, 43),p=0.008), interaction between age and ethnicity (F(8, 43)=3.59, p=0.003),116Chapter 7. User-Centred Design (UCD) Processinteraction between age and health status (F(4, 43)=13.12, p=0.001), andinteraction between ethnicity and health status (F(2,43)=10.42, p=0.001).The Commitment dimension showed significant differences as well inthe inquiry, I ate healthier foods in the past than I do today. There weresignificant differences between gender (F(1, 43) = 4.53, p=0.39), where themean difference between male and female was -0.608. Significant differencesalso existed between ethnic groups (F(2, 43), p=0.043), where the post-hocanalysis revealed differences between Canadians and First Nations (meandifference=-1.02, p=0.007), Canadians and Chinese/South Asians (meandifference=-0.74, p=0.022).7.1.2 InterviewsIn order to obtain a richer understanding of people?s thoughts around usingOSNs and their health behaviour, one-on-one in-person interviews wereconducted with 11 people that lasted approximately one hour. Participantswere recruited through university listserv and personal connections. Therewas no selection criteria except that all participants needed to be over 19years old. No honorarium or other incentives were given to the participants.There were 7 men and 4 women. 4 identified as Canadians, 2 as Mexican, 1as American, 1 as Indonesian, 1 as Korean, 1 as Persian and 1 as East Indian.Although age was not asked directly, participants were asked to select whichage range they belonged to: 6 were aged 25-34 years old, 4 were aged 35-49and one was aged 19-24. They were all users of OSNs to varying degrees:one participant checked updates every 20 minutes, and the others used it atleast once a day. As for health problems, 4 said they had health problems.The interviews were evaluated by first transcribing the interviews, group-ing each comment into categories, and then further grouping each commentinto themes. There were 13 categories that emerges when users were askedabout their usage of OSNs, which is shown on Table 7.1. There were manycomponents of Facebook R?, Twitter R?and other OSNs that appealed to theparticipants. The most common reason to use OSNs was to connect withfriends and family. The following quote shows how online social networks117Chapter 7. User-Centred Design (UCD) Processallowed the participant to connect with old friends:I found that Facebook is a very good method to keep in touchwith my friends even old friends as I could find many of my oldfriends from university or my former colleagues from my previouscompany, so in this sense it is very useful. (P 6)Table 7.1: The theme and the associated number of comments that emergedfrom interview inquiry of participants? use of OSNsCategory # of ThemesFrequency of use 14Change in frequency of use 7Provide information 7To stay connected to family, friends and other connections 7View friends? activities 7Different uses/purposes for different social networks 7Get information 5Self promotion 2Participate in social games 2Linking two OSNs together 1Entertain friends 2Not wanting to share information 1Many of the participants said that they use online social networks toget information and view the activity of their friends, such as the followingexample:[I use Facebook] to see what my friends are doing, like whatis interesting, what interesting things are going on around mycommunity of friends. (P 4)This previous quote also provides insight to the Belonging dimension,as participants need to view activities that their friends are doing, whichbuilds a group and community network.Participants also alluded to Commitment or lack of it in their use ofOSNs. Some participants discussed how they use certain social media less118Chapter 7. User-Centred Design (UCD) Processthan they did in the past showing a lack of commitment, such as the followingexamples:I use to use Facebook but I disabled it because it wasn?t agood use of my time. (P 5)It is funny, I actually hated [Facebook] before because of theway it spams bunch of things on to your profile. I know there isa way to control that but its like what?s the point, so I actuallystopped using it for awhile, a year and a half, but I decidedto come back to it because I was getting disconnected to otherpeople who I wanted to keep in touch with. (P 10)Overall, the interview participants mentioned a number of uses andgratification or Appeal determinants for using OSNs, but the frequencyof use and level of commitment varies based on the individual and her/hisneed to use it. Interestingly, the previous quote shows the commitment toFacebook R?for this person to be more normative than affective.A total of 18 categories emerged from a category about living healthy,which can be found in Table 7.2. The categories were mostly based aroundAppeal of living healthy. Much of the discussion was around their ownpractices in healthy living as it pertained to healthy eating and exercising,for example:I do go to the gym very often and I try to exercise becauseits something that I need as it un-stresses me. (P 1)The next quote touches on the Appeal determinant of knowledge, as thisparticipant understands the importance of comprehending one?s nutritionalintake:I think monitoring what you eat is one of the most important[things] and that is one of the things that you should try to do,so [I read] all of the nutritional facts about food that I purchase.(P 2)119Chapter 7. User-Centred Design (UCD) ProcessThe participants also discussed the Belonging components or socialinfluences on health in great detail. The following quote show the socialnorms that occur through one?s friends:If you are with thin people, your behaviours tend to matchup a little better, so I think those are huge influences. (P 9)Table 7.2: The theme and the associated number of comments that emergedfrom interview inquiry of participants? thought on living healthyCategories # of ThemesHealthy eating 14Doing exercise 8Importance of health 6Need to be organized 3Relieving stress 2awareness of importance of healthy living 2Motivation to live healthy is to lose weight 2Find it is easy to be healthy 2Reminders on food products pertaining to health 1Living healthy improves one?s chronic health conditions 1Need to be committed to live healthy 1Balanced lifestyle leads to healthy lifestyle 1Need to be motivated to live healthy 1Will power is important 1Need to improve health bheaviour 1Clinical information 1Self-initiative is more important than friends 1Mental health 1Negative social pressures were also mentioned:Well if you go out with friends who eat bad stuff, drink alcohol,eat at MacDonald?s everyday, eat those fried stuff, well you wouldeat them too. (P 8)The difficulty in committing to healthy behaviour was discussed by manyof the participants as well as possible reasons why they have not been ableto commit to healthy behaviour, as shown by the following quotes:120Chapter 7. User-Centred Design (UCD) ProcessI think that it really varies from one period or year to anotherperiod. There [is] summertime [when] there are lots of activitiesand I?m really a big fan of outdoor activities and I have thingsthat I do: I go out and I go mountain climbing and stuff and Ifeel like I?m doing better and doing more exercise and that makesme feel healthier too. (P 4)I think a lot of [healthy living] comes down to being betterorganized. You know finding time making time one of thoseexpressions for the things you need to be doing maybe alsoprioritize. (P 9)Overall, interview participants felt that they generally had the knowledgeto eat healthy and they knew that they should be exercising more. However,they felt that there were barriers in motivation to maintaining a healthylifestyle.7.1.3 Discussion and Iteration of the FrameworkAs the results confirm, different population groups? behaviour is affecteddifferently by the various determinants. For this reason, we categorizethe determinants between the most and least overlap between the variouspopulation groups. These strong determinants lead to design strategies thatshould have the strongest impact across cultural and age groups versus onesthat may need tailoring. For example, respondents across age and ethnicgroups said they use online social networks to maintain connectivity withfamily and friends.There is an important caveat to this iteration of our framework. Thequestionnaire inquired only about use of existing OSNs and personal healthbehaviour separately. We expect that some of these determinants will bemuch more important for an OSN that is designed to motivate health be-haviour change. As was shown in the ABC Framework, there is significantinterplay between the determinants from both domains when put together.Specifically, the three determinants that have a larger impact when the121Chapter 7. User-Centred Design (UCD) Processdomains are coupled are: 1) self-discovery, 2) expectation about outcomes,and 3)environmental cues. Self-discovery can allow one to understand one?shealth behaviour, which leads to designs that include personal health infor-matics about the user such as sodium intake over time. Expectation aboutoutcomes becomes much more evident through the visibility of one?s nutri-tional intake and exercise level. Environmental cues may also be designedinto the OSN by displaying evidence-based ?seals of approval? when certainactivity meets health and medical criteria. Thus, as seen in the next section,we exploit these determinants in proposing design strategies for an onlinesocial network promoting health behaviour change.7.2 Paper Prototypes for VivoSpaceWe now begin to design an OSN for health behaviour change called VivoSpace.Paper prototypes are developed based on the ABC Framework and theresults of the initial user inquiry. However, the interviews for the initialuser inquiry were conducted after these prototype were developed in orderto complete the entire work proposed for this doctoral work. The interviewparticipants were the same for the initial user inquiry as for the paperprototype evaluation. Although it would be been ideal to have conductedtwo separate interviews for each phase of the UCD process, we feel thatthe results of the interviews from the initial user inquiry would not havechanged the design of the prototypes significantly. Furthermore, any designconsideration that would have arisen from the interview from the initial userinquiry can be adopted into the design of the medium fidelity prototypes.7.2.1 Paper Prototype DesignThe design strategy of the paper prototypes was to combine an individual?sinformation such as organizational data (calendar and task list) with healthinformation (such as nutritional intake and physical activity) to engage usersin their health data and ensure that health fits into the user?s overall digitalinformation. The paper prototypes provide relatively high-fidelity aesthetics122Chapter 7. User-Centred Design (UCD) ProcessFigure 7.5: Timeline page for the VivoSpace paper prototype. Timeline pageis where users are able to log their daily activity and share with any portion oftheir social network or not share it.to allow us to obtain feedback on both the aesthetic appeal as well as howusers feel about its use. There were 14 pages in total developed using AdobeIllustrator R?. Figures 7.5 and 7.6 show the timeline page and the dashboardpage respectively; the other pages can be found in the Fourth Appendix.The overall design of the paper prototypes include three main frames:the organization pane, the digital asset pane, and the content pane. Theleft pane is the organization pane and it contains items such as an overallscale to see how the user is performing in terms of their health behaviour,a calendar that allows the user to enter upcoming events such as a dinnerengagement with friends and also has the ability to invite friends to events,123Chapter 7. User-Centred Design (UCD) ProcessFigure 7.6: Dashboard page for the VivoSpace paper prototype. Dashboardof weekly performance with flags displayed on the graph to show what activitiesthat were logged on that day.a to-do list that will allow the user to manage all their action items whetherthey are health related or not, and finally a list of the friends or contacts onthe VivoSpace system. The right pane is a consolidation of the users digitalassets such as music, photos, movies and links that will be connected to theiriTunes and/or other digital storage locations either online or on their personalcomputer. This pane also has connections to online communities that arepart of VivoSpace, including a restaurant community where users can raterestaurants and suggest healthy menu items, a recipe community that allowusers to share recipes, and a health community to allow discussions aroundspecific health topics. These two panes are meant to build the Appealdimension of the theoretical framework by linking to digital assets such124Chapter 7. User-Centred Design (UCD) Processas music and other informational needs of the user so that health is notseparated from other parts the users life. The central and most prominentpane contains all of the content, including a timeline where users enter theirhealth related activities, a Facebook-style newsfeed and a dashboard.The timeline page (Figure 7.5) is where users log their daily healthactivity. Based on this activity, VivoSpace provides the health informationfor that activity such as calories and sodium consumed or calories burned. Forexample, a user can add that they had a specific restaurant meal and a coupleof glasses of wine; the system will look up the health related information forthis activity such as total calories, amount of sodium and amount of saturatedfat, and return that information. This will change the user?s knowledge ofhow their behaviour affects their health, which is a central determinant forhealth behaviour change in the ABC Framework. VivoSpace also providesthe user with the ability to link a health activity to their social activity;for example, the user in Figure 7.5 had the posted restaurant meal withtwo friends who are also on VivoSpace. This will provide the user withfeedback on social influences on their health, as there may be certain friendswho are good influences, while others are not. This visibility into the user?ssocial determinants should motivate them to change their health behaviour asdefined by the ABC Framework. Specifically, the Belonging dimension ofthe theoretical framework to motivate health behaviour change includes thesubjective norm determinant. The user can also share any of the informationin the timeline with all, none, or a portion of their social network. Theactivity for friends can be seen in the Facebook R?- or Twitter R?-style newsfeedpage.Figure 7.6 shows a health dashboard based on the information thatwas logged. The user?s health performance is shown initially in a narrowchannel as happy and sad faces with higher fidelity information providedbelow. Users have access to a full graphical view of various health variableswith annotations of activities that were logged. The ?Winners and losers?tab on the dashboard show how the user is performing when compared totheir friends. This tab provides a social gaming experience. The best andworst performing friends (top three and bottom three) are shown for each125Chapter 7. User-Centred Design (UCD) Processday to build social motivation. The ?my map? tab provides a geospatial viewof one?s movements and location of activities. The prototypes also includeprofile presets, where users can select which health variables they wish tosee. Users can also view and select evidence-based seals such as ?DiabetesSafe? or ?Low in Saturated Fat?.The mapping of the design elements shown in the paper prototypes ofVivoSpace and the determinants from the ABC Framework is shown inTable 7.3.Table 7.3: Mapping of the behavioural determinants from the ABC Frame-work to the design elements in the Paper PrototypeDeterminant Design ElementProvide Information Allow the user to provide the diet, physical activity, andother health information on the timeline and newsfeed pagesGet Information, andKnowledgeNutritional information is obtained after diet and physicalactivity information is entered; Information about friends?health information is obtainedMaintain Connectivityto Friends and Family,Sense of belonging, Groupnorms, Shared identity,Social Interaction, Subjec-tive Norms, and PersonalKnowledge of othersThe newsfeed allow the user to see and comment on friendsstatus updates; the list of friends are shown on the bottomleft of the page allow user to view their profileEntertainment, and Goals The MyMap page allows the user to see where they (theuser and their friends) have walked or done other activity,and with which friends; and the goals page allows the userto set goals and see their ability to meet their goal throughthe dashboardSocial Enhancement, Per-ceived Facilitators, SocialComparisonThe Winners & Losers page builds in competition betweenfriends to see who preformed the best and the worst eachweekSelf Discovery, Knowledge,and Self-efficacyThe dashboard page builds self-discovery by allowing theuser to see the change in health information combined withwho they were with on certain daysConvenience Narrow Channel health indicator at top left; Calendar thatlinks to existing events as well as health deadlines; To-dolist links to existing tasks as well as health tasks; a link touser?s digital assets on the right-hand bar126Chapter 7. User-Centred Design (UCD) Process7.2.2 EvaluationThe same 11 adults were interviewed that participated in the initial userinquiry, and they are described in Section 7.1.2. After the participants wereasked about their thoughts on use of OSNs and health as described in Section7.1.2, participants were asked for feedback on all 14 pages of VivoSpace?spaper prototypes. The participants were regular users of technology andOSNs. One participant used social media throughout the day, checkingtheir friends status updates every few minutes. 9 used either Facebook R?orTwitter R?several times everyday. One respondent stopped using Facebook R?,but continued to use Twitter R?a few times a week. Figure 7.7 shows aphotograph of all 14 pages laid out during one of the interviews. First, eachparticipant was walked through the functionality for each page, and thenthey were asked questions based on the ABC Framework.Figure 7.7: Photograph of all 14 pages of the paper prototype laid out duringthe interviews.The interview questions about the paper prototypes of VivoSpace resultedin 394 comments being collected and analyzed. They were coded into 10127Chapter 7. User-Centred Design (UCD) ProcessTable 7.4: Qualitative analysis of feedback of VivoSpace showing the categories,number of comments in each category and number of themes that emerged foreach category.Category # of Comments # of ThemesDifficulties with VivoSpace 91 20?Likes? about VivoSpace 84 17Recommendations 82 23Dislikes about VivoSpace 37 9VivoSpace can influence health behaviour 29 7Positive about social features 21 4Design aesthetics 16 8Temporal aspects 20 3Negative about social features 10 7Explanation of other health software 4 2categories and then each comment is grouped into related themes [39]. Table2 shows these 10 categories with the number of comments for each categoryand the number of themes that emerged in each category.Table 7.5 shows the themes that emerged from the category ?difficultieswith VivoSpace?. The main concern was the perceived difficulty in enteringinformation, as it was felt that inaccurate information would make thesystem less effective. Privacy concerns were also raised, as it was felt thathealth information is personal. The second most frequently mentioned wasconcerns around privacy of health information. Specifically, participantsvoiced concern around whether they would be willing to share unhealthybehaviour, and some felt that they would not share health information at all.Many felt that access to the digital assets (personal library) did not fit thescope of VivoSpace, and that the prototypes had too much information.The themes shown in Table 7.5 for what the participants did not likeabout the paper prototype design of VivoSpace can be better understood byreviewing what the participants actually said:I would not be able to contend with the amount of data entryneeded to give me good results, and that would be an issue. [P11]Yeah, I don?t want my girlfriend to know that I had a burger,128Chapter 7. User-Centred Design (UCD) ProcessTable 7.5: Themes emerging from ?Difficulties with VivoSpace? category.Theme # of CommentsToo difficult to enter information & data collection concerns 20Privacy: not wanting to share unhealthy habits 13Too much material 10Digital assets/personal library does not fit 7Lack the motivation to use the system 4Not wanting to join another OSN 4Sees difficulty in adding a recipe 4Privacy: willing to share the nutritional information 3Seals are not trustworthy 2Only health conscious people would find it enjoyable 2Concerns about how recipes are shared 2Needs a certain amount of people to be interesting 2Better to provide broad guidelines than numbers 2Privacy concerns: Not wanting to share the information 26 other items mentioned once each 1I want her to think that I?m having healthy food. [P1]There must be much more simplicity for the site becausepeople might want something quick, they want something fun.[P7]There were many aspects of VivoSpace that participants liked. Table 7.6shows the themes that emerged from this category and the number ofcomments for each theme. The most frequently mentioned was that loggingof health information would be helpful, which is at odds the perceiveddifficulty in logging this information. The dashboard was the page thatwas most liked, as well as the recipe sharing aspect of the prototype. Theparticipants liked certain design elements such as the personal preset icons.Encouragingly, participants did like some of the social gaming aspects suchas the winners and losers and the idea of using OSNs to track life behaviour.The themes shown in Table 7.6 for what the participants did like about thepaper prototype design of VivoSpace can be better understood by reviewingwhat the participants actually said:.. even if it helps me as a personal tools to show me how I129Chapter 7. User-Centred Design (UCD) ProcessTable 7.6: Themes emerging from ?Likes about VivoSpace? category.Theme # of CommentsPersonal health informatics would be helpful 16Likes dashboard 16Likes recipe sharing aspect 9Like the personal preset icons 8Likes winners and losers 4Likes the idea of OSN to track life behaviour 5Likes newsfeed / familiar Facebook feel 4VivoSpace would help one to organize one?s life 3Likes MyMap 3Likes calendar 26 other items mentioned once each 1am doing , I think I would keep using it and the social for mewould be optional. [P5]I like this kind of dashboard. I can see what I have done andhow something like it can affect my future. [P6]The participants shared many recommendations to improve VivoSpace(Table 7.7). They were very encouraged by the idea of social gaming andthere were numerous suggestions to create challenges to allow groups to assistone in achieving their goals. Another recommendation was to make oneshealth goals more central to the design. The participants were concernedabout managing another OSN, so they suggested that VivoSpace shouldintegrate with existing OSNs like Facebook R?and/or Twitter R?.An example of how one participant suggested that the creation of groupgoals would be beneficial to VivoSpace can be found in the following quote:...if I set a goal and people join and try to achieve the samegoal then that alone even if we don?t know the person, createsa community say that person is having the same problem thatI am having and trying to achieve the same goal, so that alonecreates a sense of connection with that person and the progressupdates. [P5]130Chapter 7. User-Centred Design (UCD) ProcessTable 7.7: Themes emerging from ?Recommendations for VivoSpace? category.Theme # of CommentsCreation of challenges or groups working together to achieve a goal 20Goals need to be more central 12Better to allow for customized dashboards and trackers 7Need to integrate with existing OSNs and online calendars 7VivoSpace should remain focused on health information 2Create badges / sharing of other achievements 2Information of friends on Winners & Losers should include more 2Suggestions for dashboard 2System needs to provide recommendations on how to live healthy 2Need to be able to customize the to-do list and calendar colours 25 other items mentioned once each 17.2.3 DiscussionThe interview evaluation of the paper prototypes of VivoSpace reveals how theinterpretation of the design elements from the ABC Framework resonatedwith the user, and how the design elements can be reworked. The designfeatures that resonated with the users were those associated with personalhealth informatics aspects and the dashboard. Therefore, the determinantsfrom the ABC Framework that were provided in the design were motivationto use VivoSpace in order to Provide Information and Social Enhancementthrough the ability to enter personal health information, and motivationto change health behaviour by providing a dashboard that supported thebuilding of Knowledge of healthy foods and Self-Efficacy in one?s ability tolive in a healthy manner.There were many aspects of the ABC Framework that can be incorpo-rated in a better manner. Specifically, the Entertainment, Social Enhance-ment, and Social Comparison determinants were too soft in the design, andthe gaming features need to be better incorporated into the design. Thesuggestion to have group goals and challenges presents some better ways tomake social gaming features more central. Furthermore, the design was toocomplex and tried to incorporate too much material, so where we felt thedesign was allowing for the Convenience of consolidating digital information,131Chapter 7. User-Centred Design (UCD) Processit was actually making the system too complex. We need to remove thedigital assets feature and simplifying the design by having less information oneach page. Another key aspect that needs to be addressed is the motivationto Provide Information, the interview evaluation revealed that the currentdesign does not provide motivation to enter information; therefore, the gamedesign needs to reward users for providing information, which may allow forgreater motivation to Provide Information.There were also other aspects of the design of the paper prototypethat the interviews revealed. Interview participants were fascinated by thesocialization of health information and suggested the creation of challengesand group health activities as motivational features. However, the privacyissues raised still need to be resolved: the next iteration of the design needsto provide the user with a sense of control over their privacy.7.3 Medium Fidelity Prototype for VivoSpaceThe evaluation of the Paper Prototypes for VivoSpace through the use ofthe ABC Framework allowed us to discover how to better interpret thedeterminants of the framework into design elements that both promote useand health behaviour change. The changes that we described in Section 7.2.3were incorporated into a Medium Fidelity Prototype, which provided aninteractive system that was evaluated in a laboratory setting. This mediumfidelity prototype was developed using HTML, CSS, Javascript and jQuerywith the vision to present a realistic interactive representation of our system.In total there were 32 HTML pages, 1 css file, and 2 javascript files.The main activity page for VivoSpace?s medium fidelity prototype isshown in Figure 7.8. The Medium Fidelity prototype has three main areas.The left side has the list of friends with links to their home page. There isalso a link to be able to invite new friends to join VivoSpace. The calendarand to-do list is also available on the left side bar. All of these features remainsimilar to the Paper Prototype with the only minor revision of bringing thelist of friends to the top to make the social aspects more prevalent. Thetop bar shows a picture of the user along with a summary of the gaming132Chapter 7. User-Centred Design (UCD) Process! Figure 7.8: A screenshot of the Medium Fidelity Prototype for VivoSpaceshowing the main activity page.features. There are now three main ways to engage the user through gaming:1) through individual goals, which are personal and allow the user to earnstars when completed; 2) through clubs, which are collaborative group goals,which allow the user to earn badges; and 3) through challenges, which arecompetitive group goals, and allow the user to earn trophies. The mainarea of VivoSpace is shown below the goals summary. The user can entertheir meals, weight or physical activity. Once entered, VivoSpace shows thenutritional value for the food or calories expended for physical activities, andallows the user to share the activity. Once the activity is shared, the user?ssocial network connections (or friends as we will call them) can view it and133Chapter 7. User-Centred Design (UCD) Processcomment on it.7.3.1 Key Functions of Medium Fidelity PrototypeThere are 6 main functions that the medium fidelity prototype provides:1. Entry of meals and physical activity: Provides a means to enter mealsor activity (Figure 7.8); cumulative daily values for each of the nutrients aredisplayed with any evidence-based seals if it meets set criteria. The user canchange the types of activities that she/he may log, the nutrients that aredisplayed, and the daily targets. This allows for the following determinantsfrom the ABC Framework: provide information, get information, self-discovery, convenience, entertainment, social enhancement, health outcomes,and environmental cues.2. Newsfeed: The newsfeed page shows activities and accomplishments thatfriends shared. Any logged activity above can be shared with the user?sfriends, and then it will appear on their friends newsfeed page, and theycan comment on it. This allows for the following determinants from theABC Framework: get information, maintain interpersonal connectiv-ity,entertainment, shared identity, knowledge, perceived facilitators, socialcomparison, social interaction, and personal knowledge of others.3. Dashboard: The dashboard page shows a summary of how the user is doingin terms of the nutritional intake based on the daily targets that are set.Time series charts are also provided along with a green checkmark for thosenutrients where the target is met, and a red high or low where the target is notmet. Charts are displayed for each nutrient or the user?s weight when the iconis clicked on the summary table (Figure 7.9). This allows for the followingdeterminants from the ABC Framework: get information, entertainment,self-discovery, convenience, knowledge, health outcomes, perceived barriers,perceived facilitators, incentives, and self-efficacy.4. Personal goals: The goals section provides the ability to track and createnew health goals, and to view rewards for successes. The current active goalsare shown with the nutritional intake compared against the target goals;charts and definitions of nutrients are also provided. New goals can also be134Chapter 7. User-Centred Design (UCD) Processcreated from a library of goals such as lose weight and healthy heart. Starsare earned when goals are successfully completed; users can view their ownstars and their friends? stars. This allows for the following determinants ofuse from the ABC Framework: social enhancement, entertainment, goals,self-discovery, knowledge, health outcomes, self-efficacy, perceived barriersand facilitators, and attitude.5. Group goals (clubs): Clubs are similar to goals with the exception thatusers friends are invited to participate in the club. When viewing currentclubs users can see how other members of the club are doing. Members ofthe club can comment on people?s progress in the club. Badges are earnedwhen members successfully complete the requirements. Users can view andcomment on their friends? badges. This allows for the following determinantsof use from the ABC Framework: social enhancement, entertainment,maintain connectivity, self-efficacy, get information, provide information,shared identity, goals, perceived facilitator, attitude, social interaction, socialidenitity, sense of belonging and self-efficacy through others6. Competitive goals (challenges): Challenges are similar to clubs withthe exception that there are competitive and there is only one winner.Challenges display a leaderboard. The winner of challenges earns a trophy.The determinants for use are the same as those listed for group goals.Screen captures for all the pages of the medium fidelity prototype forVivoSpace can be found in the Fifth Appendix.The medium fidelity prototype shows less information on each page,which make the design less complex than the paper prototypes. The entryof the food and physical activity and the newsfeed is easier to navigate andsimplified. The goals and gaming features were the biggest change that weremade to the design, as there are now more central by placing a summary atthe top of the site. Furthermore, the goals now have three different levels:individual, group, and competitive allowing user to participate in the mannerthat suits them.135Chapter 7. User-Centred Design (UCD) ProcessFigure 7.9: A screenshot of the Dashboard page of the medium fidelityprototype for VivoSpace showing the calories icon selected from the dashboardsummary table, which displays the historical chart for Calories consumed.7.3.2 Evaluation MethodsThe methods to evaluate VivoSpace based on the determinants of the ABCFramework involved multiple laboratory experiments. The purpose was todetermine if the design of VivoSpace provided the determinants for use ofthe OSN and motivation to change health behaviour. A total of 36 adultsparticipated in the experiments. They were recruited through universitylistserves, posters located around campus, and through advertisements onCraig?s list.The determinants of appeal were measured directly using self-reportthrough questionnaire feedback after the participant completed specific taskson the medium fidelity prototype. Some of the belonging determinants136Chapter 7. User-Centred Design (UCD) Processwere also enquired directly. However, measuring belonging cannot truly bemeasured through direct inquiry such as self-reports, as users? perceptionabout belonging and actual sense-of-belonging are often divergent. Forthis reason, we turned to the field of behavioural economics and adoptedthe helping game experiment [103] to evaluate if VivoSpace evokes indirectreciprocity. The method for how this experiment was adapted for theevaluation of the medium fidelity prototype is described in the HelpingGame Experiment section. Similarly, commitment is a temporal dimensionand difficult to measure in a 1-2 hour experiment; however, the in-groupexperiment [29] is an indirect means to evaluate if VivoSpace promotes groupcommitment. All experiments are conducted on a MacBook Pro laptop witha magic mouse. The VivoSpace application is displayed using Firefox R? webbrowser.18 of the 36 participants (Participant A group) completed all three exper-iments. These 18 participants first complete the individual task experiment,which takes approximately 1 hour to complete. Participant B group (18total) then individually joins each participation in the A group, and theycomplete the helping game and group commitment experiments togetherin pairs, which takes another 1 hour to complete. Each participant in theA group were remunerated $10 and each participant in the B group wereremunerated $5. A step-by-step description of methods and questionnairesused in the laboratory experiments are provided in the Sixth Appendix.ParticipantsOf the Participant A group, 10 were male and 8 were female. There were 7aged 19-24, 5 aged 25-34, 5 aged 35-49 and 1 was aged 50-64. The ethnicidentity for this group was: 10 were Canadian, 3 were West Asian, 1 wasChinese, 1 was Hispanic, 1 was First Nations, 1 was European and 1 wasAustralian. The majority were students: 5 were undergraduate students andanother 5 were graduate students. Of the remaining participants, 4 wereunemployed, 1 was a canvasser, 1 was a cleaner, 1 was a postdoctoral fellowand 1 was a physician.137Chapter 7. User-Centred Design (UCD) ProcessIn the Participant B group, 10 were male and 8 were female. There were12 aged 25-34 and 6 aged 35-49. 8 were Canadian, 3 were West Asian, 3 wereEuropean, 1 was South Asian, 1 was Australian, 1 was Chinese and 1 wasAmerican. 6 were graduate students and 3 were software developers. Theoccupations of the remaining 9 were: employment assistance worker, post-doctoral fellow, professor, college teacher, researcher, software developmentmanager, scientist, education program manager, and administrator.The participant distribution did have diversity in gender and occupation.There was also some diversity achieved in age and ethnicity. The importanceof achieving a diverse participant base is important because VivoSpace isbeing designed for use by a broad population. Therefore, we aimed to achievea representative sample of participants.Individual Task ExperimentThe individual task experiment methodology is drawn from traditionalusability tests. During this experiment, each participant is asked to completea group of tasks on VivoSpace. There are six groups of tasks, which correspondto the 6 key functions that are outlined in Section 7.3.1. After each taskgroup, the participant is given a questionnaire to complete. The questionnairecontains statements, where each statement correlates to a determinant fromthe ABC Framework. The participant can provide their level of agreementor disagreement to each statement using the 7-point Likert scale that isprovided, where 1 is strongly disagree and 7 is strongly agree. Most ofthe determinants that were enquired are from the Appeal dimension, butthere are also some from the Belonging dimension. Those Belongingdeterminants enquired through this method are chosen because they are easyto inquire directly.The follow-up questionnaire after each group of tasks included statementssuch as the following, which correspond to a determinant from the ABCFramework (full questionnaires for each of the task groups can be found inthe Sixth Appendix):? I would be able to gain information about myself and my capabilities by using138Chapter 7. User-Centred Design (UCD) Processa system like this (Appeal: self-discovery)? The newsfeed would allow me to stay connected with my friends and family(Appeal: maintain interpersonal connectivity)? The newsfeed would allow me to view how my friends and family are stayinghealthy (Belonging: social comparison)? It would be entertaining to participate in clubs (Appeal: entertainment)Helping Game ExperimentThe determinants in the Belonging dimension of the ABC Framework aredifficult to measure through direct inquiry methods such as those describedabove in the individual task experiment. Therefore, indirect experimentalmethods are used to measure the determinants that contribute to belonging.Indirect reciprocity is a critical factor that facilitates sense of belonging, andother related determinants such a social categorization and group comparison.The Helping Game Experiment from experimental behavioural economicshas shown to provide an understanding of indirect reciprocity and groupbelonging [103]. This experiment is based on the repeated helping gamedeveloped by Nowak and Sigmund [80, 81]. The helping game experimentevaluates indirect reciprocity, which is necessary for OSNs to develop so-cial interaction and cooperation through group participation, feedback anddiscussion. Experimental behavioural economics is a leader in developinglaboratory experiments that indirectly measure behaviours, as often individ-uals are not able to describe why or how they behave in particular situations.For this reason, we adopted the experiment described by Seinen et al. [103]to be applied to the evaluation of VivoSpace in a laboratory setting. In theSeinen et al. experiment, there was no actual activity that the randomlyassigned pairs were helping each other on. They were simply being askedif they would help or not help. We adapt this experiment to be applied toproviding help in completing tasks on VivoSpace.We employ a mixed design to the helping game experiment in a similarmanner as the Seinen et al. experiment [103]. In our experiment, afterParticipant A has completed the individual task experiment, she/he is139Chapter 7. User-Centred Design (UCD) Processjoined by Participant B. Participant A is now an expert on VivoSpace andunderstands how to use it, and Participant B is a novice. Participant Aand B do not know each other. This set-up provides a good backdrop toapply the Helping Game Experiment. The following rules are provided to theparticipants: 1) there are 26 tasks that Participant B must complete, whichare shown on a sheet of paper to both participants; participant A has alreadycompleted all of these tasks; 2) each task has a cost associated with it; thereare 5 tasks that cost $5 and there are 21 tasks that cost $1; participant A isprovided with $50, which is provided as 50 fake $1 bills; participant B hasno money; 3) every time, Participant A helps B, she/he is given a point, sothe maximum points that can be earned is 26; Participant A starts with nopoints; 4) in the first condition, Participant B has 17 points. In the secondcondition, no information is provided on Participant B?s points; 5) beforeParticipant B can start each task, Participant A must decide if she/he isgoing to help her/him; and 6) the object of the game is to earn points.Therefore the mixed design experiment has 2 variables with two conditionsin each variable. The first variable is the two conditions assigned to eachpair: information about participant B?s points is provided or no informationabout participant B?s points is provided. The second variable is withinsubjects and it is the high cost tasks and low cost tasks. Therefore, the 4conditions in this mixed design are: information provided and high cost,information provided and low cost, no information provided and high cost,and no information provided and low cost. We are looking to see if theeffect of helping on VivoSpace will produce different results from the Seinenet al. [103] experiment, which found that having information about theirpartners points resulted in a statistically significant difference in the numberof times help was provided. The helper (participant A) is also asked formotivations to help or not help and if any strategy was invoked during thehelping game through open-ended questions.140Chapter 7. User-Centred Design (UCD) ProcessGroup Commitment ExperimentAlthough measuring Commitment to VivoSpace and new health behaviouris not possible in a laboratory experiment, group commitment has beenmeasured in the laboratory by social psychologists. If VivoSpace can invokegroup commitment, it will assist in developing commitment to the VivoSpacesystem and commitment to new health behaviours. The group commitmentexperiment has been adapted from Ellemers et al. experiments [29, 30]. Thepremise of the experiment is that group commitment can be measured bycreating groups where the group boundaries are permeable. In other words,individuals have the option of staying with the group or moving to anothergroup. The people in the group do not know each other and by imposinga situation where group status is provided and compared to other groupsdifferent conditions are created.Again, we use a mixed design experiment. The same partners from thehelping game experiment are now told that they are team, and must completea 10-question multiple-choice test on VivoSpace. The test contains obscurequestions that are not readily evident in the VivoSpace prototype. Theyare allowed to navigate through the system as they decide together on theresponse to each question. After the test is complete, the participants areseparated and provided with their score and the overall average score forthis test. One person is told they scored 70% and the average for the testis 50%, and the other person is told they scored 70% and the average forthe test is 90%. The two conditions are counter balanced, as half the timethe person that was the helper (participant A) in the previous experimentis given the below average condition and the other half is given the betterthan average condition. The participants are then given the option of groupmobility as two separate questions with different caveats. The first caveat isthat they can leave their partner but they will not be able to use VivoSpace,and the second caveat is that it would cost them $50 to leave. This mixeddesign experiment has four conditions: above average stay with VivoSpace,above average stay at no cost, below average stay with VivoSpace, and belowaverage stay at no cost. The reason to stay with their partner to continue to141Chapter 7. User-Centred Design (UCD) Processuse VivoSpace or leave their partner but also to lose the use of VivoSpacewas also inquired through an open-ended question.7.3.3 ResultsThe results for all three experiments are described below.Individual Task ExperimentThe results of the 7-point Likert questionnaire provide an understandingof how each of the 6 task groups promoted the Appeal determinants andsome Belonging determinants of behaviour being sought through VivoSpace.The responses were all 7-point Likert scale, where 1 was strongly disagreeand 7 was strongly agree. Each question is inquiring about a behaviouraldeterminant from the ABC Framework.Figure 7.10 shows the mean and standard deviation to the questionnaireresponses for the first task group. This first group of tasks involved enteringan activity, which was a meal at a local restaurant chain, and changingtarget values for nutrients and types of activities that can be logged. Theresults show that the entering activity task group most strongly endorsesthe following determinants: self-discovery, get information, convenience andhealth outcomes. The design does not favour the determinant to provideinformation. The remaining determinants, entertainment, social enhance-ment, and environmental cues, are neither strong nor weak. For this reason,we have run further statistical analysis on them. Factorial ANOVA analysison these three determinants was performed, where the factors were genderand age group. It was found that there was a statistically significant differ-ence between gender for finding the entertaining determinant (F(1,12)=4.6,p=0.05), where the mean difference between male and female is -1.4 withfemales finding it more entertaining then men.Figure 7.11 shows the mean and standard deviation for the questionnaireresponses to the second task group. This task group was based on thenewsfeed page and commenting on their friends activities. The responses allshow very good agreement to both the Appeal and Belonging determinants142Chapter 7. User-Centred Design (UCD) ProcessFigure 7.10: Mean 7-point Likert responses for Entering Activity task groupshowing the relevant Appeal determinants. The error bars represent thestandard deviation.that the design is aiming to promote. The Appeal determinants are getinformation, connection to friends and family, entertainment, shared identity,knowledge, and perceived facilitators. The Belonging determinants aresocial comparison, personal knowledge of others, social interaction, personalattraction to others through similarities, and social norms.Figure 7.12 shows the mean and standard deviation for the responsesto the third task group. This inquiry is around the dashboard page. Thereis very strong agreement for many of the Appeal determinants especiallyget information, self-discovery, convenience and knowledge. There is lessagreement in the dashboard providing any value to perceived barriers &facilitators, and it also does not provide a very strong incentive to healthyliving. Further analysis by factorial ANOVA shows no statistically significant143Chapter 7. User-Centred Design (UCD) ProcessFigure 7.11: Mean 7-point Likert responses for Newsfeed task group showingthe relevant Appeal and Belonging determinants. The error bars representthe standard deviation.differences between gender and age for these determinants.Figure 7.13 shows the mean and standard deviation for the responsesto the fourth task group, which is based on goals and star rewards forsuccessfully completing goals. Overall the determinants for the goals taskswere attained through the design of VivoSpace. However, the participantsfelt that receiving and sharing star rewards was not very entertaining, andthey would not use it to enhance their social position. Further analysis ofthese two determinants through a factorial ANOVA show that there is nostatistical difference between gender and age groups.Figure 7.14 shows results for the fifth (clubs) and sixth (challenges) taskgroup. There was good agreement that the design of the clubs pages with theAppeal and Belonging determinants, but the design of the challenges pagesscored lower for almost all determinants. Further, the design did not supportsocial enhancement especially for clubs. Further analysis factorial ANOVA144Chapter 7. User-Centred Design (UCD) ProcessFigure 7.12: Mean 7-point Likert responses for Dashboard task group showingthe relevant Appeal determinants. The error bars represent the standarddeviation.found that there is a statistically significant difference in the challengestask group between male and female in social enhancement (F(1,12)=5.777,p=0.033) with a mean difference between male and female of 1.8. Statisticallysignificant difference in the interaction between gender and age groups forsubjective norms (F(2,12)=4.22, p=0.041) was found showing that differentgenders in different age groups felt that challenges promoted subjective norms.Helping Game ExperimentA mixed design factorial 2x2 ANOVA is run on the results of the HelpingGame Experiment. The dependent variable is the percent of times ParticipantA helped Participant B. The within subject variable is the cost (cheap orexpensive) for the tasks. The between subject variable is information providedor no information provided about Participant B?s score. The results showthat there is a significant difference between the cheap and expensive tasks(F(1, 16)=5.54, p=0.032). The mean difference between the cheap andexpensive is 23.86%. This is not surprising and consistent with the Seinen et145Chapter 7. User-Centred Design (UCD) ProcessFigure 7.13: Mean 7-point Likert responses for Goals task group showingthe relevant Appeal determinants. The error bars represent the standarddeviation.al. experiment [103]. This result also shows that there is validity to the useof fake money as the cost of the tasks played a role in participants decisionto help or not help.The analysis of variance for knowledge of Participant B?s score in the2x2 factorial ANOVA reveals divergent results from the Seinen et al. ex-periment [103]. Interestingly, there is no statistically significant differencebetween the two conditions: information and no information (F(1, 16)=0.51,p=0.386). This provides some evidence that VivoSpace generates indirectreciprocity because the choice to help or not help was not influenced bythe points accumulated but rather some other factors. For this reason, wemust assume that VivoSpace played a factor in the decision to help (ornot help). Figure 7.15 shows the estimated marginal means and standarddeviation for the percent of tasks that Participant A helped in the mixed de-146Chapter 7. User-Centred Design (UCD) ProcessFigure 7.14: Mean 7-point Likert responses for Clubs and Challenges taskgroup showing the relevant Appeal and Belonging determinants. The errorbars represent the standard deviation.sign helping game experiment. Further, there was no statistically significantinteraction effects between the information condition and the cost condition(F(1,16)=2.34, p=0.146).When the helpers (Participant A) were asked about their motivationsfor helping, the answers varied greatly. Some said that it was because theywanted to be helpful, others wanted to gain points, and some were pragmaticand said they helped so that they were not merely observers in the game. Itwas also interesting to learn about the reasons for not helping, as often itwas because they felt that the tasks were easy because VivoSpace was simpleto use. This illustrates a limitation in the application of this experiment tomeasure indirect reciprocity, as we are basing our prediction on the designof VivoSpace to invoke a desire to help. However, this qualitative data does147Chapter 7. User-Centred Design (UCD) ProcessFigure 7.15: Estimated marginal mean values and standard deviation for per-cent of tasks helped during helping game experiment (n=9 for each condition).reveal engagement in the VivoSpace system during the experiment. For thoseparticipants who did know their partners score, this seemed to play a factorin their helping strategy to varying degrees, as many participants said thatthey were not too concerned by their partners score.Group Commitment ExperimentThe results of the group commitment experiment reveal that participantswere inclined to stay with their groups rather than leave them at some cost.The results are shown on Figure 7.16.After pairs of participants completed their test on VivoSpace, each partic-ipant was told that they either performed better than the average or worsethan the average. They were then asked if they would leave their partner andno longer use VivoSpace, and they were also asked if they would leave theirpartner for a cost of $50. The results show that most participants are inclinedto stay with their partner even those that were told that they performedpoorly. Statistical analysis was run on this 2x2 mixed design through Chi-148Chapter 7. User-Centred Design (UCD) ProcessFigure 7.16: Percent willing to stay or leave in the group commitment experi-ment (n=18 for each condition).Square test of association. The results show no statistically significant resultsbetween the test performance condition (higher and lower than average)and the choice to stay with the group for VivoSpace (Chi-Square(1)=1.639,p=0.200). Furthermore, there was no statistical difference between the testperformance conditions (higher and lower than average) and the choice to staywith the group at no cost or leave for $50 (Chi-Square(1)=1.172, p=0.279).This shows that VivoSpace did promote group commitment within the 36adults that participated in the experiment because the use of VivoSpacepromoted staying with the team despite poor performance.We also analyzed the qualitative results, where reasons for staying tocontinue to use VivoSpace or leave and losing the use of VivoSpace. Forthose participants that performed better than average, their reasons weremore indicative of the group dynamics, and they chose to stay because theyfound their partner to be helpful and knowledgeable. For most of those thatdid worse than the average, their reasons for staying with their partner werebased more on the desire to continue to use VivoSpace.149Chapter 7. User-Centred Design (UCD) Process7.3.4 DiscussionThe ABC Framework provided a foundation to measure the determinantsfor use of an OSN designed for health behaviour change. When the determi-nants within the Appeal dimension were enquired through questionnaireresponses after interacting with the system, it was found that many of thedeterminants were met in the design of VivoSpace?s medium fidelity proto-type. However, there was variation in the responses between the clubs andchallenges aspects of the design especially between males and females. Forthis reason, it would be beneficial for the design to combine goal, clubs andchallenges into a single component that allows for participants to decide toinvite friends and make it competitive or collaborative. This would allowthe goals component to appeal to the majority of users. The individual taskexperiment also revealed the weakest area of the design, which is motiva-tion to provide information, an integral part of the system. Without databeing logged, the other components in the design become less meaningfulas only partial health information may be logged. Therefore, the designof VivoSpace should be iterated to ensure stronger motivation to provideinformation. Some Belonging determinants were also inquired in this ex-periment, and the result show that the newsfeed and clubs components ofthe design provided the greatest support for these social determinants ofuse and health behaviour change. In summary, the Appeal determinantsfrom the ABC Framework can be measured through a task experiment,where the determinants are inquired through questionnaire feedback withLikert-scale responses.The helping game experiment provides evidence that the medium fidelityprototype for VivoSpace promotes indirect reciprocity and by extensionBelonging determinants. Indirect reciprocity would promote the follow-ing belonging determinants: subjective norms, shared identity and socialinteraction with others. Since there was no statistically significant differ-ence between having and not having information about their partners score(status), we can assume that VivoSpace played a part. This is because,in the Seinen et al. experiment, the knowledge of their partners score did150Chapter 7. User-Centred Design (UCD) Processplay a statistically significant difference than those who did not have thisinformation [103]. Although there are many variables that could interferewith this experiment, these are encouraging results. By showing that therewas no statistically significant difference, the motivation to help or not helpwould be based on the design of the prototype rather than their partnersscore. One limitation of our adaption of this experiment is that we used fakemoney; however, the results from the within subjects variable (expensiveand cheap tasks) did show a significant difference. These results provideevidence that the limitation of fake money did not play a role in limiting theexperiment. The results of the open-ended responses (for motivation to help)also supports that this experiment is a measure of indirect reciprocity, asmany participants said that they helped because they enjoy helping othersor it is in their nature to be helpful. When we asked about their motivationto not help, another limitation of our adaptation was revealed, as manysaid that it was because they found the task to be easy. Therefore, futureuse of the helping game experiment should consider other aspects of helpbeyond usability of the system. One example may be to help their partnerunderstand the nutritional value of a meal through the VivoSpace system.The group commitment experiment shows that VivoSpace does providegroup commitment. Participants were willing to stay with their groupseven those participants that performed worse than average. Furthermore,when the cost to leave the group was to block use of VivoSpace or a costof $50, there was still no statistically significant difference. Showing thatVivoSpace does promote commitment as much as economic gain. Althoughthe answer to the question to stay or leave question was made independentlyand privately, there is a risk that participants are not willing to admit theirdesire to leave the group. This is a limitation of this experiment.It is difficult to assess how the ABC Framework can be adapted or it-erated based on the results of the evaluation of the medium fidelity prototypeof VivoSpace. Although we could use the determinants from the frameworkto evaluate the prototype, we could not evaluate the interactions betweenthe determinants to use the system and the determinants for behaviourchange. The primary reason for this is because we could not truly assess151Chapter 7. User-Centred Design (UCD) Processhealth behaviour change in the short timespan of a laboratory experiment.At best, we can make some preliminary observations of how the frameworkmight work to inform the design. The Appeal determinants social enhance-ment, entertainment, goals, and Perceived Facilitators can be linked to theBelonging determinants group norms, social categorization, and subjectivenorms, which can be provided through an engaging social gaming experience.The social gaming experience can be enhanced and also looser in its couplingto the goals features. These changes were made in the high fidelity prototypeof VivoSpace.152Chapter 8ConclusionsThe main goal of this thesis was to clearly explicate the design of OSNsfor health behaviour change from a theoretical approach. We distilled thedeterminants for use of OSNs and health behaviour change to develop theABC Framework, which was used in a UCD process to both design andevaluate an OSN for health behaviour change. The UCD process includedInitial User Inquiry through questionnaires and interviews, paper prototypes,medium fidelity prototype, and the high-fidelity prototype. The high-fidelityprototype was evaluated in a field experiment using the ABC Framework.This research yielded design principles for OSNs for health behaviour change.This chapter summarizes the primary contributions of this research. It alsodiscusses the secondary contributions that came out of the research, as wellas discussion of direction for future research. The lessons that were learnedfrom this work is also described.8.1 Primary ContributionThe primary contributions of this research are the evaluated and iteratedAppeal Belonging Commitment Framework, the design principles foran OSN for health behaviour change, and the high-fidelity prototype ofVivoSpace that was able to change some health behaviour.8.1.1 Appeal Belonging Commitment FrameworkPrevious research in the design of technology including social technology hashad limited (if any) consideration of theoretical models for health behaviourchange. The Appeal Belonging Commitment (ABC) Framework is153Chapter 8. Conclusionsa conceptual framework for the design and evaluation of OSNs designed forhealth behaviour change that is derived from theoretical models. This frame-work addresses the gap in research within the human-computer interactioncommunity by providing a theoretically based framework that allows for thedesign and evaluation of OSNs for health behaviour change.Collation of Theoretical Models to Obtain the Determinants forUse of OSNs and for Health Behaviour ChangeThe ABC Framework was derived from theoretical models for use ofOSNs and for health behaviour change. We reviewed and distilled thefollowing theories for use of OSNs: the Uses and Gratification Theory, SocialInfluence Model ; Social Identity Theory ; Common Bond Theory ; CommonIdentity Theory ; Theory of Organizational Commitment ; and BehaviourChain for Online Participation. The individually based and socially baseddeterminants for use of OSNs were drawn from these theories. Temporalstages and attachment categories were also considered. Overlap between thedeterminants in various theories led to a collation of the determinants, anda broad perspective of all the aspects of behavioural determinants that leadto use of OSNs.Similarly, we reviewed and distilled the following theories for healthbehaviour change: the Health Belief Model ; Social Cognitive Theory ; Theoryof Reasoned Action; Theory of Planned Behaviour ; Common Sense Model ;and the Transtheoretical Model. The individually based and socially baseddeterminants were drawn from these theories, as well as the stages of change.We were able to obtain a fuller picture for determinants of health behaviourchange by considering the overlap between the theories as well as the deter-minants that were unique to only single theory. This approach contributesto existing theories by providing a theoretical framework that is more com-prehensive; for example, the Social Cognitive Theory add Self-Efficacy tothe Health Belief Model, but the Theory of Reasoned Action adds Attitudetowards Health Behaviour to both the Social Cognitive Theory and the HealthBelief Model, but neglects Knowledge, which was considered in the Health154Chapter 8. ConclusionsBelief Model and the Social Cognitive Theory.Interplay Between the Determinants for Use of OSNs and Deter-minants for Health Behaviour ChangeThe interplay is the relationship between the determinants, and in particularthe interplay between the determinants within the two domains: use ofOSNs and health behaviour change. The ABC Framework is then thecombination of the individual and social determinants for use of OSNsand health behaviour change combined with the interplay between thedeterminants. The interplay between the determinants allows designersto better interpret the theoretical framework so that they can design andevaluation OSNs based on the interplay between the determinants of thetwo domains. The interplay between the determinants for use of OSNsand the determinants for health behaviour change were validated throughthe field experiment. The interplay allows the design principles to developfor an OSN designed to change health behaviour. By explicitly showinghow specific determinants for use of OSNs such as Provide Information cancontribute to health behaviour change by showing the determinants that itis suppose to influence. Therefore, the ABC Framework can be used toevaluate OSNs for health behaviour change, which shows how the designshould be iterated to obtain more change in Health Behaviour. For example,the field experiment of our high-fidelity prototype revealed that many ofthe individually-based determinants such as Self-Discovery were met, whichled to an increase in Self-Efficacy, but the design needs to promote thesocially based determinants for use of OSNs such as Social Categorizationto encourage Subjective Norms and other social determinants for healthbehaviour change to occur. The final ABC Framework is described inChapter 5.Using the ABC FrameworkThe ABC Framework can be used by researchers to both design socialtechnologies for health behaviour change as well as evaluate social technologies155Chapter 8. Conclusionsfor health behaviour change. By having a theoretical framework that broadlycollates the determinants for use and health behaviour change, researchers candesign social technologies that considers all aspects. Furthermore, researcherscan use the framework to evaluate existing social technologies. This can bedone through pre- and post-experiments to determine if there is any changein the determinants for health behaviour, or they can use the frameworkdetermine if the determinants for use are met in the design in a mannersimilar to a heuristic evaluation.8.1.2 Design PrinciplesWe developed design principles based on the ABC Framework and throughthe results of the field experiment. The design principles that we havedeveloped contribute to future research as well as the development of newcommercial application that are designed from a theoretical foundation,which should lead to more efficacious change in health behaviour. The finalABC Framework showed the determinants for use of OSNs and healthbehaviour change change, and the interplay between them, so specific designprinciples were developed that link back to the theoretical framework. TheABC Framework informs the design of OSNs for health behaviour change,which is critical as the number of websites and mobile applications in thisdomain continues to grow. Through the application of the framework, thegrowing number of commercial applications can be designed to lead to moremeaningful health behaviour change for its users. The determinants for useof OSNs from the ABC Framework were formalized into design principles,which had been utilized and evaluated in the design of VivoSpace. Thesedesign elements were matched to the determinants for use of OSNs andhealth behaviour change.This research has shows that the design principles include both individualor single-user features as well as social features. Individual features includesuch elements as the dashboard, private logs, personal goals (when theuser chooses not to invite any friends to complete a goal with them), andaccumulation of points with levelling-up game features. Although an OSN156Chapter 8. Conclusionsis social in its design, HCI research has shown that even a purely sociallydesigned OSN such as Facebook R?has personal motivations for use, such asloading photos to have a personal store of the photos and access to thesephotos from any location [125], which is also validated through our theoreticalapproach. Social OSN features such as shared log entries, commenting onlogs, completing a goal with friends, and awareness of friends points andlevels are also included in the design principles.The design principles as outlined in Chapter 6 include both generaland specific principles. These design principles and features can be furtherabstracted and viewed through various lenses to create new interactiontechniques that will lead to future research in the design of OSN for healthbehaviour change. Furthermore, simplified design principles are provided foruse by industry as described in Section 6.18.8.1.3 The VivoSpace PrototypeThe high fidelity prototype called VivoSpace of an OSN for health behaviourchange was developed through a UCD process with the ABC Frameworkproviding the points of inquiry for the evaluation through each stage ofthe UCD process. The prototype was able to positively change some ofthe individual determinants for health behaviour change in individuals thatare associated with a primary care clinic. Specifically, VivoSpace was ableto change Attitude Towards Physical Activity, Perceived Self-Efficacy forEating a Health Diet, Perceived Self-Efficacy Towards Physical Activity, andStages of Change. Furthermore, VivoSpace was also able positively changehealth behaviour. There was statistically significant results for participantsassociated with a primary clinic in the Patient Activation Measure (PAM R?),which is a validated clinical measure for patient?s knowledge and confidencein managing their own health. Positive changes were also seen for the patientsassociated with a clinic for the number of times that participants walkedper week. The VivoSpace high fidelity prototype is described in detail inChapter 4.157Chapter 8. Conclusions8.2 Secondary ContributionsThrough the theoretically based UCD methodology that resulted in theprimary contributions described in Section 8.1, there were two secondarycontributions that also resulted from this research. We obtained an under-standing of the target user groups that would most benefit from an OSNdesigned for health behaviour change. Furthermore, we were also able toobtain an understanding of the ability to maintain the acquired changes afteruse of the OSN has ended.8.2.1 Target User GroupsAn OSN designed for health behaviour change is most efficacious when thenumber of connections that a user has is relatively small (in the order of 10),as apposed to a large diffuse social network connections as we see on largesocial network sites such as Facebook R?. This allows for the ability to havethe most impact on the health determinants from the design principles thatare provided from this research. Furthermore, the small social network usergroup should also be considered. Based on the results of the field experiment,we were able to compare two groups in their use of an OSN designed forhealth behaviour change: 1) a close-tie social network group that was notassociated with the same primary medical clinic; and 2) a loose-tie socialnetwork group that was associated with the same primary medical clinic.The results showed that the loose-tie clinical group were more engaged in thesocial aspects of VivoSpace. Additionally, the clinical group showed somestatistically significant change in the self-efficacy and attitude determinantsfor health behaviour change, and this group also showed a positive change intheir Patient Activation Measure (PAM R?).These results show that an OSN designed for health behaviour changeshows the greatest impact when applied to a group of individuals that comefrom the same socioeconomic strata and share the same primary medicalclinic that has a focus on wellness. The potential to use OSNs with clinicalpatients, who would benefit the most from preventative clinical interventions158Chapter 8. Conclusionscan be substantive in reducing healthcare costs through the prevention ofserious and costly medical illnesses.The current understanding of the efficacy of an OSN for health behaviourchange on other groups is currently limited to the two groups included inthe field experiment. Future work can be done by testing prototypes ondifferent groups such as First Nations groups, who have epidemic prevalenceof diabetes. This can potentially show how the design needs to be modifiedfor specific cultural groups, and its ability to change the determinants forhealth behaviour change.8.2.2 Maintained Health Behaviour Beyond UseThe use of ICTs for health behaviour change needs to be designed with theend-point of health behaviour change rather than habitual use of the ICT.We need to ensure that dependency on the tool is not being created throughthese technical solution. Instead, we are designing this OSN with the endpoint of building individual?s ability to maintain healthy behaviour. Thusthe OSN should not be a crutch to healthy living, but rather a means toachieve the ability to maintain healthy behaviour. The high fidelity design ofVivoSpace showed that many of the changes in the determinants for healthbehaviour change were maintain after use of VivoSpace ended. Althoughthese results were small and did not apply to all cases where changes wereobserved, it shows that this goal is plausible. We expect that by applying thedesign iterations that were outlined in Chapter 6 further sustained changescan be observed.8.3 Relevant PublicationsThis work yielded several publications and presentations through conferenceproceedings, a book chapter, workshop organization and participation, andinvited presentations.159Chapter 8. ConclusionsConference ProceedingsN. Kamal, S. Fels, and J. McGrenere (2013). Helping me helping you: design-ing to influence health behaviour through social connections. INTERACT2013. Cape Town, South Africa. (To appear)N. Kamal and S. Fels (2013). A user-centred methodology for designing anonline social network to motivate health behaviour change. Studies in HealthTechnology and Informatics, Volume 183: Enabling Health and HealthcareThrough ICT. 286-290. IOS Press. DOI: 10.3233/978-1-61499-203-5-286N. Kamal and S. Fels (2012). Determining the determinants of health be-haviour change through online social networks. In M. Bang, E. L. Ragnemalm(Eds.), Persuasive 2012, Lecture Notes in Computer Science 7284. Pages1-12. Springer Berlin/Heidelberg 2012. doi: 10.1007/978-3-642-31037-9 1N. Kamal, S. Fels, M. Blackstock, and K. Ho (2011). VivoSpace: Towardshealth behaviour change using social gaming. In J. C. Anacelto, S. Fels,N. Graham, B. Kapralos, S. El Nasr, and K. Stanley (Eds.), Entertain-ment Computing International Conference for Entertainment Computing2011, Lecture Notes in Computer Science 6972. Pages 319-330. SpringerBerlin/Heidelberg. doi:10.1007/978-3-642-24500-8 35N. Kamal, S. Fels, and K. Ho (2010). Online social networks for personalhealth informatics to promote health behavior. In The Second ACM SIGMMWorkshop on Social Media (WSM 2010). Oct 25-29, 2010. Firenze, Italy.Pages 47-52. http://doi.acm.org/10.1145/1878151.1878167Book ChapterN. Kamal, S. Fels, M. Blackstock, and K. Ho (2013). The ABCs of de-signing social networks for health behaviour change: The VivoSpace socialnetwork. In E. Kranakis (Eds.), Advances in Network Analysis and its160Chapter 8. ConclusionsApplications, Mathematics in Industry, Volume 18, Part 3, pages 323-348.Springer Berlin/Heidelberg. DOI: 10.1007/978-3-642-30904-5 15WorkshopsN. Kamal, S. Fels, M. Fergusson, J. Preece, D. Cosley, and S. Munson (2013).Designing social media for change. CHI ?13 Extended Abstracts on HumanFactors in Computing Systems, 3183-3186.N. Kamal, and S. Fels (2013). Increasing sociability of online social networksfor personal health informatics. ACM CHI 2013 Workshop Designing SocialMedia for Change. http://socialmedia4change.org/kamal/N. Kamal, S. Fels, K. Ho, L. Cheng, and M. Blackstock (2012). Patient-clinician partnership through a personal online health social network system.ACM CHI 2012 Workshop Bridging Clinical and Non-Clinical Health Prac-tices: Opportunities and Challengeshttp://www.ics.uci.edu/ yunanc/chi2012health/Participants.htmlN. Kamal, S. Fels, and M. Blackstock (2011). Personal health informatics:What is the role for online social networks? ACM CHI 2011 WorkshopPersonal Informatics and HCI: Design, Theory, and Social Implications.http://personalinformatics.org/chi2011/kamalPeer Reviewed PresentationsN. Kamal (2012). Designing VivoSpace: An online social network to motivatehealth behaviour change. For Panel Let?s Play: Motivate Healthy BehaviourUsing Games (M. Fergusson and N. Kamal). SXSW Interaction 2012, March2012, Austin, TX. http://schedule.sxsw.com/2012/events/event IAP11179N. Kamal (2011). Appeal, Belonging, Commitment (ABC) Conceptual161Chapter 8. ConclusionsFramework and a User Centered Design Process: An online social networkfor positive health behavior change. SoCS (Social Computational Systems)Workshop. NSF funded. Minneapolis, MN. June 9 - 11, 2011. (DoctoralSymposium with poster presentation)N. Kamal, S. Fels, K. Ho. (2010). Framework for personal health manage-ment using social networks. MITACS Workshop on Social Networks (Aug9-13, 2010) Vancouver, BC.8.4 LimitationsThere are several limitations to this research, which we will describe inthis section. Many of these limitations are addressed in the next section(Section 8.5 Directions for Future Research). The first limitation is onthe reliance on self-report data, which has the possibility of bias and itthreatens the construct validity of the experiments. This was somewhataddressed with the use of control groups, as the control group was alsoexposed to the same self-report questions; however, true behaviour changeand changes in overall health through clinical measures such as weight andpercent fat would more accurately measure changes in health behaviour.It should be noted that self-reports are used in clinical encounters, as wellas health and HCI research. The second limitation is evaluation of theABC Framework, as the evaluation was conducted with only with a smallgroup of participants from a narrow geographic and socioeconomic strata, sothe framework was not validate but rather there was evidence to supportthe final ABC Framework. The framework?s validation and iteration hasonly begun, and should be evaluated further with more groups. Along asimilar vein, the VivoSpace prototype was only tested against a control group.Further comparisons can be done with lower level interventions such as fooddiaries and use of commercial applications such as FitBit R?.162Chapter 8. Conclusions8.5 Directions for Future ResearchThis research answers the call for a more theoretical foundation to the designand evaluation of technology for behaviour change [47]. However, this workis only the beginning for HCI research in the design and evaluation of socialtechnology for health behaviour change using a theoretical foundation. Thereare many possibilities for future research in this area.1. The role of the clinician in this OSN needs to be considered. Since thechanges that were seen in the field experiment were for the clinical group,we need to consider how the clinician fits into the OSN. We need to beable to design for communication between individual and the clinician, andthe ability to share information with the clinician differently than sharinginformation with the individual?s peer group. Further research can also bedone to consider how this type of technology can augment clinical groupvisits, so that there is a face-to-face component to peer contact.2. The ABC Framework should be used to evaluate exiting commercialapplications for health behaviour change. The theoretically based ABCFramework should be used to evaluate existing commercial applications tosee which design features are contributing to the determinants for healthbehaviour change, and which design elements are not contributing. Further-more, the evaluation can also reveal where specific commercial applicationsare failing, which can lead to the development of commercial applicationthat lead to more efficacious health behaviour change.3. The ABC Framework was initially evaluated in the field experiment andshould be further validated and iterated. Future research can further evaluatethe ABC Framework through field evaluation of social technologies forhealth behaviour change to iterate the theoretical conceptual framework.Further iterations of the ABC Framework will allow for the design offuture OSNs that can lead to greater changes in health behaviour.163Chapter 8. Conclusions4. Future research should be done to better understand how to design fordifferent groups. The initial UCD process showed that there are differencesbetween gender, age groups, and ethnic groups in the determinants for use ofOSNs and health behaviour change. Furthermore, health behaviour changewas not observed for the younger non-clinical group. Larger field studies canreveal more insight into how different gender, age, and ethnic groups relateto determinants of the ABC Framework, and how new design principlescan be tailored for specific groups. Therefore, future research can be done todesign for different groups, and to iterate the ABC Framework for differentgenders, age groups, and ethnic groups. Conversely, additional field experi-ments with small groups of different age groups and ethnic groups can alsobe done to better understand each group?s relation to the determinants fromthe ABC Framework, so that tailored design principles can be developedfor specific groups. Specifically, future research can look at how to designsocial technology for younger closely-tied groups.5. Future field studies can also compare the VivoSpace prototype with lowerlevel interventions such as food diaries and technologies such at FitBit R?to see if designing using the ABC Framework provides more change overconventional interventions.8.6 Lessons LearnedWe have learned a great deal from this research. Primarily the lessonslearned relate to the accuracy of applying the ABC Framework to the low-and medium-fidelity prototypes. Although inquiring through self-reportsand indirect inquiry methods based on the ABC Framework providessome understanding of the design?s ability to meet the requirements of theframework, the value of the framework is limited. The evaluation of the low-and medium- fidelity prototype should be rapid and focus on user preferences,usability, and affect. For example, our low-fidelity prototype and our medium164Chapter 8. Conclusionsfidelity prototype both revealed that the users would not Provide Information;however, in the field experiment with the high-fidelity prototype, the userssaid that Providing Information was the main motivator to use VivoSpace.This shows that individual?s perceptions of their behavioural determinantsfor use are different in a laboratory than in the field.The UCD process should continue through multiple field experimentswith larger number of participants in each iteration. Our field experimentrevealed some usability issues with the social features. The participantswanted to have email notification to encourage their use of the commentsand group goals feature, so through a small pilot field experiment, we canfind these usability issue that can only be identified in the field, iterate thedesign, and then run a larger field experiment with a prototype that moreaccurately reflects the determinants that we are trying to achieve such asSocial Interaction in the example described.8.7 Concluding CommentsDesigning technologies for health behaviour change is a growing field of studyin HCI research and in industry. Many of these technologies have socialaspects to their design. Furthermore, health research shows the importance ofsocial connections to one?s health. For these reasons, we use OSNs as the basisfor the designing a technology for positive health behaviour change. Thiswork contributes to providing a theoretically based conceptual framework,the ABC Framework, for designing and evaluating and OSN for healthbehaviour change. 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The design of thisprototype is described in Chapter 4.Main Home Page181First Appendix: Screen Captures of High-Fidelity PrototypeMain Home Page when food item is clicked182First Appendix: Screen Captures of High-Fidelity PrototypeNewsfeed showing friends? log entries183First Appendix: Screen Captures of High-Fidelity PrototypeDashboard when a help question mark is clicked184First Appendix: Screen Captures of High-Fidelity PrototypeNotifications is clicked185First Appendix: Screen Captures of High-Fidelity PrototypeGoals Page186First Appendix: Screen Captures of High-Fidelity PrototypeCustomize page accessed by clicking Customize onDashboard or going to profile187First Appendix: Screen Captures of High-Fidelity PrototypeCustomize page when a help question mark is clicked188First Appendix: Screen Captures of High-Fidelity PrototypeCurrent Level and Revealed Character pop-up whenLevel is click on Home Page189Second Appendix:Questionnaires for FieldExperiment of High-FidelityPrototypeThis appendix provides all the questionnaires for the field experimentthat was conducted to evaluate the high-fidelity prototype of VivoSpace.It included the pre-questionnaire for all groups. This questionnaire wasalso the mid- and post-questionnaire for the control group. After the pre-questionnaire, this appendix also has the questionnaire that was used for themid- and post-questionnaire for the experimental group. The measures andthe results of the field experiment are described in detail in Chapter 4.Pre-study questionnaire for All Participants, andmid- and post-questionnaire for control group1) Please provide your PARTICIPANT NUMBER that you were given bythe researcher. If you can?t remember your number, please email NoreenKamal at noreenk@ece.ubc.caI. Demographic Information2) Please specify your gendera) Femaleb) Male3) What is your age?190Second Appendix: Questionnaires for Field Experiment of High-Fidelity Prototype4) What is your profession? (Please indicate that you are ?unemployed? ifyou are currently seeking employment. If you look after the home and/orchildren, please indicate ?homemaker?)5) What is the highest level of education you have received?a) High school graduate or lessb) Trade school or some university/collegec) University/college graduate or more6) What is your household income?a) Less than $20,000b) $20,000 to $29,999c) $30,000 to $39,999d) $40,000 to $49,999e) $50,000 to $64,999f) $65,000 to $79,000g) $80,000 or more7) Please indicate how frequently (if ever) you use the following online socialnetworksNever,I have tried it out (1 to 3 times),Monthly (or a few times/month),Weekly(or a few times/week), Daily (or a few times/day)FacebookTwitterGoogle PlusOther (specify below)II. Your Health Status8) Please indicate if you are a current or past patient at one of our partnerclinicsa) I am a current weight management patient at Dr. Kara Nances clinic191Second Appendix: Questionnaires for Field Experiment of High-Fidelity Prototypeb) I am a past weight management patient at Dr. Kara Nances clinicc) I am a current regular medical patient at Dr. Kara Nances clinicd) I am a current patient at Connect Healthe) none of the abovef) I am a past patient at Connect Healthg) I am a medical group visit patient at Connect Health9) Please describe if you have participated in any other wellness, weight loss,or health programs10) Do you have any health problems?a) Yesb) No11) Please specify the health problem(s)12) What is your current weight? lbs13) What is your current height?FeetInches14) How many servings do you consume on average every week for the fol-lowing foods?SaladsFruitsVegetablesFrench FriesPotato Chips (or similar)15) How often do you do on average every week for the following activities?Walking (30 minutes or more)Cardio or Aerobic Exercise like jogging (20 min or more)192Second Appendix: Questionnaires for Field Experiment of High-Fidelity PrototypeActive sportsOther activities like GardeningResistance exercise (like weight lifting)16) How healthy do you think you are? (6-point Likert Scale: 1 (very un-healthy) - 6 (very healthy))17) Please select which statement best describes your current stage in livinghealthya) I am not considering changing my lifestyle to live healthierb) I am thinking about changing my lifestyle to live healthierc) I am starting to prepare to change my lifestyle to live healthierd) I am changing my lifestyle and I am living in a healthy waye) I am now maintaining the lifestyle changes that I have made to continueto live healthy18) Were you in a different stage 4 months ago?a) Yesb) No19) Which stage were you in 4 months ago?a) I was not considering changing my lifestyle to live healthierb) I was thinking about changing my lifestyle to live healthierc) I was starting to prepare to change my lifestyle to live healthierd) I was changing my lifestyle and I am living in a healthy waye) I was maintaining the lifestyle changes that I have made to continue tolive healthy20) Please provide any additional comments about your current or past stagein living healthyNutrition and Health Multiple Choice testPlease answer the questions based on your current knowledge. Do not ask193Second Appendix: Questionnaires for Field Experiment of High-Fidelity Prototypefor help. Do no use the internet to find the answers.21) How many calories (approximately) does the average person ideallyconsume daily?a) 500 caloriesb) 1,000 caloriesc) 2,000 caloriesd) 3,000 calories22) All fats are unhealthya) Trueb) False23) What foods have high fiber content (select the most accurate item below)a) Whole wheat bread, beans and vegetablesb) Any breads and cereals grains (such as oat, barley, rice and quinoa)c) Whole wheat bread and meatsd) All of the above24) Even walking at a slow pace will burn caloriesa) Trueb) False25) What is iron?a) Iron is a mineral that helps produce red blood cells and helps transportoxygen throughout the bodyb) Iron is a nutrient that helps build and repair body tissuec) Iron is a nutrient that helps the digestive systemd) Iron is a nutrient that helps keep skin healthy26) Select the most correct response about sugara) Sugar is necessary in small amountsb) Sugar is not necessary for good health in any amount194Second Appendix: Questionnaires for Field Experiment of High-Fidelity Prototypec) Sugar is not found naturally in breadsd) All carbohydrates are sugars27) Select the most correct response about salta) Any amount of salt is unhealthyb) Sodium is found in saltc) Eating high amounts of salt leads to diabetesd) Eating too much salt leads to low blood pressure28) How does a person lose weight?a) With the help of certain drugs and special dietb) By eating more white meat and vegetablesc) By eating less food (fewer calories) and exercising mored) Only by exercising more29) What is Vitamin C good for?a) It will make my bones strongb) It helps heal woundsc) It helps me to recover from a cold or flud) It helps with night vision30) Protein is found in what foods?a) Potatoesb) Breadsc) Tomatoesd) MilkThoughts on Your Health31) Please select how strongly you agree or disagree with the following state-ments.5-point Likert Scale: Strongly Disagree, Disagree, Neutral, Agree, StronglyAgree195Second Appendix: Questionnaires for Field Experiment of High-Fidelity Prototypea) I feel that there are many barriers to healthy living such as lack of timeb) I have many strategies to assist me in living healthy such as remindersc) I understand that how events are connected such as eating better leads tobecoming healthy and avoiding illnessd) The food I eat does have an effect on my overall healthe) My activity level including walking and/or exercising has an effect on myoverall healthf) I have a good understanding of nutritional value of foodsg)I am capable of eating highly nutritious foods and resisting unhealthy foodsh) I am capable of increasing my activity level by walking or exercising everydayi) I am motivated to live in a healthy manner because of rewards such aslosing weight (or other rewards)j) I have health goals that I try to meet in the long term (over one month)k) I have health goals that I try to meet in the short term (over one day orweek)l) Eating healthy foods and leading an active lifestyle will help me to avoidillnessm) Eating healthy foods and leading an active lifestyle will help me to livelongern) I enjoy eating healthy foods and avoiding unhealthy foodso) I enjoy leading an active lifestyle and exercising regularlyp) I have similar eating and exercising habits as my familyq)I have similar eating and exercising habits as my friendsr) I often feel obligated to eat healthy foods because of my family and friendss) I often feel obligated to lead an active life and exercise because of myfamily and friendst) I often feel obligated to eat healthy foods because of societys expectationsu)I often feel obligated to lead an active life and exercise because of societysexpectationsv) I learn that I am capable of living healthier by seeing what my friendsand family are doingw)Some of my friends and family (or other systems and technologies) help196Second Appendix: Questionnaires for Field Experiment of High-Fidelity Prototypeme to live healthierx) Some of my friends and family (or other things such as work) prevent mefrom living healthiery) I think eating healthy foods and leading an active lifestyle will help me toavoid illness because of what others have told mez) I am motivated to live healthier based on what society and experts havetold me32) Please feel free to provide any additional comments about your thoughtson your personal health.Evaluation of your engagement as a patient33) Please select if you how strongly you agree or disagree with the followingstatements.4-point Likert Scale: Strongly Disagree, Disagree, Agree, Strongly Agreea) When all is said and done, I am the person who is reponsible for managingmy health conditionb) Taking an active role in my own health care is the most important factorin determining my health and ability to functionc) I know what each of my prescribed medications dod) I am confident I can tell my health care provider concerns I have evenwhen he or she does not aske) I am confident that I can tell when I need to go get medical care andwhen I can handle a health problem myselff) I know the lifestyle changes like diet and exercise that are recommendedfor my health conditiong) I am confident that I can follow through on medical treatments I need todo at homeh) I am confident that I can take actions that will help prevent or minimizesome symptoms or problems associated with i) my health condition(s)j) I am confident that I can find trustworthy sources of information aboutmy health condition and my health choices197Second Appendix: Questionnaires for Field Experiment of High-Fidelity Prototypek) I am confident that I can follow through on medical recommendationsmy health care provider makes, such as changing my diet or doing regularexercisel) I understand the nature and causes of my health condition(s)m) I know the different medical treatment options available to my healthconditionn) I have been able to maintain the lifestyle changes for my health that Ihave madeo) I know how to prevent further problems with my health condition(s)p) I know about the self-treatments for my health condition(s)q) I have made the changes in my lifestyle like diet and exercise that arerecommended for my health conditionr) I am confident I can figure out solutions when new situations or problemsarise with my health conditions) I am able to handle symptoms of my health condition on my own at homet) I am confident that I can maintain lifestyle changes like diet and exerciseeven during times of stressu) I am able to handle problems of my health condition on my own at homev) I am confident I can keep my health problems from interfering with thethings I want to dow) Maintaining the lifestyle changes that are recommended for my healthcondition is NOT too hard to do on a daily basis198Second Appendix: Questionnaires for Field Experiment of High-Fidelity PrototypeMid- and Post-Questionnaire for Experimental Group1) Please provide your PARTICIPANT NUMBER that you were given bythe researcher. If you can?t remember your number, please email NoreenKamal at noreenk@ece.ubc.ca2) Please select which statement best describes your current stage in livinghealthya) I am not considering changing my lifestyle to live healthierb) I am thinking about changing my lifestyle to live healthierc) I am starting to prepare to change my lifestyle to live healthierd) I am changing my lifestyle and I am living in a healthy waye) I am now maintaining the lifestyle changes that I have made to continueto live healthy3) Please provide any additional comments about your current or past stagein living healthy4) What is your current weight? lbs5) What is your current height?FeetInches6) How many servings do you consume on average every week for the follow-ing foods?SaladsFruitsVegetablesFrench FriesPotato Chips (or similar)7) How often do you do on average every week for the following activities?Walking (30 minutes or more)199Second Appendix: Questionnaires for Field Experiment of High-Fidelity PrototypeCardio or Aerobic Exercise like jogging (20 min or more)Active sportsOther activities like GardeningResistance exercise (like weight lifting)8) How healthy do you think you are? (6-point Likert Scale: 1 (very un-healthy) - 6 (very healthy))Nutrition and Health Multiple Choice testPlease answer the questions based on your current knowledge. Do not askfor help. Do no use the internet to find the answers.9) How many calories (approximately) does the average person ideally con-sume daily?a) 500 caloriesb) 1,000 caloriesc) 2,000 caloriesd) 3,000 calories10) All fats are unhealthya) Trueb) False12) What foods have high fiber content (select the most accurate item below)a) Whole wheat bread, beans and vegetablesb) Any breads and cereals grains (such as oat, barley, rice and quinoa)c) Whole wheat bread and meatsd) All of the above13) Even walking at a slow pace will burn caloriesa) Trueb) False200Second Appendix: Questionnaires for Field Experiment of High-Fidelity Prototype14) What is iron?a) Iron is a mineral that helps produce red blood cells and helps transportoxygen throughout the bodyb) Iron is a nutrient that helps build and repair body tissuec) Iron is a nutrient that helps the digestive systemd) Iron is a nutrient that helps keep skin healthy15) Select the most correct response about sugara) Sugar is necessary in small amountsb) Sugar is not necessary for good health in any amountc) Sugar is not found naturally in breadsd) All carbohydrates are sugars16) Select the most correct response about salta) Any amount of salt is unhealthyb) Sodium is found in saltc) Eating high amounts of salt leads to diabetesd) Eating too much salt leads to low blood pressure17) How does a person lose weight?a) With the help of certain drugs and special dietb) By eating more white meat and vegetablesc) By eating less food (fewer calories) and exercising mored) Only by exercising more18) What is Vitamin C good for?a) It will make my bones strongb) It helps heal woundsc) It helps me to recover from a cold or flud) It helps with night vision19) Protein is found in what foods?a) Potatoes201Second Appendix: Questionnaires for Field Experiment of High-Fidelity Prototypeb) Breadsc) Tomatoesd) MilkThoughts on VivoSpace19) What feature(s) of VivoSpace did you like the most?20) What feature(s) of VivoSpace did you like the least?21) Do you have any suggestions on how to improve VivoSpace?22) What were some of the reasons that you stopped using VivoSpace?23) What features would have motivated you to continue to use VivoSpace?24) Do you have any other thoughts about VivoSpace that you would like toshare?Please select how strongly you agree or disagree with the following statements.25) I used VivoSpace to get information (such as nutritional information)a) strongly disagree b) disagree c) neutral d) agree e) strongly agree26) Please provide additional information about your thoughts on gettinginformation from VivoSpace27) I used VivoSpace to provide information (such as my meals and physicalactivity)a) strongly disagree b) disagree c) neutral d) agree e) strongly agree28) Please provide additional information about your thoughts on providinginformation on VivoSpace29) I used VivoSpace to connect with other people202Second Appendix: Questionnaires for Field Experiment of High-Fidelity Prototypea) strongly disagree b) disagree c) neutral d) agree e) strongly agree30) Please provide additional information about your thoughts on connectingwith other people on VivoSpace31) I used VivoSpace to learn more about myself (e.g. my eating habits)a) strongly disagree b) disagree c) neutral d) agree e) strongly agree32) Please provide additional information about your thoughts on learningmore about yourself from VivoSpace33) I used VivoSpace to look good to others on VivoSpace (e.g. show othersthat you are eating nutritious foods)a) strongly disagree b) disagree c) neutral d) agree e) strongly agree34) Please provide additional information about your thoughts on usingVivoSpace to look good to others35) I used VivoSpace because it was entertaining (e.g. achieving new levelsor successfully completing goals)a) strongly disagree b) disagree c) neutral d) agree e) strongly agree36) Please provide additional information about your thoughts on VivoSpacebeing entertaining37) I used VivoSpace to relate to people who are similar to myselfa) strongly disagree b) disagree c) neutral d) agree e) strongly agree38) Please provide additional information about your thoughts on usingVivoSpace to relate to similar people39) I used VivoSpace because it was a convenient way to obtain healthinformation (or other conveniences)a) strongly disagree b) disagree c) neutral d) agree e) strongly agree40) Please provide additional information about your thoughts on VivoSpacebeing convenientYour thoughts on your health and use of VivoSpace203Second Appendix: Questionnaires for Field Experiment of High-Fidelity Prototype41) Please select how strongly you agree or disagree with the following state-ments.5-point Likert scale: Strongly disagree, Disagree, Neutral, Agree, StronglyAgreea) I feel that there are many barriers to healthy living such as lack of timeb) I better understood barriers by viewing my health information on VivoSpacec) I better understood barriers by connecting with others on VivoSpaced) The convenience of VivoSpace helped me to overcome barrierse) I was better able to overcome barriers because I wanted to look good toothers on VivoSpace (e.g. your friends on VivoSpace )42) Were there any other aspects of VivoSpace that helped you to overcomebarriers to living in a healthy way?43) Please select how strongly you agree or disagree with the following state-ments.5-point Likert scale: Strongly disagree, Disagree, Neutral, Agree, StronglyAgreea) have many strategies to assist me in living healthy such as remindersb) I was able to have new ways to assist me in living healthier by viewingmy information on VivoSpacec) I was able to have new ways to assist me in living healthier by connectingwith others on VivoSpaced) The convenience of VivoSpace helped me to assist me in living healthiere) I was able to have new ways to assist me in living healthier because Iwanted to look good to others on VivoSpace44) Were there any other aspects of VivoSpace that assisted you to live in ahealthy way?45) Please select how strongly you agree or disagree with the following state-ments.204Second Appendix: Questionnaires for Field Experiment of High-Fidelity Prototype5-point Likert scale: Strongly disagree, Disagree, Neutral, Agree, StronglyAgreea) I understand how events are connected such as eating better leads tobecoming healthy and avoiding illnessb) I was able to understand how events are connected for my personal healthfrom the information that I received on VivoSpace such as nutritional infor-mationc) I was able to understand how events are connected for my personal healthbecause I wanted to promote myself to others on VivoSpaced) I was able to understand how events are connected for my personal healththrough exchanging comments with other people on VivoSpace46) Were there any other aspects of VivoSpace that helped you to understandhow events are connected to your personal health47) Please select how strongly you agree or disagree with the following state-ments.5-point Likert scale: Strongly disagree, Disagree, Neutral, Agree, StronglyAgreea) The food I eat does have an effect on my overall healthb) My activity level including walking and/or exercising has an effect on myoverall healthc) I have a better appreciation that the food I eat and/or exercising affectsmy health through the information that I received on VivoSpace such asnutritional informationd) I have a better appreciation that the food I eat and/or exercising affectsmy health through the gaming features on VivoSpace like the completion ofgoals48) Were there any other features on VivoSpace that changed how youbelieved that the food you eat and/or exercising affects your overall health49) Please select how strongly you agree or disagree with the following state-205Second Appendix: Questionnaires for Field Experiment of High-Fidelity Prototypements. 5-point Likert scale: Strongly disagree, Disagree, Neutral, Agree,Strongly Agreea) I have a good understanding of nutritional value of foodsb) I obtained a good understanding of nutritional value for foods from theinformation that I received from VivoSpace50) What other aspects of VivoSpace provided you the opportunity to learnabout the nutritional value of foods and other healthy behaviors?51) Please select how strongly you agree or disagree with the following state-ments.5-point Likert scale: Strongly disagree, Disagree, Neutral, Agree, StronglyAgreea) I am capable of eating highly nutritious foods and resisting unhealthyfoodsb) I am capable of increasing my activity level by walking or exercising everydayc) VivoSpace allowed me to discover more about myself that showed me mycapabilities for eating healthy and exercisingd) I was able to learn about my capabilities by logging my eating/activityinformation on VivoSpace52) What other aspects of VivoSpace showed you what you are capable of?53) Please select how strongly you agree or disagree with the following state-ments.5-point Likert scale: Strongly disagree, Disagree, Neutral, Agree, StronglyAgreea) I am motivated to live in a healthy manner because of rewards such aslosing weight (or other rewards)b) The gaming features in VivoSpace motivated me to live in a healthy manner54) Were there any other rewards or incentives that VivoSpace provided that206Second Appendix: Questionnaires for Field Experiment of High-Fidelity Prototypemotivated you to be healthier?55) Please select how strongly you agree or disagree with the following state-ments.5-point Likert scale: Strongly disagree, Disagree, Neutral, Agree, StronglyAgreea) I have health goals that I try to meet in the long term (over one month)b) I have health goals that I try to meet in the short term (over one day orweek)c) The goals feature on VivoSpace helped me to meet my goals56) Were there any other aspects of VivoSpace that helped you to meet yourgoals?57) Please select how strongly you agree or disagree with the following state-ments.5-point Likert scale: Strongly disagree, Disagree, Neutral, Agree, StronglyAgreea) Eating healthy foods and leading an active lifestyle will help me to avoidillnessb) Eating healthy foods and leading an active lifestyle will help me to livelongerc) I have a better understanding of how eating healthy and exercising morewill help me to avoid illness through the information that I obtained inVivoSpace58) Were there any other aspects of VivoSpace that helped you to understandhow healthy eating and exercising can help avoid illness?59) Please select how strongly you agree or disagree with the following state-ments.5-point Likert scale: Strongly disagree, Disagree, Neutral, Agree, StronglyAgree207Second Appendix: Questionnaires for Field Experiment of High-Fidelity Prototypea) I enjoy eating healthy foods and avoiding unhealthy foodsb) I enjoy leading an active lifestyle and exercising regularlyc) The gaming features of VivoSpace helped me to enjoy healthy eating andexercising more60) Were there any other features of VivoSpace that helped you to enjoyhealthy eating and exercising more?61) Please select how strongly you agree or disagree with the following state-ments.5-point Likert scale: Strongly disagree, Disagree, Neutral, Agree, StronglyAgreea) I have similar eating and exercising habits as my familyb) I have similar eating and exercising habits as my friendsc) I have similar eating and exercising habits as my friends on VivoSpaced) VivoSpace allowed me to be a part of a group that helped me to havesimilar eating and exercise habits as my VivoSpace Friendse) VivoSpace allowed me to feel that I belonged to a group that helped meto have similar eating and exercise habits as my VivoSpace Friendsf) VivoSpace allowed me to see what my VivoSpace friends are doing thathelped me to have similar eating and exercise habits as my VivoSpace friendsg) VivoSpace allowed me to be dependent on others in VivoSpace, whichhelped me to have similar eating and exercise habits as my VivoSpace friendsh) VivoSpace allowed for the development of groups (such as group goals)that helped me to have similar eating and exercise habits as my VivoSpacefriends62) What other aspects of VivoSpace helped you to have similar eating andexercise habits as your VivoSpace friends? Why?63) Please select how strongly you agree or disagree with the following state-ments.5-point Likert scale: Strongly disagree, Disagree, Neutral, Agree, Strongly208Second Appendix: Questionnaires for Field Experiment of High-Fidelity PrototypeAgreea) I often feel obligated to eat healthy foods because of my family and friendsb) I often feel obligated to lead an active life and exercise because of myfamily and friendsc) I often feel obligated to eat healthy foods because of societys expectationsd) I often feel obligated to lead an active life and exercise because of societysexpectationse) VivoSpace allowed me to be a part of a group that made me feel obligatedto be healthierf) VivoSpace allowed me to feel that I belonged to a group that made mefeel obligated to be healthierg) VivoSpace allowed me to see what my VivoSpace friends are doing thatmade me feel obligated to be healthier64) Were there any other aspects to VivoSpace that made you feel obligatedto be healthier by eating healthier foods and/or exercising more?65) Please select how strongly you agree or disagree with the following state-ments.5-point Likert scale: Strongly disagree, Disagree, Neutral, Agree, StronglyAgreea) I learned that I am capable of living healthier by seeing what my friendsand family are doingb) VivoSpace allowed me to compare my health habits to others, whichshowed me that I am capable of living healthierc) VivoSpace allowed me to have personal knowledge of others, which showedme that I am capable of living healthierd) VivoSpace allowed for the development of groups (such as group goals),which showed me that I am capable of living healthier66) Were there any other aspects of VivoSpace that showed you that youare capable of living healthier?209Second Appendix: Questionnaires for Field Experiment of High-Fidelity Prototype67) Please select how strongly you agree or disagree with the following state-ments.5-point Likert scale: Strongly disagree, Disagree, Neutral, Agree, StronglyAgreea) Some of my friends and family (or other systems and technologies) helpme to live healthierb) VivoSpace allowed me to be a part of a group that helped me to livehealthierc) VivoSpace allowed me to interact with others that helped me to livehealthierd) VivoSpace allowed me to be dependent on others in VivoSpace, whichhelped me to live healthiere) VivoSpace allowed to compare my health habits with others, which helpedme to live healthier68) Were there any other aspects of VivoSpace that helped you to live health-ier?69) Please select how strongly you agree or disagree with the following state-ments.5-point Likert scale: Strongly disagree, Disagree, Neutral, Agree, StronglyAgreea) Some of my friends and family (or other things such as work) prevent mefrom living healthierb) VivoSpace allowed me to interact with others that helped me to overcomebarriers to living healthierc) VivoSpace allowed me to compare my health habits with others, whichhelped me to overcome barriers to living healthier70) Where there any other aspects of VivoSpace that helped you to overcomesocial barriers to living healthier?71) Please select how strongly you agree or disagree with the following state-210Second Appendix: Questionnaires for Field Experiment of High-Fidelity Prototypements.5-point Likert scale: Strongly disagree, Disagree, Neutral, Agree, StronglyAgreea) I think eating healthy foods and leading an active lifestyle will help me toavoid illness because of what others have told meb) VivoSpace allowed me to see what my VivoSpace friends are doing thatallowed me to see that living healthy will help me to avoid illnessc) VivoSpace allowed me to interact with others on VivoSpace that allowedme to learn that living healthy will help me to avoid illnessd) VivoSpace allowed me to have personal knowledge of others that allowedme to see that living healthy will help me to avoid illness72) Were there any other aspects of VivoSpace that allowed you to see thatliving healthy will help you to avoid illness?73) Please select how strongly you agree or disagree with the following state-ments.5-point Likert scale: Strongly disagree, Disagree, Neutral, Agree, StronglyAgreea) I am motivated to live healthier based on what society and experts havetold meb) VivoSpace allowed me to be a part of a group that motivated me to livehealthier based on what society and experts have told mec) VivoSpace allowed me to develop a sense of belonging that motivated meto live healthier based on what society and experts have told med) Some of the people on VivoSpace motivated me to live healthier based onwhat society and experts have told mee) VivoSpace allowed me to interact with others on VivoSpace that motivatedme to live healthier based on what society and experts have told me74) Were there any other aspects of VivoSpace that motivated you to livehealthier based on what society and experts have told you?211Second Appendix: Questionnaires for Field Experiment of High-Fidelity Prototype75) How do you feel a system such as VivoSpace can help you change ormaintain good health behavior?76) Do you feel that your health behavior has changed (e.g. are you eatinghealthier foods)?77) Do you have any additional thoughts on your health?Evaluation of your engagement as a patient33) Please select if you how strongly you agree or disagree with the followingstatements.4-point Likert Scale: Strongly Disagree, Disagree, Agree, Strongly Agreea) When all is said and done, I am the person who is reponsible for managingmy health conditionb) Taking an active role in my own health care is the most important factorin determining my health and ability to functionc) I know what each of my prescribed medications dod) I am confident I can tell my health care provider concerns I have evenwhen he or she does not aske) I am confident that I can tell when I need to go get medical care andwhen I can handle a health problem myselff) I know the lifestyle changes like diet and exercise that are recommendedfor my health conditiong) I am confident that I can follow through on medical treatments I need todo at homeh) I am confident that I can take actions that will help prevent or minimizesome symptoms or problems associated with i) my health condition(s)j) I am confident that I can find trustworthy sources of information aboutmy health condition and my health choicesk) I am confident that I can follow through on medical recommendationsmy health care provider makes, such as changing my diet or doing regularexercise212Second Appendix: Questionnaires for Field Experiment of High-Fidelity Prototypel) I understand the nature and causes of my health condition(s)m) I know the different medical treatment options available to my healthconditionn) I have been able to maintain the lifestyle changes for my health that Ihave madeo) I know how to prevent further problems with my health condition(s)p) I know about the self-treatments for my health condition(s)q) I have made the changes in my lifestyle like diet and exercise that arerecommended for my health conditionr) I am confident I can figure out solutions when new situations or problemsarise with my health conditions) I am able to handle symptoms of my health condition on my own at homet) I am confident that I can maintain lifestyle changes like diet and exerciseeven during times of stressu) I am able to handle problems of my health condition on my own at homev) I am confident I can keep my health problems from interfering with thethings I want to dow) Maintaining the lifestyle changes that are recommended for my healthcondition is NOT too hard to do on a daily basis213Third Appendix: Initial UserInquiry Questionnaire andInterview QuestionsThis appendix contains the initial user inquiry questionnaire that wasused at the beginning of the UCD process. Following the questionnaire, theinterview questions are also shown. The initial user inquiry is described indetail in Chapter 7 Section 7.1.Initial User Inquiry QuestionnaireI. Demographic information1. Please specify your gender.a. Femaleb. Male2. Which age group do you belong to? (select one)a. 19-24 years oldb. 25-34 years oldc. 35-49 years oldd. 50-64 years olde. 65-74 years oldf. 75 years old and older3. Do you identify as a First Nations or Aboriginal person (North AmericanIndian, Metis, or Inuit)? If you answer yes to this question, please go to214Third Appendix: Initial User Inquiry Questionnaire and Interview QuestionsQuestion 7.a. Yesb. No4. If you answered No to question 3, do you primarily identify as beingCanadian?a. Yesb. No5. If you answered No to question 4, which ethnic group do you primarilyidentify belonging to, please specifya. Chineseb. East Asian (including Japanese, Korean)c. South East Asian (Including Filipino, Malaysian, Thai, Indonesian, Viet-namese, Cambodian)d. South Asian (including Punjabi, Indian, Pakistani, Bangladeshi, SriLankan)e. Arabf. West Asian (including Iranian, Afghani)g. Hispanic (including Mexican, Cuban, South & Central American)h. Other:6. Do you identify with a secondary ethnic group?a. Yes. please specifyb. NoII. Computer and Mobile Phone Usage7. Do you own a computer?a. Yesb. No8. Do you own a mobile phone?215Third Appendix: Initial User Inquiry Questionnaire and Interview Questionsa. Yesb. No9. If yes, please specify the brand of mobile phone?a. iPhoneb. Blackberryc. Android (includes: HTC Magic, Google Nexus One, LG Eve, MotorolaQuench, Motorola droid, Motorola CLIQ XT, Motorola Backflip, SamsungI7500, Sony Experia, Acer Liquid)d. Windows Mobile (includes: HTC Typhoon, HTC Breeze, HTC Oxygen,HP IPAC)e. Symbian (includes: Nokia, Sony P800 & P900)f. Other. Please Specify10. Please specify how often you use the following technology (Throughoutthe day, at least once a day, at least once a week, a few times a day, a fewtimes a month, once a month or less, or never):a. Use a computerb. Use emailc. Use a mobile phoned. Use the internet on a computere. Use the internet on a mobile phoneIII. Use of Social Networks11. Please specify how often you have used the followings online socialnetworks over the past 2 months (Throughout the day, at least once a day,at least once a week, a few times a day, a few times a month, once a monthor less, or never):a. Facebookb. Linkedinc. MySpaced. Twitter216Third Appendix: Initial User Inquiry Questionnaire and Interview Questionse. Orkutf. Other. Please Specify:12. Do you use online communities such as special interest online forums ordiscussion groups?a. Yesb. No13. If yes, please specify the online community (or communities) that youhave participated in.14. If you answered yes to question 12, how often do you use the onlinecommunity? (If you participate in more than one online community, pleasespecify for the online community that you use most often)a. Throughout the dayb. At least once a dayc. At least once a weekd. A few times a monthe. Once a month or less15. If you use or have used online social networks or online communities,please select how strongly you agree or disagree with the following statementson the reasons that you use online social networks and/or online communi-ties(Strongly disagree, disagree, neutral, agree, strongly agree):a. I use online social networks and/or online communities to get informationb. I use online social networks and/or online communities to provide infor-mationc. I use online social networks and/or online communities for entertainmentor to pass timed. I use online social networks and/or online communities for conveniencesuch as easy access to friendse I use online social networks and/or online communities to maintain con-nection with people217Third Appendix: Initial User Inquiry Questionnaire and Interview Questionsf. I use online social networks and/or online communities to have moreinfluence with people I know or to enhance my social positiong. I use online social networks and/or online communities to learn moreabout myselfh. I use online social networks and/or online communities to belong to agroup or communityi. I use online social networks and/or online communities to connect withsimilar peoplej. I continue to use social networks and/or online communities because I amfond of using itk. I continue to use social networks because I feel that I would loose some-thing if I stopped using itl. I continue to use social networks because everyone is using themj. I have used online social networks or online communities more in the pastthan I do currently16. Please provide any additional information about your use of online socialnetworks and/or online communities.IV. Informational Needs17. Please select how you store the information type below (Computer ormobile phone, paper, both paper and computer/mobile phone, do not storethis type of information):a. Phone numbers for family and friendsb. Addresses for family and friendsc. Information about upcoming social eventsd. Information about appointmentse. Personal to-do listsf. Doctors (or other health person) office information (e.g. address andphone number)g. Prescription informationh. Nutritional information (e.g. food that you have eaten)i. Information about exercise218Third Appendix: Initial User Inquiry Questionnaire and Interview Questionsj. Information about how to live healthy18. Please specify any other type of information that is not listed above andcomment about your method of storing this information.19. Does anyone else in your home assist you with managing your personalinformation?a. Yes. Please specify types of personal informationb. No20. If yes, please specify who in your household assists you with the manage-ment of your personal information. (Select all that apply)a. Wife or female partnerb. Husband or male partnerc. Motherd. Fathere. Sisterf. Brotherg. Daughterh. Soni. Other. Please Specify21. Does anyone else in your home assist you with managing your healthinformation?a. Yes. Please specify type of health informationb. No22. If yes, please specify who in your household assists you with the manage-ment of your health information. (Select all that apply)a. Wife or female partnerb. Husband or male partnerc. Motherd. Father219Third Appendix: Initial User Inquiry Questionnaire and Interview Questionse. Sisterf. Brotherg. Daughterh. Soni. Other. Please Specify23. Do you assist anyone in your household with the management of theirpersonal information?a. Yes. Please specify type of personal informationb. No24. If yes, please specify who in your household you assist with the manage-ment of their personal information. (Select all that apply)a. Wife or female partnerb. Husband or male partnerc. Motherd. Fathere. Sisterf. Brotherg. Daughterh. Soni. Other. Please Specify25. Do you assist anyone in your household with the management of theirhealth information?a. Yes. Please specify type of health informationb. No26. If yes, please specify who in your household you assist with the manage-ment of their health information. (select all that apply)a. Wife or female partnerb. Husband or male partnerc. Mother220Third Appendix: Initial User Inquiry Questionnaire and Interview Questionsd. Fathere. Sisterf. Brotherg. Daughterh. Soni. Other. Please Specify27. Please feel free to make any additional comments about the storage andmanagement of personal information and health information.V. Your health status and thoughts about your health28. Do you have any health problems?a. Yesb. No29. If yes, please specify the health problem(s)30. Does anyone in your household have any health problems?c. Yesd. No31. If yes, please specify the health problems(s)32. Please select if you how strongly you agree or disagree with the followingstatements (Strong disagree, disagree, neutral, agree, strongly agree):} a. Ilive a healthy lifestyleb. I eat healthy foodc. I exercise regularlyd. I am concerned about my healthe. I understand how to live in a healthy wayf. I understand the nutritional value for the food I eatg. My friends and family influence the food that I eath. My friends and family influence how much I exercise221Third Appendix: Initial User Inquiry Questionnaire and Interview Questionsi. My friends and family are positive influences on my healthj. I find it easy to eat healthy foodk. I find it easy to exercise regularlyl. I ate healthier foods in the past than I do todaym. I exercised more in the past than I do todayn. I find it difficult to maintain a healthy lifestyleo. I feel that I am capable of living a healthier life33. Please feel free to provide any additional comments about your thoughtson your personal health.222Third Appendix: Initial User Inquiry Questionnaire and Interview QuestionsInterview QuestionsI. Demographic information1. Please specify your gender.a. Femaleb. Male2. Which age group do you belong to?a. 19-24 years oldb. 25-34 years oldc. 35-49 years oldd. 50-64 years olde. 65-74 years oldf. 75 years old and older3. Do you identify as a First Nations or Aboriginal person (North AmericanIndian, Metis, or Inuit)?4. Do you primarily identify as being Canadian?5. If you answered No to question 4, which ethnic group do you primarilyidentify belonging to?6. Do you identify with a secondary ethnic group? Which one?II. Computer and Mobile Phone Usage7. Do you own a computer? How often do you use it? What do you primarilyuse it for?8. Do you own a mobile phone? How often do you use it? What do youprimarily use it for? If yes, please specify the brand of mobile phone?223Third Appendix: Initial User Inquiry Questionnaire and Interview Questions9. Do you use the internet? How often to you use it? What do you primarilyuse it for?III. Use of Online Social Networks10. Do you use online social networks (e.g. facebook, myspace, linkedin,Friendster, Orkut)? How often do you use it? What do you primarily use itfor?11. Do you use online communities such as special interest online forums ordiscussion groups? How often do you use it? What do you primarily use it for?IV. Your health status and thoughts about your health12. Do you have any health problems? Explain.13. What are your thoughts about living a healthy lifestyle? What does ittake? Do you feel that you do live healthy?14. Do your friends and family influence your health behaviour?V. Feedback on prototypes (show prototypes and explain thembriefly)15. What are your initial thoughts on these prototypes?16. Would this type of system be fun and enjoyable to use? Why or whynot?17. What benefits would this type of communication provide to you?18. Would this type of system allow you to belong to a social group or224Third Appendix: Initial User Inquiry Questionnaire and Interview Questionscommunity? Why or why not?19. Would you want to continue to use this system over a long period oftime? Why or why not?20. Would this type of system influence your health behaviour? Why or whynot?21. Would this type of system allow you to see the key influences of healthbehaviour? Why or why not?22. Would this type of system allow you to be influenced by your socialgroup? Why or why not? How can we design this so that the influence ispositive?23. Would this system allow you to see change in health behaviour overtime? Why or why not?24. What changes would you like to see in the design of this system?225Fourth Appendix: PaperPrototypesThis chapter shows each page of the paper prototypes that were developedusing Adobe Illustrator. The design and evaluation of the paper prototypesare described in detail in Section 7.2.NewsfeedNewsEditsubitemHome | edit Pro!leSearch LogoutvivoSPACE Noreen SampleOrganizer Personal Libary/ArchiveMusicphotosmoviesvideoslinksNews My Timeline DashboardFriendsAll WorkTo DoMay 2011Work BBQ DinnerClean KitchenDrive CarpoolMum?s Birthday PartyFriendsConnections5 new massegesFamiliy CaretakerAdd Text to shareAttach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    HGeorge DreamHanna FictionBarack ObamaHank HomeIrvin StarIToday?s performance balanceShareGrilled Halibut with LeaksHanna FictionGrilled HalibuttMeet my new puppy!His name is Norbert. I just love him.30 Minutes ago | Comment | LikeGeorge DreamIt?s so cute, can?t wait to meet it. are you going to bring him by the baseball game?write a commentIrvin StarI gave this recipe a try and it is great!write a comment7 Hours ago | Comment | Like654 calInvite: Bowling Night! Are you in21  Hours ago | Comment | LikeBarack Obamawrite a commentWednesday May 18, 5.30pm        attendingCommunityAddet by Hank Home !"#$%%%$&#'($ $ )**$"#(()+#($,-!"$,-.#/0(1$#2#/3(1$-#4#/3$)00($5*.6#$,)4#7!!6$/#'(8226Fourth Appendix: Paper PrototypesMy TimelineNewsEditsubitemHome | edit Pro!leSearch LogoutvivoSPACE Noreen SampleOrganizer Personal Libary/ArchiveMusicphotosmoviesvideoslinksNews My Timeline DashboardFriendsAll WorkTo DoMay 2011Work BBQ DinnerClean KitchenDrive CarpoolMum?s Birthday PartyFriendsConnections5 new massegesFamiliy CaretakerAdd Text to shareAttach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    HGeorge DreamHanna FictionBarack ObamaHank HomeIrvin StarIToday?s performance balanceShareGrilled Halibut with LeaksHanna FictionGrilled HalibuttMeet my new puppy!His name is Norbert. I just love him.30 Minutes ago | Comment | LikeGeorge DreamIt?s so cute, can?t wait to meet it. are you going to bring him by the baseball game?write a commentIrvin StarI gave this recipe a try and it is great!write a comment7 Hours ago | Comment | Like654 calInvite: Bowling Night! Are you in21  Hours ago | Comment | LikeBarack Obamawrite a commentWednesday May 18, 5.30pm        attendingCommunityAddet by Hank HomeAdd personal entryAttach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    May 201019Shareadd/edit options to choose from in ProleSaturatedFatmgcal  calToday Tuesday, 19th  May 9.00am108mg/dl 136/s163lbWalking 15 minsBreakfast Cerials 185 calVitamin C Sublement 85 mgdailysWednesday, 18  May 8.00pmSome personal information about what I did that day.I walked there and it was a beautiful spring day.  The girls and  had a really nice time, but ate to much. Shared with CaretakersShared with Family, Friends, CaretakersGourmet Burger & Caipirinna 312cal 62min1010cal 25gFatDinner at Earls with Irvin and CloeediteditWednesday, 18  May 4.00pm Shared with not sharedDouble Double from TH 150cal16 oz Co#ee, 2 sugar, 2 creampastat Earlsat Tim Hortons !"#$%%%$&'"#(')#$ $ *+,-.$!/$,(($0#+1!),($)!*#12$,3*!",*'-,((4$,55#5$!+$0#+1!),($6+'**#)$78,)56+'*')9$0,+*1:227Fourth Appendix: Paper PrototypesDashboardNewsEditsubitemHome | edit Pro!leSearch LogoutvivoSPACE Noreen SampleOrganizer Personal Libary/ArchiveMusicphotosmoviesvideoslinksNews My Timeline DashboardFriendsAll WorkTo DoMay 2011Work BBQ DinnerClean KitchenDrive CarpoolMum?s Birthday PartyFriendsConnections5 new massegesFamiliy CaretakerAdd Text to shareAttach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    HGeorge DreamHanna FictionBarack ObamaHank HomeIrvin StarIToday?s performance balanceShareGrilled Halibut with LeaksHanna FictionGrilled HalibuttMeet my new puppy!His name is Norbert. I just love him.30 Minutes ago | Comment | LikeGeorge DreamIt?s so cute, can?t wait to meet it. are you going to bring him by the baseball game?write a commentIrvin StarI gave this recipe a try and it is great!write a comment7 Hours ago | Comment | Like654 calInvite: Bowling Night! Are you in21  Hours ago | Comment | LikeBarack Obamawrite a commentWednesday May 18, 5.30pm        attendingCommunityAddet by Hank HomeAdd personal entryAttach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    May 201019Shareadd/edit options to choose from in ProleSaturatedFatmgcal  calToday Tuesday, 19th  May 9.00am108mg/dl 136/s163lbWalking 15 minsBreakfast Cerials 185 calVitamin C Sublement 85 mgdailysWednesday, 18  May 8.00pmSome personal information about what I did that day.I walked there and it was a beautiful spring day.  The girls and  had a really nice time, but ate to much. Shared with CaretakersShared with Family, Friends, CaretakersGourmet Burger & Caipirinna 312cal 62min1010cal 25gFatDinner at Earls with Irvin and CloeediteditWednesday, 18  May 4.00pm Shared with not sharedDouble Double from TH 150cal16 oz Co#ee, 2 sugar, 2 creampastat Earlsat Tim Hortonsgoalsmy map events performanceweeks performancesun mon frithuwedtue satMay 201015 - 21 !"#$%&!'#$$ ()'#$* +",#$-  .!#$/ 012#$3 &4 #$5$6#(2'$6#(2' $6#(2' $6#(2' $6#(2' $6#(2' $6#(2'78#(2'78#(2' 78#(2' 78#(2' 78#(2' 78#(2' 78#(2'$537#94:$537#94: $537#94: $537#94: $537#94: $537#94: $537#94:$%6;&$%6;& $%6;& $%6;& $%6;& $%6;& $%6;&$*6$*6 $*6 $*6 $*6 $*6 $*6$/-#:<$/6#:< $/*#:< $/-#:< $/-#:< $/-#:< $/*#:<performance details$53#94:-53#94: $53#94: $53#94: -37#94: *%7#94: *37#94:fat *7#=*6#= *6#= *6#= *6#= %6#= %6#=winners&loosers !"#$%%%$&'()*!'+,  !"#$%#&'()"* +"",-. )'-%#/"01 (23#/3/%(1 ')3/4/3. %4"#4/"+ 228Fourth Appendix: Paper PrototypesDashboard when an icon is clickedNewsEditsubitemHome | edit Pro!leSearch LogoutvivoSPACE Noreen SampleOrganizer Personal Libary/ArchiveMusicphotosmoviesvideoslinksNews My Timeline DashboardFriendsAll WorkTo DoMay 2011Work BBQ DinnerClean KitchenDrive CarpoolMum?s Birthday PartyFriendsConnections5 new massegesFamiliy CaretakerAdd Text to shareAttach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    HGeorge DreamHanna FictionBarack ObamaHank HomeIrvin StarIToday?s performance balanceShareGrilled Halibut with LeaksHanna FictionGrilled HalibuttMeet my new puppy!His name is Norbert. I just love him.30 Minutes ago | Comment | LikeGeorge DreamIt?s so cute, can?t wait to meet it. are you going to bring him by the baseball game?write a commentIrvin StarI gave this recipe a try and it is great!write a comment7 Hours ago | Comment | Like654 calInvite: Bowling Night! Are you in21  Hours ago | Comment | LikeBarack Obamawrite a commentWednesday May 18, 5.30pm        attendingCommunityAddet by Hank HomeAdd personal entryAttach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    May 201019Shareadd/edit options to choose from in ProleSaturatedFatmgcal  calToday Tuesday, 19th  May 9.00am108mg/dl 136/s163lbWalking 15 minsBreakfast Cerials 185 calVitamin C Sublement 85 mgdailysWednesday, 18  May 8.00pmSome personal information about what I did that day.I walked there and it was a beautiful spring day.  The girls and  had a really nice time, but ate to much. Shared with CaretakersShared with Family, Friends, CaretakersGourmet Burger & Caipirinna 312cal 62min1010cal 25gFatDinner at Earls with Irvin and CloeediteditWednesday, 18  May 4.00pm Shared with not sharedDouble Double from TH 150cal16 oz Co#ee, 2 sugar, 2 creampastat Earlsat Tim Hortonsgoalsmy map events performanceweeks performancesun mon frithuwedtue satMay 201015 - 21 !"#$%&!'#$$ ()'#$* +",#$-  .!#$/ 012#$3 &4 #$5$6#(2'$6#(2' $6#(2' $6#(2' $6#(2' $6#(2' $6#(2'78#(2'78#(2' 78#(2' 78#(2' 78#(2' 78#(2' 78#(2'$537#94:$537#94: $537#94: $537#94: $537#94: $537#94: $537#94:$%6;&$%6;& $%6;& $%6;& $%6;& $%6;& $%6;&$*6$*6 $*6 $*6 $*6 $*6 $*6$/-#:<$/6#:< $/*#:< $/-#:< $/-#:< $/-#:< $/*#:<performance details$53#94:-53#94: $53#94: $53#94: -37#94: *%7#94: *37#94:fatCal burnedCalories !"#$%Lunch at Fat Burger  with Irvin Star granola Breakfast &!'#$$ ()'#$* +",#$-  .!#$/ 012#$3 &4 #$5*368*688**68*888$368$688$*68$888368688*68Goal185 Caloriesperfor ance overviewcalorie etails825 Calories*7#=*6#= *6#= *6#= *6#= %6#= %6#=winners&loosers !"#$%%%$&'()*!'+,  !"#$# %& '()'*)+, )'"+- ."/ 0123)(-229Fourth Appendix: Paper PrototypesWinners and LosersNewsEditsubitemHome | edit Pro!leSearch LogoutvivoSPACE Noreen SampleOrganizer Personal Libary/ArchiveMusicphotosmoviesvideoslinksNews My Timeline DashboardFriendsAll WorkTo DoMay 2011Work BBQ DinnerClean KitchenDrive CarpoolMum?s Birthday PartyFriendsConnections5 new massegesFamiliy CaretakerAdd Text to shareAttach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    HGeorge DreamHanna FictionBarack ObamaHank HomeIrvin StarIToday?s performance balanceShareGrilled Halibut with LeaksHanna FictionGrilled HalibuttMeet my new puppy!His name is Norbert. I just love him.30 Minutes ago | Comment | LikeGeorge DreamIt?s so cute, can?t wait to meet it. are you going to bring him by the baseball game?write a commentIrvin StarI gave this recipe a try and it is great!write a comment7 Hours ago | Comment | Like654 calInvite: Bowling Night! Are you in21  Hours ago | Comment | LikeBarack Obamawrite a commentWednesday May 18, 5.30pm        attendingCommunityAddet by Hank HomeAdd personal entryAttach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    May 201019Shareadd/edit options to choose from in ProleSaturatedFatmgcal  calToday Tuesday, 19th  May 9.00am108mg/dl 136/s163lbWalking 15 minsBreakfast Cerials 185 calVitamin C Sublement 85 mgdailysWednesday, 18  May 8.00pmSome personal information about what I did that day.I walked there and it was a beautiful spring day.  The girls and  had a really nice time, but ate to much. Shared with CaretakersShared with Family, Friends, CaretakersGourmet Burger & Caipirinna 312cal 62min1010cal 25gFatDinner at Earls with Irvin and CloeediteditWednesday, 18  May 4.00pm Shared with not sharedDouble Double from TH 150cal16 oz Co#ee, 2 sugar, 2 creampastat Earlsat Tim Hortonsgoalsmy map events performanceweeks performancesun mon frithuwedtue satMay 201015 - 21winners&looserswinnners & loosersWinner of the week Looser of the weekIrvin Hank meme Hanna Barack GeorgeIrvinmemeHanna BarackHank memeIrvin me GeorgeIrvinHannaHannaMonaGeorgeHankHankHankMonaBarack2 Trophes !"#$%%%$&'()*!'+,  !"##$%&'())&$%&*  +$$,-. /01$* +2) "& %$032"#/ 42$"% /)0-&5 06040% 4) 10,$ "4 1)%$ 7-0.89-230Fourth Appendix: Paper PrototypesWinners and Losers when elements are clickedNewsEditsubitemHome | edit Pro!leSearch LogoutvivoSPACE Noreen SampleOrganizer Personal Libary/ArchiveMusicphotosmoviesvideoslinksNews My Timeline DashboardFriendsAll WorkTo DoMay 2011Work BBQ DinnerClean KitchenDrive CarpoolMum?s Birthday PartyFriendsConnections5 new massegesFamiliy CaretakerAdd Text to shareAttach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    HGeorge DreamHanna FictionBarack ObamaHank HomeIrvin StarIToday?s performance balanceShareGrilled Halibut with LeaksHanna FictionGrilled HalibuttMeet my new puppy!His name is Norbert. I just love him.30 Minutes ago | Comment | LikeGeorge DreamIt?s so cute, can?t wait to meet it. are you going to bring him by the baseball game?write a commentIrvin StarI gave this recipe a try and it is great!write a comment7 Hours ago | Comment | Like654 calInvite: Bowling Night! Are you in21  Hours ago | Comment | LikeBarack Obamawrite a commentWednesday May 18, 5.30pm        attendingCommunityAddet by Hank HomeAdd personal entryAttach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    May 201019Shareadd/edit options to choose from in ProleSaturatedFatmgcal  calToday Tuesday, 19th  May 9.00am108mg/dl 136/s163lbWalking 15 minsBreakfast Cerials 185 calVitamin C Sublement 85 mgdailysWednesday, 18  May 8.00pmSome personal information about what I did that day.I walked there and it was a beautiful spring day.  The girls and  had a really nice time, but ate to much. Shared with CaretakersShared with Family, Friends, CaretakersGourmet Burger & Caipirinna 312cal 62min1010cal 25gFatDinner at Earls with Irvin and CloeediteditWednesday, 18  May 4.00pm Shared with not sharedDouble Double from TH 150cal16 oz Co#ee, 2 sugar, 2 creampastat Earlsat Tim Hortonsgoalsmy map events performanceweeks performancesun mon frithuwedtue satMay 201015 - 21winners&looserswinnners & loosersWinner of the week Looser of the weekMay 20111758 calGoal 1750 cal2358 calGoal 1800 cal1850alGoal 1750 calIrvin Hank meme Hanna Barack GeorgeIrvinmemeHanna BarackHank memeIrvin me GeorgeIrvinHannaHannaMonaGeorgeHankHankHankMonaBarack2 Trophes !"#$%%%$&'()*!'+,  !"#$# %&''()*+,""*()*-  ./&.0&'1 2 #()*"' *3"4* ."'*$5(6 .2/")&(* 7" *(7 1"2/231Fourth Appendix: Paper PrototypesMy MapNewsEditsubitemHome | edit Pro!leSearch LogoutvivoSPACE Noreen SampleOrganizer Personal Libary/ArchiveMusicphotosmoviesvideoslinksNews My Timeline DashboardFriendsAll WorkTo DoMay 2011Work BBQ DinnerClean KitchenDrive CarpoolMum?s Birthday PartyFriendsConnections5 new massegesFamiliy CaretakerAdd Text to shareAttach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    HGeorge DreamHanna FictionBarack ObamaHank HomeIrvin StarIToday?s performance balanceShareGrilled Halibut with LeaksHanna FictionGrilled HalibuttMeet my new puppy!His name is Norbert. I just love him.30 Minutes ago | Comment | LikeGeorge DreamIt?s so cute, can?t wait to meet it. are you going to bring him by the baseball game?write a commentIrvin StarI gave this recipe a try and it is great!write a comment7 Hours ago | Comment | Like654 calInvite: Bowling Night! Are you in21  Hours ago | Comment | LikeBarack Obamawrite a commentWednesday May 18, 5.30pm        attendingCommunityAddet by Hank Homegoalsmy map events performanceweeks performancesun mon frithuwedtue satMay 201015 - 21my mapWedn sday May 18Dinner at EarlsGourmet Burger & Caipirinna1010 CaloriesTime: 8.30 pmLength:  2 hours+ 2 other friendswalking 60 minutes calories burned 280public transport 15 kmwinners&loosers !"#$%%%$&'()*!'+,  !" #$%& '()* *+ ),+- *,. +%*/+0 +1 ,$2/03 $ %.4)+0$5 #$%6 777232Fourth Appendix: Paper PrototypesRecipesNewsEditsubitemHome | edit Pro!leSearch LogoutvivoSPACE Noreen SampleOrganizer Personal Libary/ArchiveMusicphotosmoviesvideoslinksNews My Timeline DashboardFriendsAll WorkTo DoMay 2011Work BBQ DinnerClean KitchenDrive CarpoolMum?s Birthday PartyFriendsConnections5 new massegesFamiliy CaretakerAdd Text to shareAttach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    HGeorge DreamHanna FictionBarack ObamaHank HomeIrvin StarIToday?s performance balanceShareGrilled Halibut with LeaksHanna FictionGrilled HalibuttMeet my new puppy!His name is Norbert. I just love him.30 Minutes ago | Comment | LikeGeorge DreamIt?s so cute, can?t wait to meet it. are you going to bring him by the baseball game?write a commentIrvin StarI gave this recipe a try and it is great!write a comment7 Hours ago | Comment | Like654 calInvite: Bowling Night! Are you in21  Hours ago | Comment | LikeBarack Obamawrite a commentWednesday May 18, 5.30pm        attendingCommunityAddet by Hank Home !!"#$%&'()*"$(+%,Attach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    May 201019Shareadd/edit options to choose from in ProleSaturatedFatmgcal  calToday Tuesday, 19th  May 9.00am108mg/dl 136/s163lbWalking 15 minsBreakfast Cerials 185 calVitamin C Sublement 85 mgdailysWednesday, 18  May 8.00pm-'.$"#$%&'()*"/(0'%.)+/'(")1'2+"34)+"5"!/!"+4)+"!),65"3)*7$!"+4$%$")(!"/+"3)&")"1$)2+/02*"&#%/(8"!),6""94$"8/%*&")(!""4)!")"%$)**,"(/:$"+/.$;"12+")+$"+'".2:46"Shared with CaretakersShared with Family, Friends, CaretakersGourmet Burger & Caipirinna 312cal 62min1010cal 25gFatDinner at Earls with Irvin and CloeediteditWednesday, 18  May 4.00pm Shared with not shared<'21*$"<'21*$"0%'."9="150cal16 oz Co#ee, 2 sugar, 2 creampastRecipeavoritsRecipe Add recipeFavoriteAdd to Favorites Create a VariationWrite Review !""#$%&'()))(*+,%-+ !"#$%!&!$'())*$+,%-!',..#*/%0!()'/1)!2/%+!,1%/,*$!%,!'()&%)!,2*!3)($/,*-!&44!%,!5&3,#(/%)$-!()3/)2$-!666233Fourth Appendix: Paper PrototypesRecipes overview pageNewsEditsubitemHome | edit Pro!leSearch LogoutvivoSPACE Noreen SampleOrganizer Personal Libary/ArchiveMusicphotosmoviesvideoslinksNews My Timeline DashboardFriendsAll WorkTo DoMay 2011Work BBQ DinnerClean KitchenDrive CarpoolMum?s Birthday PartyFriendsConnections5 new massegesFamiliy CaretakerAdd Text to shareAttach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    HGeorge DreamHanna FictionBarack ObamaHank HomeIrvin StarIToday?s performance balanceShareGrilled Halibut with LeaksHanna FictionGrilled HalibuttMeet my new puppy!His name is Norbert. I just love him.30 Minutes ago | Comment | LikeGeorge DreamIt?s so cute, can?t wait to meet it. are you going to bring him by the baseball game?write a commentIrvin StarI gave this recipe a try and it is great!write a comment7 Hours ago | Comment | Like654 calInvite: Bowling Night! Are you in21  Hours ago | Comment | LikeBarack Obamawrite a commentWednesday May 18, 5.30pm        attendingCommunityAddet by Hank Home !!"#$%&'()*"$(+%,Attach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    May 201019Shareadd/edit options to choose from in ProleSaturatedFatmgcal  calToday Tuesday, 19th  May 9.00am108mg/dl 136/s163lbWalking 15 minsBreakfast Cerials 185 calVitamin C Sublement 85 mgdailysWednesday, 18  May 8.00pm-'.$"#$%&'()*"/(0'%.)+/'(")1'2+"34)+"5"!/!"+4)+"!),65"3)*7$!"+4$%$")(!"/+"3)&")"1$)2+/02*"&#%/(8"!),6""94$"8/%*&")(!""4)!")"%$)**,"(/:$"+/.$;"12+")+$"+'".2:46"Shared with CaretakersShared with Family, Friends, CaretakersGourmet Burger & Caipirinna 312cal 62min1010cal 25gFatDinner at Earls with Irvin and CloeediteditWednesday, 18  May 4.00pm Shared with not shared<'21*$"<'21*$"0%'."9="150cal16 oz Co#ee, 2 sugar, 2 creampastRecipeavoritsRecipe Add recipeFavorite !""#$%&'()))(*+,%-+  !"#$%&'()*+ ,- .)&*$/"0 *)1('$/ 2'(3 4"#$%&'() &)1'.)*234Fourth Appendix: Paper PrototypesCreate Recipe PageNewsEditsubitemHome | edit Pro!leSearch LogoutvivoSPACE Noreen SampleOrganizer Personal Libary/ArchiveMusicphotosmoviesvideoslinksNews My Timeline DashboardFriendsAll WorkTo DoMay 2011Work BBQ DinnerClean KitchenDrive CarpoolMum?s Birthday PartyFriendsConnections5 new massegesFamiliy CaretakerAdd Text to shareAttach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    HGeorge DreamHanna FictionBarack ObamaHank HomeIrvin StarIToday?s performance balanceShareGrilled Halibut with LeaksHanna FictionGrilled HalibuttMeet my new puppy!His name is Norbert. I just love him.30 Minutes ago | Comment | LikeGeorge DreamIt?s so cute, can?t wait to meet it. are you going to bring him by the baseball game?write a commentIrvin StarI gave this recipe a try and it is great!write a comment7 Hours ago | Comment | Like654 calInvite: Bowling Night! Are you in21  Hours ago | Comment | LikeBarack Obamawrite a commentWednesday May 18, 5.30pm        attendingCommunityAddet by Hank Home !!"#$%&'()*"$(+%,Attach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    May 201019Shareadd/edit options to choose from in ProleSaturatedFatmgcal  calToday Tuesday, 19th  May 9.00am108mg/dl 136/s163lbWalking 15 minsBreakfast Cerials 185 calVitamin C Sublement 85 mgdailysWednesday, 18  May 8.00pm-'.$"#$%&'()*"/(0'%.)+/'(")1'2+"34)+"5"!/!"+4)+"!),65"3)*7$!"+4$%$")(!"/+"3)&")"1$)2+/02*"&#%/(8"!),6""94$"8/%*&")(!""4)!")"%$)**,"(/:$"+/.$;"12+")+$"+'".2:46"Shared with CaretakersShared with Family, Friends, CaretakersGourmet Burger & Caipirinna 312cal 62min1010cal 25gFatDinner at Earls with Irvin and CloeediteditWednesday, 18  May 4.00pm Shared with not shared<'21*$"<'21*$"0%'."9="150cal16 oz Co#ee, 2 sugar, 2 creampastRecipeavoritsRecipe Add recipe !""#$%&'()))(*+,%-+ !"#$%!&!$'())*$+,%-!+,.!%,!&//!0)($,*&1!()'20)235Fourth Appendix: Paper PrototypesPersonal Profile PageNewsEditsubitemHome | edit Pro!leSearch LogoutvivoSPACE Noreen SampleOrganizer Personal Libary/ArchiveMusicphotosmoviesvideoslinksNews My Timeline DashboardFriendsAll WorkTo DoMay 2011Work BBQ DinnerClean KitchenDrive CarpoolMum?s Birthday PartyFriendsConnections5 new massegesFamiliy CaretakerAdd Text to shareAttach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    HGeorge DreamHanna FictionBarack ObamaHank HomeIrvin StarIToday?s performance balanceShareGrilled Halibut with LeaksHanna FictionGrilled HalibuttMeet my new puppy!His name is Norbert. I just love him.30 Minutes ago | Comment | LikeGeorge DreamIt?s so cute, can?t wait to meet it. are you going to bring him by the baseball game?write a commentIrvin StarI gave this recipe a try and it is great!write a comment7 Hours ago | Comment | Like654 calInvite: Bowling Night! Are you in21  Hours ago | Comment | LikeBarack Obamawrite a commentWednesday May 18, 5.30pm        attendingCommunityAddet by Hank HomeAdd personal entryAttach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    May 201019Shareadd/edit options to choose from in ProleSaturatedFatmgcal  calToday Tuesday, 19th  May 9.00am108mg/dl 136/s163lbWalking 15 minsBreakfast Cerials 185 calVitamin C Sublement 85 mgdailysWednesday, 18  May 8.00pmSome personal information about what I did that day.I walked there and it was a beautiful spring day.  The girls and  had a really nice time, but ate to much. Shared with CaretakersShared with Family, Friends, CaretakersGourmet Burger & Caipirinna 312cal 62min1010cal 25gFatDinner at Earls with Irvin and CloeediteditWednesday, 18  May 4.00pm Shared with not sharedDouble Double from TH 150cal16 oz Co#ee, 2 sugar, 2 creampastat Earlsat Tim Hortonsgoalsmy map events performanceweeks performancesun mon frithuwedtue satMay 201015 - 21winners&loosersInfo Seals Health CommunityShared with allFirst Name: Noreen Mid le Name: S cond Name: SampleShared with Family, Friends, CaretakersAddress:Shared with Family, Friends, CaretakersNationality: CanadianShared with allWebsite: infosample.orgShared with Family, Friends, CaretakersDate of Birth: 17 April 1976Shared with CaretakersHight: 168 cmWeight: 135 lbBMI: 35Shared with Family, Friends, CaretakersBio: linkedInShared with Family, FriendsRelationship: marriedShared with Family, FriendsInterests: running, reading, moviesPro!le PictureShare AllFriendsWorkFamilyCaretakersGroups:FriendsWorkFamilyCaretakersaddeditediteditediteditediteditediteditedit !"#$%&'()*$+++$,-.'  !"#$%&'( )&*%#+',-%& .-,/ 0#%12$ ,% 3#"',"4 %2,-%&$ %* $/'#-&04 555236Fourth Appendix: Paper PrototypesApproval SealsNewsEditsubitemHome | edit Pro!leSearch LogoutvivoSPACE Noreen SampleOrganizer Personal Libary/ArchiveMusicphotosmoviesvideoslinksNews My Timeline DashboardFriendsAll WorkTo DoMay 2011Work BBQ DinnerClean KitchenDrive CarpoolMum?s Birthday PartyFriendsConnections5 new massegesFamiliy CaretakerAdd Text to shareAttach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    HGeorge DreamHanna FictionBarack ObamaHank HomeIrvin StarIToday?s performance balanceShareGrilled Halibut with LeaksHanna FictionGrilled HalibuttMeet my new puppy!His name is Norbert. I just love him.30 Minutes ago | Comment | LikeGeorge DreamIt?s so cute, can?t wait to meet it. are you going to bring him by the baseball game?write a commentIrvin StarI gave this recipe a try and it is great!write a comment7 Hours ago | Comment | Like654 calInvite: Bowling Night! Are you in21  Hours ago | Comment | LikeBarack Obamawrite a commentWednesday May 18, 5.30pm        attendingCommunityAddet by Hank HomeInfo Seals Health CommunityeditSealsHealth Check is one important way the Heart and Stroke Foundation helps Canadians eat well. Healthy eating is one of the most important things you can do to improve your overall health. Whether you are cooking at home or eating out, you can make healthy choices that will help you feel and look better and at the same time lower your risk of heart disease and stroke and other diseases.http://www.healthcheck.orgDiabetis SocietyDo you want a better quality of life and better health in your middle and older years? There is now a solid body of medical research showing that patients who have one or more chronic diseases like high blood pressure, high cholesterol, heart disease or diabetes can live longer lives, have fewer heart attacks, strokes, kidney failure and other complications if they succeed in reaching speci!c goals for their conditions. http://www.primedphysicians.com/health/chronic.htmlVegetarian SocietyThe Vegetarian Society of the United Kingdom is the oldest vegetar-ian organisation in the world. It is an educational charity promoting understanding and respect for vegetarian lifestyles http://www.vegsoc.org/add !"#$%&'()*$+++$,*-).  !"#$% &' ()#*( +(), -& $*#((.'/ '&&,0 1+-".-.&1 &" 2)#*-2237Fourth Appendix: Paper PrototypesPersonal PresetsNewsEditsubitemHome | edit Pro!leSearch LogoutvivoSPACE Noreen SampleOrganizer Personal Libary/ArchiveMusicphotosmoviesvideoslinksNews My Timeline DashboardFriendsAll WorkTo DoMay 2011Work BBQ DinnerClean KitchenDrive CarpoolMum?s Birthday PartyFriendsConnections5 new massegesFamiliy CaretakerAdd Text to shareAttach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    HGeorge DreamHanna FictionBarack ObamaHank HomeIrvin StarIToday?s performance balanceShareGrilled Halibut with LeaksHanna FictionGrilled HalibuttMeet my new puppy!His name is Norbert. I just love him.30 Minutes ago | Comment | LikeGeorge DreamIt?s so cute, can?t wait to meet it. are you going to bring him by the baseball game?write a commentIrvin StarI gave this recipe a try and it is great!write a comment7 Hours ago | Comment | Like654 calInvite: Bowling Night! Are you in21  Hours ago | Comment | LikeBarack Obamawrite a commentWednesday May 18, 5.30pm        attendingCommunityAddet by Hank HomeAdd personal entryAttach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    May 201019Shareadd/edit options to choose from in ProleSaturatedFatmgcal  calToday Tuesday, 19th  May 9.00am108mg/dl 136/s163lbWalking 15 minsBreakfast Cerials 185 calVitamin C Sublement 85 mgdailysWednesday, 18  May 8.00pmSome personal information about what I did that day.I walked there and it was a beautiful spring day.  The girls and  had a really nice time, but ate to much. Shared with CaretakersShared with Family, Friends, CaretakersGourmet Burger & Caipirinna 312cal 62min1010cal 25gFatDinner at Earls with Irvin and CloeediteditWednesday, 18  May 4.00pm Shared with not sharedDouble Double from TH 150cal16 oz Co#ee, 2 sugar, 2 creampastat Earlsat Tim Hortonsgoalsmy map events performanceweeks performancesun mon frithuwedtue satMay 201015 - 21winners&loosersInfo Seals Health CommunityeditPersonal Presetweight heartratestrengthwalking cardio exercisecalories eatenbloodsugercalories burnedCaloriesActivity Shared with allNutritionSalt Sodium VitaminC Iron ProteinCalcium SugarSaturatedFatTransFatMedical  Shared with CaretakersShared with Family, Friends, CaretakersShared with Friends, CaretakersDaily Target Shared with Family, Friends, CaretakersWalking 15 minsBreakfast Cereals 185 calVitamin C Supplement 85 mgediteditediteditediteditediteditedit !"#$%&'()*$+++$,*&-'./)$,&*-*#  !"# $% &'()* &+", -,.+/0 (0 #(1")(0"23 4.++," (4+0, *+$ /'0# #+ $," 5+6 *+$6 #6'47(08238Fourth Appendix: Paper PrototypesPersonal Presets when elements are clickedNewsEditsubitemHome | edit Pro!leSearch LogoutvivoSPACE Noreen SampleOrganizer Personal Libary/ArchiveMusicphotosmoviesvideoslinksNews My Timeline DashboardFriendsAll WorkTo DoMay 2011Work BBQ DinnerClean KitchenDrive CarpoolMum?s Birthday PartyFriendsConnections5 new massegesFamiliy CaretakerAdd Text to shareAttach Photo  |  Recipe  |  Event  |  Video  |   Link  | Music    HGeorge DreamHanna FictionBarack ObamaHank HomeIrvin StarIToday?s performance balanceShareGrilled Halibut with LeaksHanna FictionGrilled HalibuttMeet my new puppy!His name is Norbert. I just love him.30 Minutes ago | Comment | LikeGeorge DreamIt?s so cute, can?t wait to meet it. are you going to bring him by the baseball game?write a commentIrvin StarI gave this recipe a try and it is great!write a comment7 Hours ago | Comment | Like654 calInvite: Bowling Night! Are you in21  Hours ago | Comment | LikeBarack Obamawrite a commentWednesday May 18, 5.30pm        attendingCommunityAddet by Hank HomeInfo Seals Health CommunityeditPersonal Presetweight heartratestrenghwalking cardio exercisecalories eatenbloodsugercalories burnedCaloriesActivity Shared with allNutritionSalt Sodium VitaminC Iron ProteinCalcium SugarSaturatedFatTransFatMedical  Shared with CaretakersShared with Family, Friends, CaretakersShared with Friends, CaretakersTrans FatTrans fat is the common name for unsaturated fat with trans-isomer fatty acid(s). Because the term refers to the conguration of a double carbon-carbon bond, trans fats may be monounsaturated or polyunsaturated but never saturated.http://en.wikipedia.org/wiki/Trans_fatDaily Does !ings I do everyday. Automaticly tracked in My TimelineDayly Does Shared with Family, Friends, CaretakersWalking 15 minsBreakfast Cerials 185 calVitamin C Sublement 85 mg !"#$%&'()*$+++$,*&-'./)$,&*-*#  !"#$#%& %'"( )*+",-./)"* 01 '""23,)*4 ", 56)57)*4239Fifth Appendix: ScreenCaptures of Medium FidelityPrototypesInitial Landing Page240Fifth Appendix: Screen Captures of Medium Fidelity PrototypesNewsfeed241Fifth Appendix: Screen Captures of Medium Fidelity PrototypesMy Activities (User Activities)242Fifth Appendix: Screen Captures of Medium Fidelity PrototypesSet Loggers Page243Fifth Appendix: Screen Captures of Medium Fidelity PrototypesSet Targets Page244Fifth Appendix: Screen Captures of Medium Fidelity PrototypesSet Seals Page245Fifth Appendix: Screen Captures of Medium Fidelity PrototypesDashboard Page246Fifth Appendix: Screen Captures of Medium Fidelity PrototypesDashboard Page when Icon is Clicked247Fifth Appendix: Screen Captures of Medium Fidelity PrototypesMain Goals Page248Fifth Appendix: Screen Captures of Medium Fidelity PrototypesCreate Goals Page (Step 1)249Fifth Appendix: Screen Captures of Medium Fidelity PrototypesCreate Goals Page (Step 2)250Fifth Appendix: Screen Captures of Medium Fidelity PrototypesMy Stars (Successfully Completed Goals)251Fifth Appendix: Screen Captures of Medium Fidelity PrototypesMy Friends? Stars (Successfully Completed Goalsby Friends)252Fifth Appendix: Screen Captures of Medium Fidelity PrototypesMain Clubs Page253Fifth Appendix: Screen Captures of Medium Fidelity PrototypesJoin Clubs Page254Fifth Appendix: Screen Captures of Medium Fidelity PrototypesCreate Clubs Page (Step 1)255Fifth Appendix: Screen Captures of Medium Fidelity PrototypesCreate Goals Page (Step 2)256Fifth Appendix: Screen Captures of Medium Fidelity PrototypesMy Badges (Successfully Completed Clubs)257Fifth Appendix: Screen Captures of Medium Fidelity PrototypesMy Friends? Badges (Successfully Completed Badgesby Friends)258Fifth Appendix: Screen Captures of Medium Fidelity PrototypesMain Challenges Page259Fifth Appendix: Screen Captures of Medium Fidelity PrototypesJoin Challenges Page260Fifth Appendix: Screen Captures of Medium Fidelity PrototypesCreate Challenge Page (Step 1)261Fifth Appendix: Screen Captures of Medium Fidelity PrototypesCreate Challenge Page (Step 2)262Fifth Appendix: Screen Captures of Medium Fidelity PrototypesMy Trophies (Successfully Completed Challenges)263Fifth Appendix: Screen Captures of Medium Fidelity PrototypesMy Friends? Trophies (Successfully Completed Chal-lenges by Friends)264Sixth Appendix: LaboratoryEvaluation ofMedium-Fidelity PrototypeThis appendix shows the questionnaire and steps that were taken by theexperimenter for the entire laboratory experiment that evaluated the mediumfidelity prototype of VivoSpace. The first questionnaire was completed byall the participants. This is followed by the individual task experiment thatwas done by half of the participants to evaluated Appeal determinantsof the ABC Framework. The steps followed by the experimenter andthe questions asked of the participants for the helping game is describednext. The final section shows the Test given and the steps followed by theexperimenter for the group commitment experiment. The experiment andthe results are described in detail in Section 7.3.Questionnaire for All ParticipantsAll participants will be asked basic demographic questions to understand thediversity of participants that completed the study. These questions are thefollowing:1. Please specify your gendera. Femaleb. Male2. Which age group do you belong to? (select one)a. 19-24 years old265Sixth Appendix: Laboratory Evaluation of Medium-Fidelity Prototypeb. 25-34 years oldc. 35-49 years oldd. 50-64 years olde. 65-74 years oldf. 75 years old and older3. Do you identify as a First Nations or Aboriginal person (North AmericanIndian, Metis, or Inuit)?If you answer yes to this question, please go to Question 6.a. Yesb. No4. If you answered No to question 3, do you primarily identify as beingCanadian?a. Yesb. No5. If you answered No to question 4, which ethnic group do you primarilyidentify belonging to, please specifya. Chineseb. East Asian (including Japanese, Korean)c. South East Asian (Including Filipino, Malaysian, Thai, Indonesian, Viet-namese, Cambodian)d. South Asian (including Punjabi, Indian, Pakistani, Bangladeshi, SriLankan)e. Arabf. West Asian (including Iranian, Afghani)g. Hispanic (including Mexican, Cuban, South & Central American)h. Other:6. If you are you a student, please specify the followinga. Undergraduateb. Graduate266Sixth Appendix: Laboratory Evaluation of Medium-Fidelity Prototypec. Post-graduated. Other:7. If you are not a student, please specify your occupationI. Appeal:Script and tasks to measure the Appeal of the systemYou will be asked to complete the following tasks. Data will be collectedby asking specific questions on the tasks and the results of completing thetask to determine how well the system is designed for users like you. Audiorecording and a recording of the screen as you move through the tasks willbe made to collect data about the usability of the tasks.A. You have recently joined VivoSpace and you decide to log yourfood to see how your nutritional intake is.1. Enter the following activity that you did recently with a friend, who isalso your friend on Vivospace:a. You want to log that you ate at Whit Spot Restaurant. Type the followingin the enter activity area: White Spot Chargrilled Burgerb. You did this activity with Barrack Obama, so select Barrack as the friendthat you did this activity with.c. Now Log the activity2. Answer the following questions:a. How many calories are in this meal?b. What do the target mean to you?3. In the walking activity that you have already completed and logged onVivoSpace, add a comment in response to your friends Kaths commenta. Please write: I wish you could have joined us.267Sixth Appendix: Laboratory Evaluation of Medium-Fidelity Prototype4. Go to the Targets pagea. Select Sodium as a nutrient that you want to track and change the amountto 700mgb. Select Fibre as a nutrient that you want to track and change the value to50 gc. You are interested in the iron nutrient, but you are unsure of what this is.i. Can you find out more about iron?ii. If so, what can you find?5. Go to the Loggers pagea. You no longer want to track resistance exercise but you do want to trackbiking.i. Please select or unselect as appropriate6. Go to the Seals pagea. You are interested in the Oceanwise seal and want to learn more.i. What can you find out?ii. You want to select this seal, so please select it.7. Feedback (feel free to play with the website while answering the question).a. Likert-Scale responses (1-7)i. I found the information that the system provided useful when I enteredwhat I ate usefulii. I found the nutritional information (calories, saturated fat and protein)that I received usefuliii. I would find it easy to enter my health informationiv. I would be able to gain information about myself and my capabilities byusing a system like thisv. I found the targets on the my activity page easy to understandvi. I found the targets page easy to understand in terms of the nutrition andvaluesvii. I would find this system entertaining to useviii. I could learn more about myself and my health through using VivoSpace268Sixth Appendix: Laboratory Evaluation of Medium-Fidelity Prototypeix. By sharing my activities, I could build my social position or have moreinfluence on my friendsx. I would use a system like this to provide information on my activities tomy friendsxi. I would use a system like this because I can share my experiences andidentity with friends who are similarxii. I would this system to learn the health outcomes of my activitiesxiii. The health check logo provided me with information about the healthi-ness of activity based on society and/or an external sourcexiv. Please tell the experimenter your thoughts on this prototypeB. Newsfeed page1. Go to the Newsfeed pagea. What do you first see when you go to this page?b. What is this page showing you?c. How do these activities show up on your newsfeed page?d. Please enter a comment on Williams activity, such as good job2. Feedback (please feel free to play with the system as you answer thesequestions):a. Likert Responses:i. A newsfeed such as this would provide me with information about myfriends that I would find usefulii. This would allow me to stay connected with my friendsiii. I would find it entertaining to view my friends activitiesiv. I would be able to discover shared or similar experiences and identitiesthrough the newsfeedv. I would be able to learn about health (e.g. what activities and foods aregood for me) through the newsfeedvi. I would be able to view how my friends are staying healthyvii. I would be able to see how my friends are overcoming barriers to stayinghealthy269Sixth Appendix: Laboratory Evaluation of Medium-Fidelity Prototypeviii. I would be able to learn what types of activities are healthierix. I would be able to know what my friends are doingx. I would be able to interact with my friendsxi. I would be able to see friends that I have similarities withxii. I would model my activities to match healthy activities completed byfriends.xiii. Please tell the experimenter your thoughts on this prototypeC. Dashboard Page1. Go to the Dashboard Pagea. This week, how are you doing with respect to the amount of calories thatyou are consuming?b. What is the definition of calories?c. View the chart for Calories.i. Were you better at the beginning of the week? Why?ii. How do you think you will be do next week based on the information onthe chart?d. What areas did you perform well at this week? Why?2. Feedback (please feel free to play with the system as you answer thesequestions): a. Likert Responses:i. The dashboard provides useful informationii. It is entertaining to be able to use this dashboard over timeiii. I would be able to learn about myself through the dashboardiv. It is convenient to see the information that the dashboard providesv. I would be able to gain health knowledge about myselfvi. I would be able to learn health outcomes based on my activities vii. Iwould be able to learn about barriers to healthier livingviii. I would be able to learn about facilitators (what helps) to healthierlivingix. The dashboard provides an incentive (a reason) to live healthierx. The dashboard allows me to understand my capabilities in term of healthy270Sixth Appendix: Laboratory Evaluation of Medium-Fidelity Prototypelivingxi. Please tell the experimenter your thoughts on this prototypeD. Goals1. You are interested in created some health goals.a. View your existing goalsb. What is the name of one of your current goalsc. In the lose weight goal, how much weight have you lost?d. Based on your current averages, what targets are you doing well in?e. Based on your current averages, what targets do you need to improve in?f. What is the definition of Saturated fats?g. Go to the page to create a goalh. Browse the library of goals that you can createi. Recently, one of your family friends has had a heart attack, so you decideto create a healthy heart goalj. Give this goal a name that is different than the defaultk. You also decide to select a lower trans fat goal, so enter 3 g/day for transfatl. Select a start date of todaym. Select an end date of next of the end of next monthn. Then create this goalo. By meeting a goal in the specified timeframe, you have earned some stars.How many stars have you earned?p. Find the page that lists all of your starsq. How many of your stars have you shared with your friends?r. View the chart for the sodium star? What does the chart tell you aboutyour sodium consumption?s. Go to the page that shows the stars that your friends have earned.t. What star has your friend Barrack Obama earned?u. Comment on his star achievement2. Feedback (please feel free to play with the system as you answer thesequestions):271Sixth Appendix: Laboratory Evaluation of Medium-Fidelity Prototypea. Likert Responses:i. By setting goals with a start date and end date, I will try to meet thegoal.ii. The types of goals shown in the library are adequateiii. The ability to create goals and earn stars is entertainingiv. I can earn respect from my friends or enhance my social position byearning starsv. I can learn about myself through the ability to participate in goals andearn starsvi. I can be motivated to overcome barriers to healthier living by usingVivoSpace to achieve my goals and earn starsvii. I can understand about my capabilities to live health through the goalsfunctionalityviii. I can be able to gain health knowledge about myselfix. I can be able to learn health outcomes based on my activitiesx. I would be able to learn about barriers to healthier livingxi. I would be able to learn about facilitators (what helps) to healthier livingxii. I would create goals to overcome my feeling about certain activities thatI know are healthyxiii. I would participate in clubs to allow me to live healthier and have abetter attitude towards itxiv. Please tell the experimenter your thoughts on this prototypeE. Clubs1. You are interested in the clubsa. First you want to see the clubs that you are a part of, go to your clubsb. What clubs are you a part of?c. Who else is part of this club?d. How are you doing over time (are you getting better or worse)?e. Now, you want to join a club. Go to the page to join clubsf. You Ashtons club, what is the name of it?g. What does his club involve?272Sixth Appendix: Laboratory Evaluation of Medium-Fidelity Prototypeh. Join Ashtons clubi. You decide to create a club of your own, so that you can allow others tojoin it. Go to the create clubs pagej. Choose the lose weight club from the library.k. Call it ?lose 10 lbs club?l. Change the daily value for saturated to 7g/daym. Enter tomorrow as the start daten. Enter the end of October for the end dateo. Make this club closed on to those people that you invitep. Invite the following friends: William, Joey and Maggieq. Create the clubr. You now want to view the badges that you have earned from clubs thatyou completed successfully, go to your badges pages. How many badges have you earned?t. Out of the badges that you earned, which one was from a club that youcreated?u. What did you have to do to earn this badge?v. View the badges that your friends have earnedw. What did your friend Maggie do to earn her badge?x. Comment on her badge by saying ?very impressive Maggie!?2. Feedback (please feel free to play with the system as you answer thesequestions):a. Likert Responses:i. It would be entertaining to participate in clubsii. I would participate in clubs to have more status than my friends or toenhance my social positioniii. I would participate in clubs to be connected with my friendsiv. I would participate in clubs to learn more about myself and what I amcapable ofv. I would participate in clubs to obtain information about myself and/or myfriends vi. I would participate in clubs to provide information about myselfvii. I would participate in clubs to build a common or shared identity with273Sixth Appendix: Laboratory Evaluation of Medium-Fidelity Prototypemy friendsviii. I would participate in clubs to have an incentive to live healthierix. I would participate in clubs to have health related goalsx. I would participate in clubs to overcome any negative feelings I may haveabout certain activities that I know are healthyxi. I would participate in clubs to have my friends motivate me to livehealthierxii. I would participate in clubs to allow me to live healthier have a betterattitude towards itxiii. I would participate in clubs to support from my friendsxiv. I would participate in clubs to interact with my friendsxv. I would participate in clubs to get to know other people betterxvi. I would participate in clubs to learn who I am similar toxvii. I would participate in clubs to belong to a groupxviii. I would participate in clubs to gain positive influence from my friendsand other membersxix. I would participate in clubs to learn about my own capability by seeingwhat others are capable ofxx. I would participate in clubs to act as a way to have my friends help meto live healthierxxi. Please tell the experimenter your thoughts on this prototypeF. Challenges1. You are interested in the Challengesa. First you want to see the challenges that you are participating in, go toyour challengesb. What challenges are you participating in?c. Who else is participating in this challenge?d. Who is winning the challenge?e. How are you performing?f. Now, you want to join a challenge. Go to the page to join challengesg. For Joeys challenge, what is the name of it?h. What does his challenge involve?274Sixth Appendix: Laboratory Evaluation of Medium-Fidelity Prototypei. Join Joeys challengej. Now you want to create a challenge, go to the create challenges pagek. Choose the lose weight challenge from the libraryl. Give the challenge the following name Lose the most weight before the fallm. Set the main target as 15 lbsn. Set the start date for next week and the end date for the beginning ofOctobero. Open this challenge for everyonep. Invite all your friends to participateq. Create the Challenger. Now you want to see how many trophies you have won in the challengesthat you have participated in. Go to your trophies pages. How many trophies have you wont. View the trophies that your friends have won.u. Which of your friends have won the a trophy2. Feedback (please feel free to play with the system as you answer thesequestions): b. Likert Responses:i. It would be entertaining to participate in challengesii. I would participate in challenges to have more status than my friends orto enhance my social positioniii. I would participate in challenges to be connected with my friendsiv. I would participate in challenges to learn more about myself and what Iam capable ofv. I would participate in challenges to obtain information about myselfand/or my friendsvi. I would participate in challenges to provide information about myselfvii. I would participate in challenges to build a common or shared identitywith my friendsviii. I would participate in challenges to have an incentive to live healthierix. I would participate in challenges to have health related goalsx. I would participate in challenges to overcome any negative feelings I mayhave about certain activities that I know are healthy275Sixth Appendix: Laboratory Evaluation of Medium-Fidelity Prototypexi. I would participate in challenges to motivate me to live healthierxii. I would participate in challenges to allow me to live healthier have abetter attitude towards healthy activitiesxiii. I would participate in challenges to be part of a groupxiv. I would participate in challenges to interact with my friendsxv. I would participate in challenges to get to know other people betterxvi. I would participate in challenges to learn who I am similar toxvii. I would participate in challenges to compare myself with othersxviii. I would participate in challenges to belong to a groupxix. I would participate in challenges to gain positive influence from myfriends and other membersxx. I would participate in challenges to learn about my own capability byseeing what others are capable ofxxi. I would participate in challenges to act as a way to have my friends helpme to live healthierxxii. Please tell the experimenter your thoughts on this prototypeII. BELONGINGRepeated Helping Game Experiment: A second participant (B) joins thefirst participant (A). Care will be taken to ensure that two do not know eachother. They are randomized into two conditions.Instructions for Condition 11. Participant A is given 50 fake $1 bills (they are 3?x2? size printed copiesof Canadas old 1 dollar bill), and Participant A is told that the ParticipantB has just gone through a similar study with another person and earned18 points by helping another person. A single point is earned every timeParticipant A decides to help Participant B. However, Participant B hasnever seen VivoSpace before.276Sixth Appendix: Laboratory Evaluation of Medium-Fidelity Prototype2. Participant B will be asked to complete tasks on VivoSpace and theParticipant A can help participant B, but it will cost her/him $1 dollar formost tasks and $5 dollars for other tasksa. Participant A will earn a point every time she/he chooses to help Partici-pant B for any taskb. Participant B will earn twice the amount that it cost participant A everytime participant A helps Participant Bc. The points that Participant A and B are displayed on a whiteboard infront of each participant3. You can choose to end this experiment at anytime if you feel uncomfortableand you can choose to have your data removed from this study permanently.Instructions for Condition 21. Participant A is given 50 fake $1 bills (they are 3?x2? size printed copiesof Canadas old 1 dollar bill), and Participant A is told that the ParticipantB has just gone through a similar study with another person and earnedsome points by helping another person. A single point is earned every timeParticipant A decides to help Participant B. However, Participant B hasnever seen VivoSpace before.2. Participant B will be asked to complete tasks on VivoSpace and theParticipant A can help participant B, but it will cost her/him $1 dollar formost tasks and $5 dollars for other tasksa. Participant A will earn a point every time she/he chooses to help Partici-pant B for any taskb. Participant B will earn twice the amount that it cost participant A everytime participant A helps Participant Bc. The points that Participant A (but NOT B) are displayed on a whiteboardin front of the participants3. You can choose to end this experiment at anytime if you feel uncomfortableand you can choose to have your data removed from this study permanently.277Sixth Appendix: Laboratory Evaluation of Medium-Fidelity PrototypeHere are the tasks that participant B is asked to complete and the costto help is presented beside each task. Before participant B starts the taskparticipant A can choose to help otherwise A cannot help B until the nexttask.1) You want to log that you ate at White Spot Restaurant. Type the follow-ing in the enter activity area: White Spot Chargrilled Burger; you did thisactivity with Barrack Obama, so select Barrack as the friend that you didthis activity with. Now Log the activity ($5)2) In the walking activity that you have already completed and logged onVivoSpace, add a comment in response to your friends Kaths comment.Please write: I wish you could have joined us. ($1)3) Go to the Loggers page. You no longer want to track resistance exercisebut you do want to track biking. Please select or unselect as appropriate($1)4) Go to the Seals page. You are interested in the Oceanwise seal. You wantto select this seal, so please select it. ($1)5) Go to the Newsfeed page. Please enter a comment on Williams activity,such as good job. ($5)6) Go to the Dashboard Page. This week, how are you doing with respect tothe amount of calories that you are consuming? What is the definition ofcalories? ($1)7) View the chart for Calories. ($1)8) View your existing goals. What is the name of one of your current goals?($1)9) Go to the page to create a goal. Browse the library of goals that you cancreate. You decide to create a healthy heart goal. Give this goal a namethat is different than the default. You also decide to select a lower trans fatgoal, so enter 3 g/day for trans fat. Select a start date of today. Select anend date of next of the end of next month. Then create this goal. ($5)10) By meeting a goal in the specified timeframe, you have earned some stars.How many stars have you earned? Find the page that lists all of your stars($1)278Sixth Appendix: Laboratory Evaluation of Medium-Fidelity Prototype11) How many of your stars have you shared with your friends? ($1)12) View the chart for the sodium star? ($1)13) Go to the page that shows the stars that your friends have earned. ($1)14) What star has your friend Barrack Obama earned? ($1)15) First you want to see the clubs that you are a part of, go to your clubs.What clubs are you a part of? ($1)16) Now, you want to join a club. Go to the page to join clubs. You seeAshtons club. Join Ashtons club ($1)17) You decide to create a club of your own, so that you can allow othersto join it. Go to the create clubs page. Choose the lose weight club fromthe library. Call it lose 10 lbs club. Change the daily value for saturated to7g/day. Enter tomorrow as the start date. Enter the end of October for theend date. Make this club closed on to those people that you invite. Invitethe following friends: William, Joey and Maggie. Create the club ($5)18) You now want to view the badges that you have earned from clubs thatyou completed successfully, go to your badges page. How many badges haveyou earned? ($1)19) Out of the badges that you earned, which one was from a club that youcreated? ($1)20) View the badges that your friends have earned. Notice Maggies badge.Comment on her badge by saying very impressive Maggie! ($1)21) You want to see the challenges that you are participating in, go to yourchallenges. What challenges are you participating in? ($1)22) Who is winning this challenge? ($1)23) Now, you want to join a challenge. Go to the page to join challenges.Notice Joeys challenge. Join Joeys challenge ($1)24) Now you want to create a challenge, go to the create challenges page.Choose the lose weight challenge from the library. Give the challenge thefollowing name Lose the most weight before the fall. Set the main target as15 lbs. Set the start date for next week and the end date for the beginningof October. Open this challenge for everyone. Invite all your friends toparticipate. Create the Challenge ($5)25) Now you want to see how many trophies you have won in the challenges279Sixth Appendix: Laboratory Evaluation of Medium-Fidelity Prototypethat you have participated in. Go to your trophies page. How many trophieshave you won? ($1)26) View the trophies that your friends have won. Which of your friendshave won a trophy? ($1)Both Participants are given paper questionnaires to complete and taken toa private setting to be able to complete them without any fear that theirpartner will see what they are writing.1. Questions for participant A:a. What were your reasons & motivations for helping B?b. What were your reasons & motivations for not helping B?c. Did you develop a strategy when playing this game?2. Questions for participant B (feel free to play with VivoSpace as you answerthese questions):a. Please provide your general thoughts on VivoSpace and make any sugges-tions for improvementsIII. COMMITMENTIn-group experiment: Both Participant A and B are given the following ques-tions to answer about VivoSpace. They need to develop answers together asa team, and they can play with VivoSpace when trying to find the answer:1. You can only view your friends activities in the newsfeed if the activityhas been shared by your friend even if you were with your friend when youdid the activitya. Trueb. False2. Please select the correct way to earn starsa. By successfully completing a goal that you have setb. By successfully completing a goal that either you have set or a friend has280Sixth Appendix: Laboratory Evaluation of Medium-Fidelity Prototypesetc. By successfully completing a goal by the deadlined. You earn a star when the deadline for a goal is reached3. What happens to goals where the targets are not reacheda. You have the option of creating a new deadlineb. They are no longer visiblec. They are shown in your goals paged. It is not clear in the prototype4. Evidence-based seal appear automatically when an activity is entereda. Trueb. False5. Clubs are competitivea. Trueb. False6. Only the following number of people can earn a badge in any cluba. It depends on the clubb. All members can earn a badgec. Only one member can earn a badged. It is not clear in the prototype7. Badges are earned when the following occursa. When the targets are metb. When the first person meets the targetsc. Simply by joining the clubd. After the end date8. Challenges are competitivea. Trueb. False281Sixth Appendix: Laboratory Evaluation of Medium-Fidelity Prototype9. Only the following number of people can earn a trophy in any challengea. It depends on the challengeb. All participants in the challengec. Only one participant can earn a trophyd. It is not clear in the prototype10. When a friend earns a badge or trophy it is automatically visible to youa. No, they need to share it firstb. Yes, this is trueAlternately, each participant is told the following in private:1. You scored 70% and the average is 90%.a. Would you keep working with this group, if it was the only way to continueusing VivoSpace?a. Yes, I would stay with this group rather than go to another group to useVivoSpace.b. No, I would go to another group and stop using VivoSpaceb. Why?c. Would you keep working with this group, if it cost you $50 (of the fundsused for the helping game) to leave the group?a. Yes, I would stay with this group at no costb. No, I would pay $50 to work with another group2. You scored 70% and the average is 50%a. Would you keep working with this group, if it was the only way to continueusing VivoSpace?a. Yes, I would stay with this group rather than go to another groupb. No, I would go to another group and stop using VivoSpaceb. Why?c. Would you keep working with this group, if it cost you $50 (of the fundsused for the helping game) to leave the group?282Sixth Appendix: Laboratory Evaluation of Medium-Fidelity Prototypea. Yes, I would stay with this group at no costb. No, I would pay $50 to work with another groupFull disclosure statement is provided to each participant and read to each par-ticipant that explains the deceptions in both the Belonging and Commitmentexperiments and the reasons for it.283

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