Our study showed a positive effect of SNS interventions on health behavior-related outcomes, but there was considerable heterogeneity. Protocol registration The protocol for this systematic review is registered at http://www.crd.york.ac.uk/PROSPERO with the number CRD42013004140.

Difficulties are often an unavoidable but important part of the learning process. This seems particularly so for complex conceptual learning. Challenges in the learning process are however, particularly difficult to detect and respond to in educational environments where growing class sizes and the increased use of digital technologies mean that teachers are unable to provide nuanced and personalized feedback and support to help students overcome their difficulties. Individual differences, the specifics of the learning activity, and the difficulty of giving individual feedback in large classes and digital environments all add to the challenge of responding to student difficulties and confusion. In this integrative review, we aim to explore difficulties and resulting emotional responses in learning. We will review the primary principles of cognitive disequilibrium and contrast these principles with work on desirable difficulties, productive failure, impasse driven learning, and pure discovery-based learning. We conclude with a theoretical model of the zones of optimal and sub-optimal confusion as a way of conceptualizing the parameters of productive and non-productive difficulties experienced by students while they learn.

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BackgroundPersonally controlled health management systems (PCHMS), which may include a personal health record (PHR), health management tools, and information resources, have been advocated as a next-generation technology to improve health behaviors and outcomes. There have been successful trials of PCHMS in various health settings. However, there is mixed evidence for whether consumers will use these systems over the long term and whether they ultimately lead to improved health outcomes and behaviors.ObjectiveThe aim was to test whether use of a PCHMS by consumers can increase the uptake or updating of a written asthma action plan (AAP) among adults with asthma.MethodsA 12-month parallel 2-group randomized controlled trial was conducted. Participants living with asthma were recruited nationally in Australia between April and August 2013, and randomized 1:1 to either the PCHMS group or control group (online static educational content). The primary outcome measure was possession of an up-to-date written AAP poststudy. Secondary measures included (1) utilizing the AAP; (2) planned or unplanned visits to a health care professional for asthma-related concerns; (3) severe asthma exacerbation, inadequately controlled asthma, or worsening of asthma that required a change in treatment; and (4) number of days lost from work or study due to asthma. Ancillary analyses examined reasons for adoption or nonadoption of the intervention. Outcome measures were collected by online questionnaire prestudy, monthly, and poststudy.ResultsA total of 330 eligible participants were randomized into 1 of 2 arms (intervention: n=154; control: n=176). Access to the PCHMS was not associated with a significant difference in any of the primary or secondary outcomes. Most participants (80.5%, 124/154) did not access the intervention or accessed it only once.ConclusionsDespite the intervention being effective in other preventive care settings, system use was negligible and outcome changes were not seen as a result. Consumers must perceive the need for assistance with a task and assign priority to the task supported by the eHealth intervention. Additionally, the cost of adopting the intervention (eg, additional effort, time spent learning the new system) must be lower than the benefit. Otherwise, there is high risk consumers will not adopt the eHealth intervention.Trial RegistrationAustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000716864; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362714 (Archived by WebCite® at http://www.webcitation.org/6dMV6hg4A)

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