BackgroundThe combination of self-tracking and persuasive eCoaching in automated interventions is a new and promising approach for healthy lifestyle management.ObjectiveThe aim of this study was to identify key components of self-tracking and persuasive eCoaching in automated healthy lifestyle interventions that contribute to their effectiveness on health outcomes, usability, and adherence. A secondary aim was to identify the way in which these key components should be designed to contribute to improved health outcomes, usability, and adherence.MethodsThe scoping review methodology proposed by Arskey and O’Malley was applied. Scopus, EMBASE, PsycINFO, and PubMed were searched for publications dated from January 1, 2013 to January 31, 2016 that included (1) self-tracking, (2) persuasive eCoaching, and (3) healthy lifestyle intervention.ResultsThe search resulted in 32 publications, 17 of which provided results regarding the effect on health outcomes, 27 of which provided results regarding usability, and 13 of which provided results regarding adherence. Among the 32 publications, 27 described an intervention. The most commonly applied persuasive eCoaching components in the described interventions were personalization (n=24), suggestion (n=19), goal-setting (n=17), simulation (n=17), and reminders (n=15). As for self-tracking components, most interventions utilized an accelerometer to measure steps (n=11). Furthermore, the medium through which the user could access the intervention was usually a mobile phone (n=10). The following key components and their specific design seem to influence both health outcomes and usability in a positive way: reduction by setting short-term goals to eventually reach long-term goals, personalization of goals, praise messages, reminders to input self-tracking data into the technology, use of validity-tested devices, integration of self-tracking and persuasive eCoaching, and provision of face-to-face instructions during implementation. In addition, health outcomes or usability were not negatively affected when more effort was requested from participants to input data into the technology. The data extracted from the included publications provided limited ability to identify key components for adherence. However, one key component was identified for both usability and adherence, namely the provision of personalized content.ConclusionsThis scoping review provides a first overview of the key components in automated healthy lifestyle interventions combining self-tracking and persuasive eCoaching that can be utilized during the development of such interventions. Future studies should focus on the identification of key components for effects on adherence, as adherence is a prerequisite for an intervention to be effective.

Background: For a stress-management app to be persuasive and impactful, designers and developers should obtain a clear perspective of the value proposition according to key stakeholders before development. However, this is often not the case. In order to increase the chance of creating an impact by means of the Resilience Navigator app, this study aims to identify key stakeholders and work with them to gain an in-depth understanding of the value proposition of this stress-management app. Methods: The approach used in this study builds on the approaches taken by Van Limburg et al. and Van Woezik et al. An initial list of stakeholders was identified by means of a literature scan. Stakeholders on this initial list took an online survey to identify key stakeholders with a ranking system. Semi-structured interviews were conducted with a subset of key stakeholders to identify the value proposition using the value proposition canvas as a framework for data collection. Finally, the value proposition was validated by key stakeholders during focus groups. Results: The key stakeholders identified included employees, employers, participation councils within organisations, HR advisors, product owners, company doctors, and business analysts. The interviews produced a list of approximately one hundred values from which fifteen core values were distilled. One example is to take into account time constraints experienced by users during stress periods. In general, the Resilience Navigator app's main goal is to increase awareness of personal stress levels and causes of stress. In addition, the sub-goal is to increase skills for effective stress management. The focus groups validated the idea that the most important values were reflected in the value proposition and had been appropriately translated into design elements, according to key stakeholders.

Self-tracking and automated persuasive eCoaching combined in a smartphone application may enhance stress management among employees at an early stage. For the application to be persuasive and create impact, we need to achieve a fit between the design and end-users' and important stakeholders' values. Semi-structured interviews were conducted among 8 employees and 8 human resource advisors to identify values of self-tracking, persuasive eCoaching, and preconditions (e.g., privacy and implementation) for a stress management application, using the value proposition design by Osterwalder et al. Results suggest essential features and functionalities that the application should possess. In general, respondents see potential in combining self-tracking and persuasive eCoaching for stress management via a smartphone application. Future design of the application should mainly focus on gaining awareness about the level of stress and causes of stress. In addition, the application should possess a positive approach besides solely the focus on negative aspects of stress.

Smartphones are powerful tools for reaching the user when it is most needed, i.e. Just-In-Time (JIT). In the context of stress management in professionals, self-tracking can create awareness about stress and eCoaching can provide personalised JIT coping suggestions. Employees should also be receptive to take in or act upon the JIT-messages. Therefore, this study aims to explore what factors (emotional state, events or conditions, and content of the message) affect the employees' receptivity to JIT-messages. 17 participants were invited to use a prototype of the Resilience Navigator app for two weeks. The mixed-methods approach consisted of mixed effects models analysis on data collected via the app (receptivity and the factors of interest) and qualitative analysis on semi-structured interview data collected after the study period. The overall finding was that the participants' receptivity in the context of stress management often mismatches with the most relevant moments for JIT-messages. For example, emotions with a negative valence seemed to influence the receptivity towards JIT-messages negatively, although the perceived relevance was high. As technology can pinpoint the most receptive and relevant moment for sending JIT-messages, we advocate to further study this topic with more robust quantitative data.

ContentsChapter 1 General introduction Part 1 Creating value with self-tracking and persuasive eCoaching Chapter 2 Key components in eHealth interventions combining self-tracking and persuasive eCoaching to promote a healthier lifestyle: a scoping review.Chapter 3

Background An eHealth tool that coaches employees through the process of reflection has the potential to support employees with moderate levels of stress to increase their capacity for resilience. Most eHealth tools that include self-tracking summarize the collected data for the users. However, users need to gain a deeper understanding of the data and decide upon the next step to take through self-reflection. Objective In this study, we aimed to examine the perceived effectiveness of the guidance offered by an automated e-Coach during employees’ self-reflection process in gaining insights into their situation and on their perceived stress and resilience capacities and the usefulness of the design elements of the e-Coach during this process. Methods Of the 28 participants, 14 (50%) completed the 6-week BringBalance program that allowed participants to perform reflection via four phases: identification, strategy generation, experimentation, and evaluation. Data collection consisted of log data, ecological momentary assessment (EMA) questionnaires for reflection provided by the e-Coach, in-depth interviews, and a pre- and posttest survey (including the Brief Resilience Scale and the Perceived Stress Scale). The posttest survey also asked about the utility of the elements of the e-Coach for reflection. A mixed methods approach was followed. Results Pre- and posttest scores on perceived stress and resilience were not much different among completers (no statistical test performed). The automated e-Coach did enable users to gain an understanding of factors that influenced their stress levels and capacity for resilience (identification phase) and to learn the principles of useful strategies to improve their capacity for resilience (strategy generation phase). Design elements of the e-Coach reduced the reflection process into smaller steps to re-evaluate situations and helped them to observe a trend (identification phase). However, users experienced difficulties integrating the chosen strategies into their daily life (experimentation phase). Moreover, the identified events related to stress and resilience were too specific through the guidance offered by the e-Coach (identification phase), and the events did not recur, which consequently left users unable to sufficiently practice (strategy generation phase), experiment (experimentation phase), and evaluate (evaluation phase) the techniques during meaningful events. Conclusions Participants were able to perform self-reflection under the guidance of the automated e-Coach, which often led toward gaining new insights. To improve the reflection process, more guidance should be offered by the e-Coach that would aid employees to identify events that recur in daily life. Future research could study the effects of the suggested improvements on the quality of reflection via an automated e-Coach.

BACKGROUND An eHealth tool that guides employees through the process of reflection has the potential to support employees with moderate levels of stress to increase their capacity for resilience. Most eHealth tools that include self-tracking summarise the collected data for the users. However, users need to gain a deeper understanding of the data and decide upon the next step to take through self-reflection. OBJECTIVE In this study, we aimed to examine: (1) the perceived effectiveness of the guidance offered by an automated eCoach during employees’ self-reflection process in gaining insights into their situation and on their perceived stress and resilience capacities; and (2) the usefulness of the design elements of the eCoach during this process. METHODS Of the twenty-eight participants, fourteen completed the six-week BringBalance programme that allowed participants to perform reflection via four phases (Gilbert and Trudel, 2001): 1) identification, 2) strategy generation, 3) experimentation, and 4) evaluation. Data collection consisted of log data, EMA questionnaires for reflection provided by the eCoach, in-depth interviews, and a pre-and post-test survey (including the Brief Resilience Scale and the Perceived Stress Scale). The post-test survey also asked about the utility of the elements of the eCoach for reflection. RESULTS Although users did not perceive a beneficial effect on stress and resilience capacities, the automated eCoach did enable users to gain an understanding of factors that influenced their stress levels and capacity for resilience and to learn the principles of useful strategies to improve their capacity for resilience. Design elements of the eCoach reduced the reflection process into smaller steps to re-evaluate situations and helped them to observe a trend. However, users experienced difficulties integrating the chosen strategies into their daily life. Moreover, the identified events related to stress and resilience were too specific through the guidance offered by the eCoach and the events did not recur, which consequently left users unable to sufficiently practise, experiment, and evaluate the techniques during meaningful events. CONCLUSIONS Although participants did not report improvements to their stress and resilience capacities, they were able to perform self-reflection under the guidance of the automated eCoach, which often led towards gaining new insights. To improve the reflection process, more guidance should be offered by the eCoach that would aid employees to identify events that recur in daily life. Future research could study the effects of the suggested improvements on the quality of reflection via an automated eCoach.