Background Chronic obstructive pulmonary disease (COPD) is highly prevalent and significantly affects the daily functioning of patients. Self-management strategies, including increasing physical activity, can help people with COPD have better health and a better quality of life. Digital mobile health (mHealth) techniques have the potential to aid the delivery of self-management interventions for COPD. We developed an mHealth intervention (Self-Management supported by Assistive, Rehabilitative, and Telehealth technologies-COPD [SMART-COPD]), delivered via a smartphone app and an activity tracker, to help people with COPD maintain (or increase) physical activity after undertaking pulmonary rehabilitation (PR). Objective This study aimed to determine the feasibility and acceptability of using the SMART-COPD intervention for the self-management of physical activity and to explore the feasibility of conducting a future randomized controlled trial (RCT) to investigate its effectiveness. Methods We conducted a randomized feasibility study. A total of 30 participants with COPD were randomly allocated to receive the SMART-COPD intervention (n=19) or control (n=11). Participants used SMART-COPD throughout PR and for 8 weeks afterward (ie, maintenance) to set physical activity goals and monitor their progress. Questionnaire-based and physical activity–based outcome measures were taken at baseline, the end of PR, and the end of maintenance. Participants, and health care professionals involved in PR delivery, were interviewed about their experiences with the technology. Results Overall, 47% (14/30) of participants withdrew from the study. Difficulty in using the technology was a common reason for withdrawal. Participants who completed the study had better baseline health and more prior experience with digital technology, compared with participants who withdrew. Participants who completed the study were generally positive about the technology and found it easy to use. Some participants felt their health had benefitted from using the technology and that it assisted them in achieving physical activity goals. Activity tracking and self-reporting were both found to be problematic as outcome measures of physical activity for this study. There was dissatisfaction among some control group members regarding their allocation. Conclusions mHealth shows promise in helping people with COPD self-manage their physical activity levels. mHealth interventions for COPD self-management may be more acceptable to people with prior experience of using digital technology and may be more beneficial if used at an earlier stage of COPD. Simplicity and usability were more important for engagement with the SMART-COPD intervention than personalization; therefore, the intervention should be simplified for future use. Future evaluation will require consideration of individual factors and their effect on mHealth efficacy and use; within-subject comparison of step count values; and an opportunity for control group participants to use the intervention if an RCT were to be carried out. Sample size calculations for a future evaluation would need to consider the high dropout rates.

Background Individuals living with long-term physical health conditions frequently experience co-occurring mental health problems. This comorbidity has a significant impact on an individual’s levels of emotional distress, health outcomes, and associated health care utilization. As health care services struggle to meet demand and care increasingly moves to the community, digital tools are being promoted to support patients to self-manage their health. One such technology is the autonomous virtual agent (chatbot, conversational agent), which uses artificial intelligence (AI) to process the user’s written or spoken natural language and then to select or construct the corresponding appropriate responses. Objective This study aimed to co-design the content, functionality, and interface modalities of an autonomous virtual agent to support self-management for patients with an exemplar long-term condition (LTC; chronic pulmonary obstructive disease [COPD]) and then to assess the acceptability and system content. Methods We conducted 2 co-design workshops and a proof-of-concept implementation of an autonomous virtual agent with natural language processing capabilities. This implementation formed the basis for video-based scenario testing of acceptability with adults with a diagnosis of COPD and health professionals involved in their care. Results Adults (n=6) with a diagnosis of COPD and health professionals (n=5) specified 4 priority self-management scenarios for which they would like to receive support: at the time of diagnosis ( information provision ), during acute exacerbations ( crisis support ), during periods of low mood ( emotional support ), and for general self-management ( motivation ). From the scenario testing, 12 additional adults with COPD felt the system to be both acceptable and engaging, particularly with regard to internet-of-things capabilities. They felt the system would be particularly useful for individuals living alone. Conclusions Patients did not explicitly separate mental and physical health needs, although the content they developed for the virtual agent had a clear psychological approach. Supported self-management delivered via an autonomous virtual agent was acceptable to the participants. A co-design process has allowed the research team to identify key design principles, content, and functionality to underpin an autonomous agent for delivering self-management support to older adults living with COPD and potentially other LTCs.

IntroductionGroup-based cognitive stimulation is the only nonpharmacologic intervention recommended by the UK National Institute for Clinical and Health Excellence for people with dementia. The potential of technology to extend the availability of group-based cognitive stimulation has not been tested.MethodsOne hundred sixty-one people with dementia participated in an eight-session group activity using Computer Interactive Reminiscence and Conversation Aid (CIRCA). Cognition, quality of life, and general health were assessed before intervention, postintervention, and 3 months later.ResultsThere was a significant improvement in cognition and quality of life at the end of the CIRCA group intervention, which was further improved at 3-month follow-up.DiscussionCIRCA group sessions improved cognition and quality of life similar to group-based cognitive stimulation approved by the National Institute for Clinical and Health Excellence. These benefits were maintained at 3-month follow-up. The data confirm the potential of CIRCA, which can be populated with different cultural and language contents for different user groups.

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Service robots with advanced intelligence capabilities can potentially transform servicescapes. However, limited attention has been given to how consumers experiencing vulnerabilities, particularly those with disabilities, envisage the characteristics of robots’ prospective integration into emotionally intense servicescapes, such as long-term care (LTC). We take an interdisciplinary approach conducting three exploratory studies with consumers with disabilities involving Community Philosophy, LEGO ® Serious Play ®, and Design Thinking methods. Addressing a lack of consumer-centric research, we offer a three-fold contribution by 1) developing a conceptualization of consumer-conceived value of robots in LTC, which are envisaged as a supporting resource offering consumers opportunities to realize value; 2) empirically evidencing pathogenic vulnerabilities as a potential value-destruction factor to underscore the importance of integrating service robots research with a service inclusion paradigm; and 3) providing a theoretical extension and clarification of prior characterizations of robots’ empathetic and emotion-related AI capabilities. Consumers with disabilities conceive robots able to stimulate and regulate emotions by mimicking cognitive and behavioral empathy, but unable to express affective and moral empathy, which is central to care experience. While providing support for care practices, for the foreseeable future, service robots will not, in themselves, actualize the experience of “being cared for.”