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      Is Wearable Technology Becoming Part of Us? Developing and Validating a Measurement Scale for Wearable Technology Embodiment

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          Abstract

          Background

          To experience external objects in such a way that they are perceived as an integral part of one’s own body is called embodiment. Wearable technology is a category of objects, which, due to its intrinsic properties (eg, close to the body, inviting frequent interaction, and access to personal information), is likely to be embodied. This phenomenon, which is referred to in this paper as wearable technology embodiment, has led to extensive conceptual considerations in various research fields. These considerations and further possibilities with regard to quantifying wearable technology embodiment are of particular value to the mobile health (mHealth) field. For example, the ability to predict the effectiveness of mHealth interventions and knowing the extent to which people embody the technology might be crucial for improving mHealth adherence. To facilitate examining wearable technology embodiment, we developed a measurement scale for this construct.

          Objective

          This study aimed to conceptualize wearable technology embodiment, create an instrument to measure it, and test the predictive validity of the scale using well-known constructs related to technology adoption. The introduced instrument has 3 dimensions and includes 9 measurement items. The items are distributed evenly between the 3 dimensions, which include body extension, cognitive extension, and self-extension.

          Methods

          Data were collected through a vignette-based survey (n=182). Each respondent was given 3 different vignettes, describing a hypothetical situation using a different type of wearable technology (a smart phone, a smart wristband, or a smart watch) with the purpose of tracking daily activities. Scale dimensions and item reliability were tested for their validity and Goodness of Fit Index (GFI).

          Results

          Convergent validity of the 3 dimensions and their reliability were established as confirmatory factor analysis factor loadings (>0.70), average variance extracted values (>0.50), and minimum item to total correlations (>0.40) exceeded established threshold values. The reliability of the dimensions was also confirmed as Cronbach alpha and composite reliability exceeded 0.70. GFI testing confirmed that the 3 dimensions function as intercorrelated first-order factors. Predictive validity testing showed that these dimensions significantly add to multiple constructs associated with predicting the adoption of new technologies (ie, trust, perceived usefulness, involvement, attitude, and continuous intention).

          Conclusions

          The wearable technology embodiment measurement instrument has shown promise as a tool to measure the extension of an individual’s body, cognition, and self, as well as predict certain aspects of technology adoption. This 3-dimensional instrument can be applied to mixed method research and used by wearable technology developers to improve future versions through such things as fit, improved accuracy of biofeedback data, and customizable features or fashion to connect to the users’ personal identity. Further research is recommended to apply this measurement instrument to multiple scenarios and technologies, and more diverse user groups.

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          Most cited references60

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          Persuasive System Design Does Matter: A Systematic Review of Adherence to Web-Based Interventions

          Background Although web-based interventions for promoting health and health-related behavior can be effective, poor adherence is a common issue that needs to be addressed. Technology as a means to communicate the content in web-based interventions has been neglected in research. Indeed, technology is often seen as a black-box, a mere tool that has no effect or value and serves only as a vehicle to deliver intervention content. In this paper we examine technology from a holistic perspective. We see it as a vital and inseparable aspect of web-based interventions to help explain and understand adherence. Objective This study aims to review the literature on web-based health interventions to investigate whether intervention characteristics and persuasive design affect adherence to a web-based intervention. Methods We conducted a systematic review of studies into web-based health interventions. Per intervention, intervention characteristics, persuasive technology elements and adherence were coded. We performed a multiple regression analysis to investigate whether these variables could predict adherence. Results We included 101 articles on 83 interventions. The typical web-based intervention is meant to be used once a week, is modular in set-up, is updated once a week, lasts for 10 weeks, includes interaction with the system and a counselor and peers on the web, includes some persuasive technology elements, and about 50% of the participants adhere to the intervention. Regarding persuasive technology, we see that primary task support elements are most commonly employed (mean 2.9 out of a possible 7.0). Dialogue support and social support are less commonly employed (mean 1.5 and 1.2 out of a possible 7.0, respectively). When comparing the interventions of the different health care areas, we find significant differences in intended usage (p = .004), setup (p < .001), updates (p < .001), frequency of interaction with a counselor (p < .001), the system (p = .003) and peers (p = .017), duration (F = 6.068, p = .004), adherence (F = 4.833, p = .010) and the number of primary task support elements (F = 5.631, p = .005). Our final regression model explained 55% of the variance in adherence. In this model, a RCT study as opposed to an observational study, increased interaction with a counselor, more frequent intended usage, more frequent updates and more extensive employment of dialogue support significantly predicted better adherence. Conclusions Using intervention characteristics and persuasive technology elements, a substantial amount of variance in adherence can be explained. Although there are differences between health care areas on intervention characteristics, health care area per se does not predict adherence. Rather, the differences in technology and interaction predict adherence. The results of this study can be used to make an informed decision about how to design a web-based intervention to which patients are more likely to adhere.
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            Restoring natural sensory feedback in real-time bidirectional hand prostheses.

            Hand loss is a highly disabling event that markedly affects the quality of life. To achieve a close to natural replacement for the lost hand, the user should be provided with the rich sensations that we naturally perceive when grasping or manipulating an object. Ideal bidirectional hand prostheses should involve both a reliable decoding of the user's intentions and the delivery of nearly "natural" sensory feedback through remnant afferent pathways, simultaneously and in real time. However, current hand prostheses fail to achieve these requirements, particularly because they lack any sensory feedback. We show that by stimulating the median and ulnar nerve fascicles using transversal multichannel intrafascicular electrodes, according to the information provided by the artificial sensors from a hand prosthesis, physiologically appropriate (near-natural) sensory information can be provided to an amputee during the real-time decoding of different grasping tasks to control a dexterous hand prosthesis. This feedback enabled the participant to effectively modulate the grasping force of the prosthesis with no visual or auditory feedback. Three different force levels were distinguished and consistently used by the subject. The results also demonstrate that a high complexity of perception can be obtained, allowing the subject to identify the stiffness and shape of three different objects by exploiting different characteristics of the elicited sensations. This approach could improve the efficacy and "life-like" quality of hand prostheses, resulting in a keystone strategy for the near-natural replacement of missing hands.
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              Personal Sensing: Understanding Mental Health Using Ubiquitous Sensors and Machine Learning.

              Sensors in everyday devices, such as our phones, wearables, and computers, leave a stream of digital traces. Personal sensing refers to collecting and analyzing data from sensors embedded in the context of daily life with the aim of identifying human behaviors, thoughts, feelings, and traits. This article provides a critical review of personal sensing research related to mental health, focused principally on smartphones, but also including studies of wearables, social media, and computers. We provide a layered, hierarchical model for translating raw sensor data into markers of behaviors and states related to mental health. Also discussed are research methods as well as challenges, including privacy and problems of dimensionality. Although personal sensing is still in its infancy, it holds great promise as a method for conducting mental health research and as a clinical tool for monitoring at-risk populations and providing the foundation for the next generation of mobile health (or mHealth) interventions.
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                Author and article information

                Contributors
                Journal
                JMIR Mhealth Uhealth
                JMIR Mhealth Uhealth
                JMU
                JMIR mHealth and uHealth
                JMIR Publications (Toronto, Canada )
                2291-5222
                August 2019
                09 August 2019
                : 7
                : 8
                : e12771
                Affiliations
                [1 ] Biomedical Signals and Systems University of Twente Enschede Netherlands
                [2 ] Center for Market Insights Amsterdam University of Applied Sciences Amsterdam Netherlands
                [3 ] Ziekenhuis Groep Twente Almelo Netherlands
                [4 ] Department of Psychology, Health and Technology University of Twente Enschede Netherlands
                Author notes
                Corresponding Author: Elizabeth C Nelson e.c.nelson@ 123456utwente.nl
                Author information
                http://orcid.org/0000-0001-7422-1015
                http://orcid.org/0000-0003-1042-7887
                http://orcid.org/0000-0001-8730-1487
                http://orcid.org/0000-0002-5013-9225
                Article
                v7i8e12771
                10.2196/12771
                6709898
                31400106
                aa089196-9310-472b-91d1-5f7911bbd9f1
                ©Elizabeth C Nelson, Tibert Verhagen, Miriam Vollenbroek-Hutten, Matthijs L Noordzij. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 09.08.2019.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/.as well as this copyright and license information must be included.

                History
                : 9 November 2018
                : 10 January 2019
                : 18 March 2019
                : 6 April 2019
                Categories
                Original Paper
                Original Paper

                embodiment,wearable technology,measurement development,human technology interaction,ehealth,mhealth,wearable electronic devices,self-help devices,health information technology,medical informatics

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