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Health behaviour is crucial for influencing health, making it a key component in health promotion. However, changing behaviours is complex, as many factors interact to determine health behaviours. Information, awareness, and knowledge are important but not enough. It is essential to move beyond focusing solely on individual psychological and cognitive factors to an understanding of the complex processes involved in health behaviour change. Social-ecological models account for these complex processes but risk being overly broad and all-encompassing.

This qualitative grounded theory study explores how individual, interpersonal, and environmental factors interplay to influence health behaviour, and examines how social-ecological models in health promotion can be tailored to address different ecological needs. Participants were recruited from a community-based cardiovascular disease-prevention program in Northern Sweden. Data was collected through in-depth interviews about health and health behaviours throughout the life course among middle-aged men and women.

The results illustrate how factors obstructing or enabling health behaviours vary in patterned ways for individuals with different health identities. Social-ecological interventions could be more effective if adapted to the specific needs of people with different health identities. In addition to screening for various risk factors, screening for health identities could be helpful in designing social-ecological health-promoting interventions.

Introduction: The increased focus on the ethical aspects of artificial intelligence (AI) follows the increased use in society of data-driven analyses of personal information collected in the use of digital applications for various purposes that the individual is often not aware of. The purpose of this study is to investigate how values and norms are transformed into design choices in a participatory design process of an AI-based digital coaching application for promoting health and to prevent cardiovascular diseases, where a variety of expertise and perspectives are represented.

Method: A participatory design process was conducted engaging domain professionals and potential users in co-design workshops, interviews and observations of prototype use. The design process and outcome was analyzed from a responsible design of AI systems perspective.

Results: The results include deepened understanding of the values and norms underlying health coaching applications and how an AI-based intervention could provide person-tailored support in managing conflicting norms. Further, the study contributes to increased awareness of the value of participatory design in achieving value-based design of AI systems aimed at promoting health through behavior change, and the inclusion of social norms as a design material in the process.

Conclusion: It was concluded that the relationship between the anticipated future users and the organization(s) or enterprises developing and implementing the health-promoting application is directing which values are manifested in the application.

Purpose: As sharing on social media has become an integrated part of everyday life, health and public health actors have started to show interest in the potential of people’s peer-to-peer sharing of health-related personal information (HRI) for health interventions. In this article we focus on how people make sense of sharing HRI on social media.

Methods: Twenty-two people between the ages 40 and 60 who had taken part in a regional health intervention were interviewed. Using theories about social media sharing, we explore their understandings and negotiations about whether, how much, and how to share HRI and discuss the results in relation to peer-to-peer sharing as a strategy in interventions.

Results: We identified three aspects that were perceived as particularly risky: loss of control, effects on identity, and affecting others negatively, along with strategies that were used to manage risks in practice: avoiding sharing, allocating, and embedding HRI.

Conclusions: By allocating and embedding HRI, people can unlock motivating affordances for health work. However, strategies to manage risks can also be counterproductive. For actors to provide equality in health promotion, initiatives that include social media sharing need to be mindful of the sometimes counterproductive effects this may have on people’s engagement.

BACKGROUND: Chronic diseases, including cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, and cerebrovascular diseases, contribute to the most significant disease burden worldwide, negatively impacting patients and their family members. People with chronic diseases have common modifiable behavioral risk factors, including smoking, alcohol overconsumption, and unhealthy diets. Digital-based interventions for promoting and sustaining behavioral changes have flourished in recent years, although evidence of the cost-effectiveness of such interventions remains inconclusive.

OBJECTIVE: In this study, we aimed to investigate the cost-effectiveness of digital health interventions for behavioral changes among people with chronic diseases.

METHODS: This systematic review evaluated published studies focused on the economic evaluation of digital tools for behavioral change among adults with chronic diseases. We followed the Population, Intervention, Comparator, and Outcomes framework to retrieve relevant publications from 4 databases: PubMed, CINAHL, Scopus, and Web of Science. We used the Joanna Briggs Institute's criteria for economic evaluation and randomized controlled trials to assess the risk of bias in the studies. Two researchers independently screened, assessed the quality, and extracted data from the studies selected for the review.

RESULTS: In total, 20 studies published between 2003 and 2021 fulfilled our inclusion criteria. All the studies were conducted in high-income countries. These studies used telephones, SMS text messaging, mobile health apps, and websites as digital tools for behavior change communication. Most digital tools for interventions focused on diet and nutrition (17/20, 85%) and physical activity (16/20, 80%), and a few focused on smoking and tobacco control (8/20, 40%), alcohol reduction (6/20, 30%), and reduction of salt intake (3/20, 15%). Most studies (17/20, 85%) used the health care payer perspective for economic analysis, and only 15% (3/20) used the societal perspective. Only 45% (9/20) of studies conducted a full economic evaluation. Most studies (7/20, 35%) based on full economic evaluation and 30% (6/20) of studies based on partial economic evaluation found digital health interventions to be cost-effective and cost-saving. Most studies had short follow-ups and failed to include proper indicators for economic evaluation, such as quality-adjusted life-years, disability-adjusted life-years, lack of discounting, and sensitivity analysis.

CONCLUSIONS: Digital health interventions for behavioral change among people with chronic diseases are cost-effective in high-income settings and can therefore be scaled up. Similar evidence from low- and middle-income countries based on properly designed studies for cost-effectiveness evaluation is urgently required. A full economic evaluation is needed to provide robust evidence for the cost-effectiveness of digital health interventions and their potential for scaling up in a wider population. Future studies should follow the National Institute for Health and Clinical Excellence recommendations to take a societal perspective, apply discounting, address parameter uncertainty, and apply a lifelong time horizon.

Our behavior and our lifestyle habits are the foundation of our health, they affect the risk of developing non-communicable diseases such as diabetes and cardiovascular diseases. Today these non- communicable diseases are the leading cause of death. The Västerbotten Intervention Program (VIP) is one of very few population-oriented initiatives which, by offering all individuals aged 40, 50 and 60 a health intervention, aims to improve behavior and lifestyle habits in the population and thus increase the conditions for a healthier population and reduce healthcare related costs. The individual health interventions, performed every tenth year, was not designed to support individuals’ choices on a day-to-day basis between the health check-ups. Therefore, STAR-C an interdisciplinary research program, aims at developing a digital coaching system that could be used for supplying personalized digital coaching to support the evaluation and maintenance of healthy behavioral changes. This digital coaching system could, in the future, be used as complementary tool within VIP. The purpose of this study is to further explore these complements of a digital coach. This study presents a user-perspective from semi-structured interviews with VIP-participants and their views on a digital coach, what digital coach functions that could be useful and what kind of benefits this till could have being used as a complement to VIP. The results show that VIP-participants are missing tools for behavioral change support, and that factors such as personalization, motivation to and support during a behavioral change is important. Most important, for the participants in this study, was that a digital coach must be easy to use and user friendly.

A broad range of aspects are needed to be taken into consideration in the design and development of personalized coaching systems based on artificial intelligence methodologies. This research presents the initial phase of joining different professional and stakeholder perspectives on behavior change technologies into a flexible design proposal for a digital coaching system. The diversity and sometimes opposed views on content, behavior, purposes and context were managed using a structured argument-based design approach, which also feed into the behavior of the personalized system. Results include a set of personalization strategies that will be further elaborated with the target user group to manage sensitive issues such as ethics, social norms, privacy, motivation, autonomy and social relatedness.