FemTech is an emerging industry offering products, software, and services to support women’s health and well-being. Within FemTech, mobile health applications (mHealth apps) are popular for managing menstruation, fertility, pregnancy, and menopause. Yet, these apps expose users to deceptive and misleading practices, which can be characterized as Dark Patterns in user experience (or dark UX). Dark UX in commercial FemTech mHealth apps is underexplored, leaving a critical gap in understanding how deceptive patterns manifest in intimate health contexts, the harms they cause, and how to address them. We crowd-source and thematically analyze user accounts of dark UX through user reviews from sixteen systematically selected FemTech mHealth apps. User-reported accounts of dark UX in FemTech mHealth apps reveal several problematic design patterns, which emphasize risks for minors and the need for more transparent design of FemTech mHealth apps. Based on our results, we outline recommendations for enhancing ethical UX design and furthering regulatory action in FemTech.

Personal health informatics systems have been centered around individual efforts, overlooking the role of social factors in health. Over seven years of research ( n \(=\) 153), we examined how socially-enabled personal informatics systems can support physical activity—a behavior critical in promoting physical and mental health. We prioritized exploring this topic with families in low-socioeconomic status (SES) neighborhoods because they face increased barriers to being active due to inequities. Through our systems development, qualitative studies, and theoretical foundation, we developed the Socio-Cognitive Framework for Personal Health Informatics systems that shows how five socio-cognitive concepts (aspirations, data exposure, stories, belongingness, and impediments) influence self-efficacy and outcome expectations that are linked to health behavior. We then provide recommendations on how to design and evaluate such systems. We further argue that socially-enabled health informatics tools can support marginalized communities in reducing health disparities through the collective efforts of families, neighbors, and peers.

Peer matching can enhance the impact of social health technologies. By matching similar peers, online health communities can optimally facilitate social modeling that supports positive health attitudes and moods. However, little work has examined how to operationalize similarities in digital health tools, thus limiting our ability to perform optimal peer matching. To address this gap, we conducted a factorial experiment to examine how three categories of similarity variables (i.e., Demographic, Ability, Experiential) can be used to perform peer matching that supports the social modeling of physical activity. We focus this study on physical activity because it is a health behavior that reduces the risk of chronic diseases. We also prioritized this study for single-caregiver mothers who often face substantial barriers to being active because of immense employment and household responsibilities, especially Black single-caregiver mothers. We recruited 309 single-caregiver mothers (49% Black, 51% white), then we asked them to listen to peer audio storytelling about family physical activity. We randomly matched/mismatched the storyteller's profile using the three categories of similarity variables. Our analyses demonstrated that matching by Demographic variables led to a significantly higher Physical Activity Intention. Furthermore, our subgroup analyses indicated that Black single-caregiver mothers experienced a significant and immediate effect of peer matching in Physical Activity Intention, Self-efficacy, and mood. In contrast, white single-caregiver mothers did not report any significant immediate effect. Collectively, our data suggest that peer matching in health storytelling is potentially beneficial for racially minoritized groups; and that having diverse representations in health technology is required for promoting health equity.

Physical activity (PA) is crucial for reducing the risk of obesity, an epidemic that disproportionately burdens families of low-socioeconomic status (SES). While fitness tracking tools can increase PA awareness, more work is needed to examine (1) how such tools can help people benefit from their social environment, and (2) how reflections can help enhance PA attitudes. We investigated how fitness tracking tools for families can support social modeling and self-modeling (through reflection), two critical processes in Social Cognitive Theory. We developed StoryMap, a novel fitness tracking app for families aimed at supporting both modes of modeling. Then, we conducted a five-week qualitative study evaluating StoryMap with 16 low-SES families. Our findings contribute an understanding of how social and self-modeling can be implemented in fitness tracking tools and how both modes of modeling can enhance key PA attitudes: self-efficacy and outcome expectations. Finally, we propose design recommendations for social personal informatics tools.

Physical activity (PA) is critical for reducing the risk of obesity, a prevalent health concern that burdens low-socioeconomic status (SES) households. While self-tracking apps can increase PA, encouraging app engagement remains a challenge, thus limiting the app's efficacy. To understand how to better support caregiver's motivation to use family health apps, we designed and evaluated Storywell?a mobile app for promoting family PA. Guided by Self-Determination Theory, Storywell provides social rewards (e.g., storybooks with interactive reflective questions) aimed at supporting relatedness and motivation. Our 3-month qualitative study with 18 families revealed satisfying moments that can affect caregiver's motivation. We contribute new knowledge on designing satisfying moments that heighten the motivation to use health apps, especially for low-SES families who face many barriers to using such systems.

Caregivers of persons with dementia (PWD) experience higher rates of stress, social isolation, and poor mental and physical health compared to non-caregiving populations. There is a vital need for engaging, sustainable, and scalable resources to support social, physical, and emotional wellbeing amongst caregivers of PWD. To explore this open design space, we designed and conducted a 6-week mixed-method evaluation of Go&Grow, a pervasive social exergame in which flowers grow as users increase physical activity and interact with other caregivers of PWD. Our findings showed that using Go&Grow helped participants relieve stress, increase physical activity, and develop empathy for and patience towards the loved one with dementia that they cared for. At the same time, tension arose as some caregivers desired to learn about the life challenges that Go&Grow users faced, while others hesitated to share such content. We discuss our findings and recommendations for future technology that promotes caregivers' time for themselves, understanding of PWD, and connections with other caregivers.

Wearable activity trackers can encourage physical activity (PA)-a behavior critical for preventing obesity and reducing the risks of chronic diseases. However, prior work has rarely explored how these tools can leverage family support or help people think about strategies for being active-wo factors necessary for achieving regular PA. In this 2-month qualitative study, we investigated PA tracking practices amongst 14 families living in low-income neighborhoods, where obesity is prevalent. We characterize how social discussions of PA data rarely extended beyond the early stages of experiential learning, thus limiting the utility of PA trackers. Caregivers and children rarely analyzed their experiences to derive insights about the meaning of their PA data for their wellbeing. Those who engaged in these higher-order learning processes were often influenced by parenting beliefs shaped by personal health experiences. We contribute recommendations for how technology can more effectively support family experiential learning using PA tracking data.

Low-socioeconomic status (SES) families face increased barriers to physical activity (PA)-a behavior critical for reducing and preventing chronic disease. Research has explored how wearable PA trackers can encourage increased activity, and how the adoption of such trackers is driven by people's emotions and social needs. However, more work is needed to understand how PA trackers are perceived and adopted by low-SES families, where PA may be deprioritized due to economic stresses, limited resources, and perceived crime. Accordingly, we conducted a two-month, in-depth qualitative study, exploring low-SES caregivers' perspectives on PA tracking and promotion. Our findings show how PA tracking was impacted by caregivers' attitudes toward safety, which were influenced by how they perceived social connections within their neighborhoods; and cognitive-emotional processes. We conclude that PA tracking tools for low-SES families should help caregivers and children to experience and celebrate progress.

Diverse disciplines, including Human-Computer Interaction have explored how mobile health (mHealth) applications can transform healthcare and health promotion. Increasingly, research has explored how mHealth tools can promote healthy behaviors within vulnerable populations-groups that disproportionately experience barriers to wellness. We conducted a systematic review of 83 papers from diverse disciplines to characterize the design and impact of mHealth tools in low-socioeconomic (low-SES) and racial/ethnic minority individuals. Our findings highlight that the diversity within low-SES and racial/ethnic minority groups was not reflected in the populations studied. Most studies focused on improving the health of individuals, often neglecting factors at the community and society levels that influence health disparities. Moreover, few improvements in health outcomes were demonstrated. We further discuss factors that acted as barriers and facilitators of mHealth intervention adoption. Our findings highlight trends that can drive critically needed digital health innovations for vulnerable populations.

HCI research has increasingly examined how sensing technologies can help people capture and visualize data about their health-related behaviors. Yet, few systems help people reflect more fundamentally on the factors that influence behaviors such as physical activity (PA). To address this research gap, we take a novel approach, examining how such reflections can be stimulated through a medium that generations of families have used for reflection and teaching: storytelling. Through observations and interviews, we studied how 13 families interacted with a low-fidelity prototype, and their attitudes towards this tool. Our prototype used storytelling and interactive prompts to scaffold reflection on factors that impact children's PA. We contribute to HCI research by characterizing how families interacted with a story-driven reflection tool, and how such a tool can encourage critical processes for behavior change. Informed by the Transtheoretical Model, we present design implications for reflective informatics systems.

Social networking applications (SNAs) have been touted as promising platforms for activism: they provide a platform by which voices can be heard and collective action mobilized. Yet, little work has studied the suitability of existing SNAs for enabling youth advocacy efforts. We conducted an intensive 5-week qualitative study with 10th graders to understand how existing SNAs support and inhibit youth advocacy. We contribute to the field of Human-Computer Interaction (HCI) by explicating several themes regarding the barriers youth face when using SNAs for advocacy, features in existing SNAs that are not suitable for youth advocacy, and the peer pressure youth perceive when advocating for serious issues in these environments. We conclude with recommendations for how existing SNA features could be reformed to better support youth advocacy.

Parents play a critical role in facilitating children's physical activity, as they are an important source of modeling and support. While Human-Computer Interaction (HCI) researchers have explored exergame design for children or adults separately, an important open area of work is identifying design guidelines for family exergames. One question that researchers have increasingly posed is, how can exergames be designed to avoid potential negative consequences of competition? To address these questions we designed Spaceship Launch, an exergame for parents and kids in lower income neighborhoods, where obesity is most prevalent. We describe our iterative design process: the formative study to identify design opportunities, our resulting system, and our field evaluation of the tool. Our findings highlight the impact of SL on physical activity intentions, and how parental preferences for in-game competition were aligned with the psychological needs of relatedness and competence. We conclude with design recommendations for future family-focused exergames.