Anonymized, informal environments, such as social media, provide opportunities for individuals to naturally exchange information and receive or provide social support for stigmatized conditions, such as mental health. The sensitive nature of the content shared on these platforms requires automated moderation, which is often based on keyword detection. However, what is considered as support versus risk in these contexts can be controversial and more situated. To investigate how we might better define what is supportive versus harmful content, we examined 49,006 YouTube comments on videos about college students' mental health, using statistical tests and qualitative content analysis with a clinical psychologist. We studied (1) the association between community 'Likes' and both self-disclosure and related linguistic features and (2) when comments exhibiting features associated with community 'Likes' reflect perceived support versus harm in the context of mental health. We discuss the situatedness of how community-generated comments containing self-disclosure can be either supportive or potentially harmful from a clinical perspective. This work highlights the need for a paradigmatic change in developing automated moderation rules and assumptions toward social media environments for supporting mental health.

Community telehealth programs (CTPs) enable low-income older adults to receive telehealth services in community settings (e.g., retirement homes). The Telehealth Intervention Program for Seniors (TIPS) is a CTP that provides vital sign monitoring services managed by remote nurses. TIPS has successfully recruited and retained Limited English Proficient (LEP) participants, but lack of language services might hinder LEP participants’ equitable access to care. We conducted a two-part mixed-methods study. We first qualitatively analyzed 40 nurse notes to identify challenges nurses encounter gathering information due to language barriers and the workarounds they employed to address these. We then tested our qualitative findings on 23,975 nurse notes to quantify and compare how these challenges and workarounds scale between LEP and English-proficient TIPS participants. We present future research implications beyond low-hanging solutions, such as automated translation services, and discuss how novel technological solutions can support and ameliorate nurse workarounds and caregiver burden.

Generative Artificial Intelligence (AI) is integrated into everyday technology, including news, education, and social media. AI has further pervaded private conversations as conversational partners, auto-completion, and response suggestions. As social media becomes young people’s main method of peer support exchange, we need to understand when and how AI can facilitate and assist in such exchanges in a beneficial, safe, and socially appropriate way. We asked 622 young people to complete an online survey and evaluate blinded human- and AI-generated responses to help-seeking messages. We found that participants preferred the AI-generated response to situations about relationships, self-expression, and physical health. However, when addressing a sensitive topic, like suicidal thoughts, young people preferred the human response. We also discuss the role of training in online peer support exchange and its implications for supporting young people’s well-being. Disclaimer: This paper includes sensitive topics, including suicide ideation. Reader discretion is advised.

The CSCW and HCI community has increasingly examined ways to support informal caregivers through technology, given the increasing burden and its consequences on caregivers' emotional and physical health. In this paper, we interviewed 12 informal caregivers of Persons Living With Dementia (PLWD) to understand their needs and current coping strategies for overcoming caregiving burden, specifically around emotion work. The caregivers associated different personal meanings with caregiving. Participants wanted technology to take over some of the utilitarian, mundane caregiving tasks. At the same time, they did not want technology to take over the tasks that fostered personal connections with PLWD. As the disease progressed, caregivers started to lose their perceived bond with PLWD, making it more challenging to juggle between rewarding, positive emotions with negative experiences. We discuss such complexity of emotion work using the notion of Invisible Work to understand when technology should or should not support the emotion work engaged in informal caregiving.

The design of digital interventions for mental health often overlooks the foundational belief in one’s own self-worth and related ability to develop close relationships with others. Attachment theory explains these interpersonal aspects, which have long been associated with positive mental health outcomes such as resilience when faced with adversity. We report on generative interviews with mentors experienced in supporting youth, as part of design work initiated by community leaders concerned about the traumatic effects of gun violence and systemic racism on local youth. These community leaders wanted to extend their existing mentoring efforts through digital technology. We identified attachment theory as the best fit for helping us understand how mentors are addressing trauma among youth, in ways that can inform how we design in support of these relationships and communities. We introduce attachment-informed design as a set of design principles that represent a novel approach to digital mental health interventions.

Although youth increasingly communicate with peers online, we know little about how private online channels play a role in providing a supportive environment for youth. To fill this gap, we asked youth to donate their Instagram Direct Messages and filtered them by the phrase “help me.” From this query, we analyzed 82 conversations comprised of 336,760 messages that 42 participants donated. These threads often began as casual conversations among friends or lovers they met offline or online. The conversations evolved into sharing negative experiences about everyday stress (e.g., school, dating) to severe mental health disclosures (e.g., suicide). Disclosures were usually reciprocated with relatable experiences and positive peer support. We also discovered unsupport as a theme, where conversation members denied giving support, a unique finding in the online social support literature. We discuss the role of social media-based private channels and their implications for design in supporting youth’s mental health. Content Warning: This paper includes sensitive topics, including self-harm and suicide ideation. Reader discretion is advised.

Minjin Rheua*, Ji Youn Shina, Wei Penga & Jina Huh-Yooba Media and Information, Michigan State University, East Lansing, Michigan, USAb Department of Information Science, Drexel University, Philadelphia, Pennsylvania, USAMinjin Rheu is a Ph.D. candidate in the Department of Media and Information at Michigan State University. Her research delves into how specific designs or features of communication technology influences users’ motivational and cognitive processes through which people change or adopt their health and prosocial behaviors.Ji Youn Shin is a Ph.D. student in the Department of Media and Information at Michigan State University. Her research includes human-computer interaction, human-centered design, and health communication. She designs and evaluates technologies for supporting individuals’ health and wellness in various health contexts, including family caregiving and pediatric chronic illnesses.Wei Peng is a Professor in the Department of Media and Information, Michigan State University. Her research focuses on the psychological and social mechanisms of behavior change and their application in the design of interactive media for health and wellness promotion.Jina Huh-Yoo is an Assistant Professor of Human-Computer Interaction at Drexel University's College of Computing & Informatics. Her research areas include human-computer interaction, health informatics, and research ethics of health informatics technologies. She was a PI of NIH and NSF-funded projects in promoting health and wellness through consumer-facing technologies.CONTACT Minjin Rheu [email protected] Media and Information, Michigan State University, 404 Wilson Rd, Room 414, East Lansing, MI 48823, USAABSTRACTOff-the-shelf conversational agents are permeating people’s everyday lives. In these artificial intelligence devices, trust plays a key role in users’ initial adoption and successful utilization. Factors enhancing trust toward conversational agents include appearances, voice features, and communication styles. Synthesizing such work will be useful in designing evidence-based, trustworthy conversational agents appropriate for various contexts. We conducted a systematic review of the experimental studies that investigated the effect of conversational agents’ and users’ characteristics on trust. From a full-text review of 29 articles, we identified five agent design-themes affecting trust toward conversational agents: social intelligence of the agent, voice characteristics and communication style, look of the agent, non-verbal communication, and performance quality. We also found that participants’ demographic, personality, or use context moderate the effect of these themes. We discuss implications for designing trustworthy conversational agents and responsibilities around on stereotypes and social norm building through agent design.

Diverse fields, including CSCW, Communication, and Human Development studies, have investigated how technologies can better support parent-child relationships. While these studies are scattered across literature, little effort has been made to synthesize the findings. We conducted a review of studies that examined the factors associated with parent-child relationships that are mediated by technologies. Specifically, we synthesized previous studies based on children's age groups and different family contexts, including cohabitation. From a total of 12,942 search results from two databases, and 32 results from the hand-searching process, we conducted a full-text review of 190 articles and identified 19 suitable studies. An additional search during the revision cycle resulted in 6 more full-text reviews and 1 additional study being included in the data analysis. We analyzed challenges and facilitators in designing CSCW systems supporting parent-child relationships for families living together or apart and families with children of different developmental stages. Findings showed two common challenges, which should be addressed in technology designed to support parent-child relationships: discrepancies in expected communication between parents and child(ren) and the complex emotions of parents toward parenting caused by their busy schedules. Challenges specific to families who are living apart included consequences from being physically distant and having limited access to communication resources. The following factors commonly helped facilitate parent-child relationships: (1) reciprocity norms of the family (2) reinforcement of transparency, affection, and trust, (3) a physical proxy of each other through an object or interface design, (4) accessibility, the sophistication level of technology, and communication resources, (5) enjoyable, age-appropriate shared content among parents and children, and (6) situational awareness and routine as ways to increase parent-child relationships. Media richness and synchronicity in system design and privacy preservation without interruption facilitated parent-child relationships of families living apart. Based on the findings, we discuss opportunities for technological innovation for physically co-located families and the importance of considering children's age and developmental stages in designing technology for parent-child relationships.

Digital technology that is prevalent in people's everyday lives, including smart home devices, mobile apps and social media, increasingly lack regulations for how the user data can be collected, used or disseminated. The CSCW and the larger computing community continue to evaluate and understand the potential negative impacts of research involving digital technologies. As more research involves digital data, Institutional Review Boards (IRBs) take on the difficult task of evaluating and determining risks--likelihood of potential harms--from digital research. Learning more about IRBs' role in concretizing harm and its likelihood will help us critically examine the current approach to regulating digital research, and has implications for how researchers can reflect on their own data practices. We interviewed 22 U.S.-based IRB members and found that, for the interviewees, "being digital" added a risk. Being digital meant increasing possibilities of confidentiality breach, unintended collection of sensitive information, and unauthorized data reuse. Concurrently, interviewees found it difficult to pinpoint the direct harms that come out of those risks. The ambiguous, messy, and situated contexts of digital research data did not fit neatly into current human subjects research protection protocols. We discuss potential solutions for understanding risks and harms of digital technology and implications for the responsibilities of the CSCW and the larger computing community in conducting digital research.

By learning from the existing family mealtime activities, family members can be motivated to make the positive changes towards better relationships, which are important for the physical and mental health of children. Moreover, the details of family mealtime activities provide rich information for study in sociology and culture. This paper presents FamilyLog - a practical system to log family mealtime activities using smartphones and smartwatches. FamilyLog automatically detects and logs details of activities during the mealtime, including occurrence and duration of meal, conversations, participants, TV viewing, etc., in an unobtrusive manner. Based on the sensor data collected from real families, we carefully design robust yet lightweight signal features from a set of complex activities during the meal, including clattering sound, arm gestures of eating, human voice, TV sound, etc. Moreover, FamilyLog opportunistically fuses data from built-in sensors of multiple mobile devices available in a family with a CRFs-based classifier. To evaluate the real-world performance of FamilyLog, we perform extensive experiments that consist of 77 days of sensor data from 37 subjects in 8 families with children. FamilyLog can detect those events with high accuracy across different families and home environments.

Research has shown that family mealtime plays a critical role in establishing good relationships among family members and maintaining their physical and mental health. In particular, regularly eating dinner as a family significantly reduces prevalence of obesity. However, American families with children spend only 1 hour on family meals while three hours watching TV on an average work day. Fine-grained activity-logging is proven effective for increasing self-awareness and motivating people to modify their life styles for improved wellness. This paper presents FamilyLog - a practical system to log family mealtime activities using smartphones and smartwatches. FamilyLog automatically detects and logs details of activities during the mealtime, including occurrence and duration of meal, conversations, participants, TV viewing etc., in an unobtrusive manner. Based on the sensor data collected from real families, we carefully design robust yet lightweight signal features from a set of complex activities during the meal, including clattering sound, arm gestures of eating, human voice, TV sound, etc. Moreover, FamilyLog opportunistically fuses data from built-in sensors of multiple mobile devices available in a family through an HMM-based classifier. To evaluate the real-world performance of FamilyLog, we perform extensive experiments that consist of 77 days of sensor data from 37 subjects in 8 families with children. Our results show that FamilyLog can detect those events with high accuracy across different families and home environments.

Research shows the critical role of social relationships in behavior change, and the advancement of mobile technologies brings new opportunities of using online social support for persuasive applications. In this paper, we propose Relational Norm Intervention (RNI) model for behavior change, which involves two individuals as a target user and a helper respectively. RNI model uses Negative Reinforcement and Other-Regarding Preferences as motivating factors for behavior change. The model features the passive participation of a helper who will undergo artificially generated discomforts (e.g., limited access to a mobile device) when a target user performs against a target behavior. Based on in-depth discussions from a two-phase design workshop, we designed and implemented BeUpright, a mobile application employing RNI model to correct sitting posture of a target user. Also, we conducted a two-week study to evaluate the effectiveness and user experience of BeUpright. The study showed that RNI model has a potential to increase efficacy, in terms of behavior change, compared to conventional notification approaches. The most influential factor of RNI model in the changing the behavior of target users was the intention to avoid discomforting their helpers. RNI model also showed a potential to help unmotivated individuals in behavior change. We discuss the mechanism of RNI model in relation to prior literature on behavior change and implications of exploiting discomfort in mobile behavior change services.

Through online health communities (OHCs), patients and caregivers exchange their illness experiences and strategies for overcoming the illness, and provide emotional support. To facilitate healthy and lively conversations in these communities, their members should be continuously monitored and nurtured by OHC administrators. The main challenge of OHC administrators' tasks lies in understanding the diverse dimensions of conversation threads that lead to productive discussions in their communities. In this paper, we present a design study in which three domain expert groups participated, an OHC researcher and two OHC administrators of online health communities, which was conducted to find with a visual analytic solution. Through our design study, we characterized the domain goals of OHC administrators and derived tasks to achieve these goals. As a result of this study, we propose a system called VisOHC, which visualizes individual OHC conversation threads as collapsed boxes-a visual metaphor of conversation threads. In addition, we augmented the posters' reply authorship network with marks and/or beams to show conversation dynamics within threads. We also developed unique measures tailored to the characteristics of OHCs, which can be encoded for thread visualizations at the users' requests. Our observation of the two administrators while using VisOHC showed that it supports their tasks and reveals interesting insights into online health communities. Finally, we share our methodological lessons on probing visual designs together with domain experts by allowing them to freely encode measurements into visual variables.

Online health communities are known to provide psychosocial support. However, concerns for misinformation being shared around clinical information persist. An existing practice addressing this concern includes monitoring and, as needed, discouraging asking clinical questions in the community. In this paper, I examine such practice where moderators redirected patients to see their health care providers instead of consulting the community. I observed that, contrary to common beliefs, community members provided constructive tips and persuaded the patients to see doctors rather than attempting to make a diagnosis or give medical advice. Moderators' posts on redirecting patients to see their providers were highly associated with no more follow up replies, potentially hindering active community dynamic. The findings showed what is previously thought of as a solution-quality control through moderation-might not be best and that the community, in coordination with moderators, can provide critical help in addressing clinical questions and building constructive information sharing community environment.

Many theories and empirical research show the critical role of social relationships in shaping human behavior. Mobile and persuasive technologies present increased opportunities for affecting people's behavior. We propose the relational intervention model, which provokes a paired helper when the user performs a target behavior. In this demo, we present BeUpright, a posture-correction mobile application based on the relational intervention model.

Many patients visit online health communities to receive support. In face-to-face support groups, health professionals facilitate peer-patients exchanging experience while adding their clinical expertise when necessary. However, the large scale of online health communities makes it challenging for such health professional moderators' involvement to happen. To address this challenge of delivering clinical expertise to where patients need them, we explore the idea of semi-automatically providing clinical expertise in online health communities. We interviewed 14 clinicians showing them example peer-patient conversation threads. From the interviews, we examined the ideal practice of clinicians providing expertise to patients. The clinicians continuously assessed when peer-patients were providing appropriate support, what kinds of clinical help they could give online, and when to defer to patients' healthcare providers. The findings inform requirements for building a semi-automated system delivering clinical expertise in online health communities.

Studies have shown positive impact of video blogs (vlogs) on patient education. However, we know little on how patient-initiated vlogs shape the relationships among vloggers and viewers. We qualitatively analyzed 72 vlogs on YouTube by users diagnosed with HIV, diabetes, or cancer and 1,274 comments posted to the vlogs to understand viewers' perspectives on the vlogs. We found that the unique video medium allowed intense and enriched personal and contextual disclosure to the viewers, leading to strong community-building activities and social support among vloggers and commenters, both informationally and emotionally. Furthermore, the unique communication structure of the vlogs allowed ad hoc small groups to form, which showed different group behavior than typical text-based social media, such as online communities. We provide implications to the Health Care Industry (HCI) community on how future technologies for health vlogs could be designed to further support chronic illness management.

Health video blogs (vlogs) allow individuals with chronic illnesses to share their stories, experiences, and knowledge with the general public. Furthermore, health vlogs help in creating a connection between the vlogger and the viewers. In this work, we present a qualitative study examining the various methods that health vloggers use to establish a connection with their viewers. We found that vloggers used genres to express specific messages to their viewers while using the uniqueness of video to establish a deeper connection with their viewers. Health vloggers also explicitly sought interaction with their viewers. Based on these results, we present design implications to help facilitate and build sustainable communities for vloggers.

attend to personal and medical needs in a holistic manner. Whether current communities structure interaction between health professionals and patients to address the whole person is an open question. To gain insights into this question, we examined a sample of online patient communities to understand health professionals' involvement in bringing in medical advice into peer-patient conversations. We found the communities fall short in supporting the whole person, because (1) patient expertise and clinical expertise generated by health professionals are shared separately, and (2) patients' quantified data are separate from narrative experiences. Such separation in the design of these systems can lead to limitations in addressing patients' interwoven medical and personal concerns. We discuss dilemmas and design implications for supporting the whole person in online patient communities.

Coping with chronic illness disease is a long and lonely journey, because the burden of managing the illness on a daily basis is placed upon the patients themselves. In this paper, we present our findings for how diabetes patient support groups help one another find individualized strategies for managing diabetes. Through field observations of face-to-face diabetes support groups, content analysis of an online diabetes community, and interviews, we found several help interactions that are critical in helping patients in finding individualized solutions. Those are: (1) patients operationalize their experiences to easily contextualize and share executable strategies; (2) operationalization has to be done within the larger context of sharing illness trajectories; and (3) the support groups develop common understanding towards diabetes management. We further discuss how our findings translate into design implications for supporting chronic illness patients in online community settings.

In this paper, we seek to advance the research around utilizing collaborative help for supporting individualized use of technologies. We do this by shedding light on the ways that users of MythTV, a highly flexible open-source software system for home entertainment enthusiasts, collaboratively help one another in maintaining their individualized MythTV systems. By analyzing the MythTV user community's mailing list archive, documentation, and wiki, coupled with user interviews we discuss how the community utilizes configuration artifacts as proxies to easily mobilize and exchange knowledge. While exchanging concrete artifacts such as scripts and configuration files was seen to sometimes increase the efficiency of knowledge transfer, it also presented several challenges. Negotiating the transparency of configuration artifacts, navigating the customization and appropriation gulfs, and aligning usage trajectories all emerged as problematic areas. We discuss design implications that address these challenges. Our findings provide a crucial understanding for how to support users in their individualized use of systems.

In this paper, we report our findings on the impact of providing users with varying degrees of control in an automated interactive scheduling system. While automated scheduling techniques such as constraint optimization have been widely adopted in a variety of scheduling applications, such applications require that users relinquish a certain amount of control to the system. The implications of such a shift in control are not clear for people who oversee the scheduling of human activities, for example, case managers scheduling patient appointments in hospitals and clinics. We asked our participants to use a working prototype system for clinic scheduling to complete a series of scheduling problems that we designed. We varied the size of the problems---i.e., the number of patients to be scheduled---and the style of interaction in ways that are associated with different degrees of user control. We recorded standard usability metrics and conducted post-task written surveys and interviews. Our results suggest that although maintaining full user control decreases efficiency as the problem becomes larger, the participants still preferred to have full user control in completing scheduling tasks. We end with design implications in supporting users' increased acceptance of automated scheduling systems.

In this paper, we report our findings on the adoption practices of used personal digital assistants (PDAs) to inform reuse of outdated computing products. Our interviews with 12 eBay users who bought used PDAs showed a variety of ways in which users indirectly supported sustainability. This allowed us to re-examine sustainability as something that is dynamically and arbitrarily shaped by the users and not just dependent on the sustainable feature of the product. We end with design implications for supporting users' shaping of sustainability.

For emerging group technologies that require evaluations on long-term use and social norms, assumptions, and implicit rules that develop around the technologies, standard usability testing may not be adequate. At the same time, field based research that allows for observing technology use over long-term is costly in terms of time. In this paper, we present a rapid method that we call progressive scenarios, which could help replicate the processes by which interpretations evolve over time in natural settings and how invisible assumptions and social norms dictate the technology use. Using a preliminary design concept of a publicly available ambient personal information and communication system, we demonstrate how the method helped to elicit design implications.