While much has been written on the age-based digital divide, more understanding of the relative importance of factors affecting use of the internet is needed. This paper analyses nationally representative data from the English Longitudinal Study of Ageing (ELSA) to understand older adults’ frequency of using the internet and reasons for not using it more. We examine the extent to which health, lifestyle, and sociodemographic correlate with the pronounced age gradient in not using the internet. We find that the reasons why people in the 80+ cohort did not use the internet more are not qualitatively different from the reasons people aged 50–64 or 65–79 did not use it more, but do differ between rare and regular users. We also find that of the myriad factors that are potentially relevant, only cognitive ability, educational attainment, and employment status were robustly associated with the age gradient in internet use.

Wheelchair users often face significant barriers to maintaining and adapting their chairs, from resource constraints to limited access to professional services. In response, many turn to social media platforms such as YouTube to share and learn practical knowledge. However, little is known about how wheelchair users document and exchange repair, maintenance, and customization practices online. To address this gap, we analyzed 290 YouTube videos alongside 800 sampled comments using thematic coding and statistical analysis. Our findings revealed diverse user needs, from enhancing mobility to expressing identity, which were addressed through a spectrum of DIY acts, such as accessorizing, bricolage, and major modifications. Engagement analysis further reveals how styling videos attract a broad audience, while custom-built “chair tours” become hubs of knowledge and solidarity. We reflect on using YouTube as a research source and call for a design approach grounded in solidarity that supports the full spectrum of DIY practices.

Adolescence is often associated with emotional upheaval and teens themselves value support with their emotions. HCI research on emotion regulation has focused on lab-based interventions for those with the greatest needs. This paper explores how adolescents use commercially available videogames in their daily environments and how these practices relate to emotion regulation. We conducted a 2-week diary and interview study with eleven teens asking them to reflect on their videogame practices and emotions. We deployed a multimodal diary to encourage authentic teen voice on factors not typically considered in intervention studies. Our findings indicate that teens use videogames to regulate their emotions and to recover from stress in diverse ways. These processes are often intertwined with adolescents’ social relationships and can be mediated through game affordances. We argue that traditional approaches to emotion regulation may be too individualistic to recognise or support the social dynamics that define teens’ emotional lives.

As people age, sleep often becomes lighter, more fragmented, and a source of increasing concern. Smart rings, like Oura, offer a discreet and comfortable means of supporting sleep tracking, yet it remains unclear how older adults engage with the sleep-related insights they provide. Our research investigates how older adults engage with wearable-derived physiological and behavioural sleep data, the barriers they encounter in understanding health metrics, and the ways these technologies influence self-perception and wellbeing practices. We report findings from a one-month diary study (n=20) and follow-up interviews (n=10) after around four months of ring use. Participants reflected on the meanings they attributed to app-based metrics, and whether such feedback felt useful, confusing, or intrusive, revealing misalignments with youthful defaults that negatively impacted engagement. We explore this in terms of "age friction" and discuss opportunities for more age-inclusive wearable technologies that promote meaningful engagement with personal health and wellbeing data.

Abstract The focus on managing problems that can arise for older adults has meant that extant HCI and Ageing research has not given the concepts of “age”’ and “ageing” the explicit theoretical attention they deserve. Attending to this gap, we critically examine a ten-year corpus of CHI publications through the lens of an existing typology that we have further developed to analyse how age is understood, interpreted, and constructed in the field of HCI. Our resulting multidimensional typology of age in HCI elucidates the distinctive characteristics of older adults considered when designing with and for this user group, but also highlights the need for a more critical, reflexive, social constructivist approach to age in HCI. Applying this approach, we explore age as a multidimensional system of stratification to better understand the phenomenon of the age-based digital divide.

While AI chatbots have been proposed to support wheelchair provision services in low- and middle-income countries (LMICs), the perception of physical therapists regarding how they could be integrated into their service workflow remains unclear. We conducted semi-structured interviews with 11 professionals from Africa and South Asia, using two design probes to investigate the potential and limitations of using chatbots in their everyday wheelchair assessment services. Our findings revealed 13 tensions that arise when the envisioned chatbot use misaligns with three interconnected domains - professional values, practice structures, and contextual readiness, such as conflicts in professional autonomy, evolving responsibilities, and confidence in AI. To guide more situated chatbot design, we proposed a tension-informed design framework that centers professional practice and surfaces tensions as opportunities rather than barriers. We discuss how introducing chatbots in LMICs should aim to amplify professionals’ capacity and align with the nature of assistive technology services.

In the context of extensive bank branch closures, and a rapidly ageing population, older adults’ (OAs’) reluctance to adopt digital banking platforms by themselves is concerning. However, many OAs rely on the support of close others (COs) to complete banking activities with them. This support is mostly provided through “unofficial” mechanisms such as sharing online banking credentials, which risk an OA's privacy and security. This paper replicates a Canadian study with OAs in a UK context and extends it with co-design workshops focused on novel banking solutions for OAs and COs, helping to formalise the role of unofficial proxies within online platforms. Results show that unofficial proxy banking also occurs with COs in a UK context and co-design reveals barriers to OAs’ use of banking technology independently. We discuss recommendations for flexible, easily authenticated and easy to learn digital banking solutions for OAs in the future.

Positionality is a concept that acknowledges subjectivities, values and experiences of researchers as influencing approaches to and outcomes and implications of research; it underlines the importance of reflexivity and self-awareness. To understand how positionality is used in HCI, we conducted two studies: (i) a scoping review of positionality and reflexivity statements in the CHI papers in the last 11 years and (ii) a survey of HCI researchers (n=75). Our findings show that positionality statements are often a box-ticking exercise and their influence on the research is rarely discussed. While positionality statements are often used and requested in papers, they are often restricted to more sensitive areas of research and impact marginalised identities. We argue that positionality statements can be valuable but not as markers of methodological rigour. Our contributions include a current snapshot of positionality in HCI and reflections on the role of positionality statements in HCI.

The uptake of digital technology by older adults and service-providers has been partly driven by the pandemic but more recently by the erosion of in-person services because of increasing austerity and a harsher global economic climate. Against the backdrop of the UK’s cost of living crisis, we examine technology used frequently within five older adults’ households. Through two rounds of interviews and participant diaries, we show benefits and struggles of participants’ costly technology use, reflecting on what ‘cost of living’ means when technology designed to simplify older peoples lives, encounters problems. For HCI practitioners, we provide evidence of how personal smart devices can be better tailored to help older adults support themselves both economically and practically, during the cost of living crisis. We propose avenues for future research and design that better support indirect costs and reflect on how personal devices can be made self-sustaining, integrated and repairable.

Social isolation is a common experience for LGBT+ older adults (OAs) that is often compounded by prejudices of age, sexuality, or gender identity. Little research has explored the specific social needs and barriers that LGBT+ OAs face, particularly in online spaces. To address this gap, we conducted interviews with 10 LGBT+ OAs and an inclusive housing service provider. Our research highlights the importance of LGBT+ community engagement and digitally-supported social networks’ role for LGBT+ OAs. We identify challenges such as managing online identity, navigating LGBT+ social media apps and websites, as well as digital disconnectedness challenges among those with lower digital literacy. Recommendations include improving social platforms allowing LGBT+ OAs to manage selective identity characteristics, promoting genuineness and trust in LGBT+ platforms by employing tiered blocking and interest-driven connections, and non-digital outreach strategies for collaborations between LGBT+ organizations and senior centers to engage hidden and isolated LGBT+ OAs.

Digital climate actions are an important aspect in centring voices in climate activism and therefore, it is important to study how digital channels support or hinder the actions of climate activists. Specifically, due to identity-related factors, people of colour (POC) could feel marginalised and othered, making it difficult to fit in in climate communities but online anonymity might help relieve these concerns. However, little research informs us what digital platforms POC actually use for building and engaging in climate communities including social media platforms (e.g., Facebook and Instagram), instant messaging channels (e.g., WhatsApp and Telegram), microblogging (e.g., Twitter), online newsletters and petitions and how these platforms and their anonymity features support or do not support their participation. Therefore, the current mixed-methods survey study was conducted to investigate what POC's choices of digital platforms are and how anonymity features support their participation in digital climate actions including their sense of safety and belonging. The results from 264 participants of five racial backgrounds i.e., White, Black, South Asian, Central, East and South East (CESE) Asians and mixed race, showed that there were different patterns in digital platform usage where most participants of colour had more distributed platform choices than White participants who were more likely to engage on identified sites such as Facebook and petitions. We also found that POC are more likely to engage on encrypted communication channels such as Telegram and WhatsApp and some anonymous actions than White participants. Results understanding the effects of anonymity reinforced that anonymity is important for POC's engagement because of safety reasons, however, being able to identify other POC is also important to their engagement as they might feel safer, giving them more courage to engage unanonymously. POC's need for anonymity, therefore, presented a contradictory but interesting paradox. Our study contributes to highlighting the importance of pluralistic and inclusive frameworks including trauma-informed computing and intersectionality in technological design which emphasises aspects of individual safety, community and digital platform trust and community support, collaboration and intersectional needs.

Flexible working, including in resource-constrained settings such as long-haul flights, poses considerable challenges. While research in mixed reality (MR) offers the potential for enhancing experiences of working on airplanes (WoA), what input modalities and interactions might be suitable for such workspaces is under-explored. To address this gap, we created four design probes and demonstrated their interactions within MR for WoA using a branching decision-based interactive video. 24 participants engaged in the think-aloud study with the video where they selected which probe to watch based on personal preference and order. The follow-up interview further solidified their general preferences for intuitive and friction-free inputs, revealed strong concerns about reliability, discreetness, and portability, and showed high enthusiasm for interactive video. Based on these findings, we contribute a context-driven design space of input modalities for WoA in MR, extending the understanding of design opportunities for inputs with MR in confined spaces.

To tackle the lack of wheelchair service information and training in low and middle-income countries (LMICs), we deployed Wheelpedia, a WhatsApp chatbot powered by a large language model (LLM) as a design probe for 2 months to concretely explore how it can support wheelchair users and professionals in Nigeria and Kenya. Through 18 semi-structured interviews and analysis of 471 messages, we focused on not only Wheelpedia's acceptability and usability but also how users orient themselves with the probe, integrate its information, and manage trust with it. The findings revealed participants' overwhelming enthusiasm towards the chatbot's potential in education, fostering empowerment, and reducing social stigma. We discuss challenges like users' difficulty in formulating questions, unfamiliarity with the concept of chatbots, and requests for image output. This paper contributes valuable insights into the design implications and research opportunities for deploying LLM chatbots in low-resourced settings with complex accessibility needs.

There are growing efforts to reduce the harmful effects of deceptive patterns pervasively employed on e-commerce websites. However, efforts to produce new guidelines and introduce ethical design standards geared towards older adults have been limited. We investigate the potential of a serious game in fostering older adults' resilience against manipulative designs in e-commerce through two studies. First, a survey with older adults (N = 61), explored their attitudes towards deceptive patterns and identified characteristics influencing them. We then created a serious game, 'Shopopolis', to bolster older adults' resistance to manipulative designs online and evaluated its efficacy with older adults (N = 65). Our findings show that Shopopolis is a valuable tool for enhancing awareness, concern, and recognition skills related to e-commerce deceptive patterns. We discuss older adults' unique perspectives on deceptive patterns and consider how insights can shape the design of targeted protective measures like Shopopolis for older adults in e-commerce contexts.

Misinformation has emerged as a significant threat to public health in recent years and has been observed across numerous health issues, the most prolific being COVID-19. Though increasing attention has been paid to women's health within the social scientific and HCI communities, very little research has holistically explored the unique challenges women face when navigating health misinformation. To address this gap, we conducted a qualitative diary and interview study aimed at investigating women's perceptions and lived experiences of health misinformation on social media, and how they respond emotionally and behaviourally to health misinformation encountered in their day-to-day lives. We found that participants perceived health misinformation as ubiquitous and poorly-managed by social media platforms, resulting in a lack of trust in current moderation and fact-checking interventions. We also observed that encounters with misinformation triggered negative emotional responses, which participants attempted to navigate through ad-hoc strategies such as drawing on personal experience and reading social media comment sections, which facilitated collective sensemaking. We discuss our findings in relation to the design of targeted interventions which empower women to engage constructively with health information on social media. In particular, we underscore the importance of trust, accountability, and intersectionality in future design and research practice, and encourage a holistic view of how women are impacted by misinformation.

Participation in climate activism is often facilitated by joining groups on digital platforms, for online and in-person participation in the movement. However, despite the easy access to communities digitally, people of colour (POC) are underrepresented in the UK in climate activism. Little research provides insight into why the voices of POC are underrepresented and how to level the playing field for participation in climate activism, which is just as important to POC. To investigate this, we conducted a qualitative semi-structured interview study with POC who are active in the climate movement (N=12). We identified five main themes: (i) gaining membership to the climate activism community, (ii) experiencing challenges in belonging with respect to identity characteristics, (iii) participating in protest through relevant issues and values, (iv) feeling fear due to differences and marginalisation, and (v) developing strategies for control and utilising anonymity. Our findings show how people's racial and other minoritised identity is crucial in influencing their sense of belonging and community and in turn their participation in climate activism and perhaps other opinion-based movements. For movements to be more inclusive, we urge the HCI and CSCW community to rethink designs influenced by structures of power and centre diverse values and issues instead of universal ones to amplify the voices of minoritised identities. Suggestions on how technologies could achieve this are discussed.

Wearables integrating movement sonification can support body-perception changes and related physical activity; yet, we lack design principles for such sonifications. Through two mixed-methods studies, we investigate sound pitch and movement direction interaction effects on self-perception during squat exercises. We measured effects on body perception, affective quality of the experience, and actual and perceived movement, and compared them with two control conditions: no-sound and vibrotactile feedback. Results show that regardless of movement direction, ascending pitch enhances several body feelings and overall experience quality, while descending pitch increases movement acceleration. These effects were moderated by exercise physical demand. Sound and vibrotactile feedback enhanced flexibility and strength feelings, respectively, and contributed to exercise completion in different ways. Sound was perceived as an internal-to-body force while vibrotactile feedback was perceived as an external-to-body force. Feedback effects were stronger in people with lower fitness levels. We discuss results in terms of malleability of body perceptions and highlight opportunities to support demanding physical activity through wearable devices.

Many cohabiting millennials report dissatisfaction about declining levels of sexual desire. Barriers such as desire discrepancy, lack of communication, changing needs, and habituality interfere with sexual desire and relationship satisfaction. This paper explores whether technology has a role in supporting and increasing sexual desire or developing an understanding of different individual needs towards sexual desire within couples’ relationships and how it can do so. To explore this, we conducted a survey (n=77) and interview study (n=12). Results show that participants wanted a shared, dedicated, and protected space to playfully explore their individual desire with each other. They felt technology could facilitate a better understanding of their evolving needs as a couple, motivate open sexual communication, bring spontaneity, and hands-on exploration; however, technology should not inflict judgement or obligations on desire levels; it should help to understand and situate differing needs in a relationship meaningfully. We share our reflections on the role of technology and raise important considerations in such technology design.

Games can be powerful vehicles for gender identity exploration and self-reflection but are often subject to designers' biases including gender representation, limiting such opportunities. Using a game jam as a research-through-design method, alongside qualitative interviews with the creators, this paper explores how the process of creating games and the games themselves can facilitate exploration of and reflection on gender identity. We highlight aspects of identity people want to explore; how different game elements can support processes of exploring these, and what aspects are missing in games. Further, the process of creating and playing helped participants reflect on and reframe their understanding of gender regardless of their identity/experience. Finally, we reflect on the process of designing an inclusive jam around the topic of gender identity, which can be sensitive and divisive. Our work results in implications for the design of games and other potential tools for gender exploration.

Ninety percent of the 1.2 billion people who need assistive technology (AT) do not have access. Information seeking practices directly impact the ability of AT producers, procurers, and providers (AT professionals) to match a user's needs with appropriate AT, yet the AT marketplace is interdisciplinary and fragmented, complicating information seeking. We explored common limitations experienced by AT professionals when searching information to develop solutions for a diversity of users with multi-faceted needs. Through Template Analysis of 22 expert interviews, we find current search engines do not yield the necessary information, or appropriately tailor search results, impacting individuals’ awareness of products and subsequently their availability and the overall effectiveness of AT provision. We present value-based design implications to improve functionality of future AT-information seeking platforms, through incorporating smarter systems to support decision-making and need-matching whilst ensuring ethical standards for disability fairness remain.

Most research on Location-Based Games (LBGs) has been conducted on non-disabled players, meaning the experiences of disabled players are not well understood and potentially overlooked. As such, this research aimed to address the following questions: 1). What are the barriers and needs of disabled LBGs players? 2). How can LBGs be made more inclusive and accessible? To address these questions, two studies were conducted in the form of an online qualitative questionnaire and a series of co-design workshops. Results articulate the needs, barriers, and desired features of 60 participants. Based on our findings and through the collaborative work with disabled players we articulate 4 guidelines for game designers and developers aimed at improving the accessibility of LBGs: 1) Adding avatar features that better represent disabled characteristics, 2). Providing different input options for phone interactions, 3) Allowing for disabled specific accounts and 4) Introducing a messenger feature to LBGs.

Menarche is an important milestone and time of transition, where children and adolescents need information and support. Parents provide significant support, but barriers such as parents’ own lack of confidence and information interfere. Existing technology for menstrual health is not always appropriate or accessible to younger adolescents and children. We ran two studies: Study1, an interview and design study explored how parents support children for menarche, their use of technology for this, and to understand the gaps. Study2 evaluated a design concept based on Study1, to gain further insights. Our findings show that menarche is an emotional time for parents and children; parents provide support and shared sensemaking but there is space for technology in providing scaffolding for parents to provide further support. However, there is a balance between sharing or support and privacy or control that needs to be negotiated between parents and children. We conclude with some reflections.

The COVID-19 pandemic forced researchers to find new ways to continue research, as universities and laboratories experienced closure due to nationwide lockdowns in many countries worldwide, including conducting experiments, workshops, and ethnographic work online. While this had a significant impact on the majority of research work across SIGCHI, research relating to disability and ageing was most impacted due to the additional challenges of recruiting participants, finding accessible online platforms, and ensuring seamless participation while juggling platform accessibility issues, facilitation, and supporting participants’ needs. These challenges were more extreme for disabled researchers. In this workshop, we aim to bring together researchers, designers, and practitioners to explore effective strategies and brainstorm actionable guidelines for supporting disability inclusive online research methods and platforms.

Orientation and mobility (O&M) training provides essential skills and techniques for safe and independent mobility for blind and partially sighted (BPS) people. The demand for O&M training is increasing as the number of people living with vision impairment increases. Despite the growing portfolio of HCI research on assistive technologies (AT), few studies have examined the experiences of BPS people during O&M training, including the use of technology to aid O&M training. To address this gap, we conducted semi-structured interviews with 20 BPS people and 8 Mobility and Orientation Trainers (MOT). The interviews were thematically analysed and organised into four overarching themes discussing factors influencing the self-efficacy belief of BPS people: Tools and Strategies for O&M training, Technology Use in O&M Training, Changing Personal and Social Circumstances, and Social Influences. We further highlight opportunities for combinations of multimodal technologies to increase access to and effectiveness of O&M training.

Negative body perceptions are a major predictor of physical inactivity, a serious health concern. Sensory feedback can be used to alter such body perceptions; movement sonification, in particular, has been suggested to affect body perception and levels of physical activity (PA) in inactive people. We investigated how metaphorical sounds impact body perception and PA. We report two qualitative studies centered on performing different strengthening/flexibility exercises using SoniBand, a wearable that augments movement through different sounds. The first study involved physically active participants and served to obtain a nuanced understanding of the sonifications’ impact. The second, in the home of physically inactive participants, served to identify which effects could support PA adherence. Our findings show that movement sonification based on metaphors led to changes in body perception (e.g., feeling strong) and PA (e.g., repetitions) in both populations, but effects could differ according to the existing PA-level. We discuss principles for metaphor-based sonification design to foster PA.

Interacting with natural environments such as parks and the countryside improves health and wellbeing. These spaces allow for exercise, relaxation, socialising and exploring nature, however, they are often not used by blind and partially sighted people (BPSP). To better understand the needs of BPSP for outdoor leisure experience and barriers encountered in planning, accessing and engaging with natural environments, we conducted an exploratory qualitative online survey (22 BPSP), semi-structured interviews (20 BPSP) and a focus group (9 BPSP; 1 support worker). We also explored how current technologies support park experiences for BPSP. Our findings identify common barriers across the stages of planning (e.g. limited accessible information about parks), accessing (e.g. poor wayfinding systems), engaging with and sharing leisure experiences. Across all stages (PLan, Access, Engage, Share) we found a common theme of Contribute. BPSP wished to co-plan their trip, contribute to ways of helping others access a place, develop multisensory approaches to engaging in their surroundings and share their experiences to help others. In this paper, we present the initial work supporting the development of a framework for understanding the leisure experiences of BPSP. We explore this theme of contribution and propose a framework where this feeds into each of the stages of leisure experience, resulting in the proposed, PLACES framework (PLan, Access, Contribute, Engage, Share), which aims to provide a foundation for future research on accessibility and outdoor leisure experiences for BPSP and people with disabilities.

Innovations in the field of assistive technology are usually evaluated based on practical considerations related to their ability to perform certain functions. However, social and emotional aspects play a huge role in how people with disabilities interact with assistive products and services. Over a five months period, we tested an innovative wheelchair service provision model that leverages 3D printing and Computer Aided Design to provide bespoke wheelchairs in Kenya. The study involved eight expert wheelchair users and five healthcare professionals who routinely provide wheelchair services in their community. Results from the study show that both users and providers attributed great value to both the novel service delivery model and the wheelchairs produced as part of the study. The reasons for their appreciation went far beyond the practical considerations and were rooted in the fact that the service delivery model and the wheelchairs promoted core values of agency, empowerment and self-expression.

Increasingly popular, long-distance running events (LDRE) attract not just runners but an exponentially increasing number of spectators. Due to the long duration and broad geographic spread of such events, interactions between them are limited to brief moments when runners (R) pass by their supporting spectators (S). Current technology is limited in its potential for supporting interactions and mainly measures and displays basic running information to spectators who passively consume it. In this paper, we conducted qualitative studies for an in-depth understanding of the R&S' shared experience during LDRE and how technology can enrich this experience. We propose a two-layer DyPECS framework, highlighting the rich dynamics of the R&S multi-faceted running journey and of their micro-encounters. DyPECS is enriched by the findings from our in depth qualitative studies. We finally present design implications for the multi-facet co-experience of R&S during LDRE.

While digital technologies are increasingly being used to provide support and diagnoses remotely, it is unclear whether they offer adequate emotional support and appropriate messages in navigating complex, stigmatised and sensitive conditions that can have a momentous impact on people's lives. In this paper, we investigate how and why people access existing HIV resources, and their experiences of using these resources through a survey with 197 respondents and an interview and think-aloud study with 28 participants. Our findings indicate that many HIV-related resources do not address the anxiety-provoking reasons for access, reinforce stigma and neglect to provide important information and emotional support. We finally discuss potential ways of addressing these issues in the current environment where more sexual health services are being delivered online.

Although clinical best practice suggests that affect awareness could enable more effective technological support for physical rehabilitation through personalisation to psychological needs, designers need to consider what affective states matter, and how they should be tracked and addressed. In this article, we set the standard by analysing how the major affective factors in chronic pain (pain, fear/anxiety, and low/depressed mood) interfere with everyday physical functioning. Further, based on discussion of the modality that should be used to track these states to enable technology to address them, we investigated the possibility of using movement behaviour to automatically detect the states. Using two body movement datasets on people with chronic pain, we show that movement behaviour enables very good discrimination between two emotional distress levels (F1=0.86), and three pain levels (F1=0.9). Performance remained high (F1=0.78 for two pain levels) with a reduced set of movement sensors. Finally, in an overall discussion, we suggest how technology-provided encouragement and awareness can be personalised given the capability to automatically monitor the relevant states, towards addressing the barriers that they pose. In addition, we highlight movement behaviour features to be tracked to provide technology with information necessary for such personalisation.

While most rehabilitation technologies target situated exercise sessions and associated performance metrics, physiotherapists recommend physical activities that are integrated with everyday functioning. We conducted a 1-2 week home study to explore how people with chronic pain use wearable technology that senses and sonifies movement (i.e., movement mapped to sound in real-time) to do functional activity (e.g., loading the dishwasher). Our results show that real-time movement sonification led to an increased sense of control during challenging everyday tasks. Sonification calibrated to functional activity facilitated application of pain management techniques such as pacing. When calibrated to individual needs, sonification enabled serendipitous discovery of physical capabilities otherwise obscured by a focus on pain or a dysfunctional proprioceptive system. A physiotherapist was invited to comment on the implications of our findings. We conclude by discussing opportunities provided by wearable sensing technology to enable better functioning, the ultimate goal of physical rehabilitation.

Chronic (persistent) pain (CP) affects 1 in 10 adults; clinical resources are insufficient, and anxiety about activity restricts lives. Technological aids monitor activity but lack necessary psychological support. This article proposes a new sonification framework, Go-with-the-Flow, informed by physiotherapists and people with CP. The framework proposes articulation of user-defined sonified exercise spaces (SESs) tailored to psychological needs and physical capabilities that enhance body and movement awareness to rebuild confidence in physical activity. A smartphone-based wearable device and a Kinect-based device were designed based on the framework to track movement and breathing and sonify them during physical activity. In control studies conducted to evaluate the sonification strategies, people with CP reported increased performance, motivation, awareness of movement, and relaxation with sound feedback. Home studies, a focus group, and a survey of CP patients conducted at the end of a hospital pain management session provided an in-depth understanding of how different aspects of the SESs and their calibration can facilitate self-directed rehabilitation and how the wearable version of the device can facilitate transfer of gains from exercise to feared or demanding activities in real life. We conclude by discussing the implications of our findings on the design of technology for physical rehabilitation.

Pain-related emotions are a major barrier to effective self rehabilitation in chronic pain. Automated coaching systems capable of detecting these emotions are a potential solution. This paper lays the foundation for the development of such systems by making three contributions. First, through literature reviews, an overview of how pain is expressed in chronic pain and the motivation for detecting it in physical rehabilitation is provided. Second, a fully labelled multimodal dataset (named `EmoPain') containing high resolution multiple-view face videos, head mounted and room audio signals, full body 3D motion capture and electromyographic signals from back muscles is supplied. Natural unconstrained pain related facial expressions and body movement behaviours were elicited from people with chronic pain carrying out physical exercises. Both instructed and non-instructed exercises were considered to reflect traditional scenarios of physiotherapist directed therapy and home-based self-directed therapy. Two sets of labels were assigned: level of pain from facial expressions annotated by eight raters and the occurrence of six pain-related body behaviours segmented by four experts. Third, through exploratory experiments grounded in the data, the factors and challenges in the automated recognition of such expressions and behaviour are described, the paper concludes by discussing potential avenues in the context of these findings also highlighting differences for the two exercise scenarios addressed.

Physical activity is important for improving quality of life in people with chronic pain. However, actual or anticipated pain exacerbation, and lack of confidence when doing physical activity, make it difficult to maintain and build towards long-term activity goals. Research guiding the design of interactive technology to motivate and support physical activity in people with chronic pain is lacking. We conducted studies with: (1) people with chronic pain, to understand how they maintained and increased physical activity in daily life and what factors deterred them; and (2) pain-specialist physiotherapists, to understand how they supported people with chronic pain. Building on this understanding, we investigated the use of auditory feedback to address some of the psychological barriers and needs identified and to increase self-efficacy, motivation and confidence in physical activity. We conclude by discussing further design opportunities based on the overall findings.