Exergames are becoming increasingly popular and have shown potential for motivating physical activity. Past research suggests that social (multiplayer) exergames offer players an engaging experience and good aerobic exercises. Our systematic review summarizes existing work and identifies gaps, trends, and patterns on social exergame research in the domain of health and wellness. A search was conducted in the ACM Digital Library, IEEE Xplore, and PubMed. After screening 2272 records, we identified 73 studies from 2013 to 2023 that meet the inclusion criteria. Our results reveal that step tracking is the most commonly implemented measure of physical activity in social exergames, and that competition, rewards, and cooperation are the most common features used for designing the games. Our results also show that the effectiveness of social exergames is intricately linked to a combination of factors, including group size, player matching, and game features. The main contribution of this paper is (1) an analysis of features and group dynamics employed for designing social exergames, and (2) how game features affect the games’ outcome (both positive and negative) uncovering challenges and opportunities to advance future research in this area. Our findings in the current review provides insights for the design and implementation of social exergaming helping users to experience more socially satisfying game experiences thereby increasing the motivation for exercise, as well as gaining social benefits.

Persuasive systems motivate behaviour change using persuasive strategies (PS) which are often implemented in various ways. However, whether or not the effectiveness of PS varies depending on implementation choices is yet to be investigated via an empirical study. We conduct a large-scale study of 568 participants to investigate if and how individuals at different Stages of Change (SoC) respond to different implementations of each strategy in the same system. We also explore why the implementations motivate behaviour change using ARCS motivation model. Our results show that people’s SoC plays a significant role in the perceived effectiveness of different implementations of the same strategy and that the implementations motivate for different reasons. For instance, people at the precontemplation stage are motivated by reward strategy implemented as badges because it increases their Confidence, while people in the preparation stage prefer reward implemented as points to build their Confidence. Our work links SoC theory with motivation theory and Persuasive Systems Design (PSD) model to offer practical guidelines for tailoring PS implementations to individuals to motivate behaviour change.

Traditional health systems mostly rely on rules created by experts to offer adaptive interventions to patients. However, with recent advances in artificial intelligence (AI) and machine learning (ML) techniques, health-related systems are becoming more sophisticated with higher accuracy in providing more personalized interventions or treatments to individual patients. In this paper, we present an extensive literature review to explore the current trends in ML-based adaptive systems for health and well-being. We conduct a systematic search for articles published between January 2011 and April 2022 and selected 87 articles that met our inclusion criteria for review. The selected articles target 18 health and wellness domains including disease management, assistive healthcare, medical diagnosis, mental health, physical activity, dietary management, health monitoring, substance use, smoking cessation, homeopathy remedy finding, patient privacy, mobile health (mHealth) apps finder, clinician knowledge representation for neonatal emergency care, dental and oral health, medication management, disease surveillance, medical specialty recommendation, and health awareness. Our review focuses on five key areas across the target domains: data collection strategies, model development process, ML techniques utilized, model evaluation techniques, as well as adaptive or personalization strategies for health and wellness interventions. We also identified various technical and methodological challenges including data volume constraints, data quality issues, data diversity or variability issues, infrastructure-related issues, and suitability of interventions which offer directions for future work in this area. Finally, we offer recommendations for tackling these challenges, leveraging on technological advances such as multimodality, Cloud technology, online learning, edge computing, automatic re-calibration, Bluetooth auto-reconnection, feedback pipeline, federated learning, explainable AI, and co-creation of health and wellness interventions.

Mobile health (mHealth) apps show potential contributions as interactive systems for managing users' health conditions. They are also used to improve health habits using behaviour change strategies. However, the trends, effectiveness, and design practices of these apps in terms of behaviour change are unclear yet. With a collaboration between researchers, domain experts, interactive systems developers and professionals, this paper aims to fill this gap by systematically investigating 70 mHealth apps using two popular behaviour change frameworks, namely App Behaviour Change Scale (ABACUS) and the Persuasive System Design (PSD) model. The study investigates the most common strategies and how these strategies were designed and implemented in the apps to achieve the targeted design objectives. Furthermore, the study evaluates apps' behaviour change potential using the behaviour Change Score (BCS), a measure we introduced to evaluate how the apps employ behaviour change strategies. The results show that 1) Journaling is the most common category of apps. 2) the most employed strategies are Self-monitoring, Customize and Personalize, and Reminders. And 3) there is a positive correlation between apps' ranks (based on ratings and installation) and the BCS score of most strategies. Based on our findings, we offer recommendations for designing and developing mHealth apps and present opportunities for future work in this area.

Over the years, there has been a global increase in the use of technology to deliver interventions for health and wellness, such as improving people's mental health and resilience. An example of such technology is the Q-Life app which aims to improve people's resilience to stress and adverse life events through various coping mechanisms, including journaling. Using a combination of sentiment analysis and thematic analysis methods, this paper presents the results of analyzing 6023 journal entries from 755 users. We uncover both positive and negative factors that are associated with resilience. First, we apply two lexicon-based and eight machine learning (ML) techniques to classify journal entries into positive or negative sentiment polarity, and then compare the performance of these classifiers to determine the best performing classifier overall. Our results show that Support Vector Machine (SVM) is the best classifier overall, outperforming other ML classifiers and lexicon-based classifiers with a high F1-score of 89.7%. Second, we conduct thematic analysis of negative and positive journal entries to identify themes representing factors associated with resilience either negatively or positively, and to determine various coping mechanisms. Our findings reveal 14 negative themes such as stress, worry, loneliness, lack of motivation, sickness, relationship issues, as well as depression and anxiety. Also, 13 positive themes emerged including self-efficacy, gratitude, socialization, progression, relaxation, and physical activity. Seven (7) coping mechanisms are also identified including time management, quality sleep, and mindfulness. Finally, we reflect on our findings and suggest technological interventions that address the negative factors to promote resilience.

Persuasive systems (PS) are effective at motivating behaviour change using various persuasive strategies. Research shows that tailoring these systems increases their effectiveness. However, there is little knowledge on how PS can be tailored to people's Stages of Change (SoC). We conduct a large-scale study of 568 participants to investigate how individuals at different SoC respond to various strategies. We also explore why the strategies motivate behaviour change using the ARCS motivation model. Our results show that people's SoC plays a significant role in the perceived persuasiveness of different strategies and that the strategies motivate for different reasons. For instance, people at the precontemplation stage tend to be strongly motivated by self-monitoring strategy because it raises their consciousness or self-awareness. Our work is the first to link research on the theory of SoC with the theory of motivation and Persuasive Systems Design (PSD) model to develop practical guidelines to inform the tailoring of persuasive systems.

Increased physical activity has been shown to reduce morbidity and mortality among adults. Over the years, mobile apps have been developed to encourage people to engage in physical activity, such as walking or running, by employing various persuasive strategies. However, the choice of these strategies is often based on designers' intuition without knowing if the strategies will be effective for target audience and the target behaviour. To address this gap, we conduct a study with 103 adults to assess the perceived effectiveness of 12 widely used strategies in health games design. The strategies are based on the Persuasive Systems Design (PSD) framework. Our results reveal that the strategies are effective for promoting physical activity at varying degrees. These results inform the development of the game, called TreeCare. Next, we conduct a 3-week field study involving 23 target users to evaluate the game in terms of effectiveness and usability. Our results show that TreeCare significantly improved users' physical activity levels. In addition, the game is found to be easy to use, engaging, aesthetically pleasing, and enjoyable. We reflect on our findings and offer practical guidelines to inform the design of effective and usable persuasive applications.

Diabetes is a non-communicable disease associated with increased level of glucose due to inadequate supply of insulin (known as Type 1 diabetes) or inability to use insulin efficiently (known as Type 2 diabetes). Though the exact cause of Type 1 diabetes is unknown, the probable causes are genetics and environmental factors (such as exposure to viruses). On the other hand, Type 2 diabetes is largely linked to unhealthy lifestyle choices. In Nigeria, many people are believed to be living with diabetes and the country's diabetes prevalence rate is one of the highest in Africa. To determine the factors responsible for diabetes prevalence in Nigeria, we analyzed social media contents related to diabetes since billions of people, including diabetic patients and healthcare professionals, use social media platforms to freely share their experiences and discuss many health-related topics. None of the existing research targets the African audience who are also major users of social media platforms; hence our work aims to close this gap by leveraging an African social media platform targeted at Nigerians to gather diabetes-related data, and then applying machine learning technique to detect those factors responsible for diabetes prevalence in Nigeria. Based on our results, we discussed positive behavioural or lifestyle changes that are necessary to prevent and treat diabetes in Nigeria, as well as intervention designs required to bring about those changes. Future work will develop a diabetes intervention application implementing all the design features highlighted in Section V of this paper and making it generally accessible to Nigerians.