Piloting of the virtual telecare technology 'Addison Care' to promote self-management in persons with chronic diseases in a community setting: protocol for a mixed-methods user experience, user engagement and usability pilot study.

INTRODUCTION: Chronic diseases in older adults are one of the major epidemiological challenges of current times and leading cause of disability, poor quality of life, high healthcare costs and death. Self-management of chronic diseases is essential to improve health behaviours and health outcomes. Technology-assisted interventions have shown to improve self-management of chronic diseases. Virtual avatars can be a key factor for the acceptance of these technologies. Addison Care is a home-based telecare solution equipped with a virtual avatar named Addison, connecting older persons with their caregivers via an easy-to-use technology. A central advantage is that Addison Care provides access to self-management support for an up-to-now highly under-represented population-older persons with chronic disease(s), which enables them to profit from e-health in everyday life. METHODS AND ANALYSIS: A pragmatic, non-randomised, one-arm pilot study applying an embedded mixed-methods approach will be conducted to examine user experience, usability and user engagement of the virtual avatar Addison. Participants will be at least 65 years and will be recruited between September 2022 and November 2022 from hospitals during the discharge process to home care. Standardised instruments, such as the User Experience Questionnaire, System Usability Scale, Instrumental Activities of Daily Living scale, Short-Form-8-Questionnaire, UCLA Loneliness Scale, Geriatric Depression Scale, Stendal Adherence with Medication Score and Self-Efficacy for Managing Chronic Diseases Scale, as well as survey-based assessments, semistructured interviews and think-aloud protocols, will be used. The study seeks to enrol 20 patients that meet the criteria. ETHICS AND DISSEMINATION: The study protocol has been approved by the ethic committee of the German Society for Nursing Science (21-037). The results are intended to be published in peer-reviewed journals and disseminated through conference papers. TRIAL REGISTRATION NUMBER: DRKS00025992.

Effectiveness of Lateral Auditory Collision Warnings: Should Warnings Be Toward Danger or Toward Safety?

OBJECTIVE: The present study investigated the design of spatially oriented auditory collision-warning signals to facilitate drivers' responses to potential collisions. BACKGROUND: Prior studies on collision warnings have mostly focused on manual driving. It is necessary to examine the design of collision warnings for safe takeover actions in semi-autonomous driving. METHOD: In a video-based semi-autonomous driving scenario, participants responded to pedestrians walking across the road, with a warning tone presented in either the avoidance direction or the collision direction. The time interval between the warning tone and the potential collision was also manipulated. In Experiment 1, pedestrians always started walking from one side of the road to the other side. In Experiment 2, pedestrians appeared in the middle of the road and walked toward either side of the road. RESULTS: In Experiment 1, drivers reacted to the pedestrian faster with collision-direction warnings than with avoidance-direction warnings. In Experiment 2, the difference between the two warning directions became nonsignificant. In both experiments, shorter time intervals to potential collisions resulted in faster reactions but did not influence the effect of warning direction. CONCLUSION: The collision-direction warnings were advantageous over the avoidance-direction warnings only when they occurred at the same lateral location as the pedestrian, indicating that this advantage was due to the capture of attention by the auditory warning signals. APPLICATION: The present results indicate that drivers would benefit most when warnings occur at the side of potential collision objects rather than the direction of a desirable action during semi-autonomous driving.

Toward a Better Understanding of In-Vehicle Auditory Warnings and Background Noise.

OBJECTIVE: The effectiveness of three types of in-vehicle warnings was assessed in a driving simulator across different noise conditions. BACKGROUND: Although there has been much research comparing different types of warnings in auditory displays and interfaces, many of these investigations have been conducted in quiet laboratory environments with little to no consideration of background noise. Furthermore, the suitability of some auditory warning types, such as spearcons, as car warnings has not been investigated. METHOD: Two experiments were conducted to assess the effectiveness of three auditory warnings (spearcons, text-to-speech, auditory icons) with different types of background noise while participants performed a simulated driving task. RESULTS: Our results showed that both the nature of the background noise and the type of auditory warning influenced warning recognition accuracy and reaction time. Spearcons outperformed text-to-speech warnings in relatively quiet environments, such as in the baseline noise condition where no music or talk-radio was played. However, spearcons were not better than text-to-speech warnings with other background noises. Similarly, the effectiveness of auditory icons as warnings fluctuated across background noise, but, overall, auditory icons were the least efficient of the three warning types. CONCLUSION: Our results supported that background noise can have an idiosyncratic effect on a warning's effectiveness and illuminated the need for future research into ameliorating the effects of background noise. APPLICATION: This research can be applied to better present warnings based on the anticipated auditory environment in which they will be communicated.

Examining the Role of Eye Movements During Conversational Listening in Noise.

Speech comprehension is often thought of as an entirely auditory process, but both normal hearing and hearing-impaired individuals sometimes use visual attention to disambiguate speech, particularly when it is difficult to hear. Many studies have investigated how visual attention (or the lack thereof) impacts the perception of simple speech sounds such as isolated consonants, but there is a gap in the literature concerning visual attention during natural speech comprehension. This issue needs to be addressed, as individuals process sounds and words in everyday speech differently than when they are separated into individual elements with no competing sound sources or noise. Moreover, further research is needed to explore patterns of eye movements during speech comprehension - especially in the presence of noise - as such an investigation would allow us to better understand how people strategically use visual information while processing speech. To this end, we conducted an experiment to track eye-gaze behavior during a series of listening tasks as a function of the number of speakers, background noise intensity, and the presence or absence of simulated hearing impairment. Our specific aims were to discover how individuals might adapt their oculomotor behavior to compensate for the difficulty of the listening scenario, such as when listening in noisy environments or experiencing simulated hearing loss. Speech comprehension difficulty was manipulated by simulating hearing loss and varying background noise intensity. Results showed that eye movements were affected by the number of speakers, simulated hearing impairment, and the presence of noise. Further, findings showed that differing levels of signal-to-noise ratio (SNR) led to changes in eye-gaze behavior. Most notably, we found that the addition of visual information (i.e. videos vs. auditory information only) led to enhanced speech comprehension - highlighting the strategic usage of visual information during this process.

Relationships among pain intensity, pain-related distress, and psychological distress in pre-surgical total knee arthroplasty patients: a secondary analysis.

The current study aimed to examine the relationships between movement and resting pain intensity, pain-related distress, and psychological distress in participants scheduled for total knee arthroplasty (TKA). This study examined the impact of anxiety, depression, and pain catastrophizing on the relationship between pain intensity and pain-related distress. Data analyzed for the current study (N = 346) were collected at baseline as part of a larger Randomized Controlled Trial investigating the efficacy of TENS for TKA (TANK Study). Participants provided demographic information, pain intensity and pain-related distress, and completed validated measures of depression, anxiety, and pain catastrophizing. Only 58% of the sample reported resting pain >0 while 92% of the sample reported movement pain >0. Both movement and resting pain intensity correlated significantly with distress (rs = .86, p < .01 and .79, p < .01, respectively). About three quarters to two thirds of the sample (78% for resting pain and 65% for movement pain) reported different pain intensity and pain-related distress. Both pain intensity and pain-related distress demonstrated significant relationships with anxiety, depression, and catastrophizing. Of participants reporting pain, those reporting higher anxiety reported higher levels of distress compared to pain intensity. These findings suggest that anxious patients may be particularly distressed by movement pain preceding TKA. Future research is needed to investigate the utility of brief psychological interventions for pre-surgical TKA patients.