Improved readability and functions needed for mHealth apps targeting patients with heart failure: An app store review.

To maintain their quality of life and avoid hospitalization and early mortality, patients with heart failure must recognize and respond to symptoms of exacerbation. A promising method for engaging patients in their self-care is through mobile health applications (mHealth apps). However, for mHealth to have its greatest chance for improving patient outcomes, the app content must be readable, provide useful functions and be based in evidence. The study aimed to determine: (1) readability, (2) types of functions, and (3) linkage to authoritative sources of evidence for self-care focused mHealth apps targeting heart failure patients that are available in the Apple and Google Play Stores. We systematically searched for mHealth apps targeting patients with heart failure in the Apple and Google Play Stores and applied selection criteria. Readability of randomly selected informational paragraphs were determined using Flesch-Kincaid grade level test tool in Microsoft Word. Ten mHealth apps met our criteria. Only one had a reading grade level at or below the recommended 6th grade reading level (average 9.35). The most common functions were tracking, clinical data feedback, and non-data-based reminders and alerts. Only three had statements that clearly linked the mHealth app content to trustworthy, evidence-based sources. Only two had interoperability with the electronic health record and only one had a communication feature with clinicians. Future mHealth designs that are tailored to patients' literacy level and have advanced functions may hold greater potential for improving patient outcomes.

Computer-Controlled Virtual Humans in Patient-Facing Systems: Systematic Review and Meta-Analysis.

BACKGROUND: Virtual humans (VH) are computer-generated characters that appear humanlike and simulate face-to-face conversations using verbal and nonverbal cues. Unlike formless conversational agents, like smart speakers or chatbots, VH bring together the capabilities of both a conversational agent and an interactive avatar (computer-represented digital characters). Although their use in patient-facing systems has garnered substantial interest, it is unknown to what extent VH are effective in health applications. OBJECTIVE: The purpose of this review was to examine the effectiveness of VH in patient-facing systems. The design and implementation characteristics of these systems were also examined. METHODS: Electronic bibliographic databases were searched for peer-reviewed articles with relevant key terms. Studies were included in the systematic review if they designed or evaluated VH in patient-facing systems. Of the included studies, studies that used a randomized controlled trial to evaluate VH were included in the meta-analysis; they were then summarized using the PICOTS framework (population, intervention, comparison group, outcomes, time frame, setting). Summary effect sizes, using random-effects models, were calculated, and the risk of bias was assessed. RESULTS: Among the 8,125 unique records identified, 53 articles describing 33 unique systems, were qualitatively, systematically reviewed. Two distinct design categories emerged - simple VH and VH augmented with health sensors and trackers. Of the 53 articles, 16 (26 studies) with 44 primary and 22 secondary outcomes were included in the meta-analysis. Meta-analysis of the 44 primary outcome measures revealed a significant difference between intervention and control conditions, favoring the VH intervention (SMD = .166, 95% CI .039-.292, P=.012), but with evidence of some heterogeneity, I2=49.3%. There were more cross-sectional (k=15) than longitudinal studies (k=11). The intervention was delivered using a personal computer in most studies (k=18), followed by a tablet (k=4), mobile kiosk (k=2), head-mounted display (k=1), and a desktop computer in a community center (k=1). CONCLUSIONS: We offer evidence for the efficacy of VH in patient-facing systems. Considering that studies included different population and outcome types, more focused analysis is needed in the future. Future studies also need to identify what features of virtual human interventions contribute toward their effectiveness.

Categorization-based stranger avoidance does not explain the uncanny valley effect.

The uncanny valley hypothesis predicts that an entity appearing almost human risks eliciting cold, eerie feelings in viewers. Categorization-based stranger avoidance theory identifies the cause of this feeling as categorizing the entity into a novel category. This explanation is doubtful because stranger is not a novel category in adults; infants do not avoid strangers while the category stranger remains novel; infants old enough to fear strangers prefer photographs of strangers to those more closely resembling a familiar person; and the uncanny valley's characteristic eeriness is seldom felt when meeting strangers. We repeated our original experiment with a more realistic 3D computer model and found no support for categorization-based stranger avoidance theory. By contrast, realism inconsistency theory explains cold, eerie feelings elicited by transitions between instances of two different, mutually exclusive categories, given that at least one category is anthropomorphic: Cold, eerie feelings are caused by prediction error from perceiving some features as features of the first category and other features as features of the second category. In principle, realism inconsistency theory can explain not only negative evaluations of transitions between real and computer modeled humans but also between different vertebrate species.

Familiar faces rendered strange: Why inconsistent realism drives characters into the uncanny valley.

Computer-modeled characters resembling real people sometimes elicit cold, eerie feelings. This effect, called the uncanny valley, has been attributed to uncertainty about whether the character is human or living or real. Uncertainty, however, neither explains why anthropomorphic characters lie in the uncanny valley nor their characteristic eeriness. We propose that realism inconsistency causes anthropomorphic characters to appear unfamiliar, despite their physical similarity to real people, owing to perceptual narrowing. We further propose that their unfamiliar, fake appearance elicits cold, eerie feelings, motivating threat avoidance. In our experiment, 365 participants categorized and rated objects, animals, and humans whose realism was manipulated along consistency-reduced and control transitions. These data were used to quantify a Bayesian model of categorical perception. In hypothesis testing, we found reducing realism consistency did not make objects appear less familiar, but only animals and humans, thereby eliciting cold, eerie feelings. Next, structural equation models elucidated the relation among realism inconsistency (measured objectively in a two-dimensional Morlet wavelet domain inspired by the primary visual cortex), realism, familiarity, eeriness, and warmth. The fact that reducing realism consistency only elicited cold, eerie feelings toward anthropomorphic characters, and only when it lessened familiarity, indicates the role of perceptual narrowing in the uncanny valley.

Reducing consistency in human realism increases the uncanny valley effect; increasing category uncertainty does not.

Human replicas may elicit unintended cold, eerie feelings in viewers, an effect known as the uncanny valley. Masahiro Mori, who proposed the effect in 1970, attributed it to inconsistencies in the replica's realism with some of its features perceived as human and others as nonhuman. This study aims to determine whether reducing realism consistency in visual features increases the uncanny valley effect. In three rounds of experiments, 548 participants categorized and rated humans, animals, and objects that varied from computer animated to real. Two sets of features were manipulated to reduce realism consistency. (For humans, the sets were eyes-eyelashes-mouth and skin-nose-eyebrows.) Reducing realism consistency caused humans and animals, but not objects, to appear eerier and colder. However, the predictions of a competing theory, proposed by Ernst Jentsch in 1906, were not supported: The most ambiguous representations-those eliciting the greatest category uncertainty-were neither the eeriest nor the coldest.