Chiistel Be Naeyei

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vrije 0niversiteit Brussel
Ioculteit Fconomiscbe, Sociole en Politieke Wetenscboppen en
Solvoy Business Scbool
StuJy Areo: Communicotion StuJies
Supervisor: Prof. Br. An }ocobs
Tbeme: Sleepinq witb Tecbnoloqy Port ll
Besiqninq for Personol Eeoltb

Tbesis submitteJ to obtoin tbe qroJe of
Hoster of Science in Communicotion StuJies
New HeJio onJ Society in Furope






















AcoJemic Yeor 201S-2014
2






I solemnly declare that I have written this masters thesis Sleeping
with technology Designing for Personal Health myself.
I am aware of the rules on plagiarism and have therefore ensured
that these have been applied in this masters thesis.
15-11-2013 Christel De Maeyer



































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Sleeping with Technology Part II
Designing for Personal Health

Is 24/7 self-monitoring creating enough awareness and
persuasion to get a balanced lifestyle? Will self-monitoring
affect general wellbeing among self-monitored people?

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6
Short Abstract
We observe that more smart devices are becoming part of our
daily life, and people that quantify aspects of their lifestyle are
becoming more mainstream. In doing so, they leave a huge digital
footprint behind in an active and passive way.
We notice that the Quantified Self is mainly focused on creating
awareness towards a healthier lifestyle. We learn that there are
opportunities for realizing healthcare that is more oriented and
organized around prevention. Not only on an individual level, but
also on a population level. Patterns might be discovered in user
data helping to support predictions in a more granular and
personalized way. At the same time, a lot of questions arise when
using Quantified Self. How do these device integrate in peoples
daily life? Are they as effective as we think? Do they create enough
awareness and persuasion to create a sustainable and healthier
lifestyle? Do they facilitate a structural behavior change with the
user? Do they continue the lifestyle they adopted during the
tracking period? Or are we seeing more a temporary phenomenon
in the usage and behavior changes?
Other questions that arise are privacy, integration in the European
Social Security system, new business models around these devices
and apps.

7


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Thanks To:

Supervisor Prof. Dr. An Jacobs, SMIT VUB, Belgium
Dr. BJ Fogg, Persuasive Technology Lab, Stanford University, US

Mark Nelson, Peace Innovation Lab, Stanford University, US
Quantified Self Community, my tribe
Friends for listening to my experiments
BodyMedia Inc. in delivering the armbands used in this research
Mike McGrath, proofreading this thesis
The participants who were dedicated for 7 months in joining this
research

Taking a break for doing this master and especially to focus on my
research was one of my better moves. Being able to take time to
read, write, joining conferences and having a peaceful, healthy
lifestyle, was just great, relaxing and liberating. Apart for the exam
stress !. My mission in doing this was to valorize my years of
experience in the digital field, and starting to specialize in the next
big thing, Personal Informatics. I believe this has a great future and
is the next logical step in the digital world and digital health.
Thinking about health as a skill instead of an illness.
I would also like to thank all the people around me to be such good
listeners and to gave their trust and be so open about their lives.
Not getting bored about my ongoing talks about Quantified Self,
sleep and other obsessions. The numerous people I talked to at
conferences. The opportunity I had to have a break-out session on
sleep tracking during the Quantified Self conference, gave more
insight from different people, I would otherwise never had.
BodyMedia Inc., Zeo Inc. and Lark, who give their trust in providing
me with the necessary equipment, their on going support, skype
talks and so forth.
11
Especially thanks to An Jacobs for the critical approach and thinking
towards my subject and writing. In feeding me to think in different
ways towards the subject.
As I see myself as a research subject, I kept track of my habits -
study-write among other things, during this academic year to see
my time investment. Lift application tracked my habits and
summarized the frequency of my habits.







The writing includes writing for my thesis, writing papers, and
writing articles concerning my research. In total 86 check ins. The
habit says 30 minutes, but it is much more than that, usually
12
around 4 hours writing a day. I started tracking in October. In total
344 hours, 43 days, 1,5 month.
The study moments are mainly reading for my master thesis; there
are 79 check ins starting October 2012. It is possible I forgot to
check in, but Im pretty rigid about it. So lets say that I studied an
average of 4 hours per check in (there will be peaks here and there),
that would be 316 hours 39,5 days, 1,3 month.
In addition, there are the classes that are not included in the study
check ins. An academic year is more or less 6 months activity; in
the master year we had 4 hours a week (October-December, 13
weeks, 52 hours), 8 hours a week (February May, 9 weeks, 72
hours, I noted a few weeks less, because I was abroad for a few
weeks and not attending the lectures)
In total 784 hours, is 98 days, 3,2 months on full time basis 8 hours
a day. Spread over 9 months one academic year.
An overview on my Green Span Behavior.

1S
Abstract
We observe that more smart devices are becoming part of our
daily life, and people that quantify aspects of their lifestyle are
becoming more mainstream. In doing so, they leave a huge digital
footprint behind in an active and passive way.
We notice that the Quantified Self is mainly focused on creating
awareness towards a healthier lifestyle. We learn that there are
opportunities for realizing healthcare that is more oriented and
organized around prevention. Not only on an individual level, but
also on a population level. Patterns might be discovered in user
data helping to support predictions in a more granular and
personalized way. At the same time, a lot of questions arise when
using Quantified Self. How do these device integrate in peoples
daily life? Are they as effective as we think? Do they create enough
awareness and persuasion to create a sustainable and healthier
lifestyle? Do they facilitate a structural behavior change with the
user? Do they continue the lifestyle they adopted during the
tracking period? Or are we seeing more a temporary phenomenon
in the usage and behavior changes?
Other questions that arise are privacy, integration in the European
Social Security system, new business models around these devices
and apps.
In this thesis, we would like to focus on the adoptation of the
devices and behavior changes that these devices might trigger.
We discuss these different aspects based on the explorative insights
we collected by doing empirical research creating a social quasi-
experimental set up for a mid long term period (project duration:
sept 2012-sept 2013). We started with 10 participants who were
not using any tracking devices at the start of the project. We gave
each participant a BodyMedia armband and access to the BodyMedia
Activity manager to monitor their progress and goals. The active
research testing period took place during two periods of two
14
months (fall spring), giving us the opportunity to look into
seasonal differences. The gap during the months in-between we
evaluated whether the participants spontaneously tracked
themselves. Next, recruited from the start of the research a control
group of people with matching profiles (N=10) who did not have an
armband. From the control group, we collected lifestyle information
with the same tools (weekly survey and in depth interview) we used
with the 10 people wearing the armband (experimental group). This
allowed us to evaluate the effect of attention by the
researcher/coach in making these lifestyle changes. In order to get
a clearer view of the behavior types, we used Foggs Behavior Grid
to map the profiles of the participants and their progress. We use
Fogg Behavior Model to evaluate the Persuasive Technology side of
the BodyMedia device.
The results show a wide range of aspects that come in play while
using the BodyMedia device. In choosing for a variety in the
participants, the mid-long term setup, working with a control group,
we gained a lot of insights in this research. Rich in findings and
future research possibilities. In parallel with Foggs Behavior Model,
we see positive and negative behavior based on the three-core
motivators sensation anticipation social cohesion. Additionally,
the simplicity factors that influence the ability to achieve a behavior
change, were elements that rose within our research, as well. These
factors are time in terms of planning and seasons, brain cycles in
terms of emotions that come with the data analysis, physical effort,
none-routines, building new habits and maintaining them. Last but
not least the out of the ordinary effect that takes place while
wearing these devices, which we also see in Swans arguments.
Through the whole research process, we see an interesting
evolution in the control and experimental group. Somehow the
experimental group creates a certain dependency on the technology
while the control group goes through a more cognitive process. The
1S
little changes they made during the research were somehow more
embedded in their brain. During the research, we were able to
validate Foggs theory in using the Behavior Model and the Behavior
Grid. Almost every aspect of this theory became prevalent in the
research.

Keywords
personal health, lifelogging, quantified self, self management,
personal informatics, behavior design

1. Introduction
In recent years, we see increasing problems in peoples lifestyle:
lack of physical activity, the wrong eating habits and not sleeping
enough hours. This results in more health risks and chronic diseases.
According to the World Health Organisation 60% of the global
population has not succeeded in having a minimum, moderate 30-
minute of daily physical activity. This inactivity contributes to large
medical costs (WHO - 2003).
Technological solutions that create new insights through monitoring
and quantifying ourselves could help us get on the way to a more
active lifestyle with increased wellbeing. Some details about
Quantified Self in the US market. 60% of US adults currently
tracking their weight, diet or exercise routine. 33 % US adults
tracking other aspects such as blood sugar, blood pressure,
headaches or sleep patterns
1
. 27 % US Internet users tracking
health data online
2
, 9 % have signed up for text message health
alerts. There are 40.000 smartphone health applications available
3
.

1
http:www.ucsf.euunews2u121u1291Sself-tiacking-may-become-key-
element-peisonalizeu-meuicine
2
http:pewinteinet.oig~meuiafilesiepoits2u11pip_social_life_of_health_i
nfo.puf
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http:pewinteinet.oig~meuiaFilesRepoits2u12PIP_NobileBealth2u12.
puf
16
This thesis is not intended as a summation of all the available
devices and apps on the market, or as indicating any preferences.
As we see in the studies above, most of the devices are designed
and developed in the US. Perhaps thats because preventive health
care is a more urgent topic in the US than in Europe, due mainly to
the American healthcare system and the American lifestyle. In
recent years weve seen a lot of mobile apps and sensor wearables
coming on the market which have a focus on health or wellbeing,
measuring physical activity, calorie burning, sleep and steps. They
come in different shapes and sizes and price ranges. These devices
are accessible but at this stage more popular with the early adopter
population that has a great interest in self-monitoring and data
visualisation of themselves. They might become mainstream, but
there are some barriers at the moment. (Swan, 2013) put the self-
tracking barriers in two categories, the first is from a practical
perspective, and the second is the mindset. The practical one is
about making the self-tracking tools more easy to use, less
expensive or inexpensive, comfortable and above all automated,
which Swan refers to as passive tracking or passive data collection
(Swan, 2013, p.BD93). We are not completely agreeing with the
complete automated process, passive tracking. This might lower the
awareness, as the user is not consciously involved anymore in the
data gathering. We do agree that the data gathering progress
should be very seamlessly, but the user had to have some kind of
involvement in a certain way. Swan is also talking about different
ways to give incentives like social support, arise community
awareness and financial incentives to change peoples behavior. The
example Swan uses for financial incentives is the one from Safeway
Health Measures
4
, where employees are getting incentives to stay
at the same weight or lower weight based on an average weight per

4
http:csisite.safeway.compeopleemployeeshealth-wellness#piettyPhoto
17
year. Their contribution in their health insurance would be
influenced based on their weight specifications and healthy living.
This is the start of social sorting which we will explain later on.
Privacy might be at risk and is differently handled in Europe then in
the US. The second barrier is the mindset; this is more about
cultural, social and philosophical aspects. For example, individuals
might find that the self-tracking is an alien activity. This aspect is
in parallel with the social cohesion and social acceptance within
Foggs simplicity factors. We will elaborate on this later in the
theory and results of our research. Obviously people will not change
behavior just like that it is a difficult process; there are many things
to consider when developing and designing these self-tracking tools,
whether they are devices or apps.
Well-designed products and well-designed technology could be tools
to create awareness and facilitate behavior change. This thesis will
focus on Persuasive Technology coined by Dr. BJ Fogg (Fogg, 2003)
in his research on Behavior Design. Its about applying behavior
design to different behavior types with the intent of arriving at a
certain behavioral goal for a specific behavior type. It is an area
that starts from different behavior types and how we can apply
design with intent having a certain behavior type in mind, with the
goal of changing someones behavior. Hence the title of this thesis
Designing for Personal Health. In developing the different aspects
of this thesis, we worked with a use case to evaluate the whole
technology adoptation process of our participants and integration in
their everyday lives. We also use the theory of Persuasive
Technology (Fogg, 2003) to analyse the device and its design for
persuasion. The device we chose to use is the BodyMedia on-body
armband from BodyMedia Inc. This FDA approved device is
positioned as a consumer product in the US. In Belgium, it is widely
used in research facilities and hospitals.
18
The thesis will cover 4 main chapters to frame the theory of
Designing for Personal Health. First Persuasive Technology
Framework where we discuss the different Persuasive Technology
models in different media, second Personal Informatics, the tools
which have the aim to measure and change behavior to a certain
extent, third Behavior change and Self-monitoring, how behavior
change can happen within a self-monitoring environment, looking at
different behavior models, fourth from Quantified Self to Preventive
Healthcare.
We will close with our research model, results and conclusion.

1.1. Framework of Persuasive technology
BJ Fogg coined persuasive Technology in early 2000 (Fogg, 2003).
Persuasive technology is technology designed to influence peoples
behavior through social pressure or persuasion. Web applications,
mobile apps and mobile devices are becoming more focused on
motivating and influencing users. Besides the usability of websites,
mobile apps and devices, integration of motivation principles will be
increasingly important to help people to achieve their goals. We see
this happen in different areas, like productivity products,
collaboration platforms, social networks, e-commerce and more
recently also in a variety of mobile apps and mobile devices.
In past years, weve seen an evolution in Persuasive Technology, on
different platforms in different areas and domains. We intend to set
out a framework of Persuasive Technology to get a clear view on
what is happening today in this area and in which medium.

1.1.1. Online Persuasive Technology
BJ Fogg frames Persuasive Technology (Fogg, 2003, p 1) or
Behavior Design as any device, application, platform that allows
interactivity and is designed to change peoples attitudes or
behavior. We first saw this happening on the Internet where
19
persuasive technology is used for stimulating sales, for example,
based on profiles of members or accounts. The user receives related
offers based on his or her buying behavior or profile on that website
(e.g. Amazon), resulting, for example, in purchasing more books or
other goods (Fogg, 2003).

1.1.2. Mass Interpersonal Persuasion
The development of social networks and the opening of platforms to
third parties to develop applications and games is one of the biggest
steps for Mass Interpersonal Persuasion (MIP). MIP is working with
the social influence we all create when posting to news feeds or
sharing games and apps. This is also known as the social influence
dynamic. (BJ Fogg, 2007)

1.1.3. Mobile Persuasion
Mobile phones make persuasion very powerful. The persuasive
experience can be personal and can tackle more delicate behavior
changes. In addition, it is also focused and targeted (Fogg, 2007).
With the release of the smartphones, we see an explosion of mobile
apps that are targeted to change peoples behavior especially in the
area of wellbeing and health. We can look at the smartphone as a
wearable device, but I see a distinction in this device. The
smartphone is usually in our pocket or bag and not necessarily
attached to our body. At the same time, we see devices coming in
the market in the form of wrist or armbands, smart clothing, to
name some examples, which have sensors to measure whatever we
do and which we wear. We can call these wearable devices or
wearable objects. These forms of mobile persuasion are the new
trend that makes people aware of a certain behavior and are
designed to change those behaviors at the same time. For example
wearable devices measure calorie burning, physical activity from
moderate to vigorous, how many miles run, etc. Early devices sync
2u
to website application where theres a dashboard to follow your
everyday progress. Recent devices synchronize in real-time and
give immediate feedback. (Swamy & Slek, 2012)

1.2. Wearable devices Technologies
Although it is not our intention to give a list of all the devices and
apps that are on the market these days, it makes sense to highlight
some of them and go a bit deeper into the technology they use.
Basically, you have 2 categories in this area. Devices that have a
synchronous or asynchronous data transfer process.
1. Wearable devices that synchronize in real-time with blue tooth
or wireless technology, synchronous data syncing process.
2. Wearable device that come with a USB connection to upload
the data online. These are older versions of the system but
still very up to date, a-synchronous syncing. In this category,
you usually have an app available that shows the data on
your smartphone Android or IOS phones.
The future lies in optimizing both systems, synchronized to each
other web and mobile. The optimal solutions lies in realtime data
synchronization and sending realtime information that can stimulate
the motivation of the user while in a certain mode. When the users
opt in for such a feature, we call this putting Hot Triggers in
motivated peoples path (BJ Fogg, 2007). In our research, we focus
on the arm and wristbands that are in todays market. As
mentioned before in the introduction, we chose BodyMedia armband
to work with, but it is interesting to look at the different models that
are there today.

1.2.1. The arm or wristbands
Today there are four popular armbands/wristbands on the market
The arm or wristbands presented here are designed to change
lifestyles to varying degrees. Their primary focus is on preventive
21
healthcare, and all are measuring physical activity, calorie burning
and sleep. The one exception Nike Fuel, it does not track sleep.
Since we use these measure indicators in our research, it makes
sense to take a look at the different models.

1. Jawbone Up measures sleep, physical activity in time (steps),
calorie burning, and food intake.

Iiq. 1 }owbone 0p tecbnicol specificotions

2. Nike Fuel measures steps, calorie burning and physical activity

Iiq. 2 Nike Iuel tecbnicol specificotions

22

3. Lark Life just launched during the writing of this thesis, measures
sleep, physical activity (steps) and food intake

Iiq. S lork life tecbnicol specificotions

4. BodyMedia measures sleep, calorie burning, physical activity in
time, steps, food intake

Iiq. 4 BoJyHeJio ormbonJ sensors

2S
BodyMedia is one of the markets first, with about 11 years of
product research. With sensors placed on the arm, it is the only one,
which can truly be called an armband. Lark Life, for example, is
using an intelligent accelerometer, while Jawbone Up is detecting
micro movements for physical activity and during sleep by using
MotionX algorithms to check to see which sleep phase you are in.
The algorithm is based on biomechanics and the mechanics of
machine motion.
5


1.2.2. Data Presentation in Dashboards and Apps That
Come with These Devices
Wearable devices have a generic architecture, where sensors collect
data and the collected data is transferred to a mobile application
or/and web application. Then one can analyze and learn from the
presented data. The user can act on the data, share the data or
choose not to.

Iiq. S Arcbitecture Persuosive system for Sensor Weorobles

The data uploaded to these dashboards are presented in different
ways. Each device has its own data presentation. They all give data
on physical activity expressed in time, number of steps during a
given day, calorie burning or sleep. Sleep details, such as deep
sleep or REM, vary by the product. The consumption of food
presents a common problem for all these devices as they struggle

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to determine food input. Some of the apps integrate photo material
while others allow the user to input food data. None of these
solutions is really accurate, and all are time consuming.
The longer one uses the device and gather data, the more feedback
one will get from the dashboard system. One can also detect
patterns in ones habits and have the ability to act on them. All
these applications, whether mobile or web have more or less the
same follow up system, which we will call a taxonomy of self-
tracking devices. This is an adapted taxonomy from the one of
(Ananthanarayan, Siek, 2012). Some of the follow up systems will
be more successful than others. We will further discuss why some of
them are more successful than others.

1.2.3. Taxonomy of Self Tracking Process

Iiq. 6 AJopteJ Toxonomy self monitorinq process




1.2.3.1. Goal Setting
Goal setting is an important element in self-monitoring. Goal
orientation helps to achieve the goals and also identifies the issues
Selfmonitoiing
piocess
uoal setting
Bata
inteipietation
Coaching
feeuback loop
Peisonal
coaching uiaiy
function
2S
in an individuals life by linking the data to the users goals (Barau,
Kay, et al, 2012). Goal setting theory teaches us that, proximal,
specific, difficult yet attainable goals result in higher task
performance compared to no goals or easy goals. (Locke,
Latham, 2002, p.705-717). Goals constitute the focal points
around which human behavior is organized (Fishbach,
Ferguson, 2007, p2)
The user begins with self-tracking devices by making an account, or
profile, and setting goals. In the case of BodyMedia FIT, the device
we use in our research, the respondent fills in details such as
male/female; right/left handed; weight; height; age; bedtime and
wake-up time. The user can set his or her goals weight loss;
maintain weight or increasing physical activity in the same profile.

1.2.3.2. Data Upload and Interpretation
The user starts wearing the device and gathers data along the way
through the sensors. This data can be uploaded daily or is
synchronised in real-time. After uploading the data the user gets a
view on his or her daily activities, calorie burning and sleep
efficiency in the case of the BodyMedia device. The longer you use
the device, the more it gets to know you and provides feedback
accordingly.

1.2.3.3. Communication - Coaching
Most of the devices send communication to the email address that
was gained with ones profile. This communication delivers
information about ones progress based on the data input while
taking into account ones profile and coaching program. With the
BodyMedia device, this communication is done through their activity
manager and reaches the user when uploading the data and the
system has made an evaluation. Other devices will send coaching
feedback through email or even immediate notification when it is a
26
realtime synchronization process. Lark Life, for example, sends
immediate feedback when inputting new information or upon the
synching process.

1.2.3.4. Personal Coaching
In the taxonomy of self-tracking it is interesting to consider a fourth
element, personal coaching (Fogg, 2007). It could be a service that
is build around these devices. Professional coachers in a specific
domain can deliver services; caretakers specialized in diets and
nutrition, sports or movement physical activity coaches that we
already know from fitness centers for examples.

So far weve been focused on arm and wristbands in the self-
tracking area, but as mentioned before there are other approaches
in this field, like mobile applications, smart clothing, heart rate belts,
body scales, all these tools are categorized as Personal Informatics.

2. Personal Informatics
!Personal Informatics are a class of tools that help people
collect personally relevant data, information for the purpose
to self-reflection and self-monitoring. These tools help
people gain self-knowledge about ones behaviors, habits
and thoughts. It goes by other names such as Living by
numbers, personal analytics, quantified self, and self-
tracking. (Ian Li, 2011, p1)
The devices we illustrated in chapter 1.2. come with their own
dashboards and systems to interpret the data. The dashboard is the
data layer presentation of a database that lies behind that layer. In
reality, there is much more information available that the user does
not see the dashboard presents a summary of all the data. There
are numerous apps that are available as well that use the same
27
systematic to track oneself in independent apps on iOS or Android
phones. Many of these apps have a focus on health and a better
quality of life. Some of them use crowdsourcing to validate eating
habits, like The Eatery app. We will illustrate some of these
dashboards as examples.

Iiq. 7 BoJyHeJio JosbboorJ tbot comes witb tbe BoJyHeJio ormbonJ


Iiq. 8 }owbone 0p JosbboorJ on i0S Pbone
28

Iiq. 9 lork life JosbboorJ on tbe iPbone

Iiq. 10 Tbe Fotery opp uses crowJsourcinq for trockinq your fooJ onJ bow beoltby you eot

Iiq. 11 lift, boseJ on tiny bobits tbeory of Br. B} Ioqq, ollows you put in your bobits, follow tbem onJ moke
tbem routine.

As one can see the apps and devices come in different models with
different goals and approaches. They all follow the same
29
methodologies, which we already set out in 1.2.3 Taxonomy of Self-
tracking Process.
Self-monitoring is a process that is used in clinical environments to
keep track of heart conditions, sleep-tracking to confirm sleep
apnea, glucose monitors to check on the sugar level and many
other purposes. Obviously the devices we used in our research are
not at that high-level clinical tool. However, in the field of
preventive health care, where the main goals are to raise individual
awareness and create positive change, these devices can certainly
be useful. Make people aware about their lifestyle, wellbeing and
health in order to anticipate on it where necessary.

2.1. Goal Setting in Personal Informatics - A Deeper
Understanding
As we saw in the taxonomy of self-monitoring goal setting is an
important element of Personal Informatics. We briefly saw the
theory of goal setting and how the importance of specific and
proximal goal setting helps to reach or achieve one goals.
Maintaining goals linked with wellbeing in ones daily routine is
challenging and when these goals are linked to the personal
wearable devices one has more insight and self-knowledge to
maintain the goals that were set. Ferguson and Fishbach, 2007,
p3, define a goal as a cognitive representation of a desired
end-point that impacts evaluation, emotions and behavior.
Goals often vary in time and situation of the user, and influence the
achievement of that goal. Therefore it is also important to have the
ability to change goals along the way within these tracking
applications. Runkeeper is a good example on how we can setup the
goal setting within the application. One can set small, tiny goals
depending on what you want to achieve. After each action, one gets
an overview on ones progress accompanied with positive,
constructive feedback.
Su
In order to achieve a goal, there is a set of behavior changes, plans
and objectives that go with the desired end-point. For example in
order to achieve weight loss, one needs to learn about healthy food,
portion control and of what a structured healthy diet consists. This
knowledge helps to maintain the newly created habit, and in this
manner the new lifestyle that goes with it to achieve the goal.
In our chapter on behavior change, we go deeper into this subject
because setting goals is not enough the goals need to be desirable
in order to stimulate motivation.
Within this construction, it is important that the user thinks about
realistic goal setting, think in baby steps (Fogg
6
) For example, one
might want to walk at least 30 minutes a day. Instead of planning
this in one walk, one could do different walks of 5 or 10 minutes
during the day, which take less planning and the goal will be easier
to achieve.

In maintaining goals, it is interesting to reflect on the past, as well.
We can do this through these tools of Personal Informatics. Besides
active tracking, there is also passive tracking. This means
individuals leave a huge digital footprint behind by just using the
Internet, this gives the ability to create a more holistic view on
ones lifestyle. This digital footprint could be used to gather and
evaluate phases in ones life that reflect on ones life in general,
ones digital history.

2.2. Digital History - Mirrors of Life Experience
A personalized digital history is constructed in different ways. In this
construction of digital history, we see positive and negative effects.
We will start with the positive effects and then go into the negative
effects, as well.

6
http:tinyhabits.com
S1
Personal Informatics is one of the tools that allow tracking one or
more aspects of ones life. Each tool has its own technical
environment to keep track and evaluate ones progress. Individuals
who track themselves are leaving a real trail of data behind in the
digital space and building a digital history of their digital life. These
trails are also built through social networks, mobile apps, check-ins
and online via the web. This digital history could be used to give a
positive empowerment to the users and stimulate behavior changes
in different areas. Looking back and reflect on the past in order to
do better in the future and maybe re-framing ones life (Ramirez,
Hekler, 2012).
Basically, we see two forms of tracking. One is passive tracking,
and usually done by using cookies. They are used within websites to
keep track of the users activity online. For example, Google uses
this in their search engine for Adsense and also to provide
personalized search results. The second form is active tracking.
Here the user posts info about themselves, for example, in the news
feeds on Facebook, check-ins in Foursquare, Flickr photos and so
forth. All this data is saved in databases and available for evaluation
of oneself. The logical step would be software that aggregates an
overview of all this data in one place, your personal content, your
digital narrative story or diary to look back on certain periods or
phases in ones life. Examples of this are fluxstream.com, an open
source personalized data visualization framework, or Microsoft
Health Vault.
S2

Iiq. 12 Iluxstreom.com open source personol Joto visuolizotion fromework

These personal data visualizations provide the ability to browse to
your digital past in a quantitative and qualitative way. Re-live your
life in a certain way. (Sellen, Whittaker, 2010, p73-74), speak
about the Five Rs in doing this:

Recollecting Technology could help us mentally to re-live
specific moments, experiences (episodic
memories)

Reminiscing As a special case of recollection, re-live past
experiences for emotional or sentimental
reasons. Browsing photos or other social
experiences.
Retrieving This concerns retrieving documents, email
and web pages. This can help to see when
one wrote it, in what context.
Reflecting A more abstract way of looking back on the
history, viewing patterns on past
experiences, can be related to health, can
be related to emotional periods, looking at
information from different angles and
perspectives. It is about learning and self-
SS
identity.
Remembering
Intentions
Remembering prospective events in ones
life (prospective memory), as opposed to
things that happened in the past. Our
everyday activities require that we
constantly defer actions, and plan future
activities, for example, run errands, take
medication or show up for appointments!
Toble 1 Iive rs, {Sellen, Wbittoker, 2010, p7S-74)


Based on the different data information that is gathered by the user,
and the goal setting that a user can do, one could get more advice
or recommendations for living a healthier life. In addition, one can
detect success stories and periods that were less successful, or
periods where one is less dynamic or more dynamic. Happy and less
happy times. The user can detect contextual factors in his or her life.
Like seasonal effects that influence outdoors sports or exercise.
Peak periods at work could be roadblocks to eating healthy, and so
forth. These insights could help to optimize lives for the better.
Basically optimizing lives in a way it fits best for an individual.
Lift is a nice example of an application that lets you keep track of
ones habits. We will use my own Lift tracking example.
S4

Iiq. 1S 0verview of writinq S0 minutes 0ctober 2012 - }uly 201S {it is octuolly more tben S0 minutes, but to
illustrote).

December has a peak period. I was writing papers for AAAI
Conference and Chi 2013. January exams, February a short holiday,
March in San Francisco on a conference, April finishing my ideas on
the theoretical framework of this thesis, June exams, July started
again to fine tune and processing research results. The contextual
factors in this case are mainly time and availability to write and
priority.
Another example is Exercise

Iiq. 14 Fxercise bobit overview 0ctober 2012 - }uly 201S

SS
As my exercise - running and Tai Chi- is mainly an outdoor activity,
usually in the morning, it is sensitive to the weather, time and my
health conditions. In addition, I use Instagram to take a picture
after my Tai Chi session and Runkeepr to keep track of my activity.
I use the BodyMedia armband to provide a detailed overview on
steps. Moderate or vigorous activity and calorie burning.

Iiq. 1S Runkeeper overview }onuory - }uly 201S.

Iiq. 16 lnstoqrom compile from Toi Cbi Sessions.

These three tracking methods illustrate how these apps can be used.
They give an overview on my activity status, weather conditions,
and mental states, available time or health conditions. To optimize
my winter activity, I should think about indoor activities, only I
dont like to do that, so I most probably will not act on it, not
motivated! Everybody will use these in different ways, as to how
they fit for each person nd of course it is a bit of work to keep track
and put in the check-ins.
S6
In this example, there are some contextual factors at play in doing
my activity, weather, time and availability. We go more into depth
on this when we talk about the research results, as they are
important factors to consider. There are more contextual factors at
play in peoples lives, some we can try to control, but with other
factors it is not always possible. We discuss other side effects of
these devices and apps in the next chapter.

2.3. Different Effects in Personal Informatics
So far we have illustrated a positive view and possible positive
impact on individuals. But technology is never neutral and can have
different side effects, as well. For now, we will look at two different
levels and their impact. First we look at the macro level of the Big
Data that becomes available online, second, the micro level data
driven life data mining and behavior mining of users profile
building the digital divide.

2.3.1. The Big Data Idea
First we want to clarify what Big Data is. A collection of data sets
so large and complex that it becomes difficult to process using on-
hand database management tools or traditional data processing
applications, (Snijders, Matzat, Reips, 2012,p1). The challenges
include capture, curation, storage, search, sharing, analysis, and
visualization.
Our focus is on sharing and analysis of Big Data in Personal
Informatics.
As mainly companies today develop Personal Informatics tools,
usually startups, the gathered data is stored at their servers, and
they own the data. We see examples in collaborative platforms like
PatientsLikeMe, Cure Together. Data gathered by sensor devices
like myZeo, BodyMedia, Lark and many others. Social platforms like
Facebook, professional platforms like LinkedIn, and so forth. In the
S7
act of using the former mentioned apps, platforms and devices, the
data is gathered by the user and stored on the servers by the
providing companies, we find a dichotomy in this act. In one way,
sharing your health or wellbeing data on former mentioned
platforms is an opportunity to learn and stimulate each other, even
do competitions in specialised groups, for example, the best sleeper,
the best blood pressure, burn most calories, and so forth. This can
be seen in online communities that improve health or wellbeing
(Topol, 2012). On the flip side, these platforms are in the hands of
entrepreneurs and the companies who deliver these services. The
data might be exploited for other reasons that the user is not really
aware of.
An example is PatientsLikeMe, where people can share their medical
conditions, and how they cope. The business model is to exploit the
database, instead of using advertising (Goetz, 2010). Other
example: myZEO platform gives the ability to compare your own
data with all the others who are posting their sleep data,
categorized by gender and age. While writing this thesis, myZeo
went bankrupt, and the website is completely down. Users cannot
access their data anymore no warnings were sent out. What
happens with users data in cases like this?
Analyzing the gathered data could lead to a form of social sorting
(Lyon, 2003) of a population, when this happens in a non-
anonymous way like we saw in the Safeway example in the
introduction. The employees get a financial incentive when they
keep their weight in control. In this way, the privacy of individuals is
seriously threatened. It might lead to a dictatorial regulation in
healthcare, insurance and so forth. This threatens our privacy in
general and may be used in our advantage or disadvantage. If the
data of a given person shows that he or she has a sedentary
lifestyle and there is no positive progress in the data and the data
would also show that the person is not eating very healthily, he or
S8
she could be notified of not taking care of her or his healthy
lifestyle. And since the process is not showing any changes, there
might be a conclusion that there is no willingness to changing bad
habits, resulting in a higher health insurance rate or not getting any
health insurance at all.

2.3.2. A Data-driven Life or Living by
Numbers
Logging oneself is not really new, people do this all the time. They
keep a diary of their life they keep their expenses, track their
weight and so forth. The difference now is that we have sensors
that can do this for us. They are more mechanically accurate, not
biased, not emotionally involved - machines dont have empathy
and dont have memory problems. Human memory is poor (Wolf,
2011). At the same time, the unemotional character of these
machines/sensors can be very confronting and blunt, and may not
give the feedback that users expect. In using these devices or apps,
we also notice a human biased perception by the user. For example
within sleep tracking, the data shows good results, while the user
thinks he, or she didnt sleep well, in the mind of the user is a
different perception.
The dashboards, which summarize ones tracked activities, could
give negative results to the user. Creating a tunnel effect with the
user. Users often go not into detail of the dashboard information,
looking only at one aspect of it and are attracted by the visual
information, having a tunnel effect view (Sosik, Cosley, 2012). And
as mentioned before the feedback can create a kind of a nagging
effect, which results in an irritated user. It is important in the
design of the dashboard to consider positive and constructive
feedback to the user, so there is stimulation towards motivation
instead of negative experiences that lower the users self-esteem
and by consequence lowers their motivation.
S9

2.4. The Relationship Between Humans, Conscious and
Machines.

The idea that individuals identify with technology was something
that came up in the 60s. Electronic media came up in forms of
radio in the 20s, television in the 40s, telephone 1890s and so
forth. The idea that a radio is an extension of the ear, television an
extension of the eye and ear, and so forth. It was Marshall McLuhan
who pinpointed this notion of Technology as an extension of
human kind (McLuhan, 1964, p63, 173). With the technology
surrounding us in many ways, this quote is coming again in
literature and is becoming a popular thought or idea again.
Technology that enhances and augment our lives (Castells,
2004, p7), by means of organizing our lives, our activities. Within
this research gathering information by collecting data for one self
with software and micro-electronics, smartphones or smart devices.
Concepts we can apply to its fullest on this new wave of wearable
devices, mobile smartphones and all the possibilities that come with
Personal Informatics. They become an add on or extension of our
brain, hold detailed information of our behavior, body, our everyday
life in great detail, actually much more detail then that we can
grasp. Individuals are identifying themselves with machines and
technology, call it their external consciousness. Technologies
heal and hurt (Van Den Eede, 2012, p145), the data we gather
from apps and devices can be a positive or negative experience,
they might not mirror what we thought, they can trigger different
emotions.
Computers as a second skin or mental prothesis (Heim,
2004, p312). We have become one with the computers in this case
with the device.
4u
The identification with machines and technology goes further than
just holding information about individuals. They also are a way of
creating a status symbol of oneself. Todays devices create a sort of
affection status with the users it can become something they love,
and trust, and thus users have big expectations of their devices.
To work further on the idea of designing Personal Informatics tools
or devices, one needs to think about the idea that these tools and
devices start caring about their user. The user is central in
designing these apps and devices. As with the affectionate robots
used in nursing homes (Taggart, Turkle, Kidd, 2005), they will
become inevitable in certain individuals everyday life.

2.5. The Digital Divide
You might find the statement technology will become inevitable in
individuals everyday life kind of a bold statement, and it is.
Discussing these topics with peers, we tend to forget about the
digital divide. In order to use Personal Informatics tools, we depend
on Internet and broadband access. Relying on smart devices, smart
clothing and users who are digital literate. According to Digimeter
2011 (Flemish region), 7,1 % of the Flemish population has no
computer at home. Of households that own a computer 91,4% has
an Internet connection 89,8%. Smartphone users 40,4 %, not
detailed if they are owners or not. Of the smartphone owners,
23,8 % has a mobile data subscription. These statistics shows that
not everybody has a smartphone or Internet connections.
Personal Informatics is very high on the Maslow pyramid (Maslow,
1943) and at this time not really integrated in everybodys life. On
the contrary, one might get very different reactions and approaches
towards this topic; we will talk more about this in our research
results. The Maslow hierarchy of needs shows that people seek to
satisfy gradually higher human needs with physical needs like food
and shelter, going higher up towards security and safety, friendship
41
and family, self-esteem, confidence and achievement to morality,
creativity, problem solving, acceptance of facts. Personal
informatics is about self-improvement in a self-centered
environment for self-actualization.

Iiq. 17 Hoslow PyromiJ of neeJs, o tbeory of Eumon Hotivotion, 194S. (Maslow, 1954)

Personal Informatics is in an early stage of adoptation,
appropriation and self-actualization. As time goes on it will become
more and more important in different sectors, and in some it is
already more popular than others. (Swan, 2012)

3. Behavior Change and Self-monitoring
In our introduction, we illustrated the framework of Persuasive
Technology, where the definition is any device, application,
platform that allows interactivity and is designed to change peoples
attitudes or behavior (Fogg, 2003) We also looked at the taxonomy
of self-monitoring devices where we saw different steps in
evaluating the self-monitoring process. In the chapter of Personal
Informatics, we went more deeply into how these devices, apps and
platforms work and how the data is gathered and visualized for the
user. We looked at the positive and negative sides of Personal
Informatics.
In this chapter, we will go deeper into the behavior changes that
can be triggered by these self- monitoring devices. We will start
with self-monitoring and self-observation and what that means in
42
the Personal Informatics environment. We examine how we gain
self-knowledge, and what are we doing with it. This chapter ends
with behavior change and motivation and the different theoretical
behavior models we can use to facilitate behavior change within a
Personal Informatics environment.


3.1. Self-monitoring and Self-observation
Self-monitoring and self-observation in this thesis refers to gather
information for oneself and to be able to observe the gathered
information and our behavior while wearing wearable devices. In
our case, we use the BodyMedia armband. The self-monitoring and
observation is happening in a natural setting and not in a clinical
setting. One wears the devices when they want and where they
want. The aim for our research is just to see how these devices can
integrate with an individuals everyday life.
- Self-observation, observing ones behavior, and analysing
ones data gathered in the self-monitoring. (Stephen M.
Johnson, Geoffry White, 1971) In the study of Self-
observation as an agent of behavioral change, the belief is
that self-monitoring leads to prediction and self-observation
could have an impact on behavior change. The study also
suggests that self-observation procedures may often be
reactive and that this reactivity might be considered as an
agent of behavioral change. (Stephen M. Johnson, Geoffry
White, 1971)
People can observe different aspects of their lives. The Principles of
Psychology, (James, 1890
7
) talks about The Constituents of The Self.
The material self, the social self and the spiritual self.

7
http:psychclassics.yoiku.ca}amesPiinciplespiin1u.htm
4S
- The material self, my or mine, our body, seems to be the
innermost part of the self. This includes our children, our
family, our clothes, tangible objects that we call mine or my.
- The social self, our environment, and the recognition we get
from our friends, how other people see us, we like to get
noticed in some way.
- The spiritual self, our most inner or subjective being.
According to Ian Li (2011, p10), in Personal Informatics
The material self: tools that let you track where you are
(Foursquare), keep track of your books (Shelfari), photos
(Flickr), BodyMedia armband, tracks your body, etc
The social self, tools that track how you relate to others
(Klout), how your professional network is (LinkedIn Maps),
representation of yourself (Facebook, Foursquare)
The spiritual self, the online diaries, blogs, journals that are
online, mood apps and happiness apps, where people talk
about their emotions and feelings, publicly or privately.
Other aspects of the self are its behavior, how we act, what our
attitudes are, in relation to our environments, and other people
that surround us (Skinner, 1938).
- Self-monitoring, a procedure in a (mostly) natural setting
where someone monitors or records a certain behavior and its
occurrences, with the goal to know more about ones self
(Korotitsch & Nelson, 1999, p 415).
Within the self-monitoring, Korotitsch & Nelson see two
components. First, one must discriminate or notice an
occurrence of the target behavior. This may be an action,
thought or feeling. Second - the client must produce a record
of the occurrences as well as any additional information (e.g.
intensity ratings, or antecedent stimuli), (Korotitsch & Nelson,
1999, p 415).
44
In Personal Informatics, self-monitoring is done by either wearable
sensor devices or mobile apps. These devices are still in early stage
and are not 100 % accurate. As we have seen in previous chapters,
we note mechanically accurateness and human perception
accurateness, where the latter might be biased.
Issues with self-monitoring, when one makes notes about a certain
behavior and its occurrences, in a clinical environment or natural
setting, there is always a problem in accuracy, especially in a
private setting. Besides the monitoring, there are always situational
factors that might influence the data or make it vary.
With the self-monitoring procedure, accuracy is estimated with
three types of criteria:
- First, comparison to data obtained by independent direct
observers
- Second, comparison of self-monitored data to mechanical
devices
- Third, comparison to behavioral by products, self-monitored
calorie intake might be evaluated relative to weight changes
(Mahoney, Moura, & Wade, 1973)
One needs to wear these devices on a regular basis to get an
accurate view and discover patterns. Then, one needs to learn how
to interpret the data. In order to stay motivated and to learn these
different aspects, personal coaches or therapists might be an
additional help to trigger the behavior change and maintain the
changes.
In the idea of self-monitoring and self-observation comes self-
knowledge. The whole idea of self-monitoring is to create self-
knowledge and self-insight.

3.2. Self-knowledge and Self - insight
Self-knowledge refers to knowledge of ones particular mental
states, including ones beliefs, desires and sensations. It also
4S
sometimes used to refer to knowledge about persisting self-identity
conditions, or character traits (Brie, Gertler, 2011)
Gaining self-knowledge is one of the goals of Personal Informatics,
but it is not so easy and often a failure. There are several reasons
why that can be noted why this is happening. One of them is
personal motives and the ways are mind is working. One of the
main reasons might be because people tend to be motivated to
keep negative experiences outside their consciousness, because
they generate unpleasant feelings or provoke anxiety. (Wilson &
Dunn, 2004) Self-knowledge is said to be quite limited,
though repression is usually so successful that people do not
know that it is limited. (Wilson & Dunn, 2004, p17.3). People
repress negative experiences because it is so easy to do that they
are not aware of the repression unless removing the repressive
forces provokes it.
Other research shows that memories are positively biased. People
tend to remember positive events and negative events tend to fade
away. This bias has two causes one lies in peoples perception, and
the second one is the effect of fading away in the case of negative
events. (Walker, Skowronski, 2003). Fading away effect has two
causes, mobilization and minimization (Taylor, 1991). When a
person has a negative experience, these two mechanisms are
activated. The first mechanism is the mobilization of resources.
When a negative event happens, people mobilize their biological,
psychological, and social resources to cope with the immediate
consequences of the event. The second mechanism is minimization.
People activate opponent processes with the goal of
minimizing the impact of the event. It occurs biologically,
cognitively, and socially (Walker, Skowronski, 2003, p 206).
Ways of increasing self-knowledge include introspection, learning
about one selfs mental states or recent past events. We saw in The
Digital History that gathering all the digital content that is out there
46
about one self could help in reliving certain episodes of our lives and
help to reflect on it. Another way to gain self-knowledge is looking
at one self through the eyes of others and observing our own
behavior. In a way, we look through the devices to ourselves and
see how we behave in certain areas.
Personal Informatics aims to present an accurate view towards the
user. The sensors gather raw data, and there are no emotions
involved as we saw in the side effects of Personal Informatics. This
data can trigger either positive or negative confrontations. Either
way this has an impact on the usage of these devices or apps that
aim to stimulate behavior change. We will discuss this in our
research results. It is worthwhile to think about the self-perception
and reality; it might not always be in our advantage, but can create
awareness and self-consciousness that results in a behavior change.

3.3. Behavior Change and Motivation
As seen in the previous chapters on self-knowledge and self-
observation, people might be triggered towards behavior change.
They might get motivated to do something on their current situation
if it seems necessary. People might use Personal Informatics for
different reasons. Since this is an early stage phenomenon, they
might do it because it is cool and hip to do, meanwhile learning
about facts and figures of themselves on how they behave. There
might also be a category who has medical conditions, who want to
track themselves and keep log files when certain episodes occur.
For example, by using a blood pressure measuring device that
keeps track of your blood pressure. Can detect the peaks of a rise
of blood pressure and what might have caused it. It might also be
on the demand of specialist to keep track of your weight in case of
thyroid gland problems for example. The users goal is to know
about themselves and specifically about certain behaviors. By
getting the self-knowledge, self-insights (Hixon & Swann, 1993) and
47
awareness that is provided by the wearable devices, people might
be encouraged to change behavior to feel better or change certain
aspects in their lives.
However, behavior changes are not always easy to do, because
people are creatures of habits, BJ Fogg
8
. They have to be
motivated to do so.

3.4. Intrinsic and Extrinsic Motivation
Lets take a look at different aspects of motivation. We can distinct
two different sorts of motivation. First, intrinsic motivation occurs
when someone is moved or inspired to do something, it is internal
motivation. When doing a certain task, one feels good about it;
there are no external factors at play like rewards. Extrinsic
motivation, external motivation differs in this. The motivation is
usually connected to some kind of reward, money or getting a good
grade. One is doing a certain task because he or she gets paid for it,
or one will study hard to get a good grade. (Ryan & Deci, 2000).
The level of motivation, high or low motivation can have different
amounts or kinds of motivation. For example in behavior change,
we see three core motivators, sensation, anticipation and social
cohesion; we go more into depth when we explain the Behavior
Model of Fogg.
Intrinsic motivation is also referred to as acting because of the
enjoyment, fun and curiosity factor in doing something, it is
spontaneous behavior, while extrinsic motivation might need extra
stimulation, a reward to achieve something (Ryan & Deci, 2000).

8
http:tinyhabits.com
48

Iiq. 18. lntrinsic onJ extrinsic motivotion {Ryon&Beci 2000).

In Personal Informatics, we look at three aspects of extrinsic
motivation.
First, identification, because the user of wearable devices is
identifying with the personal importance of behavior. Accepting
regulation in the form of feedback and reporting he or she gets from
the dashboard data to change a certain behavior based on ones
own goals set in the dashboard.
Second, integration, integration lies closely to intrinsic motivation,
but differs because of integrated regulation is separate from the
behavior and its instrumental value, even though there is a will and
valued by the self. Integration occurs when identified regulations
have been fully assimilated to the self. through self-examination
and bringing new regulations into congruence with ones values and
needs (Ryan, Deci, 2000, p 62).
Third, introjection describes a type of internal regulations where
people perform actions under the form of pressure in order to avoid
guilt or anxiety or to attain pride and ego-enhancement (Ryan
&Deci, 2000, p 62). In the era of social platforms, and sharing the
data we gather, this might be an extra stimulation to come to a
behavior change. As a form of peer pressure.
49
If intrinsic motivation plus these three elements in extrinsic
motivation can be triggered by the wearable devices weve talked
about in previous chapters, one can almost be certain that a change
of behavior might occur, because of a self identification with the
devices. We will look at this assumption closer in our research
results, where we can map this theory together with Foggs
Behavior Model.

3.5. Foggs Behavior Model
1. There needs to be Motivation
2. There needs to be an Ability to act
3. There needs to be a Trigger

Iiq. 19 B} Ioqq Bebovior HoJel, bttp:,,www.beboviormoJel.orq, 2007.

In addition to these three elements that need to come together at
the same time, there are subcomponents that make a behavior
change more accessible than others.
1. Ability
Simplicity depending on the audience and context
there might be trade offs.
Su
i. Money
ii. Time
iii. Physical effort
iv. Brain cycles (require lots of thinking)
v. Social deviance (out of comfort, not the usual)
vi. None routine
2. Motivation, 3 core motivators
a. Sensation Pleasure and pain
b. Social cohesion Social acceptance and social rejection
c. Anticipation Hope and fear

In addition to BJ Fogg behavior model, we also need to look at
different methods on how we can map certain behavior types,
match target behaviors and look for solutions to achieve in behavior
change. Mapping behavior types and behavior targets help us look
at patterns in behavior change and come to solutions. We will look
at behavior change through different models, but in our research we
chose for the Behavior Grid Model, which maps 15 different
behavior types.

3.6. Foggs Behavior Grid
The Behavior Grid is based on the work of Fogg
9
and is an outcome-
based method to for classifying research and design in Persuasive
Technology. The Behavior Grid is based on different types of
behavior and consists of 15 certain behavior types. In the grid, the
rows refer to a different behavior duration: dot behavior is behavior
change that happens only once, for example, stop smoking; second
a span behavior, occurs for a certain time span, for example,
Ramadan in Islamic community; third, path behavior is where the
behavior change becomes a routine and is basically a behavior
change for life, for example, becoming a vegetarian. The columns in

9
http:behavioigiiu.oig
S1
the grid refer to behavior familiarity or change. The first two
columns (Green) deal with new behavior, familiar behavior is a
(Blue) behavior, the last 3 columns are about familiar behavior, but
deal with change. (Purple) Behavior is dealing with increasing a
behavior, (Gray) is dealing with decreasing a behavior, while
(Black) is dealing with stopping a certain behavior. We will look
further on in this classification of behavior types and explain each
one of them since it is the basis of our research, but first it is
needed to look at previous theories of classifying behavior changes.
There have been several methods in classifying behaviors, but we
can distinguish two main traditions, Banduras Efficacy Theory
(previously Social Cognitive Theory).
Banduras Self-efficacy, peoples beliefs about their
capabilities to produce effects (Bandura,1994, p 2).
Self-efficacy, is the belief of people to have influence on events or
episodes in their lives by performing certain actions. When people
have high self-confidence, they will experience difficult episodes as
challenges rather than problems to avoid. People with a high self-
efficacy have the feeling they are more in control of things.
The second tradition is the one of Transtheoretical Model (TTM, also
called the Stages of Change Model), Prochaka and DiClemente.

Iiq. 20 Tronstbeoreticol HoJel, Procbosko onJ Biclemente, 1997; tbe lost sequences ore porollel witb Ioqqs
Bebovior HoJel.
S2

3.6.1. The Transtheoretical Model
The Transtheoretical Model sees change as a process over several
stages involving progress, through a series of 6 stages.
First Precontemplation, in this stage the individual is not yet
thinking about change or does not have the intent to change.
People in this stage are not aware a certain behavior, and they are
not motivated. Second Contemplating, people in this stage have the
intention to change a certain behavior, and most probably will do so
within 6 months. They are more aware of a certain behavior, but
also see pro and contra, which might lead to a long time of taking
no action. Third Preparation, here people are thinking about taking
action to change a certain behavior, they have a plan, and most
probably been thinking about it a long time. Fourth Action, in this
stage, individuals have action, and there might be the first results
to measure change of behavior. Fifth Maintenance, this stage is
about maintaining the behavior change and avoid relapse. In other
words creating a routine. Sixth Termination, in this stage people,
are or will not have a relapse and have 0 temptation and have
100% self-efficasy (Prochaska, Velicier, 1997).
This model was also criticized (Adams and White, 2004), and we will
look at one aspect of it, which we can apply to our own research.
For example, someone wants to have more physical activity.
Physical activity is not a single behavior change, but a complex of
different specific actions such as a sport activity, leisure activity,
riding bike from home to work and back. All these things are
physical activity so behavior change will fall into different categories
and different stages as well (Adams and White, 2004).
The difference between Foggs Model and the Transtheorectical
Model is mainly that, within Foggs model, the user is already
motivated to start a behavior change. There are no progress steps.
Foggs behavior model is based on three elements that need to
SS
come together at the same time! Motivation, ability and trigger (call
to action). The higher the ability, the higher the motivation will be.
As explained in the Behavior Model 3.5.
Now that we covered the different theories and have a deeper
understanding of classifying behavior change, we can go into detail
with the Behavior Grid.

3.6.2. The Behavior Grid in Detail

Iiq. 21 Bebovior 6riJ, Ioqq 2010.
In Personal Informatics, it is necessary when we design for people,
to think clearly what we want to achieve with the app or device we
are offering to the user. The Behavior Grid is a tool that makes you
think about these different aspects.
Let us take a closer look at each behavior type and implement them
in a hypothetic use case (the reference of this material is not online
nor in papers, but the documentation and beta versions of these are
available on demand. Or via mail (bjfogg@stanford.edu).

3.6.2.1. A Green Behavior
A Green Dot Behavior:
We want someone to create a new behavior one time. Within health,
this could be for the women, breast cancer examination. With the
men at a certain age, it could be a prostate examination.
S4
In order to achieve or to work towards this new behavior we need
to think about the Behavior Model, as well.
- We need to increase the number of triggers leading to the
new behavior (think about the breast cancer campaigns that
are organized on a regular basis. The personalized mailings
women get at the age of 50.
- Usually the ability is low with a new behavior. We need to
enhance the ability, make it easier to do. In the case of breast
cancer, combine this with the yearly visit to the gynecologist.
- Bring the motivation to a higher point by decreasing the fear.
Remember when we wrote about the core motivators in the
Behavior Model, fear is one of them. The fear to have breast
cancer might lead to ignorance, even though one knows
better. Having a yearly breast cancer check up after a certain
age is a smart thing to do.
According to Fogg within a Green Dot behavior we have two primary
problems: low ability and fear. The opposite motivator in fear is
hope. If a new behavior creates excitement and hope in the
foreseeing future the new behavior might be easier to achieve.
Keep this in mind because we will encounter this phenomenon again
later in the research results.

A Green Span Behavior:
A Green Span Behavior in health. Pieter wants to start a diet. Doing
a diet is a complex change. But it is usually done for a certain time
until one achieves his or her weight loss or weight gain. The idea of
a diet is also to make a structural change in ones eating habits. It
is therefor very close to a path behavior, as well. In a sense that
the knowledge one gains during the diet one tries to maintain this
new behavior to not have a relapse and gain x kilos or lose x kilos
in the near future.
The Behavior Design Process would split in two phases:
SS
- Phase 1, designing for commitment, the conversion
- Phase 2, designing for maintaining, the continuation
Lets take the wearable devices as an example. We want people to
wear these devices (new behavior = Green), to discover their
behavior patterns and to act on it when necessary.
Phase 1: designing for commitment (conversion)
- Increasing triggers to wear the devices. This can be done by
awareness campaigns, advertising. Triggers will do a call to
buy the devices or to use apps. Some are free and will create
a faster commitment (simplicity factor of Money).
- Increasing the ability to wear the devices, the new behavior.
Making them simple to use, invisible, hidden and discrete, not
stigmatizing.
- Increasing the motivation for wearing the devices. By
decreasing fear, although they also trigger hope and pleasure.
In the case of the device also social acceptance plays a role.
Phase 2: designing for maintenance (continued practice)
In phase 2, the triggers are the most important element. To think
about triggers, we will introduce two new behavior types: Cycles
and Cues.
Think about cycles in terms of behavior that returns on a regular
basis. For example, brushing teeth, eating breakfast, lunch, dinner
and so on. Cycle behavior can also happen once a week or once
month and once a year, for example, practicing Tai Chi three times
a week.
Cues will happen in response to something. Something is broken
we will fix it. The doorbell rings, we open the door and so forth.
These cues happen and are usually unpredictable.
Cycles and Cues can become associated over time. For example
while practicing Tai Chi one listens to Asian meditation music, so
these two will become associated. If one is hearing meditation
music, the Tai Chi will automatically come in ones mind too and
S6
might create a Zen state of being, this is an implicit cue. An
explicit cue could be an text alert to tell you havent been moving
for more then an hour, in case of our wearable devices. The user
might act on this cue.
Green Span Maintenance:
In order to design triggers in Green Span maintenance, we need to
know whether the behavior is a cycle or cue behavior, regular or
irregular behavior. For example, with the wearable devices, the
more you wear them, the better the device gets to know you, they
learn about the behavior what are cycle behaviors or irregular
behaviors. Depending on your behavior you will get cues
associated with your cyclical behavior, that is recorded while
gathering the data. Some apps will send a text message in the form
of Hey, it is 9.00 oclock, you usually have run at 9.00 AM, how
about start doing a run now?
Tracking your food is cycle cue behavior that is associated over
time. You eat on a regular basis. You start logging your food,
because you want to know your calorie intake. By using the app, it
will get to know your eating times because you have been logging
your food on a regular basis. When you forget to log your food, the
app will notice this and will send a text message saying: you
usually are eating at this time, dont forget to log your food. These
triggers we call hot triggers, they happen during or send out
during the activity and in the right window. This is optimal
Persuasive Technology.

Irregular cues and maintenance:
Irregular cues are unpredictable cues, and causes action when they
happen, as we seen in previous examples. Within the sefl-tracking
environment, we are always confronted with new behavior, using
the apps and devices are in itself a new behavior. To maintain the
usage of these apps is challenging. We can put triggers or alerts for
S7
using the app. GPS4Soul is an app like that. One can set the time to
receive an alert; it will then warn the user when is the time to
measure ones stress level. The alert is the cue - trigger to measure
ones stress level. They will create the association to measure your
stress level.


Iiq. 22 Screensbot of olerts useJ in mobile opps.

A Green Path Behavior
A Green Path Behavior in health, lets say that Christel wants to
practice Tai Chi three times a week. For Christel it is new behavior,
she needs to learn Tai Chi, it is a new behavior (Green). Christel is
going to do this on a regular basis in the foreseeable future it will
also be Green Path Behavior.
In the Green Path Behavior, we also need to increase the triggers
and the ability factor. In the case of Tai chi, fear might be a big
uPS4Soul, aleit to measuie
my stiess level at noon.


Runkeepei uses uPS anu can
uetect weathei conuitions.
When it is bau weathei, it
stimulates to exeicise
inuoois.
S8
word, although the complexity of the movements might result in
dropping out. The ability factor here is in the direction of physical
effort and brain cycle. Here is why. The Tai Chi is a series of
movement that will bring one in a kind of flow. There are a lot of
advantages in learning Tai Chi, and one needs to keep this in mind
while learning this. One needs to memorize (brain cycle) the
movements and one need to learn balance, coordination of arms,
legs and hands (physical effort).
Other example, wearing a tracking device one just bought.
Depending on ones situation, this will create fear in confirming
ones behavior or not. Hope to measure something and to change
something for the better. Pleasure, doing something cool with new
technology. It might be exciting to see how much one moves during
the day and when this all happens. Unexpected events might occur.
We will discuss the latter extensively in our research results.
Path behaviors have the aim to create routines, rituals even. A
behavior we do almost automatically is included in path behavior.
Examples, you always buy your music at the Itunes store or your
books at the Amazon store.
In the design process, we need to think the same as in the Green
Span Behavior.
The conversion is a Dot Green Behavior, it is new and done once.
The dot behavior will go into a span or path behavior it will go to a
lifestyle change.

3.6.2.2. A Blue Behavior
A Blue Dot Behavior is about performing a familiar behavior once.
In health eat an apple after lunch.
A Blue Behavior is something we need to think about carefully. One
behavior can be familiar to someone but at the same time, not for
someone else. Someone might be used to buy products online
S9
someone else might not have that familiar behavior. In a Blue
Behavior, there can be a mix of behavior types.
A Blue Behavior usually targets group or person who are familiar,
with a certain behavior.
The ability in Blue Behavior will usually be higher than with a Green
Behavior.
Some Blue Dot behaviors are having a big impact or commitment,
others will have this less.
Buy a car is familiar behavior but costs a lot of money. While other
things might be free or low cost.
In a Blue behavior, the triggers are important. One already knows
the behavior, one just need that extra push to do it. Example, Piet,
wants to go for a run in the afternoon during the weekend. Piet
thought about it, but he never comes to it. Just one message could
give that extra push to go for a run. Via SMS or an app or putting it
in his calendar that sends an alert when the time is there.
If the triggers dont work, one might look at the ability factors, or
simplicity factors.
In our example of running, we might look at the time factor, does it
take a lot of time, do we need to prepare for a run. Piet might think
about putting the running gear ready in the morning, so he just
needs to put on running shoes and go.
Running is free; money will not be a factor. Is running socially
accepted? In some cultures not, in others it is more accepted.
Running could be a physical effort if one does it in the evening, one
might be tired. None- routine, one needs to plan a good moment
during the day, if it is disrupting another routine it is unlikely to
happen. Is it difficult to find a good running path? Find a good
environment to do the run might be a brain cycle.
In the Blue Span and Path Behavior, we need to think about the
previously explained examples and theory in the Green Behavior.
Looking at the triggers, ability factors and motivation.
6u

We covered Green and Blue Behavior types, which are targetted to
perform a new behavior or perform familiar behavior. We will now
tap into the behavior types that focus on change. Increasing
decreasing or stopping an exiting behavior.

3.6.2.3. A Purple Behavior
A Purple behavior is increasing a familiar behavior. A behavior we
already do like running or sleeping. The Purple Behavior is about
increasing that certain behavior. For example sleep. According to
studies, people sleep less or have not a good quality of sleep. A
Purple Behavior might help to think about increasing sleep hours.
In the case of running, one might make the run more intense, and
looking for different challenges in the run, more hills or a longer run.
A Purple Behavior can be increased in several ways:
- Increasing for a longer time (running 45 minutes instead of
30 minutes)
- Intensity (running more hills)
- More expertise or precision (learn about sleep)
In a Purple Behavior, we want to work on the triggers and the
abilities. Usually the motivation is already there, but we need more
ability to increase a certain behavior.
As mentioned before there are 6 ability factors or simplicity factors,
we can work on. Lets take an example. If someone is already
tracking themselves for a while and seems to be a regular user, the
company might try to sell other services to that customer. Maybe
that person is ready for more sophisticated data and will buy a
premium service to learn more about him or herself. Runkeeper
offers several services and offers these within their application. By
offering them within the application, they are ready available, easy
accessible and one click away. To the user they will offer more
detail, increasing knowledge about their physical activity.
61
We covered the routines of Span and Path behavior; in the Green
Behavior, they also apply to the Purple Span and Path Behavior.
Creating Commitment and continuation of the familiar behavior.

3.6.2.4. A Gray Behavior
The Gray Behavior is about reducing a certain behavior. Here we
will reduce triggers and reduce the ability to do a certain behavior.
The opposite of what we do with the Purple Behavior. Some
examples of Gray Behavior: drinking less coffee, eat less junk food,
spent less time on Facebook and so forth.
The Gray Dot behavior is reducing a certain behavior one time.
They often induce a Span Behavior or Path Behavior over time. For
example, we want to stop smoking. It might be easy to not smoke
for one day. Then after one day of stop smoking, one try to stop for
a week and so forth. To eventually quit smoking completely.
Smoking is a very good example to use in this Gray Path Behavior.
Governments agreed on a campaign to make smoking forbidden
within public areas, bars and restaurants. This reduced the smoking
in these places, and were actions for some to quit smoking, creating
the awareness that smoking is not good for you. In addition, there
are the photos on the cigarettes that were really shocking.
Cigarettes became much more expensive and so forth. The
simplicity factors we spoke of before are applied in this case too.
Money, increasing the price of the cigarettes. Social acceptance,
making smoking not allowed in public spaces makes use of peer
pressure. If you lit a cigarette in bar now, people will look at you,
and not always with friendly eyes.
Within a Gray Behavior we want to
- Reduce the triggers
- Reduce the ability to do something
- Reduce the motivation
62
We want the three elements that need to come together within The
Fogg Behavior Model not to happen at the same time, so most likely
they wont happen. There are fewer triggers, less ability and less
motivation.
With a Gray behavior, we can come in a Purple behavior, as well.
For example, one wants to reduce cola drinking and instead will
drink more water. The Gray Dot behavior, less cola drinking. The
Purple Dot Behavior drink more water.

3.6.2.5. A Black Behavior
A Black Behavior is about stopping a certain behavior. A Gray
Behavior will often induce a Black Behavior. As seen in our example
when one smokes less or does not have the ability to smoke in a lot
of places will reduce the behavior and one might feel better about
his or her health that eventually one stops smoking. They same
theory applies here for stopping a certain behavior. We decrease
the trigger or stop the triggering. We decrease the ability or create
no ability those two elements will motivate less to do a certain
behavior.

3.6.2.6. How Behavior Types Relate to Each Other
Behavior types relate to each other in the Fogg Behavior Grid.
Purple Behavior is related to the Blue Behavior, it is already a
familiar behavior. The Blue Behavior is the heart of the Purple
Behavior. For example, if one has a Blue Behavior like swimming
once a week, and one will do it twice a week, at some point on, this
would be Purple Behavior, increasing ones swimming activity.
Purple fades to Blue, if one does an increasing behavior, like the
Purple Behavior mentioned above, going for a swim twice a week
instead of once a week, it will become the norm and will become a
Blue Path behavior.The increasing part stops, and the swimming
twice a week will be the norm.
6S
The Gray Behavior will relate to a Purple Behavior, and also to Black
Behavior. The Gray Behavior might induce a Purple Behavior as
shown in the cola example. The Gray Behavior can also induce a
Black Behavior, as shown in our smoking example.

We covered the complete theory of Foggs Behavior Grid which
helps us to think more clearly about the design process of behavior
change. We would like to close this with a scenario of a personae
example who wants to change certain aspects in his lifestyle.

Think about the following scenario: Paul is living and working in
Ghent, he has a car and a bike, and since his work is always in the
office he decides that he wants to be outside more and meanwhile
increase his physical activity. When he reaches one goal he can
adjust his goal again, or add another goal. Paul chose to take walks
during his lunch hour. He is going to increase his physical activity
and hopes it will become routine and maintain his new habit.
Increasing a certain familiar behavior for a certain period is a
Purple Span behavior, but it also a new habit Green Dot Behavior,
and since Paul would like it to be routine and maintain his new habit
he will follow this path to become a Blue Path Behavior, it will
become a norm in his lifestyle. In other words, progressing from a
Purple Span to Blue Path behavior.
If we would like to design the new Fitibit, it might be interesting to
map our target audience to this grid. As the Fitibit is aiming at
increasing physical activity, and maybe creating new habits as well
in achieving the goal, we might look at a green span and a purple
span behavior with an ideal outcome of a blue path and a purple
path behavior. This means green, a new habit creation, for
examples Pauls walks between lunchtime. This increases his
physical activity going into a purple span behavior, as well. And Paul
64
feels so good with his life changes that this new behavior becomes
routine, and Paul is now in the blue path behavior.
To conclude this chapter we have taken a closer look at different
behavior models. Foggs Behavior Model where three elements need
to come together at the same time. The Transtheoretical Behavior
Model a model that uses 6 stages of progress. The Behavior Grid,
which is based on different methods to map behavior to three types
of behavior, dot, span and path behavior mapped towards
increasing/decreasing existing behavior, creating new behavior,
stop existing behavior or reinitiate a familiar behavior.
To come to the idea of preventive health care through Personal
Informatics or Quantified Self and Persuasive Technology, these
theories are important to look at in detail. As these concepts are
developed and designed towards motivating people and trigger
behavior and attitude changes. In the next chapter, we will see that
other aspects come into play when transferring the Quantified Self
movement to a Preventive Healthcare domain. We will touch on
infrastructure, concepts of preventive heath care and different views
in realizing preventive health care.

4. From Quantified Self to Preventive Healthcare
In this thesis, we have discussed several elements of the Quantified
Self. We have tried to create a theoretical framework to show that
the Quantified Self could have a meaning in a preventive healthcare
environment by means of making people aware of certain behaviors
in their lifestyle or wellbeing and the ability to act on that
awareness when it is necessary. The move to digital health, self-
monitoring, the big data idea and crowdsourced health platforms,
might give new perspectives towards health treatment. Being more
a preventive vision than a cure vision. It could change the
relationship between the medical specialists and doctors, creating a
collaborative relationship rather than a hierarchical relationship.
6S
People can get very knowledgeable about their life patterns,
attitudes and behavior towards their physical condition and lifestyle
in general. (Swan, 2012)
The health care sector so far has not really embraced all the
potential of the digital era. It is late in coming since health care is a
conservative industry. According to Eric Topol (2012) Medicine is
about to go through its biggest shakeup in history.
This chapter has the aim of looking at the state of preventive
healthcare today and possible future visions. We examine different
examples of digital health solutions, shifts that are happening in the
industry, and the related privacy and liability issues in this new area.

4.1. Preventive health care preventive medicine
Preventive health care and preventive medicine are fairly new
concepts and not yet fully articulated in public dialogue. The
biggest shift in Preventive Medicine Health care is in the
concept that the patient is not just a patients treatment in a
personalized manner, but the patient, really is a participant,
or simply a person, becomes the nexus of action-taking and
empowerment (Swan, 2012, p95).
Through quantified self tools, that we discussed before in this thesis,
individuals are now able to get insight on life patterns, baselines
measures, and changes or variances at certain moments and how to
handle or go about this. Lets look into an expanded concept of
health and health care by Swan.


66











Iiq. 2S Eeoltb 20S0: An exponJeJ concept of beoltb onJ beoltb core {Swon, ,2012, p9S).

In the left column, Swan categorizes possible health outcomes and
objectives that we can map to the BodyMedia device we use in our
research.
The more we go upwards in the column, the more participation we
see from the individual, like self-expression, enhancement,
prevention, baseline, variability and improvement. Self-monitoring
tools today play already a role in optimizing physical aspects of
individuals life towards prevention and wellbeing. In addition and
as mentioned before, individuals also can use their Internet
behavior to map the past and learn about their patterns, as well.
In the bottom row, we find the different Personal Health Informatics,
which gives more detail on individual digitized genome, details on
DNA structures and microbiome. The data health streams are
important on an isolation level, but also in broader group setting, to
look at patterns and recurrent events or episodes in individuals lives.
In the middle of the graph, we have the individual where he or she
has different possibilities to learn about him or herself and
participate in their own health and wellbeing.
67
1. In the first tier, the numerous smart sensor devices that are
widely used in the US are represented. Being always-on
gives constant information about health and physical status.
The apps and devices also give baseline and variances
information to work with and improve on where necessary. In
the US it becomes a mainstream behavior to track oneself.
2. In the second tier we see peer collaborators and health
advisors. This is the extension of the first tier in the middle
graph. Movements like quantified self, or interest groups arise
around these apps and devices where individuals talk about
their experiences and actions they take. New services will
arise in the form of personal advisors; coaching, preventive
care practitioners and so forth.
3. Finally, public health professionals are the third tier in the
graph. This extends when resources of prevention, wellbeing
have been exhausted, and deeper expertise is needed.
In prevention, the most essential element is the self-action taking,
and the always-on monitoring apps and devices that give insights
on peoples lives. The most successful initiatives for engaging
individuals in the health context so far have been the ones
who give personalized recommendations and secondary
social interactions, gamification, attractive data visualization
of contributed information and other modern techniques to
make using technologies fun and simultaneously achieving
behavior goals (Swan, 2012, p 98).

4.2. Different Ideas in Realizing Preventive Health Care
Within the preventive health care domain, we can distinguish
different ideas that already start playing a role in the digital health
environment. We will look at three of them. The Quantified Self,
Social Health Networks and The Big Health Data. We close with
some thoughts on privacy and ownership of the data.
68
4.2.1. The Quantified Self
The Quantified Self tools that are on the market today give people
the ability to measure themselves in different ways. Weve
discussed these tools extensively in previous pages. These tools
give rise to user groups or meetups, where individuals discuss these
tools and how they go about using all the data that is gathered.
Within these groups, we can define different audiences, early
adopters, technical people and individuals who are interested in
their lifestyle and wellbeing. This movement will become bigger,
professional and mature, and might grow towards a recognized
preventive healthcare domain.

4.2.2. Social Health Networks
Social Networks have been popular for a while now, in addition we
see the rise of focused social networks. In health, we see social
networks like Patients Like Me, Cure Together. These two social
networks have the aim to gather information on different diseases.
MyDietation, and Asthmapolis now Propeller Health, have the aim
to focus on specific chronic disease. MyDietation is focused on
creating a professional relation between the user and professional
dietitians. Offering several services online. The user tracks his or
her diet, with a mobile app. The user synchronizes the data and is
followed by a professional dietitian, who can give recommendations
or feedback on the reported diet.
Propeller Health is one of the leading Mobile platforms for
respiratory health management. Propeller Health uses a small blue
tooth device that connects the inhaler to a mobile app, and gives
detailed information about the location where an asthma patient is
using the inhaler and how often. It creates not only a personal diary
for the user, but at the same time maps locations that are not ideal
for the asthma patient. The doctor gets a detailed overview on the
patients behavior and where the asthma symptoms are apparent or
69
not under control. These social health networks give the ability to
people to share their information, experiences and struggles they
have with peers. Swan sees four layers in social health network
systems where different information can be found.

Iiq. 24 Services proviJeJ by sociol beoltb networks {Swon, 2009, p49S).

One of the most popular networks and weve referred to it
numerous times, is Patients Like Me, started in 2004. In December
2008, had 26,059 patients. Since 2008 membership has grown by
10% per month, with the goal of having one million patients,
covering 200 diseases by 2012.

4.2.3. Big Health Data
The quantified self and social health networks gather a lot of data.
This so called big data provides the ability to learn about patterns
of an individuals lifestyle. Big data offers the possibility of
predicting certain aspects of a persons lifestyle.
In conclusion, we can look at the model proposed by The Institute
of the Future to come to a model that is relevant for different
aspects of the health care infrastructure. This is where software
services, sensors, wearable devices; medical equipment and
communications come together in one centered infrastructure.
7u

Iiq. 2S Iromework for puttinq user ot tbe center of combinotoriol innovotion in tbe beoltb informotion
tecbnoloqy infrostructure {lITI Eeoltbcore 2020, pS).

The diagram gives a framework where the user is the center of
different combinations in the health information technology
infrastructure. The yellow center represents the ideal state in which
the full array of information technologies is deployed for precise and
contextually-appropriate assistance towards therapeutic goals (IFTF,
Healthtcare 2020, p5).

4.2.4. Privacy and Ownership
In the previous chapter, we showed that the privacy of the user is
something crucial to think about. On the one hand, users are in the
habit of sharing their information but want to be in control of that
information and decide with whom they want to share it. On the
other hand, companies have the ownership of that data and can
decide what they do with it. Health data is maybe more critical than
financial data that is gathered by institutions and companies. In
that way, health and biology gives a detailed portrait of an
individual. Abusing this data and taking away the trust that
individuals have can block innovation in this new realm.
Startups in this area are looking at different incentives to give
people extras in order to gather data: Personal benefits: like
paying individuals for old data or new tracked data.
71
Community benefits: offering to return benefits to the community
by moving products of research into the public domain or otherwise
providing affordable access to these products and research insights
may offer a more manageable strategy for organizations to
encourage patient participation. Security and privacy: an
individuals desire for data control may range from leaving health
history extremely private to making data open and viewable by
anyone, and may also differ based on the autonomy of the data.
(IFTF, Healthtcare 2020)

We highlighted four ideas of change in preventive health care or
personalized medicine. Today we are changing from a cure
paradigm focused on treatment and diagnosis based on phenotypes
(the observation of the physical or biochemical characteristics of an
organism) to the new paradigm based on personalised and
predictive medicine. As mentioned in the four ideas, an individual
will have more information on him or herself. They will be well
informed when they look for professional help or when they notice a
variance in their patterns. By digitizing ones genes and DNA,
medical professionals will have much more detailed information as
well on an individual to be able to predict disease before it will come
to the surface (IFTF, Healthtcare 2020).
But we are not there yet. There is a need to watch on the ethics and
morals of this domain. Governments and care institutions have to
support these ideas and embrace this transformation with an open
mind. Investments from private and public sources will be needed
to let this new paradigm grow and become established.
72
5. Empirical Data on Designing for Personal Health.
The research we are setting up is phase II of a bigger study on
personal health. The first phase had a focus on sleep only, and
researched the impact of being Always on and the impact on sleep.
We looked at how people deal with technology on an everyday basis
in their work and private life. We measured sleep with a Zeo device
bedside model. The device gives detailed information on your sleep
time to fall a sleep, wake up times, how long youve being a wake
during the night, REM and DEEP and light sleep. I was especially
interested if participants would change behavior when needed,
based on the information they got from the device.

Phase II goes further into this trend, but now we let people self-
track themselves for 24/7 with BodyMedia device. This device
measures calorie burning, physical activity, steps, sleep and food
intake, BodyMedia gives a more overall image of daily and night
activities and behavior than the previous device we used. Here the
interest is also in the area of behavior change. How people read
their data, how they deal with the data, and how they act on it and
make little changes in their daily life if needed.

5.1. Why This Research?
In the past years, weve seen increasing problems in peoples
lifestyle: lack of physical activity the wrong eating habits and not
sleeping enough hours, resulting in more health risks and chronic
diseases. According to the World Health Organization 60% of the
global population has not succeeded in having a minimum,
moderate 30-minute of daily physical activity. This inactivity
contributes to large medical costs (WHO - 2003). In addition, social
security systems might change as well, and might lead more to self-
management in personal health.

7S
The research has different purposes and can be interesting
in different areas:
The development of personal health is one, as mentioned in the
previous paragraph.
The second one is getting insights on devices and applications that
are already in the market. By analyzing them with a small field test
we will learn how people deal with the knowledge they get from the
device. We want to understand how they integrate these devices in
their everyday life It might give insights in a new sub industry of e-
health, where e-health is the bigger picture and where preventive
healthcare is the first step towards self-knowledge of individuals
about their health.
Third, it might stimulate innovation and help startups in this area to
think about behavior design, which is so important in this area. We
can learn much about the devices that are in the market and
dominant in the US. In Europe, we are still in a very early stage of
this new movement.
Business models around these devices important as well, we need
to think about the long tail possibilities of these devices and apps.
Do we need to implement them in our social security system, or do
we need to target on the consumer market?

5.2. Target Audience For This Research and Motivation

This research is mainly positioned for an academic audience, but I
would like to take the opportunity to bring it further towards a
broader audience including policy makers and organizations like
Flanders Care or the Pharma industry. Part of this research could be
helpful for companies who would like to innovate in this area, or
could be helpful for startups in this area. At the same time, I hope
the participants in this research gain a lot of insights into their
lifestyle. I hope this will change their outlook on their life and
74
hopefully they will act on it if necessary. To be happy and be more
balanced between private and professional life.

5.3. Research phases and methodology.
5.3.1. Exploration phase

My research exploration phase started before this academic year. It
started in 2009 2010, when I was first introduced to the ZEO
device. I guess you can call this my field work time, exploring the
community and so forth. It triggered a lot of interest with me, and it
all was very intriguing.
My previous research brought me into the Quantified Self
movement in Brussels in May 2012. I think it is important to note,
because I was so happy to meet people in Belgium who also were
interested in self-tracking and that I could talk to them about my
experiences and my first findings in this area. This group was an
opening to a lot of other contacts too. This was important and in a
way very enlightening.
I started thinking about my second phase of my research on
personal health and explored different devices that I could use to do
my research within a hands-on experiment. My summer in the US
was very helpful from that perspective since I was with people who
are also working in this area. This lead to the opportunity to get 10
BodyMedia armbands which were a good choice for practical field
research. We let people experiment with this device and setup a
guided environment to let them explore this to its fullest.

Next there was the literature that was available on Persuasive
Technology in healthcare and early studies on Personal Informatics
and wearable devices. More comparative research was based on
existing literature. I categorized this research, found links to my
own research and looked for differences, added values and critics.
7S
In addition, I found a separate study on behavior change and
experimental psychology in this area.


Iiq. 26 Reseorcb pilers.

This phase brought me to my question.
Is 24/7 self-monitoring creating enough awareness and
persuasion to achieve a balanced lifestyle? Will it generate
general well being among self-monitored people.


5.3.2. Research Method
In this thesis, we discuss different aspects of device adoptation
based on the explorative insights we collected with empirical
research creating a social quasi-experimental set up for a mid-long
term period (project duration: sept 2012-sept 2013). We started
with 10 participants who were not using any tracking devices at the
start of the project. We gave each participant a BodyMedia armband
and access to the BodyMedia Activity manager to monitor their
progress and goals. The active research testing period took place
during two periods of two months (fall spring), giving us the
opportunity to look into seasonal differences. The gap during the
Besigning
foi
Peisonal
Bealth
Fielu test, choice of
uevices neeueu, what
is in the maiket anu
available foi ieseaich
Litaietuie on piouuct
uesing, usability
Liteiatuie on
Peisonal health
Liteiatuie on
Peisuasive
technology in e-health
Liteiatuie on
Peisonal Infoimatics
Liteiatuie on
expeiimental
psychology
- Tianstheoietical Nouel
- Fogg's Behavioi mouel
- Skinnei theoiy
Walks, lab meetings
anu QS confeience
76
months in-between we evaluated whether the participants
spontaneously tracked themselves. Next, recruited from the start of
the research a control group of people with matching profiles
(N=10) who did not have an armband. From the control group, we
collected lifestyle information with the same tools (weekly survey
and in depth interview) we used with the 10 people wearing the
armband (experimental group). This allowed us to evaluate the
effect of attention by the researcher/coach in making these lifestyle
changes. In order to get a clearer view of the behavior types, we
used Foggs Behavior Grid to map the profiles of the participants
and their progress. We use Fogg Behavior Model to evaluate the
Persuasive Technology side of the BodyMedia Device.

5.3.3. Sampling - Data Collection



Iiq. 27 Somplinq toble.

Our sampling is based on non-probability sampling or purposeful
sampling. This allowed us to go in depth on behavior changes and
provided for privacy and trust. Each participant was interviewed
before starting the experiment to assess whether they were really
uenuei Age Cultuie Lifestyle
77
interested and if it had a purpose in their life. As we aimed for a
small field test, we chose for ten participants, five male, five female.
Age ranges from 30-60, no early adopters but late majority except
one (Rogers, 2003). He is in the research for professional reasons
and also because of his high blood pressure. All of the participants
had a higher education. To check on culture differences we had 4
participants in the US California San Francisco and 13 European
participants in Belgium.
This was possible because the survey had two sections, one on
technology and application dashboard, and one section on behavior
change, routines and attitudes.

5.3.4. Mid-Long Term Research


Iiq. 28 Toble miJ lonq-term reseorcb.

We chose the mid-long term research method in order to obtain a
better view of the usage of the self-tracking device. First, mid-long
term research allows the participants to track their behavior
through a longer period of time and in different seasons. This gives
us a better view of lifestyle patterns in general and not outliers or
peaks in their lives. It also shows the sustainability of the devices in
peoples everyday life. Would participants continue to wear the
device on a spontaneous basis during the silent period when there
was no contact with the researcher/coach? Would they value the
device on the same basis as in the beginning phase at the start of
0ctobei -
Novembei
Phase I
Fall
tiacking
Becembei
- Febiuaiy
Phase II
Silent
Peiiou
Naich-
Apiil
Phase III
Spiing
tiacking
78
the research period in October 2012? How would they feel about the
whole process of learning about themselves? What will they do with
all these insights about themselves?

5.3.5. Data Collection
5.3.5.1. BodyMedia Data Collection Reports

Within this research we collected different data. First, we have the
BodyMedia device data. These are Excel spreadsheets with data on
calorie burning, steps, physical activity, sleep and for some, calorie
intake. We asked for this data at the start of the research and after
the first two weeks. In the middle of Phase I (October-November)
and at the end of November 2012, finishing the first phase of this
research. We did the same regime in the third phase of the
BodyMedia data collection. In phase II there was no contact at all
with the participants, this was silent period in the research.
Second, we had in depth interviews after each phase with each
participant. Third, we had in phase I and III surveys on Google Doc
that each participant had to fill in. These were delivered on
Saturday morning at eight oclock and they had to send them back
on the following Tuesday 12.00 GMT+1 timezone. This deadline and
routine were strict because otherwise the forms would get too close
to each other and give distorted views. Phase I focused on how
they felt about the device, how they created new habits, how their
mood was and if they had something special to report. This regime
of surveys was also sent out to the control group. They didnt ha
any questions on the device of course.

We compiled the BodyMedia Excel data in to one Excel file per
participant with the average data that was available. This gave a
good overview on the evolution on usage and behavior. All these
files you can find on the DVD that is included with this research.
79
The In-Depth Interviews
In our research method, interpretive research, we chose the
grounded theory (Glaser and Strauss, 1967) where we go through
different phases of analyzing our interviews. This process is a very
good approach, because you take the time to reflect on everything
over time, the transcription of the interviews in verbatim style takes
its time, but is already very helpful to begin the coding process.

The different steps we go through:
Transcribing the interviews in verbatim style
Open coding, where we try to split the content of the interviews
connected to keywords
Axial coding, where we put the different keyword categories based
on questions that were asked during the interview, makes the
content clearer and allows one to discover connections and
correlations.
Selective coding, drilling it down to a more narrow view. We used
mind mapping for this.

5.3.5.2. Foggs Behavior Model
We used Foggs Behavior Model to evaluate the Persuasive
Technology part of the BodyMedia device.

8u

Iiq. 29 Ioqq, Bebovior HoJel, 2007.

Iiq. S0 Ioqq 2008, Hotivotion, boseJ on tbree core motivotors.

As explained in the theory, Foggs model says three components
need to come together at the same time; otherwise it is very
unlikely a behavior change is going to happen.
81
Motivation - in the motivation process we have three core
motivators, sensation, anticipation and social cohesion.
Ability, the higher the ability, the more likely the action will happen.
Here we can add some things to think about also fall within the
simplicity aspects. Like money, time, physical efforts, brain cycle,
none routine and out of the ordinary, could be barriers for the
ability. The simple the act to achieve behavior change, the more
likely it is going to happen, as well. Think about the one-click
buying process at Amazon.
Triggers are the facilitator, sparks, signals, call to action.
By using these three elements, we can measure the BodyMedia
device and its software application to see if all these elements are
coming together at the same time. If it makes people aware of
certain behavior. And to measure if participants acted on the
created awareness, if they would feel this is needed.

5.3.5.3. Foggs Behavior Grid

Iiq. S1 Bebovior 6riJ, Ioqq, 2010

82
The Behavior Grid allows us to map the participants in the start
phase and to measure their process. We need to learn how they
react to the process of joining this mid-long term research. Will they
create routines? Are the new habits temporary? Are they actually
creating new habits? Do they stay with the same lifestyle as it was
before the research?

5.4. The Participants
Details on experimental group, height is in inches. Weight in lbs.
RE1
Birthdate: 01/18/1971
Age: 42
Height: 63
Weight: 122.5 lbs.
Gender: female
Handedness: right
Smoker: yes
BMI: 21.7
Nationality: BE

Manager 2 kids, but
newly
formed
family as
well,
sometimes
4 kids.
Very active
person,
wanted to
lose
weight, and
be more
active
Not an
early
adopter
RE2
Birthdate: 10/26/1975
Age: 36
Height: 67
Weight: 158.6 lbs.
Gender: female
Handedness: left
Smoker: yes
BMI: 24.84
Nationality: US
Manager Active
person,
outgoing,
no kids.
Wanted to
lose
weight,
change
diet, and
was curious
Not
tech
savvy,
not an
early
adopter
RE3
Birthdate: 06/02/1971
Age: 41
Project
manager
Medical
condition
severe
Not an
early
adopter,
8S
Height: 66
Weight: 187 lbs.
Gender: female
Handedness: right
Smoker: no
BMI: 30.18
Nationality: US-BE
back
problems.
Weight loss
and
exercise in
some way
or be more
active
tech
savy
RE4
Birthdate: 08/23/1948
Age: 64
Height: 66
Weight: 130 lbs.
Gender: female
Handedness: right
Smoker: no
BMI: 20.98
Nationality: US
Part time Active,
mainly
weight loss
and
tracking of
activity,
curious
Not
tech
savvy,
not an
early
adopter
RE5
Birthdate: 08/06/1952
Age: 60
Height: 66
Weight: 161 lbs.
Gender: female
Handedness: right
Smoker: no
BMI: 25.99
Nationality: BE
Goverment
project
manager
Weight
loss,
overweight,
more
activity
Not
tech
savvy,
not an
early
adopter
RE6
Birthdate: 03/15/1972
Age: 40
Height: 69
Weight: 150 lbs.
Gender: male
Handedness: right
Smoker: no
BMI: 22.15
Developer
Owner
Curious
about
technology,
interested
in other
participants
results
Tech
savvy,
early
adopter
84
Nationality: BE
RE7
Birthdate: 07/10/1970
Age: 42
Height: 74
Weight: 229 lbs.
Gender: male
Handedness: right
Smoker: no
BMI: 29.40
Nationality: BE
Unemployed
during
research
Weight loss
and more
exercise,
prep for
triathalon,
overweight
Tech
savvy,
not an
early
adopter
RE9
Birthdate: 04/15/1983
Age: 29
Height: 730
Weight: 185 lbs.
Gender: male
Handedness: right
Smoker: no
BMI: 24.41
Nationality: BE
Project
Manager
Sleep
interest
Tech
savvy,
not an
early
adopter
RE10
Birthdate: 09/17/1975
Age: 37
Height: 70
Weight: 128 lbs.
Gender: male
Handedness: left
Smoker: yes
BMI: 18.37
Nationality: BE
Docent -
Artist
Sleep
interest
Not so
tech
savvy,
not an
early
adopter

Details perticipants control group
RC1 F-BE -40+ Medical condition
back problems.
Unemployed during
research
Before research created
a routine after back
operation, weight loss
and exercise (biking)
8S
RC2 F-BE 53 Administration job Wanted to lose weight
RC3 F-BE 35+ PHD candidate+art
researcher
No goals, leading
current lifestyle
RC4 - F -US 40+ Researcher/analyst
in SFO
Wanted to have more
sleep
RC5 M- BE20 + Project manager Wanted to drink less
coffee, more exercise
RC6 M-BE-44 Docent Weight Loss and sleep
more
RC7 M-BE-55 Manager social
sector
Medical condition in the
past sensitive to
stress depression
lead a very structured
life before research
Toble 2 Fxperimentol onJ control qroup Jetoils.

5.5. Limitations of Research
We selected a mid-long term research process as in our previous
work. In a self-tracking environment, this is an important element
in order to see whether these devices have a sustainable effect. We
also learn more about the self and can reflect on pattern forming in
the participants life; episodes or events, silent periods, seasonal
effects and so forth. Unlike our previous research, only two people
dropped out for very specific reasons, which we explain later in the
results. This longer process has its advantages for the participant in
this case, but they need to see the advantages, because it requires
more motivation from the participants. For the researcher, it is
obviously more work, but worthwhile the effort. You learn and get
so much insight in the research subject. This is nt so much a
limitation apart from the continuous involvement and how it
influences the researchers life.
In selecting the participants for the experimental group, we mainly
chose for people who were not used to be living on the edge in
technology. Instead, we chose to have people who lead non-
86
technology oriented lives. They thought they could change little
things here and there to gain a better lifestyle. They were
interested in using a device like BodyMedia to achieve this. Two
people tracked themselves before, one for professional and medical
reasons; he is in the Quantified Self meetup group, so very
conscious of the different devices in the market. Another person
who was in my previous research and used the Zeo device for sleep
tracking. Integrating these two people in the research had negative
and positive points for the research. It was a way to compare how
they reacted on a different device in case of the Zeo user. We were
able to contrast this with the QS person to see how he acted on this
technology in a different manner and what the triggers were.
The idea of the control group was very good, but challenging to find
matching persons considering their personality, age, gender and so
forth. Unfortunately, we only found 7 people who were prepared to
go along with this for such a long period. Nevertheless this was very
interesting and gave more insight into the whole process.
We also had a Google group platform where participants could talk
and share experiences among each other about this experiment. We
occasionally posted articles about the Quantified Self, as well.
Unfortunately, this was not used much, except for the US
participants who were more open and talkative on this platform.
This aspect of our research is not discussed in the results because
we lacked data.
The research literature on the subjects of personal health and
personalized medicine is mainly found in the US. Books and papers
that are published are mostly produced in the US. It would have
been interesting to see European perspectives, as well. We see this
as a limitation in cultural views and different approaches in this new
paradigm on digital health. Again, the devices that are on the
market today are mainly US devices and fall completely under US
law. It will be interesting to see how Europe will deal with the data
87
gathered by these devices. How European companies will approach
business models and so forth. This is surely interesting to explore
for future research topics. The economic side of this new
phenomenon and implementation in European medical environment
with a social security system that might be at risk because it is no
longer sustainable for the years or generations to come.

6. Research Results
As this research covers three phases and has two groups,
(experimental and control) we worked out the results accordingly.
Additionally we make a distinction between the device research and
behavior research. We would like to work with this research flow.

Iiq. S2 Reseorcb moJel

6.1. The Affordance of BodyMedia Device
The BodyMedia device affords us to measure our calorie burning,
calorie intake, steps, physical activity and sleep. These are the 5
parameters that we operate by to measure the participants their
current lifestyle in the beginning of the research. In phase I-III we
evaluated these parameters on a regular basis to see if there are
E
x
p
e
i
i
m
a
n
t
a
l

g
i
o
u
p

- Phase I-
II-III
- Bevice
auoptation
- Behavioi
C
o
n
t
i
o
l

g
i
o
u
p

- Phase I-
II-III
- uoalsetting
- Behavioi
B
i
f
f
e
i
e
n
t

u
a
t
a
c
o
l
l
e
c
t
i
o
n

- Bouy Neuia
uata
- Weekly
suiveys in
phase I-III
- In uepth
inteiviews
aftei each
phase
88
changes or if the participants moved, burned more calories. Sleep
more or less. If they stayed the same during the whole period.
The BodyMedia device was perceived as very easy to use. You just
wear the armband on your upper arm and the sensors measure the
parameters mentioned before. With the armband is a USB cable
that connects to your computer. Synchronizes the data, and you
can see what happens on a daily basis.

6.2. BodyMedia and Foggs Behavior Model
Phase I showed the three positive core motivators, sensation in
terms of pleasure, anticipation in the form of hope and belonging in
the form of acceptance social cohesion. With the pleasure came
the curiosity, the new, acceptance being part of a group that is
involved in something cool, a cool experiment, and the hope of
achieving something. We find ourselves in the upper right quadrant
of Foggs Behavior model. In phase I the participants were very
enthusiastic about the device, they were intrinsically motivated. The
three motivators mentioned above were fully present in wearing
and experiencing the armband. They were all triggered to use it; it
was simple, and participants were above all curious. The ability was
there; it was very easy to use and to wear. We found ourselves in
the upper right quadrant of the behavior model towards success.
BodyMedia was greeted with high motivation and was perceived as
easy to use.
89
Iiq. SS Ioqqs Bebovior HoJel, 2007.

In the next subchapters, we present the results of Phase I on
different levels. First, the ease of use and technology adoptation
process. Second, the identification with the device. Third, making
small changes. Fourth, contextual factors and fifth service around
the device. Notice the evolution each participant goes through.

6.3. Qualitative Analysis Phase I Fall
6.3.1. Ease of Use and Adoptation process of the
BodyMedia Armband
Adjusting to wearing the armband went very well. After week 2, the
questionnaire responses showed that the participants didnt notice
the armband while wearing it. It became part of their bodies. The
only thing most of them reported was a slight irritation when
wearing it for more than 20 hours in a row. The sensors sticking on
their arm was the chief complaint. Another aspect of wearing the
armband was the reaction of the outside world. Some of the
participants didnt like the design because it was not discrete
enough. The outside worlds perception of the armband is diverse.
Reactions ranged from do you wear a jail armband device to do
0ppei iight quauiant
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you have a medical condition? Depending the environment people
reacted positively or negatively when participants explained why
they were wearing the armband. None digital people acted very
suspiciously and found this really weird to do, while people working
in a digital space found it really interesting. They wanted to try it
themselves. We could also observe this in the control group. Most of
the people in the control group were not interested or were hesitant
to wear some kind of tracking device in general, typically because of
fear of the unknown.
Using the activity manager was perceived as user friendly. However,
the interviews showed us that the participants did not use all the
functionalities in the activity manager to get in detail on their
analysis. We have indications that people who are more tech savvy
are more explorative than the participants that were labeled as non-
tech savvy. In the beginning, the participants were eager to enter
their food intake into the application, but after week 2 tracking food
intake decreased as it is very time consuming task, and a few
participants found that the tracking system failed because of that.
The issue is, that for EU countries, the American food data that is
used in the system as the standard reference is not usable because
of very different eating habits and products. EU participants needed
to enter their food intake data manually, which is a big task with
questionable accuracy. The participants noted their food on
separate paper to keep track. In general to handle food intake in an
easy and accurate way is a problem at the moment in the different
apps and devices. People try to simplify the paths they take. They
try to simplify their lives, preferring short routes to longer ones.
(Norman, 2010, p 126-127) Another point that came up was not
being able to share your food input with others within the family or
with friends, if you use several BodyMedia devices within one family
you have to put the food in for each person, as each device
connects to a separate account.
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A lot of participants said, in future use they would not wear the
armband all the time. They would be more triggered to wear the
armband exercise, or when they have a problem.
The participants spent an average of 37 minutes, a minimum of 20
minutes and a maximum of 60 minutes a week to analyzing the
data and evaluate their behavior.
The participants found that this was a surprise and created a lot of
awareness around their behavior.
Most participants saw this as a good tool for a healthier life. Most
admitted that they need the extra awareness it creates. Even
though they know how they behave. The facts and figures are
surprises in a positive and negative way. Depending on the location
and their occupation, they were also surprised sometimes about
their lack of physical activity, while others were surprised they had
quite a lot of physical activity. This awareness is the trigger and
stimulates motivation as mentioned in the process of Foggs
behavior model. We will see later in the ability process that it is not
always obvious to change behavior and act on this awareness and
consciousness.
Not all the participants are tech savvy or early adopters, so the
mobile aspect is not something they are waiting for or is important
for them. they could see the advantage. Those who have a
smartphone would like it to be accessible and have immediate
feedback when they wanted it.

6.3.2. Identification With The Device
We asked about the experience of the armband as an extension of
oneself, following the idea of McLuhan (1964) that technology
becomes an extension of our senses. The feeling the armband elicits
depends on how the participants were dealing with the device. Not
that they were emotionally involved with it, but saw this more as
their external consciousness to see the details on their physical
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activity, food and sleep patterns and act on it where necessary.
Others saw it as a tool to reach their goals, get more insight on
their health and lifestyle as a whole and using the data to discover
patterns and learn from it.

Most of the participants see a positive change in their attitudes and
behave more consciously because of the device they need that
extra push to act and most of them also in a way liked the
controlling factor that device has on them (Ryan & Deci 2000).

6.3.3. Making Small Changes
In line with the expectations of Foggs Behavior Model, small
changes in behavior and attitudes were reported by most
participants: trying to have more activity in terms of taking stairs
more, park a bit further away, drink more water, drink less coffee.
They mostly focused on the goals the BodyMedia system supports in
the first place: physical activity and food intake. A few were
focusing on their sleep patterns and were surprised of their good
sleep others were surprised they had a lot of interruptions in their
sleep and were surprised they did not sleep so well.
Three of the participants had medical conditions. It is clear that
they are much more motivated in changing lifestyles. All three of
them were bicycling and running 3 or more times a week, two of
them changed their eating and alcohol drinking habits very
drastically and succeeding in continuing these newly created habits
before they started tracking. Two of them were in the control group
and one of them was acting on little changes, as well. The survey
questions helped them to think about their daily activity apart from
the routines they already created. Once people are confronted with
a medical condition, they are much more serious and conscious
about the fragility of life. We can clearly see primary and secondary
needs in self-tracking our behavior. In relation to this research and
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research we did before in the same area; we found that participants
who are middle aged, close to 40 and up, are much more conscious
and aware about their lifestyle, and are willing to change little
things, but have a hard time in doing it. Work, time and family
related factors are playing a big role in this.
The other participants in both groups who set goals (Locke, Latham,
2002) for themselves, succeeded in their goals, and hope to
continue them in the next phases of this research. Most of the
participants in the control group admitted that having the weekly
surveys were helping them in pursuing their goals and needed that
extra attention or pressure to succeed in their goals and stay aware.
The control group felt less involved in the whole process of the
social experiment.

6.3.4. Contextual Factors
Clearly there are a lot of contextual factors that play a role in
changing behavior (Fogg, 2009). In Belgium, the main obstacles
were the weather it is a big influencer for not being triggered to
go outside, especially in the winter. In addition living in the city or
more rural area will make the latter more attractive to exercise,
since the countryside is very inviting to run or to bicycle.
Participants who live in California more specifically in San Francisco
find it very enjoyable to be active there. The hills are challenging for
walks and biking. They find it an attractive environment to have a
healthy lifestyle.
Family has a positive and negative impact. Negative because it is
time consuming and not everybody is on the same page. Then
again if they are and they can integrate their changes in the whole
family it works great.
Most of the participants have a full time job. Some of them work a
bit less, and then obviously have more time to exercise. Work
seems to be the biggest obstacle to balance out their lives. There is
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not much time left to do other things, so somehow the physical
activity needs to be integrated in the work environment. One could
think about lunch walks or meet and walk, but the location plays a
role along with the weather and whether or not it is socially
accepted.
The eating part is with most of them not a big problem, they are all
very conscious about food, and try to eat freshly and home made
food as much as possible. We see a difference in the American food,
mainly in quality of food. As the BodyMedia system uses an
American product database, the US participants who input food, got
to much sodium as feedback on a regular basis, EU participants
didnt get that message because they use different products which
they dont find in the database.

6.3.5. Services Around the Device
We collected data about the participants by weekly survey. This
created another insight related to the general services needed
around these kinds of tools. All of the participants liked the personal
mediation in having a weekly form to fill in. They found the follow
up and checking in stimulating, and put pressure in achieving their
goals. Personal coaching might be something to consider via chat
applications, or physical meet-ups. Most of our participants are
willing to use this service., if this would be a professional setup, and
within an acceptable price range.

6.3.6. Phase I Conclusion
The first phase shows that using self-tracking devices makes the
participants more aware about their behavior, and most of them
also acted on it. Participants had a better self-esteem because they
achieved in their goals they set at the beginning. The application
that comes with the armband is user friendly and stimulates the
participants to check it on a regular basis. Participants spent time
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on it every week, most of them like to do that at ease and make
time for it. Being part of a study influenced them and stimulated
them. It will be interesting to see how they will do in the three-
month quiet period. We see in the control group the participants
who set goals they also succeeded in regularly achieving them, but
after two weeks of not receiving a check in form, some of them let
it go a bit although they wanted to continue. The idea to have some
sort of external control that checks in on you, on a regular basis, is
the motivation that drives good behavior or attitudes. For
participants with medical conditions, the context changes and
behavior modifications are taken much more seriously. In our next
tracking phase in the spring the weather conditions will be changed
and the environment will be different. We expect people to be more
active because of that. We will also discover whether they tracked
themselves spontaneously during the three months of silence,
without personal mediation.

6.4. Phase II Winter
The Silent Period - Experimental Group
The silent period went from December to February. We created this
break to see if participants were going to track themselves
spontaneously during this period. Would they be evenly aware of
everything they started in phase I without contact with the
researcher We had the same regime for the experimental and
control group.
This period was I think the most interesting period for the research.
In terms of the discovery on how the participants reacted to it. They
were free to do what ever they wanted.
At first only 2 people continued tracking themselves. One
participant continued for two weeks, a dietitian, with professional
interest. The second participant continued tracking for about 80 %
of his time. He is fascinated with his sleep patterns. So he didnt
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really quit at all. All the others stopped their self-tracking activity
immediately.

6.4.1. The Mental and Physical Triggers
The primary mental trigger for not collecting self-tracking data was
boredom. The participants wanted to be disconnected completely.
Other arguments were lack of time. Many found that food logging
blocked their motivation because the data entry was cumbersome.
The primary physical trigger was annoyance with the device. That it
was always on their arm, all the time.

6.4.2. Self-awareness
During phase I the participants claimed to be much more self-aware
about their attitudes and behavior. During the silent period this
changed a bit.
Six participants had the same self-awareness during the silent
period, from those six participants one was using other devices to
track (the Quantified Self person) and one continued tracking,
because his interest in sleep. So actually four participants of the ten
had the same self-awareness during the silent period when they
were not self-tracking themselves.
Four other participants were less aware during this period of not
self-tracking themselves. But they reported to be more aware then
before the research started.

6.4.3. Habit Forming
Five participants continued their habits, including the one who uses
other self-tracking devices. Four participants actually continued
their habits without using the device.



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The Silent Period Control group
6.4.4. Self-Awareness and Habit Forming
Self-awareness remained with three control group participants
because they need structure in their life. They felt good with the
habits they formed during phase I. Three were less aware but for
severe reasons. One participant felt burned out, and the other one
had a relapse of a medical condition, back problem. This created
other priorities with them. One participant in the control group set
no goals and the research had hardly any impact on her. Regarding
habit continuation, four participants continued their habits two
started and stopped; their behavior yo-yoed back and forth. One
participant stopped completely because of her medical condition but
stayed alert on the food intake.

6.4.5. Silent Period Conclusion
Participants in the experimental group were chosen because they
had an interest in experimenting with this device. All of them were
ready to make little changes in their lives. This is important to note.
One cannot generalize this effect. We would need a bigger
representative population and maybe also a different target group
to explore this effect. Nevertheless this is an interesting evolution of
this research. It might show that people who wear these devices
rely on the technology to better their lives. To stay more aware and
to continue their habits. In a way, this technology makes
participants a bit mentally lazy and dependent. When the
technology is not there anymore, the memory of it fades away from
the participants. Like the scene in 2001, A Space Odyssey, when
Dave is disconnecting the artificial brain HAL 9000, HAL says Dave
my mind is going, I can feel it, I can feel it. (Carr, 2010, p 20) The
film sequence is on you tube
10
.

1u
http:www.youtube.comwatch.v=c8N72t7aScY.
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When taking the interviews with the participants of the control
group it became clear: they felt much more conscious aware all the
time. It was more embedded in their brain and their mental system.

6.5. Phase III Spring
We started phase III in March immediately following the silent
period. It was not easy to get everybody going again at the start of
this phase. There is a clear distinction in usage of the BodyMedia
device. We highlight this distinction in the quantitatitve part of the
research results.
It was a real problem for some picking up this routine again. We
also had two drop-outs in the experimental group in this period.
First we would like to look at Foggs behavior model again. We see
the three core motivators that would stimulate behavior change,
sensation, anticipation and social cohesion. In the third phase of our
research, we see a rise of the negative sides of these motivators. In
the pleasure we saw that the curiosity, the new and novel
experience was one of the main drivers. This faded away almost
completely in phase III. The participants where not so triggered to
start again, because they knew what was coming, the new was
gone. Only a few were looking forward to it. In the social cohesion,
we saw that participants were rejecting the device more because of
its design, not being discrete, and since wearing it is not so
comfortable. In the anticipation part, we noticed that some got
frustrated about the data, the confrontation of the collected data
and not being able to do something about it. With these conclusions
we found ourselves in the lower left quadrant of the Foggs
behaviors model towards failure. But lets go into detail to explain
all this.
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Iiq. S4 Ioqqs Bebovior HoJel, 2007.

6.5.1. Starting Up Again in The Experimental Group
Lets start with the positive. Five participants didnt find it difficult to
start self-tracking again. Two were looking forward to it, and saw it
as a boost to start being conscious about their habits again. From
the five participants, one continued tracking during the whole period,
so for him it was neutral. Three other participants had a very
difficult time in starting up. Others felt it was familiar the
participants knew what was coming. Some participants felt it was
strange on the physical side, the out of the ordinary. The Quantified
Self person is used to have the devices around him and did not
think about it. Another one had more work and less time on his
hands. Without a 9-5 job, routines are harder to build.
One of the participants (RE8) quoted: if you want to do it well, it is
work, and it takes time, synchronizing the data, analyzing the data
and acting on it.

6.5.2. Mental Triggers in the Reboot Phase.
The device was more trusted with five of the participants and felt
more familiar. Everything worked, the battery, the connection, it
was so easy. They were looking forward to starting again. It was
The lowei left quauiant
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like going back to school. They were curious about the results and
were motivated to start moving more and taking care of food intake.
The long-term effect of the tracking is important, like preparing for
a triathlon.

6.5.3. Mental Roadblocks in the Reboot Phase
Three participants found it extremely difficult to start self-tracking
again, and two of them didnt start again. The dropouts are
interesting cases. One participant already had problems with the
device in phase I. She felt electric shocks when she was wearing the
device. This gave her pain in the elbow. She didnt startup because
of the pain and the uncomfortable feeling the device gave her
physically. This participant is using myFitnessPal now to track her
activity and food intake data.
The other participant has a severe medical condition which requires
frequent trips to the hospital. However, in the last two years she
hasnt been in the hospital because she changed behavior in my
first research on sleep monitoring. She felt better because she was
resting more, moving differently, and developed better sleeping
habits. This was accompanied by big changes in her family life, as
well. Her husband start working in the same city and did not
commute anymore. In short, a big improvement. In phase I she
already mentioned not feeling so engaged with the BodyMedia
device than with the Zeo device. The BodyMedia device tracked
physical activity; food intake and calorie burning and the participant
didnt see any improvements on her data. She was struggling with
her weight for a long time, and because of her back problem was
not able to do sports. She was confronted with her data over and
over again, and it confirmed what she already knew. She was
frustrated by the fact that she was not able do to something about
it. Then the manual input of calorie consumption became more a
burden than fun because of the time needed for data entry. It made
1u1
her feel like a failure. With added personal issues going on in her
life self-tracking was not a priority anymore.
The last participant had hard feelings about starting again because
she needs time to make changes in her life in general to adjust to
something new. Although she mentioned during the interview she
was still interested and curious, she didnt really acted on it. An
interesting thought from her I wonder if the first time is not bang,
if people would self-track them again.

6.5.4. Physical Side of the Device
The device in this phase was perceived differently compared to
phase I. It felt familiar, but negative feelings rose towards wearing
it with some of the participants. The reactions from the outside
world had an effect too, being springtime, it is often visible. All the
questions from the outside world start to annoy participants. They
go tired of explaining what they were doing. Some were
uncomfortable wearing it, sometimes putting it on too tight, and it
made marks on the arm.

6.5.5. Long Term Use
Four participants see the value in longer term self-tracking. Three of
the four were most interested in their sleep. Others saw it on an
event basis or when they feel it is needed. For example, after a
summer or holiday period when people need it more. As we saw in
the previous analysis, the attention is fading way. The interest is
going away because the newness is gone. It creates a kind of a
self-tracking fatigue. Participants know what is coming. For others,
it provides a trusted and familiar feeling and likes to have that data
confirmation. The devices grow on them over time.



1u2
6.5.6. Data Analysis
Weve seen that in phase I that participants spent significant time to
analyzing their data. From 20 to 60 minutes, with an average of 37
minutes a week. In phase III, the range is from 10 to 60 minutes.
Some check it on a daily basis to see how they slept others did it
once a week. Those that checked data once a week got lost in their
activities during that week. They didnt remember what they did
and therefore could not relate to the data accurately. It would be
interesting to work with a personalized visual data platform and
have a logging function or keep a diary that they can use to log
activities manually if they want to. Building digital histories of data
that individuals gather by active tracking in using Personal
Informatics tools and passive tracking by just using the internet
(Ramirez, Hekler, 2011).

Data analysis is not always a good news show. For some of the
participants, it is a picture of their lifestyle state. It shows them that
they need to be active or eat differently. And they anticipate the
news is going to be bad.
One of the participants (RE8) felt influenced in his motivation by the
data. Even anticipated upfront on the results.
Quote: It is two sided, if you have good data you are motivated, but if
you know it will not be good, there is less motivation because of the
confrontation.
Another participant (RE3), got really frustrated and annoyed, even
worried about her health on the longer term, she also dropped out
in the research in Phase III: Frustrated in the data, that is it right
there. That is the summary. I think I gave that in my feedback. It is
just like ok; I dont want to be confronted again, because nothing is
really changed.
Other participants really liked it and did different experiments to
explore their reactions and behavior.
1uS
RE4 quoted: Yes, how many steps I take and how many hours I
sleep. Turn the computer on, I got more sleep than that. It is
interesting to see how many times you wake up during the night.
Yeah, I even slept in another bed at the house, oh yeah and then I
slept better. I was doing tests with myself.
Even though (RE2) dropped out in Phase III because of electric
shocks in her elbow, she liked to see the data and learn how to
stay healthy and stay in shape. Quote: Fascinates me might be an
extreme word here, but lets call it lost in translation. I would
definitely say it something that is interesting. It is nice to find new
ways to get healthier or to maintain your health or more in shape or
things like that.

6.5.7. Overall Accomplishment After 7 Months Self-
tracking
The Experimental Group
All participants except one stated that they felt like they had
accomplished something. They were much more aware of their
lifestyle and what their habits were. They got facts and figures to
work with. They saw an improvement in their lifestyle. Or they got
confirmation that they were doing ok.
RE10 was the only participant that was very consistent in wearing
the armband over the whole period. Had his own peculiar approach
towards wearing the armband.
Quote: !Yes, on the psychology side. I didn't change anything,
because I wanted to see how I am, and saw that I'm stable. The
long-term tracking allows you to get to know yourself. What your
routines are and habits and to see if you need to do changes. But I
think I'm ok.
Being part of this experiment and being a participant in the group
gave an extra stimulus to the participants. Despite the fact that
1u4
most people didnt know each other. The data they got from the
device created awareness and made them more conscious about
their behavior.
As RE5 quoted: You are confronted with the facts. Feels like being
aware is an accomplishment. Group effect was nice, even though I
didn't know the people.
RE4 was the most active and enthusiastic person in the research.
Quote: Yeah, I do I feel like I was part of a group, and like
keeping track of what I was doing, so yeah I feel like I
accomplished something. Keeping track of what I did and set.
Lifestyle changes, I think I did, it makes me feel more conscious.
Your activities the food you ate, yes it did.
The one who stated that there was no feeling of accomplishment
felt that she was armed with more information, which also scared
her.

6.5.8. Startup Phase in the Control Group.
In the control group, there were no major problems to starting
again. Most of the participants continued with their habits and had
the same awareness. Most of them knew now what they need to be
aware of, and how to take care of it. They just felt good about
themselves by continuing what they started. One was not really
looking forward because he felt that yes it is going to start again,
and Im going to fail again. Basically, he felt very unstable.

6.5.9. Overall Accomplishment After 7 Months
The Control group
Most of the participants noticed they have a consistent lifestyle. One
really felt like it changed her lifestyle and started with the Weight
watchers. She felt like joining the research was part of that
stimulation. Others like the check-ins, with an external person.
Overall most of them became more aware certain aspects in their
1uS
lifestyle. Others were already conscious of certain aspects of their
lifestyle they cared about. Aspects connected to their general
wellbeing and medical condition.

6.5.10. Contextual Factors in Changing Behavior
Before going to the experimental groups quantitative data, we
would like to review the contextual factors in changing behavior.
These are important factors to analyze within the self-tracking
environment.
We looked at simplicity factors within the Fogg behavior model.
There are 6 simplicity factors to consider having potentially an
influence on behavior change and the ability to act on something or
not. This is not only so in the self-tracking environment but also in
other trends and markets. These factors have to do with the
following: money, time, brain cycles, physical effort, out of the
ordinary, none routine. Lets explain each one of these factors and
how they relate to our research.
- Money: Tracking devices are relatively expensive this might
be an obstacle to buying them. Participants in this research
got them for free so this not a factor studied in this research.
- Time: As one of the participants said during an interview, if
you want to do this well it takes time. We also saw that the
lack of time was one of the reasons not to continue the
tracking. Different participants noted that lack of time was
one of the reasons not to continue the tracking. Time was an
obstacle for some to have physical activity.
- Brain cycles: This has different aspects. Is something difficult
or easy to do? Does it require a lot of thinking? In our
research, we noticed that some participants got really
emotional and frustrated about the data. Not giving the
results they thought or got confronted with the data over and
over again, not able to change things.
1u6
- Physical effort: Does it require a lot of physical efforts? For
some of the participants, physical activity is a problem in
terms of time but also in terms of effort or the emotional state
of mind of doing something in general. One of the participants
is working with a home trainer. In the spring, it is not a big
effort to ride the home trainer on a regular basis. However in
the winter, the room is not heated, it is not a cozy place. The
motivation is very low to ride the home trainer in the winter
just because of the environment and the interior.
- Out of ordinary: It is not seen a lot, fear of the unknown. We
saw with a lot of participants that they get a lot of questions
about the armband. It is seen as a kind of alien behavior; it is
out of the ordinary. This might be a reason why users might
not wear it all the time.
- Non-routine: Wearing the armband was non-routine for all the
participants. Amazingly almost everybody picked up that
routine quickly, except a few. Also, surprising is how
everybody stopped after phase I. And as we will see in phase
III, that routine faded a way with a lot of the participants too.
So it is not really something that gets integrated like that.
There has to be a need.

We would like to apply these factors when considering the device,
and towards behavior change. Obviously they are connected to each
other, but physical effort is not so much applied to the device, as
this asks no effort at all. Wearing the device is also a no brainer,
however, analyzing the data and acting on it is a brain cycle, and
might go together with a lot of emotions.
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Iiq. SS BoJyHeJio - simplicity foctors influencinq obility.

Iiq. S6 Bebovior cbonqe - simplicity foctors influencinq obility.

Other contextual factors we explained in phase I, are the weather,
family, living single and being single.
The weather conditions: the weather in Belgium is a roadblock as
mentioned in the findings of phase I. This also was very clear in the
spring when it atypically started snowing again in March people
started to get depressed and passive. They were not triggered to go
outside at all. Participants living in San Francisco hardly have a
winter, they have more activity in general. It is also a vibrant city
with lots to do.
Family and relational status: having a family with kids can be a
blessing when behavior changes get integrated in the family
routines. If not it is not so easy to do. Being single and living single
can be a blessing too, because you basically do whatever you want.
However, there is also a dark side. That there is no motivation to do
something because you feel kind of alone and not triggered to take
some action to feel good for yourself. You let it go a bit.
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Lets take a look at the actual data every participant gathered, and
what we can conclude about that.

7. Quantitative Data from The Experimental Group.
Before giving the BodyMedia data results of each participant in the
experimental group, we would like to explain how the BodyMedia
device works. This is information from the BodyMedia website.
What happens when you wear the armband not all the time?
The armband will fill in calories for any time you were not wearing it.
That data will be an estimate based on your body parameters and
your previous activity. The more you wear the armband, the more
accurate your values will be.
If you don't wear the armband for 30 minutes or more during "non-
sleep" hours, you will have to Edit Off-Body time.
Wear the armband for workouts only?
The system is designed to be worn all day. You can wear the
armband during workouts only, if you wish. In that case, for best
results, we recommend wearing it for at least 10 minutes before
and after your workout.

How does the Armband calculate calories burned?
The armband contains 4 sensors that measure motion, body
temperature fluctuations, skin temperature, and skin conductivity
(galvanic skin response). A proprietary algorithm uses this collected
raw information along with your personal body parameters to
deliver readings on calories; activity levels, steps, lying down and
sleeps time.
On a side note: the armband does not calculate biking well.

Each participants data graph displays a target baseline that
compares the current results with the target. The target baseline is
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based on the BodyMedia profile and whether the participant wanted
to change at a slow, moderate or fast pace.


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RE1
Target baseline
Calorie burning 1685
Calorie intake 1435
Physical activity per day 0:45
Steps per day 8000

Iiq. S7 Boto RF1 Pbose l-lll compile

In phase I RE1 wore the Armband for 49% of the time. In phase III
RE1 wore the Armband 29% of the time. RE1s goals were to lose
weight and to have more physical activity. RE1 succeeded in weight
loss, but did not succeed in reaching physical activity goals.
We can not report on RE1s calorie consumption because the data
was only entered twice. However, during interviews RE1 reported
the loss of two kilos in phase I.

RE1s sleep efficiency rose from 73 % to an 86 % over time. Longer
measurement duration will show if this is just a moment of better
sleep in April or a new trend. RE1 started to meditate and changed
some things in the professional life, as well.
u Suu 1uuu 1Suu 2uuu 2Suu Suuu SSuu
Aimbanu on bouy in %
Caloiiebuining av
Caloiieintake Av
Physical activity in minuteshoui
Steps
Sleep effeciency in peicentage
Aimbanu on
bouy in %
Caloiiebuinin
g av
Caloiieintake
Av
Physical
activity in
minuteshoui
Steps
Sleep
effeciency in
peicentage
Phase III 29 1621 48 1991 79.S
PhaseI 49 1881 48 2961 7S
/6F4
111
RE1 does not really wears the armband on a consistent basis to
make a good analysis. If RE1 had worn the armband always at night
to measure sleep, this would give a more accurate result. If RE1
would have worn the armband during the day, from the time she
wakes up until she goes to bed, or when RE1 is doing certain
activities, and measure this all the time, it would give a better view.

112
RE2
Target baseline
Calorie burning 2415
Calorie intake 1665
Physical activity per day 0:45
Steps per day 8000

Iiq. S8 Boto RF2 Pbose l-lll compile - lll not ovoiloble Jrop out

RE2 wore the Armband 57% of the time in phase I and burned
more calories than targeted but consumed more calories than
targeted. RE2s goals were losing weight and according to the
results succeeded in this. The sleep results are very good with this
participant. RE2 is one of the few who entered food intake data.
RE2 dropped out in the research because of the electric shocks she
felt in her elbow. She felt very uncomfortable wearing it. RE2 is now
using myFitnessPal.





u 1uuu 2uuu Suuu 4uuu Suuu 6uuu 7uuu 8uuu 9uuu 1uuuu
Aimbanu on bouy in %
Caloiiebuining av
Caloiieintake Av
Physical activity in minuteshoui
Steps
Sleep effeciency in peicentage
Aimbanu on
bouy in %
Caloiiebuini
ng av
Caloiieintak
e Av
Physical
activity in
minutes
houi
Steps
Sleep
effeciency in
peicentage
Phase I S7 2994 198u 18u 8927 87
/6F(
11S
RE3
Target baseline
Calorie burning 2425
Calorie intake 2175
Physical activity per day 0:45
Steps per day 8000

Iiq. S9 Boto RFS Pbose l-lll compile, pbose lll not ovoiloble, Jrop out

RE3s goals were increasing physical activity and weight loss. RE3
filled in her calorie consumption in the first two weeks of October
but stopped at the end of the second week. Her physical activity
rose in the month of November and calorie burning goes from 2400
to 2714, with some data outliers here and there. In general we can
say that RE3 has good physical activity according to her profile.
There isnt enough calorie consumption data to make any
assumptions on this. A longer measuring period is needed to make
any conclusions about this.
RE3 dropped out in phase III because of confrontations and
frustration in the data results. She also had personal reasons for
discontinuing her participation.
u 1uuu 2uuu Suuu 4uuu Suuu 6uuu 7uuu 8uuu
Aimbanu on bouy in %
Caloiiebuining av
Caloiieintake Av
Physical activity in minuteshoui
Steps
Sleep effeciency in peicentage
Aimbanu on
bouy in %
Caloiiebuini
ng av
Caloiieintak
e Av
Physical
activity in
minutes
houi
Steps
Sleep
effeciency in
peicentage
Phase I 96 2621 74 7u99 81.S
/6F*
114
RE4
Target baseline
Calorie burning 2580
Calorie intake 2080
Physical activity per day 0:45
Steps per day 8000

Iiq. 40 Boto RF4 Pbose l-lll compile

RE4 is the star of the research, scoring well on all levels and in both
phases. RE4 is one of the few participants who consistently filled in
calorie consumption. During the interviews, she said she felt really
happy. She was amazed about her results, and she is the most
active person in the group of women. She wore the armband very
consistently, from 80% to 97% of the time. She succeeded in
general on all levels.
u 1uuu 2uuu Suuu 4uuu Suuu 6uuu 7uuu 8uuu 9uuu
Aimbanu on bouy in %
Caloiiebuining av
Caloiieintake Av
Physical activity in minuteshoui
Steps
Sleep effeciency in peicentage
Aimbanu on
bouy in %
Caloiiebuini
ng av
Caloiieintak
e Av
Physical
activity in
minutes
houi
Steps
Sleep
effeciency in
peicentage
Phase III 9S 279S 1S96 S22 84S7 86
Phase I 8u 27S2 129S Suu SS78 81
/6FI
11S
RE5
Target baseline
Calorie burning 1384
Calorie intake 1134
Physical activity per day 0:45
Steps per day 8000

Iiq. 41 Boto RFS Pbose l-lll compile

RE5 wore the armband very consistently, 93%-97% of the time in
phase I. Phase III decreased a bit from 74%-88% of the time. RE5
was consistent in filling in calorie consumption data perhaps
because RE5 is a dietician. RE5 didnt succeed in the goal of losing
weight as her problem is too much calorie intake. This is clearly
shown in the results the baseline is 1134. Although RE5 has a lot of
physical activity, it is not enough to lower her weight. Phase I
shows more physical activity than Phase III.




u 1uuu 2uuu Suuu 4uuu Suuu 6uuu 7uuu
Aimbanu on bouy in %
Caloiiebuining av
Caloiieintake Av
Physical activity in minutes
Steps
Sleep effeciency in peicentage
Aimbanu on
bouy in %
Caloiiebuini
ng av
Caloiieintak
e Av
Physical
activity in
minutes
Steps
Sleep
effeciency in
peicentage
Phase III 81 1926 178u S6 S7S9 77
Phase I 9S 2114 1712 S2 S8uu 78.S
/6F9
116
RE6
Target baseline
Calorie burning 2135
Calorie intake 1885
Physical activity per day 0:45
Steps per day 8000


Iiq. 42 Boto RF6 Pbose l-lll compile

RE6 had a defect in the armband in between the two phases. This
result is shown in phase III. Overall the results of RE6 conform to
the target baseline.

u 1uuu 2uuu Suuu 4uuu Suuu 6uuu 7uuu 8uuu 9uuu
Aimbanu on bouy in %
Caloiiebuining av
Caloiieintake Av
Physical activity in minuteshoui
Steps
Sleep effeciency in peicentage
Aimbanu on
bouy in %
Caloiiebuini
ng av
Caloiieintak
e Av
Physical
activity in
minutes
houi
Steps
Sleep
effeciency in
peicentage
Phase III 4S 2S84 91 4S21 71
Phase I 76 2SSS 1Su 8SSS 6S
/6F+
117
RE7
Target baseline
Calorie burning 3445
Calorie intake 2445
Physical activity per day 1:30
Steps per day 10000

Iiq. 4S Boto RF7 Pbose l-lll compile

RE7s data collection was inconsistent. He went snowboarding in
phase III and had an extensive period abroad. During this time, RE7
didnt enter any data for off-body activity. This is one of the main
reasons why phase III had fewer results.

u 1uuu 2uuu Suuu 4uuu Suuu 6uuu 7uuu 8uuu
Aimbanu on bouy in %
Caloiiebuining av
Caloiieintake Av
Physical activity in minuteshoui
Steps
Sleep effeciency in peicentage
Aimbanu on
bouy in %
Caloiiebuini
ng av
Caloiieintak
e Av
Physical
activity in
minutes
houi
Steps
Sleep
effeciency in
peicentage
Phase III SS 299u 8u 42S2 7S
Phase I 87 SS96 18uS 1S8 7uu2 72
/6FK
118
RE8
Target baseline
Calorie burning 2890
Calorie intake 2390
Physical activity per day 0:45
Steps per day 8000

Iiq. 44 Boto RF8 Pbose l-lll compile

RE8 did well in overall performance despite self reporting a lower
motivation in phase III. He is one of the few and the only man who
kept the food logging going through the research period!

u 1uuu 2uuu Suuu 4uuu Suuu 6uuu 7uuu 8uuu 9uuu 1uuuu
Aimbanu on bouy in %
Caloiiebuining av
Caloiieintake Av
Physical activity in minuteshoui
Steps
Sleep effeciency in peicentage
Aimbanu on
bouy in %
Caloiiebuini
ng av
Caloiieintak
e Av
Physical
activity in
minutes
houi
Steps
Sleep
effeciency in
peicentage
Phase III 68 2912 187S 21S 6942 69
PhaseI 71 S214 22SS 297 9uS4 67
/6FD
119
RE9
Target baseline
Calorie burning 2805
Calorie intake 2555
Physical activity 1:30
Steps 10000

Iiq. 4S Boto RF9 Pbose l-lll compile

RE9 maintained consistent behavior in both phases.

u 1uuu 2uuu Suuu 4uuu Suuu 6uuu 7uuu 8uuu 9uuu
Aimbanu on bouy in %
Caloiiebuining av
Caloiieintake Av
Physical activity in minuteshoui
Steps
Sleep effeciency in peicentage
Aimbanu on
bouy in %
Caloiiebuini
ng av
Caloiieintak
e Av
Physical
activity in
minutes
houi
Steps
Sleep
effeciency in
peicentage
Phase III 78 SSS1 276 8S89 78
PhaseI 8S SS1S 28S 77S2 8S
/6F)
12u
RE10
Target baseline
Calorie burning 2320
Calorie intake 2320
Physical activity per day 0:45
Steps per day 8000

Iiq. 46 Boto RF10 Pbose l-lll compile

RE10 maintained consistent behavior in both phases. RE10 lost the
armband in phase III around mid-march, but was happy to find it
again in May.

7.1. Conclusion of the Quantitative Data
Among the female participants RE1-RE5, two of them dropped out
for serious reasons. Weve mentioned this before.
Three of the five women continued on a consistent basis to enter
the food logging data. From the five women, we can say that only
two of them continued measuring themselves on a continuous basis
in both phases. The third one didnt drop out, but only measured
u 1uuu 2uuu Suuu 4uuu Suuu 6uuu 7uuu 8uuu 9uuu 1uuuu
Aimbanu on bouy in %
Caloiiebuining av
Caloiieintake Av
Physical activity in minuteshoui
Steps
Sleep effeciency in peicentage
Aimbanu on
bouy in %
Caloiiebuini
ng av
Caloiieintak
e Av
Physical
activity in
minutes
houi
Steps
Sleep
effeciency in
peicentage
Phase III 91 2614 S19 8742 9u
PhaseI 8u 26u2 4u9 7967 91
/6F4F
121
herself from 10% to 49% of the time during both phases. The data
was not collected regularly enough to conclude anything.
Only one person of the five succeeded in reaching her targets
according to the data. This could be because women were working
on their weight control while the men were interested in physical
activity and sleep efficiency.
The men did a bit better. We see consistent behavior with the men.
One of the five men continued food logging in both phases. All five
men reached their targets. However, we dont have data from four
of them for food intake.
Do we need to conclude that there is a gender difference in the
usage of the technology and achieving the targets? Are men more
motivated? Do women have other worries that ask more triggers
and ability? The data shows us some answers but a bigger sample
will give more insights on this topic.

7.2. Behavior Grid Model Applied
According to the data we can define several behavior types. We
have three behavioral starting types. First, Green Dot Behavior,
eight particpants in the experimental group didnt use any self
tracking devices or apps before. Second, Purple Span Behavior,
where we increase a certain type of behavior for a certain period of
time. Third, Gray Span Behavior, where we want to decrease a
certain type of behavior.
We classify physical activity and sleeping efficiency in Purple Span
Behavior. These participants want to be more active. Have a better
sleep pattern or sleep more and it is familiar behavior.
We can classify the calorie intake within a Gray Path Behavior.
Participants want to decrease calorie intake in order to eat less,
they want to work on portion control or eat differently, healthier.
We see the male participants succeeding in their targets of moving
more and sleep efficiency. Most of them go from a Purple Span to a
122
Blue Path Behavior. Blue Path Behavior is maintaining a certain
behavior from now on. One participant is preparing for a triathlon,
he will go from a Purple Span to Blue Span Behavior, as he wants to
maintain or better his performance for a certain period of time.
As for the women who want to lose weight or maintain their weight,
we can recommend going from a Gray Span Behavior to see how
the food intake works, and if it is easy to maintain. Than they could
grow to a Blue Path Behavior. This would mean they have
structured their eating habits, so they dont have relapses.

8. Conclusion
This research revealed many interesting aspects of importance to
the Quantified Self movement as well as possible future use for
preventive healthcare and personal medicine. The research covers
different aspects that is divided in two categories. First, there is the
participants adoptation to the BodyMedia device. Second the
behavioral aspects of using the BodyMedia device.
The mid-long term research was a very good approach to arrive at
the findings that we discovered during this period. We had seasonal
effects, holiday effects, profession related effects and personal
related effects during this period.
We saw that participants were very eager to start this research and
all of them were more or less engaged in this study. This primarily
had to do with the perceptions of new and curiosity that the
BodyMedia device triggered in the participants. They were willing to
learn how they behaved and were eager to change little things in
their lives. We saw the same enthusiasm in the control group, not
with all the participants in the control group, but with the majority.
The experimental group stated that the device was very easy to use,
creating self-awareness, surprising in a positive and negative way.
However, not all the participants acted on their increased self-
awareness. Changing behavior and building routines is not an easy
12S
thing to do. The participants were more actively involved in the
first phase than in phase III. They liked that extra push that the
device created in phase I. In phase III the women let it go a bit and
were not talking about the extra push anymore. We saw a drastic
drop in the usage of the device with women in phase III. There
were two drop outs and one with incomplete and ignorable data.
The men scored better in the overall research in terms of wearing
the device, and reaching their targets. They were more critical in
the interviews, but than had a higher degree of involvement. This
could have to do with a different focus in targets. Men wanted to
know more about their sleep and physical activity, while the women
were more into weight loss. Weight loss is more difficult to do and
asks for a different discipline. To measure the weight loss, one
needs to complete the food logging on a consistent basis, and only
three women did this on a continuous basis and one man. The
whole group found the food logging a cumbersome process and
time consuming. It was a failure in the using the activity manager
for food logging.
We noticed that participants did not always examine the details in
the data presented by the Activity Manager. They looked at the
dashboard for general findings but didnt click the triangles for
detailed data. Some of them were not aware that was a button to
get more detail. This was more prevalent in phase I than in phase
III. When we asked participants questions about their details on
food intake they asked, How do you know that? This shows that
the participants were focused on a general view and are less
interested in the details or were not aware of detailed information
behind the general dashboard presentation (Sosik, Cosley, 2012).
This is a sad finding because you learn so much in these details. For
example, what their diet is like. For most of the participants their
food consisted of 40% - 50% carbs, 20% 30% fat and less then
20% protein. This understanding of food intake helps to make
124
changes and lets one think in a structured way about what ones eat.
It is not only the portions but also the type of food that matters.
We also noticed the effect of seasonal change in this seven month
period. Especially in Belgium, where it started snowing again in
March. This was very hard for everybody. In the experimental and
control group we observed winter blues, little depressions, the
cocooning effect and eating differently. There was no spring feeling
at all. In April, this got a bit better. This influenced our research and
showed that the weather has a big impact on the participants not
only in using the device, but also on their behavior and state of
mind.
We saw the first divide in the experimental and control group in the
silent period, when there was no contact with the researcher. Most
of the participants in the experimental group stopped tracking
themselves and also stopped their newly created habits that came
along with self-tracking. In the control group, most participants
were equally self-aware and continued with their habits. This might
mean that the experimental group was more dependent on the
technology to stay self-aware and to maintain the behavior they
formed during the first phase. There is a lack of mental processing
and embeddings of the self-awareness process without the device.
We shape our tools then tools shape us (McLuhan, 1964), they exist
as external objects but we stay dependent on them.
In parallel with Foggs theory on simplicity, we saw other specific
reasons why the experimental group did not continue tracking. Lack
of time, brain cycles in terms of emotions and effort, the
cumbersome nature of food logging, non-routine in creating new
habits and maintaining them, out of the ordinary, the device thats
seen as an alien aspect, actions and questions about the device
from the outside world were all aspects that were observed in the
reasons participants did not continue tracking themselves. The
check-ins with surveys stopped during this time, and that was a
12S
missing factor in the whole process. We see here an opportunity to
have personal coaching in forms like physical meet ups, online
check ins, chats and the like. We also noticed that some
participants analyze the data weekly and then forgot about their
activities they had during the week and could not relate to certain
data peaks they had. This could be an opportunity to have an
additional feature in the armband where users have the ability to
keep a diary of some sort, where they can note special events.
Another option is to have a personalized data visualization
dashboard, where users can bundle, aggregate other activities they
track with other devices or apps. To make the mirror of life
complete. (Ramirez, Hekler, 2012).

In phase III, we noticed a slight self-tracking fatigue. The new
and curiousity factors had faded for most of the participants. The
device felt familiar; it gave trust and the participants knew what
was coming. The data presentation would show the fact and figures
again, and for some this was not what they wanted to see. If the
data was good, they were motivated. If the data was not good,
there was less interest. When the data showed bad results over and
over again, it creates frustration and irritation with the user. It
lowers self-esteem and can create worry. On the other hand if it is
all good news the user will be happy and encouraged to continue
good behavior and have higher self-esteem. A human touch in
these devices and apps is very important. In other words, the
device should provide positive and constructive feedback.
This phase showed that during longer periods things happen in
peoples lives. Life is not always a good news show. Personal
problems within the family, or medical problems that developed
during the research period were roadblocks to continuing
self-tracking or other aspects of the research. This was an equal
happening for some participants in the control group. We can
126
conclude that this is not really related to the research. When
problems arise, priorities get shuffled, and people might change
their scope in order to deal with their problems.
Another remarkable effect we saw in phase I and phase III was that
the US participants were very active and conscientious on all levels,
even in food logging. The US participants were a minority in the
group but the data was markedly different. Living in a vibrant city
that is inviting to walk and the weather is always relatively nice
makes a big difference in the participants state of mind. There is a
bigger trigger to go outside. They showed more self-awareness
about food. Not that they always acted on it, but the awareness was
there. US Silicon Valley participants attitudes are very different,
not being representative for the rest of the US.
We can state that in the control and experimental groups that self-
awareness was improved. In the experimental group, there was
more guidance through the gathering of the data by the device. The
detailed information showed the participants what they had to work
on and motivated them to make changes where necessary. Showing
facts and figures of ones behavior is perceived as an added value of
the device.
In the control group the goal setting was an important element to
achieve in changes, this is also within the experimental group but
also here it was guided by the application and by default something
to think about.
Together with the research we did last year on sleep, there is an
important component that shows that this technology will not be
used all the time. Instead, it will be a temporary use. It will be used
when people feel like they want to know more about a certain
aspect of their life. It will be used to track exercise for example.
Measuring physical activity during a certain moment in time or
when it is needed, because some medical condition that pops up.
There has to be a need; this can be a mental need, to confirm ones
127
thoughts on certain behavior or physical need because the body
tries to tell you something.
The research shows there are many aspects to think about and to
optimize in the field of Quantified Self. There is room for
improvement and more experimentation. We would like to highlight
some of these aspects based on the findings from our research.

9. Recommendations for Future Research
This research was done with a small group of participants. This in
itself is subject to discussion, and we cannot generalize our findings,
given such a small sample size. That said; our research shows that
there is room for improvement and that self-tracking with
technology is something we need to think through clearly. Open
questions remain. How we can continue to motivate people to do
this? How can they maintain their self-awareness and good behavior
in a proactive manner? Long-term tracking will teach people about
their lifestyle patterns. Short-term tracking will give momentum
views of certain aspects of peoples life. This is not bad in itself and
can be interesting when you have a change in your life for a certain
span of time and to track how you react to that. To find correlations
with other aspects or normal behavior, you need longer duration
of tracking information.

9.1. Mediation by Professionals
Longer-term self-tracking could be mediated by professionals. For
example with exercises one could be coached by a fitness
professional. For weight loss one could be coached by dietician or
join group sessions, in the example of Weight watchers. This can be
organized online or offline, both options should be available.
Some companies offer this by email based on your results. This is
fine but not enough from the perspective of the users. There is no
empathy in the emails. The algorithm will check how often you used
128
the device or app and will then notify you accordingly. You might
not have worked out for a while, and there might be a reason for
this. Maybe you were ill. If you cannot log this in the app or the
devices dashboard, you get a blunt mail saying you havent worked
out for X days with no empathy at all. The feedback is not an easy
task to solve, but it is important because it becomes annoying and
irritating very fast. There always needs to be an option to opt out if
the app or device uses this technique.

9.2. Design and Development
The research taught us that wearing tracking devices creates
reactions from the outside world. To put it in Swans words,
outsiders may see this as an alien concept (Swan, 2013). The
design of these devices should be integrated with the body like a
natural extension. This may be done with smart clothing, contextual
clothing. Then it would be invisible. The problem is that we dont
wear the same clothes all the time so it should be detachable;
waterproof etc.. Maybe sensors should be integrated in underwear -
something we wear quite often. The sensors should be like second-
skin objects, nano sensor wearables. The data gathering should be
intuitive whether it is synchronized in real time or not. We see that
the participants took time to analyze the data in the research. This
indicates that it is important to create that kind of involvement and
engagement within the whole process of self-tracking. With data
synchronization and downloading it, is important that it is a fluent
process. Some devices use Bluetooth, and it can be very
cumbersome use, especially for less technical people. The battery
life of these devices is another challenge. With the BodyMedia
device, the battery life is impressive, and a real added value
compared to other devices. Other devices last for 24 hours, which
is a short battery life. Certain apps rapidly consume the battery
charge of your smartphone.
129
9.3. Open Data for Personalized Data Visualization
The more we track ourselves, the more data we gather. First
initiatives come in the digital world to bring all this data together.
Weve talked about examples in our theory. The need to have open
data systems to gather all that information in one location for the
user to access is one consideration. The way these devices gather
data is not the same. For example on-body sensors will measure
more accurate information than wristbands that are based on
motion detection. A Fitbit clip-on will give different results than a
Lark wristband or a BodyMedia armband. All the data details need
to be studied to provide the most accurate view for the user.
Another aspect to consider is whether or not the data creates an
information overload for the user. In other words, will he or she still
grasp the significant bits of data. Some users might not be
interested in all of the data but just one aspect of concern in their
lifestyle.
We still need to think in terms of added value for the user. All of the
self-tracking devices and apps aim to facilitate behavior change or
to measure aspects of someones life. They can help as
complementary information in certain medical situations, but it does
not replace human professional assistance and more professional
medically approved observation techniques.

9.4. Business Models
In the US we see more and more premium services built around
self-tracking devices and apps. Some of the devices are not cheap,
and you have to pay subscription fees to see the data that is
gathered by the device. Services around the devices and apps could
deliver a long tail effect in this market. In Europe, one could look at
the possibility of how to integrate the well being apps with the
social security system that is in place. Can there be a tax refund for
1Su
self-tracking devices when they prove to be valuable for some
medical conditions like chronic diseases?
Hopefully, we dont make the same mistake as Internet content
owners. In that medium content is offered for free. It is difficult to
turn this around to a paid model. I recommend no free lunches here.
No advertising. To keep it clean and clutter free. A good example
from Germany is http://www.vitavision-app.com/, discreetly
sponsored by Accu-Chek Blood Glucose Monitoring system from
Roche, here the advertising element is almost invisible and hidden
in the credits. It was built by Ogilvy Virtual Health in Germany. This
is a free app for the user but Accu-chek could integrate the data
gathering into a follow-up platform where glucose measuring is
reported. Collaborations like this give the user confidence.
Especially when it gets strong support from the diabetes
community as is the case for this app.
An interesting evolution we saw in the research is the rise of
advertising and design agencies that build these apps and devices.
This includes firms like Razorfish Healthware, Ogilvy Virtual Health,
Ideo, Frog Design and others. They bring a different approach to
the digital health market.

I am convinced we can make behavior changes with The Quantified
Self concept in a sustainable way. Working in a multidisciplinary
way, different ideas and thoughts are brought together to make a
better place for people. It must start with the people because they
are in the center of this whole environment.






1S1


















1S2
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1S4





1SS
Websites
Social Network sites
http://mydietitian.com
http://propellerhealth.com
http://curetogether.com
http://patienslikeme.com
http://lift.com mobile app for tiny habits
http://instagram.com - used as mood example and weather states
Quantified Self Devices - websites
http://bodymedia.com - acquired by http://jawbone.com during the
writing of this thesis.
http://larklife.com
http://www.nike.com/us/en_us/c/nikeplus-fuelband
http://thequantifiedself.com
BJ Foggs websites
http://bjfogg.com
http://tinyhabits.com
http://www.behaviorgrid.org
The desactivation of HAL 9000
http://www.youtube.com/watch?v=c8N72t7aScY
Personal data vizualization framework
http://www.fluxstream.com
https://www.healthvault.com/be/en
Research sources
http://www.ucsf.edu/news/2012/10/12913/self-tracking-may-
become-key-element-personalized-medicine
http://pewinternet.org/~/media/files/reports/2011/pip_social_life_o
f_health_info.pdf
http://pewinternet.org/~/media/Files/Reports/2012/PIP_MobileHeal
th2012.pdf


1S6
Other
http://csrsite.safeway.com/people/employees/health-
wellness/#prettyPhoto



1S7
Figures and tables
FIu. 1 }AWB0NE 0P TECBNICAL SPECIFICATI0NS ........................................................................................... 21
FIu. 2 NIKE F0EL TECBNICAL SPECIFICATI0NS ................................................................................................. 21
FIu. S LARK LIFE TECBNICAL SPECIFICATI0NS ................................................................................................. 22
FIu. 4 B0BYNEBIA ARNBANB SENS0RS ............................................................................................................... 22
FIu. S ARCBITECT0RE PERS0ASIvE SYSTEN F0R SENS0R WEARABLES .............................................. 2S
FIu. 6 ABAPTEB TAX0N0NY SELF N0NIT0RINu PR0CESS ......................................................................... 24
FIu. 7 B0BYNEBIA BASBB0ARB TBAT C0NES WITB TBE B0BYNEBIA ARNBANB ....................... 27
FIu. 8 }AWB0NE 0P BASBB0ARB 0N I0S PB0NE ............................................................................................. 27
FIu. 9 LARK LIFE BASBB0ARB 0N TBE IPB0NE ................................................................................................ 28
FIu. 1u TBE EATERY APP 0SES CR0WBS00RCINu F0R TRACKINu Y00R F00B ANB B0W
BEALTBY Y00 EAT ................................................................................................................................................. 28
FIu. 11 LIFT, BASEB 0N 'TINY BABITS' TBE0RY 0F BR. B} F0uu, ALL0WS Y00 P0T IN Y00R
BABITS, F0LL0W TBEN ANB NAKE TBEN R00TINE. .......................................................................... 28
FIu. 12 FL0XSTREAN.C0N 0PEN S00RCE PERS0NAL BATA vIS0ALIZATI0N FRANEW0RK ..... S2
TABLE 1 FIvE R'S, (SELLEN, WBITTAKER, 2u1u, P7S-74) ............................................................................. SS
FIu. 1S 0vERvIEW 0F WRITINu Su NIN0TES 0CT0BER 2u12 - }0LY 2u1S (IT IS ACT0ALLY
N0RE TBEN Su NIN0TES, B0T T0 ILL0STRATE). .................................................................................. S4
FIu. 14 EXERCISE BABIT 0vERvIEW 0CT0BER 2u12 - }0LY 2u1S ........................................................... S4
FIu. 1S R0NKEEPER 0vERvIEW }AN0ARY - }0LY 2u1S. ................................................................................ SS
FIu. 16 INSTAuRAN C0NPILE FR0N TAI CBI SESSI0NS. ............................................................................... SS
FIu. 17 NASL0W PYRANIB 0F NEEBS, A TBE0RY 0F B0NAN N0TIvATI0N, 194S. (MASLOW,
1954) .............................................................................................................................................................................. 41
FIu. 18. INTRINSIC ANB EXTRINSIC N0TIvATI0N (RYAN&BECI 2uuu). ................................................ 48
FIu. 19 B} F0uu BEBAvI0R N0BEL, BTTP:WWW.BEBAvI0RN0BEL.0Ru 2uu7. ....................... 49
FIu. 2u TRANSTBE0RETICAL N0BEL, PR0CBASKA ANB BICLENENTE, 1997; TBE LAST
SEQ0ENCES ARE PARALLEL WITB F0uu'S BEBAvI0R N0BEL. ....................................................... S1
FIu. 21 BEBAvI0R uRIB, F0uu 2u1u. ...................................................................................................................... SS
FIu. 22 SCREENSB0T 0F ALERTS 0SEB IN N0BILE APPS. ............................................................................ S7
FIu. 2S BEALTB 2uSu: AN EXPANBEB C0NCEPT 0F BEALTB ANB BEALTB CARE (SWAN, ,2u12).
.......................................................................................................................................................................................... 66
FIu. 24 SERvICES PR0vIBEB BY S0CIAL BEALTB NETW0RKS (SWAN, 2uu9, P49S). ..................... 69
FIu. 2S FRANEW0RK F0R P0TTINu 0SER AT TBE CENTER 0F C0NBINAT0RIAL INN0vATI0N
IN TBE BEALTB INF0RNATI0N TECBN0L0uY INFRASTR0CT0RE (IFTF BEALTBCARE
2u2u, PS). ..................................................................................................................................................................... 7u
FIu. 26 RESEARCB PILERS. ........................................................................................................................................... 7S
FIu. 27 SANPLINu TABLE. ............................................................................................................................................. 76
FIu. 28 TABLE NIB L0Nu-TERN RESEARCB. ....................................................................................................... 77
FIu. 29 F0uu, BEBAvI0R N0BEL, 2uu7. ................................................................................................................ 8u
FIu. Su F0uu 2uu8, N0TIvATI0N, BASEB 0N TBREE C0RE N0TIvAT0RS. ......................................... 8u
FIu. S1 BEBAvI0R uRIB, F0uu, 2u1u ...................................................................................................................... 81
TABLE 2 EXPERINENTAL ANB C0NTR0L uR00P BETAILS. ........................................................................ 8S
FIu. S2 RESEARCB N0BEL ............................................................................................................................................ 87
FIu. SS F0uu'S BEBAvI0R N0BEL, 2uu7. ............................................................................................................. 89
FIu. S4 F0uu'S BEBAvI0R N0BEL, 2uu7. .............................................................................................................. 99
FIu. SS B0BYNEBIA - SINPLICITY FACT0RS INFL0ENCINu ABILITY. .................................................. 1u7
FIu. S6 BEBAvI0R CBANuE - SINPLICITY FACT0RS INFL0ENCINu ABILITY. .................................. 1u7
FIu. S7 BATA RE1 PBASE I-III C0NPILE ............................................................................................................... 11u
FIu. S8 BATA RE2 PBASE I-III C0NPILE - III N0T AvAILABLE BR0P 00T .......................................... 112
FIu. S9 BATA RES PBASE I-III C0NPILE, PBASE III N0T AvAILABLE, BR0P 00T ............................ 11S
FIu. 4u BATA RE4 PBASE I-III C0NPILE ............................................................................................................... 114
FIu. 41 BATA RES PBASE I-III C0NPILE ............................................................................................................... 11S
FIu. 42 BATA RE6 PBASE I-III C0NPILE ............................................................................................................... 116
FIu. 4S BATA RE7 PBASE I-III C0NPILE ............................................................................................................... 117
FIu. 44 BATA RE8 PBASE I-III C0NPILE ............................................................................................................... 118
FIu. 4S BATA RE9 PBASE I-III C0NPILE ............................................................................................................... 119
FIu. 46 BATA RE1u PBASE I-III C0NPILE ............................................................................................................ 12u

1S8

Appendix
Weekly Surveys
Experimental Group
PhaseI
R1_R6_BodyMediaSelftrackingSurvey_EG
Phase II
BodyMediaintermediateQ1AphaseII(responses)Exp
erimental
Phase III
BodyMediaExperimentalGroupReport1 to report 6

Control Group
Phase I
BodyMediaCOntrolGroupReport01-05
Phase II
BodyMediaintermediateQ1APhaseII(responses)
Phase III
BodyMediaControlgroupPhaseIIIReport1-5

BodyMedia data exports
Phase I
RE1-10
Phase III
RE1_10

Interviews (Audio)
Control Group
Phase I
RC1_13_11_2012
RC2_4_11_2012
RC3_13_11_2012
1S9
RC4_16_11_2012
RC5_17_11_2012
RC6_13_11_2012
RC7_16_11_2012
Phase III
RC1_13_05_2013
RC2_05_05_2013
RC3_30_04_2013
RC4_19_05_2013
RC5_10_05_2013
RC6_08_05_2013
RC7_07_05_2013
Experimental Group
Phase I
RE1_01_11_2012
RE2_05_11_2012
RE3_08_11_2012
RE4_05_11_2012
RE5_10_11_2012
RE6_05_11_2012
RE7_09_11_2012
RE8_08_11_2012
RE9_12_12_2012
RE10_03_11_2012
Phase II-III
RE1_26_05_2013
RE2_26_04_2013
RE3_23_04_2013
RE4_13_05_2013
RE5_06_05_2013
RE6_20_05_2013
RE7_14_05_2013
14u
RE8_13_05_2013
RE9_14_05_2013
RE10_14_05_2013

Transcripts of interviews
Interviews Phase I
Control Group
Interviews RC1-RC7
Axiale Codering
Selective coding
Open Coding
Experimental Group
Interviews RE1-RE10
Axiale Codering
Selective coding
Open Coding
Interviews Phase II_III
Control Group
Interviews RC1-RC7
Axiale codering Control Group Phase II III
SelectiveControl Group Phase II III
OpencoderingControlGr
Experimental Group
Interviews RE1-RE10
Axiale Codering Experimental group Phase II III
Open CoderingExperimentG
SelectiveCoderingExperimentalGroup Phase II-III
Other
Papers to explore research topic
Breakout session QS Conference Europe (Audio)
Poster Medicine 2.0
Paper AAAI conference Shikakeology