Saskia M Kelders

University of Twente | UT · Department of Psychology, Health and Technology (PHT)

BACKGROUND Spinal surgery patients report high levels of insecurity, pain, stress and anxiety, before and after surgery. A digital health intervention, based on Acceptance and Commitment Therapy and positive psychology has been developed to enhance psychological flexibility and well-being and to reduce postsurgical pain. OBJECTIVE The objective of...

Background Low motivation and suboptimal cognitive skills are common among forensic psychiatric patients. By focusing on doing and experiencing, innovative technologies could offer an alternative to existing treatment for this patient group. One promising technology is DEEP, a VR biofeedback game that teaches diaphragmatic breathing, which has show...

While virtual reality (VR) shows much promise for treatment of psychiatric disorders, it is not widely used in practice. Models as the Consolidated Framework for Implementation Research (CFIR) can be used to guide implementation, but not much is known about how to translate these models into concrete implementation processes. To identify relevant i...

Background: There is increasing empirical evidence for the positive mental health effects of compassion-based interventions. Although numerous smartphone apps offering compassion-based interventions ('compassion apps') are now available for the general public, the quality of these apps has not yet been reviewed. A qualitative review of existing co...

Background Virtual reality (VR) is increasingly used in healthcare settings as recent technological advancements create possibilities for diagnosis and treatment. VR is a technology that uses a headset to simulate a reality in which the user is immersed in a virtual environment, creating the impression that the user is physically present in this vi...

Introduction: Spinal surgery patients often experience pain as well as stress, anxiety or even depression before surgery, highlighting the need for better mental preparation before undergoing surgery. Acceptance and Commitment Therapy and positive psychology have proven effective in coping with chronic pain and providing long-term skills that enha...

Background: An essential value in mental health care is compassion: awareness of suffering, tolerating difficult feelings in the face of suffering, and acting or being motivated to alleviate suffering. Currently, technologies for mental health care are on the rise and could offer several advantages, such as more options for self-management by clien...

Self-guided eHealth has the benefit of providing autonomy to patients. However, the autonomy comes with a cost; elevated attrition rates. Embodied Conversational Agents (‘robots on screen’), have technological capabilities to build rapport with eHealth users and to support them, but are costly to realize and their evidence is inconclusive. We inves...

Background: Chile has a high prevalence of postpartum depression and a significant treatment gap. Some barriers to postpartum depression care uncover the need for more easily accessible and lower-cost interventions. Chile's high utilization of digital technologies across all social strata and the increased use of pregnancy and parenting apps open...

Introduction: Self-management is one of the cornerstones in the treatment of bipolar disorder (BD). Complementing interventions by apps are seen as a good opportunity to support self-management. However, there is insufficient knowledge about understanding the use of health-related applications by consumers with BD for self-management purposes. Ai...

The lack of adoption of eMental Health technologies by people with severe mental illness (SMI) might be explained by a mismatch between technology design and users’ skills, context and preferences. Co-design can optimize this fit, but populations labelled as ‘vulnerable’ are often excluded or misrepresented. The goal of this study is to gain insigh...

BACKGROUND An essential value in mental health care is compassion: awareness of suffering, tolerating difficult feelings in the face of suffering, and acting or being motivated to alleviate suffering. Currently, technologies for mental health care are on the rise and could offer several advantages, such as more options for self-management by client...

Background: An essential value in mental health care is compassion: awareness of suffering, tolerating difficult feelings in the face of suffering, and acting or being motivated to alleviate suffering. Currently, technologies for mental health care are on the rise and could offer several advantages, such as more options for self-management by clie...

Introduction In Bipolar Disorder (BD), people report a lower quality of life and lower levels of well-being than the general population. Additionally, patients with bipolar disorder have unmet needs which are closely linked to elements of positive psychology. Objectives The current study aimed to gain insight from patients with BD and care profess...

BACKGROUND Patients with Bipolar Disorder (BD) report a lower quality of life and lower levels of well-being than the general population, and have unmet needs closely linked to positive psychology domains. Although a growing number of studies evaluated the impact of positive psychology interventions (PPIs) on patients with severe mental illness in...

Background: Patients with Bipolar Disorder (BD) report a lower quality of life and lower levels of well-being than the general population. Despite the growing availability of psychotherapeutic and self-management interventions, there are still important unmet needs. These unmet needs are closely linked to positive psychology domains. Although a gr...

BACKGROUND Lack of physical activity (PA) is a common issue with detrimental consequences for the health of people with severe mental illness (SMI). Existing PA interventions show suboptimal effects because they require substantial cognitive skills, including goal setting and writing, while cognitive deficits are common in this population. To bolst...

Background Lack of physical activity is a common issue with detrimental consequences for the health of people with severe mental illness (SMI). Existing physical activity interventions show suboptimal effects as they require substantial cognitive skills, including goal setting and writing, whereas cognitive deficits are common in this population. T...

Background: Thorough holistic development of eHealth can contribute to a good fit among the technology, its users, and the context. However, despite the availability of frameworks, not much is known about specific research activities for different aims, phases, and settings. This results in researchers having to reinvent the wheel. Consequently, th...

Background The Life-Chart Method (LCM) is an effective self-management treatment option in bipolar disorder (BD). There is insufficient knowledge about the consumers' needs and desires for an e-monitoring solution. The first step towards a new mood monitoring application is an extended inventory among consumers and professionals.Background The aim...

BACKGROUND Thorough participatory development of eHealth is necessary to ensure a good fit between the technology, its users and the context. However, despite the importance of development and the availability of frameworks, not much is known about specific methods for different aims, phases and settings, resulting in researchers having to reinvent...

Introduction: Developing a good therapeutic alliance is considered essential for the responsible delivery of psychotherapy. Text-based digital psychotherapy has become increasingly common, yet much remains unclear about the alliance and its importance for delivering mental health care via a digital format. To employ text-based digital therapies res...

Background Research has shown that self-control training (SCT) is an effective intervention to increase self-control and behaviour driven by self-control, such as reactive aggression. We developed an app that offers SCT by asking users to use their non-dominant hand for daily tasks, and aimed to examine whether participants that received SCT via ap...

Stress is a prevalent issue amongst patients with chronic conditions. As eHealth interventions are gaining importance, it becomes more relevant to invoke the possibilities from the eHealth technology itself to provide motivational acts during experiences of stress as to enhance adherence to the intervention. Embodied Conversational Agents (ECA's) a...

The added value of autobiographical reflexivity and persuasive technology (PT) compared to critical reflection was examined in a blended learning course. The main outcome measure was achieving a professional identity (PI). A Randomized Control Trial (RCT) was carried out with three measurement points (baseline, post-course, follow-up) and had three...

Background: Although eMental health interventions, especially when delivered in a blended way, have great potential to improve the quality and efficiency of mental health care, their use in practice lags behind expectations. The Fit for Blended Care (FfBC) instrument was developed to support therapists and clients in shaping blended care in a way t...

To strengthen students' professional identity (PI), it is vital to give reflection a central place in higher education. The aim of this study is to determine the extent to which students reflect on five components of PI (self-image, self-esteem, task perception, job motivation and future perspective) and at what reflection level. Twenty-five reflec...

Persuasive technology can support users of self-paced eLearning courses during critical moments of low motivation. Agent-based models (ABMs) - a relatively unfamiliar phenomenon within the persuasive technology and eLearning domains- offers a potentially relevant methodology to understand when the support should be delivered. Using ABMs, the dynami...

BACKGROUND Although eMental health interventions, especially when delivered in a blended way, have great potential to improve the quality and efficiency of mental health care, their use in practice lags behind expectations. The Fit for Blended Care (FfBC) instrument was developed to support therapists and clients in shaping blended care in a way th...

Whereas blended learning can deliver several benefits to students in higher education, their achievement depends on how exactly it is designed. A participatory design is recommendable to try to meet the needs of all stakeholders. The Persuasive System Design-model can be used to motivate students during the online part of the course. In the design...

Within the context of eHealth interventions, a shared understanding of what constitutes engagement in and with eHealth technologies is missing. A clearer understanding of engagement could provide a valuable starting point for guidelines relating to the design and development of eHealth technologies. Given the cross-disciplinary use of the term “eng...

Background: While eMental health interventions can have many potential benefits for mental health care, implementation outcomes are often disappointing. In order to improve these outcomes, there is a need for a better understanding of complex, dynamic interactions between a broad range of implementation-related factors. These interactions and proc...

Introduction: In this study, a blended learning course, designed using a participatory design approach and Persuasive Technology (PT), was evaluated by students and teachers. The use of a participatory design and PT may help facilitate a blended learning course that motivates students and supports teachers in this relatively new field. Method: Stud...

Background: Personal health records (PHRs) provide the opportunity for self-management support, enhancing communication between patients and caregivers, and maintaining and/or improving the quality of chronic disease management. Their implementation is a multi-level and complex process, requiring a holistic approach that takes into account the tec...

BACKGROUND While eMental health interventions can have many potential benefits for mental health care, implementation outcomes are often disappointing. In order to improve these outcomes, there is a need for a better understanding of complex, dynamic interactions between a broad range of implementation-related factors. These interactions and proces...

Background: There is growing evidence of the positive effects of electronic health (eHealth) interventions for patients with chronic illness, but implementation of such interventions into practice is challenging. Implementation strategies that potentially impact implementation outcomes and implementation success have been identified. Which strateg...

Background: The use of electronic health (eHealth) technologies in practice often is lower than expected, mostly because there is no optimal fit among a technology, the characteristics of prospective users, and their context. To improve this fit, a thorough systematic development process is recommended. However, more knowledge about suitable devel...

Objective: Recovery following lumbar fusion surgery is frequently accompanied by post-operative pain, and patients often continue to experience some level of chronic pain. There is a scarcity of qualitative research focusing on patient experiences regarding lumbar fusion surgery. This study aims to clarify how lumbar fusion surgery patients experi...

Online Positive Psychology Interventions (oPPIs) can provide a low-cost way to improve wellbeing in the general population. However, for these interventions to be effective, participants need to use them for a longer period of time and need to practice the content in their daily lives. This means that participants need to feel engaged with the inte...

The main goal of this report is to identify promising avenues of technology in forensic care. These recommendations can be used to determine where and how to invest time and money for the coming years. To reach this goal, the following research questions were formulated: • What is the current state of affairs with regard to technology in forensic d...

Prior research has shown that the more patients know about their disease, health, and lifestyle the better the health outcomes are. Patients who are suffering from either a physical disease with mental consequences or from mental illnesses can contribute to their own feeling of mental well-being by following evidence-based online, self-guided thera...

BACKGROUND User-Centered Design (UCD) is seen as a vital determinant of a healthcare informatics’ success. Yet, an increasing number of software companies work according to the Agile software development method, which is difficult to integrate with UCD practices. Log file analysis may provide opportunities for integrating UCD practices in the Agile...

Background: An increasing number of software companies work according to the agile software development method, which is difficult to integrate with user-centered design (UCD) practices. Log file analysis may provide opportunities for integrating UCD practices in the agile process. However, research within health care information technology mostly...

BACKGROUND There is increasing empirical evidence for the positive mental health effects of compassion-based interventions. Although numerous smartphone apps offering compassion-based interventions (‘compassion apps’) are now available for the general public, these apps have not been reviewed on their quality before. OBJECTIVE The current study fo...

In development, implementation and evaluation of eHealth it is essential to account for stakeholders' perspectives, opinions and values, which are statements that specify what stakeholders want to achieve or improve via a technology. The use of values enables developers to systematically include stakeholders' perspectives and the context of use in...

In eHealth, engagement is viewed as an important factor in explaining why interventions are beneficial to some and not to others. However, a shared understanding of what engagement is and how to measure it, is missing. This paper presents the set-up of the development and initial validation of a new scale to measure engagement with eHealth interven...

Background: Although literature and practice underline the potential of virtual reality (VR) for forensic mental healthcare, studies that explore why and in what way VR can be of added value for treatment of forensic psychiatric patients is lacking. Goals: This study aimed to identify (1) points of improvements in existing forensic mental health tr...

As seen throughout this book, eHealth is a promising way to improve health, wellbeing and healthcare. However, for eHealth technologies to have an effect, they need to be accepted and used in the intended way to benefit most from what eHealth technologies have to offer. But this has often proven to be difficult to promote. In this chapter, we will...

This chapter aims to describe persuasive health technology to help you understand the strategies that can improve the adherence to eHealth technologies and increase their effectiveness. As we have seen in Chapter 2 , behaviour change is important to improve health and well-being. Behaviour change techniques can be implemented in eHealth technology...

This is the first book to provide a comprehensive overview of the social and technological context from which eHealth applications have arisen, the psychological principles on which they are based, and the key development and evaluation issues relevant to their successful intervention. Integrating how eHealth applications can be used for both ment...

Background Treatment of offenders in forensic mental health is complex. Often, these in- or outpatients have low treatment motivation, suffer from multiple disorders, and have poor literacy skills. eHealth may be able to improve treatment outcomes because of its potential to increase motivation and engagement, and it can overcome the predominant on...

Background: Gamification is a promising strategy to increase the effectiveness of Web-based mental health interventions by enhancing engagement. However, because most studies focus on the longer term effects of gamification (eg, effectiveness or adherence at the end of the intervention period), there is limited insight into how gamification may en...

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Background: In electronic health (eHealth) evaluations, there is increasing attention for studying the actual usage of a technology in relation to the outcomes found, often by studying the adherence to the technology. On the basis of the definition of adherence, we suggest that the following three elements are necessary to determine adherence to eH...

Background Web-based mental health interventions have evolved from innovative prototypes to evidence-based and clinically applied solutions for mental diseases such as depression and anxiety. Open-access, self-guided types of these solutions hold the promise of reaching and treating a large population at a reasonable cost. However, a considerable f...

In electronic health (eHealth) research, limited insight has been obtained on process outcomes or how the use of technology has contributed to the users' ability to have a healthier life, improved well-being, or activate new attitudes in their daily tasks. As a result, eHealth is often perceived as a black box. To open this black box of eHealth, me...

Animallike robot companions such as robotic seal Paro are increasingly used in dementia care due to the positive effects that interaction with these robots can have on the well-being of these patients. Touch is one of the most important interaction modalities for patients with dementia and can be a natural way to interact with animallike robots. To...

This study aimed to explore supportive capabilities of VAs with the potential benefit in mind that users of self-guided eHealth interventions could be better supported. Spontaneous empathy and the explicitly expressed intention of non-responsive VAs to deliver user support is likely capable to engage and motivate users. Responsive VAs have even lar...

BACKGROUND Web-based mental health interventions have evolved from innovative prototypes to evidence-based and clinically applied solutions for mental diseases such as depression and anxiety. Open-access, self-guided types of these solutions hold the promise of reaching and treating a large population at a reasonable cost. However, a considerable f...

Background: Research has shown that web-based interventions concerning mental health can be effective, although there is a broad range in effect sizes. Why some interventions are more effective than others is not clear. Persuasive technology is one of the aspects which has a positive influence on changing attitude and/or behavior, and can contribu...

Web-based interventions for people with depressive symptoms are needed and show promising effects. However, it is a consistent finding that human support is needed and this makes implementation costly. This study investigates the adherence and effectiveness of a human-supported and automated-supported web-based intervention for people with mild to...

Nowadays, technology is increasingly used to increase people’s well-being. For example, many mobile and Web-based apps have been developed that can support people to become mentally fit or to manage their daily diet. However, analyses of current Web-based interventions show that many systems are only used by a specific group of users (eg, women, hi...

Internet interventions have been shown to be effective for treatment of mental health complaints. Although non-adherence poses a problem, persuasive technology might be a solution. However, there is limited insight in how and why technology may lead to more adherence and effectiveness. This study explores the role of involvement in a Behavior Chang...

The Third International Workshop on Behavior Change Support Systems provides a place to discuss recent advances in BCSS research. The selected papers show that research into behavior change support systems is expanding: not only by trying to reach more and other people, but also by expanding the contexts where BCSSs are employed. A key point for al...

Introduction: eHealth is gaining more and more ground in health psychology and behavioral medicine to support well-being, a healthier lifestyle or adherence to medications. Despite the large number of eHealth projects to date, the actual use of eHealth interventions is lower than expected. Many projects in Health fail to survive beyond the pilot ph...

Introduction: My Health Platform and e-Vita are two of the largest Dutch personal health records (PHRs) for improving self-management of patients with chronic diseases. Functions include insight in and monitoring of clinical data, self-management support and patient-provider communication. The University of Twente conducts two PhD projects to impro...

To develop effective behaviour change support systems, persuasive technology can be used. The persuasive systems design model offers a frame-work to identify and operationalize such elements. In this pilot study, we evalu-ate the questionnaire developed to measure perceived persuasiveness of infor-mation technology. We analyzed verbatim user-test t...