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Digital health interventions frequently struggle to sustain engagement over time, particularly when users are under stress and have limited time. This challenge is highly visible in informal caregiving for individuals with cancer. Informal caregivers must quickly assume complex practical responsibilities while managing uncertainty, emotional distress, and changing family roles. Many also report feeling excluded from care processes and lacking timely guidance from healthcare professionals. In such a context, engagement cannot be understood as a simple usage metric. It is closely linked to whether a digital tool fits into everyday life, provides meaningful support, and strengthens the caregiver's sense of competence and connection. If the intervention does not align with lived realities, even well-designed systems risk limited uptake and short-term use.

The Carer eSupport project aimed to develop and evaluate a web-based application to strengthen informal caregivers' preparedness for caregiving and support their well-being [2]. The intervention was developed through a human-centred design process that actively involved caregivers and healthcare professionals. The design focused on providing reliable information, practical guidance, psychosocial resources, and opportunities to connect both with peers and with healthcare professionals. From the outset, our goal was not to optimise engagement as a primary outcome. Instead, we sought to design content and features that would feel meaningful, relevant, and supportive in caregivers' everyday lives. The theoretical foundation drew on perspectives of well-being, particularly eudaimonic aspects such as competence, autonomy, and a sense of purpose. We aimed to create a resource that caregivers could turn to when they needed it, rather than a platform that required constant attention or ongoing interaction. However, during the feasibility study and pilot testing, it became clear that the intervention's potential impact depended strongly on how, and whether, caregivers engaged with it. Engagement was shaped not only by usability, but also by emotional readiness, perceived relevance, trust in the healthcare system, and the time and energy caregivers had available. In this setting, engagement could not be reduced to interaction metrics. It was closely connected to caregivers' lived experiences and the practical and emotional demands they faced each day.

Healthcare systems worldwide face increasing pressure due to resource limitations and the rising care demands of ageing populations. In cancer care, the shift from hospital-based treatment to home environments has placed much of the daily caregiving on family members. Known as informal caregivers (ICs), these individuals provide unpaid support, often taking on this role out of necessity rather than choice. They frequently lack access to the information and resources required for effective caregiving at home.

These increased responsibilities, combined with insufficient support, have significant implications for ICs’ well-being. Well-being is a multidimensional concept that includes physical health, mental state, and emotional stability. It is particularly vulnerable during major life transitions, such as when a close relative is diagnosed with a severe illness. ICs of individuals with head and neck cancer (HNC) are especially affected. This thesis is part of the Carer eSupport project, which aims to develop and evaluate a web-based application to support ICs.

The thesis aims to provide guidelines for developing and evaluating web-based applications that support the well-being of ICs of individuals with HNC. It also identifies factors that influence the acceptance and use of such applications. In doing so, the thesis highlights the situation of ICs, who play an essential role in cancer care but often receive limited support.

The thesis comprises five journal articles. A human-centred design process guided the overall work. Qualitative methods, including focus groups and interviews, were primarily used. Empirical data were analysed through thematic analysis.

Findings highlight challenges faced by ICs, including exclusion from healthcare processes, disruptions to daily routines, uncertainty about treatment outcomes, and shifts in identity and relationships. The results emphasise the need to address both functional needs, such as tailored information and structured support, and psychosocial challenges.

Acceptance and use depend on usability, trust, emotional relevance, and support from the healthcare system. Web-based applications can strengthen ICs' preparedness and support well-being when they are accessible, credible, and connected to human support. Designing for ICs’ well-being, therefore, requires approaches rooted in their daily routines and backed by healthcare systems that recognise ICs as partners in cancer care.

Background: Informal caregivers (ICs), often family members or close friends, provide essential support to individuals with head and neck cancer. However, they are frequently unprepared for the emotional, practical, and medical challenges involved. Web-based applications offer promising opportunities to support ICs, but their long-term adoption and acceptance remain uncertain.

Objective: This paper presents the development of Carer eSupport, a web-based application to support ICs’ well-being and preparedness for caregiving. We detail the design and functionality of the Carer eSupport application and explain how it responds to both the functional and psychological needs of ICs. Additionally, we report findings from the pilot study and highlight the initial challenges ICs faced when engaging with the application, along with the strategies used to overcome them.

Methods: The study involved a multicenter research trial across ear, nose, and throat clinics and oncology and radiotherapy clinics at 4 university hospitals in Sweden. The application was developed through 3 human-centered design (HCD) iterations involving ICs, health care professionals, and researchers in human-computer interaction and cancer care.

Results: The results present an overview of the current version of Carer eSupport (developed during the third design iteration), with a focus on features that address the psychological needs of ICs, including competence, autonomy, and a sense of connection to others. The pilot study achieved a 66.7% (20/30) consent rate, a 75% (9/12) successful login rate among participants, and a 13.3% (4/30) attrition rate, meeting the established criteria. The pilot study confirmed the application’s readiness for further evaluation in an ongoing randomized controlled trial. It also identified challenges, including the time constraints of ICs, login and authentication issues, limited IT infrastructure, and gaps in digital literacy.

Conclusions: Findings from the HCD process and pilot study indicate that a personalized, interactive application like Carer eSupport can provide meaningful support for ICs of individuals with head and neck cancer. The integration of HCD and health care science offers early guidance for developing digital tools that are both evidence-based and empathetic, with potential relevance beyond caregiving contexts.

Background

Informal caregivers (ICs) of individuals with head and neck cancer (HNC) often face heavy responsibilities with little preparation or support. Web-based health applications might be beneficial in this context, but their acceptance and influence on ICs' well-being require further investigation.

Objective

This study examines the acceptance and use of a web-based application designed to improve ICs' preparedness for caregiving and support their well-being. It also extends the Unified Theory of Acceptance and Use of Technology (UTAUT) with eudaimonic motivation, defined as the drive for personal growth, purpose, and self-actualisation, to explore how the application may enhance ICs’ well-being.

Methods

A multicentre feasibility study was carried out at ear, nose, and throat, oncology, and radiotherapy clinics across four Swedish university hospitals. Nineteen ICs took part in semi-structured interviews after five weeks of using Carer eSupport. Data were analysed through deductive thematic analysis guided by the extended UTAUT model.

Results

ICs perceived Carer eSupport as relevant and helpful in strengthening competence and preparedness. Barriers included information overload, lack of personalisation, and usability challenges. Participants recommended adding online forums, meetings with healthcare professionals, psychological support, and a more aesthetically improved layout.

Conclusion

Web-based applications have the potential to improve ICs’ preparedness and well-being if barriers to acceptance and use are addressed. Extending UTAUT with eudaimonic motivation provided new insights into how such applications can meet ICs’ intrinsic needs and support acceptance. This feasibility study lays the foundation for a forthcoming randomised controlled trial to evaluate the effectiveness of the application.

Introduction: Students experiencing poor wellbeing in elementary school can suffer lifelong consequences, including low self-esteem or depression. Understanding how to increase student wellbeing through information-based approaches is therefore important. While previous research has explored wellbeing frameworks, this study uniquely investigates the intersection of elementary school wellbeing with Internet of Things (IoT) implementation potential.

Method: We present the first comprehensive requirements analysis gathered from both staff and students for improving wellbeing in an elementary school in rural Sweden, with the aim of implementing IoT solutions. We collected qualitative data through individual interviews and workshops with 25 staff members and a survey from 464 students. We analyzed the data in an inductively and deductively way, using the Konu and Rimpel & auml;'s wellbeing framework.

Results: Our novel findings reveal alignment between staff and student perspectives across the framework's categories: having, loving, being and health. One example is the importance of motivation in each learning situation and creating a foundation for good social relations among the students. The requirements related to the health category received the least attention, reflecting less focus on individual student circumstances.

Discussion: This study contributes new knowledge by detailing wellbeing needs for elementary school and relating them to data-driven innovation, such as IoT, for gathering both objective and subjective information. We also acknowledge that this creates additional demands on current solutions and raises significant privacy concerns in school environments. Future research will incorporate expert IoT knowledge and develop prototype solution based on these identified requirements.

Health care increasingly depends on information and communication technology. This offers both opportunities and challenges when designing connected health systems. While individual studies examined particular cases, there is a limited synthesis of insights across projects. The objective of this paper is to explore these opportunities and challenges by examining 6 diverse connected health projects and synthesizing lessons from an expert workshop. To achieve this, we conducted a full-day workshop that brought together 6 connected health projects. The workshop used an iterative and participatory process which included paper submissions and presentations and facilitated discussions, and a gallery walk to enable cross-case comparison and collaborative reflection. Thematic analysis of workshop outputs was then used to synthesize key opportunities and challenges in designing connected health systems. The 6 projects represented a variety of design methods and approaches to connected health, and their discussion surfaced both opportunities and challenges in this domain. Key opportunities include improving data integration and usability, enhancing collaboration across stakeholders, using a user-centered and iterative design process, addressing complexity in sociotechnical systems, sustainability, and adopting digital infrastructures for seamless communication. Participants also identified important challenges, namely exchange of information, interoperability, and communication; ethical considerations, rules, and regulations; understanding design, evaluation, and standards; actionable data, reliability, quality, and trust in data; and stakeholder involvement. The contribution of this paper lies in the synthesis of insights across multiple projects and perspectives to provide practical guidance for researchers, designers, and policymakers. By highlighting opportunities and challenges in designing connected health systems, the findings emphasize the importance of patient-centered, sustainable, and collaborative design approaches while also pointing to the need to address persistent barriers. Advancing connected health will require adopting iterative and inclusive design processes that prioritize patient-centeredness, sustainability, and collaboration across health care systems.

Informal caregivers (ICs), including the patient's spouse, close relatives, or friends, play an important role in caregiving individuals with head and neck cancer (HNC). AI-based chatbots might offer information and assistance related to caregiving. This study presents the viewpoints of ICs and healthcare professionals (HCPs) on using AI-based chatbots in caring for individuals with HNC. A total of six focus groups were conducted with 15 ICs and 13 HCPs from three Swedish university hospitals. The study uncovers a widespread hesitancy toward the intention to use AI-based chatbots among ICs and HCPs. Factors contributing to this reluctance include their distrust in chatbot-provided information, negative past experiences of using chatbots, and lack of human connection in chatbot interactions. Embracing a holistic approach is crucial when designing chatbots, ensuring active user engagement and incorporating their perspectives into the design process.

The ‘Design Methods in Connected Health’ workshop aims to bridge the gap between research, practice, and design in the field of Connected Health. Connected Health refers to the integration of various technologies, such as wireless, digital, and telehealth, to create a patient-centric healthcare model that improves care delivery and outcomes. This workshop explores innovative design approaches that enhance user experience, accessibility, and the effectiveness of electronic health technologies. Drawing from disciplines like Human-Computer Interaction (HCI), Information Systems (IS), Health Informatics, and Healthcare, participants engage in discussions and collaborative activities to examine diverse design methods and their impact on user engagement and health outcomes. The workshop's objectives include sharing best practices, fostering collaboration, and ultimately drafting a joint scientific paper based on the insights gained. Through dynamic activities, such as a gallery walk, participants critically assess design methods and collaborate to determine the most suitable approaches for Connected Health applications.

Background: Informal caregivers, often family members or friends, play a crucial role in supporting individuals with chronic illnesses, disabilities, or age-related needs. However, the demands of caregiving can be overwhelming, leading to stress, burnout, and negative impacts on caregivers’ well-being. IT applications have emerged as potential solutions to support informal caregivers, but their design and evaluation often lack a comprehensive understanding of caregivers’ needs and preferences. By understanding caregivers’ perspectives on these issues, this review aimed to inform the development of more effective and user-centered IT solutions that truly support caregivers’ needs.

Objective: The purpose of this study was to conduct a scoping review to outline design recommendations for IT applications gathered from informal caregivers. In addition, this study presents evaluations of the use of IT applications by informal caregivers.

Methods: A five-step scoping review methodology was used to map relevant literature in the following manner: (1) research question identification, (2) relevant study identification, (3) selection of pertinent studies for review, (4) data charting from the selected literature, and (5) summarization and reporting of results. A structured search was conducted across the PubMed, Scopus, IEEE Xplore Digital Library, Web of Science, and ACM Digital Library databases. In addition, reference list hand searches and keyword searches in Google Scholar were undertaken. The inclusion criteria comprised research articles (journal and conference) focusing on IT applications tailored for informal caregivers, primarily qualitative studies. Two reviewers independently identified articles for review and extracted the data. Conflicts were resolved through discussion, with a third reviewer consulted if consensus could not be attained. Thematic analysis was used to analyze the data.

Results: A total of 82 articles were selected for the scoping review—44 (54%) related to design and 39 (48%) related to evaluation of IT applications. Six overarching themes emerged related to designing IT applications: information access, support systems, streamlining care-related tasks, fostering informal caregivers’ well-being, communication with formal health care professionals, and task support. Furthermore, 3 broad themes emerged related to the evaluation of IT applications for informal caregivers: facilitators of using IT applications, barriers to using IT applications, and suggestions for improving IT applications for informal caregivers.

Conclusions: To our knowledge, this is the first study to map the literature on the design and evaluation of IT applications for informal caregivers. This scoping review outlines current practices and recommendations for designing and evaluating the use of IT applications for informal caregivers. It identifies 6 key design themes and 3 evaluation themes, offering valuable insights for future development in this field. These findings provide a road map for enhancing user-centric IT solutions in informal caregiver support technologies.

Informal caregivers, crucial contributors to healthcare, face myriad challenges in supporting individuals with health needs. While IT applications offer promising solutions, some caregivers hesitate to adopt them, favoring traditional communication approaches with healthcare and support providers. This study, conducted in Sweden, presents why caregivers are reluctant to use IT applications. Through a qualitative approach involving group interviews with caregiver association members, four key themes emerged, namely, need for in-person support with grief and stress, need for private support spaces, cognitive impairment, and financial constraints. Understanding these barriers is crucial for developing inclusive caregiving strategies that balance IT-based solutions with in-person assistance, promoting a sustainable caregiving support ecosystem.