Anthony Duffy

Background: Wearable technologies are rapidly transforming the health care landscape by enabling the tracking of real-time physiological and behavioral data used in healthy lifestyle interventions. Despite their widespread adoption in the consumer market, scientific validation of their impact on the brain remains limited, and factors influencing effects on cognition and adherence are not fully understood. This gap is critical, as consumers, health care providers, and researchers depend on these data to unlock the potential of wearables for cognitive support. Objective: We aim to assess the effectiveness, engagement, and acceptability of a commercially available smartwatch healthy lifestyle intervention on cognitive enhancement in healthy adults, using a convergent parallel mixed methods design. We seek to provide a comprehensive, replicable methodological framework to evaluate wearable technology interventions targeting cognitive enhancement in healthy adults. Methods: Healthy adults aged 18 to 40 years with a sedentary lifestyle (N=72) interested in participating in a healthy lifestyle intervention will be recruited in the Vancouver Metropolitan Area, BC, Canada. Participants will be randomly assigned into an intervention group using an Apple Watch or a control group following standard physical activity guidelines without an Apple Watch for a period of 4 weeks. Effectiveness will be evaluated through (1) cognitive function (primary outcome)—executive function, specifically inhibitory control, via electroencephalogram-based event-related potentials (N2/P3) during a go/no-go task; (2) resting-state brain activity via electroencephalogram spectral power; (3) behavioral performance (reaction time and accuracy); (4) perceived health (36-item Short Form Health Survey); and (5) qualitative analysis of factors affecting the intervention’s effectiveness. Engagement will be assessed through goal completion metrics and qualitative analysis of barriers, facilitators, and usage patterns. Acceptability will be assessed through System Usability Scale scores and qualitative analysis of factors affecting usability, satisfaction, and user preferences. This design integrates assessments before, during, and after intervention. Qualitative assessments will include weekly check-ins and semistructured interviews to obtain a comprehensive understanding of factors influencing the effectiveness, engagement, and acceptability of the intervention. Exploratory outcomes include descriptions of possible interactions between the 3 constructs and comparison of smartwatch-tracked vs self-reported goal completion. Results: The study received funding from the AGE-WELL Network Centres of Excellence (April 2020-March 2023) and was approved by the Simon Fraser University Research Ethics Board. Enrollment for the study is ongoing. As of October 2026, data have been collected from 48 participants and are currently being processed and analyzed. The first results are expected to be published in 2027. Conclusions: This study outlines a foundational framework for evaluating the effectiveness, engagement, and acceptability of wearable health interventions targeting cognitive enhancement in healthy adults. Furthermore, our mixed methods approach with randomized controlled comparison is expected to inform the design and development of effective, engaging, and friendly wearable brain health technologies.

Background: Adolescent sleep duration can substantially impact mood, behavior, and academic attainment. While hundreds of sleep-related apps are available to download, none have been cocreated with adolescents from underserved populations in the United Kingdom. Objective: This study aimed to explore adolescents’ views, expectations, and experiences with a novel app to improve sleep, called Sleep Solved, to understand which features were perceived as positive and helpful, and to identify ways to further enhance its usefulness. Sleep Solved is part of a larger stepped behavior change study and was cocreated with adolescents from underserved groups to make the app accessible and engaging for this population. Methods: A total of 63 participants aged 16‐18 years from across the United Kingdom completed semistructured interviews after trying the app. Interviews were analyzed using inductive thematic analysis, as outlined by Braun and Clarke, with a particular focus on the views of individuals from underserved ethnic and socioeconomic groups. Results: Participants perceived Sleep Solved as a useful tool that provides helpful advice regarding changeable behaviors to improve sleep hygiene. Cocreated features of the app, such as the Sleep Stars gamified rewards system and the easy-read, science-based “sleep hacks,” were viewed positively by participants, who reported that they had a beneficial impact on their sleep and sleep schedule. Praise was given for the app’s ease of use and how the science of sleep was explained at an appropriate level, without being overwhelming. Compared to sleep advice on social media platforms, Sleep Solved was considered more reliable and trustworthy. Participants described better sleep hygiene, such as a regular sleep routine and a longer sleep duration, and increased feelings of improved mood and energy. Conclusions: This study found that a cocreated sleep app, designed with input from adolescents in underserved UK populations, was perceived as accessible, reliable, and effective in supporting positive sleep behavior change. Although sleep duration was not objectively tested, participants, particularly those from low socioeconomic status backgrounds and diverse ethnicities, reported improved sleep routines and mood, highlighting the potential of co-designed digital tools to engage and benefit adolescent users.

BACKGROUND Wearable technologies, such as the Apple Watch, are rapidly transforming the healthcare landscape by enabling the tracking of real-time physiological and behavioral data used in healthy lifestyle interventions. Despite their widespread adoption in the consumer market, scientific validation of their impact on the brain remains limited, and factors influencing adherence and effects on cognition are not fully understood. This gap is critical as consumers, healthcare providers, and researchers depend on this data to unlock the potential of wearables for cognitive support. OBJECTIVE In this study, we aim to assess the cognitive and behavioral effect of a commercially available wearable technology, the Apple Watch, on the brain, while exploring user experience (UX) factors influencing adherence, engagement, and acceptability of wearable healthy lifestyle interventions. Our goal is to provide comprehensive guidelines to evaluate the effect of wearable technologies on the brain, which could potentially shape the future of brain health interventions. METHODS Healthy adults aged 18-40 with a sedentary lifestyle (n=72) will be recruited in the Vancouver Metropolitan Area, BC, Canada. Participants will be randomized into an intervention group following a healthy lifestyle intervention using an Apple Watch or a control group following standard physical activity guidelines without an Apple Watch over a period of four weeks. We will employ a convergent parallel mixed methods design to investigate three constructs of a wearable healthy lifestyle intervention: effectiveness, engagement, and acceptability. This design integrates pre-, during, and post-intervention assessments combining quantitative and qualitative approaches. Effectiveness will be evaluated with quantitative assessments including perceived health (SF-36), behavioral performance (Go/No-Go task) and cognitive activity (EEG-based ERPs and resting-state activity). Engagement and acceptability will be assessed using questionnaires (goals completion and System Usability Scale, respectively). Qualitative assessments will include weekly check-ins and semi-structured interviews to capture UX factors influencing the acceptability of the intervention. Secondary outcomes include descriptions of possible interactions between the three constructs. RESULTS The study received funding by the AGE-WELL Network Centres of Excellence (April 2020–March 2023) and the Pacific Economic Development Agency of Canada (April 2022–March 2025) and was approved by Simon Fraser University’s Research Ethics Board. Enrollment for the study is ongoing. The data collected from participants who have successfully completed the intervention is currently being processed and analyzed. The first results are expected to be published by the end of 2025. CONCLUSIONS This study outlines a foundational framework for evaluating the effect of wearable health interventions on the brain. Further, we hope our mixed methods approach will inform the design and development of effective, engaging, and friendly wearable brain health technologies.

BACKGROUND Adolescent sleep duration can substantially impact mood, behavior, and academic attainment. While hundreds of sleep-related apps are available to download, none have been co-created with adolescents from underserved populations in the UK. OBJECTIVE The aim of this study was to explore adolescents' views, expectations and experiences with a novel app to improve sleep, called Sleep Solved, to understand which features were perceived as positive and helpful, and to identify ways to further enhance its usefulness. Sleep Solved is part of a larger stepped behavior change study and was co-created with adolescents from underserved groups to make the app accessible and engaging for this population. METHODS Sixty-three participants aged 16-18 from across the UK completed semi-structured interviews after trying the app. Interviews were analyzed using inductive thematic analysis, with a particular focus on the views of individuals from underserved ethnic and socioeconomic groups. RESULTS Participants perceived Sleep Solved as a useful tool that provides helpful advice regarding changeable behaviors to improve sleep hygiene. Co-created features of the app, such as the Sleep Stars gamified rewards system and the easy-read, science-based ‘sleep hacks’, were viewed positively by participants, who reported that it had a beneficial impact on their sleep and sleep schedule. Praise was given for the app’s ease of use, and how the science of sleep was explained at an appropriate level, without being overwhelming. Compared to sleep advice on social media platforms, Sleep Solved was considered more reliable and trustworthy. Participants described better sleep hygiene, such as a regular sleep routine and a longer sleep duration, and increased feelings of improved mood and energy. CONCLUSIONS This study found that a co-created sleep app, designed with input from adolescents in underserved UK populations, was perceived as accessible, reliable, and effective in supporting positive sleep behavior change. Participants, particularly those from low socioeconomic status (SES) backgrounds and diverse ethnicities, reported improved sleep routines and mood, highlighting the potential of co-designed digital tools to engage and benefit adolescent users.

INTRODUCTION: Co-design has become a fundamental pillar of formative digital health research. Typically, this approach involves in–person workshops that involve a rich but limited amount of data. Virtually crowdsourcing co-design, however, provides the promise of rapid and vastly increased data. This is a novel, exploratory approach in mHealth design that may appease common health research concerns surrounding reliability and validity, whilst providing swifter feedback to meet product development timelines.OBJECTIVES: The objective of this exploratory single case study was to explore the virtual, crowdsourced, co-design of Sleep Solved, an educational mHealth sleep app designed with teens. In doing so, we wished to learn which virtual methods were used to engage teens in the co-design and to explore how these virtual co-design methods can be adapted for large-scale ideation and testing.METHODS: We conducted an enquiry-based iterative case study utilising the Bayazit 3-stage model. 85 teens participated over 11 months. Data was thematically analysed over several design iterations.RESULTS: Rapid virtual feedback allowed for quick pivots in a short time frame. Four stages of feedback from teens led to iterative changes to scientific information contextualisation and user experience, from lo-fidelity mock-ups through to a coded app beta.CONCLUSION: The co-design of Sleep Solved exemplified the potential of virtually crowdsourcing teens in mHealth. Key to this evolution will be the ability to leverage big data utilising AI and machine learning approaches to data collation and synthesization, such that meaningful and contextual findings can be applied in line with software development timelines.

Background: Digital health interventions (DHIs) are changing the dynamic of health care by providing personalized, private, and instantaneous solutions to end users. However, the explosion of digital health has been fraught with challenges. The approach to co-design with end users varies across a diverse domain of stakeholders, often resulting in siloed approaches with no clear consensus. The concept of validating user experiences contrasts greatly between digital stakeholders (ie, user experience and retention) and health stakeholders (ie, safety and efficacy). Several methodologies and frameworks are being implemented to address this challenge to varying degrees of success. Objective: We aimed to broadly examine the advancements and challenges to co-design DHIs with end users over the last decade. This task was undertaken to identify the key problem areas at the domain level, with the ultimate goal of creating recommendations for better approaches to co-design DHIs with end users. Methods: We conducted a systematic search of key databases for co-design studies involving end users in DHIs. Searches were divided into 3 relevant streams: health behavior, user experience, and digital methodologies and frameworks. The eligibility criteria were guided by the PerSPEcTiF framework and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. In line with this framework, studies were included in this review that (1) address research on DHIs; (2) focus on interaction and co-design with end users; (3) explain results such that uptake, effectiveness, satisfaction, and health outcomes are discernible, positively or negatively; and (4) describe actionable procedures for better DHI design. The search was conducted in a diverse group of 6 bibliographical databases from January 2015 to May 2024: PsycINFO, PubMed (MEDLINE), Web of Science, CINAHL, Institute of Electrical and Electronics Engineers Xplore, and Scopus. From the 13,961 studies initially screened for titles and abstracts, 489 (3.6%) were eligible for a full-text screening, of which 171 (1.2%) studies matched the inclusion criteria and were included in a qualitative synthesis. Results: Of the 171 studies analyzed across 52 journals, we found 5 different research approaches, spanning 8 different digital health solution types and 5 different design methodologies. These studies identified several core themes when co-designing with end users: advancements, which included participatory co-design; challenges, which included participatory co-design, environment and context, testing, and cost and scale; and gaps, which included a pragmatic hybridized framework and industry implementability. Conclusions: This research supports a pragmatic shift toward using mixed methods approaches at scale, methods that are primed to take advantage of the emerging big data era of digital health co-design. This organic outlook should blend the vision of digital health co-designers with the pragmatism of Agile design methodology and the rigor of health care metrics. Trial Registration: PROSPERO CRD42021238164; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021238164 International Registered Report Identifier (IRRID): RR2-10.2196/28083

Background: Poor sleep is a common problem in adolescents aged 14 to 18 years. Difficulties with sleep have been found to have a bidirectional link to mental health problems. Objective: This new research sought to involve young people in the co-creation of a new app, particularly those from underserved communities. The Sleep Solved app uses science-based advice to improve sleep-related behaviors and well-being. The app was developed using the person-based approach, underpinned by the social cognitive theory and the social-ecological model of sleep health. Methods: Young people (aged 14-18 y) were recruited from across the United Kingdom to contribute to patient and public involvement (PPI) activities. In partnership with our peer researcher (MHJ), we used a multitude of methods to engage with PPI contributors, including web-based workshops, surveys, think-aloud interviews, focus groups, and app beta testing. Results: A total of 85 young people provided PPI feedback: 54 (64%) young women, 27 (32%) young men, 2 (2%) genderfluid people, 1 (1%) nonbinary person, and 1 (1%) who reported “prefer not to say.” Their levels of deprivation ranged from among the 40% most deprived to the 20% least deprived areas. Most had self-identified sleep problems, ranging from 2 to 3 times per week to >4 times per week. Attitudes toward the app were positive, with praise for its usability and use of science-based yet accessible information. Think-aloud interviews and a focus group identified a range of elements that may influence the use of the app, including the need to pay attention to language choices and readability. User experiences in the form of narrated audio clips were used to normalize sleep problems and provide examples of how the app had helped these users. Conclusions: Young people were interested in using an app to better support their sleep and mental health. The app was co-created with strong links to theory- and evidence-based sleep hygiene behaviors. Future work to establish the effectiveness of the intervention, perhaps in a randomized controlled trial, would provide support for potential UK-wide rollout.

BACKGROUND Poor sleep is a common problem in adolescents aged 14 to 18 years. Difficulties with sleep have been found to have a bidirectional link to mental health problems. OBJECTIVE This new research sought to involve young people in the co-creation of a new app, particularly those from underserved communities. The Sleep Solved app uses science-based advice to improve sleep-related behaviors and well-being. The app was developed using the person-based approach, underpinned by the social cognitive theory and the social-ecological model of sleep health. METHODS Young people (aged 14-18 y) were recruited from across the United Kingdom to contribute to patient and public involvement (PPI) activities. In partnership with our peer researcher (MHJ), we used a multitude of methods to engage with PPI contributors, including web-based workshops, surveys, think-aloud interviews, focus groups, and app beta testing. RESULTS A total of 85 young people provided PPI feedback: 54 (64%) young women, 27 (32%) young men, 2 (2%) genderfluid people, 1 (1%) nonbinary person, and 1 (1%) who reported “prefer not to say.” Their levels of deprivation ranged from among the 40% most deprived to the 20% least deprived areas. Most had self-identified sleep problems, ranging from 2 to 3 times per week to >4 times per week. Attitudes toward the app were positive, with praise for its usability and use of science-based yet accessible information. Think-aloud interviews and a focus group identified a range of elements that may influence the use of the app, including the need to pay attention to language choices and readability. User experiences in the form of narrated audio clips were used to normalize sleep problems and provide examples of how the app had helped these users. CONCLUSIONS Young people were interested in using an app to better support their sleep and mental health. The app was co-created with strong links to theory- and evidence-based sleep hygiene behaviors. Future work to establish the effectiveness of the intervention, perhaps in a randomized controlled trial, would provide support for potential UK-wide rollout.

BACKGROUND Digital health interventions (DHIs) are changing the dynamic of health care by providing personalized, private, and instantaneous solutions to end users. However, the explosion of digital health has been fraught with challenges. The approach to co-design with end users varies across a diverse domain of stakeholders, often resulting in siloed approaches with no clear consensus. The concept of validating user experiences contrasts greatly between digital stakeholders (ie, user experience and retention) and health stakeholders (ie, safety and efficacy). Several methodologies and frameworks are being implemented to address this challenge to varying degrees of success. OBJECTIVE We aimed to broadly examine the advancements and challenges to co-design DHIs with end users over the last decade. This task was undertaken to identify the key problem areas at the domain level, with the ultimate goal of creating recommendations for better approaches to co-design DHIs with end users. METHODS We conducted a systematic search of key databases for co-design studies involving end users in DHIs. Searches were divided into 3 relevant streams: health behavior, user experience, and digital methodologies and frameworks. The eligibility criteria were guided by the PerSPEcTiF framework and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. In line with this framework, studies were included in this review that (1) address research on DHIs; (2) focus on interaction and co-design with end users; (3) explain results such that uptake, effectiveness, satisfaction, and health outcomes are discernible, positively or negatively; and (4) describe actionable procedures for better DHI design. The search was conducted in a diverse group of 6 bibliographical databases from January 2015 to May 2024: PsycINFO, PubMed (MEDLINE), Web of Science, CINAHL, Institute of Electrical and Electronics Engineers Xplore, and Scopus. From the 13,961 studies initially screened for titles and abstracts, 489 (3.6%) were eligible for a full-text screening, of which 171 (1.2%) studies matched the inclusion criteria and were included in a qualitative synthesis. RESULTS Of the 171 studies analyzed across 52 journals, we found 5 different research approaches, spanning 8 different digital health solution types and 5 different design methodologies. These studies identified several core themes when co-designing with end users: advancements, which included participatory co-design; challenges, which included participatory co-design, environment and context, testing, and cost and scale; and gaps, which included a pragmatic hybridized framework and industry implementability. CONCLUSIONS This research supports a pragmatic shift toward using mixed methods approaches at scale, methods that are primed to take advantage of the emerging big data era of digital health co-design. This organic outlook should blend the vision of digital health co-designers with the pragmatism of Agile design methodology and the rigor of health care metrics. CLINICALTRIAL PROSPERO CRD42021238164; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021238164 INTERNATIONAL REGISTERED REPORT RR2-10.2196/28083