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  <front>
    <journal-meta />
    <article-meta>
      <title-group>
        <article-title>Sustained Use and Lasting Effects of Behavior Change Support Systems</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Sriram Iyengar</string-name>
          <email>iyengar@medicine.tamhsc.edu</email>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Piiastiina Tikka</string-name>
          <email>piiastiina.tikka@oulu.fi</email>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Lisette van Gemert-Pijnen</string-name>
          <xref ref-type="aff" rid="aff1">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Harri Oinas-Kukko- nen</string-name>
          <email>harri.oinas-kukkonen@oulu.fi</email>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <aff id="aff0">
          <label>0</label>
          <institution>Oulu Advanced Research on Service and Information Systems Group, Faculty of Information Technology and Electrical Engineering, University of Oulu</institution>
          ,
          <addr-line>Oulu</addr-line>
          ,
          <country country="FI">Finland</country>
        </aff>
        <aff id="aff1">
          <label>1</label>
          <institution>Psychology, Health &amp; Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente</institution>
          ,
          <addr-line>Enschede</addr-line>
          ,
          <country country="NL">The Netherlands</country>
        </aff>
        <aff id="aff2">
          <label>2</label>
          <institution>School of Medicine, Texas A&amp;M Health Science Center</institution>
          ,
          <country country="US">USA</country>
        </aff>
      </contrib-group>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>Introduction</title>
      <p>
        Behavior Change Support Systems (BCSS), comprise a collection of systems
constructs that are specifically designed to help and support behavior change in individuals
or groups. The highly multi-disciplinary nature of designing and implementing
behavior change strategies and systems for the strategies has been in the forefront of
advancing persuasive technology from early on [
        <xref ref-type="bibr" rid="ref1 ref2 ref3 ref4">1, 2, 3, 4</xref>
        ]. The persuasive technology field is
becoming a linking pin connecting natural and social sciences, requiring a holistic view
on persuasive technologies, as well as multi- disciplinary approach for design,
implementation, and evaluation. So far, the capacities of technologies to change behaviors
and to continuously monitor the progress and effects of interventions are not being used
to its full potential.
      </p>
      <p>The use of technologies as persuaders may shed a new light on the interaction
process of persuasion, influencing attitudes and behaviors. Yet, although human-computer
interaction is social in nature and people often do see computers as social actors, it is
still unknown how these interactions re-shape attitude, beliefs, and emotions, or how
they change behavior, and what the drawbacks are for persuasion via technologies.
Humans re-shape technology, changing their goals during usage. This means that
persuasion is not a static ad-hoc event but an ongoing process.</p>
      <p>Technology has the capacity to create smart (virtual) persuasive environments that
provide simultaneously multimodal cues and psycho-physiological feedback for
personal change by strengthening emotional, social, and physical presence. An array of
persuasive applications has been developed over the past decade with an aim to induce
desirable behavior change. Persuasive applications have shown promising results in
motivating and supporting people to change or adopt new behaviors and attitudes in
various domains such as health and wellbeing, sustainable energy, education, and
marketing.</p>
      <p>The International Workshop series on Behavior Change Support Systems (BCSS)
aims at connecting multidisciplinary researchers, practitioners and experts from a
variety of scientific domains, such as information sciences, human-computer
interaction, industrial design, psychology and medicine. This interactive workshop acts as a
forum where experts from multiple disciplines can present their work, and can discuss
and debate the pillars for persuasive technology. The Seventh International Workshop
series on Behavior Change Support Systems comprises new and interesting work on
BCSSs in general and also a more focused theme of longevity either as regards
sustained use of a system or in terms of lasting effects.
2</p>
    </sec>
    <sec id="sec-2">
      <title>Longevity</title>
      <p>
        Whether lifestyle-related or managing a chronic illness, behavior change requires
longevity. Either through sustained use of a system, or in terms of lasting effects. Where
it is necessary to observe and understand the immediate effects of BCSSs on behavior,
it is also necessary to highlight the need for the broader time span view on the use and
effects of these systems. For example, with chronic illnesses such as hypertension,
diabetes, or depression, the diagnosis and following treatments are often merely the
beginning for the patient, who then enters a life-long self-management process regarding
his or her condition. Similarly, a long-time favorite of the persuasive technology field
and BCSS interventions, obesity [
        <xref ref-type="bibr" rid="ref5">5</xref>
        ], is a slow process where overweight that is
collected over years will also take years to take off. Other behavioral domains, from
wellbeing to ecological behaviors, often involve a more sustained learning and rehearsal
curve, and systems that remain helpful and supportive for the users beyond a few weeks
or months could potentially lead to behavior change that is still effective years later.
      </p>
      <p>
        New technologies allow us to gather larger amounts of data from multiple sources,
e.g., multi-sensor data and self-tracking data, that can be used for customization and
personalization purposes. Where the focus was on small, exact datasets and causal
connections in the past (i.e. knowing “why”); advances in big data cause a paradigm shift
towards the gathering or linkage of large amounts of (noisy) data to demonstrate the
presence of (unexpected) correlational connections (i.e. knowing “what”) [
        <xref ref-type="bibr" rid="ref6">6</xref>
        ]. Though
this opens new exciting frontiers of research, important concerns have been raised as
well concerning issues like safety, profiling, purpose limitation, liability, data
ownership, and (above all) privacy [
        <xref ref-type="bibr" rid="ref5 ref6 ref7 ref8">5, 6, 7, 8</xref>
        ]. Such issues should be dealt with appropriately,
to enhance the public’s trust in technological advancements.
      </p>
      <p>
        The persuasive technology field is becoming a linking pin connecting natural and
social sciences, requiring a holistic view on persuasive technologies, as well as
multidisciplinary approach for design, implementation, and evaluation. So far, the capacities
of technologies to change behaviors and to continuously monitor the progress and
effects of interventions are not being used to its full potential. Specific aspects of the
intervention (its content or the system) contributing to the results and user adherence
often remain unknown, known as the ‘black box’ phenomenon [
        <xref ref-type="bibr" rid="ref9">9</xref>
        ].
      </p>
      <p>The use of technologies as persuaders may shed a new light on the interaction
process of persuasion, influencing attitudes and behaviors. Yet, although human-computer
interaction is social in nature and people often do see computers as social actors, it is
still unknown how these interactions re-shape attitude, beliefs, and emotions, or how
they change behavior, and what the drawbacks are for persuasion via technologies.
Humans re-shape technology, changing their goals during usage. This means that
persuasion is not a static ad-hoc event but an ongoing process.</p>
      <p>Validated and suitable evaluation methods are needed, as well as mixed-methods
approaches to measure engagement, emotions, and social influence of persuasive
technologies in smart environments. BCSSs pose a number of specific challenges, such as
personal goal-setting, personalized feedback, support for computer-mediated
communication, 24/7 availability, feasible business models, as well as suitable methods and
processes to develop scalable software platforms and architectures for these systems.
3</p>
    </sec>
    <sec id="sec-3">
      <title>The Seventh International Workshop on BCSS</title>
      <p>This year’s implementation of the workshop was organized in in conjunction with
the 14th International Conference on Persuasive Technology 2019, in Limassol,
Cyprus, by Prof. Sriram Iyengar (Texas A&amp;M, USA) as Programme chair, and Dr
Piiastiina Tikka (University of Oulu, Finland) as Organising chair. The founders and general
co-chairs of the workshop series are Harri Oinas-Kukkonen (University of Oulu,
Finland) and Lisette van Gemert-Pijnen (University of Twente, The Netherlands).</p>
      <p>We wish to thank the following program committee members:
• Dr Laurance Alpay, Inholland University, The Netherlands
• Dr Grace Dal Sasso, Federal University of Santa Catarina, Brasil
• Dr Jose Florez-Arango, MD, Texas A&amp;M, USA
• Dr Sandra Burri Gram-Hansen, Aalborg University, Denmark
• Dr Padma Narasimhan, MBBS, University of New South Wales, Australia
• Dr Scott Sittig, University of South Alabama, USA
• Dr Tugba Taskaya Temizel, Middle East Technical University, Turkey
We also wish to thank several ad-hoc reviewers who volunteered to provide peer
reviews for the submitted manuscripts.
4</p>
    </sec>
    <sec id="sec-4">
      <title>Presented work</title>
      <p>In this seventh occurrence of the BCSS workshop, we have nine papers presented
by a global network of researchers.</p>
      <p>
        In the area of assistive and rehabilitation research Peres et al. present “Augmented
Crutches”, a persuasive system designed to assist those with impaired mobility enhance
independent movement and reduce dependence on therapists [
        <xref ref-type="bibr" rid="ref10">10</xref>
        ]. Kekkonen and
colleagues address usability issues in persuasive systems that incorporate social
comparison [
        <xref ref-type="bibr" rid="ref11">11</xref>
        ]. Konstanti et al. present Behavior Change Design Cards, a structured and
creative design methodology for developing persuasive systems [
        <xref ref-type="bibr" rid="ref12">12</xref>
        ].
      </p>
      <p>
        De Franco et al present a case for incorporating the Transtheoretical behavior
change model to design persuasive systems with sustained effectiveness [
        <xref ref-type="bibr" rid="ref13">13</xref>
        ]. Chow
and colleagues discuss embedded persuasive technologies that take advantage of smart
and connected sensors [
        <xref ref-type="bibr" rid="ref14">14</xref>
        ]. Almutairi et al. present a case for nudging in systems for
asthma management [15[.
      </p>
      <p>
        Kashimoto and colleagues describe a persuasive system for encouraging use of
electronic coupons received on smartphones [
        <xref ref-type="bibr" rid="ref16">16</xref>
        ]. Kegel et al. explore the potential of using
computer literacy in software design as means of creating tailored of adaptive systems
that would enhance the likelihood of continued system use [
        <xref ref-type="bibr" rid="ref17">17</xref>
        ]. Finally, Klaassen and
colleagues describe two case studies related to persuasion by doing and performing
actions [
        <xref ref-type="bibr" rid="ref18">18</xref>
        ].
      </p>
      <p>Overall, the rich variety of presented work at the workshop once again illustrated
the necessity of interdisciplinary approaches and the benefits of viewing BCSSs from
a variety of scientific perspectives. From such a multifaceted starting point we are
bound to learn both the science and the art of building and studying BCSSs that work
for the intended users in the intended manner.
5</p>
    </sec>
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          )
          <article-title>In Body Experiences: Persuasion by Doing</article-title>
          .
          <source>CEUR Workshop Proceedings</source>
          , in this issue.
        </mixed-citation>
      </ref>
    </ref-list>
  </back>
</article>