Master´s Theses and Doctoral Dissertations

Bridging the Gap: Designing Digital Technologies to Empower Cardiac Patients Between Hospital and Rehabilitation

Höppchen, Isabel
Dissertation

Paris Lodron Universität Salzburg, June 2025

Betreuer at PLUS: Prof. Dr. DI Alexander Meschtscherjakov
Betreuer at LBI-DHP: Dr. Daniela Wurhofer & Dr. Stefan Tino Kulnik

Abstract:

Cardiac rehabilitation (CR) is a key element of secondary prevention for patients with cardiovascular disease, yet global and national uptake remains low. In Austria, less than one third of eligible patients participate in CR. Reasons for patients’ low utilization of CR are multifaceted, pointing to fragmented care transitions, limited information flow, and emotional or motivational barriers.

This dissertation investigates how digital technologies can support cardiac patients during the critical phase between hospital discharge and the start of rehabilitation. By combining Human-Computer Interaction and Implementation Science, the work adopts a patient-centered approach to explore patient needs, co-design digital solutions for the suboptimal use of CR, and examine the integration of these solutions into real-world clinical routines.

Empirical findings were generated mainly through qualitative methods, centered around a co-design workshop series with cardiac patients and healthcare professionals. The insights informed the development of the HERO smartphone application – a mobile health technology designed to support patients’ orientation during the transition from hospital to CR, assist them in regaining emotional balance after a cardiac event, and motivate them to make the most of their CR participation.

This dissertation makes three core contributions: First, it provides empirical insights into cardiac patients’ behavioral, emotional, and informational needs during care transitions, with a focus on barriers to CR uptake. Second, it introduces two conceptual frameworks: a pathway-based patient information map, and four design principles — timely access, actionable guidance, peer narratives, and short-term usability — for mobile health technologies supporting transitional care. Third, it presents a co-designed, field-tested mobile health technology, the HERO app, aligned with real-world clinical constraints and user needs.

Overall, the findings underscore the added value of integrating Human-Computer Interaction and Implementation Science to bridge gaps in fragmented care pathways. Mobile health technologies such as the HERO app show promising potential in providing targeted, timely, and trustworthy support. Consequently, they may enhance patients’ self- management and decision-making, empowering them to take a more active role in their recovery.

Exploring Self-Tracking Practices of Older Adults with CVD to Design LLM-Enabled Data Sense-Making

Dai, Duosi
Masterarbeit

KTH Royal Institute of Technology (Master’s Programme, Interactive Media Technology), 03.07.2025

Supervisor at KTH: Sanna Kuoppamäki
Supervisors at LBI-DHP: Jan Smeddinck, Pavithren V S Pakianathan

Abstract:

Self-tracking technologies such as wearable devices and mobile health apps have become part of everyday health management for many people. For older adults living with cardiovascular disease (CVD), these tools offer potential support for staying active and maintaining independence. However, the data they generate often feels emotionally overwhelming or difficult to interpret. This study explores how older adults with CVD make sense of their physical activity data and reflects on how these practices can inform the design of Large Language Model (LLM)-based tools that aim to support such data sensemaking. A seven-day diary study followed by in-depth interviews was conducted with eight older adults between the ages of 64 and 82, all diagnosed with CVD.

The interview data was analyzed using inductive thematic analysis, which resulted in the development of four key themes. First, participants experienced emotional ambivalence towards health data, where reassurance and stress often coexisted. Second, they gradually developed a sense of ownership over their health narratives by interpreting data on their own terms. Third, they used tracking data as objective evidence to guide personal decision-making. Fourth, they valued subjective bodily sensations over numerical outputs when those conflicted. These themes reflect the complex, situated ways older adults engage with digital health tracking tools.

Based on these findings, this thesis outlines design implications for LLM-based tools aimed at supporting older adults’ sensemaking practices. The proposed directions include enabling emotionally responsive feedback, reinforcing personal agency and autonomy, offering data-driven guidance tailored to individual needs, and reflecting embodied experiences in data interpretation. Future LLM-based data sensemaking tools should not only be intelligent but also  personalized and emotionally attuned to older adults’ lived realities.

Bridging the Intention-Behavior Gap in Physical Activity:
Towards a Dynamic Within-Person Perspective

Haag, David
Doctoral Dissertation

Paris Lodron Universität Salzburg, April 2025

Supervisor at PLUS: Univ.-Prof. Dr. Jens Blechert
Supervisors at LBI-DHP: Jan Smeddinck, Dieter Hayn

Abstract:

The world is facing a physical inactivity ‘pandemic’. Almost a third of the global adult population are not meeting the recommended levels of physical activity (PA) set by the World Health Organization (WHO). This insufficient PA is a leading risk factor for non-communicable diseases, such as heart disease, type 2 diabetes, and obesity, that lead mortality rankings all over the globe. While individuals frequently set goals to exercise more, a substantial gap persists between these intentions and their actual behavior. This is commonly referred to as the intention-behavior gap. Building on social-cognitive (e.g., the Health Action Process Approach) and dual-process theories (e.g., Temporal Self-Regulation Theory), this dissertation investigates when and how individuals translate their goal intentions into day-to-day PA behavior.

Three empirical papers form the core of this work. Paper 1, using ecological momentary assessment (EMA), found that setting short-term PA intentions (referring to four-hour windows) was associated with a sharp increase in the likelihood of actually engaging in PA within that timeframe (~28-fold). Yet, a quarter of these intentions still went unrealized. Moreover, the translation of these short-term intentions into behavior was more likely when individuals planned more specifically, felt more self-efficacious about enacting the momentary intention, and momentary intention strength was higher. Paper 2 showed that positive, high-energetic affective states (e.g., feeling energized) and low anticipated contextual barriers (e.g., minimal scheduling constraints) facilitated the formation of such short-term intentions, although these internal and external context factors were not directly associated with actual PA engagement. Paper 3, an intervention trial testing reinforced implementation intentions in a guided mobile health approach, demonstrated significantly higher moderate-to-vigorous PA in the intervention group – potentially through fostering short-term intention formation, their enactment, and context-triggered, ‘spontaneous’ exercise bouts.

The findings collectively highlight that PA behavior is shaped by an interplay of reflective (planning, self-efficacy) and automatic or impulsive (affect, environmental cues) processes that become active on a momentary level. Introducing the concept of “transitional intentions” (TIs) – situated, time-bound derivatives of goal intentions – may further illuminate how momentary fluctuations in reflective and impulsive processes contribute to the intention-behavior gap. Building on these insights, this dissertation provides practical recommendations for the design of Just-in-Time Adaptive Interventions (JITAIs) that can provide personalized PA support when it is needed most.

Strengthening Health and Relationships: Exploring Collaborative Health Technologies to Promote Physical Activity in Cohabiting Couples

Krah, Eva-Maria
Master Thesis

Paris Lodron Universität Salzburg und Fachhochschule Salzburg (Joint Master Programme on Human-Computer Interaction), 02.12.2024

Supervisors: Dr. Daniela Wurhofer, Dr. Mascha Beuthel

Abstract:

The global prevalence of physical inactivity represents a significant public health concern. Although previous research suggests that family relationships, particularly couple relationships, can motivate healthy behaviors, health technologies supporting couples in adopting health behaviors remain understudied.

Therefore, this thesis employed a Research through Design approach to explore health technologies for cohabiting couples and their potential to promote physical activity. A comprehensive literature review informed the development of a research prototype. To investigate couples’ interactions and experiences with this prototype and explore its effects on physical activity awareness and behavior, a four-week technology probe study was conducted with seven couples (14 individuals). Following their participation in the technology probe study, couples contributed their ideas for health technologies promoting physical activity in couples in a workshop-like setting.

The findings revealed that participants appreciated the collaborative nature of the research prototype. Moreover, it improved physical activity awareness and significantly increased step counts throughout the study period. The insights obtained align with prior work suggesting that cooperative health technologies facilitating joint reflection as well as mutual support and understanding can promote healthy behaviors in a family context.

Furthermore, the results suggest that collaborative health technologies for couples should provide options for self-monitoring and that couples may benefit from additional competitive features. Health technologies could also help couples negotiate the right level of data sharing and support the reflection process. Moreover, this research demonstrated that an ambient display could stimulate discussions about physical activity, highlighting the potential for shared family spaces to foster reflection on health-related topics.

Participants ideated technologies to support couples in joint physical activity planning and monitoring, serve as a motivational third party, and allow couples to compete with other couples. These ideas, the developed research prototype, and the insights gained from engaging participants in its use and observing its effects make a valuable contribution to the advancement of health technologies for physical activity promotion in couples.

A comparison of haptic and visual support for navigation in an audio-based city game

Tkacz, Jakub
Master Thesis

Informaatioteknologian ja viestinnän tiedekunta – Faculty of Information Technology and Communication Sciences; Tampere University, 2024

Supervisors at University Tampere:  Dr. Ahmed Farooq und Prof. Mark van Gils
Supervisors at LBI-DHP: Jan Smeddinck, Devender Kumar

Abstract:

Navigation is a fundamental aspect of human life, yet current solutions are designed for vehicles, leaving pedestrian navigation as a derivative of its car equivalent. This thesis investigates a novel approach to pedestrian navigation, using haptic feedback to provide directional hints. Three methods were compared within navigation in an active city game: a haptic belt equipped with 16 vibrators, a smartwatch used as a haptic compass, and a smartphone with a compass displayed on the screen used as a baseline. A user study was used to evaluate these devices on four dimensions – comfort, performance, intuitiveness, and preference, gathering data via questionnaires, interviews, and logs from the devices. The results indicate that the visual compass, outperformed other methods in most dimensions, offering familiar experience and precise directions. Moreover, it was least prone to GPS inaccuracies by offering constant feedback. The haptic devices, even though showing lower results, were offering the highest environmental awareness, which may be beneficial in different scenarios or locations. Based on the experience from the user study, the multi-modal StageNav framework was introduced. It divides navigation into five distinct stages, recommending different feedback methods for each phase. This framework offers flexibility for designers and ensures that navigation offers the highest performance. The primary goal of the framework is to enhance the experience and safety of pedestrian navigation.

A Digital Talk Test for Assessing Exercise Intensity of Patients with Cardiovascular Diseases

Geiger, Laura
Master Thesis

Universität Innsbruck (Department of Computer Science), 04.03.2024

Supervisor (UIBK): Ass.-Prof. Dipl.-Ing. Clemens Sauerwein, PhD
Co-Supervisor (LBI DHP): Mag. Dr. Daniela Wurhofer, Bakk. techn., Dr. Devender Kumar, Dr.-Ing. Jan David Smeddinck, BSc, MSc

Abstract

Addressing cardiovascular diseases as a significant global health concern requires innovative approaches to enhance patient care and rehabilitation. One of these approaches is the development of a digital version of the Talk Test which enables patients to self-assess their intensity through speech during workouts. Furthermore, the automated assessment of exercise intensity through speech related to the Talk Test offers a compelling and engaging research area. Currently, no publicly available machine learning approaches address the automated exercise intensity estimation.

In this thesis a prototype of the Digital Talk Test, called aktivtalk, is created and used in a comparative study to collect self-assessed voice samples. The usability of the aktivtalk application achieves a higher user satisfaction compared to the non digital approach in the study. Furthermore, an initial machine learning model is created to predict the exercise intensity zone without the need for self-assessment. The performance of the model with the self-assessed labels even slightly outper- formed a traditional age and pulse based labeling approach. In summary, this thesis emphasizes the potential of the Digital Talk Test as a valuable tool for assessing and managing exercise intensity in patients with cardiovascular diseases, highlighting its reliability, usability, and potential for future development in digital healthcare.

Social activities online – integrating social elements in a digital health app to support a heart-healthy lifestyle

Kolosovskaia, Daria
Master Thesis

Paris Lodron University Salzburg and Salzburg University of Applied Sciences  (Joint Master Programme on Human-Computer Interaction), 01.02.2024

Supervisor: Dr. Daniela Wurhofer

Towards a warning system for inaccuracies in PPG-based heart rate measurements on smartwatches : a supervised deep learning approach

Brunner, Marlene
Master Thesis

Paris Lodron University Salzburg, Faculty for Digital and Analytical Sciences, 14.09.2023

Supervisors: Univ.-Prof. Dr. Arne Bathke, Dr.-Ing. Jan Smeddinck BSc, MSc, Dr. Devender Kumar

Abstract:

Wearable devices that measure Heart Rate (HR) using Photoplethysmography (PPG), such as smartwatches or fitness bands, have become increasingly popular in recent years. However, the accuracy of PPG-based HR measurements can be affected by a number of factors. This thesis investigates the accuracy and validity of PPG-based HR measurements in comparison to gold standard Elektrocardiogram (ECG) readings. First background literature is summarized to investigate the current state of the art in PPG-based HR measurement. Then, a real world data set is analyzed to assess the accuracy of PPG-based HR measurements in a real-world setting. The first part of the thesis shows that PPG-based HR measurements can be inaccurate, particularly at high exercise intensities. To address this issue, a Linear Regression model and two Deep Learning models have been developed to predict the measurement errors that occur based on the data stream from the wearable alone. The results show that a Deep Learning model based on a Convolutional Neural Network (CNN) outperforms the other models. The model is able to reliably detect large measurement errors and therefore it is possible to develop a warning system to inform the end user of the wearable when those large deviations from the gold standard occur.

Implementation and evaluation of an application that suggests physical exercises to bridge waiting times in everyday life

Maislinger, Magdalena
Master Thesis

Fachhochschule Salzburg (Multi Media Technology), Puch bei Hallein, September 2022

Supervisor: Dr. Daniela Wurhofer

Einsatz digitaler Technologien in der kardiologischen Rehabilitation aus der Sicht österreichischer Gesundheitsexpert:innen – Entwicklung einer Onlinebefragung

Lunz, Luisa
Master Thesis

Paris Lodron University Salzburg (Sport- und Bewegungswissenschaft), Salzburg, April 2022

Supervisor: Assoz. Prof. Dr. Sabine Würth

Technology as bridge between health professionals and patients

Neunteufel, Julia
Master Thesis

Paris Lodron University Salzburg and Salzburg University of Applied Sciences  (Joint Master Programme on Human-Computer Interaction), Salzburg, 05.09.2021

Supervisors: Dr. Daniela Wurhofer & Dr. Bernhard Maurer

Zusammenfassung:

Ziel: Der Zweck dieser Studie ist es, zu erforschen, ob und wie Technologie zur gemeinsamen Rehabilitationsplanung durch medizinisches Fachpersonal und PatientInnen beitragen kann.
Hintergrund: Weltweit stellen Herz-Kreislauf-Erkrankungen unverändert die häufigste Todesursache dar und sind somit eine Herausforderung für das Gesundheitswesen in Bezug auf Personal und Kosten. Rehabilitation und die Unterstützung der PatientInnen, langfristig aktiver zu werden, sind in diesem Zusammenhang wichtige Aspekte. Technologie findet hier verstärkt Anwendung. Die Gestaltung einer solchen Technologie ist noch in der Erforschung. Die Verwendung eines personenzentrierten Ansatzes in Verbindung mit Theorien aus dem digitalen Gesundheitsbereich kann für das Thema von Nutzen sein.
Herangehensweise: In dieser Studie nahmen fünf RehabilitationsexpertInnen und sieben PatientInnen teil. Dabei wurden semi-strukturierte Interviews, Beobachtungen und eine 14-tägige Tagebuchphase durchgeführt, um die Bedeutung von Technologie im Kontext der Rehabilitationsplanung zu untersuchen. Zur Auswertung der Daten wurde eine thematische Analyse verwendet.
Ergebnisse und Diskussion: Es konnten mehrere Faktoren, die die Einhaltung der vorgeschriebenen Aktivitäten beeinflussen, festgestellt werden. Vor allem die Motivation, die Ziele und der körperliche Zustand der PatientInnen konnten als solche Faktoren definiert werden. Die Technologie half bei der Erstellung maßgeschneiderter Trainingspläne und positive Auswirkungen auf das Gesundheitsverhalten der Teilnehmenden konnten festgestellt werden. Bei der Umsetzung des Trainings selbst wurde das digitale Tool als wenig unterstützend empfunden. In dieser Studie hat sich herausgestellt, dass Automatisierung, wie etwa das automatische Aufzeichnen der Aktivitäten durch andere Geräte, für die BenutzerInnen wünschenswert ist. Darüber hinaus schien es wichtig zu sein, sich realistische Ziele zu setzen, was durch eine passende Abbildung der Ziele in einer digitalen Anwendung unterstützt werden kann.
Fazit: Die Implementierung von mHealth im klinischen Umfeld birgt das Potenzial für eine effiziente und personenzentrierte Behandlungsplanung. Die Verwendung geeigneter Theorien aus Disziplinen wie der Psychologie sollte einer der treibenden Bestandteile in der Entwurfsphase eines solchen Produkts sein. Darüber hinaus ist aber auch ein geeignetes Konzept für die Implementierung der Technologie in die Organisation wichtig. Des Weiteren können das Setzen passender Ziele und das automatische Aufzeichnen der sportlichen Aktivitäten den Erfolg von mHealth Produkten steigern. Die Rückmeldung über die Aktivitäten der PatientInnen durch die Fachkräfte in der App, aber auch persönlich, ist wichtig für das Engagement der PatientInnen für ihre Behandlung.
Schlüsselwörter: medizinische Informatik, personen-zentrierte Medizin, gemeinsame Entscheidungsfindung, persuasive technology, Verhaltensänderung, mHealth, Ethnographie, HCI im Designen von mHealth