Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Without effective self-care, people with diabetic foot ulcers (DFUs) are at risk of prolonged healing times, hospitalization, amputation, and reduced quality of life. Despite these consequences, adherence to DFU self-care remains low. New strategies are needed to engage people in the self-care of their DFUs. Objective: We aimed to evaluate the usability and usefulness of a new mobile application to engage people with DFUs in self-care. Methods: We developed a new mobile application, “MyFootCare”, to engage patients with DFU through goal-setting, progress monitoring, and reminders in self-care. Key features included novel visual analytics that automatically extracts and monitors DFU size information from mobile phone photos of the foot. A functional prototype of MyFootCare was created and evaluated through a user-centred design process with 11 participants with DFUs. Data were collected through semi-structured interviews discussing existing self-care practices and observations of MyFootCare with participants. Data were analysed qualitatively through thematic analysis. Results: Key themes were: (1) Participants already used mobile phone photos to monitor their DFU progress, but (2) had limited experience with using smartphone applications. (3) Participants desired the objective DFU size data provided by the tracking feature of MyFootCare to monitor their DFU progress. (4) Participants were ambivalent about the MyFootCare goal setting and diary features, commenting that these features were useful but also that it was unlikely that they would use them. (5) Participants desired to share their MyFootCare data with their clinicians to demonstrate engagement in self-care and to reflect on their progress. Conclusions: MyFootCare shows promising features to engage people in DFU self-care. Most notably, ulcer size data is useful to monitor progress and engage people. However, more work is needed to improve the usability and accuracy of MyFootCare, i.e., by refining the process of taking and analysing DFU photos and removing unnecessary features. These findings open the door for further work to develop a system that is easy to use and functions in everyday life conditions, and to trial it with people with DFUs and their carers.

In recent years a variety of mobile apps, wearable technologies and embedded systems have emerged that allow individuals to track the amount and the quality of their sleep in their own beds. Despite the widespread adoption of these technologies, little is known about the challenges that current users face in tracking and analysing their sleep. Hence we conducted a qualitative study to examine the practices of current users of sleep tracking technologies and to identify challenges in current practice. Based on data collected from 5 online forums for users of sleep-tracking technologies, we identified 22 different challenges under the following 4 themes: tracking continuity, trust, data manipulation, and data interpretation. Based on these results, we propose 6 design opportunities to assist researchers and practitioners in designing sleep-tracking technologies

Wearable devices like Fitbit and Apple Watch provide convenient access to personal information about sleep habits. However, it is unclear if awareness of one's sleep habits also translates into improved sleep. Hence, we conducted an interview study with 12 people who track their sleep with Fitbit devices to investigate if they have managed to improve their sleep and to examine potential barriers for improving sleep. The participants reported increased awareness of sleep habits, but none of the participants managed to improve their sleep. They faced three barriers in improving their sleep: (1) not knowing what is normal sleep, (2) not being able to diagnose the reasons for a lack of sleep, and (3) not knowing how to act. This paper discusses how to address these barriers, both conceptually as well through design considerations - reference points, connections to lifestyle data, and personalised recommendations - to help users gain improvements in wellbeing from their personal data.