This article draws on the sociology of expectations to examine the construction of expectations of ‘ethical AI’ and considers the implications of these expectations for communication governance. We first analyse a range of public documents to identify the key actors, mechanisms and issues which structure societal expectations around artificial intelligence (AI) and an emerging discourse on ethics. We then explore expectations of AI and ethics through a survey of members of the public. Finally, we discuss the implications of our findings for the role of AI in communication governance. We find that, despite societal expectations that we can design ethical AI, and public expectations that developers and governments should share responsibility for the outcomes of AI use, there is a significant divergence between these expectations and the ways in which AI technologies are currently used and governed in large scale communication systems. We conclude that discourses of ‘ethical AI’ are generically performative, but to become more effective we need to acknowledge the limitations of contemporary AI and the requirement for extensive human labour to meet the challenges of communication governance. An effective ethics of AI requires domain appropriate AI tools, updated professional practices, dignified places of work and robust regulatory and accountability frameworks.

Background: Maternal mental health impacts both parental well-being and childhood development. In the United Kingdom, 15% of women are affected by depression during pregnancy or within 1 year of giving birth. Suicide is a leading cause of perinatal maternal mortality, and it is estimated that >50% of perinatal depression cases go undiagnosed. Mobile technologies are potentially valuable tools for the early recognition of depressive symptoms, but complex design challenges must be addressed to enable their use in public health screening.Objective: The aim of this study was to explore the issues and challenges surrounding the use of mobile phones for the self-report of psychological well-being during pregnancy.Methods: This paper presents design research carried out as part of the development of BrightSelf, a mobile app for the self-report of psychological well-being during pregnancy. Design sessions were carried out with 38 participants, including pregnant women, mothers, midwives, and other health professionals. Overall, 19 hours of audio were fully transcribed and used as the basis of thematic analysis.Results: The study highlighted anxieties concerning the pregnancy journey, challenges surrounding current approaches to the appraisal of well-being in perinatal care, and the midwife-patient relationship. Designers should consider the framing of perinatal mental health technologies, the experience of self-report, supporting self-awareness and disclosure, providing value to users through both self-report and supplementary features, and designing for longitudinal engagement.Conclusions: This study highlights the needs, motivations, and anxieties of women with respect to technology use in pregnancy and implications for the design of mobile health technologies.

Health and wellbeing applications increasingly raise ethical issues for design. User-centred and participatory design approaches, while grounded in everyday wisdom, cannot be expected to address ethical reflection consistently, as multiple value systems come into play. We explore the potential of phronesis, a concept from Aristotelian virtue ethics, for mHealth design. Phronesis describes wisdom and judgment garnered from practical experience of specific situations in context. Applied phronesis contributes everyday wisdom to challenging issues for vulnerable target users. Drawing on research into mHealth technologies for psychological wellbeing, we explore how phronesis can inform ethical design. Using a case study on an app for self-reporting symptoms of depression during pregnancy, we present a framework for incorporating a phronetic approach into design, involving: (a) a wide feedback net to capture phronetic input early in design; (b) observing the order of feedback, which directly affects value priorities in design; (c) ethical pluralism recognising different coexisting value systems; (d) acknowledging subjectivity in the disclosure and recognition of individual researcher and participant values. We offer insights into how a phronetic approach can contribute everyday wisdom to designing mHealth technologies to help designers foster the values that promote human flourishing.

• Sharing personal data in public health is very different from the closed-circle of personal data use. • Sharing data has both pragmatic (time, workload etc.) and psychosocial (confidence, competence, connectedness etc.) implications for care. • Health professionals must balance care for the individual against the wellbeing of the patient population. • Women prefer reflective and conversational, rather than directive or transactional, feedback. • Designers are advised to focus on strategies to support negotiation, navigate uncertainty, and realise a shared practice of wellbeing.

Background: Technology is increasingly being used and evolving in the dementia care landscape. One such technology that has gained traction over the last decade is virtual reality (VR). VR is being applied in many areas of dementia care, including cognitive assessment and training, reminiscence therapy, music therapy, and other recreational VR applications. Despite the plethora of applications, they are often not shaped by the experiences and perceptions of older adults living with dementia. Currently, there is no qualitative evidence synthesis (QES) to explore this area. This review aimed to provide qualitative evidence supporting existing systematic reviews in this area. Objective: The aim of this QES was to explore key stakeholders’ experiences and perceptions of VR for older adults living with dementia. It aimed to explore the barriers and facilitators to VR use and provide recommendations for future design and implementation. Methods: QES was used, which involved a systematic search of 6 databases to identify studies that qualitatively explored key stakeholders’ experiences and perceptions of VR for older adults living with dementia. Thematic synthesis was used to integrate the findings of 14 studies (from 15 reports). The Critical Appraisal Skills Programme tool was used to assess the methodological quality of the included studies. The confidence placed in the review findings was assessed using the GRADE-CERQUAL (Confidence in the Evidence from Reviews of Qualitative research). Results: A total of 15 reports from 14 studies were included in the review, consisting of a range of levels of VR immersion, stages of dementia, and care contexts. Three analytical themes were generated: stepping into virtuality, a virtual world, and returning to reality. The results indicate the importance of sensitively designing and introducing VR to this population, as older adults living with dementia often have no prior experience of using this technology. VR can be a positive experience for older adults living with dementia and can provide meaningful interactions, positive expressions, and long-term impacts on everyday functioning. However, it should be acknowledged that some negative associations must be accounted for before, during, and after use. Conclusions: This review highlights the positive implications as well as negative associations of VR use. It emphasizes the need for VR design and implementation driven by the needs and views of older adults living with dementia as well as with other key stakeholders. Future research needs to explore the vital role that older adults living with dementia can play in the design process and how they can be empowered to meaningfully design and use this technology.

Virtual Reality (VR) is increasingly being applied in dementia care across a range of applications and domains including health and wellbeing. Despite the commercial availability of VR, informants of design are not always aware of its functionality and capabilities, to meaningfully contribute to VR design. In designing VR applications for people living with dementia, it is recommended that older adults living with dementia and their support persons be involved in the design process using participatory approaches, thereby giving them a voice on the design of technology from the outset. A VR technology probe is a useful means of familiarising older adults living with dementia and their informal caregivers with the knowledge and understanding of interactive VR to employ technology that supports them to maintain their social health. This paper charts the implementation and evaluation of a VR technology probe, VR FOUNDations. To explore their experiences, nine older adults living with dementia and their nine informal caregivers trialled VR FOUNDations and completed semi-structured interviews after its use. Overall, older adults living with dementia and their informal caregivers perceived VR FOUNDations to achieve its aim of increasing understanding and inspiring future design decisions. The findings also identified promising positive experiences using a VR technology probe which may be indicative of its applicability to social health and wellbeing domains. This paper advocates for the structured design and implementation of VR technology probes as a pre-requisite to the participatory design of VR applications for the health and wellbeing of people living with dementia. The use of such technology probes may afford older adults living with dementia and their informal caregivers the best opportunity to contribute to design decisions and participate in technology design to support their health and wellbeing.