Bernd Fabian Schneider
Title
Dr.
Last Name
Schneider
First name
Bernd Fabian
Email
bernd.schneider@unisg.ch
Phone
+41 71 224 7206
5 results
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Item type:Publication, Long-Term Usage of Breeze, a Gamified Breathing Training App, and Its Effect on Momentary Relaxation in People With Cancer: Cohort Study(JMIR Publications Inc., 2025-12-16); ;Budig, Tobias ;Schläpfer, Sonja ;Lukic Yanick XavierBackground: People with cancer often experience stress. Digital health interventions can help individuals increase momentary relaxation. Breeze is a gamified breathing training that can be embedded into digital health interventions. Its effectiveness in controlled cross-sectional studies has been demonstrated. However, adherence to Breeze and its effect on momentary relaxation in longitudinal interventional studies has yet to be investigated. Objective: This study aimed to assess Breeze across 3 key dimensions: (1) its usage over time compared to other intervention components; (2) the accuracy with which users adhered to the guiding breathing pattern provided by Breeze; and (3) its effect on momentary relaxation, including the impact of the duration of the breathing session delivered by Breeze. Methods: Breeze was 1 of 7 relaxation techniques included in the CanRelax 2.0 app, designed specifically for individuals diagnosed with cancer. Participants could select any of the 7 techniques to promote momentary relaxation. The intervention was designed to last 10 weeks. However, participants were allowed to use the CanRelax 2.0 app after that period. Participants were adults diagnosed with cancer in the last 5 years recruited across Switzerland, Germany, and Austria. Adherence to the intended breathing pattern was measured using a Pearson correlation coefficient. Momentary relaxation was measured pre- and post-exercise using an 11-point visual analog scale. Statistical analyses included linear mixed effects models and calculations of effect sizes. We further analyzed the relationship between session duration and the magnitude of momentary relaxation and compared Breeze’s efficacy and time efficiency to the other available techniques. Results: Of 279 participants, 118 (42.3%) used Breeze at least once. The 118 participants engaged in 754 breathing sessions with Breeze. Momentary relaxation was assessed and calculated for 249 (33.0%) Breeze sessions. The use of Breeze declined initially but remained stable even after 10 weeks. Participants followed the predefined breathing rates of Breeze (r=0.9). On average, a small effect (−0.42; P<.001; d=0.19) on momentary relaxation was observed, with 2-minute breathing sessions (−0.30; P=.02; d=0.13) showing a small effect, whereas a large effect (−1.53; P=.03; d=0.74) was observed for breathing sessions of 4 minutes or longer. Conclusions: This study demonstrates the potential of Breeze to alleviate acute stress in individuals with chronic conditions, such as cancer. By combining gamification with evidence-based breathing techniques, Breeze fosters sustained user engagement and momentary relaxation. Participants adhered well to the guided breathing. While even short breathing sessions of 2 minutes provided modest momentary relaxation, longer durations (≥4 min) were considerably more effective. Future research aims to assess the impact of Breeze on other populations and chronic conditions.Type:journal articleJournal:JMIR Serious GamesVolume:13DOI:10.2196/70297Scopus© Citations 4 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Leveraging Influencers to Reach and Engage Vulnerable Individuals With a Digital Health Intervention: Quasi-Experimental Field Study(JMIR Publications Inc., 2025-09-05); ;Harperink, Samira ;Priyam Joshi; Theresa SchachnerBackground: Noncommunicable diseases are the leading cause of death, present economic challenges to health care systems worldwide, and disproportionally affect vulnerable individuals with low socioeconomic status (SES). While digital health interventions (DHIs) offer scalable and cost-effective solutions to promote health literacy and encourage behavior change, key challenges concern how to effectively reach and engage vulnerable individuals. To this end, social media influencers provide a unique opportunity to reach millions, and lasting engagement can be ensured through the design of DHIs in a manner that specifically appeals to low-SES individuals through alignment with their social background. Objective: The objectives of this study were 2-fold: to assess the effectiveness of leveraging influencers to reach vulnerable individuals (as measured via app downloads per stream viewers) and evaluate how the design of a DHI can improve engagement among this group (as measured via completion of the intervention). Methods: This study used a cross-sectional, quasi-experimental field design to assess both (1) the effectiveness of influencers in reaching vulnerable individuals and (2) the impact of specific design elements—such as gamification and storytelling—on user engagement using a stress management DHI featuring a slow-paced breathing exercise. In total, 3 differently designed versions of this DHI were developed following a fractional factorial design (StressLess, Breeze, and TragicKingdom). Reach was calculated as the number of downloads per viewers per stream and influencer. Engagement with the DHI was measured via number of conversational turns and milestone and intervention completion rates. Participants’ SES and technology acceptance were evaluated through a postintervention survey. Descriptive statistics, chi-square tests, and ANOVAs were used to examine the effects of the DHI design on reach and engagement metrics. Results: The recruitment via 8 influencers (total streams=25; total viewers=12,667) generated 220 downloads. The average reach ratio across streams amounted to 16.2% (SD 15.5%), with significant differences between conditions (ꭓ22=8.0, P=.02; StressLess: 8.1%, SD 9.3%; Breeze: 14%, SD 10.5%; TragicKingdom: 28.4%, SD 17.6%). The intervention completion rate across all DHI versions amounted to 7.7% (17/220), with no significant differences between conditions (P=.48). Conclusions: This work provides the first evidence that recruitment via influencers yields high reach ratios, moving far beyond the reach of traditional social media platforms. Nonetheless, based on the data collected, the ability to leverage such platforms to recruit vulnerable individuals remains unclear. In addition, while engagement with the promoted interventions was initially high, the completion rate of the full breathing exercise was comparably low, indicating that the influencer promotion strategy cannot fully overcome the well-documented adherence barriers in digital health.Type:journal articleJournal:Journal of Medical Internet ResearchVolume:27DOI:10.2196/67174Scopus© Citations 5 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Towards RehabCoach: Design and Preliminary Evaluation of a Conversational Agent Supporting Unsupervised Therapy After Stroke(IEEE, 2024-09-01) ;Giada Devittori ;Mehdi Akeddar ;Alexandra Retevoi; Viktoria CvetkovaType:conference paperJournal:2024 10th IEEE RAS/EMBS International Conference for Biomedical Robotics and Biomechatronics (BioRob) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Long-term usage of the gamified breathing training Breeze and its effect on momentary relaxation in people with cancer: A cohort study (Preprint)(JMIR Publications Inc., 2024-12-19); ;Tobias Budig ;Sonja Schläpfer ;Yanick Xavier LukicBACKGROUND People with cancer often experience stress. Digital health interventions (DHIs) can help individuals increase momentary relaxation. Breeze is a gamified breathing training that can be embedded into DHIs. Its effectiveness in controlled cross-sectional studies was shown. However, adherence to Breeze and its effect on momentary relaxation in longitudinal interventional studies has yet to be investigated. OBJECTIVE This work aims to assess the use of Breeze and its effect on momentary relaxation in people with cancer. METHODS Breeze was one of seven relaxation techniques included in the CanRelax 2.0 app, designed specifically for individuals diagnosed with cancer. Participants could select any of the seven techniques to promote momentary relaxation. The intervention was designed to last 10 weeks. However, participants were allowed to use the CanRelax 2.0 app after that period. Participants were adults diagnosed with cancer in the last five years recruited across Switzerland, Germany, and Austria. Momentary relaxation was measured pre- and post-exercise using an 11-point visual analog scale, while Breeze was assessed through objective usage metrics. Statistical analyses included linear mixed-effects models and effect size calculations. RESULTS Out of 352 participants, 118 (33.5%) used Breeze at least once. The 118 participants engaged in 754 breathing sessions with Breeze. Momentary relaxation was assessed and calculated for 249 (33.0%) Breeze sessions. The use of Breeze remained stable even after the formal intervention period. Participants also followed the pre-defined breathing rates of Breeze. On average, a small effect on momentary relaxation was observed for 2-minute breathing sessions (d = .20), while a large effect (d = .74) resulted from breathing sessions >=4 minutes. CONCLUSIONS This study shows the potential of Breeze to reduce acute stress in individuals with a chronic condition, such as cancer. By combining gamification with evidence-based breathing techniques, Breeze fosters sustained user engagement and momentary relaxation. Future research aims to assess the impact of Breeze on other populations and chronic conditions. CLINICALTRIAL German Clinical Trials Register DRKS00027546; registered on 23 February 2022Type:digital resource - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Leveraging Influencers to Reach and Engage Vulnerable Individuals: A Quasi-Experimental Field Study with a Digital Health Intervention (Preprint)(JMIR Publications Inc., 2025-02-10); ;Samira Harperink ;Priyam Joshi; Theresa SchachnerBackground: Non-communicable diseases (NCDs) are the leading cause of death, present economic challenges to healthcare systems worldwide, and disproportionally affect vulnerable individuals of low socioeconomic status (SES). While digital health interventions (DHIs) offer scalable and cost-effective solutions to promote health literacy and encourage behavior change, key challenges concern how to effectively (a) REACH and (b) ENGAGE vulnerable individuals. To this end, (a) social media influencers provide a unique opportunity to reach millions; and (b), ensure lasting engagement by designing DHIs in a manner that specifically appeals to low SES individuals through alignment with their social background. Objective: The objectives of this study are twofold: To assess the effectiveness of leveraging influencers to reach vulnerable individuals (as measured via app downloads per stream viewers) and to evaluate how the design of a DHI can improve engagement among this group (as measured via completion of intervention). Methods: This study utilized a cross-sectional, quasi-experimental field design to assess both (a) the effectiveness of influencers reaching vulnerable individuals and (b) the impact of specific design elements—such as gamification and storytelling—on user engagement with a stress-management DHI featuring a slow-paced breathing exercise. Three differently designed versions of this DHI were developed following a fractional factorial design (i.e., STRESSLESS, BREEZE, and TRAGICKINGDOM). Reach was calculated as the number of downloads per viewers per stream and influencer. Engagement with the DHI was measured via number of conversational turns, and milestone and intervention completion rates. Participants' SES and technology acceptance were evaluated through a post-intervention survey. Descriptive statistics, ꭓ2-tests, and ANOVAs were used to examine effects of the DHI design on reach and engagement metrics. Results: The recruitment via eight influencers (Total Streams = 25; Total Viewers = 12,667) generated 220 downloads. The average reach ratio across streams amounted to 16.2%, with significant differences between conditions, ꭓ2(2) = 8.04, p = .018: STRESSLESS: 8.1%; BREEZE: 14.0%; TRAGICKINGDOM: 28.4%. The intervention completion rate across all DHI versions amounted to 7.7% (17 out of 220), with no significant differences between conditions. Conclusions: This work provides first evidence that recruitment via influencers yields high reach ratios, moving far beyond the reach of traditional social media platforms. Nonetheless, based on the data collected, the ability to leverage such platforms to recruit and engage vulnerable individuals with DHIs remains unclear. Additionally, while engagement with the promoted interventions was initially high, completion rate of the full breathing exercise was comparably low, indicating that influencer promotion strategy cannot fully overcome the well-documented adherence barriers in digital health.Type:working paperJournal:Journal of Medical Internet Research