Tobias Kowatsch
Title
Prof. Dr.
Last Name
Kowatsch
First name
Tobias
Email
tobias.kowatsch@unisg.ch
ORCID
Phone
+41 71 224 7244
Web Site
375 results
Now showing 1 - 10 of 375
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Item type:Publication, Deep phenotyping of suicidal ideation after discharge from psychiatric inpatient care: study protocol for an interdisciplinary, multicentre prospective observational study in Psychiatric University Hospitals(BMJ, 2026-02) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Development, Deployment, and Evaluation of DyMand: Wearable AI for In-Situ Detection and Capture of Couples’ Dyadic Interactions in Chronic Disease Management(Association for Computing Machinery (ACM), 2026-07-24); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Same Breath, Different Device: Comparing VR and Smartphone Biofeedback Breathing TrainingSlow breathing holds promise in strengthening mental resilience and reducing acute stress. Prior work presented distinct prototypes of smartphone and VR mobile biofeedback breathing trainings (MBBTs) but lacked direct comparisons. This study aimed to evaluate whether a VR MBBT offers advantages over smartphone MBBT in perceived (relaxation) effectiveness and intention to use, while maintaining non-inferiority in perceived breathing detection accuracy. A within-subject laboratory study with 67 participants was conducted. No evidence was found that the VR MBBT was perceived as more effective. The breathing detection algorithm, originally optimized for smartphones, was perceived as non-inferior in VR MBBT, indicating potential for cross-platform scalability. We found no evidence that intention to use was higher for VR, suggesting that practical considerations such as accessibility and cost may outweigh technology-based preferences. Although these findings are promising, future research must assess their applicability in the real world and ensure accessibility to VR for equitable use.Type:journal articleJournal:Extended Abstracts of the 2026 CHI Conference on Human Factors in Computing Systems (CHI EA '26) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The Impact of a Reward-and-Progression Loop on Engagement with a Mobile Breathing Training: Preliminary Findings from a 15-day Field Study(ACM, 2026-04-13); Engagement with digital health interventions (DHIs) often declines over time, with many users discontinuing use after initial adoption. Gamification has been proposed to address this challenge, yet evidence on its effectiveness remains mixed. This exploratory study examines whether a reward-and-progression loop (RPL), linking performance to daily-constrained collectible coins and unlockable visual features, is associated with differences in engagement in a mobile biofeedback breathing training (MBBT). Twenty participants were randomly assigned to a control or an RPL condition and used the application over 15 days. Engagement was operationalized using two metrics: the number of active days and median session duration per user. Participants in the RPL condition showed more active days than those in the control condition (median = 7 vs. 2). Session duration was comparable across conditions, though more variable in the RPL condition. These preliminary findings suggest that RPLs may support more frequent engagement in DHIs and warrant further investigation.Type:journal articleJournal:Extended Abstracts of the 2026 CHI Conference on Human Factors in Computing Systems - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Association between working alliance and treatment outcomes in a mobile health intervention with a conversational agent (CanRelax)his study explored the association between the digital working alliance and treatment outcomes in users of a fully automated mobile health app with a conversational agent (CanRelax app 2.0), which was effective in reducing distress in adults with cancer. This expands research about the working alliance association to an innovative setting. Drawing on secondary data from a randomized controlled trial, we examined whether the strength of the working alliance—and its three subcomponents: bond, task, goal—assessed at week 4 using the Working Alliance Inventory for Internet Interventions, was related to distress levels at week 10. The analysis population consisted of adults diagnosed with cancer in the past five years who received the CanRelax app 2.0 (N = 117). Participants accessed a conversational agent–guided intervention featuring mindfulness, relaxation, and personalized weekly coaching modules with behavior change techniques. Mean subscale scores (bond: 4.04, SD = 0.95; goal: 3.46, SD = 0.74; task: 2.79, SD = 0.75; 1–5 scale) indicated good working alliance. Partial correlations adjusting for baseline distress, sex, age, and treatment expectation indicated a small negative association between working alliance and distress (r = −0.18), particularly for the task and goal components. No significant association was found for the bond subscale in the overall sample. Associations were stronger in females, and baseline treatment expectations were positively related to working alliance. These findings suggest a stronger working alliance may contribute to better treatment outcomes in fully automated digital health interventions, and optimizing goal and task agreement could further enhance intervention effectiveness.Type:journal articleJournal:Internet InventionsVolume:44 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Structured Large Language Model Workflows for Motivational Interviewing in Health Behavior Change: Proof-of-Concept Study(JMIR Publications, 2026-07-06) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Financial incentives and health coaching to improve glycemic outcomes among young adults with type 1 diabetes: A factorial randomized trial (SweetGoals)(Elsevier BV (Netherlands), 2026-09); Lim-Liberty, FrancesAim This study aimed to improve glycemic control among young adults with type 1 diabetes (T1D), an at-risk and understudied population. Method N = 300 young adults with T1D recruited nationally were randomized to the factorial combination of (1) financial incentives targeting glucose checking and mealtime behaviors and (2) web health coaching focused on increasing motivation and goal setting for self-management behaviors. All received a smartphone app that accessed device data and provided weekly goal feedback. The intervention lasted 6 months. HbA1c (A1c) was assessed at baseline, +6 months, and +12 months. The mean number of glucose checking and mealtime goals met per week during the intervention were tested as mediators of intervention effects on A1c at 12 months. Results A1c was significantly reduced from baseline to +12 months across all participants. Indirect effects of both incentives and coaching on A1c reductions were significant and partially mediated by mealtime but not glucose checking goal achievement. There was no synergistic (interaction) effect of incentives and coaching. Conclusion Incentives and coaching both improved critical mealtime behavior but through different strategies. These results suggest that either intervention would be suitable for future testing and dissemination, and that lower cost of incentives may favor their prioritization.Type:journal articleJournal:Diabetes Research and Clinical PracticeVolume:239 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Stakeholder-perceived value and reimbursement pathways for a voice assistant in dementia care: evidence from SwitzerlandObjectives Population ageing is driving up the prevalence of dementia and intensifying pressure on family carers and long-term care systems. Digital assistive technologies are widely promoted as part of the response, yet they seldom come with a workable reimbursement or implementation model. Using GRACE, an embodied voice assistant for people with dementia (PWD), as an empirical case, this study examines how stakeholder evidence can be translated into setting-specific reimbursement and implementation pathways within the Swiss healthcare system. Methods We conducted 23 semi-structured interviews with healthcare experts (n = 10), professional care staff (n = 9), insurance sector experts (n = 3) and one informal caregiver. German-language transcripts were analysed using codebook-informed thematic analysis and the Business Model Canvas. A policy-translation step distinguished participant statements, author inferences, and literature or policy input. Reporting follows COREQ. Results Stakeholders perceived potential value for PWD in companionship, cognitive activation, orientation and daily structure, and anticipated relief for caregivers. A pivotal finding was that home and institutional settings were expected to carry different requirements and therefore different payer logics. Financing was identified as the dominant barrier: basic mandatory insurance was seen as slow, costly and biased toward curative care, whereas out-of-pocket purchase, shared institutional ownership and supplementary or hybrid arrangements appeared more feasible in the near term. Caregiver acceptance, staff training and demonstrated effectiveness recurred as anticipated enablers. Conclusions Stakeholder evidence can translate perceived value into setting-specific reimbursement and implementation pathways, offering transferable guidance for assistive technologies whose benefits are expected to accumulate across users and care systems. For GRACE, we propose an exploratory pathway beginning with equitably safeguarded out-of-pocket deployment in home care, with movement towards supplementary, hybrid and, potentially, basic insurance contingent on evidence generation. A product split by care setting could align each variant with the payer most likely to benefit. The model is stakeholder-informed and requires validation with PWD and family caregivers. Public Interest Summary Dementia places growing pressure on families and on care services. Voice assistants may support people with early dementia, but it is often unclear who should pay for them and what evidence is needed. We interviewed 23 Swiss professionals, insurance sector experts and one family caregiver about GRACE, a research voice-assistant prototype. Stakeholders anticipated benefits such as companionship, daily structure and caregiver relief, but they had viewed a video rather than used the system. They expected home and residential-care settings to need different product designs and funding arrangements. We therefore propose an exploratory pathway that links each setting and expected benefit to a plausible payer and evidence requirement. Early self-pay or institutional use would require equity safeguards and cannot justify claims of cost savings. Because people with dementia were not interviewed and only one family caregiver participated, the findings describe stakeholder expectations and must be tested directly with intended users and families.Type:journal articleJournal:Health Policy and TechnologyVolume:15Issue:10 - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Health equity readiness index for digital health organizationsBackground As healthcare becomes increasingly digitalized, new challenges and opportunities arise for advancing health equity. In response, a broad range of frameworks and recommendations have emerged to guide equitable innovation. Yet despite this momentum, real world progress remains limited and many digital health organizations (DHOs) struggle to translate health equity principles into concrete, actionable strategies. One promising avenue for closing this implementation gap lies in the use of organizational readiness assessments that not only diagnose current capacity but also help to define a roadmap for improvement. In response, this study introduces the Health Equity Readiness Index and a supporting novel self-assessment tool designed to support DHOs in evaluating and advancing their readiness to act on health equity. Methods Drawing on established frameworks from health equity, responsible AI, digital innovation, and organizational change, we created a five-dimensional Health Equity Readiness Index, encompassing strategy, governance, culture, data, and community collaboration. Each dimension was operationalized into 15 readiness indicators across four levels. A corresponding digital self-assessment tool was developed and evaluated for usability, acceptability, and perceived utility through user testing and a structured online survey targeting DHOs. Results The resulting tool provides a structured, low-barrier mechanism for DHOs to assess their current equity capacity and identify priority areas for improvement. Survey results (N = 124) showed broad applicability across diverse organizational contexts, with respondents spanning regions, service types, and roles. Participants rated the tool highly across all constructs (M ≥ 4.39/5). Qualitative feedback highlighted five overarching strengths (clarity, diagnostic value, actionability, usability, awareness) and three areas for future improvement (examples, customization, additional features). Overall, respondents perceived the tool as both relevant and actionable for guiding equity-oriented strategy. Conclusion This study contributes a novel framework and diagnostic tool for advancing organizational readiness for health equity in digital health, supporting DHOs in moving from intention to implementation. It also offers potential utility for funders, regulators, and health systems seeking to institutionalize equity through incentives or benchmarking.Type:journal articleJournal:International Journal for Equity in Health - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Early viability assessment of a Business-to-Consumer (B2C) model for digital diabetes screening in Switzerland(2026-01-28); Background Type 2 diabetes (T2D) represents a rapidly growing public health and economic burden. Although early intervention can reverse the progression of prediabetes, traditional risk screening remains underutilized. Digital biomarkers derived from smartphones and wearables offer scalable real-time detection, yet financial barriers constrain their integration into health systems. This study assesses the viability of a Business-to-Consumer (B2C) digital diabetes screening venture within the Swiss healthcare system. Methods The Innovating in Healthcare Framework was applied to evaluate system alignment across six factors: structure, financing, public policy, technology, consumers, and accountability. Financial viability was modeled using a Monte Carlo program for probabilistic breakeven estimation, and one- and two-way sensitivity analyses for key funnel, price, and CAC variables. A discounted cash flow model assessed value creation. Sustainability was evaluated across four dimensions: revenue potential, cost efficiency, managerial scalability, and technological adaptability. Results The venture showed strong alignment with consumer readiness, technology, and accountability, but weak fit in financing, public policy, and system structure. Financial modeling indicated positive cash flow in Year 4, with a 57% probability of breakeven within seven years. At 2917 users in Year 7, cumulative cash flow was slightly below zero. Profitability becomes feasible only when price ≥CHF 40, CAC ≤CHF 200, and screening participation ≥10%. Against a-priori thresholds, breakeven probability and NPV remain insufficient, while IRR often exceeds 20%. Long-term viability requires these conditions or transitioning to reimbursed B2B pathways. Conclusions A B2C model can reach financial viability under favorable price and acquisition thresholds, but its long-term sustainability ultimately depends on regulatory validation that enables reimbursement.Type:journal articleJournal:BMC Health Services ResearchVolume:26Issue:1