2024 Volume 6 Issue 1 Article ID: 2023-0028-CT
Since the 2000s, the term “disruptive technology” has become often used in the medical and healthcare fields to refer to technologies that disrupt existing systems and transform them into new value systems1,2,3). How should disruptive technologies like artificial intelligence (AI) be applied to occupational health? AI is ambivalent regarding its advantages and disadvantages. Recent technological advances have been remarkable, and various digital health technologies (DHTs) are expected to help people with health interventions in the future4). DHTs are being studied worldwide, particularly for interventions in workers’ mental health5,6). Although further studies are warranted, interventions using DHTs, such as smartphones, apps, wearable devices, and internet interviews6,7,8), can potentially enhance mental health-related outcomes. However, according to the history of the Industrial Revolution, disruptive technologies have created new work systems, changed working styles, and resulted in new health problems for workers. We are now in the era of the Fourth Industrial Revolution. It is so-called Industry 4.0, encompassing a set of intelligent digital technologies that include Internet of Things networks, AI, Big Data, robotics, and automation integrated into manufacturing, industrial, and service processes. Human factors and ergonomics (HFE) is a scientific discipline for harmonizing human well-being and system performance and can play an essential role in resolving the ambiguity between advantages and disadvantages.
Traditionally, occupational health in Japan has followed a post-hoc approach, in which countermeasures are only considered after a problem has become apparent. However, technological innovations are advancing at a faster rate than expected. Occupational health requires a new proactive approach to prevent upcoming critical health problems caused by new working methods induced by disruptive technologies. Recent HFE studies have stressed the back-casting approach9,10) for rapidly responding to such transformations. The back-casting approach first sets a desirable/arriving future and then extracts issues to be addressed backward to connect the specified future to the present (Figure 1).
Occupational health in the new era needs to apply HFE to design interactions appropriately and proactively between workers’ well-being and disruptive technologies and components of individual, environmental, and organizational factors based on a systems approach strategy10,11). The “system” includes humans and other elements of physical, psychosocial, cognitive, and organizational environments. The systems approach focuses on interactions among them to optimize human well-being and system performance10,11). In other words, the systems approach, defined by the International Ergonomics Association, is a problem-solving method that emphasizes the comprehensive, not improving just one specific element but harmonizing their interactions that apply theory, principles, data, and methods to design and optimize human well-being and overall system performance11). As previously stated, disruptive technologies have created new work systems, changed working styles, and resulted in health problems for new workers. In this context, we should begin by predicting the technological trends in DHTs that are expected to be utilized in the future. The back-casting measures for occupational health would be informative to prepare in advance for the upcoming transformation regarding technological trends.
Thus, we would like to introduce one of our trials for the back-casting approach to possible mental health interventions. It is first necessary to understand the current classification of DHTs to consider potential health issues that may arise from the future prevalence of DHTs. We have, therefore, defined the utilization scenarios for DHTs in Japan12) and classified 11 technology areas utilized in mental health interventions, including heart rate estimation, exercise/physical activity, sleep estimation, contactless heart rate/pulse wave estimation, voice and emotion analysis, self-care/cognitive behavioral therapy/mindfulness, dietary management, psychological safety, communication robots, avatar/metaverse, and brain wave devices13). Then, we focused on a specialized scientific database dedicated to technical fields: the Institute of Electrical and Electronics Engineers (IEEE) databases in electrical and electronics engineering and computer science. We extracted keywords for each of the 11 technical areas and comprehensively searched articles, such as books, conference papers, journal papers, and magazines, from the database. We counted the articles received by the IEEE based on keywords in each of the 11 technology areas. The results showed that 334,838 articles were published between 2003 and 2022. The category with the highest number of articles published over the 20 years was voice and emotion analysis (n=106,427), followed by exercise/physical activity (n=36,939), brain wave devices (n=17,417), heart rate estimation (n=14,256), avatar/metaverse (n=7,620), communication robots (n=5,865), sleep estimation (n=4,387), psychological safety (n=1,315), contactless heart rate/pulse wave estimation (n=670), dietary management (n=601), self-care/cognitive behavioral therapy/mindfulness (n=267), and others (n=139,074). Figure 2 shows the technological trends based on the number of articles in these 11 categories over the past 20 years, and eTable 1 shows keywords searched for each technical area. From the perspective of technological development, technologies currently commonly discussed in healthcare-related journal papers, such as accelerators, pedometers, and other technologies used in exercise/physical activity, peaked in 2019 and then leveled off. Contrastingly, since 2013, there has been a surge in technological development related to the category of voice emotion analysis, and we expect to see more services regarding mental health in the future.
These trends can explain the upcoming increase in prominence, suggesting a direction for developing occupational health services that utilize these technologies. For example, a communication robot may be equipped with various sensors to estimate mental health risks based on data obtained from pulse waves, brain wave data, voice, and facial expression information and to raise issues with workers or the enterprise’s occupational health staff at an early stage. Alternatively, voice emotion analysis and facial recognition systems in personal devices can quickly determine stress levels. This is not a pipedream but a world that will eventually come true. However, it should be noted that DHT services at this time include some that are cobbled together and whose quality cannot be guaranteed. In other words, it includes DHT services that claim to be “effective for mental health” but have not been tested for their sensitivity or specificity or have not been conducted in randomized controlled trials.
Advantages in DHTs will increase the potential for early prevention of employee mental health problems. However, while there are benefits to well-being, if these technologies are used in the workplace environment, there will be controversy regarding issues such as the handling of information obtained from individuals and their use outside working hours14). Therefore, ambivalence is always accompanied by increased convenience. This issue potentially puts them at risk of having their mental health-related problems disclosed to others, even if the person does not want them to be. Additionally, workers may be concerned if the DHTs have an after-hours tracking feature. One of the solutions may require discussions that include the protection of personal information, such as the “avoidance of unintended disclosure of disease risk,” “feature to choose to turn off tracking functionality outside of work hours,” and “opt-in collection of information,” as well as the formulation of guidelines by the government and stakeholders. Thus, it is important to anticipate in advance the balance of benefits and harms by using innovative technologies and to consider and prepare solutions in advance. In other words, a back-casting approach, such as the example above, enables us to show the direction to be prepared in the occupational health field and assess upcoming issues to be addressed. Occupational health should urgently be prepared for the Industry 4.0 wave to predict potentially available technologies.
This work was supported by the Japan Agency for Medical Research and Development (AMED) under Grant Number JP22rea522006.
TE contributed to the design of this study. CY, MT, NT, and TE performed the data collected. NT drafted the manuscript. All the authors contributed to the writing of the manuscript, critical revision, and agreed with the final version.
T.E. received research support from ES Japan, Inc. for developing a solution business using voice-emotional signature analysis. The other authors declare no conflicts of interest.
| Technical areas | Searching keywords |
|---|---|
| heart rate estimation | (((“Document Title”:online) OR (“Document Title”: internet) OR (“Document Title”: web) OR (“Document Title”:app) OR (“Document Title”: apps) OR (“Document Title”: computer) OR (“Document Title”: digital) OR (“Document Title”:smartphone) OR (“Document Title”: game) OR (“Document Title”: telemedicine) OR (“Document Title”: smart-phone) OR (“Document Title”: e-health) OR (“Document Title”: ehealth) OR (“Document Title”: mobile) OR (“Document Title”: mhealth) OR (“Document Title”: m-health) OR (“Document Title”: wearable) OR (“Document Title”: smartwatch) OR (“Document Title”:smart-watch) OR (“Document Title”:biosensing) OR (“Document Title”:wearable electronic device) OR (“Document Title”:mobile app)) AND (“Document Title”:heart rate) OR (“Document Title”: blood pressure)) OR (“Document Title”:arrhythmias) OR (“Document Title”:heart rhythm) OR (“Document Title”:cardiac output) OR (“Document Title”:photoplethysmography) OR (“Document Title”: electrocardiography) OR (“Document Title”: electrocardiographic) OR (“Document Title”: electrocardiogram) OR (“Document Title”: electrocardiograph) OR (“Document Title”:oxygen saturation) OR (“Document Title”:RR interval) OR (“Document Title”:LF/HF) OR (“Document Title”:ECG) OR (“Document Title”:PPG) OR (“Document Title”:heart rate monitor) OR (“Document Title”:heart rate variability) OR (“Document Title”:heart rate) OR (“Document Title”: variability sensor) OR (“Document Title”:heart rate zone) OR (“Document Title”:maximum heart rate) OR (“Document Title”:thoracic impedance) OR (“Document Title”:photoplethysmography sensor) OR (“Document Title”:vital-sign monitoring) OR (“Document Title”:electrocardiogram Sensor) OR (“Document Title”:handheld ECG) OR (“Document Title”:blood pressure sensor) OR (“Document Title”:sweat microfluidic biosensors) OR (“Document Title”:tattoo biosensor) OR (“Document Title”:camera based PPG) |
| brain wave devices | (“Document Title”: electroencephalography) OR (“Document Title”: electroencephalographic) OR (“Document Title”: electroencephalogram) OR (“Document Title”: electroencephalograph) OR (“Document Title”:magnetic resonance imaging) OR (“Document Title”:functional MRI) OR (“Document Title”:fMRI) OR (“Document Title”:neurofeedback) OR (“Document Title”:brain computer interfaces) OR (“Document Title”:EEG) OR (“Document Title”:fNIRS) OR (“Document Title”:alpha wave) OR (“Document Title”:brain health) OR (“Document Title”:functional Near-Infrared Spectroscopy) OR (“Document Title”:brain sensing headband) OR (“Document Title”:wireless mobile EEG) OR (“Document Title”:brain monitoring) OR (“Document Title”:brain training apps) |
| contactless heart rate/pulse wave estimation | (“Document Title”:heart rate determination) OR (“Document Title”:heart rate monitoring) OR (“Document Title”:rPPG) OR (“Document Title”:remote photoplethysmography) OR (“Document Title”:non-contact heart rate monitor) OR (“Document Title”:non-contact pulse monitor) OR (“Document Title”:video-based heart rate monitoring) OR (“Document Title”:radar-based heart rate monitoring) OR (“Document Title”:infrared-based heart rate monitoring) OR (“Document Title”:non-invasive heart rate measurement) OR (“Document Title”:remote heart rate monitoring) OR (“Document Title”:heart rate variability measurement) |
| communication robots | (“Document Title”:robotics) OR (“Document Title”:socially assistive robot) OR (“Document Title”:robot therapy) OR (“Document Title”:robot assisted therapy) OR (“Document Title”:chatbot) OR (“Document Title”:chatGPT) OR (“Document Title”:psychiatric robot) OR (“Document Title”:robot companion for mental health) OR (“Document Title”:health chatbot) OR (“Document Title”:mental health robot) OR (“Document Title”:therapeutic robot) OR (“Document Title”:robot mediated therapy) OR (“Document Title”:human-robot interaction in mental health) OR (“Document Title”:emotional support robot) OR (“Document Title”:cognitive-behavioral therapy robot) OR (“Document Title”:psychological enrichment) OR (“Document Title”:human-interactive robots) OR (“Document Title”:healing robots) |
| avatar/metaverse | (“Document Title”:virtual reality) OR (“Document Title”:VR) OR (“Document Title”:internet based intervention) OR (“Document Title”:metaverse avatar therapy) OR (“Document Title”:avatar-based therapy) OR (“Document Title”:virtual reality interventions) OR (“Document Title”:virtual reality relaxation techniques) OR (“Document Title”:virtual reality meditation techniques) OR (“Document Title”:virtual reality cognitive-behavioral therapy) OR (“Document Title”:virtual reality mindfulness interventions) OR (“Document Title”:avatar-mediated communication) OR (“Document Title”:metaverse interventions) OR (“Document Title”:metaverse-based assessment) |
| voice and emotion analysis | (“Document Title”:facial recognition) OR (“Document Title”:facial expression recognition) OR (“Document Title”:voice recognition) OR (“Document Title”:wavelet analysis) OR (“Document Title”:speech recognition software) OR (“Document Title”:phonetics) OR (“Document Title”:natural language processing) OR (“Document Title”:neural networks) OR (“Document Title”:signal processing) OR (“Document Title”:speech synthesis) OR (“Document Title”:voice analysis) OR (“Document Title”:speech analysis) OR (“Document Title”:physiological signals) OR (“Document Title”:iris recognition) OR (“Document Title”:emotion recognition) OR (“Document Title”:affective computing) OR (“Document Title”:non-invasive sensing) OR (“Document Title”:speech signal processing) OR (“Document Title”:audio signal processing) OR (“Document Title”:acoustic signal processing) OR (“Document Title”:voice signal processing) OR (“Document Title”:digital signal processing for speech) OR (“Document Title”:speech enhancement) OR (“Document Title”:speech recognition) OR (“Document Title”:speaker identification) OR (“Document Title”:speaker diarization) OR (“Document Title”:emotion recognition from speech) OR (“Document Title”:prosody analysis) OR (“Document Title”:self-attention mechanism) OR (“Document Title”:neural attention) OR (“Document Title”:transformer model) OR (“Document Title”:mel frequency cepstral coefficients) OR (“Document Title”:automatic speech recognition) OR (“Document Title”:speech emotion recognition) OR (“Document Title”:bidirectional long short-term memory) OR (“Document Title”:interactive emotional dyadic motion) |
| exercise/physical activity | (((“Document Title”:online) OR (“Document Title”: internet) OR (“Document Title”: web) OR (“Document Title”:app) OR (“Document Title”: apps) OR (“Document Title”: computer) OR (“Document Title”: digital) OR (“Document Title”:smartphone) OR (“Document Title”: game) OR (“Document Title”: telemedicine) OR (“Document Title”: smart-phone) OR (“Document Title”: e-health) OR (“Document Title”: ehealth) OR (“Document Title”: mobile) OR (“Document Title”: mhealth) OR (“Document Title”: m-health) OR (“Document Title”: wearable) OR (“Document Title”: smartwatch) OR (“Document Title”:smart-watch) OR (“Document Title”:biosensing) OR (“Document Title”:wearable electronic device) OR (“Document Title”:mobile app)) AND (“Document Title”: exercise) OR (“Document Title”: physical activity) OR (“Document Title”:body temperature) OR (“Document Title”:sedentary behavior) OR (“Document Title”:sedentary time) OR (“Document Title”:walking)) OR (“Document Title”:motion capture) OR (“Document Title”:fitness trackers) OR (“Document Title”:activity tracker) OR (“Document Title”:accelerometry) OR (“Document Title”:actigraphy) OR (“Document Title”:biomechanical phenomena) OR (“Document Title”:biomechanics) OR (“Document Title”:ecological parameter monitoring) OR (“Document Title”: electromyography) OR (“Document Title”: electromyographic) OR (“Document Title”: electromyogram) OR (“Document Title”: electromyograph)OR (“Document Title”:gyroscope) OR (“Document Title”:motion sensor) OR (“Document Title”:physical activity monitoring) OR (“Document Title”:exercise monitoring) OR (“Document Title”:inertial sensors) OR (“Document Title”:pedometer) OR (“Document Title”:GPS tracking) OR (“Document Title”:health monitoring) OR (“Document Title”:accelerometer) OR (“Document Title”:magnetometers) OR (“Document Title”:steps) |
| sleep estimation | (((“Document Title”:online) OR (“Document Title”: internet) OR (“Document Title”: web) OR (“Document Title”:app) OR (“Document Title”: apps) OR (“Document Title”: computer) OR (“Document Title”: digital) OR (“Document Title”:smartphone) OR (“Document Title”: game) OR (“Document Title”: telemedicine) OR (“Document Title”: smart-phone) OR (“Document Title”: e-health) OR (“Document Title”: ehealth) OR (“Document Title”: mobile) OR (“Document Title”: mhealth) OR (“Document Title”: m-health) OR (“Document Title”: wearable) OR (“Document Title”: smartwatch) OR (“Document Title”:smart-watch) OR (“Document Title”:biosensing) OR (“Document Title”:wearable electronic device) OR (“Document Title”:mobile app)) AND (“Document Title”: sleep) OR (“Document Title”: respiration)) OR (“Document Title”:polysomnography) OR (“Document Title”:sleep stages) OR (“Document Title”:oximetry) OR (“Document Title”:pulse oximeter) OR (“Document Title”:snoring) OR (“Document Title”:SpO2) OR (“Document Title”: electrooculography) OR (“Document Title”: electrooculographic) OR (“Document Title”: electrooculogram) OR (“Document Title”: electrooculography) OR (“Document Title”:PSG) OR (“Document Title”:sleep efficiency) OR (“Document Title”:heart rate variability) OR (“Document Title”:HRV) OR (“Document Title”: non-rapid eye movement sleep) OR (“Document Title”:rapid eye movement sleep) OR (“Document Title”:sleep diary) OR (“Document Title”:sleep analysis) OR (“Document Title”:sleep assessment devices) OR (“Document Title”:sleep patterns) OR (“Document Title”:sleep monitor) OR (“Document Title”:wearable sleep tracking technology) OR (“Document Title”:wearable sleep monitoring technology) OR (“Document Title”:sleep disorders) |
| dietary management | (((“Document Title”:online) OR (“Document Title”: internet) OR (“Document Title”: web) OR (“Document Title”:app) OR (“Document Title”: apps) OR (“Document Title”: computer) OR (“Document Title”: digital) OR (“Document Title”:smartphone) OR (“Document Title”: game) OR (“Document Title”: telemedicine) OR (“Document Title”: smart-phone) OR (“Document Title”: e-health) OR (“Document Title”: ehealth) OR (“Document Title”: mobile) OR (“Document Title”: mhealth) OR (“Document Title”: m-health) OR (“Document Title”: wearable) OR (“Document Title”: smartwatch) OR (“Document Title”:smart-watch) OR (“Document Title”:biosensing) OR (“Document Title”:wearable electronic device) OR (“Document Title”:mobile app)) AND (“Document Title”: diet) OR (“Document Title”: meal) OR (“Document Title”:nutritional status) OR (“Document Title”:eating) OR (“Document Title”:energy intake) OR (“Document Title”:feeding behavior) OR (“Document Title”:eating behavior) OR (“Document Title”:food intake)) OR (“Document Title”:self-monitoring app) OR (“Document Title”:nutrition counseling app) OR (“Document Title”:diet app) OR (“Document Title”:nutrition app) OR (“Document Title”:meal tracking app) OR (“Document Title”:food diary app) OR (“Document Title”:calorie tracking app) OR (“Document Title”:calorie counting) OR (“Document Title”:dietitian app) OR (“Document Title”:feeding and eating disorders) |
| psychological safety | (((“Document Title”:online) OR (“Document Title”: internet) OR (“Document Title”: web) OR (“Document Title”:app) OR (“Document Title”: apps) OR (“Document Title”: computer) OR (“Document Title”: digital) OR (“Document Title”:smartphone) OR (“Document Title”: game) OR (“Document Title”: telemedicine) OR (“Document Title”: smart-phone) OR (“Document Title”: e-health) OR (“Document Title”: ehealth) OR (“Document Title”: mobile) OR (“Document Title”: mhealth) OR (“Document Title”: m-health) OR (“Document Title”: wearable) OR (“Document Title”: smartwatch) OR (“Document Title”:smart-watch) OR (“Document Title”:biosensing) OR (“Document Title”:wearable electronic device) OR (“Document Title”:mobile app)) AND (“Document Title”: crew resource management) OR (“Document Title”: mentoring) OR (“Document Title”: psychological safety) OR (“Document Title”: stress management training) OR (“Document Title”: teamwork training) OR (“Document Title”: communication training)) OR (“Document Title”: psychological education) OR (“Document Title”: coaching) |
| self-care/ cognitive behavioral therapy /mindfulness | (((“Document Title”:online) OR (“Document Title”: internet) OR (“Document Title”: web) OR (“Document Title”:app) OR (“Document Title”: apps) OR (“Document Title”: computer) OR (“Document Title”: digital) OR (“Document Title”:smartphone) OR (“Document Title”: game) OR (“Document Title”: telemedicine) OR (“Document Title”: smart-phone) OR (“Document Title”: e-health) OR (“Document Title”: ehealth) OR (“Document Title”: mobile) OR (“Document Title”: mhealth) OR (“Document Title”: m-health) OR (“Document Title”: wearable) OR (“Document Title”: smartwatch) OR (“Document Title”:smart-watch) OR (“Document Title”:biosensing) OR (“Document Title”:wearable electronic device) OR (“Document Title”:mobile app)) AND (“Document Title”: cognitive behavioral therapy) OR (“Document Title”: play Therapy) OR (“Document Title”: cognitive training) OR (“Document Title”: mindfulness)) OR (“Document Title”: digital psychotherapy) OR (“Document Title”: emotion regulation training) OR (“Document Title”:mental health training) OR (“Document Title”:mental health intervention) OR (“Document Title”:mindfulness training) OR (“Document Title”:Resilience training) OR (“Document Title”:mental health apps) OR (“Document Title”:self-care apps) OR (“Document Title”:digital mental health interventions) OR (“Document Title”:mobile mental health apps) OR (“Document Title”:smartphone apps for mental health) OR (“Document Title”:e-mental health interventions) OR (“Document Title”:technology-based mental health) |
