Technology-Based Innovations to Foster Personalized Healthy Lifestyles and Well-Being: A Targeted Review

Enhanced control of periodontitis by an artificial intelligence-enabled multimodal-sensing toothbrush and targeted mHealth micromessages: A randomized trial

AIM

Treatment of periodontitis, a chronic inflammatory disease driven by biofilm dysbiosis, remains challenging due to patients' poor performance and adherence to the necessary oral hygiene procedures. Novel, artificial intelligence-enabled multimodal-sensing toothbrushes (AI-MST) can guide patients' oral hygiene practices in real-time and transmit valuable data to clinicians, thus enabling effective remote monitoring and guidance. The aim of this trial was to assess the effect of such a system as an adjunct to clinical practice guideline-conform treatment.

MATERIALS AND METHODS

This was a single-centre, double-blind, standard-of-care controlled, randomized, parallel-group, superiority trial. Male and female adults with generalized Stage II/III periodontitis were recruited at the Shanghai Ninth People's Hospital, China. Subjects received a standard-of-care oral hygiene regimen or a technology-enabled, theory-based digital intervention consisting of an AI-MST and targeted doctor's guidance by remote micromessaging. Additionally, both groups received guideline-conform periodontal treatment. The primary outcome was the resolution of inflamed periodontal pockets (≥4 mm with bleeding on probing) at 6 months. The intention-to-treat (ITT) analysis included all subjects who received the allocated treatment and at least one follow-up.

RESULTS

One hundred patients were randomized and treated (50 tests/controls) between 1 February and 30 November 2022. Forty-eight tests (19 females) and 47 controls (16 females) were analysed in the ITT population. At 6 months, the proportion of inflamed periodontal pockets decreased from 80.7% (95% confidence interval [CI] 76.5-84.8) to 52.3% (47.7-57.0) in the control group, and from 81.4% (77.1-85.6) to 44.4% (39.9-48.9) in the test group. The inter-group difference was 7.9% (1.6-14.6, p < .05). Test subjects achieved better levels of oral hygiene (p < .001). No significant adverse events were observed.

CONCLUSIONS

The tested digital health intervention significantly improved the outcome of periodontal therapy by enhancing the adherence and performance of self-performed oral hygiene. The model breaks the traditional model of oral health care and has the potential to improve efficiency and reduce costs (NCT05137392).

Mental Health and Well-Being in Racial or Ethnic Minority Individuals After Using a Faith and Prayer Mobile App (Pray.com): Feasibility and Preliminary Efficacy Trial

BACKGROUND

Research is needed on how faith and prayer apps fit within the values of racial and ethnic minority (REM) groups, as well as whether such apps are effective in promoting mental health and well-being.

OBJECTIVE

This study aims to determine the feasibility and preliminary effectiveness of using the mobile app Pray.com on mental health and well-being among REM participants.

METHODS

This study was a single-group (N=77), 4-week feasibility trial in REM groups (65/77, 84% Black or African American). Participants were asked to use the Pray.com app at no cost for at least 5 times per week for 5 minutes per day. Participants completed questionnaires at the baseline and postintervention time points. Feasibility questionnaires were only completed at the postintervention time point, including qualitative interviews (n=15). The feasibility questions included acceptability (ie, satisfaction, intent to continue use, perceived appropriateness, and fit within culture), demand (ie, self-reported app use, expressed interest, and perceived demand), and practicality (ie, ease or difficulty of use, ability to use the app, and cost-effectiveness). Frequency and descriptive statistics were used to analyze feasibility outcomes. Changes in dependent variables were analyzed using paired-sample 2-tailed t tests. Partial correlations were conducted to explore the association between app use and outcomes, controlling for baseline scores.

RESULTS

Participants reported (54/72, 75% responded with "very likely" or "likely" to the feasibility questions) that they perceived the Pray.com app as acceptable. These findings were supported by qualitative interviews (n=15). Most participants (62/72, 86%) did not meet the app use prescription but expressed interest in using the app in the future and perceived demand for it in their communities. In addition, participants reported that the app was easy to use and perceived it to be inexpensive (US $7.99). Participants reported improved mental health (ie, stress and depressive and anxiety symptoms) and well-being (ie, satisfaction with life, spiritual well-being, religious commitment, and racial or ethnic identity development) at postintervention despite relatively low average levels and high variability of app use (average total of 45.83, SD 111.90 min over the course of the study). Greater app use was significantly associated with improvements in mental health and spiritual well-being. However, app use and study methodology limitations suggest that the study results may not accurately capture the full impact of Pray.com use.

CONCLUSIONS

This is the first study to assess the feasibility of a faith and prayer app for mental health and well-being in a sample of REM individuals. Our findings suggest that the use of a faith and prayer app (ie, Pray.com) could be feasible and significantly impactful for the improvement of mental health symptoms and well-being in REM individuals and their communities, especially Black and African American individuals with a Christian affiliation. Further research is warranted.

Examining the Use of Autonomous Systems for Home Health Support Using a Smart Mirror

The home is becoming a key location for healthcare delivery, including the use of technology driven by autonomous systems (AS) to monitor and support healthcare plans. Using the example of a smart mirror, this paper describes the outcomes of focus groups with people with multiple sclerosis (MS; n = 6) and people who have had a stroke (n = 15) to understand their attitudes towards the use of AS for healthcare in the home. Qualitative data were analysed using a thematic analysis. The results indicate that the use of such technology depends on the level of adaptability and responsiveness to users' specific circumstances, including their relationships with the healthcare system. A smart mirror would need to support manual entry, responsive goal setting, the effective aggregation of data sources and integration with other technology, have a range of input methods, be supportive rather than prescriptive in messaging, and give the user full control of their data. The barriers to its adoption include a perceived lack of portability and practicality, a lack of accessibility and inclusivity, a sense of redundancy, feeling overwhelmed by multiple technological devices, and a lack of trust in data sharing. These results inform the development and deployment of future health technologies based on the lived experiences of people with health conditions who require ongoing care.

A nutritional web-based approach in obesity and diabetes before and during the COVID-19 lockdown

INTRODUCTION

Obesity and type 2 diabetes (T2D) are two closely related pandemic conditions. Novel technologies represent promising tools for their management, the use of which has been greatly encouraged during the COVID-19 pandemic. The aim of the present study is to compare a web-based nutritional intervention versus a traditional one, before and during the Italian 'lockdown' period due to the COVID-19 outbreak, in overweight and obese subjects affected by T2D or impaired glucose regulation (IGR).

METHODS

For the study, 36 subjects were randomly allocated into two arms: a traditional arm, providing face-to-face individual and group-based intervention; and a web arm, deploying the in-presence traditional approach with intervention provided through web technologies. The outcomes were the data resulting from the comparison between the subjects' anthropometric and clinical parameters as well as PREDIMED scores at baseline with those at 3 months (T3), 6 months (T6) and at lockdown.

RESULTS

In the web arm we detected a progressive reduction in weight and body mass index (BMI) from baseline to T6 and a minimal increase of both parameters during the lockdown. Improvement of these parameters compared with baseline was observed in controls during the lockdown. The PREDIMED score improved at T6 compared with baseline in both arms. Significant variations were observed considering weight (p < 0.001), BMI (p = 0.001) and PREDIMED scores (p = 0.023) over time.

DISCUSSION

The study showed the effectiveness and feasibility of a short-term nutritional web-based intervention in patients affected by T2D or IGR before and during the COVID 19 pandemic.Clinical Trial registration number: NCT04386200, ClinicalTrials.gov.

Technology & behavioral changes mediation for personnel safety intentions: Crisis in theoretical framework

With a theoretical S-O-R(stimulus-organism-response) framework, the study focused on the technology and behavioral changes ensuring personal safety intentions in developed countries. Covid-19 Crisis made the scenario feel the difference in rich people's society or not? Rare research focused on technology-related behavioral changes due to the 20^th century and a surge in data insights. A random sampling technique was used to analyze data from 580 individuals. At first, P.L.S. (partial least square) analysis proved that leisure, health anxiety-related information flow, and especially new social media trends had substantial effects on technology and behavioral changes. Statistical results, including time series and correlation results, focused more on personnel safety intentions in China. Individual-based historical data proved a huge data use intentions change even until 2022. Hence, the first-ever preliminary research findings will open a new aperture in information management.

Persuasive Technologies and Social Interactions in Professional Environments: Embedded Qualitative Case Study

BACKGROUND

Although previous studies have highlighted the impact of interactions on the web in the context of patient-health care professional (HCP) dyads, this paper extends that context to a triad that includes the role of employers and associated settings with social groups.

OBJECTIVE

This study aims to evaluate how the interactions between individuals and the social use of the platform affect individuals' use of persuasive technology and, in turn, their work environment actions and responses, by implementing a persuasive technology health and wellness platform in a work environment.

METHODS

For 8 months, we deployed a persuasive technology platform with different combinations of health-related features and content in 1 embedded case design with 8 fire stations for a small Canadian city (total number of participant firefighters, n=141) assigned to 1 of 2 treatments-interactive or static webpages. We used text-based content analysis techniques for outcome measures, drawn from a total of 29 participant exit interviews. In addition, medical assessments were conducted at baseline, midpoint, and end point by 7 HCPs and 1 researcher (BM), who also served as the data steward and managed the study.

RESULTS

Our results reveal that group, social, and work influences introduce new elements to the use of persuasive technology, which interact to foster higher levels of individual success. The platform in our study served as part of a larger social system, providing information that facilitated new behaviors at work and home. The 8-month group programs centered on exercise, nutrition, and smoking cessation. Groups of participants coached by certified professionals showed significant increases in sodium awareness, levels of actual exercise, and consistency of activities. As a result of the study, of 141 people, 15 (10.6%) were notified of serious medical health issues and 29 (20.6%) underwent blood work assessments and a privacy shield (protected by federal law) was enacted to protect employees from losing their employment based on any health concerns disclosed.

CONCLUSIONS

The persuasive technology platform, in combination with self-management and professional management and social interactions, significantly altered work management behaviors. Interactions among individual outcomes, group influences, and social situations strongly influenced individuals' behaviors in their work and home environments. Three things further improved the positive results that we observed: privacy shields (which allowed employees to reveal health concerns without fear of professional consequences), individual private activities aligned with group activities, and integration between HCP work with localized, organizational work roles.

Methods for Human-Centered eHealth Development: Narrative Scoping Review

Background

Thorough holistic development of eHealth can contribute to a good fit among the technology, its users, and the context. However, despite the availability of frameworks, not much is known about specific research activities for different aims, phases, and settings. This results in researchers having to reinvent the wheel. Consequently, there is a need to synthesize existing knowledge on research activities for participatory eHealth development processes.

Objective

The 3 main goals of this review are to create an overview of the development strategies used in studies based on the CeHRes (Center for eHealth Research) Roadmap, create an overview of the goals for which these methods can be used, and provide insight into the lessons learned about these methods.

Methods

We included eHealth development studies that were based on the phases and/or principles of the CeHRes Roadmap. This framework was selected because of its focus on participatory, iterative eHealth design in context and to limit the scope of this review. Data were extracted about the type of strategy used, rationale for using the strategy, research questions, and reported information on lessons learned. The most frequently mentioned lessons learned were summarized using a narrative, inductive approach.

Results

In the included 160 papers, a distinction was made between overarching development methods (n=10) and products (n=7). Methods are used to gather new data, whereas products can be used to synthesize previously collected data and support the collection of new data. The identified methods were focus groups, interviews, questionnaires, usability tests, literature studies, desk research, log data analyses, card sorting, Delphi studies, and experience sampling. The identified products were prototypes, requirements, stakeholder maps, values, behavior change strategies, personas, and business models. Examples of how these methods and products were applied in the development process and information about lessons learned were provided.

Conclusions

This study shows that there is a plethora of methods and products that can be used at different points in the development process and in different settings. To do justice to the complexity of eHealth development, it seems that multiple strategies should be combined. In addition, we found no evidence for an optimal single step-by-step approach to develop eHealth. Rather, researchers need to select the most suitable research methods for their research objectives, the context in which data are collected, and the characteristics of the participants. This study serves as a first step toward creating a toolkit to support researchers in applying the CeHRes Roadmap to practice. In this way, they can shape the most suitable and efficient eHealth development process.

Perspective: Opportunities and Challenges of Technology Tools in Dietary and Activity Assessment: Bridging Stakeholder Viewpoints

The science and tools of measuring energy intake and output in humans have rapidly advanced in the last decade. Engineered devices such as wearables and sensors, software applications, and Web-based tools are now ubiquitous in both research and consumer environments. The assessment of energy expenditure in particular has progressed from reliance on self-report instruments to advanced technologies requiring collaboration across multiple disciplines, from optics to accelerometry. In contrast, assessing energy intake still heavily relies on self-report mechanisms. Although these tools have improved, moving from paper-based to online reporting, considerable room for refinement remains in existing tools, and great opportunities exist for novel, transformational tools, including those using spectroscopy and chemo-sensing. This report reviews the state of the science, and the opportunities and challenges in existing and emerging technologies, from the perspectives of 3 key stakeholders: researchers, users, and developers. Each stakeholder approaches these tools with unique requirements: researchers are concerned with validity, accuracy, data detail and abundance, and ethical use; users with ease of use and privacy; and developers with high adherence and utilization, intellectual property, licensing rights, and monetization. Cross-cutting concerns include frequent updating and integration of the food and nutrient databases on which assessments rely, improving accessibility and reducing disparities in use, and maintaining reliable technical assistance. These contextual challenges are discussed in terms of opportunities and further steps in the direction of personalized health.

Physical Activity and Health Promotion in Esports and Gaming-Discussing Unique Opportunities for an Unprecedented Cultural Phenomenon

Due to long periods of sedentary behavior, and unhealthy diets gamers and esports players are at risk for numerous chronic diseases and all-cause mortality. Health research has started addressing the public health implications of the esports phenomenon, drawing a bleak picture of this megatrend. However, instead of just highlighting adverse public health implications of this trend, it is recommended to become involved in this phenomenon and positively influence it. Esports has an enormous potential for physical activity and health-promoting efforts, provides a context for broadly disseminating interventions, and offers new ways of gaining access to an often-neglected population. This paper presents: the potential of the esports phenomenon to promote physical activity, health, and well-being in gamers and esports players; the strategic and preventive solutions to ameliorate esports possible adverse health impacts; and the utilization of esports technology (streams, media platforms, exergames, etc.) as an innovative health promotion tool, especially reaching gamers and esports players with attractive and interactive interventions. This is to encourage systematic scientific research so that evidence-based guidelines and intervention strategies involving regular physical activity, healthy diet, and sleep hygiene for esports will be developed. The goal is to promote public health approaches that move toward a better integration of esports and gaming.

Personalized mobile technologies for lifestyle behavior change: A systematic review, meta-analysis, and meta-regression

Given that the one-size-fits-all approach to mobile health interventions have limited effects, a personalized approach might be necessary to promote healthy behaviors and prevent chronic conditions. Our systematic review aims to evaluate the effectiveness of personalized mobile interventions on lifestyle behaviors (i.e., physical activity, diet, smoking and alcohol consumption), and identify the effective key features of such interventions. We included any experimental trials that tested a personalized mobile app or fitness tracker and reported any lifestyle behavior measures. We conducted a narrative synthesis for all studies, and a meta-analysis of randomized controlled trials. Thirty-nine articles describing 31 interventions were included (n = 77,243, 64% women). All interventions personalized content and rarely personalized other features. Source of data included system-captured (12 interventions), user-reported (11 interventions) or both (8 interventions). The meta-analysis showed a moderate positive effect on lifestyle behavior outcomes (standardized difference in means [SDM] 0.663, 95% CI 0.228 to 1.10). A meta-regression model including source of data found that interventions that used system-captured data for personalization were associated with higher effectiveness than those that used user-reported data (SDM 1.48, 95% CI 0.76 to 2.19). In summary, the field is in its infancy, with preliminary evidence of the potential efficacy of personalization in improving lifestyle behaviors. Source of data for personalization might be important in determining intervention effectiveness. To fully exploit the potential of personalization, future high-quality studies should investigate the integration of multiple data from different sources and include personalized features other than content.

A Digital Platform for Facilitating Personalized Dementia Care in Nursing Homes: Formative Evaluation Study

Background

Care personalization is key to the well-being of people with dementia according to person-centered care. With the development of the internet of things, a large quantity of personal data can be collected securely and reliably, which has the potential to facilitate care personalization for people with dementia. Yet, there are limited assistive technologies developed for this purpose, and the user acceptance of assistive technologies is low in nursing homes. Therefore, through a data-enabled design approach, a digital platform was developed for helping the care team in a nursing home to personalize dementia care, specifically in the management of behavioral and psychological dementia symptoms.

Objective

This study aimed to evaluate the digital platform in a real-life context with potential users from the following two aspects: (1) to explore if the digital platform could help with generating insights on the current state of each person with dementia and (2) to gather feedback on the digital platform from the care team.

Methods

The digital platform was deployed in the nursing home for 7 weeks and the data collected were visualized and presented to the care team via the digital platform. The visualizations were analyzed by the researchers for pattern detection. Meanwhile, the care team was asked to examine the visualizations and were interviewed for the following: (1) if any insights and actions were generated from the examination, (2) the usefulness of the digital platform, and (3) the improvements they would like to see.

Results

The data collected on the digital platform demonstrated its potential for pattern detection. Insights were generated by the care team and categorized into “client level,” “ward level,” and “team level.” The corresponding actions taken by the care team were classified into “investigation” and “implementation.” User acceptance varied across the care team, and three aspects of improvement for the digital platform were identified.

Conclusions

By evaluating the digital platform, this study gained insights on applying data-enabled design for personalizing dementia care; besides, it offers future researchers some recommendations on how to integrate assistive technologies in the nursing home context.

Does Health Information Technology Promote Healthy Behaviors? The Mediating Role of Self-Regulation

Health information technology (health IT) has the potential to facilitate the self-regulation of fruit and vegetable intake (FVI) and physical activity (PA). This study explores whether using health IT for self-regulation mediates the relationship between sociodemographic factors and health behaviors including FVI and PA among U.S. adults. Bayesian mediation analysis was used to analyze a nationally representative sample of the U.S. adults (N = 3285) from Cycle 1 of the 2017 Health Information National Trends Survey (HINTS). The 95% credibility intervals (CI) were calculated for each sociodemographic factor and the mediator using health IT for self-regulation in relation to FVI and PA. About 58% of the participants used at least one type of health IT for self-regulation. Age was negatively associated with using health IT for self-regulation, whereas being a female and having a higher income and education were positively associated with it. Using health IT for self-regulation partially mediated the positive relationships between income, education, and FVI, but it is unrelated to PA. The findings support the efficacy of using health IT to regulate healthier eating. Nevertheless, the digital divide is a critical issue to consider when applying health IT to promote behavior change.

Leveraging the Power of Nondisruptive Technologies to Optimize Mental Health Treatment: Case Study

Regular assessment of the effectiveness of behavioral interventions is a potent tool for improving their relevance to patients. However, poor provider and patient adherence characterize most measurement-based care tools. Therefore, a new approach for measuring intervention effects and communicating them to providers in a seamless manner is warranted. This paper provides a brief overview of the available research evidence on novel ways to measure the effects of behavioral treatments, integrating both objective and subjective data. We highlight the importance of analyzing therapeutic conversations through natural language processing. We then suggest a conceptual framework for capitalizing on data captured through directly collected and nondisruptive methodologies to describe the client's characteristics and needs and inform clinical decision-making. We then apply this context in exploring a new tool to integrate the content of therapeutic conversations and patients' self-reports. We present a case study of how both subjective and objective measures of treatment effects were implemented in cognitive-behavioral treatment for depression and anxiety and then utilized in treatment planning, delivery, and termination. In this tool, called Eleos, the patient completes standardized measures of depression and anxiety. The content of the treatment sessions was evaluated using nondisruptive, independent measures of conversation content, fidelity to the treatment model, and the back-and-forth of client-therapist dialogue. Innovative applications of advances in digital health are needed to disseminate empirically supported interventions and measure them in a noncumbersome way. Eleos appears to be a feasible, sustainable, and effective way to assess behavioral health care.

Hardware Prototype for Wrist-Worn Simultaneous Monitoring of Environmental, Behavioral, and Physiological Parameters

We designed a low-cost wrist-worn prototype for simultaneously measuring environmental, behavioral, and physiological domains of influencing factors in healthcare. Our prototype continuously monitors ambient elements (sound level, toxic gases, ultraviolet radiation, air pressure, temperature, and humidity), personal activity (motion tracking and body positioning using gyroscope, magnetometer, and accelerometer), and vital signs (skin temperature and heart rate). An innovative three-dimensional hardware, based on the multi-physical-layer approach is introduced. Using board-to-board connectors, several physical hardware layers are stacked on top of each other. All of these layers consist of integrated and/or add-on sensors to measure certain domain (environmental, behavioral, or physiological). The prototype includes centralized data processing, transmission, and visualization. Bi-directional communication is based on Bluetooth Low Energy (BLE) and can connect to smartphones as well as smart cars and smart homes for data analytic and adverse-event alerts. This study aims to develop a prototype for simultaneous monitoring of the all three areas for monitoring of workplaces and chronic obstructive pulmonary disease (COPD) patients with a concentration on technical development and validation rather than clinical investigation. We have implemented 6 prototypes which have been tested by 5 volunteers. We have asked the subjects to test the prototype in a daily routine in both indoor (workplaces and laboratories) and outdoor. We have not imposed any specific conditions for the tests. All presented data in this work are from the same prototype. Eleven sensors measure fifteen parameters from three domains. The prototype delivers the resolutions of 0.1 part per million (PPM) for air quality parameters, 1 dB, 1 index, and 1 °C for sound pressure level, UV, and skin temperature, respectively. The battery operates for 12.5 h under the maximum sampling rates of sensors without recharging. The final expense does not exceed 133€. We validated all layers and tested the entire device with a 75 min recording. The results show the appropriate functionalities of the prototype for further development and investigations.

Developments in Privacy and Data Ownership in Mobile Health Technologies, 2016-2019

OBJECTIVES

To survey international regulatory frameworks that serve to protect privacy of personal data as a human right as well as to review the literature regarding privacy protections and data ownership in mobile health (mHealth) technologies between January 1, 2016 and June 1, 2019 in order to identify common themes.

METHODS

We performed a review of relevant literature available in English published between January 1, 2016 and June 1, 2019 from databases including PubMed, Google Scholar, and Web of Science, as well as relevant legislative background material. Articles out of scope (as detailed below) were eliminated. We categorized the remaining pool of articles and discrete themes were identified, specifically: concerns around data transmission and storage, including data ownership and the ability to re-identify previously de-identified data; issues with user consent (including the availability of appropriate privacy policies) and access control; and the changing culture and variable global attitudes toward privacy of health data.

RESULTS

Recent literature demonstrates that the security of mHealth data storage and transmission remains of wide concern, and aggregated data that were previously considered "de-identified" have now been demonstrated to be re-identifiable. Consumer-informed consent may be lacking with regard to mHealth applications due to the absence of a privacy policy and/or to text that is too complex and lengthy for most users to comprehend. The literature surveyed emphasizes improved access control strategies. This survey also illustrates a wide variety of global user perceptions regarding health data privacy.

CONCLUSION

The international regulatory framework that serves to protect privacy of personal data as a human right is diverse. Given the challenges legislators face to keep up with rapidly advancing technology, we introduce the concept of a "healthcare fiduciary" to serve the best interest of data subjects in the current environment.

Development of a mobile application to screen and manage fall risks in older people

Objective: Falls and related injuries are known to be the major health problem leading to disability and mortality among older adults. Identification and management of fall risks aimed to prevent falling is considered to be essential. The aim of this study was to develop a mobile application for screening and management of fall risks based for older adults.Method and materials: First, we determined product features based on literature reviews. Then we asked 10 experts to assess the importance of capabilities. The application was designed in Android environment based on the STEADI toolkit. Finally, the usability and satisfaction of the application were assessed among 30 older adults by means of a usability questionnaire, and the final version was modified.Results: The experts rated the majority of feasibility features to be important. The application consisted of falls risk self-assessment, and the Timed Up and Go (TUG) test to measure individual fall risks, fall prevention education, and suggestions for training based on the individuals' level of fall risk among older adults. The results of the usability assessment showed that the users were satisfied with the application, 8.83 out of 10.Conclusion: The mobile application can be used to screen and manage fall risks in older adults. It may help health providers to identify older adults at low, moderate, and high risks of falls provide education and training to minimise falls and fall-related injuries.Implications for rehabilitationFalls are a major health problem in older people. A great proportion of falls and falls related injuries are preventable.Given the availability and accessibility of various mobile health application and the increasing mobile device usage among older adults, mobile application can be used as a platform for delivering fall prevention programmes such as education and exercise training.The mobile application may be a valuable tool in the fall prevention and their consequences either in old adult.

TreC platform. An integrated and evolving care model for patients' empowerment and data repository

INTRODUCTION

Health care has been deeply revolutionized by the new wave of information and communication technology (ICT) development, particularly related to the electronic/personal health record (PHR). The present paper describes the original design and implementation approach followed in the Trentino Province (Italy) to promote an Integrated Care Model for patients' empowerment and data repository, by means of an evolving Personal Health Record - PHR platform, named TreC (Trentino Citizens Clinical Record).

MATERIALS AND METHODS

The TreC Platform is conceived as a communication hub among different stakeholders. The core assumption of the TreC platform strategy is to consider the citizen/patient as main manager and owner of both his/her own health and his/her contacts with the health care systems.

RESULTS

Over the years, the TreC platform has represented the core pillar in the digitalization process promoted at Province level. This has been strategically embedded in the multi-faceted e-government strategy endorsed by the Province of Trento. So far (October 2018), more than 89,000 citizens within the Province of Trento are using TreC platform as a way to communicate with the health care system and access their own personal health records.

CONCLUSIONS

The experience gained through the TreC platform implementation and its results are promising, supporting the idea that a PHR platform can represent a key driving factor in improving health care quality and efficiency, both from a patient and a health care staff perspective.

PharmActa: Personalized pharmaceutical care eHealth platform for patients and pharmacists

Community pharmacists are critically placed in the patient care chain being an extended frontline within primary healthcare networks across Europe. They are trained to ensure safe and effective medication use, a crucial and responsible role, extending beyond the common misconception limited to just providing timely access to medicines for the population. Technology-wise, eHealth being committed to an effective, networked, patient-centered and accessible healthcare would prove a real asset in this direction by achieving improved therapy adherence with better outcomes and direct contribution to a cost-effective healthcare system. In this work, we present PharmActa, a personalized eHealth platform that addresses key features of pharmaceutical care and enhances communication of pharmacists with patients for optimizing pharmacotherapy. PharmActa empowers patients by providing pharmaceutical care services, such as drug interactions tools, reminders for assisting adhesion and compliance, information regarding adverse drug reactions, as well as pharmacovigilance along with related tools for healthcare management. In addition, it allows the pharmacists to review the medication history in order to provide personalized pharmaceutical care services; thus enhancing their role as healthcare providers. Finally, a mechanism allowing such a system to be interconnected with a developed medical repository following European and International interoperability standards, is also presented. Thus far, the evaluation results presented in this work indicate that PharmActa can be of great benefit to healthcare professionals, especially pharmacists and patients.

Congestive Heart Failure Risk Assessment Monitoring through Internet of things and mobile Personal Health Systems

Congestive heart failure (CHF) occurs when the heart cannot provide the necessary cardiac output for the metabolic needs of the human body. The most prominent symptoms are increased venous pressure, abnormal heart and breathing rate, tiredness and leg swelling. Most important pathogenesis influence are: age, gender, high blood pressure, alcohol and smoking, sedentary lifestyle and diet, genetic predisposition and family history, diabetes, and atherosclerosis. Common causes are considered to be valvular heart disease, coronary heart disease and hypertension. CHF diagnosis can be achieved through physical examination (i.e., blood pressure, body mass index, blood tests) and echocardiography. In this work, we present a smart mobile application and internet of things capable of the early detection and real-time monitoring of CHF exacerbations, enforcing prevention on a daily basis. We refer to the architectural elements of our approach accounting for the integration of a secure access scheme, following GDPR regulation, as a novel biometric solution to increase security and access. A first validation of the system is also presented.

A Mobile Phone App for the Self-Management of Pediatric Concussion: Development and Usability Testing

BACKGROUND

Concussion is a common injury among Canadian children and adolescents that leads to a range of neurobehavioral deficits. However, noticeable gaps continue to exist in the management of pediatric concussion, with poor health outcomes associated with the inadequate application of best practice guidelines.

OBJECTIVE

The aim of this study was to describe the development and assess the usability of a mobile phone app to aid youth in the self-management of concussion. A secondary objective was to assess the usefulness of the app.

METHODS

An agile user-centered design approach was used to develop the technology, followed by a formative lab-based usability study for assessment and improvement proposals. Youths aged 10 to 18 years with a history of concussion and health care professionals involved in concussion management were recruited. This study included participants performing 12 tasks with the mobile phone app while using the think aloud protocol and the administration of the System Usability Scale (SUS), posttest questionnaire, and a semistructured interview.

RESULTS

A mobile phone app prototype called NeuroCare, an easily accessible pediatric concussion management intervention that provides easy access to expert-informed concussion management strategies and helps guide youth in self-managing and tracking their concussion recovery, was developed. A total of 7 youths aged between 10 and 18 years with a history of concussion and 7 health care professionals were recruited. The mean SUS score was 81.9, mean task success rates were greater than 90% for 92% (11/12) of the tasks, 92% (11/12) of tasks had a total error frequency of less than 11 errors, and mean task completion times were less than 2 min for 100% of the tasks.

CONCLUSIONS

Results suggest that participants rated this app as highly usable, acceptable to users, and that it may be useful in helping youth self-manage concussion.

Exploring Associations Between the Self-Reported Values, Well-Being, and Health Behaviors of Finnish Citizens: Cross-Sectional Analysis of More Than 100,000 Web-Survey Responses

BACKGROUND

Understanding the relationship between personal values, well-being, and health-related behavior could facilitate the development of engaging, effective digital interventions for promoting well-being and the healthy lifestyles of citizens. Although the associations between well-being and values have been quite extensively studied, the knowledge about the relationship between health behaviors and values is less comprehensive.

OBJECTIVE

The aim of this study was to assess retrospectively the associations between self-reported values and commitment to values combined with self-reported well-being and health behaviors from a large cross-sectional dataset.

METHODS

We analyzed 101,130 anonymous responses (mean age 44.78 years [SD 13.82]; 78.88%, 79,770/101,130 women) to a Finnish Web survey, which were collected as part of a national health promotion campaign. The data regarding personal values were unstructured, and the self-reported value items were classified into value types based on the Schwartz value theory and by applying principal component analysis. Logistic and multiple linear regression were used to explore the associations of value types and commitment to values with well-being factors (happiness, communal social activity, work, and family-related distress) and health behaviors (exercise, eating, smoking, alcohol consumption, and sleep).

RESULTS

Commitment to personal values was positively related to happiness (part r²=0.28), communal social activity (part r²=0.09), and regular exercise (part r²=0.06; P<.001 for all). Health, Power (social status and dominance), and Mental balance (self-acceptance) values had the most extensive associations with health behaviors. Regular exercise, healthy eating, and nonsmoking increased the odds of valuing Health by 71.7%, 26.8%, and 40.0%, respectively (P<.001 for all). Smoking, unhealthy eating, irregular exercise, and increased alcohol consumption increased the odds of reporting Power values by 27.80%, 27.78%, 24.66%, and 17.35%, respectively (P<.001 for all). Smoking, unhealthy eating, and irregular exercise increased the odds of reporting Mental balance values by 20.79%, 16.67%, and 15.37%, respectively (P<.001 for all). In addition, lower happiness levels increased the odds of reporting Mental balance and Power values by 24.12% and 20.69%, respectively (P<.001 for all).

CONCLUSIONS

The findings suggest that commitment to values is positively associated with happiness and highlight various, also previously unexplored, associations between values and health behaviors.

PharmActa: Empowering Patients to Avoid Clinical Significant Drug⁻Herb Interactions

Herbal medicinal products (HMPs) are the subject of increasing interest regarding their benefits for health. However, a serious concern is the potential appearance of clinically significant drug⁻herb interactions in patients. This work provides an overview of drug⁻herb interactions and an evaluation of their clinical significance. We discuss how personalized health services and mobile health applications can utilize tools that provide essential information to patients to avoid drug⁻HMP interactions. There is a specific mention to PharmActa, a dedicated mobile app for personalized pharmaceutical care with information regarding drug⁻HMPs interactions. Several studies over the years have shown that for some HMPs, the potential to present clinically significant interactions is evident, especially for many of the top selling HMPs. Towards that, PharmActa presents how we can improve the way that information regarding potential drug⁻herb interactions can be disseminated to the public. The utilization of technologies focusing on medical information and context awareness introduce a new era in healthcare. The exploitation of eHealth tools and pervasive mobile monitoring technologies in the case of HMPs will allow the citizens to be informed and avoid potential drug⁻HMPs interactions enhancing the effectiveness and ensuring safety for HMPs.

An Adaptive, Data-Driven Personalized Advisor for Increasing Physical Activity

In recent years, there has been growing interest in the use of fitness trackers and smartphone applications for promoting physical activity. Many of these applications use accelerometers to estimate the level of activity that users engage in and provide visual reports of a user's step counts. When provided, most recommendations are limited to popular general health advice. In our study, we develop an approach for providing data-driven and personalized recommendations for intraday activity planning. We generate an hour-by-hour activity plan that is based on the user's probability of adhering to the plan. The user's probability of adherence to the plan is personalized, based on his/her past activity patterns and current activity target. Using this approach, we can tailor notifications (e.g., reminders, encouragement) to each user. We can also dynamically update the user's activity plan at mid-day, if his/her actual activity deviates sufficiently from the original plan. In this paper, we describe an implementation of our approach and report our technical findings with respect to identifying typical activity patterns from historical data, predicting whether an activity target will be achieved, and adapting an activity plan based on a user's actual performance throughout the day.

The Phased Implementation of a National Telehealth Weight Management Program for Veterans: Mixed-Methods Program Evaluation

Background

The burden of obesity is high among US veterans, yet many face barriers to engaging in in-person, facility-based treatment programs. To improve access to weight-management services, the Veterans Health Administration (VHA) developed TeleMOVE, a home-based, 82-day curriculum that utilizes in-home messaging devices to promote weight loss in VHA patients facing barriers to accessing facility-based services.

Objective

The primary aim was to establish preliminary evidence for the program by comparing outcomes for TeleMOVE with standard, facility-based MOVE weight-management services (group, individual modalities) over the evaluation period based on the number of patients enrolled per site and the program’s clinical effectiveness, as demonstrated by average weight lost per patient. The secondary aim was to understand factors influencing TeleMOVE implementation variability across demonstration sites to develop recommendations to improve national program dissemination.

Methods

We employed a formative mixed-methods design to evaluate the phased implementation of TeleMOVE at 9 demonstration sites and compare patient- and site-level measures of program uptake. Data were collected between October 1, 2009 and September 30, 2011. Patient-level program outcomes were extracted from VHA patient care databases to evaluate program enrollment rates and clinical outcomes. To assess preliminary clinical effectiveness, weight loss outcomes for veterans who enrolled in TeleMOVE were compared with outcomes for veterans enrolled in standard MOVE! at each demonstration site, as well as with national averages during the first 2 years of program implementation. For the secondary aim, we invited program stakeholders to participate in 2 rounds of semistructured interviews about aspects of TeleMOVE implementation processes, site-level contextual factors, and program delivery. Twenty-eight stakeholders participated in audio-recorded interviews.

Results

Although stakeholders at 3 sites declined to be interviewed, objective program uptake was high at 2 sites, delayed-high at 2 sites, and low at 5 sites. At 6 months post enrollment, the mean weight loss was comparable for TeleMOVE (n=417) and MOVE! (n=1543) participants at −5.2 lb (SD 14.4) and −5.1 lb (SD 12.2), respectively (P=.91). All sites reported high program complexity because TeleMOVE required more staff time per participant than MOVE! due to logistical and technical assistance issues related to the devices. High-uptake sites overcame implementation challenges by leveraging communication networks with stakeholders, adapting the program to patient needs whenever possible, setting programmatic goals and monitoring feedback of results, and taking time to reflect and evaluate on delivery to foster incremental delivery improvements, whereas low-uptake sites reported less leadership support and effective communication among stakeholders.

Conclusions

This implementation evaluation of a clinical telehealth program demonstrated the value of partnership-based research in which researchers not only provided operational leaders with feedback regarding the effectiveness of a new program but also relevant feedback into contextual factors related to program implementation to enable adaptations for national deployment efforts.

Employers as Consumers of Healthcare

Amazon, Berkshire Hathaway, and JP Morgan Chase shocked the industry with its announcement to join forces to cut healthcare costs and improve healthcare services for its employees. This is just the latest of employer efforts to disrupt the industry by the creation of alternative healthcare delivery networks that demonstrate high-value, low-cost services as compared with what traditional provider systems have to offer. What factors are behind this industry disruption, and what are the key implications for nurse executives?

Immersive Interactive Technologies for Positive Change: A Scoping Review and Design Considerations

Practices such as mindfulness, introspection, and self-reflection are known to have positive short and long-term effects on health and well-being. However, in today's modern, fast-paced, technological world tempted by distractions these practices are often hard to access and relate to a broader audience. Consequently, technologies have emerged that mediate personal experiences, which is reflected in the high number of available applications designed to elicit positive changes. These technologies elicit positive changes by bringing users' attention to the self—from technologies that show representation of quantified personal data, to technologies that provide experiences that guide the user closer in understanding the self. However, while many designs available today are either built to support or are informed by these aforementioned practices, the question remains: how can we most effectively employ different design elements and interaction strategies to support positive change? Moreover, what types of input and output modalities contribute to eliciting positive states? To address these questions, we present here a state of the art scoping review of immersive interactive technologies that serve in a role of a mediator for positive change in users. We performed a literature search using ACM Digital Library, Web of Science, IEEE Xplore, and Design and Applied Arts Index (beginning of literature—January 1, 2018). We retrieved English-language articles for review, and we searched for published and unpublished studies. Risk of bias was assessed with Downs and Black 26-item QAT scale. We included 34 articles as relevant to the literature, and the analysis of the articles resulted in 38 instances of 33 immersive, interactive experiences relating to positive human functioning. Our contribution is three-fold: First we provide a scoping review of immersive interactive technologies for positive change; Second, we propose both a framework for future designs of positive interactive technologies and design consideration informed by the comparative analysis of the designs; Third, we provide design considerations for immersive, interactive technologies to elicit positive states and support positive change.

Citizen-Centric Web-Based Health Profiling Service: A Service Concept and a Profiling Method

Personalization of health interventions has been shown to increase their effectiveness. In digital services, user profiles enable this personalization. We introduce a web-based user profiling service, where citizens can 1) create various personal profiles, specific to certain health topics, by providing their personal data, 2) get summarized feedback on their health and behavioral determinants regarding each profile, and 3) share their profiles with health service providers. As part of the service, we define a profiling method that identifies the health needs and behavioral determinants of citizens, and highlights their most potential behavior change targets. The novelty in the service arises from allowing citizens to govern their health data, quantifying automatically various behavioral determinants, and summarizing aggregated knowledge efficiently via simple visualizations. The service aims to evoke personal awareness about behavior change needs and the factors influencing behavior, enable health service providers to develop and offer highly personalized, automated interventions, and facilitate time-efficient and transparent decision-making of health professionals. According to a preliminary concept evaluation with citizens (N=29), the presented profile feedback was perceived as interesting and intuitive.

Key Components in eHealth Interventions Combining Self-Tracking and Persuasive eCoaching to Promote a Healthier Lifestyle: A Scoping Review

BACKGROUND

The combination of self-tracking and persuasive eCoaching in automated interventions is a new and promising approach for healthy lifestyle management.

OBJECTIVE

The aim of this study was to identify key components of self-tracking and persuasive eCoaching in automated healthy lifestyle interventions that contribute to their effectiveness on health outcomes, usability, and adherence. A secondary aim was to identify the way in which these key components should be designed to contribute to improved health outcomes, usability, and adherence.

METHODS

The scoping review methodology proposed by Arskey and O'Malley was applied. Scopus, EMBASE, PsycINFO, and PubMed were searched for publications dated from January 1, 2013 to January 31, 2016 that included (1) self-tracking, (2) persuasive eCoaching, and (3) healthy lifestyle intervention.

RESULTS

The search resulted in 32 publications, 17 of which provided results regarding the effect on health outcomes, 27 of which provided results regarding usability, and 13 of which provided results regarding adherence. Among the 32 publications, 27 described an intervention. The most commonly applied persuasive eCoaching components in the described interventions were personalization (n=24), suggestion (n=19), goal-setting (n=17), simulation (n=17), and reminders (n=15). As for self-tracking components, most interventions utilized an accelerometer to measure steps (n=11). Furthermore, the medium through which the user could access the intervention was usually a mobile phone (n=10). The following key components and their specific design seem to influence both health outcomes and usability in a positive way: reduction by setting short-term goals to eventually reach long-term goals, personalization of goals, praise messages, reminders to input self-tracking data into the technology, use of validity-tested devices, integration of self-tracking and persuasive eCoaching, and provision of face-to-face instructions during implementation. In addition, health outcomes or usability were not negatively affected when more effort was requested from participants to input data into the technology. The data extracted from the included publications provided limited ability to identify key components for adherence. However, one key component was identified for both usability and adherence, namely the provision of personalized content.

CONCLUSIONS

This scoping review provides a first overview of the key components in automated healthy lifestyle interventions combining self-tracking and persuasive eCoaching that can be utilized during the development of such interventions. Future studies should focus on the identification of key components for effects on adherence, as adherence is a prerequisite for an intervention to be effective.