ARE NEW TECHNOLOGIES A RECOGNIZED USEFUL TOOL FOR HEALTHCARE PROVIDERS?

Health leaders and medical directors emphasize the need to include information and communication technologies (ICT) in formal healthcare programs considering their potential advantages. However, can healthcare professionals advice mHealth to their patients and are they ready to do so?

Today there are more than 2 billion smartphones’ users globally. By 2020, it is expected that this number will be multiplied by 3, reaching more than 6 billion smartphone users. In relation to this, the eHealth sector is experiencing double-digit annual growth and the number of tools and apps is continuously increasing.

A report from the IMS Institute for Healthcare Informatics has shown that more than 165.000 mHealth apps are now available in the market; more than doubling over the past two years. A high percentage of these apps are focused on healthy lifestyles offering a very attractive offer with different activities and incentives aimed at catching people’s attention (see Figure 1).

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Physical activity, healthy diet and stress management are star products among this huge offer of apps.

The World Health Organization discusses the benefits of using ICT in healthcare settings in terms of better access to information, improved communication between colleagues and patients with health providers, facilitating continuing professional development and providing learning tools for healthcare professionals, patients and the community as a whole.

Despite the evidence of the increasingly important role of ICT in healthcare, its use is not widely and homogeneously spread across different countries and healthcare settings. In general, countries differ in their market and social policies (and economies!) readiness for mHealth. In the market readiness criteria (e.g. smartphone penetration, tablet penetration, share of GPs using e-Prescription) the best performing countries often offer more than twice as good market conditions compared to the countries with low rankings. This is important because that means that the decision to prescribe an app is not only a personal bet of a healthcare provider but something that should be regulated, controlled and this must satisfy quality and appropriateness criteria too.

There are already some applications implement in healthcare settings based on mHealth, for instance:

  1. SMS alerts to remind patients to take their prescription drugs
  2. Remote diagnosis and treatment for patients who do not have easy access to health professionals
  3. Remote health monitoring devices that track and report patients’ conditions

mHealth could prove a major step change opportunity in improving the quality of care and lifestyle of patients suffering from chronic diseases or other conditions, while reducing the cost of care delivery. However, not all professionals feel confident advising to use or prescribing mHealth apps to their patients. Instead, they still use general recommendations that, in most cases, have shown low rates of adherence among patients.

In brief, before witnessing a general acceptance and massive use of mHealth across different countries and healthcare settings, several challenges must be overcome:

  1. To enable global usability of mHealth services with transparency.
  2. To develop a secure, trusted service that patients will use.
  3. To develop a clear understanding of the role operators wish to play in the mobile healthcare value chain.
  4. To tailor the mHealth business model to local situations and regulations since not all the countries have similar socio-economic conditions.
  5. To work with the governments and regulators to provide “mHealth friendly regulatory environments” and eliminate concerns about data privacy and confidentiality obligations.
  6. To demonstrate the ways that mHealth can be integrated into the existing healthcare workflow.
  7. To include the expertise of all agents involved in the design, implementation and use of mHealth solutions to leverage its potentialities.
  8. To provide efficacy and cost-benefit studies on mHealth solutions.
  9. To develop business models to show clear benefits to healthcare organisations in introducing mHealth solutions.

blogvhirAll these challenges can be effectively managed through careful planning and design. Ultimately, mHealth is only effective if adopted by healthcare professionals and patients. Thus, developers and providers must therefore be focused on developing products and services that are easy to use, without additional layers of complexity. Moreover, design and solid theoretical frameworks to build the solution are key elements. Only by ensuring the attractiveness and soundness of the service, we will increase the odds of adherence and usage.

Playing with food (knowledge) while measuring EEG – PRECIOUS food knowledge study

Thinking of your last meal can you describe how many calories, how much fiber or fat that include?

A growing amount of studies indicate a strong relationship between dietary practices, food intake, and health. The literature supports the view that unhealthy nutrition coupled with a sedentary life style is associated with several chronic diseases, such as type 2 diabetes (T2D) and cardiovascular pathologies. Food intake depends on a multitude of psychosocial and cultural factors, such as knowledge, price, convenience, taste, palatability, emotions, and the environment. Poorer diets are also more likely among less-educated and lower-income populations. Although the correlation between nutrition knowledge and dietary practices is not yet fully understood, a few studies suggest that poor food intake might be the result of inadequate or misleading nutrition knowledge. The research also shows that a growing amount of individuals struggle to make healthful decisions, which in turn impacts the individuals’ well-being.

In an effort to reduce the impact of nutrition deficits on the individual well-being, education is essential. Traditional lecture-based instructions, print material, and brochure are among the primary means for delivering information. For example, information and recommendations aiming to help people to improve their diets are regularly published. Despite these increased efforts, the outlook is not promising. According to the statistics, more than 50% of the world’s population is expected to be overweight in the next 20 years. Traditional interventions often fail to attract, engage, and motivate the target audience, which in turn impacts the likelihood of understanding, processing, recalling, and retaining the delivered information. Individual lack of interest in the topic, coupled with the intrinsic incapability of these interventions to boost the individual motivation for learning, are common reasons behind insufficient results.

New technologies offer new opportunities for delivering nutrition knowledge interventions. In this regard, gamification referring to the use of game elements in non-game contexts, appears to be a promising option. Under the concept of gamification, serious games have become increasingly popular. Serious games or games for learning (GFL) are computer games that use the fun component of traditional computer games as a tool for increasing the individual motivation for learning and acquiring knowledge. For example, by using traditional game elements, such as points, badges, levels, and challenges, serious games increase the player’s engagement with the game and motivation, which are then used as a tool for promoting education. In other words, while computer games aim to entertain the player, serious games use the entertainment component as a tool for providing knowledge, which in turn might affect the individual’s behavior. Serious games have been applied successfully in domains, such as math, physical exercise, and diet or stress management. By placing the individual in the center of the action and by providing a fun and entertaining experience, serious games and their innovative approach have shown to be a useful, effective, and powerful tool for increasing the player’s motivation to acquire new knowledge, which in turn impacts the individual behavior (Hays, 2005).

We carried out a study examining whether a serious game can be used to enhance the individual food knowledge and to increase the individual motivation towards healthful diets. For the purpose of this study, a computer game was created collaboratively by the University of Helsinki and the University of Vienna. In the laboratory study carried out in Helsinki, the participants were presented with the serious game made of two tasks, a food ranking task and a sports game. In the beginning of the game, the player is asked to customize his/her own avatar on several dimensions.  The objective of the player in the food ranking task is to rank in order (images of) foods on the basis of given criteria, whereas the objective of the player in the sports game is to win the opponent in a sports-like competition. At the end of each food ranking subtask, feedback (correct nutrition values) is given. More specifically, it was asked whether coupling the performance in the food ranking task with the performance in the intrinsically motivating sports game influences encoding of (memory for) nutritional information and attitudes/approach motivation towards healthy/unhealthy foods. In one experimental condition, the ability to beat the opponent in the sports game depends on the player’s performance in the food ranking task, whereas in the other condition, it does not. That is, the player’s performance in the food ranking task has an impact on the avatar’s outlook (smile/frown, fit/unfit) as well as speed and strength in the sports game. It was also asked whether the type of the opponent influences the outcome variables. Therefore, the game was played either against another human or against artificial intelligence (computer). To assess learning, we used a recognition (multiple choice) memory test on nutritional information. To assess approach motivation, we measured electroencephalographic (EEG) asymmetry over the prefrontal cortex in response to images of healthy/unhealthy foods. In addition to traditional self-report measures, other emotion-related physiological measures were also used, including facial electromyography (EMG, facial muscle activity), electrodermal activity (EDA), and electrocardiography (ECG, cardiac activity) (Consultant: Dr. A. Wölfel).

We have now collected data over 60 participants. According to more detailed scientific research questions we are hoping to have information also does this play really increase the food related knowledge (remember the amount of actual ingredient information) or does it had effect on approach motivation (e.g. dislike of unhealthy food). Information related nutrition and health is one of the most examined area that have lot of public interest.  There is huge amount of information that people can learn of their diet. Our approach to combine serious games and food knowledge could be on path to follow to increase food knowledge that may lead to successful behaviour change to prevent obesity and related diseases. This is information will be use when we are design PRECIOUS system that include several behaviour change techniques as delivering information (of food). It is not only what information we will deliver but how to make that information delivery successful and our approach is do that with serious game approach.

Next Generation eHealth Workshop

On the 28th of January 2016, the University of Vienna held a workshop at their facilities in Vienna on the topic of eHealth which included more than thirty people with a multitude of backgrounds, ranging from industry to public insurance or governmental institutions. One of the key goals of this workshop was to disseminate the results of our project, and to create potential opportunities for exploitation of our app and ecosystem. The workshop consisted of three parts: a lecturing part including live demos from our system, an interactive part where people were asked in groups to either design their own health or medial app or analyze potential stakeholders in this domain, and lastly a hands-on part where people could test the PRECIOUS app themselves. The feedback was overwhelming, and we believe that this workshop greatly increased the visibility of our project. Below are a few impressions of the workshop.

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Social Media Mood Predictor

 

Nowadays many people worldwide use social media like Facebook, Twitter and the like. They post, comment and share information about themselves or topics they are interested in.

In the context of PRECIOUS we investigate: Can this data be used, to tell more about a person’s mood?

For instance in [2] a web-based tool called ‘MoonPhrases’ was created to enable Twitter users to reflect about their mood and well-being. A similar approach was taken in [1], it was investigated to improve the classification of Tweets in either positive, neutral or negative sentiment. Moreover in [3] and [4] messages of Twitter users were interpreted to find out how users talk about depression in Tweets and how the usage of sentiment words of a depressed person differ from a not depressed person.

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Therefore our primary hypothesis is that it is possible to leverage mood/emotions from social media messages. The first step consists in collecting emotionally classified messages to build a classifier. As the range of possible emotions is very wide, it is important to choose predefined emotion classes, to limit the resources needed for data collection and processing of the classifier.  For example the emotion stress is very important in context of cardiovascular diseases, which are in the focus of the PRECIOUS project. Therefor a big focus is on collecting messages classified as stressed or not stressed. These classified messages are used to train a statistical model, which can determine if the writer of the message was stressed. Furthermore as a general indicator for well-being the emotions happy and sad, which correlate well with the pleasure dimension of the circumplex affect model, are in the focus here for emotion recognition.

References

[1] Hagen, M.; Potthast, M.; Büchner, M. & Stein, B.,Hanbury, A.; Kazai, G.; Rauber, A. & Fuhr, N. (Eds.), Twitter Sentiment Detection via Ensemble Classification Using Averaged Confidence Scores, Advances in Information Retrieval, Springer International Publishing, 2015, 9022, 741-754

[2] de Choudhury, M.; Gamon, M.; Hoff, A. & Roseway, A. Osmani, V.; Campbell, A. T. & Lukowicz, P. (Eds.), “Moon Phrases”: A Social Media Faciliated Tool for Emotional Reflection and Wellness, Pervasive Computing Technologies for Healthcare (PervasiveHealth), 2013 7th Int. Conference on, 2013

[3] de Choudhury, M.; Gamon, M.; Counts, S. & Horvitz, E., Predicting Depression via Social Media, Seventh International AAAI Conference on Weblogs and Social Media, 2013

[4] Minsu Park, Chiyoung Cha, Meeyoung Cha, and Yoorim, Kweon. Depressive moods of users portrayed in twitter. Telecommunications Review, Jun. 2013.

THE CHALLENGE OF MAINTAINING MOTIVATION

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mHealth apps have become ubiquitous in many aspects of our lives over the past three years. This has been fueled by the widespread availability of smartphones, tablets and laptops. Nowadays, thousands of health, wellness, self-help or even medical apps are available and can be downloaded to Android or Apple devices from different online stores.

This huge market holds promising beneficial effects especially for users. However, around 75% of apps are abandoned just three months after being downloaded. What possible causes can explain this lack of engagement?

Many apps try to engage all users in the same exact way. Huge mistake. This strategy is going to fail sooner or later. People are different and consequently, they are motivated by different things on many fronts including their health.

mHealth apps with gamification features provide psychological incentives for users to participate by appealing to their sense of achievement and enjoyment. A reminder alone may not be a compelling reason to, for instance, go to run, keep a healthy diet, or take one’s medication over time; yet, when given rewards for complying, users have been shown to participate at a higher rate. However, sustained motivation is a tricky issue and not just a matter of dangling a carrot in front of people…

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Therefore, when trying to hit the right note to engage users with their health, a wide variety of strategies is necessary, in terms of:

  • Messages and notifications: some people respond more to messages reminding benefits of engagement; others might be more motivated by being pushed to act, or by hearing of the consequences of non-engagement, etc.
  • Graphics, images, and media in general: some people like numbers and graphs; others might feel overwhelmed by statistics and prefer just images regarding health, achievements, etc.
  • Motivators: users can be motivated by competition, by helping or coaching the others to succeed, by being rewarded for the achievements and some of them, by sharing results socially, by being challenged, etc.

Additionally, a good motivational framework should be able to cover the following principles:

  • Known where you are going
  • Write your goals down
  • Look at others
  • Track your progress
  • Remember why you are doing this

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Extracted from: https://www.pinterest.com/mileyfry/motivation/

In brief, the best approach is to build a solid motivational framework and also, to be able to catch the differences of potential users and to treat them differently.

PRECIOUS approach takes into account all these factors and adapts to users by generating a virtual individual model, by asking them for their outcome goals from the very beginning and by remembering in a personalized manner progresses, achievements and meaning of actions.

In this sense, users will establish their outcome goals from the very beginning and these will be linked to health behaviors (e.g., physical activity, healthy diet, sleep, stress). PRECIOUS will met their needs by offering them different apps which will guide the users to success.

Thus, the comprehensive motivational framework of PRECIOUS put the user in the center of the action and promotes adherence, empowerment and health self-management by creating a joyful journey for the users. All of this is expected to promote and contribute to maintain long-term motivation for behavior change.

 

Sharing Experiences in Design of a Health-care Wearable Device

Monitoring and recommendation of healthy lifestyles is often challenging and requires the correlation between different health-related parameters for a particular individual. On the one hand, some of the lifestyle and biometric data inputs are only possible to be determined by 24/7 monitoring, such as physical activity tracking, sleep quality or food intake nutritional information. On the other hand, it is a big data problem as the correlation between all the inputs is rather challenging and time-consuming to be done by a human being.

Wearable devices are increasingly becoming one of the most common options for continuous monitoring and extraction of an individual’s biometric, lifestyle and activity data. Accelerometer sensors integrated in a wearable device can be used to track the daily physical activity or sleep quality while built-in gyroscope sensor can recognize pattern, such as eating, drinking or taking a bite. Furthermore, heart-rate sensors track the physical activity level or detect stressful situations. Moreover, built-in cameras are able to take a photo of a food and send it to the cloud for further processing, detection and recognition.

A wide range of commercial wearable devices now exist in the market and they are expected to be a booming industry over the next few years. There is also in increased trend of wearable platforms created for developer communities and researchers. Within the PRECIOUS project we have also initiated the design and fabrication of an experimental wearable wristband device to be able to integrate sensors which may not be available in commercial offerings and have full control to the data from the sensors in the wearable. In this article we share for the wider community some of the processes in the development of the PRECIOUS project´s wearable device.

It all started by testing the sensors on a prototype board like the one on Figure 1. The data was processed with an Arduino microcontroller board and sent to a smartphone via Bluetooth. Once the operation of the first prototype was verified, the development was taken into the next step: the Printed Circuit Board (PCB) design and fabrication of the wearable.

 

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Figure 1 Wearable device circuit on a prototype board

The electronic circuit layout of the device was designed and fabricated in home environment for verification. The circuit was then redesigned twice, ensuring the proper operation of the final device. Finally, the PCB of the wearable was fabricated in a laboratory environment in the Aalto University Design Factory and all the components were soldered (see Figure 2).

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Figure 2 Wearable sensors on printed circuit board (PCB layout shown on the left)

In order to update the software of the wearable and perform some tests, temporary wires were directly soldered to the heart of the device (the microcontroller) as shown in Figure 3.

 

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Figure 3 Microcontroller programmer hooked to the wearable sensor board.

Finally, a custom-made strap was attached to enable the wearable device to be attached to the wrist as shown in Figure. The device operation was tested by sending all the collected data (heart rate, accelerometer etc.) from the sensors to a smartphone via Bluetooth connection. The experience of this wearable design process has shown that such devices can be conveniently produced by researchers and hobbyists using relatively low-cost components (total cost if the components here was around 20 euros), whilst producing useful readings for research and for those with curiosity in this aspect of quantified self.

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Figure 4. Demonstration of the final design of the PRECIOUS wearable prototype.

From data to understanding yourself

In recent years, the world has lived in the “wellness boom”. People have increasingly been interested in self-measurements and in the market a huge amount of products and applications that allow people to try to feel better has become available. Pedometers, activity trackers, heart rate monitors, optical pulse devices, smart watches etc. allow the collection of more and more continuous knowledge of human behavior. Quantified Self activists have been at the forefront of testing new devices and applications, and bringing these noticeable to the general public.

However, diseases associated with unhealthy lifestyles such as obesity, type 2 diabetes and cardiovascular diseases have shown a steep slope upward in western countries. The question is how the potential of today’s technology can be translated into real benefits, and the thoughts of lifestyle changes into concrete actions. Another important factor to acknowledge regarding measurement data is also its reliability to be really useful. Studies have shown that the devices may show very different values, and for a consumer it can be difficult to know how reliable and accurate the readings in different applications are. Still, only on the basis of reliable data, the conclusions may be relevant and right.

To have a tangible change, we must remember the old but still highly relevant cliché about how the human being is by nature a psychophysiological and social creature, if not even more complex. Consequently, we need a comprehensive grip on what exactly I should do today to be good to myself and why. The PRECIOUS will be a system that is built on reliable sensor data. There the physiological, measured data is combined with knowledge of the user’s psychological condition and motivation. Behind everything is the virtual model build with advanced mathematical and signal processing methods from the person’s autonomic nervous system regulation as measured from heart rate variability. The heart, the most important organ to preserve life, can provide us huge amount of knowledge when it is constantly adjusting its function based on the body’s internal and external needs, day in day out for the whole journey of our lives. This knowledge, among other sensor data, is turned into observations of individual lifestyles, threats, and supportive elements of the user’s well-being. The information further affects the operation of the PRECIOUS mobile application so that the right kinds of challenges and tasks can be provided to the person at the right time, all built on proven psychological methods to support lifestyle changes.

As the development of technologies continues its fast pace, it eventually becomes possible for a person to follow his/her own well-being related parameters 24/7/365 rather ubiquitously. This makes it easier to reach also the most important goal for measuring and collecting data – to learn about ourselves. Because in the end that is what wellbeing is about: knowing and understanding ourselves and the small choices and actions we make today and tomorrow.

Human intervention study investigating the usability of mobile health tools to monitor food intake and physical activity for different user groups.

As part of the PRECIOUS project Campden BRI are conducting a study to investigate the usability of mobile health tools to monitor food intake and physical activity for different user groups.

Project timescale: From 01 August, 2015 to 30 January, 2016

Source of funding: European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no 611366.
Aims: The objective of this intervention study is to investigate the usability of two freely available mobile health tools currently on the market, and one mobile health tools currently being developed through a EC-FP7 project. The study will look at the factors that affect the usability of each mobile health tool for different user groups.

Research project description: This intervention study is being conducted as part of the wider project ‘PREventive Care Infrastructure based on Ubiquitous Sensing’ (PRECIOUS), which has received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no 611366. Overall, PRECIOUS aims to provide a preventive care system to promote healthy lifestyles, and as part of this PRECIOUS aims to develop a new monitoring tool, and use motivational techniques for educating the user about healthy eating practices. The objective of this intervention study is to investigate the usability of two freely available mobile health tools currently on the market, and one mobile health tools currently being developed through a EC-FP7 project. The study will look at the factors that affect the usability of each mobile health tool for different user groups (Age 18 to 35 years, with no children living at home, Age 18 to 65 years, with at least one child under 18 years living at home, Age 36 to 60 years, with no children living at home, and Age 61 to 75 years, with no children living at home) in order to improve the design of the EU PRECIOUS mobile health tool. In total three hundred respondents will be recruited (100 per mobile health tool) to complete a 7 day user trial of one of the three mobile health tools. They will then be asked to complete an on-line survey about the usability of the mobile health tool. The outcomes from the study will be used to improve the mobile health tool currently being developed by PRECIOUS.
Results of the study will be reported on the PRECIOUS website; http://www.thepreciousproject.eu/
For further information on the study, please contact:

Miss Charlotte Holmes
Chief Investigator
Campden BRI
GL55 6LD
charlotte.holmes[AT]campdenbri.co.uk
01386 842257

Encouraging healthier food choices and the role of technology

Over the last few decades, the obesity epidemic has continued to rise. Now in the UK a total of 23% of adults and 33.3% of 10–11-year-olds are considered to be obese. In the UK obesity costs the health care system more than £5bn each year.  Excess weight is a major risk factor for non-communicable diseases such as type 2 diabetes, cancer and heart disease, and it is well-known that these lifestyle-related diseases are now a leading cause of death globally. Diet is a key modifiable risk factor of obesity and therefore non-communicable diseases. As a result, tackling the obesity epidemic in high on the agenda for countries, not only to improve the health of their nation but to reduce the cost to their public healthcare systems and improve economic development. A whole host of approaches are being used across the EU and wider, to encourage people to make healthier food choices, whether it is through education at a school level, increasing the availability of healthier choices or using technology to track individual’s intake and encourage them to make healthier choices.

Many studies have been carried out to understand what influences a person’s choice around food and it has been shown that the average person makes up to 200 food related decisions a day. Wansink, B. (2015) reviewed over a 100 studies where consumer’s behaviours around healthy eating were investigated. From these studies, three main factors were determined to influence an individual’s decision; convenience, attractiveness, and the selection of the healthier choice being the norm. As well as these factors it is also important to recognise the impact of;1) education on why certain choices are the healthier choice and 2) the environment in which these choices are made, have. Therefore, as well as using the factors Wansink, B. (2015) identified when encouraging healthier choices it is critical to ensure there is education incorporated into the approach used and to ensure the behaviours learnt become long term rather than short term.

At PRECIOUS we are using technology to aid users to make healthier lifestyle choices. There are many benefits to the use of technology, including, ease of integration already in daily life, the high level of connectivity which allows the easy transfer of data, and the portability allowing it to be use at any time, any place. As a result, it is likely technology will continue to have a significant role in encouraging healthier food choices. It is nevertheless, important to remember the role personalisation also has in encouraging healthier food choices, during the development of these new technologies, particularly in terms of the nutritional requirements and motivational feedback. Therefore any technology developed will not only need to fit into that’s user’s life with minimal disruption, but will be able to carry out the required level of data processing to personalise its interaction with the user.  This level of personalisation can create challenges due to the number of factors influencing the personalisation required, however through the use of state of the art modelling and design, this is achievable.
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As part of the PRECIOUS project we aim to encourage healthier food choices, and in turn reduce the risk of type 2 diabetes and cardiovascular disease. To achieve this we are developing a dietary intake and physical activity application to provide individuals with an alternative way to recording their dietary intake. This app will then be part of an overall PRECIOUS system which will use state of the art motivational and gaming techniques to encourage users to change their behaviours to make healthier lifestyle choices. To ensure the application developed makes a real impact on its users, we are carrying out a consumer study to investigate what factors influence the usability of an application for different user groups.  During this study we will investigate two freely available applications and compare them to the current version of the PRECIOUS intake app and another dietary intake app being developed as part of another EU FP7-funded project called; QUALIFY. The study is expected to start in late September 2015, with the results being used to evaluate the current usability of the PRECIOUS application with super users, and then aid the further development.

 References

  1. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213720/dh_130487.pdf
  2. Wansink, B. (2015), Change Their Choice! Changing Behavior Using the CAN Approach and Activism Research. Psychol. Mark., 32: 486–500. doi: 10.1002/mar.20794

Towards a motivational framework

“If you want to change attitudes, start with a change in behaviour”
William Glasser

There is a growing body of evidence that demonstrates the potential of mobile communications to radically improve healthcare services. A vast number of applications already exist for different health conditions, but the majority offer similar functions and fail to include a comprehensive motivational framework and sufficient psychological parameters to ensure certain engagement and mid-long term adherence to the service.

Type 2 diabetes (T2D) is a complex disease with an increasing prevalence worldwide. Given this complexity, multifactorial intervention is necessary to improve long-term outcomes as stated in treatment guidelines. From a multidisciplinary perspective, psychological interventions have been utilized to favour better adjustment to the disease and all its implications. Among these psychological approaches, motivational interviewing (MI) has recently become a topic of great interest in the diabetes behavioural field, specifically, to address adherence to guidelines and behaviour change.

MI is a collaborative counselling strategy that engages people in “conversations” that guide them toward strengthening their motivation to change behaviours. It is based on the following assumptions:

  • Ambivalence about change is normal and constitutes an important motivational obstacle in improvement or recovery from a certain situation.
  • Ambivalence can be resolved by working with the individual’s intrinsic motivations and values.
  • An empathic, supportive, yet directive, counselling style provides conditions under which change can occur.

Patients struggling with chronic diseases, such as T2D, require adherence to complex daily regimens and very often, they appear to be only weakly motivated by professionals’ suggestions or other significant ones. Similarly, they could appear poorly motivated to the lifestyle and self-management issues they should address and perhaps, they are not sure on how these improvements should be achieved. A healthcare provider might recommend something such as: “Why don’t you try to exercise a little more and to have lower intake of fats?” The patient response may be reject or resistance: “Yes, but…”, ambivalence: “I’m not sure about…” or hopefully, acceptance: “Yes, you are right, I should…” But despite an initial agreement, lower rates of mid-long term adherence to guidelines are usually observed.Untitled

MI could be very useful in helping patients to assess for themselves their own motives for behaviour change and ultimately, it has been described as a better predictor for final behaviour change. This patient-centred approach is a clear shift away from the previous (and sometimes, somewhere, still very present) paternalistic professional position of feeling responsible for “fixing” the patients’ problems. More and more, it has been described how chronic conditions require a great participation, willingness and self-management abilities from patients. Thus, the “spirit of MI” is more close to a patient empowerment approach, which works perfectly for T2D patients.

The field of technology-supported healthcare is growing rapidly and offers new ways of self-management education and support. Interventions that merge MI with interactive technology may be an efficient and innovative way to address some of these issues because they can be disseminated to new settings, populations, and areas that might not otherwise have the capacity for in-person evidence-based care. MI delivered by new technologies (e.g. mobile applications) can address these issues because the content is programmable and automated (personalized, though), which may be particularly important when disseminating MI in diverse populations and in different languages. This approach is also less expensive than one-on-one treatment, offers easy access, and the anonymity overcomes the stigma sometimes associated with formal treatment.

 

There are not too many mobile applications developed with a well-established and implemented motivational framework from the very initial phases of service design. PRECIOUS service is intended to overcome such limitation and is aimed to combine a multidisciplinary scientific corpus of knowledge, nurtured from information and technology communication, engineering, and psychology and mental health sciences. Available evidence-based MI interventions showing positive results will serve as a reference too.

If you want to know how we are doing so far, you can also read our recently released Newsletter.

References

Image taken from http://www.morguefile.com/archive/display/873584