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.
blogimage

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

 

A paradigm shift in digital health

One of the biggest challenges of the 21st century will reside within the healthcare domain: around 60% of the world’s adult population is expected to be overweight by 2030 (Kelly et al. 2008). A sedentary lifestyle, including lack of physical activity and poor choice of diet, can lead to serious chronic diseases burdening public spending in this domain. Given the digital revolution which has entered nearly all markets and industries paired with increasing smartphone penetration rates, developers all over the world have responded to this alarming development by creating mobile applications to deliver health interventions. An estimated 100.000 apps have appeared until today in major mobile app stores, creating what is often referred to as the well-being app sector. However, the underlying problems remain: how do we motivate people to initiate the process of changing behaviour on the one hand, and how do we maintain this behaviour over time in way that people internalize it into their daily habits?

Current health apps are often developed without or only little involvement of health professionals, and are hence only weakly backed by scientific evidence or validation (Bujink et al. 2012, Azar et al. 2013, Boulos et al. 2014). Developers most often present island solutions to specific problems, individually collecting, processing and analysing health data. The high fragmentation of this market is thus one of the key problems in itself: the desired lifestyle change, which often entails a number of different problem areas to address, requires users to install a large number of applications. Finding them on the other hand is an enduring process: users have to try and evaluate them by themselves. There is absolutely no tailoring available to users, where users can find apps based on a match of their own requirements, which can be time or geographical limitations for instance, but also their personality.

At PRECIOUS, we are trying to solve a number of these problems with new approaches. In fact, we want to change the process of how users and developers interact with each other, and to change the way how users select applications on their mobile devices. Our approach is based on a simple assumption: if we were able to recommend apps to users that suit their problems, their situation and their personality, we believe the impact of these applications can be drastically increased. Hence, we are currently creating, designing and implementing a holistic eHealth framework, consisting of a highly-modularized system for so-called gamified applications, also including elements from motivational and behaviour change theory. Developers can finally work together for the benefit of their user, but still find opportunities within our ecosystem for monetizing their efforts. We intend a single point of contact with our users: the PRECIOUS app. In contrast to current solutions however, we intend to run third-party apps within our own app, thus we are able to recommend apps to the users that increase the probability of compliance with a specific treatment suggestions. Image for instance the goal of increasing the user’s physical activity level: current apps set specific goals for the user that are harder to achieve over time, offer gamified aspects that target the motivational side of the problem etc. However, within PRECIOUS, we go one step further: how has this application impacted other users that have used it before? What type of users have responded particularly well to it? Does the user actually have time for e.g. going on a 15 minutes run? How is the weather outside, is it actually suited for this intervention suggestion? All these factors need to be considered when suggestion that specific application.

We believe that if we find the right app, for the right person, at the right time, we can achieve a higher impact upon the individual, and have a lasting influence towards healthier behaviour.

References

  • Kelly, T, W Yang, CS Chen, K Reynolds, and J He. 2008. “Global Burden of Obesity in 2005 and Projections to 2030.” International Journal of Obesity 32 (9). Nature Publishing Group: 1431–37.
  • Buijink, Arthur Willem Gerard, Benjamin Jelle Visser, and Louise Marshall. 2012. “Medical Apps for Smartphones: Lack of Evidence Undermines Quality and Safety.” Evidence Based Medicine. BMJ Publishing Group Ltd, ebmed–d2012.
  • Azar, Kristen MJ, Lenard I Lesser, Brian Y Laing, Janna Stephens, Magi S Aurora, Lora E Burke, and Latha P Palaniappan. 2013. “Mobile Applications for Weight Management: Theory-Based Content Analysis.” American Journal of Preventive Medicine 45 (5). Elsevier: 583–89.
  • Boulos, Maged N Kamel, Ann C Brewer, Chante Karimkhani, David B Buller, and Robert P Dellavalle. 2014. “Mobile Medical and Health Apps: State of the Art, Concerns, Regulatory Control and Certification.” Online Journal of Public Health Informatics 5 (3). University of Illinois at Chicago Library: 229.

Plenary Meeting @ University of Vienna, 24-25th September 2014

On the 24th and 25th of September, University of Vienna hosted an interim PRECIOUS plenary meeting in order to discuss further details on the Virtual Individual Model, issues on the architectural structure and implementation of both back-end and front-end services, as well as motivational aspects of the system design. The PRECIOUS members managed to clarify and further detail a variety of things that will be part of the system, including potential ideas for Client-Apps that were identified within a 180s madness session/competition, rewarding the most creative ideas which could be used and delivered through mobile technologies. I think it is safe to say that everyone was excited about the ideas the partners provided, and the result turned out the be very impressive. Using the average of votes ranging from 1-5, the three highest rated ideas were finally rewarded with some (not-so-healthy) prizes. Below you can find some impressions of the meeting as well as the Client-App competition.

 

DSC03717DSC03711 DSC03744 DSC03752 DSC03770 DSC03806 DSC03888

2nd Plenary Meeting @ Campden BRI

The second two-day PRECIOUS plenary meeting took place at the facilities of Campden BRI in Chipping Campden, a fantastic little city about one and a half hours by train from London, UK. The major focus of this meeting were user requirements as well as use-cases, along with further clarification in the area of system architecture and other topics. Small workshops were held with regards to brainstorming use-cases as well as finding and prioritizing new ideas of the system. Overall, everyone agreed that it was an extremely productive meeting, in addition, it was great to see one or two new faces of project members who haven’t been able to attend the first meeting. Below are some impressions of both Chipping Campden and the second meeting.

DSCN4592

DSCN4603

DSCN4605

DSCN4607

1st Plenary Meeting @ AALTO University

The first three-day plenary meeting of the PRECIOUS project took place at AALTO University from the 3rd until the 6th of November 2013 in Helsinki. Every partner of the consortium was represented at the meeting, and the first ideas and thoughts on topics such as system architecture and virtual individual model were shared. Furthermore, plenty of organizational details were clarified, such as the logo design, website creation or other dissemination activities as well as meeting and telco intervals.

Below you can find a picture of the attendees of the first PRECIOUS meeting, along with some initial logo drafts projected in the background.

Consortium Picture

PREventive Care Infrastructure based On Ubiquitous Sensing

PRECIOUS project aims to develop a preventive care system to promote healthy lifestyles, which is comprised of three components: (1) transparent sensors for monitoring user context and health indicators (food intake, sleep and activity) that deliver ambient data about current user behavior; (2) users are represented by individual virtual models, which infer health risks and suggest behavioral changes; (3) state-of-the-art motivational techniques originating from gamification and motivational interviews to trigger a set of feedback tools to change the user habits toward more healthy behavior.