Empowerment Enabled by Information and Communications Technology and Intention to Sustain a Healthy Behavior: Survey of General Users.

BACKGROUND: Most people with chronic conditions fail to adhere to self-management behavioral guidelines. In the last 2 decades, several mobile health apps and IT-based systems have been designed and developed to help patients change and sustain their healthy behaviors. However, these systems often lead to short-term behavior change or adherence while the goal is to engage the population toward long-term behavior change. OBJECTIVE: This study aims to contribute to the development of long-term health behavior changes or to help people sustain their healthy behavior. For this purpose, we built and tested a theoretical model that includes enablers of empowerment and an intention to sustain a healthy behavior when patients are assisted by information and communications technology. METHODS: Structural equation modeling was used to analyze 427 survey returns collected from a diverse population of participants and patients. Notably, the model testing was performed for physical activity as a generally desirable healthy goal. RESULTS: Message aligned with personal goals, familiarity with technology tools, high self-efficacy, social connection, and community support played a significant role (P<.001) in empowering individuals to maintain a healthy behavior. The feeling of being empowered exhibited a strong influence, with a path coefficient of 0.681 on an intention to sustain healthy behavior. CONCLUSIONS: The uniqueness of this model is its recognition of needs (ie, social connection, community support, and self-efficacy) to sustain a healthy behavior. Individuals are empowered when they are assisted by family and community, specifically when they possess the knowledge, skills, and self-awareness to ascertain and achieve their goals. This nascent theory explains what might lead to more sustainable behavior change and is meant to help designers build better apps that enable people to conduct self-care routines and sustain their behavior.

Understanding Cancer Caregiving and Predicting Burden: An Analytics and Machine Learning Approach.

Cancer caregivers are often informal family members who may not be prepared to adequately meet the needs of patients and often experience high stress along with significant physical, emotional, and financial burdens. Accurate prediction of caregiver's burden level is highly valuable for early intervention and support. In this study, we used several machine learning approaches to build prediction models from the National Alliance for Caregiving/AARP dataset. We performed data cleansing and imputation on the raw data to give us a working dataset of cancer caregivers. Then a series of feature selection methods were used to identify predictive risk factors for burden level. Using supervised machine learning classifiers, we achieved reasonably good prediction performance (Accuracy ∼ 0.94; AUC ∼ 0.97; F1∼ 0.93). We identify a small set of 15 features that are strong predictors of burden and can be used to build Clinical Decision Support Systems.

The Effect of a Customized Nutrient-Profiling Approach on the Glycated Hemoglobin Levels of Patients With Type 2 Diabetes: Quasi-Experimental Study.

BACKGROUND: Presently, dietary management approaches are mostly oriented toward using calorie-counting and diet-tracking tools that draw our attention away from the nutritional value of our food. To improve individuals' dietary behavior, primarily that of people with type 2 diabetes, a simple technique is needed to increase their understanding of the nutritional content of their food. OBJECTIVE: This study aimed to design, develop, and evaluate a customized nutrient-profiling tool called EasyNutrition. EasyNutrition was built to introduce the new concept of nutrient profiling by applying the Intelligent Nutrition Engine, an algorithm that we developed for ranking different food recipes based on their nutritional value. This study also aimed to investigate the efficacy of EasyNutrition in lowering glycated hemoglobin (HbA1c) levels and improving dietary habits among people with type 2 diabetes. METHODS: We evaluated the utility of EasyNutrition using design science research in three sequential stages. This paper has elaborated on the third stage to investigate the efficacy of EasyNutrition in managing type 2 diabetes. A quasi-experimental study was conducted in a diabetes treatment center (n=28). The intervention group utilized EasyNutrition over 3 months, whereas participants in the control group utilized the standard of care provided by the center. Dietary habits and HbA1c levels were measured to capture any change before and after experimenting with EasyNutrition. RESULTS: The intervention group (n=9) exhibited a statistically significant change between the pre- and postexposure results of their HbA1c (t9=2.427; P=.04). Their HbA1c dropped from 8.13 to 6.72. This provided preliminary evidence of the efficacy of using a customized nutrient-profiling app in reducing HbA1c for people with type 2 diabetes. CONCLUSIONS: This study adds to the evidence base that a nutrient-profiling strategy may be a modern adjunct to diabetes dietary management. In conjunction with reliable dietary education provided by a registered dietician, EasyNutrition may have some beneficial effects to improve the dietary habits of people with type 2 diabetes.

Increasing exposure to complementary and alternative medicine treatment options through the design of a social media tool.

The current study outlines the creation of an online community designed to connect patients to providers of Complementary and Alternative Medicine (CAM) and western biomedicine. The purpose of the site was to create a forum for patients and healthcare providers to share information and social support regarding eight popular CAM treatments. First, we created a prototype and pilot tested it through a usability analysis. Second, we conducted semi-structured interviews with 12 key stakeholders from the CAM, biomedicine, and patient populations. Third, we conducted a content analysis of the discussion forums to examine common posting behaviour. We found that CAM providers were the most active contributors to the forums. This project provides proof of concept for using an online community platform to connect patients and CAM providers. Future work should attempt to engage Western medicine providers while studying techniques and features that best engage users.

An mHealth Assistive System "MyLung" to Empower Patients with Chronic Obstructive Pulmonary Disease: Design Science Research.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) comprises a group of progressive diseases that deteriorate lung functions. When patients cannot breathe, nothing else in their lives matter. Breathlessness has negative implications on patients' lives, which leads to physical and psychological limitations. Moreover, the lack of relevant and updated information about the causes and consequences of the disease can exacerbate the problems of health literacy, information accessibility, and medical adherence. OBJECTIVE: The objective of this study is to design an innovative mobile health (mHealth) app system called "MyLung" that provides complete solutions in order to increase self-awareness and promote better self-care management. This system, an information technology artifact, includes three novel integrative modules: education, risk reduction, and monitoring. METHODS: The utility and effectiveness of the assistive mobile-based technology were evaluated using a mixed-methods approach. The study combined quantitative and qualitative research methods to thoroughly understand how the assistive mobile-based technology can influence patients' behavioral intention to change their lifestyle. Thirty patients were categorized into two groups (intervention group and control group). RESULTS: The results from the quantitative analysis led to four follow-up interviews in the qualitative study. The results of the quantitative study provided significant evidence to show that the design of MyLung leads to a change in the awareness level, self-efficacy, and behavioral intention for patients with COPD. The t tests revealed a significant difference before and after using the mobile-based app with regard to the awareness level (mean 3.28 vs 4.56; t10=6.062; P<.001), self-efficacy (mean 3.11 vs 5.56; t10=2.96; P=.01), and behavioral intention (mean 2.91 vs 4.55; t10=3.212; P=.009). Independent sample t tests revealed significant differences between the intervention group and the control group in terms of the awareness level (mean 4.56 vs 3.31; t19=4.80; P<.001) and self-efficacy (mean 5.56 vs 3.66; t19=2.8; P<.01). Integration of findings from quantitative and qualitative studies reveled the impact of the design in a comprehensive manner. These inferences are referred to as "meta-inferences" in this study. CONCLUSIONS: We designed an innovative assistive mobile-based technology to empower patients with COPD, which helped increase awareness and engage patients in self-care management activities. The assistive technology aims to inform patients about the risk factors of COPD and to improve access to relevant information. Meta-inferences that emerge from the research outputs contribute to research into chronic management information systems by helping us gain a more complete understanding of the potential impacts of this proposed mobile-based design on patients with chronic disease.

Design and Usability of a Heart Failure mHealth System: A Pilot Study.

BACKGROUND: Despite the advances in mobile health (mHealth) systems, little is known about patients' and providers' experiences using a new mHealth system design. OBJECTIVE: This study aimed to understand challenges and provide design considerations for a personalized mHealth system that could effectively support heart failure (HF) patients after they transition into the home environment. METHODS: Following exploratory interviews with nurses and preventive care physicians, an mHealth system was developed. Patients were asked to measure their weight, blood pressure, and blood glucose (if they had diabetes). They were also instructed to enter symptoms, view notifications, and read messages on a mobile app that we developed. A Bluetooth-enabled weight scale, blood pressure monitor, glucometer, and mobile phone was provided after an introductory orientation and training session. HF nurses used a dashboard to view daily measurements for each patient and received text and email alerts when risk was indicated. Observations of usage, cases of deterioration, readmissions, and metrics related to system usability and quality of life outcomes were used to determine overall effectiveness of the system, whereas focus group sessions with patients were conducted to elicit participants' feedback on the system's design. RESULTS: A total of 8 patients with HF participated over a 6-month period. Overall, the mean users' satisfaction with the system ranked 73%, which was above average. Quality of life improvement was 3.6. Patients and nurses used the system on a regular basis and were able to successfully identify and manage 8 health deteriorations, of which 5 were completely managed remotely. Focus groups revealed that, on one hand, the system was beneficial and helped patients with: recording and tracking readings; receiving encouragement and reassurance from nurses; spotting and solving problems; learning from past experiences; and communication. On the other hand, findings also highlighted design issues and recommendations for future systems such as the need to communicate via other media, personalize symptom questions and messages, integrate other health tracking technologies, and provide additional methods to analyze and visualize their data. CONCLUSIONS: Understanding users' experiences provides important design considerations that could complement existing design recommendations from the literature, and, when combined with physician and nurse requirements, have the potential to yield a feasible telehealth system that is effective in supporting HF self-care. Future studies will include these guidelines and use a larger sample size to validate the outcomes.

Applying the Concept of Nutrient-Profiling to Promote Healthy Eating and Raise Individuals' Awareness of the Nutritional Quality of their Food.

Diet-related chronic diseases are on the rise. Current dietary management approaches are mostly calorie-counter tools that draw our attention away from the nutritional quality of our food choices. To improve consumers' dietary behavior, we need a simple technique to educate them about nutrition and increase their understanding of the nutritional quality of their food. This study aims to design a dietary tool to promote a nutrient-dense diet. To this end, we applied the concept of Nutrient Profiling to classify food recipes based on their nutritional quality, by developing the Intelligent Nutrition Engine. This engine undergirds our mobile-based application, Easy Nutrition, which was designed to enable users to find food recipes and understand their nutritional quality. To evaluate the usability and understandability of our approach, we piloted the prototype of Easy Nutrition on 24 consumers. The results indicate that our approach provides a sustainable avenue to help consumers manage their diets.

Healthy living with persuasive technologies: framework, issues, and challenges.

While our Y2K worries about old computers "retiring" at midnight captured the television and news media attention, a more significant "old age" phenomenon snuck onto the scene with hardly a headline: the dawn of the age of the aged. (1) The over burdened health care system will face a worldwide wave of retirees who will live longer, cost more to treat, and demand new goods and services to help them stay healthy, active, and independent. Research in persuasive technologies and the associated usage of a computing system, device, or application intentionally designed to change a person's attitude or behavior in a predetermined way is showing the potential to assist in improving healthy living, reduce the costs on the health care system, and allow the aged to maintain a more independent life. This article gives a deeper insight into the evolution of persuasive technologies and presents a framework that can guide a researcher or practitioner in comprehending more effectively the work being done in this novel research field. It also provides categories of domains within health care in which these technologies are used and surveys exemplars from published literature. The article's goal is to provide greater understanding by addressing the challenges that lie ahead for all key stakeholders that design and/or use persuasive technologies in health care.

Telemedicine taxonomy: a classification tool.

Telemedicine allows medical doctors and specialized skilled experts to provide services to patients who are in remote locations using advanced telecommunications. This paper presents a taxonomy that systematically classifies various telemedicine efforts worldwide using five major dimensions: application purpose, application area, environmental setting, communication infrastructure, and delivery options. To identify relationships and patterns between these different dimensions telemedicine programs survey data from the Telemedicine Information Exchange (TIE) was analyzed using multiple regression and path analysis. Major findings indicate that interactive video is the most preferred modality. Store-and-forward technology is preferred for ophthalmology, radiology, and pathology. However, a negative correlation exists between store-and-forward and interactive video with mental health application. The study also indicates that the Internet is still not the dominant communications infrastructure when it comes to telemedicine. We showed that these dimensions can capture almost all efforts in telemedicine and also help program planners to understand the issues in telemedicine deployment. Our findings indicate that the taxonomy is useful for categorizing and comparing existing programs, and can be used for planning future programs.

FreezeFramer: A prototype tool to monitor stress and heart rate variability.

This paper describes the design, architecture, and implementation of a software application, FreezeFramer, developed to help individuals manage stress. The application measures heart rate variability through a finger or earlobe clip-on sensor that reads pulse information. While a detailed subjective evaluation is on going, system performance analyses are reported here.