A Digital Platform to Support Self-management of Multiple Chronic Conditions (ProACT): Findings in Relation to Engagement During a One-Year Proof-of-Concept Trial.

BACKGROUND: Populations globally are ageing, resulting in higher incidence rates of chronic diseases. Digital health platforms, designed to support those with chronic conditions to self-manage at home, offer a promising solution to help people monitor their conditions and lifestyle, maintain good health, and reduce unscheduled clinical visits. However, despite high prevalence rates of multimorbidity or multiple chronic conditions, most platforms tend to focus on a single disease. A further challenge is that despite the importance of users actively engaging with such systems, little research has explored engagement. OBJECTIVE: The objectives of this study are to design and develop a digital health platform, ProACT, for facilitating older adults self-managing multimorbidity, with support from their care network, and evaluate end user engagement and experiences with this platform through a 12-month trial. METHODS: The ProACT digital health platform is presented in this paper. The platform was evaluated in a year-long proof-of-concept action research trial with 120 older persons with multimorbidity in Ireland and Belgium. Alongside the technology, participants had access to a clinical triage service responding to symptom alerts and a technical helpdesk. Interactions with the platform during the trial were logged to determine engagement. Semistructured interviews were conducted with participants and analyzed using inductive thematic analysis, whereas usability and user burden were examined using validated questionnaires. RESULTS: This paper presents the ProACT platform and its components, along with findings on engagement with the platform and its usability. Of the 120 participants who participated, 24 (20%) withdrew before the end of the study, whereas 3 (2.5%) died. The remaining 93 participants actively used the platform until the end of the trial, on average, taking 2 or 3 health readings daily over the course of the trial in Ireland and Belgium, respectively. The participants reported ProACT to be usable and of low burden. Findings from interviews revealed that participants experienced multiple benefits as a result of using ProACT, including improved self-management, health, and well-being and support from the triage service. For those who withdrew, barriers to engagement were poor health and frustration when technology, in particular sensing devices, did not work as expected. CONCLUSIONS: This is the first study to present findings from a longitudinal study of older adults using digital health technology to self-manage multimorbidity. Our findings show that older adults sustained engagement with the technology and found it usable. Potential reasons for these results include a strong focus on user-centered design and engagement throughout the project lifecycle, resulting in a platform that meets user needs, as well as the integration of behavior change techniques and personal analytics into the platform. The provision of triage and technical support services alongside the platform during the trial were also important facilitators of engagement. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/22125.

KITE: An Analytics Platform for Multimorbidity Management.

Managing multimorbidity entails processing distributed, dynamic and heterogeneous data using diverse analytics tools. We present KITE, a Cloud-based infrastructure allowing the aggregation and processing of health data using a dynamic set of analytical components. We showcase KITE in the context of the ProACT project, aiming at advancing home-based integrated care though IoT, analytics and a behavior change framework. We validate the viability of the infrastructure through an application of Bayesian networks to give a probabilistic representation of older individuals based on a variety of factors.

An Analytical Method for Multimorbidity Management Using Bayesian Networks.

This paper describes an application of Bayesian Networks to mo-del persons with multimorbidity using measurements of vital signs and lifestyle assessments. The model was developed as part of a project on the use of wearable and home sensors and tablet applications to help persons with multimorbidity and their carers manage their conditions in daily life. The training data was extracted from TILDA, an open dataset collected from a longitudinal health study of the older Irish population. A categorical BN structure was learnt using a score-based approach, with constraints on the ordering of variables. The prediction accuracy of the model is assessed using the Brier score in a cross-validation experiment. Finally, a user inter-face that allows to set some observed levels and query the resulting margi-nal probabilities from the BN is presented.

Using Semantic Technologies to Extract Highlights from Care Notes.

We propose a cognitive system for patient-centric care that leverages and combines natural language processing, semantics, and learning from users over time to support care professionals working with large volumes of patient notes. The proposed methods highlight the entities embedded in the unstructured data to provide a holistic semantic view of an individual. A user-based evaluation is presented, showing consensus between the users and the system.