A Tailored and Engaging mHealth Gamified Framework for Nutritional Behaviour Change.

Mobile health applications (apps) have been shown to be effective for improving eating habits. However, most of the existing apps rely on calorie and nutrient counting which have several limitations including the difficulty in sustaining long-term use, inaccuracy, and the risk of developing eating disorders. We designed and developed a mHealth framework for nutritional behaviour change, integrated into the CarpeDiem app, that focuses on the intake of key food groups which are known to have a higher impact on health indicators instead of the intake of nutrients. This framework is mainly based on a gamified system that delivers personalized dietary missions to the user and provides motivational recommendations that help the user to achieve these missions. Its design was guided by an evidenced-based theory of behavioural change, the HAPA model, and it is also characterized by the personalization of the system and the use of a recommender system based on advanced artificial intelligence techniques. Overall, the approach used in the present app could foster a sustained improvement of eating habits among the general population, which is the main challenge of dietary interventions, decreasing the risk of developing the chronic diseases associated with unhealthy dietary habits.

PEGASO e-Diary: User Engagement and Dietary Behavior Change of a Mobile Food Record for Adolescents.

Background: Obesity amongst children and adolescents is becoming a major health problem globally and mobile food records can play a crucial role in promoting healthy dietary habits. Objective: To describe the methodology for the implementation of the e-Diary mobile food record, to assess its capability in promoting healthy eating habits, to evaluate the factors associated with its usage and engagement. Methods: This is a descriptive study that compared the characteristics of participants engaged in the e-Diary, which was part of the PEGASO project in which an app to provide proactive health promotion was given to 365 students at 4 European sites enrolled during October to December 2016: England (UK), Scotland (UK), Lombardy (Italy), and Catalonia (Spain). The e-Diary tracked the users' dietary habits in terms of food groups, dietary indexes, and 6 dietary target behaviors relating to consumption of: fruit; vegetable; breakfast; sugar-sweetened beverages; fast-food; and snacks. The e-Diary provided also personalized suggestions for the next meal and gamification. Results: The e-Diary was used for 6 months by 357 adolescents (53.8% females). The study showed that females used the e-Diary much more than males (aOR 3.8, 95% CI 1.6-8.8). Participants aged 14 years were more engaged in the e-Diary than older age groups (aOR 5.1, 95% CI 1.4-18.8) as were those with a very good/excellent self-perceived health status compared to their peers with fair/poor health perception (aOR 4.2, 95% CI 1.3-13.3). Compared to the intervention sites, those living in Catalonia (aOR 13.2 95% CI 2.5-68.8) were more engaged. In terms of behavior change, a significant positive correlation between fruit (p < 0.0001) and vegetables (p = 0.0087) intake was observed in association with increased engagement in the e-Diary. Similarly, adolescents who used the app for more than 2 weeks had significantly higher odds of not skipping breakfast over the study period (aOR 2.5, 95% CI 1.0-6.3). Conclusions: The users highly engaged with the e-Diary were associated with improved dietary behaviors: increased consumption of fruit and vegetables and reduced skipping of breakfast. Although the overall usage of the e-Diary was high during the first weeks, it declined thereafter. Future applications should foster user engagement, particularly targeting adolescents at high risk. Clinical Trial Registration: https://www.clinicaltrials.gov/, identifier: NCT02930148.

"Hi This Is NESTORE, Your Personal Assistant": Design of an Integrated IoT System for a Personalized Coach for Healthy Aging.

In the context of the fourth revolution in healthcare technologies, leveraging monitoring and personalization across different domains becomes a key factor for providing useful services to maintain and promote well-being. This is even more crucial for older people, with aging being a complex multi-dimensional and multi-factorial process which can lead to frailty. The NESTORE project was recently funded by the EU Commission with the aim of supporting healthy older people to sustain their well-being and capacity to live independently. It is based on a multi-dimensional model of the healthy aging process that covers physical activity, nutrition, cognition, and social activity. NESTORE is based on the paradigm of the human-in-the-loop cyber-physical system that, exploiting the availability of Internet of Things technologies combined with analytics in the cloud, provides a virtual coaching system to support healthy aging. This work describes the design of the NESTORE methodology and its IoT architecture. We first model the end-user under several domains, then we present the NESTORE system that, analyzing relevant key-markers, provides coaching activities and personalized feedback to the user. Finally, we describe the validation strategy to assess the effectiveness of NESTORE as a coaching platform for healthy aging.

PEGASO: A Personalised and Motivational ICT System to Empower Adolescents Towards Healthy Lifestyles.

Unhealthy alimentary behaviours and physical inactivity habits are key risk factors for major non communicable diseases. Several researches demonstrate that juvenile obesity can lead to serious medical conditions, pathologies and have important psycho-social consequences. PEGASO is a multidisciplinary project aimed at promoting healthy lifestyles among teenagers through assistive technology. The core of this project is represented by the ICT system, which allows providing tailored interventions to the users through their smartphones in order to motivate them. The novelty of this approach consists of developing a Virtual Individual Model (VIM) for user characterization, which is based on physical, functional and behavioural parameters opportunely selected by experts. These parameters are digitised and updated thanks to the user monitoring through smartphone; data mining algorithms are applied for the detection of activity and nutrition habits and this information is used to provide personalised feedback. The user interface will be developed using gamified approaches and integrating serious games to effectively promote health literacy and facilitate behaviour change.