Co-designing a mobile Internet service for self-management of physical activity in rheumatiod arthritis

Aim: The overall aim of the thesis was to describe and evaluate the content and outcome of co-designing a mobile Internet service for self-management of physical activity in rheumatoid arthritis (RA) with active lead user involvement, within the action research paradigm. Context: Physical activity is known for its health benefits. However, maintaining a physically active lifestyle is a great challenge for most people, and maybe even more so for people living with RA. IT and mobile phones provide additional means to deliver health care services, i.e. mHealth, for physical activity self-management. Further, involvement of lead users in the development of services has been reported to improve their usability and effectiveness. Process: In the first phase of the co-design process, six focus group interviews were performed with lead users (n=26) to explore their ideas on core features (Study I). In the next phase, four workshops were conducted, which included lead users, clinical and researcher physiotherapists, an eHealth strategist and an officer from the Swedish Rheumatism Association (n=10). The aim was to specify the system requirements of the future service (Study II and III). Video recordings, natural observations, prototypes of the future service and an online notice board were used to collect data on the requirements and challenges of co-design. In the third phase, the first test version of the service was produced and evaluate in terms of the participants’ utilization of and experiences with the service (Study IV). Log-data were collected during the six week test period. Web questionnaires were sent out to and telephone interviews were performed with the participants after the test period. Content: Four core aspects that are important to consider in the development of the mHealth service were identified: features, customized options, user interface, and access and implementation (result Study I). To produce the requirements specification, the participants had to merge their different perspectives, which was the core challenge of codesign (Study II). The merging resulted in “tRAppen”, an mHealth service for maintenance of physical activity. tRAppen included two key components: 1) “My self-regulation features” and 2) “My peer support features” (result Study III). The first test version of tRAppen included 22 different behavior change techniques. Outcome: Twenty-eight participants tested tRAppen (result Study IV). Most participants registered physical activity, sent likes and made an exercise plan. tRAppen was generally rated as easy and fun to use, and all participants would recommend it to other people. The results also described the experiences of using tRAppen as being influenced by physical and mental state and personal preferences. Conclusions: The use of co-design in the development of the physical activity selfmanagement service tRAppen was successful. The first test version of tRAppen was perceived as feasible and to have the potential to support a physically active lifestyle in people with RA. Co-design in collaborative workshops was an extensive decision-making process that put high demands on the participants’ ability to find solutions, negotiate, come to agreements and reach final decisions

The Value of Patient-Reported Outcome (PRO) Data in Digital Healthcare: Using the How-R-you App as a PRO Instrument

This paper evaluates the value of using a mobile digital technology for the purpose of collecting Patient-Reported Outcome (PRO) data. We compare the use of a paper-based questionnaire and a mobile application as two different PRO instruments. Based on analysis, we conclude that use of the mobile application allows for a more nuanced picture of patients\u27 health to be established. Implications for diagnosis and medical treatment are discussed along with the need for future research

A Framework for AI-enabled Proactive mHealth with Automated Decision-making for a User’s Context

Health promotion is to enable people to take control over their health. Digital health with mHealth empowers users to establish proactive health, ubiquitously. The users shall have increased control over their health to improve their life by being proactive. To develop proactive health with the principles of prediction, prevention, and ubiquitous health, artificial intelligence with mHealth can play a pivotal role. There are various challenges for establishing proactive mHealth. For example, the system must be adaptive and provide timely interventions by considering the uniqueness of the user. The context of the user is also highly relevant for proactive mHealth. The context provides parameters as input along with information to formulate the current state of the user. Automated decision-making is significant with user-level decision-making as it enables decisions to promote well-being by technological means without human involvement. This paper presents a design framework of AI-enabled proactive mHealth that includes automated decision-making with predictive analytics, Just-in-time adaptive interventions and a P5 approach to mHealth. The significance of user-level decision-making for automated decision-making is presented. Furthermore, the paper provides a holistic view of the user's context with profile and characteristics. The paper also discusses the need for multiple parameters as inputs, and the identification of sources e.g., wearables, sensors, and other resources, with the challenges in the implementation of the framework. Finally, a proof-of-concept based on the framework provides design and implementation steps, architecture, goals, and feedback process. The framework shall provide the basis for the further development of AI-enabled proactive mHealth

Visions and Challenges in Managing and Preserving Data to Measure Quality of Life

Health-related data analysis plays an important role in self-knowledge, disease prevention, diagnosis, and quality of life assessment. With the advent of data-driven solutions, a myriad of apps and Internet of Things (IoT) devices (wearables, home-medical sensors, etc) facilitates data collection and provide cloud storage with a central administration. More recently, blockchain and other distributed ledgers became available as alternative storage options based on decentralised organisation systems. We bring attention to the human data bleeding problem and argue that neither centralised nor decentralised system organisations are a magic bullet for data-driven innovation if individual, community and societal values are ignored. The motivation for this position paper is to elaborate on strategies to protect privacy as well as to encourage data sharing and support open data without requiring a complex access protocol for researchers. Our main contribution is to outline the design of a self-regulated Open Health Archive (OHA) system with focus on quality of life (QoL) data.Comment: DSS 2018: Data-Driven Self-Regulating System

Opportunities and Challenges in Healthcare Information Systems Research: Caring for Patients with Chronic Conditions

To prepare for the 2030 “baby-boomer challenge”, some governments have begun to implement healthcare reforms over the past two decades. These reforms have led healthcare information systems (HIS) to evolve into a major research area in our discipline. This research area has an increasing individual, organizational, and economic impact. Due to the 2030 “baby-boomer challenge”, the number of elderly individuals continues to increase, and they may have chronic illnesses, such as eye problems and Alzheimer’s disease. Given the practical need for HIS that support chronic care, we decided to conduct a literature synthesis and identify opportunities for HIS research. Specifically, we present the chronic care model and analyze how IS researchers have discussed HIS to address the needs of patients with chronic illness. Further, we identify research gaps and discuss the research topics on HIS that future work can extend and customize to support these patients. Our results stimulate and guide future research in the HIS area. This paper has the potential to strengthen the body of knowledge on HIS

M-health review: joining up healthcare in a wireless world

In recent years, there has been a huge increase in the use of information and communication technologies (ICT) to deliver health and social care. This trend is bound to continue as providers (whether public or private) strive to deliver better care to more people under conditions of severe budgetary constraint

Mobile Apps to improve therapy: the health practitioner in your pocket knows you

Comunicação apresentada no 15th International Conference on Advances in Mobile Computing & Multimedia (MoMM2017), 04-06 December 2017, Salzburg, AustriaThere 1 is an emerging consumer-driven demand for a more personalised health system and, there is no question, the rapid evolution of the mobile apps market became an important driver for personalisation in the health field. The MAiThE (Mobile Apps to improve ThErapy) project focuses on the deployment and study of personalised mHealth apps to provide patients and carers with self-management capabilities to help them feel empowered in their ability to find strategies in a more informed and collaborative way, and to optimise therapy outside the clinical context, with remote support from health practitioners. The insight gathered with the development and assessment of the apps tailored to the end-users’ needs will result in a conceptual model to guide in the development of future mHealth apps. The project will produce an impact study based on thorough apps evaluations conducted on the field with participants from different contexts.N/

Mobile Apps to improve ThErapy

There is an emerging consumer-driven demand for a more personalised health system and, there is no question, the rapid evolution of the mobile apps market became an important driver for personalisation in the health field. The MAiThE (Mobile Apps to improve ThErapy) project focuses on the deployment and study of personalised mHealth apps to provide patients and carers with self-management capabilities to help them feel empowered in their ability to find strategies in a more informed and collaborative way, and to optimise therapy outside the clinical context, with remote support from health practitioners. The insight gathered with the development and assessment of the apps tailored to the end-users’ needs will result in a conceptual model to guide in the development of future mHealth apps. The project will produce an impact study based on thorough apps evaluations conducted on the field with participants from different contexts.info:eu-repo/semantics/publishedVersio

Application of Mobile Health Services to Support Patient Self-Management of Chronic Conditions

Background: Chronic conditions are the leading cause of ill-health, disability and premature death, adding huge health and socioeconomic burden to the healthcare system. Although mobile health (mHealth) services have the potential to provide patients with a timely, ubiquitous, and cost-effective means to access healthcare services, to date, much remains to be revealed for their application in chronic condition management. Aim: This doctoral project aims to comprehensively understand the application of mHealth services to support patient self-management of chronic conditions. This aim is achieved through four objectives: (1) to synthesise research evidence about health outcomes of applying mHealth services to support patient self-management of chronic conditions and the essential components to achieve these outcomes, (2) to determine the mechanism for applying mHealth services to support patient self-management of chronic conditions, (3) to explore critical factors and how these factors influence patients\u27 intention to continuously use mHealth services, and (4) to apply the above findings to guide the design of a prototype mHealth service. Methods: To increase the generalisability of the findings, three chronic conditions that could benefit from mHealth services were purposively studied to address the research objectives within the feasibility of available study sites and resources at different stages of the project. First, two literature review studies were conducted to achieve Objective 1. One was a systematic review to investigate health outcomes of mHealth services to support patient self-management of one chronic condition, unhealthy alcohol use, and the essential components to achieve these outcomes. The other was a rapid review on using behavioural theory to guide the design of mHealth services that support patient self-management of another chronic condition, hypertension. Second, two field studies were conducted to achieve Objectives 2 and 3, respectively. One was an interview study that explored patients\u27 perceptions of a mHealth service to support their self-management of hypertension in China. The other was a questionnaire survey study conducted on the same site that explored critical factors influencing patients\u27 intention to continuously use the mHealth service. Third, a clinician-led, experience-based co-design approach was implemented to apply the above-mentioned learning experience to the development practice of a mHealth service that supports patient self-management of obesity before elective surgery in Australia, achieving Objective 4. Results: Literature reviews identify five structural components - context, theory, content, delivery mode, and implementation procedure - which are essential for mHealth services to achieve three health outcomes - behavioural, physiological, and cognitive outcomes. Inductive synthesis of the interview findings lead to a 6A framework that summarises the mechanisms for mHealth services: access, assessment, assistance, awareness, ability, and activation. Mobile health services provide patients with easy access to health assessment and healthcare assistance to increase their self-management awareness and ability, thereby activating their self-management behaviours. Questionnaire survey study finds that patients\u27 intention to continuously use mHealth services can be influenced by the information quality, system quality and service quality by influencing their perceived usefulness and satisfaction with the mHealth services. Guided by Social Cognitive Theory, the developed prototype mHealth service provide patients with functions of automatic push notifications, online resources, goal setting and monitoring, and interactive health-related exchanges that encourage their physical activity, healthy eating, psychological preparation, and a positive outlook for elective surgery. The patients\u27 requirements in two focus group discussions enabled the research team to improve the mHealth service design. Conclusion: Mobile health services guided by behavioural theories can provide patients with easy access to health assessment and healthcare assistance to increase their self-management awareness and ability, thereby activating their self-management behaviours. The effort for designing mHealth services needs to be placed on crafting content (to improve information quality), developing useful functions and selecting a proper delivery mode (to improve system quality), and establishing effective implementation procedures (to improve service quality). These will ensure patients\u27 perceived usefulness and satisfaction with mHealth services, increase their intention to continuously use such services, thus supporting long-term patient self-management of chronic conditions. As demonstrated by the design case, the findings of this PhD project can be generalised to guide the design of other mHealth services that aim to support patient self-management of chronic conditions