Theory-driven Visual Design to Support Reflective Dietary Practice via mHealth: A Design Science Approach

Design for reflection in human-computer interaction (HCI) has evolved from focusing on an abstract and outcome-driven design subject towards exposing procedural or structural reflection characteristics. Although HCI research has recognized that an individual\u27s reflection is a long-lasting, multi-layered process that can be supported by meaningful design, researchers have made few efforts to derive insights from a theoretical perspective about appropriate translation into end-user visual means. Therefore, we synthesize theoretical knowledge from reflective practice and learning and argue for a differentiation between time contexts of reflection that design needs to address differently. In an interdisciplinary design-science-research project in the mHealth nutrition promotion context, we developed theory-driven guidelines for “reflection-in-action” and “reflection-on-action”. Our final design guidelines emerged from prior demonstrations and a final utility evaluation with mockup artifacts in a laboratory experiment with 64 users. Our iterative design and the resulting design guidelines offer assistance for addressing reflection design by answering reflective practice’s respective contextual requirements. Based on our user study, we show that reflection in terms of “reflection- in-action” benefits from offering actionable choice criteria in an instant timeframe, while “reflection-on-action” profits from the structured classification of behavior-related criteria from a longer, still memorable timeframe

User-centered design of nutri, a novel goal setting clinical decision support technology to improve the equity of data-driven dietary behavior change interventions in primary care

Interventions for dietary management of chronic disease increasingly leverage smartphone applications with the promise that data-driven personalization will improve effectiveness. However, since these interventions require users to collect, synthesize, and interpret data, users with more resources are more likely to benefit, thereby exacerbating existing health disparities. Multilevel interventions that distribute responsibility for dietary behavior change between patients and providers may improve equity; however, primary care providers (PCPs) lack time and training to elicit, synthesize, and interpret diet data. We hypothesize these limitations can be overcome with clinical decision support (CDS) technology that captures and synthesizes patient diet data into knowledge for PCPs to engage patients in collaborative diet goal setting, an effective behavior change technique. The aim of this study is to identify system requirements that would motivate providers to use a collaborative diet goal setting CDS and evaluate implementation design choices with the CDS prototype. We performed a 2-phase qualitative study with English and Spanish-speaking adult patients and PCPs from a federally qualified health center and an academic clinic in 30 to 60-minute semi-structured generative and usability interviews. We used an iterative design process involving user-experience designers, software engineers, and providers to develop the final CDS prototype. Using inductive thematic analysis, eight PCP and patient themes emerged. From PCP interviews we identified that: (1) Time constraints and patient characteristics influence if PCPs use personalized or generic goal setting, (2) Subjective and non-standardized processes guide personalized goal setting, (3) PCPs regard patient-generated data as an inaccurate and non-holistic representation of the patient’s diet, (4) Current clinical workflows make diet goal setting and monitoring cumbersome. For patients we found that: (1) PCP is seen as an authority figure, (2) Listening and dialog are facilitators for shared decision-making, (3) patients regard diet data as a source of truth, and (4) Goal achievement is distinct from goal setting. These themes, along with refinements identified in usability interviews, guided the iterative design of “Nutri,” a workflow-compatible CDS that synthesizes patient diet data from 24-hour recalls via a series of computational rules and presents diet goals for PCPs to discuss with patients through collaborative goal setting. The results from this study demonstrate the potential of a data-driven CDS for collaborative diet goal setting in primary care. The 2-phase user-centered iterative design process we used to design Nutri demonstrates how usability interviews can refine the operationalization of insights generated from traditional qualitative approaches. Follow-up studies will test Nutri in a clinic setting.Nutritional Science

Effects and challenges of using a nutrition assistance system: results of a long-term mixed-method study

Healthy nutrition contributes to preventing non-communicable and diet-related diseases. Recommender systems, as an integral part of mHealth technologies, address this task by supporting users with healthy food recommendations. However, knowledge about the effects of the long-term provision of health-aware recommendations in real-life situations is limited. This study investigates the impact of a mobile, personalized recommender system named Nutrilize. Our system offers automated personalized visual feedback and recommendations based on individual dietary behaviour, phenotype, and preferences. By using quantitative and qualitative measures of 34 participants during a study of 2–3 months, we provide a deeper understanding of how our nutrition application affects the users’ physique, nutrition behaviour, system interactions and system perception. Our results show that Nutrilize positively affects nutritional behaviour (conditional R2=. 342) measured by the optimal intake of each nutrient. The analysis of different application features shows that reflective visual feedback has a more substantial impact on healthy behaviour than the recommender (conditional R2=. 354). We further identify system limitations influencing this result, such as a lack of diversity, mistrust in healthiness and personalization, real-life contexts, and personal user characteristics with a qualitative analysis of semi-structured in-depth interviews. Finally, we discuss general knowledge acquired on the design of personalized mobile nutrition recommendations by identifying important factors, such as the users’ acceptance of the recommender’s taste, health, and personalization

Fork It

Obesity prevalence is at an alarmingly high rate within the United States, but especially in rural areas of Kentucky. Obesity can lead to a variety of negative physical health outcomes including heart disease, diabetes, stroke, and some cancers. There are also mental disorders associated with obesity through mechanisms such as weight stigma and self-perception. Similar to obesity rates, prevalence and mortality associated of these health outcomes are also seen at disproportionately higher rates in rural, Appalachian Kentucky. Causes for increased obesity and obesity related consequences include some genetic factors as well as behavioral factors like physical inactivity, poor diet, stress, and lack of sleep. Pike County, Kentucky is one of the Appalachian areas affected by obesity and obesity related consequences. The University of Pikeville students are a population within Pike County that are at increased risk of developing these same issues due to the poor eating habits present amongst college students and lack of concern towards chronic disease development at this life stage. However, due to university resources and capacity for collaboration, UPike students also present an opportunity for positive change during this developmental stage. The “Fork It Program” addresses the problem of poor diet for UPike students by engaging them in a nutrition app and changing the food environment through a satellite farmer’s market. Fork It will be adapted as an evidence-informed intervention using the protocol from “Use of Wearable Technology and Social Media to Improve Physical Activity and Dietary Behaviors among College Students: A 12-Week Randomized Pilot Study” (Pope et al., 2019). Tech based interventions like nutrition apps have been proven to work in this population by providing social support and personalized feedback to increase diet awareness and knowledge. Changes to the food environment have also been shown to be effective especially when paired with recipe delivery. The Fork It Program will partner with the Pike County Extension office to secure farmer’s market vendors and UPike’s Student Government Association (SGA) for app dissemination. These organizations provide expertise and already existing networks that will assist in program implementation. The specific aims of the Fork It Program are: Facilitate strong and sustainable partnerships with Extension and SGA to conduct program activities at the University of Pikeville Implement a nutrition app and satellite market at the University of Pikeville to reach 2,700 students per year Improve dietary behaviors of students at the University of Pikeville including increased home meal preparation and produce consumption Evaluate the impact of the Fork It app on students’ attitudes and knowledge regarding nutritio

Elena+ Care for COVID-19, a Pandemic Lifestyle Care Intervention: Intervention Design and Study Protocol

Background: The current COVID-19 coronavirus pandemic is an emergency on a global scale, with huge swathes of the population required to remain indoors for prolonged periods to tackle the virus. In this new context, individuals\u27 health-promoting routines are under greater strain, contributing to poorer mental and physical health. Additionally, individuals are required to keep up to date with latest health guidelines about the virus, which may be confusing in an age of social-media disinformation and shifting guidelines. To tackle these factors, we developed Elena+, a smartphone-based and conversational agent (CA) delivered pandemic lifestyle care intervention. Methods: Elena+ utilizes varied intervention components to deliver a psychoeducation-focused coaching program on the topics of: COVID-19 information, physical activity, mental health (anxiety, loneliness, mental resources), sleep and diet and nutrition. Over 43 subtopics, a CA guides individuals through content and tracks progress over time, such as changes in health outcome assessments per topic, alongside user-set behavioral intentions and user-reported actual behaviors. Ratings of the usage experience, social demographics and the user profile are also captured. Elena+ is available for public download on iOS and Android devices in English, European Spanish and Latin American Spanish with future languages and launch countries planned, and no limits on planned recruitment. Panel data methods will be used to track user progress over time in subsequent analyses. The Elena+ intervention is open-source under the Apache 2 license (MobileCoach software) and the Creative Commons 4.0 license CC BY-NC-SA (intervention logic and content), allowing future collaborations; such as cultural adaptions, integration of new sensor-related features or the development of new topics. Discussion: Digital health applications offer a low-cost and scalable route to meet challenges to public health. As Elena+ was developed by an international and interdisciplinary team in a short time frame to meet the COVID-19 pandemic, empirical data are required to discern how effective such solutions can be in meeting real world, emergent health crises. Additionally, clustering Elena+ users based on characteristics and usage behaviors could help public health practitioners understand how population-level digital health interventions can reach at-risk and sub-populations

A Risk Reduction Education Intervention for Cardiovascular Risk Factors Among College Students

ABSTRACT BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death for both men and women in the U.S. Although cardiovascular disease is often associated with middle aged and older adults, modifiable CVD risk factors are also present in young adults. PURPOSE: The purpose of this pilot study was to determine whether a cardiovascular risk reduction educational intervention delivered via Facebook is feasible and effective for modifying risk factor reduction such as decreased body mass index and increased fruit/vegetable consumption among college students. METHODS: This study involved the use of pre-test and post-test surveys modified from the Behavioral Risk Factor Surveillance System to determine intervention effectiveness. A once weekly cardiovascular risk reduction education memes, video clip, or text related to body mass index and/or fruit/vegetable consumption was posted publicly on the private Facebook page. In addition, the treatment group received a once weekly private message that had an additional cardiovascular risk reduction education meme, video clip, or text related to body mass index and/or fruit/vegetable consumption. RESULTS: Fourteen students participated in the study. The average body mass indexes were 23.02/23.07 pre-test/post-test for the intervention group and 25.97/25.61 pre-test/post-test for the control group. The average daily number of servings of fruits/vegetables was 3.14 both pre-test/post-test for the intervention group and 3.43/3.58 pre-test/post-test for the control group. There were no significant differences observed between the intervention group and the control group with regards to changes in BMI or fruit/vegetable consumption amounts from pre-test to post-test

Automatic Generation of Personalized Recommendations in eCoaching

Denne avhandlingen omhandler eCoaching for personlig livsstilsstøtte i sanntid ved bruk av informasjons- og kommunikasjonsteknologi. Utfordringen er å designe, utvikle og teknisk evaluere en prototyp av en intelligent eCoach som automatisk genererer personlige og evidensbaserte anbefalinger til en bedre livsstil. Den utviklede løsningen er fokusert på forbedring av fysisk aktivitet. Prototypen bruker bærbare medisinske aktivitetssensorer. De innsamlede data blir semantisk representert og kunstig intelligente algoritmer genererer automatisk meningsfulle, personlige og kontekstbaserte anbefalinger for mindre stillesittende tid. Oppgaven bruker den veletablerte designvitenskapelige forskningsmetodikken for å utvikle teoretiske grunnlag og praktiske implementeringer. Samlet sett fokuserer denne forskningen på teknologisk verifisering snarere enn klinisk evaluering.publishedVersio

ICT-enabled Value Creation in Community Pharmacies: An Applied Design Science Research Approach

Pharmacist-patient communication is currently limited to infrequent encounters in pharmacies, which limits the delivery of and value created by pharmacy services. We seek to better understand how ICT can enable value creation by extending pharmacist-patient communication beyond these encounters. In an applied design science research study with 21 Swiss community pharmacies, we designed an artifact that unleashes the provision of pharmacy services from personal encounters. We investigate (1) strategic intent for extending the communication, (2) business model requirements that are generated, (3) ICT capabilities that need to be developed, and (4) value that is created by the artifact instantiation. The findings can help healthcare practitioners to gain a better understanding of their current and future value proposition and policy-makers can (re-)consider the role of pharmacies and ICT-enablement in healthcare reforms. The presented process and artifact evaluation can contribute to the scientific dialog on co-evolution of artifact design and value creation