CoachAI: A Conversational Agent Assisted Health Coaching Platform

Poor lifestyle represents a health risk factor and is the leading cause of morbidity and chronic conditions. The impact of poor lifestyle can be significantly altered by individual behavior change. Although the current shift in healthcare towards a long lasting modifiable behavior, however, with increasing caregiver workload and individuals' continuous needs of care, there is a need to ease caregiver's work while ensuring continuous interaction with users. This paper describes the design and validation of CoachAI, a conversational agent assisted health coaching system to support health intervention delivery to individuals and groups. CoachAI instantiates a text based healthcare chatbot system that bridges the remote human coach and the users. This research provides three main contributions to the preventive healthcare and healthy lifestyle promotion: (1) it presents the conversational agent to aid the caregiver; (2) it aims to decrease caregiver's workload and enhance care given to users, by handling (automating) repetitive caregiver tasks; and (3) it presents a domain independent mobile health conversational agent for health intervention delivery. We will discuss our approach and analyze the results of a one month validation study on physical activity, healthy diet and stress management

A smartphone-based health care chatbot to promote self-management of chronic pain (SELMA) : pilot randomized controlled trial

Background: Ongoing pain is one of the most common diseases and has major physical, psychological, social, and economic impacts. A mobile health intervention utilizing a fully automated text-based health care chatbot (TBHC) may offer an innovative way not only to deliver coping strategies and psychoeducation for pain management but also to build a working alliance between a participant and the TBHC. Objective: The objectives of this study are twofold: (1) to describe the design and implementation to promote the chatbot painSELfMAnagement (SELMA), a 2-month smartphone-based cognitive behavior therapy (CBT) TBHC intervention for pain self-management in patients with ongoing or cyclic pain, and (2) to present findings from a pilot randomized controlled trial, in which effectiveness, influence of intention to change behavior, pain duration, working alliance, acceptance, and adherence were evaluated. Methods: Participants were recruited online and in collaboration with pain experts, and were randomized to interact with SELMA for 8 weeks either every day or every other day concerning CBT-based pain management (n=59), or weekly concerning content not related to pain management (n=43). Pain-related impairment (primary outcome), general well-being, pain intensity, and the bond scale of working alliance were measured at baseline and postintervention. Intention to change behavior and pain duration were measured at baseline only, and acceptance postintervention was assessed via self-reporting instruments. Adherence was assessed via usage data. Results: From May 2018 to August 2018, 311 adults downloaded the SELMA app, 102 of whom consented to participate and met the inclusion criteria. The average age of the women (88/102, 86.4%) and men (14/102, 13.6%) participating was 43.7 (SD 12.7) years. Baseline group comparison did not differ with respect to any demographic or clinical variable. The intervention group reported no significant change in pain-related impairment (P=.68) compared to the control group postintervention. The intention to change behavior was positively related to pain-related impairment (P=.01) and pain intensity (P=.01). Working alliance with the TBHC SELMA was comparable to that obtained in guided internet therapies with human coaches. Participants enjoyed using the app, perceiving it as useful and easy to use. Participants of the intervention group replied with an average answer ratio of 0.71 (SD 0.20) to 200 (SD 58.45) conversations initiated by SELMA. Participants’ comments revealed an appreciation of the empathic and responsible interaction with the TBHC SELMA. A main criticism was that there was no option to enter free text for the patients’ own comments. Conclusions: SELMA is feasible, as revealed mainly by positive feedback and valuable suggestions for future revisions. For example, the participants’ intention to change behavior or a more homogenous sample (eg, with a specific type of chronic pain) should be considered in further tailoring of SELMA

Applying machine learning to predict future adherence to physical activity programs.

BackgroundIdentifying individuals who are unlikely to adhere to a physical exercise regime has potential to improve physical activity interventions. The aim of this paper is to develop and test adherence prediction models using objectively measured physical activity data in the Mobile Phone-Based Physical Activity Education program (mPED) trial. To the best of our knowledge, this is the first to apply Machine Learning methods to predict exercise relapse using accelerometer-recorded physical activity data.MethodsWe use logistic regression and support vector machine methods to design two versions of a Discontinuation Prediction Score (DiPS), which uses objectively measured past data (e.g., steps and goal achievement) to provide a numerical quantity indicating the likelihood of exercise relapse in the upcoming week. The respective prediction accuracy of these two versions of DiPS are compared, and then numerical simulation is performed to explore the potential of using DiPS to selectively allocate financial incentives to participants to encourage them to increase physical activity.Resultswe had access to a physical activity trial data that were continuously collected every 60 sec every day for 9 months in 210 participants. By using the first 15 weeks of data as training and test on weeks 16-30, we show that both versions of DiPS have a test AUC of 0.9 with high sensitivity and specificity in predicting the probability of exercise adherence. Simulation results assuming different intervention regimes suggest the potential benefit of using DiPS as a score to allocate resources in physical activity intervention programs in reducing costs over other allocation schemes.ConclusionsDiPS is capable of making accurate and robust predictions for future weeks. The most predictive features are steps and physical activity intensity. Furthermore, the use of DiPS scores can be a promising approach to determine when or if to provide just-in-time messages and step goal adjustments to improve compliance. Further studies on the use of DiPS in the design of physical activity promotion programs are warranted.Trial registrationClinicalTrials.gov NCT01280812 Registered on January 21, 2011

How 5G wireless (and concomitant technologies) will revolutionize healthcare?

The need to have equitable access to quality healthcare is enshrined in the United Nations (UN) Sustainable Development Goals (SDGs), which defines the developmental agenda of the UN for the next 15 years. In particular, the third SDG focuses on the need to “ensure healthy lives and promote well-being for all at all ages”. In this paper, we build the case that 5G wireless technology, along with concomitant emerging technologies (such as IoT, big data, artificial intelligence and machine learning), will transform global healthcare systems in the near future. Our optimism around 5G-enabled healthcare stems from a confluence of significant technical pushes that are already at play: apart from the availability of high-throughput low-latency wireless connectivity, other significant factors include the democratization of computing through cloud computing; the democratization of Artificial Intelligence (AI) and cognitive computing (e.g., IBM Watson); and the commoditization of data through crowdsourcing and digital exhaust. These technologies together can finally crack a dysfunctional healthcare system that has largely been impervious to technological innovations. We highlight the persistent deficiencies of the current healthcare system and then demonstrate how the 5G-enabled healthcare revolution can fix these deficiencies. We also highlight open technical research challenges, and potential pitfalls, that may hinder the development of such a 5G-enabled health revolution

Smart Interventions for Effective Medication Adherence

In this research we present a model for medication adherence from information systems and technologies (IS/IT) perspective. Information technology applications for healthcare have the potential to improve cost-effectiveness, quality and accessibility of healthcare. To date, measurement of patient medication adherence and use of interventions to improve adherence are rare in routine clinical practice. IS/IT perspective helps in leveraging the technology advancements to develop a health IT system for effectively measuring medication adherence and administering interventions. Majority of medication adherence studies have focused on average medication adherence. Average medication adherence is the ratio of the number of doses consumed and the number of doses prescribed. It does not matter in which order or pattern patients consume the dose. Patients with enormously diverse dosing behavior can achieve the same average levels of medication adher­ence. The same outcomes with different levels of ad­herence raise the possibility that patterns of adherence affect the effectiveness of medication adherence. We propose that medication adherence research should utilize effective medication adherence (EMA), derived by including both the pattern and average medication adherence for a patient. Using design science research (DSR) approach we have developed a model as an artifact for smart interventions. We have leveraged behavior change techniques (BCTs) based on the behavior change theories to design smart intervention. Because of the need for real time requirements for the system, we are also focusing on hierarchical control system theory and reference model architecture (RMA). The benefit of using this design is to enable an intervention to be administered dynamically on a need basis. A key distinction from existing systems is that the developed model leverages probabilistic measure instead of static schedule. We have evaluated and validated the model using formal proofs and by domain experts. The research adds to the IS knowledge base by providing the theory based smart interventions leveraging BCTs and RMA for improving the medication adherence. It introduces EMA as a measurement of medication adherence to healthcare systems. Smart interventions based on EMA will further lead to reducing the healthcare cost by improving prescription outcomes

Smart Interventions for Effective Medication Adherence

In this research we present a model for medication adherence from information systems and technologies (IS/IT) perspective. Information technology applications for healthcare have the potential to improve cost-effectiveness, quality and accessibility of healthcare. To date, measurement of patient medication adherence and use of interventions to improve adherence are rare in routine clinical practice. IS/IT perspective helps in leveraging the technology advancements to develop a health IT system for effectively measuring medication adherence and administering interventions. Majority of medication adherence studies have focused on average medication adherence. Average medication adherence is the ratio of the number of doses consumed and the number of doses prescribed. It does not matter in which order or pattern patients consume the dose. Patients with enormously diverse dosing behavior can achieve the same average levels of medication adher­ence. The same outcomes with different levels of ad­herence raise the possibility that patterns of adherence affect the effectiveness of medication adherence. We propose that medication adherence research should utilize effective medication adherence (EMA), derived by including both the pattern and average medication adherence for a patient. Using design science research (DSR) approach we have developed a model as an artifact for smart interventions. We have leveraged behavior change techniques (BCTs) based on the behavior change theories to design smart intervention. Because of the need for real time requirements for the system, we are also focusing on hierarchical control system theory and reference model architecture (RMA). The benefit of using this design is to enable an intervention to be administered dynamically on a need basis. A key distinction from existing systems is that the developed model leverages probabilistic measure instead of static schedule. We have evaluated and validated the model using formal proofs and by domain experts. The research adds to the IS knowledge base by providing the theory based smart interventions leveraging BCTs and RMA for improving the medication adherence. It introduces EMA as a measurement of medication adherence to healthcare systems. Smart interventions based on EMA will further lead to reducing the healthcare cost by improving prescription outcomes