The appeal of the Functional Fitness MOT to older adults and health professionals in an outpatient setting: a mixed-method feasibility study

Purpose: To understand the views and perceptions regarding the Functional Fitness MOT (FFMOT), a battery of functional tests followed by a brief motivational interview, of both the older people undergoing it and the health professionals delivering it. Patients and methods: Physically inactive older adults (n=29) underwent the FFMOT and subsequently attended focus groups to share their perceptions of it and to discuss the barriers, motivators, health behavior change, and scope to improve physical activity (PA) levels. PA levels were recorded at baseline and again at 12 weeks together with a post-intervention questionnaire concerning behavior change. Participating physiotherapists and technical instructors were interviewed. Results: Most participants felt they had learned about their abilities and comparisons with their peers, had a change in perception about the importance of good balance and strength, and felt the FFMOT helped raise their awareness of local and self-directed physical activity opportunities. Most felt their awareness of the need for PA had not changed, but 25% of participants started a new organized PA opportunity. The health professionals perceived the FFMOT as being easy to administer, educating, and motivating for participants to increase their PA. Space, time, finances, and insecurity about having the necessary skills to conduct the FFMOTs were seen as barriers in implementing the FFMOT in daily practice. Conclusion: Over half of those offered the FFMOT accepted it, suggesting it is appealing. However, most participants felt they were already active enough and that their awareness of the need for PA had not changed. There were positive perceptions of the FFMOT from both professionals and older people, but both felt the FFMOT could be held in a community venue. The overall findings suggest that the FFMOT is feasible in the clinical setting, but its effectiveness has yet to be determined

Designing Human-Centered Collective Intelligence

Human-Centered Collective Intelligence (HCCI) is an emergent research area that seeks to bring together major research areas like machine learning, statistical modeling, information retrieval, market research, and software engineering to address challenges pertaining to deriving intelligent insights and solutions through the collaboration of several intelligent sensors, devices and data sources. An archetypal contextual CI scenario might be concerned with deriving affect-driven intelligence through multimodal emotion detection sources in a bid to determine the likability of one movie trailer over another. On the other hand, the key tenets to designing robust and evolutionary software and infrastructure architecture models to address cross-cutting quality concerns is of keen interest in the “Cloud” age of today. Some of the key quality concerns of interest in CI scenarios span the gamut of security and privacy, scalability, performance, fault-tolerance, and reliability. I present recent advances in CI system design with a focus on highlighting optimal solutions for the aforementioned cross-cutting concerns. I also describe a number of design challenges and a framework that I have determined to be critical to designing CI systems. With inspiration from machine learning, computational advertising, ubiquitous computing, and sociable robotics, this literature incorporates theories and concepts from various viewpoints to empower the collective intelligence engine, ZOEI, to discover affective state and emotional intent across multiple mediums. The discerned affective state is used in recommender systems among others to support content personalization. I dive into the design of optimal architectures that allow humans and intelligent systems to work collectively to solve complex problems. I present an evaluation of various studies that leverage the ZOEI framework to design collective intelligence

Addressing People and Place Microenvironments in Weight Loss Disparities (APP-Me): Design of a randomized controlled trial testing timely messages for weight loss behavior in low income black and white women

Background Behavioral interventions for weight loss have been less effective in lower income and black women. These poorer outcomes may in part be related to these women having more frequent exposures to social and physical situations that are obesogenic, i.e., eating and sedentary cues or situations. Objectives Working with obese, lower income black and white women, Addressing People and Place Microenvironments (APP-Me) was designed to create awareness of self-behavior at times and places of frequent eating and sedentary behavior. Design APP-Me is being evaluated in a randomized controlled trial with 240 participants recruited from federally qualified health centers located in a single Midwestern city. All participants complete four weeks of ecological momentary assessments (EMA) of situations and behavior. At the end of the four weeks, participants are randomized to enhanced usual care (UC) or UC plus APPMe. Methods APP-Me is an automated short messaging system (SMS). Messages are text, image, audio, or a combination, and are delivered to participants’ mobile devices with the intent of creating awareness at the times and places of frequent eating or sedentary behavior. The EMA data inform the timing of message deliveries. Summary This project aims to create and test timely awareness messages in a subpopulation that has not responded well to traditional behavioral interventions for weight loss. Novel aspects of the study include the involvement of a low income population, the use of data on time and place of obesogenic behavior, and message delivery time tailored to an individual’s behavioral patterns

Designing Personalised mHealth solutions: An overview

Introduction Mobile health, or mHealth, is based on mobile information and communication technologies and provides solutions for empowering individuals to participate in healthcare. Personalisation techniques have been used to increase user engagement and adherence to interventions delivered as mHealth solutions. This study aims to explore the current state of personalisation in mHealth, including its current trends and implementation. Materials and Methods We conducted a review following PRISMA guidelines. Four databases (PubMed, ACM Digital Library, IEEE Xplore, and APA PsycInfo) were searched for studies on mHealth solutions that integrate personalisation. The retrieved papers were assessed for eligibility and useful information regarding integrated personalisation techniques. Results Out of the 1,139 retrieved studies, 62 were included in the narrative synthesis. Research interest in the personalisation of mHealth solutions has increased since 2020. mHealth solutions were mainly applied to endocrine, nutritional, and metabolic diseases; mental, behavioural, or neurodevelopmental diseases; or the promotion of healthy lifestyle behaviours. Its main purposes are to support disease self-management and promote healthy lifestyle behaviours. Mobile applications are the most prevalent technological solution. Although several design models, such as user-centred and patient-centred designs, were used, no specific frameworks or models for personalisation were followed. These solutions rely on behaviour change theories, use gamification or motivational messages, and personalise the content rather than functionality. A broad range of data is used for personalisation purposes. There is a lack of studies assessing the efficacy of these solutions; therefore, further evidence is needed. Discussion Personalisation in mHealth has not been well researched. Although several techniques have been integrated, the effects of using a combination of personalisation techniques remain unclear. Although personalisation is considered a persuasive strategy, many mHealth solutions do not employ it. Conclusions Open research questions concern guidelines for successful personalisation techniques in mHealth, design frameworks, and comprehensive studies on the effects and interactions among multiple personalisation techniques

Designing personalised mHealth solutions: An overview

Introduction: Mobile health, or mHealth, is based on mobile information and communication technologies and provides solutions for empowering individuals to participate in healthcare. Personalisation techniques have been used to increase user engagement and adherence to interventions delivered as mHealth solutions. This study aims to explore the current state of personalisation in mHealth, including its current trends and implementation. Materials and Methods: We conducted a review following PRISMA guidelines. Four databases (PubMed, ACM Digital Library, IEEE Xplore, and APA PsycInfo) were searched for studies on mHealth solutions that integrate personalisation. The retrieved papers were assessed for eligibility and useful information regarding integrated personalisation techniques. Results: Out of the 1,139 retrieved studies, 62 were included in the narrative synthesis. Research interest in the personalisation of mHealth solutions has increased since 2020. mHealth solutions were mainly applied to endocrine, nutritional, and metabolic diseases; mental, behavioural, or neurodevelopmental diseases; or the promotion of healthy lifestyle behaviours. Its main purposes are to support disease self- management and promote healthy lifestyle behaviours. Mobile applications are the most prevalent technological solution. Although several design models, such as user-centred and patient-centred designs, were used, no specific frameworks or models for personalisation were followed. These solutions rely on behaviour change theories, use gamification or motivational messages, and personalise the content rather than functionality. A broad range of data is used for personalisation purposes. There is a lack of studies assessing the efficacy of these solutions; therefore, further evidence is needed. Discussion: Personalisation in mHealth has not been well researched. Although several techniques have been integrated, the effects of using a combination of personalisation techniques remain unclear. Although personalisation is considered a persuasive strategy, many mHealth solutions do not employ it. Conclusions: Open research questions concern guidelines for successful personalisation techniques in mHealth, design frameworks, and comprehensive studies on the effects and interactions among multiple personalisation techniques

Evaluating the impact of physical activity apps and wearables: interdisciplinary review

Background: Although many smartphone apps and wearables have been designed to improve physical activity, their rapidly evolving nature and complexity present challenges for evaluating their impact. Traditional methodologies, such as randomized controlled trials (RCTs), can be slow. To keep pace with rapid technological development, evaluations of mobile health technologies must be efficient. Rapid alternative research designs have been proposed, and efficient in-app data collection methods, including in-device sensors and device-generated logs, are available. Along with effectiveness, it is important to measure engagement (ie, users’ interaction and usage behavior) and acceptability (ie, users’ subjective perceptions and experiences) to help explain how and why apps and wearables work. Objectives: This study aimed to (1) explore the extent to which evaluations of physical activity apps and wearables: employ rapid research designs; assess engagement, acceptability, as well as effectiveness; use efficient data collection methods; and (2) describe which dimensions of engagement and acceptability are assessed. Method: An interdisciplinary scoping review using 8 databases from health and computing sciences. Included studies measured physical activity, and evaluated physical activity apps or wearables that provided sensor-based feedback. Results were analyzed using descriptive numerical summaries, chi-square testing, and qualitative thematic analysis. Results: A total of 1829 abstracts were screened, and 858 articles read in full. Of 111 included studies, 61 (55.0%) were published between 2015 and 2017. Most (55.0%, 61/111) were RCTs, and only 2 studies (1.8%) used rapid research designs: 1 single-case design and 1 multiphase optimization strategy. Other research designs included 23 (22.5%) repeated measures designs, 11 (9.9%) nonrandomized group designs, 10 (9.0%) case studies, and 4 (3.6%) observational studies. Less than one-third of the studies (32.0%, 35/111) investigated effectiveness, engagement, and acceptability together. To measure physical activity, most studies (90.1%, 101/111) employed sensors (either in-device [67.6%, 75/111] or external [23.4%, 26/111]). RCTs were more likely to employ external sensors (accelerometers: P=.005). Studies that assessed engagement (52.3%, 58/111) mostly used device-generated logs (91%, 53/58) to measure the frequency, depth, and length of engagement. Studies that assessed acceptability (57.7%, 64/111) most often used questionnaires (64%, 42/64) and/or qualitative methods (53%, 34/64) to explore appreciation, perceived effectiveness and usefulness, satisfaction, intention to continue use, and social acceptability. Some studies (14.4%, 16/111) assessed dimensions more closely related to usability (ie, burden of sensor wear and use, interface complexity, and perceived technical performance). Conclusions: The rapid increase of research into the impact of physical activity apps and wearables means that evaluation guidelines are urgently needed to promote efficiency through the use of rapid research designs, in-device sensors and user-logs to assess effectiveness, engagement, and acceptability. Screening articles was time-consuming because reporting across health and computing sciences lacked standardization. Reporting guidelines are therefore needed to facilitate the synthesis of evidence across disciplines

A Complex mHealth Coaching Intervention to Prevent Overweight, Obesity, and Diabetes in High-Risk Women in Antenatal Care: Protocol for a Hybrid Type 2 Effectiveness-Implementation Study

This project is funded by the European Union Commission Horizon 2020 grant entitled "Implementation Action to Prevent Diabetes from Bump 2 Baby (IMPACT DIABETES B2B) " under grant agreement 847984, with collaborative National Health and Medical Research Council, Australia co -funding under grant number APP1194234. The project is sponsored by University College Dublin. The funders and the sponsor have no role in the design of the study, the collection, analysis, and interpretation of data, or in the writing of the manuscript or decision to publish. The contributors associated with IMPACT DIABETES B2B Consortium1 are as follows: Janine Wirth, School of Agriculture and Food Science, University College Dublin, Dublin, Ireland; Mary Codd, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; Ricardo Segurado, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; Jacqueline Boyle, Eastern Health Clinical School, Monash University, Melbourne, Australia; Georgia Soldartis, Monash Health, Melbourne, Australia; Alberto Puertas, School of Medicine, University of Granada, Granada, Spain; Francisca S Molina, School of Medicine, University of Granada, Granada, Spain; Maria Garcia-Ricobaraza, School of Medicine, University of Granada, Granada, Spain; Nanna Husted Jensen, Department of Public Health, Aarhus University, Aarhus, Denmarkv; Elena Rey Velasco, Liva Healthcare, Copenhagen, Denmark.Background: Women with overweight and obesity are at higher risk of developing complications in pregnancy such as gestational diabetes and longer-term chronic conditions. Research concerning health behavior change interventions during pregnancy and postpartum shows promising effects, but implementation into routine services is sparsely investigated. Most interventions focus on the antenatal or postpartum life stages, failing to meet the needs of women. IMPACT DIABETES Bump2Baby is a multicenter project across 4 high-income countries developed to test the implementation of an antenatal and postpartum evidence-based mobile health (mHealth) coaching intervention called Bump2Baby and Me (B2B&Me) designed to sit alongside usual care in the perinatal period. Objective: We aim to explore the feasibility and implementation of the B2B&Me intervention and investigate the effectiveness of this intervention in women at risk of gestational diabetes. Methods: IMPACT DIABETES Bump2Baby is a hybrid type 2 effectiveness-implementation study, which integrates an evidence-based mHealth coaching app that includes personalized health behavior change coaching provided by health care professionals alongside antenatal care from the first antenatal visit to 12 months postpartum. The mHealth app offers the possibility of synchronous calls, asynchronous contact (including coach-participant text and video messaging exchanges tailored to the participant’s needs), and ongoing access to an extensive library of bespoke intervention materials. Participants will interact asynchronously with their health coach throughout the intervention via the app. This randomized controlled trial across 4 clinical sites within Ireland, the United Kingdom, Spain, and Australia will recruit 800 women in early pregnancy to evaluate the effectiveness on postpartum weight. The Exploration, Preparation, Implementation, and Sustainment implementation framework is the theoretical underpinning of the study. The implementation evaluation will be assessed at the individual, hospital staff, and broader community levels using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Data sources for the RE-AIM evaluation will include app and platform analytics, screening and training records, participant medical records, key informant interviews, participant and partner exit interviews, cost data, study questionnaires, staff surveys, and blood sample analyses. Results: The study was approved and registered with the Australian New Zealand Clinical Trials Registry on November 19, 2020. Recruitment commenced on February 9, 2021, and data collection is ongoing. Publication of the results is expected in 2024. Conclusions: This is the first hybrid effectiveness-implementation study of an 18-month mHealth coaching intervention in at-risk women that we are aware of. As research aims to move toward real-world implementable solutions, it is critical that hybrid studies are conducted. The data from this large multicenter study will be useful in planning the potential implementation and scale-up of evidence-based perinatal health behavior change interventions.Horizon 2020 847984National Health and Medical Research Council (NHMRC) of Australia APP119423

Personalized nutrition advice : an everyday-life perspective

This thesis presents societal preconditions for Personalized Nutrition Advice (PNA) that result from an everyday-life perspective on this innovative approach. Generally, PNA is regarded as promising, because it provides users with highly specific information on individual health risks and benefits of eating habits and the desirable changes, which may induce a high sense of personal relevance. Rapid developments in interactive computer technology (ICT) and nutrigenomics science are the innovative drivers in this area. Although indicated as promising, the limited impact of personalized advice on eating practices up to now, signals a mismatch with consumers’ everyday life. In our studies, we found that the pursuance of nutrition advices assumes that consumers have a focal concern on health, which is not always the case. Consumers value uncomplicatedness and convenience of healthful eating and the flexibility to eat for pleasure as well. More flexible advice would therefore better match with consumers’ complicated everyday life, in which health is just one of several ambitions, including social ones. A change of eating practices requires the alteration of other practices besides those directly related to the food choice chain. Advice should provide for consumers’ ability to organize healthful eating within existing chains of social practices, including discursive ones. In everyday-life, consumers have to persist in their intentions to eat healthfully vis-a-vis relevant others. In our study, consumers presented themselves as being uncomplicated, to avoid the image of health freakiness. Based on the finding that being someone who makes great effort in relation to healthful eating is a disfavored image, we conclude that for structural change, the healthy choice should become a ‘practically and socially easy choice’. We propose that PNA can contribute to this goal by using an ‘Action Approach’. The basic idea of this approach is that, besides being well-informed and motivated, consumers need to become actively involved in eating for health. By this, we mean that they are able to practically and socially organize their eating practices in order to ensure health benefits. This would involve the stimulation of a process of critical reflection on the uncomplicatedness of healthful eating and the integration of advice on the practical and social organization of changing eating practices towards health. Consumers themselves should become co-designers of this advice, as they are experts on everyday-life problems and solutions which occur when they try to pursue their healthful eating intentions. The integration of a diversity of expertise on social, ethical and practical requirements in early stages of the development process of innovative PNA is essential. Yet, our study showed that actors in diverse societal sectors were reluctant to engage in the development process of ICT and gene-based PNA. Their evidence-based working practices required that first, scientific support on the effectiveness should become available. Based on their expertise on public needs and wants, they called for a request to slow down the innovation process on behalf of the public. Current working life also does not allow for much change in roles and responsibilities, which may be needed to integrate the innovation in working practices of societal actors. In our qualitative study amongst general practitioners (GPs), we found that participants hold rather critical views on nutrition advice, and certainly on the innovative drivers. A lack of robustness, a low match with patients’ needs and equivocalness of nutritional studies were perceived as blocking GPs involvement. The social acceptability of PNA requires a participatory process. But an invitation to join the innovation process does not of necessity elicit pro-active involvement. This requires the stimulation of a critical reflection process on the meaning of ‘evidence’ from the perspectives of concerned actors and the consequences for the innovation processes. Such an exercise should aim at finding solutions, as to overcome the block about involvement. It should also target reflection on the meaning of expertise, keeping in mind the required increasing role of consumers in the design of PNA. In sum, we conclude that the alignment of PNA with societal preconditions is possible if the development process evolves as a participatory process, in which all societal actors are convinced about the valuable contribution their experience and expertise offers to this search for new ways to effectively promote healthful eating. <br/

Quality Improvement Through Evidence-Based Education: Advancing Obesity Awareness and Clinical Management Strategies for People Living with Mental Disorders

People living with mental disorders (PLWMDs) are at an increased risk for developing obesity due to poor diet, physical inactivity, and antipsychotic medications. In the United States, the general-population obesity rate is 36% compared to more than 50% for PLWMDs. Mental health professionals (MHPs), focused on addressing psychiatric conditions, seldom recognize and clinically manage obesity. Furthermore, this population is socioeconomically disadvantaged with poor dietary habits while consuming psychiatric medications that stimulate hunger, further exacerbating the risk for obesity. The Promoting Action on Research Implementation in Healthcare Services (PARISHS) framework guided this quality improvement project to improve obesity awareness and management for PLWMD at a large state psychiatric hospital. An evidence-based education intervention was implemented to positively impact obesity awareness and clinical management or MHPs. The evaluation used a validated instrument with a pre- and posttest design. Paired t test was used to analyze multiple constructs from the MHP participants (N = 50). Overall, the pretest indicated 76% of MHPs were not involved in helping obese PLWMDs manage their weight; however, the posttest data (at 90-days) revealed that 90% were involved in this activity. This represents a positive shift in obesity perceptions and management knowledge. Future research needs to evaluate the impact of the perceptions on process measures and clinical outcomes. This project led to positive social change as MHPs are more likely to address obesity in PLWMD due to their increased awareness and knowledge. This project has broader implications as the program can be duplicated in other psychiatric hospitals