Multidimensional individualised Physical ACTivity (Mi-PACT) - a technology-enabled intervention to promote physical activity in primary care: Study protocol for a randomised controlled trial

© 2015 Peacock et al. Background: Low physical activity is a major public health problem. New cost-effective approaches that stimulate meaningful long-term changes in physical activity are required, especially within primary care settings. It is becoming clear that there are various dimensions to physical activity with independent health benefits. Advances in technology mean that it is now possible to generate multidimensional physical activity 'profiles' that provide a more complete representation of physical activity and offer a variety of options that can be tailored to the individual. Mi-PACT is a randomised controlled trial designed to examine whether personalised multidimensional physical activity feedback and self-monitoring alongside trainer-supportive sessions increases physical activity and improves health outcomes in at-risk men and women. Methods/Design: We aim to recruit 216 patients from within primary care aged 40 to 70years and at medium or high risk of cardiovascular disease and/or type II diabetes mellitus. Adopting an unequal allocation ratio (intervention: control) of 2:1, participants will be randomised to one of two groups, usual care or the intervention. The control group will receive usual care from their general practitioner (GP) and standardised messages about physical activity for health. The intervention group will receive physical activity monitors and access to a web-based platform for a 3-month period to enable self-monitoring and the provision of personalised feedback regarding the multidimensional nature of physical activity. In addition, this technology-enabled feedback will be discussed with participants on 5 occasions during supportive one-to-one coaching sessions across the 3-month intervention. The primary outcome measure is physical activity, which will be directly assessed using activity monitors for a 7-day period at baseline, post intervention and at 12months. Secondary measures (at these time-points) include weight loss, fat mass, and markers of metabolic control, motivation and well-being. Discussion: Results from this study will provide insight into the effects of integrated physical activity profiling and self-monitoring combined with in-person support on physical activity and health outcomes in patients at risk of future chronic disease. Trial registration:ISRCTN18008011Trial registration date: 31 July 201

Self-Tracking by People Living with Multiple Sclerosis: Supporting Experiences of Agency in a Chronic Neurological Condition

Multiple sclerosis is a complex neurological condition. It disrupts the central nervous system leading to an individual range of physical, cognitive, and mental impairments. Research has focused on the tracking of primary disease indicators and disability outcome measures to assess the progression of this condition. However, there is little knowledge on how technologies could support the needs of people with multiple sclerosis (MS) in self-tracking their health and wellbeing. Drawing on qualitative research and design methods this thesis provides two contributions. Firstly, it improves understanding of self-tracking in MS self-management. Interview participants reported regaining a sense of control over MS through intertwining individual self-care practices with different self-tracking tools, including paper notebooks and fitness wearables. They associated experiences of control with their agency to document their health in holistic ways, involving symptom monitoring and life journaling. However, participants criticised that self-tracking apps can impede their capacities, in particular when the user experience is focused on predefined health indicators and the optimisation of health behaviour. These findings highlight the need to support people’s individual self-care intentions and agentive capacities through customisable self- tracking approaches. Secondly, this thesis contributes the design of Trackly, a technology probe that supports people in defining and colouring pictorial trackers, such as body shapes. We identify benefits and challenges of customisable and pictorial self-tracking through a field study of Trackly in MS self-management. Having been able to support their individual self-care intentions with Trackly, participants reported a spectrum of interrelated experiences of agency, including ownership, identity, awareness, mindfulness, and control. Overall, this thesis provides a qualitative account and design perspective that demonstrate how adapting self-tracking technologies to individual care needs supported experiences of agency. These findings are particularly relevant to the design of technologies aimed at leveraging personally meaningful self-care and quality of life

Self-Care Technologies in HCI: Trends, Tensions, and Opportunities

Many studies show that self-care technologies can support patients with chronic conditions and their carers in understanding the ill body and increasing control of their condition. However, many of these studies have largely privileged a medical perspective and thus overlooked how patients and carers integrate self-care into their daily lives and mediate their conditions through technology. In this review, we focus on how patients and carers use and experience self-care technology through a Human-Computer Interaction (HCI) lens. We analyse studies of self-care published in key HCI journals and conferences using the Grounded Theory Literature Review (GTLR) method and identify research trends and design tensions. We then draw out opportunities for advancing HCI research in self-care, namely, focusing further on patients' everyday life experience, considering existing collaborations in self-care, and increasing the influence on medical research and practice around self-care technology

Exploring perspectives of people with type-1 diabetes on goalsetting strategies within self-management education and care

Background. Collaborative goal-setting strategies are widely recommended for diabetes self-management support within healthcare systems. Creating self-management plans that fit with peoples’ own goals and priorities has been linked with better diabetic control. Consequently, goal-setting has become a core component of many diabetes selfmanagement programmes such as the ‘Dose Adjustment for Normal Eating (DAFNE) programme’. Within DAFNE, people with Type-1 Diabetes (T1D) develop their own goals along with action-plans to stimulate goal-achievement. While widely implemented, limited research has explored how goal-setting strategies are experienced by people with diabetes.Therefore, this study aims to explore the perspectives of people with T1D on theimplementation and value of goal-setting strategies within DAFNE and follow-up diabetes care. Furthermore, views on barriers and facilitators to goal-attainment are explored.Methods. Semi-structured interviews were conducted with 20 people with T1D who attended a DAFNE-programme. Following a longitudinal qualitative research design, interviews took place 1 week, and 6-8 months after completion of DAFNE. A recurrent cross-sectional approach is applied in which themes will be identified at each time-point using thematic analyses.Expected results. Preliminary identified themes surround the difference in value that participants place on goal-setting strategies, and the lack of support for goal-achievement within diabetes care.Current stage. Data collection complete; data-analysis ongoing.Discussion. Goal-setting strategies are increasingly included in guidelines for diabetes support and have become essential parts of many primary care improvement schemes. Therefore, exploring the perspectives of people with T1D on the value and implementation of goal-setting strategies is vital for their optimal application

Future bathroom: A study of user-centred design principles affecting usability, safety and satisfaction in bathrooms for people living with disabilities

Research and development work relating to assistive technology 2010-11 (Department of Health) Presented to Parliament pursuant to Section 22 of the Chronically Sick and Disabled Persons Act 197

An exploration of the use of theory and visualisation in behaviour change interventions to help healthcare staff prevent and control healthcare-associated infections.

Changing healthcare staff's behaviours is of paramount importance in improving infection prevention and control (IPC), and decreasing healthcare-associated infections (HAIs). Thus many supportive interventions have been developed in pertinent areas, such as hand hygiene (HH). The concepts of theory and visualisation in behaviour change research are well described and embraced across the social sciences as they provide rigorous and innovative interventional solutions. However, the use of each of these concepts within interventions in IPC and HAI-related research has not been systematically investigated, and neither has their use in combination. The current thesis thus aimed to explore this field in depth, with a view to developing evidence-based recommendations for designing behaviour change interventions combining theory and visualisation. The study comprises a sequential multimethod pragmatic inquiry. This commenced by conducting two separate integrative literature reviews, exploring the wider context of theory-based and visualisation-centred interventions respectively - both in the field of IPC and HAIs. The reviews addressed gaps in relation to the theories and visualisations that have been used in pertinent interventions, the structure and application of these, and which of them seem to work. However, they raised further questions, for example which intervention parts work better than others, and how and why parts or whole interventions work. The above questioning formed the basis for the conduct of a Delphi study, with a participating international panel of key experts (n=18) in the fields of IPC, HAIs, intervention development, theory and/or visualisation. Through three questionnaire and survey rounds, the expert panel provided insights into questions (round 1), and were asked to rank subsequent related statements according to the degree of their agreement (rounds 2 and 3). The experts' responses provided sets of theories and visualisations along with other important intervention elements (e.g. behaviour change techniques), which could be prioritised when considering combinations to use for developing focal interventions (i.e. targeted to specific behaviours of individuals or teams) and systems-based interventions (i.e. targeted to whole healthcare organisations). Finally, four focus groups - with nurses and infection control staff (n=18) from two Scottish Health Boards - aimed to obtain staff opinions and perspectives regarding IPC based on their clinical experiences. Participants were also presented with selected recommendations from the Delphi study, and were asked to comment on them and make further suggestions. Findings indicate that posters are less effective, and that work and time pressure as part of clinical practice should be considered when developing pertinent interventions. Taken together, it was possible to formulate a menu of recommendations that had their foundational basis in the combination of participatory theoretical approaches and dynamic forms of visualisation. This research provides novel insight into the role of theory and visualisation in HAIs and IPC practice. The explicit combination of theory and visualisation has been demonstrated to be very under-researched, thus these findings contribute original knowledge and offer value for practice, education and research