“Diabetes care”: Providing advanced representation of mobile diabetes diary data to general practitioner

Purpose The purpose of the research is to develop an application that will support diabetes management in general practice. The research solution was implied to allow general practitioner to see advanced represented data that was measured and recorded into mobile diabetes diary by patients with diabetes. Motivation The development of mHealth applications for patients with diabetes has large variety of mobile diabetes diaries to support self-management for a better life quality. However, these kind of applications do not play substantial role in diabetes care in general practice despite the level of advanced features in such applications. The data is not in particular use by primary care professionals due to the lack of such possibility. Besides, advanced trends representation of daily measurements of blood glucose level, insulin and carbohydrates intake, and physical activity can play significant role in providing prevention and control for diabetes patients based on their personal patterns. Methods For the research design, engineering approach was chosen. In particular, the study was based on the waterfall model of software development life cycle (SDLS). Mostly, to collect the information for the requirements and to understand medical particularity of diabetes management in general practice, such methods as interview, questionnaire and discussion were used. Participants were four medical doctors and group of technical experts who supported the development on its each step. Usability testing was performed during application prototyping and on the final software testing with users involvement. During the software testing procedure, the application showed no faults. Results “Diabetes Care” application was developed to support diabetes management in general practice, by helping general practitioner in a more rapid and qualitative way to analyze patient’s measurements. For each type of measurements were developed statistics. As well, decision support function was embedded into statistical rules for physical activity and morning glucose levels monitoring. Color representation of the decision support function was oriented on the error minimization and saving time for the rest of the consultation procedure. During the development, the application was extended with appointments and recommendation management functionality for patients. The application was tested by medical doctors in order to see its acceptance by potential users. Overall, medical doctors expressed highly positive thoughts about the application. “Diabetes Care” was accepted as comfortable to use, understandable, and intuitive. The simplicity of use, design and the idea of development were highlighted by doctors as strong research aspects. Doctors were prone to think that with possible further extensions and consideration of legal issues, the application can improve quality of diabetes care generally. Conclusion Application testing showed very promising results according to its medical doctors’ acceptance. The direction of the research was pointed as an innovative and showed strong interest to the application development from medical perspective. Despite the fact that exclusively two medical doctors have tested the application, the results of each testing procedure were similar. This allows the assumption that relevance of the “Diabetes Care” application should be tested and studied further with possible development in order to identify its potential positive effect on quality of provided diabetes management in general practice

LITERATURE REVIEW: COMPLIANCE/LIFESTYLE CHANGE FACTORS

This literature review on compliance/lifestyle change factors has been conducted within the Connected Health Early Stage Researcher Support System (CHESS) project; under the framework of Marie Skłodowska-Curie grant agreement NO. 676201 for the Work package 2. The problem of patient compliance is becoming one of the most alarming in the medical practice worldwide. Studies showed that the low level of compliance is widely spread among patients with various diseases; yet, patients with chronic diseases are in the critical position due to the need to follow recommendation for a longer period of time, and very often - lifelong. Formation of patient compliance depends on many factors, including physician’s personality and style of medical practice, organization of health care and availability of certain facilities, particular aspects of a medicinal therapy regimen, socio - economic circumstances, personal and psychological characteristics of a patient, etc. However, in most cases, patients with different chronic diseases are considered to be different subjects from the perspective of factors affecting their adherence. Therefore, there is a need for a separate investigation of different groups of patients (e.g., patients with human immunodeficiency virus (HIV), patients with heart disease, etc.). Narrowing, there is limited data on patient adherence to a particular lifestyle change recommendation and its regimens, including maintenance of physical activity and physical fitness, following a balanced diet, etc. Considering physical activity and exercise as an essential part of lifestyle to control heart disease and prevent its further progression, this review focuses on a literature review of the influence factors associated with physical-activity-related adherence modification in a group of patients with heart disease. Objectives: The objectives of the review include (A) identification of particular types of physical-activity-related behaviour and its settings in regard to adherence in patients with heart disease, (B) assembling adherence measurement criteria, (C) examination and classification of factors affecting adherence, and (D) analysis of adherence change power of specific programs, interventions, and its components based on the selected literature. Methods: A comprehensive literature review was conducted based on the Arksey and O'Malley methodological framework. The procedure included identification of the literature review scope and research questions, establishment of the criteria for the relevance, study selection, charting the materials, and collating, summarizing, and reporting the results. When it was applicable, the systematic review approach methods were used in order to narrow and increase the quality of the final results. To complete the literature review, sources were accessed between March and August 2016. Results: Outlined in the review results, a basis and key findings are highlighted for the development of the diagnostic algorithms to predict the adherence to a particular physical-activity-related behaviour of patients with heart disease. Addressed physical-activity-related behaviour is narrowed with regard to lifestyle physical activity and exercise regimen, or physical fitness. The interpretations of the results considered in the review, along with measurement criteria, and context of each of the behaviour, together with provided variety of associated factors and their complex relations to physical-activity-related adherence, allow to optimize patient assessment approaches, and as a result intervention strategies, through recommendations and rehabilitation programs tailoring for lifestyle change and adherence modification

Μοντελοποίηση της συμπεριφοράς που σχετίζεται με τη φυσική δραστηριότητα χρόνιων ασθενών, αποσκοπώντας στον υγιή τρόπο διαβίωσης

The ongoing increase in the incidence of cardiovascular disease (CVD) is often associated with unhealthy daily choices, while a healthy lifestyle is one of the essential recommendations for patients with CVD. Regardless of the importance to follow the advice, the problem of adherence became a warning in healthcare practice worldwide. To facilitate health behavior change, use of interventions appears to be the most preferred tool in cardiac care practice. However, the development of successful interventions remains relevant due to the increasing rates of patient dropouts in rehabilitation programs and hospital readmissions.The research has shown that to create integrative models of patient behavior that could be used as the core of e-health, or traditional interventions, a better understanding of the patient profile and daily patterns, development of behavioral ontologies and models, and reusability of tools and models should be addressed. This research aims to propose modeling approaches that could assist improvement in the strategy and design of technological solutions for personalization of health-related behavior support. The scope of the study comprises modeling of CVD patients’ adherence to lifestyle-based health promotion interventions with the focus on the physical activity-related behavior for healthy behavior support.The research was organized into three phases. The first phase was focused on the investigation of CVD patient determinants affecting adherence to physical activity behavior. During the second phase, the outcomes of the previous phase were approached with the ontology engineering to support the knowledge reusability and the process of recommendation given to a patient in cardiac rehabilitation (CR) practice. Three studies were organized during the third phase of the research to collect the data and explore approaches of patient behavior modeling. In the first study, patient motivation to CR program participation was examined and built a motivation classification model. The second study was organized to investigate lifestyle determinants of patient physical activity in daily life. The third study was designed to continue exploring lifestyle behavioral patterns with the use of activity trackers.The outcomes of this research extend the novel data-driven modeling approaches that could be adapted to the design of interventions aiming for health-related behavior change in the domain of patient health-related adherence. A behavioral ontology was developed to reuse the synthesized research outcomes in the field, and two computational models were created for a better understanding and description of patient adherence in the settings of CR and daily activity based on the mixed-type data origin.The recommendations for future research include further development of the ontology to extend the scope to other chronic diseases and elements of health-related lifestyle behavior, the development of the methodology for conducting research studies in the domain of patient adherence, and to advance and continue the investigation of behavioral patterns using activity trackers with a large population sample.Η συνεχιζόμενη αύξηση εμφάνισης επεισοδίων καρδιαγγειακής νόσου (CVD) συνδέεται συχνά με τις ανθυγιεινές καθημερινές επιλογές των ασθενών, παρόλο που ο υγιεινός τρόπος ζωής είναι μια από τις βασικές συστάσεις για τους ασθενείς με CVD. Παρά τη σημασία του να ακολουθούν οι ασθενείς τις ιατρικές συστάσεις, υπάρχουν προειδοποιήσεις για τη διάσταση που έχει λάβει το πρόβλημα της συμμόρφωσης στην ιατρική περίθαλψη παγκοσμίως. Για να διευκολυνθεί η αλλαγή της συμπεριφοράς στην υγεία, η χρήση συγκεκριμένων παρεμβάσεων φαίνεται να είναι το πλέον προτιμώμενο εργαλείο στην πρακτική της καρδιακής φροντίδας. Ωστόσο, η ανάπτυξη επιτυχών παρεμβάσεων παραμένει σχετική λόγω του αυξανόμενου ποσοστού εγκατάλειψης των προγραμμάτων αποκατάστασης από τους ασθενείς καθώς και του αυξανόμενου ποσοστού επανεισαγωγής στο νοσοκομείο.Η έρευνα έχει δείξει ότι για τη δημιουργία ολοκληρωμένων μοντέλων συμπεριφοράς ασθενών τα οποία θα μπορούσαν να χρησιμοποιηθούν ως πυρήνας σε παρεμβάσεις, τόσο βασισμένες στην ηλεκτρονική υγεία όσο και παραδοσιακες, είναι αναγκαια η επιδίωξη καλύτερης κατανόησης του προφίλ ασθενών και των καθημερινών προτύπων συμπεριφοράς τους, η ανάπτυξη οντολογιών και μοντέλων συμπεριφοράς και η επαναχρησιμοποίηση εργαλείων και μοντέλων. Αυτή η έρευνα στοχεύει στο να προτείνει μεθόδους μοντελοποίησης που θα μπορούσαν να βοηθήσουν στη βελτίωση της στρατηγικής και του σχεδιασμού τεχνολογικών λύσεων για την εξατομίκευση της υποστήριξης της συμπεριφοράς που σχετίζεται με την υγεία. Το πεδίο της μελέτης περιλαμβάνει τη μοντελοποίηση της συμμόρφωσης των ασθενών με CVD ως προς τον καθημερινό τρόπο ζωής, με με έμφαση στην συμπεριφορά που σχετίζεται με τη σωματική δραστηριότητα για την προαγωγή της υγιούς συμπεριφοράς.Η έρευνα οργανώθηκε σε τρεις φάσεις. Η πρώτη φάση επικεντρώθηκε στη διερεύνηση των καθοριστικών παραγόντων του ασθενούς με CVD που επηρεάζουν τη συμπεριφορά της σωματικής δραστηριότητας. Κατά τη διάρκεια της δεύτερης φάσης, τα αποτελέσματα της προηγούμενης φάσης προσεγγίστηκαν με σημασιολογικές τεχνολογίες για να υποστηρίξουν την επαναχρησιμοποίηση της γνώσης και τη διαδικασία της σύστασης που δίνεται στον ασθενή στην κλινική πρακτική της καρδιακής αποκατάστασης. Κατά τη διάρκεια της τρίτης φάσης της έρευνας οργανώθηκαν τρεις μελέτες για τη συλλογή των δεδομένων και τη διερεύνηση των προσεγγίσεων της μοντελοποίησης συμπεριφοράς των ασθενών. Στην πρώτη μελέτη, εξέτασα το κίνητρο των ασθενών στη συμμετοχή στο πρόγραμμα CR και δημιούργησα ένα μοντέλο ταξινόμησης του κίνητρου. Η δεύτερη μελέτη οργανώθηκε για να διερευνήσει τους καθοριστικούς παράγοντες του τρόπου ζωής της σωματικής δραστηριότητας των ασθενών στην καθημερινή ζωή. Η τρίτη μελέτη σχεδιάστηκε για να συνεχίσει να εξερευνά τα συμπεριφορικά πρότυπα του τρόπου ζωής με τη χρήση εργαλείων παρακολούθησης δραστηριότητας.Τα αποτελέσματα αυτής της έρευνας επεκτείνουν τις καινοτόμες προσεγγίσεις μοντελοποίησης βάσει δεδομένων, που θα μπορούσαν να προσαρμοστούν στο σχεδιασμό παρεμβάσεων με στόχο την αλλαγή της συμπεριφοράς που σχετίζεται με την υγεία, στον τομέα της συμμόρφωσης των ασθενών. Ανέπτυξα μια οντολογία συμπεριφοράς για να επαναχρησιμοποιήσω τα συνθετικά ερευνητικά αποτελέσματα στον τομέα και δημιούργησα δύο υπολογιστικά μοντέλα, βασιζόμενα σε δεδομένα μικτού τύπου, για καλύτερη κατανόηση και περιγραφή της συμμόρφωσης των ασθενών στις ρυθμίσεις της καρδιακής αποκατάστασης και της καθημερινής δραστηριότητας.Οι συστάσεις για μελλοντική έρευνα περιλαμβάνουν περαιτέρω ανάπτυξη της οντολογίας για την επέκταση του πεδίου εφαρμογής σε άλλες χρόνιες ασθένειες και στοιχεία του τρόπου ζωής που σχετίζονται με την υγεία, ανάπτυξη της μεθοδολογίας διεξαγωγής ερευνητικών μελετών στον τομέα της συμμόρφωσης των ασθενών, καθώς και προώθηση και συνέχιση της διερεύνησης μοντέλων συμπεριφοράς που χρησιμοποιούν αισθητήρες δραστηριότητας με μεγάλο πληθυσμιακό δείγμα

“OPTImAL”: an ontology for patient adherence modeling in physical activity domain

Abstract Background Maintaining physical fitness is a crucial component of the therapeutic process for patients with cardiovascular disease (CVD). Despite the known importance of being physically active, patient adherence to exercise, both in daily life and during cardiac rehabilitation (CR), is low. Patient adherence is frequently composed of numerous determinants associated with different patient aspects (e.g., psychological, clinical, etc.). Understanding the influence of such determinants is a central component of developing personalized interventions to improve or maintain patient adherence. Medical research produced evidence regarding factors affecting patients’ adherence to physical activity regimen. However, the heterogeneity of the available data is a significant challenge for knowledge reusability. Ontologies constitute one of the methods applied for efficient knowledge sharing and reuse. In this paper, we are proposing an ontology called OPTImAL, focusing on CVD patient adherence to physical activity and exercise training. Methods OPTImAL was developed following the Ontology Development 101 methodology and refined based on the NeOn framework. First, we defined the ontology specification (i.e., purpose, scope, target users, etc.). Then, we elicited domain knowledge based on the published studies. Further, the model was conceptualized, formalized and implemented, while the developed ontology was validated for its consistency. An independent cardiologist and three CR trainers evaluated the ontology for its appropriateness and usefulness. Results We developed a formal model that includes 142 classes, ten object properties, and 371 individuals, that describes the relations of different factors of CVD patient profile to adherence and adherence quality, as well as the associated types and dimensions of physical activity and exercise. 2637 logical axioms were constructed to comprise the overall concepts that the ontology defines. The ontology was successfully validated for its consistency and preliminary evaluated for its appropriateness and usefulness in medical practice. Conclusions OPTImAL describes relations of 320 factors originated from 60 multidimensional aspects (e.g., social, clinical, psychological, etc.) affecting CVD patient adherence to physical activity and exercise. The formal model is evidence-based and can serve as a knowledge tool in the practice of cardiac rehabilitation experts, supporting the process of activity regimen recommendation for better patient adherence

Overview of health behavior change interventions to promote physical-activity-related adherence in patients with heart disease

The ongoing increase in the incidence of cardiovascular disease is often associated with unhealthy lifestyle choices, while healthy lifestyle is one of the most important medical recommendations for patients with heart disease. Despite the importance of making healthy decisions daily, patient adherence to such changes is typically poor with the lowest level reported on physical activity regimen. To facilitate patient health behavior change towards a healthy lifestyle, use of health behavior interventions seems to be the most preferred tool in cardiac care routine. However, the question about use and development of successful interventions is remaining of relevance due the increasing rates of patient dropouts in rehabilitation programs and hospital readmissions. Researchers from different domains, including eHealth, are working on enabling intervention optimization. Thus, to analyze the design components that can be further used in patient adherence intervention development from the Health behavior informatics perspective, this paper provides an overview of interventions' designs in the domain of physical-activity-related adherence in patients with heart disease. The analysis of the design approaches lead to the conclusion that the central elements for intervention design are the target patient population with its specific characteristics, and chosen type of physical-activity-related behavior. Additionally, we have found that study design and its quality should be considered when analyzing a specific intervention or intervention program effect