ProHealth eCoach: user-centered design and development of an eCoach app to promote healthy lifestyle with personalized activity recommendations

Background: Regular physical activity (PA), healthy habits, and an appropriate diet are recommended guidelines to maintain a healthy lifestyle. A healthy lifestyle can help to avoid chronic diseases and long-term illnesses. A monitoring and automatic personalized lifestyle recommendation system (i.e., automatic electronic coach or eCoach) with considering clinical and ethical guidelines, individual health status, condition, and preferences may successfully help participants to follow recommendations to maintain a healthy lifestyle. As a prerequisite for the prototype design of such a helpful eCoach system, it is essential to involve the end-users and subject-matter experts throughout the iterative design process. Methods: We used an iterative user-centered design (UCD) approach to understend context of use and to collect qualitative data to develop a roadmap for self-management with eCoaching. We involved researchers, non-technical and technical, health professionals, subject-matter experts, and potential end-users in design process. We designed and developed the eCoach prototype in two stages, adopting diferent phases of the iterative design process. In design workshop 1, we focused on identifying end-users, understanding the user’s context, specifying user requirements, designing and developing an initial low-fdelity eCoach prototype. In design workshop 2, we focused on maturing the low-fdelity solution design and development for the visualization of continuous and discrete data, artifcial intelligence (AI)-based interval forecasting, personalized recommendations, and activity goals. Results: The iterative design process helped to develop a working prototype of eCoach system that meets end-user’s requirements and expectations towards an efective recommendation visualization, considering diversity in culture, quality of life, and human values. The design provides an early version of the solution, consisting of wearable technology, a mobile app following the “Google Material Design” guidelines, and web content for self-monitoring, goal setting, and lifestyle recommendations in an engaging manner between the eCoach app and end-users. Conclusions: The adopted iterative design process brings in a design focus on the user and their needs at each phase. Throughout the design process, users have been involved at the heart of the design to create a working.publishedVersio

A Smartphone App to Promote Healthy Weight Gain, Diet, and Physical Activity During Pregnancy (HealthyMoms): Protocol for a Randomized Controlled Trial

Background: Excessive gestational weight gain is common and associated with adverse outcomes both in the short and long term. Although traditional lifestyle-based interventions have shown to mitigate excess gestational weight gain, little is known about whether mobile Health (mHealth) apps can promote healthy weight gain, diet, and physical activity during pregnancy. Objective: The primary aim of the HealthyMoms trial is to determine the effectiveness of a smartphone app (HealthyMoms) for mitigating excess gestational weight gain during pregnancy. Secondary aims are to determine the effectiveness of the app on dietary habits, physical activity, body fatness, and glycemia during pregnancy. Methods: HealthyMoms is a two-arm randomized controlled trial. Women are being recruited at routine visits at the maternity clinics in Linköping, Norrköping and Motala, Sweden. Women are randomized to the control or intervention group (n=150 per group). All women will receive standard care, and women in the intervention group will also receive the HealthyMoms smartphone app. Results: Recruitment of participants to the trial was initiated in October 2017, and 190 women have so far completed the baseline measurement. The baseline measures are estimated to be finalized in December 2019, and the follow-up measures are estimated to be completed in June 2020. Conclusions: This project will evaluate a novel smartphone app intervention integrated with existing maternity health care. If successful, it has great potential to be implemented nationally in order to promote healthy weight gain and health behaviors during pregnancy

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

A Mobile Health Solution Complementing Psychopharmacology-Supported Smoking Cessation: Randomized Controlled Trial

Background: Smoking cessation is a persistent leading public health challenge. Mobile health (mHealth) solutions are emerging to improve smoking cessation treatments. Previous approaches have proposed supporting cessation with tailored motivational messages. Some managed to provide short-term improvements in smoking cessation. Yet, these approaches were either static in terms of personalization or human-based nonscalable solutions. Additionally, long-term effects were neither presented nor assessed in combination with existing psychopharmacological therapies. Objective: This study aimed to analyze the long-term efficacy of a mobile app supporting psychopharmacological therapy for smoking cessation and complementarily assess the involved innovative technology. Methods: A 12-month, randomized, open-label, parallel-group trial comparing smoking cessation rates was performed at Virgen del Rocío University Hospital in Seville (Spain). Smokers were randomly allocated to a control group (CG) receiving usual care (psychopharmacological treatment, n=120) or an intervention group (IG) receiving psychopharmacological treatment and using a mobile app providing artificial intelligence–generated and tailored smoking cessation support messages (n=120). The secondary objectives were to analyze health-related quality of life and monitor healthy lifestyle and physical exercise habits. Safety was assessed according to the presence of adverse events related to the pharmacological therapy. Per-protocol and intention-to-treat analyses were performed. Incomplete data and multinomial regression analyses were performed to assess the variables influencing participant cessation probability. The technical solution was assessed according to the precision of the tailored motivational smoking cessation messages and user engagement. Cessation and no cessation subgroups were compared using t tests. A voluntary satisfaction questionnaire was administered at the end of the intervention to all participants who completed the trial. Results: In the IG, abstinence was 2.75 times higher (adjusted OR 3.45, P=.01) in the per-protocol analysis and 2.15 times higher (adjusted OR 3.13, P=.002) in the intention-to-treat analysis. Lost data analysis and multinomial logistic models showed different patterns in participants who dropped out. Regarding safety, 14 of 120 (11.7%) IG participants and 13 of 120 (10.8%) CG participants had 19 and 23 adverse events, respectively (P=.84). None of the clinical secondary objective measures showed relevant differences between the groups. The system was able to learn and tailor messages for improved effectiveness in supporting smoking cessation but was unable to reduce the time between a message being sent and opened. In either case, there was no relevant difference between the cessation and no cessation subgroups. However, a significant difference was found in system engagement at 6 months (P=.04) but not in all subsequent months. High system appreciation was reported at the end of the study. Conclusions: The proposed mHealth solution complementing psychopharmacological therapy showed greater efficacy for achieving 1-year tobacco abstinence as compared with psychopharmacological therapy alone. It provides a basis for artificial intelligence–based future approaches. Trial Registration: ClinicalTrials.gov NCT03553173; https://clinicaltrials.gov/ct2/show/NCT03553173 International Registered Report Identifier (IRRID): RR2-10.2196/12464H2020 European Commission research and innovation program grant agreement 68112

Dynamic physical activity recommendation on personalised mobile health information service: A deep reinforcement learning approach

Mobile health (mHealth) information service makes healthcare management easier for users, who want to increase physical activity and improve health. However, the differences in activity preference among the individual, adherence problems, and uncertainty of future health outcomes may reduce the effect of the mHealth information service. The current health service system usually provides recommendations based on fixed exercise plans that do not satisfy the user specific needs. This paper seeks an efficient way to make physical activity recommendation decisions on physical activity promotion in personalised mHealth information service by establishing data-driven model. In this study, we propose a real-time interaction model to select the optimal exercise plan for the individual considering the time-varying characteristics in maximising the long-term health utility of the user. We construct a framework for mHealth information service system comprising a personalised AI module, which is based on the scientific knowledge about physical activity to evaluate the individual exercise performance, which may increase the awareness of the mHealth artificial intelligence system. The proposed deep reinforcement learning (DRL) methodology combining two classes of approaches to improve the learning capability for the mHealth information service system. A deep learning method is introduced to construct the hybrid neural network combing long-short term memory (LSTM) network and deep neural network (DNN) techniques to infer the individual exercise behavior from the time series data. A reinforcement learning method is applied based on the asynchronous advantage actor-critic algorithm to find the optimal policy through exploration and exploitation

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

INTEGRATION OF INTERNET OF THINGS AND HEALTH RECOMMENDER SYSTEMS

The Internet of Things (IoT) has become a part of our lives and has provided many enhancements to day-to-day living. In this project, IoT in healthcare is reviewed. IoT-based healthcare is utilized in remote health monitoring, observing chronic diseases, individual fitness programs, helping the elderly, and many other healthcare fields. There are three main architectures of smart IoT healthcare: Three-Layer Architecture, Service-Oriented Based Architecture (SoA), and The Middleware-Based IoT Architecture. Depending on the required services, different IoT architecture are being used. In addition, IoT healthcare services, IoT healthcare service enablers, IoT healthcare applications, and IoT healthcare services focusing on Smartwatch are presented in this research. Along with IoT in smart healthcare, Health Recommender Systems integration with IoT is important. Main Recommender Systems including Content-based filtering, Collaborative-based filtering, Knowledge-based filtering, and Hybrid filtering with machine learning algorithms are described for the Health Recommender Systems. In this study, a framework is presented for the IoT-based Health Recommender Systems. Also, a case is investigated on how different algorithms can be used for Recommender Systems and their accuracy levels are presented. Such a framework can help with the health issues, for example, risk of going to see the doctor during pandemic, taking quick actions in any health emergencies, affordability of healthcare services, and enhancing the personal lifestyle using recommendations in non-critical conditions. The proposed framework can necessitate further development of IoT-based Health Recommender Systems so that people can mitigate their medical emergencies and live a healthy life

Toward a Better Understanding of the Intention to Use mHealth Apps: Exploratory Study

Background: An increasing number of mobile health (mHealth) apps are becoming available for download and use on mobile devices. Even with the increase in availability and use of mHealth apps, there has still not been a lot of research into understanding the intention to use this kind of apps. Objective: The purpose of this study was to investigate a technology acceptance model (TAM) that has been specially designed for primary health care applications. Methods: The proposed model is an extension of the TAM, and was empirically tested using data obtained from a survey of mHealth app users (n=310). The research analyzed 2 additional external factors: promotion of health and health benefits. Data were analyzed with a PLS–SEM software and confirmed that gender moderates the adoption of mHealth apps in Spain. The explanatory capacity (R2 for behavioral intention to use) of the proposed model was 76.4%. Likewise, the relationships of the external constructs of the extended TAM were found to be significant. Results: The results show the importance of healthy habits developed by using mHealth apps. In addition, communication campaigns for these apps should be aimed at transferring the usefulness of eHealth as an agent for transforming attitudes; additionally, as more health benefits are obtained, ease of use becomes greater. Perceived usefulness (PU; β=.415, t0.001;4999=3.442, P=.001), attitude toward using (β=.301, t0.01;499=2.299, P=.02), and promotion of health (β=.210, t0.05;499=2.108, P=.03) were found to have a statistically significant impact on behavior intention to use eHealth apps (R2=76.4%). Perceived ease of use (PEOU; β=.179, t0.01;499=2.623, P=.009) and PU (β=.755, t0.001;499=12.888, P=78.2%). Furthermore, PEOU (β=.203, t0.01;499=2.810, P=.005), health benefits (β=.448, t0.001;499=4.010, P<.001), and promotion of health (β=.281, t0.01;499=2.393, P=.01) exerted a significant impact on PU (R2=72.7%). Finally, health benefits (β=.640, t0.001;499=14.948, P<.001) had a statistically significant impact on PEOU (R2=40.9%), while promotion of health (β=.865, t0.001;499=29.943, P<.001) significantly influenced health benefits (R2=74.7%). Conclusions: mHealth apps could be used to predict the behavior of patients in the face of recommendations to prevent pandemics, such as COVID-19 or SARS, and to track users’symptoms while they stay at home. Gender is a determining factor that influences the intention to use mHealth apps, so perhaps different interfaces and utilities could be designed according to gender

Stance4Health Nutritional APP: A Path to Personalized Smart Nutrition

Funding: This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 816303 and from the Plan Propio de Investigación y Transferencia of the University of Granada under the program “Intensificación de la Investigación, modalidad B”.Acknowledgments: This work is part of the doctoral thesis of Daniel Hinojosa-Nogueira conducted within the context of the “Program of Nutrition and Food Sciences” at the University of Granada and part of the doctoral thesis of Bartolome Ortiz-Viso conducted within the context of the “Program of Information and Communication technologies” at the University of Granada.Access to good nutritional health is one of the principal objectives of current society. Several e-services offer dietary advice. However, multifactorial and more individualized nutritional recommendations should be developed to recommend healthy menus according to the specific user’s needs. In this article, we present and validate a personalized nutrition system based on an application (APP) for smart devices with the capacity to offer an adaptable menu to the user. The APP was developed following a structured recommendation generation scheme, where the characteristics of the menus of 20 users were evaluated. Specific menus were generated for each user based on their preferences and nutritional requirements. These menus were evaluated by comparing their nutritional content versus the nutrient composition retrieved from dietary records. The generated menus showed great similarity to those obtained from the user dietary records. Furthermore, the generated menus showed less variability in micronutrient amounts and higher concentrations than the menus from the user records. The macronutrient deviations were also corrected in the generated menus, offering a better adaptation to the users. The presented system is a good tool for the generation of menus that are adapted to the user characteristics and a starting point to nutritional interventions.European Union’s Horizon 2020 research and innovation programme under grant agreement No 816303Plan Propio de Investigación y Transferencia of the University of Granada under the program “Intensificación de la Investigación, modalidad B

Strategies for online personalised nutrition advice employed in the development of the eNutri web app

The internet has considerable potential to improve health-related food choice at low-cost. Online solutions in this field can be deployed quickly and at very low cost, especially if they are not dependent on bespoke devices or offline processes such as the provision and analysis of biological samples. One key challenge is the automated delivery of personalised dietary advice in a replicable, scalable and inexpensive way, using valid nutrition assessment methods and effective recommendations. We have developed a web-based personalised nutrition system (eNutri) which assesses dietary intake using a validated graphical FFQ and provides personalised food-based dietary advice automatically. Its effectiveness was evaluated during an online randomised controlled trial dietary intervention (EatWellUK study) in which personalised dietary advice was compared with general population recommendations (control) delivered online. The present paper presents a review of literature relevant to this work, and describes the strategies used during the development of the eNutri app. Its design and source code have been made publicly available under a permissive open source license, so that other researchers and organisations can benefit from this work. In a context where personalised diet advice has great potential for health promotion and disease prevention at-scale and yet is not currently being offered in the most popular mobile apps, the strategies and approaches described in the present paper can help to inform and advance the design and development of technologies for personalised nutrition