Personalized support for chronic conditionsA novel approach for enhancing self-management and improving lifestyleThe work was partially supported by the Italian Ministry of Health (GR 2011 0235 2807).
18 January 2016
accepted: 02 May 2016
19 December 2017 (online)
Solutions for improving management of chronic conditions are under the attention of healthcare systems, due to the increasing prevalence caused by demographic change and better survival, and the relevant impact on healthcare expenditures. The objective of this study was to propose a comprehensive architecture of a mHealth system aimed at boosting the active and informed participation of patients in their care process, while at the same time overcoming the current technical and psychological/clinical issues highlighted by the existing literature.
After having studied the current challenges outlined in the literature, both in terms of technological and human requirements, we focused our attention on some specific psychological aspects with a view to providing patients with a comprehensive and personalized solution. Our approach has been reinforced through the results of a preliminary assessment we conducted on 22 patients with chronic conditions. The main goal of such an assessment was to provide a preliminary understanding of their needs in a real context, both in terms of self-awareness and of their predisposition toward the use of IT solutions.
According to the specific needs and features, such as mindfulness and gamification, which were identified through the literature and the preliminary assessment, we designed a comprehensive open architecture able to provide a tailor-made solution linked to specific individuals’ needs.
The present study represents the preliminary step towards the development of a solution aimed at enhancing patients’ actual perception and encouraging self-management and selfawareness for a better lifestyle. Future work regards further identification of pathology-related needs and requirements through focus groups including all stakeholders in order to describe the architecture and functionality in greater detail.
Citation: Lasorsa I, D’Antrassi P, Ajčević M, Stellato K, Di Lenarda A, Marceglia S, Accardo A. Personalized support for chronic conditions: a novel approach for enhancing self-management and improving lifestyle
- 1 DeVol R, Bedroussian A, Charuworn A, Chatterjee A, Kim IK, Kim S, Klowden K. An unhealthy America: The economic burden of chronic disease. Santa Monica: Milken Institute; 2007
- 2 Goodlin SJ, Hauptman PJ, Arnold R, Grady K, Hershberger RE, Kutner J, Masoudi F, Spertus J, Dracup K, Cleary JF, Medak R, Crispell K, Piña I, Stuart B, Whitney C, Rector T, Teno J, Renlund DG. Consensus statement: palliative and supportive care in advanced heart failure. J Card Fail 2004; 10: 200-209.
- 3 Chambless DL, Ollendick TH. Empirically supported psychological interventions: controversies and evidence. Annual Review of Psychology 2001; 52: 685-716.
- 4 Sabaté E. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003
- 5 Stellato K, Radini D, Pellizzari M, Pordenon M, Pletti L, Humar F, Apuzzo M, Di Lenarda A. New frontiers of people-centered integrated care for complex chronic disease. J Palliat Care Med 2015; 05 (234) 2.
- 6 Istepanian R, Laxminarayan S, Pattichis C. M-health: emerging mobile health systems. Berlin: Springer; 2006
- 7 Kay M, Santos J, Takane M. mHealth: New horizons for health through mobile technologies. Geneva: World Health Organization; 2011
- 8 Luanrattana R, Win KT, Fulcher J, Iverson D. Mobile technology use in medical education. Journal of medical systems 2012; 36 (01) 113-122.
- 9 Yang SC. Mobile applications and 4G wireless networks: a framework for analysis. Campus-Wide Information Systems 2012; 29 (05) 344-357.
- 10 Marceglia S, Bonacina S, Zaccaria V, Pagliari C, Pinciroli F. How might the iPad change healthcare?. Journal of the Royal Society of Medicine 2012; 105 (06) 233-241.
- 11 Grando MA, Rozenblum R, Bates DW. editors. Information technology for patient empowerment in healthcare. Berlin: De Gruyter; 2015
- 12 Sunyaev A, Dehling T, Taylor PL, Mandl KD. Availability and quality of mobile health app privacy policies. Journal of the American Medical Informatics Association 2015; 22 (e1): e28-e33.
- 13 Chen C, Haddad D, Selsky J, Hoffman JE, Kravitz RL, Estrin DE, Sim I. Making sense of mobile health data: an open architecture to improve individual-and population-level health. Journal of medical Internet research 2012; 14 (04) e112.
- 14 The PLOS Medicine Editors. A reality checkpoint for mobile health: three challenges to overcome. PLoS Med 2013; 10 (02) e1001395.
- 15 Quinn P, Habbig AK, Mantovani E, De Hert P. The data protection and medical device frameworks—obstacles to the deployment of mHealth across Europe?. European journal of health law 2013; 20 (02) 185-204.
- 16 Whittaker R. Issues in mHealth: findings from key informant interviews. Journal of medical Internet research 2012; 14 (05) e129.
- 17 Hoffman JE, Ramsey KM, Estrin D. Open architecture and standards in mobile health. In: Marsch L, Lord SE, Dallery J. editors. Behavioral Health Care and Technology. Oxford: Oxford University Press; 2015
- 18 Ambroise N, Boussonnie S, Eckmann A. A smartphone application for chronic disease self-management. In: Proceedings of the 1st conference on mobile and information technologies in medicine. 2013. Nov 20; Prague: Czech Republic; 2013
- 19 Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005; 330 (7494): 765.
- 20 Levy WC, Mozaffarian D, Linker DT, Sutradhar SC, Anker SD, Cropp AB, Anand I, Maggioni A, Burton P, Sullivan MD, Pitt B, Poole-Wilson PA, Mann DL, Packer M. The seattle heart failure model: Prediction of survival in heart failure. Circulation 2006; 113 (11) 1424-1433.
- 21 Eddy DM, Schlessinger L. Archimedes: a trial-validated model of diabetes. Diabetes Care 2003; 26 (11) 3093-3101.
- 22 Kubitschke L, Meyer I, Müller S, Stellato K, Di Lenarda A. Digital technologies as a catalyst for change towards integrated care delivery: hype or reality?. International Journal of Reliable and Quality E-Healthcare 2016; 05 (02) 31-49.
- 23 Navidian A, Yaghoubinia F, Ganjali A, Khoshsimaee S. The effect of self-care education on the awareness, attitude, and adherence to self-care behaviors in hospitalized patients due to heart failure with and without depression. PloS one 2015; 10 (06) e0130973.
- 24 Finucane ML, Alhakami A, Slovic P, Johnson SM. The affect heuristic in judgments of risks and benefits. Journal of behavioral decision making 2000; 13 (01) 1-17.
- 25 Garay-Sevilla ME, Nava LE, Malacara JM, Huerta R, de León JD, Mena A, Fajardo ME. Adherence to treatment and social support in patients with non-insulin dependent diabetes mellitus. Journal of Diabetes and its Complications 1995; 09 (02) 81-86.
- 26 Kabat-Zinn J. Full catastrophe living: how to cope with stress, pain and illness using mindfulness meditation. New York: Dell Publishing; 1990
- 27 Kabat-Zinn J. Mindfulness based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice 2003; 10 (02) 144-156.
- 28 Baer RA, Smith GT, Allen KB. Assessment of mindfulness by self-report: the Kentucky inventory of mindfulness skills. Assessment 2004; 11 (03) 191-206.
- 29 Teasdale JD, Segal ZV, Williams JMG, Ridgeway VA, Soulsby JM, Lau MA. Prevention of relapse/recurrence in major depression in mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology 2000; 68: 615-623.
- 30 Linehan M. Cognitive-behavioral treatment for borderline personality disorder. New York: Guildford press; 1993
- 31 Lau MA, Bishop SR, Segal ZV, Buis T, Anderson ND, Carlson L, Shapiro S, Carmody J, Abbey S, Devins G. The Toronto mindfulness scale: development and validation. Journal of Clinical Psychology 2006; 62 (12) 1445-1467.
- 32 Kabat-Zinn J. Coming to our senses. New York: Hyperion; 2005
- 33 Merkes M. Mindfulness-based stress reduction for people with chronic diseases. Aust J Prim Health 2000; 16 (03) 200-210.
- 34 Clark DM. Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: The IAPT experience. International Review of Psychiatry 2011; 23 (04) 318-327.
- 35 Williams AC, Eccleston C, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database of Systematic Reviews 2012; 11: CD007407.
- 36 Hofmann SG, Sawyer AT, Witt AA, Oh D. The Effect of Mindfulness-Based Therapy on Anxiety and Depression: A Meta-Analytic Review. J Consult Clin Psychol 2010; 02: 169-183.
- 37 Brown KW, Ryan RM. The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology 2003; 84: 822-848.
- 38 Bandura A. Social learning Theory. New York: General Learning Press; 1971
- 39 Di Bitonto P, Corriero N, Pesare E, Rossano V, Roselli T. Training and learning in e-Health using the gamification approach: the trainer interaction. In: Universal Access in Human-Computer Interaction. Aging and Assistive Environments. Berlin: Springer; 2014: 228-237.
- 40 Miller AS, Cafazzo JA, Seto E. A game plan: Gamification design principles in mHealth applications for chronic disease management. Health informatics journal. 2014 doi: 10.1177/1460458214537511.
- 41 Cafazzo JA, Casselman M, Hamming N, Katzman DK. Palmert MR Design of an mHealth app for the selfmanagement of adolescent type 1 diabetes: a pilot study. Journal of medical Internet research 2012; 14 (03) e70.
- 42 Chung BK. The power of mobile devices and patient engagement. In: Oldenburg J. editor. Engage! Transforming Healthcare Through Digital Patient Engagement. Chicago: HIMSS; 2012: 87-98.
- 43 Richards D, Caldwell PH. Gamification to improve adherence to clinical treatment advice: improving adherence to clinical treatment. In: Novak D, Tulu B, Brendryen H. editors. Handbook of Research on Holistic Perspectives in Gamification for Clinical Practice. Hershey: IGI Global; 2015: 47-77.
- 44 Allam A, Kostova Z, Nakamoto K, Schulz PJ. The effect of social support features and gamification on a web-based intervention for rheumatoid arthritis patients: randomized controlled trial. Journal of Medical Internet Research 2015; 17 (01) e14.
- 45 Dennis TT, Egan LJ, Babkirk S, Denefrio S. For whom the bell tolls: Neurocognitive individual differences in the acute stress-reduction effects of an attention bias modification game for anxiety. Behaviour Research and Therapy 2016; 77: 105-117.
- 46 Mueller E, Maxion-Bergemann S, Gultyaev D, Walzer S, Freemantle N, Mathieu C, Bolinder B, Gerber R, Kvasz M, Bergemann R. Development and validation of the Economic Assessment of Glycemic Control and Long-Term Effects of diabetes (EAGLE) model. Diabetes technology & therapeutics 2006; 08: 219-236.
- 47 Brown JB, Russell A, Chan W, Pedula K, Aickin M. The global diabetes model: user friendly version 3.0. Diabetes research and clinical practice. 2000; 50 (Suppl. 03) S15-S46 doi:10.1016/S0168-8227(00)00215-1.
- 48 American Diabetes Association. Standards of medical care in diabetes—2016 Abridged for primary care providers. Clinical Diabetes 2016; 34: 3-21.
- 49 Pocock SJ, Ariti CA, McMurray JJ, Maggioni A, Køber L, Squire IB, Swedberg K, Dobson J, Poppe KK, Whalley GA, Doughty RN. Predicting survival in heart failure: a risk score based on 39372 patients from 30 studies. European heart journal 2012; ehs337.
- 50 Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): Conceptualizing and measuring activation in patients and consumers. HSR: Health Services Research 2004; 39 (04) 1005-1026.