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1
RTI International is a trade name of Research Triangle Institute
2951 Flowers Road, Suite 119 ■ Atlanta, Georgia, USA 30341 Phone 770-986-5062 e-mail [email protected] 770-234-5030
ActivHealth:A PHR System for At-Risk Sedentary Adults
Barbara L. Massoudi, MPH, PhDAMIA Spring Congress
May 24, 2007
This work is licensed under a Creative Commons Attribution 3.0 License.© 2007-2009 RTI International
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Design Vision
To develop a PHR application to assist sedentary adults in becoming more physically active
Tools will support behavior change mediators within a highly individualized physical activity intervention
Create an easy to use environment that has low initial user learning requirements, but scalability for advanced users
Integrate user input from a wide variety of sources
Modular open-source framework that can be plugged into a larger PHR system
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Behavior Change Mediators
Mediators Potential Innovation
Goal-Setting A system that pulls data from a biomonitor and finds time in a person’s calendar for exercise
Self-Monitoring Small biomonitor providing data on activity level and physiological markers
Self-Efficacy Realistic goal-setting system, instant messages from a virtual friend
Social Support Supportive instant messages, GPS device locating nearest exercise facility
Rethink Thinking Podcasts delivering thought-provoking information and instant messages
Reward-Setting Biomonitor that tracks “points” and reminds people to reward themselves when a certain point level is reached
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User/Prototype Sample Population
Phase I
End-user Participants (N=28) Adult men (39%) and women (61%) Sedentary lifestyle At-risk for (43%) or suffering from (57%) chronic disease Caucasian (86%), Hispanic (7%), African-American (7%) Low-middle socio-economic status
Healthcare Provider Group (N=8) Physicians and nurses from the Dallas area Family practice and internal medicine boarded Two physical therapists
Personal trainers (N=6) Structured interviews
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Phase I - Design Analyses
User-centered design analyses Facilitated group discussions and structured interviews
with potential users Iterative design that built on past discussion to identify
important data features, processes and data needed,
for a activity focused PHR application
Technology Scan Identified a wide variety of possible technical solutions
to user needs currently available and in the future
Project HealthDesign workshops Participated in discussions with other grantees, the
design consultancy, the RWJF and others about PHRs
Review of available literature on PHRs
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Phase I Findings - Personas
Older individual – not concerned about privacy and security issues – Medicare, has time, moderate technology use
Working individual – too busy, high use of technology, concerned about privacy and security – two – formerly active (experience to fall back on, good understanding, unrealistic expectation – weekend warrior) and lifetime sedentary (lack knowledge, understanding, chasing kids around is exercise)
Chronic disease affected – more barriers (real or perceived)
Healthcare provider – primary care setting, believe important, not a lot of time, throw the guidelines at patient
Interventionist (personal trainer) – gym setting, “get in shape”, design workout and possible diet program, workout with or supervise workout, track progress over time, self-pay
Interventionist (physical therapist) – rehab situation after injury, follow-on with general wellness, physical activity advice, minimal, insurance pay, possible self-pay after acute phase
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Phase I Findings - Task Purpose Analysis
Sedentary adults: Identify goals Set up accountability Provide peer
communication/support Identify physical activity
partners Track physical activity
(manually or automatically) Review progress towards
goals Provide automated system
feedback/encouragement Upload any pertinent info to
healthcare providers
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Phase I Findings - Task Purpose Analysis
Healthcare provider:
Review patient dashboard report information (2-10 m)
Review goals and suggest some activity plans (optional)
Send encouraging messages (optional)
Make referral to interventionist
Decision support tool for making appropriate recommendation for physical activity
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Phase I Findings - Task Purpose Analysis
Interventionist: Communication/education
with clients
Scheduling clients for appointments (including reminders)
Encouragement/support of clients to engage in physical activity
Review patient data and reports
System task – add new clients
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Possible Tools & Devices
Web portal for users to access tools, store users’ goals and self-monitoring information
Devices will interface with web tools and include smart phones, PDAs, and iPods®
Biomonitors to capture data on caloric burn, caloric intake, sleep, physical activity duration, total steps taken, etc
Context sensitive messaging simulate virtual “coach” with support, incentives, and congratulations
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User/Prototype Sample Population
Phase II End-user Participants (N=5)
Adult men and women with a sedentary lifestyle
Healthcare Provider Group (N=3) Physician, nurse, and a physical therapist
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Phase II - Prototyping Plan
Systems Development Develop web-based tools to address behavior mediators Populate databases with content Creating the business rules to define system functions
User-centered Testing Develop prototype scenarios focused on major components and
processes Conduct an iterative approach to testing Collect feedback from consumers and healthcare providers
Synthesis Update systems to respond to user feedback Develop documentation on findings, recommendations, and work yet to
be completed
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Phase II - System Architecture
Sign up
Goal Setting
Rewards, Reminders
ProgressReports
Community Activities
Information Sharing
Goal Setting
Virtual Coach
Progress Monitoring
Report Engine
Virtual Community
Information Sharing
CoreCommon
ComponentAPIs
Database Access Device API
SQL Server
Presentation Tier
Device Data
Device Data
Device DataDevice
DataDevice Data
Device DataDevice
DataDevice Data
Device Data
Business Tier Data Access Tier
Data Tier
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Phase II - Peak Behind the Curtain
Components Make Fake
User Information X*
Health Status Assessment X*
Readiness for Change – Motivation Assessment X
Goal Setting X
Physical Activity Tracking X*
Rewards and Motivators X
Community of Interest X
Reporting X
Decision Support Page (Providers only) X
*Partially functional
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Phase II - Design Showstoppers
Getting users to….
Navigate to the ActivHealth portal
Set up an account including their initial set of goals, rewards, reminders, and preferences
Customizing system tools and experience to the users to the readiness for change
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Acknowledgements
RTI International
Barbara Massoudi, MPH, PhD, Director, Health Informatics (Project Director)
Murrey Olmsted, PhD, Research Psychologist (Associate Project Director)
Ann Zhang, MS, Senior Software Engineer
The Cooper Institute
Susan Campbell, PhD, Vice President for Education
Ruth Ann Carpenter, MS, Director, Dissemination
Beth Wright, MS, Director, Knowledge Management
This work is licensed under a Creative Commons Attribution 3.0 License. © Research Triangle Institute <2009>