An online lifestyle diary with a persuasive computer assistant providing feedback on self-management

Abstract

In accordance with the global trend, in The Netherlands approximately 45% of the population is overweight. Existing studies show that patient self-management can reduce these figures, but medical non-adherence is a persistent problem. eHealth can potentially increase adherence to self-management. Consequently, we designed a persuasive computer assistant and evaluated its influence on self-management, i.e., the use of an online lifestyle diary called DieetInzicht.nl. The assistant is represented by an animated iCat, which shows different facial expressions and provides cooperative feedback following principles from the motivational interviewing method. We conducted a randomized controlled trial with 118 overweight people over a period of four weeks and studied the difference between diary use with and without computer assistant feedback. Results show that the computer assistant contributed to filling in the diary more frequently, reduced the decline in motivation to perform self-management, lowered the (reported) BMI, and improved the ease of use. Furthermore, diary use increased knowledge of maintaining a healthy lifestyle. Finally, personal characteristics, i.e., locus of control, vocabulary, computer experience, age, gender, education level and initial BMI, explained the variance in the diary use and its outcome. Of the 118 participants 35 filled in the closing survey, covering motivation, BMI, lifestyle knowledge and ease of use, which implies that the findings based on these results are mainly representative for motivated participants. In general, this study shows that the Dieetinzicht eHealth service, including a personal computer assistant, is likely to support motivated overweight people and lifestyle related diseases to get a better insight in and adhere to their self-management. : O.A.BlansonHenkemans@TUDelft.n. 0928-7329/09/$17.00  2009 -IOS Press and the authors. All rights reserved 254 O.A. Blanson Henkemans et al. / Online lifestyle diary with assistant for self-managementhealth care system towards a more independent, self-determining position wherein the emphasis lies on self-management.Self-management consists of activities undertaken by individuals, families, and communities with the intention of preventing disease, limiting illness, and restoring health [27]. It aims at educating and increasing the patient's intrinsic motivation, which in turn can lead to stimulation of medical adherence [31]. Examples of self-management activities are maintaining a healthy diet [17,25] and performing physical activities [10,23]. Strikingly, although people are well informed of the impact of being overweight on their life and from the benefit of self-management, treatment non-adherence is a persistent problem [15,20]. eHealth can potentially stimulate adherence to self-management [1,26,34,42]. Remote care for people at home through Information and Communication Technology (ICT) has multiple benefits, such as lowering costs [18], aging in place [36], motivating the patient [19] developing health literacy [28,33],...

Effect of adherence to self-monitoring of diet and physical activity on weight loss in a technology-supported behavioral intervention

“…Our findings suggest that the effect of receiving a daily tailored feedback message from a PDA versus no message on long-term weight loss at 12 months was fully explained by participants’ adherence to self-monitoring diet and physical activity. Studies have shown the superiority of receiving automated feedback through digital devices in lifestyle interventions 10,19. Our findings further suggest that the mechanism for achieving differences in long-term weight loss when receiving a feedback message via a PDA was due entirely to the improved self-monitoring adherence.…”

Technology-delivered adaptations of motivational interviewing for health-related behaviors: A systematic review of the current research

“…Another subset of studies (n = 13) focused on a range of health behaviors such as having a mammogram [57], weight-loss [58, 59], reducing blood pressure[60], self-management of epilepsy[61], HIV[62,63] and asthma [64], and increasing healthy eating [65,66] and physical activity [67,68]. These researchers also recruited a range of populations (e.g., women who were overdue for a mammogram [57]; overweight adults [58] and adolescents [68]; youth with HIV [55,62]).…”

“…Four interventions had clearly defined separation between the primary therapy (e.g., CBT) and the adjunctive TAMI (as opposed to the TAMI being integrated within another intervention or approach described above). Specifically, these interventions included a tailored non-MI based website with adjunctive TAMI emails [65], online diary cards with a computerized TAMI assistant [59], an online CBT program with an adjunctive motivation-based discussion [72], and motivational messages [37]. Finally, VanDeMark and colleagues' [44] TAMI was a prelude to residential or outpatient substance use treatment.…”

“…A subset of the programs used video, voice, or animation that was specifically developed to mirror interpersonal communication (e.g., 35,48,48,53, 59,62). For instance, Blanson-Henkemans et al [59] incorporated the ‘iCat’ computer assistant who had emotive facial expressions and spoke to and supported the participants during the intervention. Gerbert et al [23] used a “video doctor” actor who provided personalized responses in the MI style.…”

“…Twelve groups of researchers who included behavioral/psychological outcomes isolated the TAMI effects [e.g., 37,46,50,59,62,63], allowing for evaluation of the influence of the TAMI itself on behavioral or psychological outcomes (See Table 4). Of these studies, ten groups reported positive results regarding the target behavior.…”