In this blog post I will generally describe the main concepts related to my PhD work.
European Project CATCH
My project is part of the Marie Curie project CATCH - “Cancer: Activating Technology for Connected Health”. The overall aim of the project is to activate technology-supported physical exercise in bridging the gap between cancer survivors’ depleted physical and emotional state, and their ability to return to a fully functional and healthy state.
Physical Activity in Cancer Survivorship
Advancements in treatment and diagnosis have led to an increase in the number of cancer survivors, such that some cancers are now considered a chronic disease rather than a fatal illness. More patients are surviving long after treatment but they struggle with side-effects from the disease and treatment which can greatly impact their condition and quality of life. Current evidence greatly supports the role of physical activity in cancer survivorship, being considered as generally safe and with the potential of having physical and psychological benefits.
However, only a small portion of this population is adhering to the minimum recommended levels of physical activity.
Technology-supported systems are worth exploring to guide and motivate physical activity among these individuals.
Physical Activity Coaching Systems - an mHealth Solution
Mobile health (mHealth) - the use of mobile devices (mobile phones, tables, PDAs and wearable devices) for health services, information, and data collection - is considered a cost-effective solution that, among other possible uses, has the potential to help chronic patients in the process of self-managing their disease and changing their behaviour towards a healthier lifestyle. These systems can be paired with monitoring sensors to quantify health in real-time; provide immediate feedback to the user; and create enjoyable experiences to the users.
Those mHealth solutions that focus on the promotion of physical activity are referred to in literature as physical activity coaching applications. The number of fitness apps and wearables existing in the market (e.g.: Fitbit, Jawbone, Nike+, Google-Fit and Apple-Health) is now in the thousands and of emerging popularity among smartphone users. Following this trend, and due to the increase in reliability of existing monitoring sensors, these systems have been receiving attention in literature showing their potential to produce positive PA outcomes both in healthy individuals as in the context of disease management. Some examples are UbiFit Garden, BeWell+ and It’s Life (this app was developed for patients with chronic pulmonary disease).
Figure 1: UbiFit Garden, on the left, and BeWell+, on the right. Both apps were developed for the general healthy population and make use of an ambient display to provide feedback on monitored physical activity.
Figure 2: It’s Life app, a monitoring and feedback tool to stimulate physical activity among COPD patients.
One of the biggest challenges of this type of system is to keep the users interested after a few days or weeks of use, which is critical when the aim is to stimulate behaviour change. This behaviour has been commonly associated with a low perceived personal relevance and a lack of engagement.
A Need for Theory-Based and Engaging Systems
Researchers in the field seem to agree on some key requirements to create effective behaviour change solutions in the long-term:
Create a tailored solution to the target population – this is important as most of the existing systems are targeted at the generally healthy population (normally those already active), and not for those who are not active at all or that have a particular condition. In this sense, it is necessary to create solutions based on target user’s context and needs.
Use relevant behavioural theory - to inform the appropriate selection and timing of intervention components.
Providing an enjoyable experience - create well-designed, usable and fun experiences. For example, using Gamification - the use of game elements in non-gaming environments -, which has been considered in the design of many fitness applications and has been a point of interest in literature.
Providing a tailored/personalized experience to each user. My project is particularly focused on this topic.
Personalization to Increase Engagement
Personalization, or tailoring, - “any of a number of methods for creating communications individualized for their receivers...” [Hawkins et al., 2008] - is believed to help increase the effectiveness of behaviour change systems. Information that is closely tailored to the individual’s convictions and motivations is more likely to be observed and remembered, increasing the intended effects of communication. The case for personalisation is further supported by the fact that nowadays people carry smartphones everywhere and can access data anywhere and anytime, which allows for real-time monitoring, feedback and motivation at the appropriate time and place.
According to op den Akker et al., 2014 there are 7 personalization strategies (Figure): Feedback – present information to the user about himself; Adaptation – direct messages to individual’s status on key theoretical determinants; User Targeting – increase attention or motivation by conveying that the communication is designed specifically for the user; Goal Setting – learn user-specific goals based on individual patterns; Context Awareness – tailoring communication based on external information; and Self Learning – learning reactions of the user to previous communications. (Check the paper for examples).
With mobile technologies becoming more and more sophisticated, there is an increase in alternative forms of personalisation that can potentially make a difference in engaging users with physical activity coaching apps.
My Project
The described above gives the general motivation to my work which relies on: exploring personalization strategies in a gamified physical activity coaching app for cancer survivors, aimed at increasing their long-term engagement with the system and hence with physical activity.
The project involves a review of the state of the art of personalization strategies used in such systems; qualitative approaches to gather insights from the end users’ perspective and to feed the design process; a phase of conceptualization and development of the application; and quantitative methods for system evaluation with cancer survivors.
I would love to hear your thoughts and ideas, so feel free to comment on this post or drop me an email to franciscoguerra@salumedia.com.