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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 bmassoudi@rti.orgFax 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>