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Title [sv]
Hållbara levnadsvaneförändringar med hjälp av skräddarsydd, anpassningsbar och riskmedveten digital coaching (STAR-C)
Title [en]
STAR-C: Sustainable behaviour change for health supported by person-Tailored, Adaptive, Risk-aware digital Coaching in a social context
Abstract [sv]
Som ett av få stora långsiktiga CVD-förebyggande primärvårdsintegrerade program är Västerbottens interventionsprogram (VIP) dokumenterat kostnadseffektivt. VIP-s kombination av en populationsinriktad lågriskstrategi med en högriskstrategi har visat sig förebygga förtida död, såväl total som CVD-relaterad. Litet är dock känt om och hur sociala nätverk och sociala medier kan användas för att förstärka VIP-effekterna utöver de insatser som deltagarna direkt möter. Digitalteknik och hälsoinformation ger nya möjligheter att skräddarsy det preventiva budskapet så att det både blir personcentrerat och ändå når ut till en långt större andel av befolkningen. Syfte med vårt sexåriga tvärvetenskapliga forskningsprogram är att fylla viktiga kunskapsluckor kring hur befolkningsinriktade hälsofrämjande och sjukdomsförebyggande program kan tillvarata och nyttja de möjligheter som sociala medier och sociala nätverk erbjuder. Vi avser att utveckla och utvärdera en teknisk plattform för personcentrerad digital coaching till stöd för beteendeförändringar vid ohälsosamma levnadsvanor. Vi vill särskilt studera hur sociala medier och sociala nätverk kan interagera med primärvården för att därmed stärka effekterna av pågående preventiva primärvårdsinsatser. Vårt program, STAR-C, är ett samarbete mellan Umeå universitets fyra fakulteter och Västerbottens landsting. Vårt team av såväl seniora som nyetablerade forskare har tvärvetenskaplig profil och har stor erfarenhet av kvalitativa och kvantitativa metoder. Vårt program utnyttjar en mixed metoddesign i sju sammankopplade och kompletterande projekt. Programmet 2019-2024 har två faser: (i) en formativa interventionsdesign och utvecklingsfas och (ii) en interventionsutvärderingsfas. STAR-C kommer att ägna stor uppmärksamhet åt både gender- och jämlikhetsperspektiven i programmets alla faser och samarbeta så att forskare, vårdpersonal och befolkning via förebyggande och hälsofrämjande insatser tillsammans bidrar till minskade hälsoklyftor.
Abstract [en]
As one of the very few long-term CVD prevention programmes globally that is integrated into routine primary health care, the Västerbotten Intervention Programme (VIP) has been shown as a cost-effective intervention which combines low-risk population and high-risk individual approaches to significantly reduce overall and CVD-specific premature mortality. However, little is known about how social networks and use of social media could be used to amplify the effect of VIP. The growth of digital and health information technologies provide an opportunity to tailor and personalise health promotion messages in the VIP, while simultaneously also widening its outreach into the population. We propose a six-year interdisciplinary research programme to address these knowledge and practice gaps. We aim to develop and evaluate a technical platform for personalized digital coaching that will support behavioural changes aimed at improving health. We will study how healthcare and social media can interact with primary care-based health promotion programs, thereby strengthening the effects of primary care prevention efforts. Our programme, STAR-C, is a collaboration between four faculties at Umeå University and the Västerbotten County Council. Our team of experienced and newly established researchers is multidisciplinary, and has extensive experience in both qualitative and quantitative methods.We will employ a mixed methods design in seven interconnected and complementary projects, which will run in two phases from 2019-2024: (i) a formative intervention design and development phase, and (ii) an intervention evaluation phase. STAR-C will use gender and equity lenses in all phases of the programme. STAR-C will strengthen collaboration between researchers, health professionals, and the population, thereby creating more effective preventive and health promotion efforts, and reducing health inequalities. Lessons learned will be shared both within Sweden and elsewhere across the globe.
Publications (3 of 3) Show all publications
Kyaw, T. L., Ng, N., Theocharaki, M., Wennberg, P. & Sahlen, K.-G. (2023). Cost-effectiveness of digital tools for behavior change interventions among people with chronic diseases: systematic review. Interactive Journal of Medical Research, 12, Article ID e42396.
Open this publication in new window or tab >>Cost-effectiveness of digital tools for behavior change interventions among people with chronic diseases: systematic review
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2023 (English)In: Interactive Journal of Medical Research, E-ISSN 1929-073X, Vol. 12, article id e42396Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Chronic diseases, including cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, and cerebrovascular diseases, contribute to the most significant disease burden worldwide, negatively impacting patients and their family members. People with chronic diseases have common modifiable behavioral risk factors, including smoking, alcohol overconsumption, and unhealthy diets. Digital-based interventions for promoting and sustaining behavioral changes have flourished in recent years, although evidence of the cost-effectiveness of such interventions remains inconclusive.

OBJECTIVE: In this study, we aimed to investigate the cost-effectiveness of digital health interventions for behavioral changes among people with chronic diseases.

METHODS: This systematic review evaluated published studies focused on the economic evaluation of digital tools for behavioral change among adults with chronic diseases. We followed the Population, Intervention, Comparator, and Outcomes framework to retrieve relevant publications from 4 databases: PubMed, CINAHL, Scopus, and Web of Science. We used the Joanna Briggs Institute's criteria for economic evaluation and randomized controlled trials to assess the risk of bias in the studies. Two researchers independently screened, assessed the quality, and extracted data from the studies selected for the review.

RESULTS: In total, 20 studies published between 2003 and 2021 fulfilled our inclusion criteria. All the studies were conducted in high-income countries. These studies used telephones, SMS text messaging, mobile health apps, and websites as digital tools for behavior change communication. Most digital tools for interventions focused on diet and nutrition (17/20, 85%) and physical activity (16/20, 80%), and a few focused on smoking and tobacco control (8/20, 40%), alcohol reduction (6/20, 30%), and reduction of salt intake (3/20, 15%). Most studies (17/20, 85%) used the health care payer perspective for economic analysis, and only 15% (3/20) used the societal perspective. Only 45% (9/20) of studies conducted a full economic evaluation. Most studies (7/20, 35%) based on full economic evaluation and 30% (6/20) of studies based on partial economic evaluation found digital health interventions to be cost-effective and cost-saving. Most studies had short follow-ups and failed to include proper indicators for economic evaluation, such as quality-adjusted life-years, disability-adjusted life-years, lack of discounting, and sensitivity analysis.

CONCLUSIONS: Digital health interventions for behavioral change among people with chronic diseases are cost-effective in high-income settings and can therefore be scaled up. Similar evidence from low- and middle-income countries based on properly designed studies for cost-effectiveness evaluation is urgently required. A full economic evaluation is needed to provide robust evidence for the cost-effectiveness of digital health interventions and their potential for scaling up in a wider population. Future studies should follow the National Institute for Health and Clinical Excellence recommendations to take a societal perspective, apply discounting, address parameter uncertainty, and apply a lifelong time horizon.

Place, publisher, year, edition, pages
JMIR Publications, 2023
Keywords
behavior, chronic diseases, cost-effectiveness, digital tools, lifestyle, mobile phone, systematic review
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-205443 (URN)10.2196/42396 (DOI)000976564200003 ()36795470 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-01461
Available from: 2023-03-06 Created: 2023-03-06 Last updated: 2023-09-05Bibliographically approved
Lidman, E. (2021). "Lev": Ett användarperspektiv på en digital coach för bättre hälsa. (Student paper). Umeå universitet
Open this publication in new window or tab >>"Lev": Ett användarperspektiv på en digital coach för bättre hälsa
2021 (Swedish)Student thesis
Abstract [en]

Our behavior and our lifestyle habits are the foundation of our health, they affect the risk of developing non-communicable diseases such as diabetes and cardiovascular diseases. Today these non- communicable diseases are the leading cause of death. The Västerbotten Intervention Program (VIP) is one of very few population-oriented initiatives which, by offering all individuals aged 40, 50 and 60 a health intervention, aims to improve behavior and lifestyle habits in the population and thus increase the conditions for a healthier population and reduce healthcare related costs. The individual health interventions, performed every tenth year, was not designed to support individuals’ choices on a day-to-day basis between the health check-ups. Therefore, STAR-C an interdisciplinary research program, aims at developing a digital coaching system that could be used for supplying personalized digital coaching to support the evaluation and maintenance of healthy behavioral changes. This digital coaching system could, in the future, be used as complementary tool within VIP. The purpose of this study is to further explore these complements of a digital coach. This study presents a user-perspective from semi-structured interviews with VIP-participants and their views on a digital coach, what digital coach functions that could be useful and what kind of benefits this till could have being used as a complement to VIP. The results show that VIP-participants are missing tools for behavioral change support, and that factors such as personalization, motivation to and support during a behavioral change is important. Most important, for the participants in this study, was that a digital coach must be easy to use and user friendly.

Publisher
p. 32
Series
Informatik Student Paper Bachelor (INFSPB) ; 2021.06
Keywords
behavior change, user centered design
National Category
Information Systems, Social aspects
Identifiers
urn:nbn:se:umu:diva-183176 (URN)
External cooperation:
Institutionen för datavetenskap, Interactive and Intelligent Systems; STAR-C
Thesis level
Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE credits
Presentation
2021-04-29, Digitalt via Zoom, 09:00 (Swedish)
Supervisors
Examiners
Available from: 2021-05-18 Created: 2021-05-18 Last updated: 2021-05-19Bibliographically approved
Lindgren, H., Guerrero, E., Jingar, M., Lindvall, K., Ng, N., Richter Sundberg, L., . . . Weinehall, L. (2020). The STAR-C Intelligent Coach: a Cross- Disciplinary Design Process of a Behaviour Change Intervention in Primary Care. In: Blobel, B., Lhotska, L., Pharow, P., Sousa, F. (Ed.), pHealth 2020: Proceedings of the 17th International Conference on Wearable Micro and Nano Technologies for Personalized Health. Paper presented at pHealth 2020, virtual conference, 14–16 September, 2020 (pp. 203-208). IOS Press, 273
Open this publication in new window or tab >>The STAR-C Intelligent Coach: a Cross- Disciplinary Design Process of a Behaviour Change Intervention in Primary Care
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2020 (English)In: pHealth 2020: Proceedings of the 17th International Conference on Wearable Micro and Nano Technologies for Personalized Health / [ed] Blobel, B., Lhotska, L., Pharow, P., Sousa, F., IOS Press, 2020, Vol. 273, p. 203-208Conference paper, Published paper (Refereed)
Abstract [en]

A broad range of aspects are needed to be taken into consideration in the design and development of personalized coaching systems based on artificial intelligence methodologies. This research presents the initial phase of joining different professional and stakeholder perspectives on behavior change technologies into a flexible design proposal for a digital coaching system. The diversity and sometimes opposed views on content, behavior, purposes and context were managed using a structured argument-based design approach, which also feed into the behavior of the personalized system. Results include a set of personalization strategies that will be further elaborated with the target user group to manage sensitive issues such as ethics, social norms, privacy, motivation, autonomy and social relatedness.

Place, publisher, year, edition, pages
IOS Press, 2020
Series
Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365 ; 273
Keywords
personalization, behavior change, participatory action design, intelligent agents, cardiovascular diseases, argumentation theory, persuasive technology
National Category
Computer Sciences Human Computer Interaction Other Medical Engineering Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Computer Science; human-computer interaction; medical informatics
Identifiers
urn:nbn:se:umu:diva-175213 (URN)10.3233/SHTI200640 (DOI)000648601600025 ()33087613 (PubMedID)2-s2.0-85092433894 (Scopus ID)978-1-64368-112-2 (ISBN)
Conference
pHealth 2020, virtual conference, 14–16 September, 2020
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2020-09-21 Created: 2020-09-21 Last updated: 2023-09-05Bibliographically approved
Principal InvestigatorNg, Nawi
Coordinating organisation
Umeå University
Funder
Period
2018-12-01 - 2021-11-30
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
DiVA, id: project:620Project, id: 2018-01461_Forte