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Directions for ICT Research in Disease Prevention




 FP7-ICT-2009.5.1 – Support Action




                                                     PREVE Overview
                                                    Project Months 1-6


                                           Niilo Saranummi
                                VTT Technical Research Centre of Finland

                               This project is partially funded under the 7th Framework Programme by the European Commission
Prevention of diseases
WHAT




                         www.preve-eu.org
PREVE – in brief

• A 12 month Support Action, under the 4th FP7 ICT Call
• Four partners




• Objective
   – Identify ICT research directions for the empowerment of citizens
     in disease prevention and the preservation of health




                     www.preve-eu.org
What PREVE delivers
                                Impact

• White Paper identify ICT research directions for the empowerment of
  citizens in disease prevention and the preservation of health
  highlighting the need to approach disease prevention from multiple
  complementary viewpoints.

• Articles offered to peer-reviewed journals and to conferences in order
  to target different stakeholders in disease prevention




                      www.preve-eu.org
PREVE impact

• “PREVE will suggest ICT research directions in primary
  prevention.
   – Thus it will open a new avenue of research in the PHS where the
     so far traditional concept “a physician in the loop” does not
     always apply and the participation of the healthcare sector may
     be indirect.
   – The lead idea of the project is “having the individual as a co-
     producer of health” and empowering individuals to take
     responsibility of their health with personalised ICT enabled PHS
     technologies and services.
   – In this way the project paves the way towards a health service
     environment where individuals and health professionals work
     jointly towards health goals.”



                     www.preve-eu.org
Prevention of diseases
WHY




                         www.preve-eu.org
The well-known health system challenges
                                    PREVE focus

• Health expenditure vs.
                                       Healthy
  value                                              At risk
                                                                        © Juha Teperi, STM

   – What is produced with €’s                                 Ill      Under
   – Quality & Access concerns                                          treated
                                                                                   Difficult to
   – Expectations & Awareness                                                      treat        Crisis



• And the drivers
   – Ageing & Care ratio
   – Life styles
   – Science, Technology and
                                                                     ”Defense lines”
     Innovation                  Burden of disease




                       www.preve-eu.org
Prevention is the best strategy

• According to WHO,
   – 77% of the disease burden in Europe is accounted for by disorders
     related to lifestyles. Furthermore, 70% of stroke and colon cancer,
     80% of coronary heart disease, and 90% of type II diabetes could
     be prevented by maintaining healthy lifestyles.
• The best prevention strategy is to lead a healthy lifestyle.
• But, although we are constantly “bombarded” with health
  promotion information that we should exercise regularly,
  eat healthy, control our weight, sleep enough, manage
  stress, not smoke and use alcohol only moderately etc. as
  a population we are not doing a good job in acting
  according to this advice.


                     www.preve-eu.org
Clearly, people need assistance

• Based on this it should be clear that we as individuals
  need assistance in primary prevention.

• The questions are
   – What kind of assistance and
   – How the assistance should be made available / offered and
   – How to ensure that the assistance provides effective help to the
     individual in changing and maintaining her lifestyle.




                     www.preve-eu.org
Health behaviours,
                                        Personalization, Environment


                       Co-
                    producer              ICT in Disease Prevention
                    network

                                         Networked business models
Prevention of diseases                   Value proposition, validation
HOW
PREVENTABLE DISEASES  ICT ENABLED PRIMARY PREVENTION




                           www.preve-eu.org
PREVE workflow – 3 phases
                                                            Where we are now

                    Barcelona            Workshops             Milan
                    16.3.2010                                  8.11.2010

                                           Belfast
                                          14.6.2010




                                                         M9                           31.11.2010
1.12.2009

       Select the                   User                                        White paper
                                                        Business               ICT Research
       diseases &               segments &
                                                      models and                Directions in
           best                   Personal
                                                      validation                  Primary
        practices                 profiles                                       Prevention
                                                       (T3.1 – 3)
          (T2.1)                 (T2.2 – 4)                                        (T3.4)


                                      www.preve-eu.org
Workflow in more detail


                                                            Personas
                          Demand (WP2, Completed)

Preventable     Clinical risk        Health         Personal     Intervention
  diseases        factors          behaviours       profiling       needs


                 Co-             Individual +
                                                 Co-creators
              producers         Environment



”My Health       Business             Value         Business     Brokering of
 Project”         cases            proposition      models         best fit

                                Supply (WP3, WIP)

                           www.preve-eu.org
Directions for ICT Research in Disease Prevention




 FP7-ICT-2009.5.1 – Support Action




                                WP2 – Analysis of the Domain


                                                       Vicente Traver
                                             Universidad Politécnica de Valencia
                                                  vtraver@upvnet.upv.es


                               This project is partially funded under the 7th Framework Programme by the European Commission
WP2 goal



General objective:
TO PERFORM AN IN-DEPTH ANALYSIS OF
THE DOMAIN OF PERSONAL HEALTH
SYSTEMS (PHS) IN PREVENTION




             www.preve-eu.org
WP2 Original specific objectives

To analyze in-depth and refine the framework for PREVE project and of the target
domain: boundaries, concepts, basic facts and benchmarking of ongoing
initiatives in primary prevention and in PHS.

To describe the intervention model for primary prevention considering the citizen
as a co-producer of health.

To assess the different and similar characteristics of the different population
groups that could benefit from primary prevention PHS.

To specialize the basic intervention model with the different population groups
generating a matrix of intervention models for different user segments.


To discuss and refine the findings in two expert workshops


                                www.preve-eu.org
Tasks

T2.1 Selection of diseases and analysis of best practices in their
prevention, incl. lifestyle management & modification (M1-M4)

T2.2 Analysis of primary and secondary prevention strategies
deployed in ongoing EU funded PHS projects and of the market
place (M1-M6)


T2.3 Personal profile, motivation, user segmentation (M1-M6)



T2.4 User segmented intervention strategies (M1-M7)


                       www.preve-eu.org
WP2 alignment within PREVE

                                         Workshops
                    Barcelona                                  Milan
                    16.3.2010                                  8.11.2010
 WP2
                                           Belfast
                                          14.6.2010




                                                                                  31.11.2010
1.12.2009

       Select the                  User                                     White paper
                                                       Business            ICT Research
       diseases &               segments &
                                                      models and            Directions in
          best                   Personal
                                                      validation              Primary
        practices                 profiles                                   Prevention
                                                       (T3.1 – 3)
         (T2.1)                  (T2.2 – 4)                                     (T3.4)



                                  www.preve-eu.org
WP2 Outputs and milestones
1st PREVE Workshop, March 16th, 2010, and Advisory
Panel Meetings in Barcelona, March 15th and 16th.




   D2.1 Selection of the            D2.2 Selection of the
relevant diseases and their      relevant diseases and their
   prevention strategies         prevention strategies (final
       (draft) (M3)                    version) (M4)


               1st milestone




              www.preve-eu.org
WP2 Outputs and milestones
2nd PREVE Workshop, June 14th, 2010, and Advisory
Panel Meetings in Belfast, June 13th and 14th.




 D2.3 User segmented            D2.4 User segmented
intervention strategies        intervention strategies
      (draft) (M6)               (final version) (M7)


             2nd milestone




            www.preve-eu.org
Lessons learnt




• The most prevalent preventable non-communicable
  diseases are all lifestyle related
• Relationship disease-disorder  risk factor
• Through prevention, scientific evidence of impact on risk
  factors

• Citizen as health co-producer
• The citizen has the responsibility to manage her health
  and wellbeing

                  www.preve-eu.org
Lessons learnt




• A 3D framework for health behaviour and behaviour
  change has been constructed based on a thorough
  analysis of existing theories, best practices and other
  ongoing initiatives
• Tailoring vs segmentation. Segmentation only valid when
  resources for intervention implementation are low and
  the targeted behaviours are relatively simple
• Personas description to illustrate the process of profiling
  and choosing intervention strategies

                     www.preve-eu.org
Directions for ICT Research in Disease Prevention




 FP7-ICT-2009.5.1 – Support Action




    Task 2.1 - The Citizen as Co-producer of Health &
       Conceptual Framework for Chronic Disease


                                                      Niels Boye
                                            University of Aarhus, Denmark

                               This project is partially funded under the 7th Framework Programme by the European Commission
The Citizen as Co-producer of Health –
                      enabled by ICT
                                 Health Service Delivery
                                              Citizen as proactive subject

                Client Centred Approach                           Citizen as co-Producer of
                Patient Centred Medicine                          Health
                                                                          Disease prevention
                                                                          Disease compensation
                                                       Model &
                                                       Concepts
                                                                          (Disease cure)
                                                                          Assisted living
                                                                                         Maturity of ICT
User as Operator
Expert Systems                                                                             User as User
                          Contemporary                                                     Layman Systems
Corporate Centred        State of the Art                          Ambient Assisted Living Individual Centred
                         in ICT and
                         Empowerment



                                              Citizen as object


                                      www.preve-eu.org
The “Present Terrain”
                 “Biological age”           (“years”)


               Demand side            100       AAL


                                                        Supply side

           0                                            100 %
(100%                                                          Patient
Citizen)
                                                        Tele
               Prevention
                                                        med




                                      0

                            www.preve-eu.org
The Future.........
                   “Biological age”   (“years”)
                                100

                                Chronic
           Preven- AAL                    Tele-
                                Disease
             tion                        medicine
                              Management
               and
                        D             D
           Lifestyle
(100%
                                                      Patient
Citizen)       D                                  D
                                                      100 %
           0




                                  0
Society                                               Hospital

                       www.preve-eu.org
Conceptual Aims of “the Citizen as
         Co-producer of Health Model"
• Information and patients as resources
• Nature, Nurture, and collaboration with institutionalized
  health care
• Personalized management of prevention (and care of
  chronic diseases) – in a citizen context
• Multilevel ICT-modeling of health and disease
  encapsulated in to personal devices –


  Personal Guidance Services (PGS)
         From: “Background document for the Consultation meeting
         on potential European Large scale Action (ELSA) on eHealth”
         European Commission “ICT for Health Unit, H1, 28.08.2009

                     www.preve-eu.org
The Personal Guidance System

• Is a ICT device: based on computer-models of healthy- and
  preventive-behaviour, achievable evidence-based
  pathways of cure, compensation, or treatment for disease
  related conditions
• The Personal Guidance System contains computer-models
  for navigation in health similar to the GPS that contains a
  model of geography and possibilities in travel
• The PGS provides the personal context of health related
  decisions and is the ICT-platform for the “Citizen as Co-
  producer of Health”.




                   www.preve-eu.org
Decision support
                                 information flows




                                                                    Data - and
                       Clinical                                    Information
                      encounter                                        flow

                                            EHR


HMO/              Research/
Region        Pharmaceutical Co                               Health-PGS
                                     Quality                  (digital avatar)
                                    Assurance


 Healthcare
 Co-production
  Research        Hospital                      Patient-NGO

                             www.preve-eu.org
Decision Support
                      Present service model

• Contemporary service model (provider push) of
  prevention:

•   Non-specific lifestyle modifications
•   Primary prevention (e.g. immunisations)
•   Secondary prevention – (e.g. screening programs)
•   Tertiary prevention of complications to disease




                    www.preve-eu.org
Prevention in the Co-Producer Model
                    context
• From the citizen and co-production of health point of view
  there is no distinction between primary, secondary and
  tertiary prevention

• It is behaviour planning and execution on the basis of
  personal-context, evidence-, and knowledge-driven ICT-
  augmented decisions




                   www.preve-eu.org
Evidence Based Associations between Risk
            Factors and Conditions
   Diseases and Disorders                            Risk Factors
          Type 2-diabetes                            Tobacco smoking


         Preventable cancer                        Alcohol consumption


       Cardiovascular disease                              Diet


            Osteoporosis                             Physical activity


      Musculoskeletal disorders                          Obesity


      Hypersensitivity disorders                        Accidents


          Mental disorders                         Working environment


Chronic obstructive pulmonary disease              Environmental factors



                                www.preve-eu.org
Co-production of Disease Prevention
             Connections between Risk Factors and Conditions
Citizen Modifiable Risk Factors

       Tobacco smoking                                  Conditions
  Citizen Modifiable Risk Factors
                                                       Type 2-diabetes
     Alcohol consumption

                                                     Preventable cancer
              Diet

                                                   Cardiovascular disease
       Physical inactivity

                                                        Osteoporosis
            Obesity

 Non-Modifiable Risk Factors                      Musculoskeletal disorders
           Accidents
                                                  Hypersensitivity disorders
     Working environment
                                                      Mental disorders
     Environmental factors
                                                     Chronic obstructive
                                                     pulmonary disease
   Family history and gender

                               www.preve-eu.org
Directions for ICT Research in Disease Prevention




 FP7-ICT-2009.5.1 – Support Action




          Task 2.2 – Analysis of primary and secondary
          prevention strategies deployed in ongoing EU
          funded PHS projects and of the market place


                                           Teresa Meneu
                               UPVLC Universidad Politécnica de Valencia

                               This project is partially funded under the 7th Framework Programme by the European Commission
Objectives

Revision of research projects of ICT and
primary prevention

Revision of commercial products, websites and
online health promotion organizations

Revision of complementary domains:
secondary and tertiary prevention, marketing

Revision of public health campaigns

             www.preve-eu.org
Main Figures
      Focus of the prevention projects
40%
35%
30%
25%
20%
15%
10%
 5%
 0%




         www.preve-eu.org
Main Figures
      Focus of the prevention websites
20%
18%
16%
14%
12%
10%
 8%
 6%
 4%
 2%
 0%




         www.preve-eu.org
Main Figures
                 Type of products
18
16
14                     4
12
10                                      Other products
 8
         1                              Videogames
 6                    12
 4   3                      7       2
         6
 2                3                 3
     2       2                  2
 0




             www.preve-eu.org
Main Figures
             Most Common Risk Factors
50%
45%
40%
35%
30%
25%                                            Projects
20%
                                               Websites /
15%
                                               Organizations
10%
 5%
 0%
      Diet      Physical    Obesity   Others
               inactivity


                www.preve-eu.org
Public Health Campaigns




                       Dietary
                       Habits,
Tobacco   Alcohol      Physical    Melanoma   Vaccination   Drugs
                      Activity &
                       Obesity




                       www.preve-eu.org
www.preve-eu.org




On PREVE website it has been created a database to collect all
related works: websites, products and projects, focused on
prevention of diseases and risk factors.
                                  www.preve-eu.org
www.preve-eu.org




www.preve-eu.org
Conclusions

Isolation of initiatives

  • Little signs of interoperability either on a technical or at a conceptual level.
  • The original purpose of the projects is mainly focused in a specific domain and was not expecting to be used or
    profited in conjunction with others.

The number of secondary prevention experiences is much bigger that those of primary
prevention
  • More mature market
  • More well defined conditions
  • More funding allocated to this domain
  • They could provide some useful information related mainly to motivation
    • Not applicable to the same extent to business models or technological solutions.

General lack of sustainable trustable business models linked to primary prevention

  • Most successful initiatives are very simple and sold as ’consumer’ products, for leisure, pleasure or beauty .
  • Interesting models linked to some healthcare initiatives: Kaiser, Mayo Clinic, Healthvault, Google Health,

Reduced participation of multiple actors in the co-creator model, most solutions have only
the individual and, in some cases, the healthcare system.


                                       www.preve-eu.org
Conclusions

Reduced presence of external influences (society, family, etc) in the picture
besides the initiatives linked to web 2.0.

Interesting results in peer motivation and support in similar domains that
could be applied to primary prevention.

The most apparently successful results are based in the physical activity
domain.

General awareness of main risk factors and potential diseases, aligned with
the results of D2.2.

Reduced support to practical implementation of strategies but much more
provision of semi-personalized guidelines.

Most projects just do population based personalization (segmentation) and
some tailoring based in a few set of individual parameters (i.e. BMI).

                         www.preve-eu.org
Directions for ICT Research in Disease Prevention




 FP7-ICT-2009.5.1 – Support Action




                   Task 2.3 – Personal profile, motivation,
                              user segmentation

                                                   Kirsikka Kaipainen
                                        VTT Technical Research Centre of Finland
                                               Kirsikka.Kaipainen@vtt.fi



                               This project is partially funded under the 7th Framework Programme by the European Commission
Objectives

• To analyze different motivation strategies proposed in literature and
  implemented in current activities that are or could be applied to
  lifestyle management and modification, especially drawing from the
  experience in advertising and marketing
• To assess the cultural and socio-economic issues that could affect the
  effectiveness of the identified motivation strategies
• To analyse user segmentation based on life stages
• To develop the concept of personal profile based on life stages, risk
  factors, motivation and socioeconomic factors
• A segmentation analysis over the population groups highlighted in
  task 2.1 for the different diseases, based in the different dimensions
  that could influence the intervention model
• To match the identified motivation strategies with the user
  segmentation produced in T2.3


                      www.preve-eu.org
FACTORS THAT INFLUENCE BEHAVIOUR




                www.preve-eu.org
Determinants of health behaviour

• Various theories and frameworks were investigated
   – Psychological theories about individual behaviour and
     stages of behaviour change
   – Theories of values and motivation
   – Developmental theories
   – Communication theories
   – Social marketing theories
   – Behavioural economics
   – Cognitive-behavioural therapies and persuasive
     technologies

 The theories overlap and complement each other
   – There is no one theory that completely explains behaviour
     and behaviour change
   – A hybrid model to include essential factors and their
     relationships is needed

                   www.preve-eu.org
Determinants of health behaviour


                     Values,          Social
                                    influences                      Ability
                   personality,
                   life stages

                                                                               Reasoned
                 Awareness         Self-efficacy        Intention
Public policy                                                                  behaviour


 Community
                                     Outcome                        Barriers
                                   expectations
Organizational
                                                                               Automatic
                                                                               behaviours
Interpersonal                             Environmental contexts

  Individual




                                  www.preve-eu.org
PROFILING THE PERSON




                www.preve-eu.org
Constituents of personal profile




 Dimensions
   for user
segmentation




           Dynamicity




                         www.preve-eu.org
INTERVENTIONS FOR BEHAVIOUR CHANGE




               www.preve-eu.org
Principles of interventions

• Primary aims:
   – Create or strengthen intention through other determinants
   – Increase abilities and remove barriers

• Guiding principles:
   – Provide immediate, tangible, personally valuable benefits for
     healthy behaviours
   – Frame health-promoting messages in an appealing manner
   – Guide people with appropriate choice architectures
   – Take advantage of trigger events
   – Make changes on multiple levels by involving different actors
   – Identify co-creators of health and involve them in interventions




                     www.preve-eu.org
PROFILE
                                                                                   Monitor trigger
    Risk factors                                                                  events and profile
Values & motivators                                                                   updates
    Resources
     Channels               Assess current Health behaviour
Current behaviours                          Diet
                                      Physical Activity
                                   Alcohol consumption                                OK, no                      Support
                                         Smoking                                   current risks                 behaviour/
                                           Stress                                                               maintenance
                                           Sleep
                                    Mental well-being


                                         Risky/poor,
                                                                                                                                  Choosing
                                  need for behaviour change


                                          Identify
                                      determinants to
                                                                                                                                appropriate
                                           target



                                       Intention per
                                                                            Lack of resources
                                                                                                               Strengthen
                                                                                                                              interventions
      Evaluate progress,                                      Strong        (external, actual
                                        behaviour?                                                              resources
     outcomes and profile                                                       abilities)?
           updates
                                    Weak or nonexistent



                                     Not aware of risks            Discouraging social                                            Unfavourable outcome
                                      and benefits /                                                  Weak self-efficacy?
                                                                     environment?                                                     expectations?
                                     misconceptions?


                                                                       Strengthen social
                                                                                                         Improve self-              Improve outcome
                                          Educate                       independence /
                                                                                                       efficacy and skills            expectations
                                                                       increase support




          Execute the                                                                              Select methods & tailor
          intervention                                                                                 the intervention

                                                              Personal characteristics
                                                                                                                                 Problem
                                                                 Values & motivators                                          characteristics
                                                                 Personal resources
                                                                                                       Co-creators
                                                                                                    Social environment
                                                                                                   Service environment
                                                                                                   Physical environment




                                               www.preve-eu.org
Personalization of interventions

• Targeting vs. tailoring
   – Targeting: designing interventions for subgroups with common
     characteristics
   – Tailoring: fitting an intervention to meet the personal needs and
     characteristics of a person rather than a group
       • The most effective approach, but traditionally costly


• ICT could enable deeply personalized, cost-efficient
  interventions
   – A Do-It-Yourself (DIY) platform for profiling yourself and to select
     interventions that match your profile
   – Means for data entry, assessment, monitoring, context-
     awareness, feedback  personal guidance and motivation



                       www.preve-eu.org
Directions for ICT Research in Disease Prevention




 FP7-ICT-2009.5.1 – Support Action




                 Task 2.4 – User Segmented Intervention
                                Strategies


                                           Teresa Meneu
                               UPVLC Universidad Politécnica de Valencia

                               This project is partially funded under the 7th Framework Programme by the European Commission
Main Objectives

To put together the collected
information from the previous tasks by:
• Defining the primary prevention intervention
  model and differentiating its main dimensions.
• Describing the disease – best intervention
  strategies matrix of T2.1 with personalization data
  resulting in a user segmented disease – best
  intervention strategies matrix.
• Concluding the work in WP2 in valuable outcomes
  for the next phase of research.

                www.preve-eu.org
Main Inputs




     T2.4             Intervention Logic
                          and Profile

Draft Primary Prevention
  Intervention Model &
       PERSONA’s


         WP3
   www.preve-eu.org
Primary Prevention Intervention Model

      DIY
     Profiler


                                                         Broker
                Analyze                   Plan

Trigger
 event


                Evaluate                 Execute

                                                   PGS

                PHS




                      www.preve-eu.org
Personalized Primary Prevention
                                 Intervention Model
                 DIY          Which is the risk
                Profiler      of the individual?                     Broker

                                                                      How to select/choose
                                                                        the intervention
                           Analyze                     Plan
                                                                           strategy?
           Trigger
            event


                           Evaluate                  Execute

                                                               PGS

  How to assess the        PHS                     How to put it in practice in
evolution and provide                                    the concrete
   readjustments?                                    time/location/need?

                                      www.preve-eu.org
Personalized Intervention Strategies

                      Profiling Matrix
Health behaviors                                        Segments that would
 (and intention)                                        benefit from behavior
                                                        maintenance interventions
      No risk                                           Segments in need of
                                                        lifestyle change with
      Low risk                                          different levels of urgency

                                                        Examples of possibly
                                                        unrealistic segments



                                           high

      High risk                             Resources
                                     low

                       Motivators

                          Life Stages

                                    www.preve-eu.org
Profiling Matrix Dimensions

Health behaviour is any activity undertaken by an individual which
influences health outcomes.
 • Regardless of actual or perceived health status, the intention can be promoting,
   protecting or maintaining health, but the attitudes and behaviours can also be harmful,
   unsafe and damaging to health.

Motivation must be present for a lifestyle change to happen and it
has much to do about sustainability of the change.
 • The motivation refers to the reason or reasons for engaging in a particular behaviour
   and it may be intrinsic, extrinsic or both.

The Resources are the tools present in the environment surrounding
the individual at his disposal to carry out an interactive action.
 • There are internal and external resources and they can have a positive or negative
   influence in the intervention.



                             www.preve-eu.org
The 4th Dimension: Life Stages

         • Life Stages




      www.preve-eu.org
From Profiling to Personalized Intervention


                          Tailoring

Profiling

                                 Personalized
                                 Intervention




              www.preve-eu.org
Monitor trigger
                 PROFILE                                                                    events and profile
                 Risk factors
                                                                                                updates
             Values & motivators
                 Resources               Assess current Health behavior
                  Channels                                 Diet
             Current behaviors                       Physical Activity
                                                  Alcohol consumption                        OK, no                                         Support behavior/
                                                                                          current risks                                       maintenance
                                                        Smoking
                                                          Stress
                                                          Sleep
                                                   Mental Wellbeing

     Student, motivated, healthy habits: She is a female.
                                                     Risky/poor,
                                              need for behavior change


     She is 20 years old and a student. She lives in a city
                                                        Identify
                                                    determinants to
                                                                                                                  1. Student

                                                                                                                                                                              Strengthen

     and with her boyfriend. Her main values are:
                                                                                                          Yes
                                                         target                                                                                                                resources




     achievement, security, power and self-direction.
                   Evaluate progress,
                  outcomes and profile
                                                     Intention per
                                                       behavior?
                                                                          Strong
                                                                                        Lack of resources
                                                                                       (external or actual
                                                                                            abilities)?                                              3. Middle age
                        updates                                                                                                                        overdoing


                                                                                                                       2. Corporate
                                                   Weak or nonexistent
                                                                                                                         wellness

                                                                                                                                                                           Strengthen social



Intervention
                                                                                                                          Discouraging social
                                                                                                                                                    Yes                     independence /
                                                                                                                            environment?
                                                                                                                                                                           increase support




    Logic                                            Aware of risks                                                                                         5. Young old
                                                     and benefits?                                                                                             person




                                                                                                                                                                             Improve self-
                                                                                                                          Weak self-efficacy?        Yes
                                                                                                                                                                           efficacy and skills




                                                     Not aware /

                                                      Male Adult, unmotivated, using services of
                                                    Misconceptions
                                                                      7. Obese child
                                                                                                                                                            4. Housewife



                                                      community wellness: He is a male. He is 34 years                  Unfavourable outcome
                                                                                                                            expectations?
                                                                                                                                                    Yes
                                                                                                                                                                           Improve outcome
                                                                                                                                                                             expectations



                                                      old and employed. He lives in a city with his wife.
                                   6. Community
                                      wellness
                                                      His main values are: security, tradition and
                                                        Educate




                       Execute the
                       intervention
                                                      benevolence.                                              Select methods & tailor
                                                                                                                    the intervention


                                                                             Personal characteristics
                                                                                   Values & motivators                                       Problem
                                                                                   Personal resources                                     characteristics

                                                                                                                      Co-creators
                                                                                                                   Social environment
                                                                                                                  Service environment
                                                                                                                  Physical environment

                                                     www.preve-eu.org
Conclusions

COMPLEXITY OF THE DOMAIN
• Specially in relation to the human nature and its natural
  reluctance to change a preferred, well established health
  behaviour, and the incredible high amount of factors and
  dimensions that need and must be considered to design an
  effective primary prevention intervention model.
• This scenario poses a set of challenges where ICT technologies
  could definitively play a significant role:
  • acquiring the required information
  • tracing the evolution and changes of the person, its context
    and her risk profile
  • processing the enormous set of information to create
    practical decision support tools for the individuals.

                   www.preve-eu.org
Conclusions

FULL PERSONALIZATION
• Designing effective and sustainable primary prevention strategies
  is a very personal issue, even for similar risk profiles, the optimal
  way to manage to reduce or overcome said risk presents different
  faces depending on the concrete individual.
• Different moments of life, different situations or events, present
  or past, would imply an instant need to recalibrate the
  intervention strategy as the things that were effective in the past
  may no longer be applicable.
• The large number of relevant health determinants shows that
  interventions need to be tailored in order to meet the personal
  needs and characteristics of a person. In segmentation
  compromises would have to be made that would limit the
  potential success of the interventions.

                     www.preve-eu.org
Conclusions

ICT ENABLING MULTILEVEL STRATEGIES
• The number of theories is large but yet no one has proven to
  be the most suitable for all individuals and all situations.
• Different scenarios may need a different approach or even a
  combination of those.
• The inclusion of ICT technologies into the picture and the way
  it would affect the behaviours has not been extensively
  studied or validated and could cause differences in the efficacy
  on the different theories.
• The use of ICT to support the interventions could dramatically
  change the limitations and boundaries that current
  intervention models have in relation to the selection or one or
  another strategy for behaviour change.

                    www.preve-eu.org
Conclusions

PREVENTION ECOSYSTEM
• Inclusion of third parties in the intervention cycle: co-
  creators
• Some of the co-creators will truly interact with the
  individual in co-creating health. Others will participate
  through the choice architectures and defaults that
  they set through policies and other actions.
• The influence of the environment is very strong and is
  dynamically present in the prevention model.
• Co-creators need to be accommodated into the
  intervention strategies.

                  www.preve-eu.org
Directions for ICT Research in Disease Prevention




 FP7-ICT-2009.5.1 – Support Action




                                                        Outlook
                                                      Months 7 – 12


                                           Niilo Saranummi
                                VTT Technical Research Centre of Finland

                               This project is partially funded under the 7th Framework Programme by the European Commission
Completion of 3rd phase

                                         Workshops
                    Barcelona                                  Milan
                    16.3.2010                                  8.11.2010
                                           Belfast
                                          14.6.2010




                                                                                  31.11.2010
1.12.2009

       Select the                   User                                    White paper
                                                        Business           ICT Research
       diseases &               segments &
                                                      models and            Directions in
           best                   Personal
                                                      validation              Primary
        practices                 profiles                                   Prevention
                                                       (T3.1 – 3)
          (T2.1)                 (T2.2 – 4)                                    (T3.4)


                                      www.preve-eu.org
Prevention of diseases
CURRENT STATUS (CONTINUED)




                         www.preve-eu.org
The health co-production ECO-system

                Political, social, economic environment




      Co-                                                 Policies
producers                                                 Incentives
                                                          Barriers
            HealthGPS
            (digital avatar)


                     Platform services (security, ID)
 PHR



                      www.preve-eu.org
The health-co-production ECO-system
                        Three layer ICT Business Model

• “App store” - Library of applications
  for managing health behaviours.
    – Built by community research and
      innovation
    – Maintained and certified by Patient-NGO’s
    – NEW business opportunity for SMEs

• Platform(s) for ICT-services.
    – Built and maintained by enterprise
      vendors.
    – Specified and tested by EC in a (major)
      CIP-like project

• The interoperability and security
  layer.
    – Specified by Standards and Directives.



                           www.preve-eu.org
Co-producers / co-creators
                of health




personal trainers, restaurants, food markets, school,
   workplace, media, healthcare professionals ...

                www.preve-eu.org
The environment matters
     ”Preloading” to create favourable conditions



  Society
 ”upstream”
                                      Communities


                           Organizations




                                       Friends
 Individual                            & family
”downstream”


               www.preve-eu.org
Examples of business cases
                          who ”owns” the customer

• Worried well & Fitness
    – Individuals pay out of their own pocket
    – Third party life insurance companies are interested
• Corporate wellness
    – The company makes H&W services available to employees
    – Reduction in insurance premiums (sickness, retirement)
• Society – policies
    – School wellness programs
• Integrated care providers (e.g. Kaiser Permanente)
    – If prevention is the best strategy it will be in the interest of IC providers to
      keep patients out of hospitals
• Health-related consumer goods & service industries
    –   Food & beverage
    –   Sports & fitness
    –   Media & edutainment
    –   Consumer electronics

                          www.preve-eu.org
PREVE specific impacts
•   Facilitating the development of prospective aspects of ICT-enabled prevention
    of diseases
     –   “White Paper” – ICT research directions
•   Reduced hospitalisation and improved disease management and treatment at
    the point of need, through more precise assessment of health status
     –   Proactive health management, i.e. Primary prevention
•   Economic benefits for health systems without compromising quality of care
     –   Freeing scarce resources to the care of the ill
•   Reinforced leadership and innovation of the industry in the area of Personal
    Health Systems and medical devices. New business models for health service
    providers and insurance sectors
     –   Health behaviours, Personalization, Networked business models, N = 1, …
•   Improved links and interaction between patients and doctors facilitating more
    active participation of patients in care processes
     –   Co-creator network, Individual + Environment
•   Accelerating the establishment of interoperability standards and of secure,
    seamless communication of health data between all involved partners,
    including patients
     –   Continua, HL7 contacts

                                www.preve-eu.org
PREVE partners

Valtion teknillinen tutkimuskeskus, VTT

Aarhus University

Fondazione Centro San Raffaele del
  Monte Tabor

Universidad Politécnica de Valencia

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PREVE project overview - months 1-6

  • 1. Directions for ICT Research in Disease Prevention FP7-ICT-2009.5.1 – Support Action PREVE Overview Project Months 1-6 Niilo Saranummi VTT Technical Research Centre of Finland This project is partially funded under the 7th Framework Programme by the European Commission
  • 2. Prevention of diseases WHAT www.preve-eu.org
  • 3. PREVE – in brief • A 12 month Support Action, under the 4th FP7 ICT Call • Four partners • Objective – Identify ICT research directions for the empowerment of citizens in disease prevention and the preservation of health www.preve-eu.org
  • 4. What PREVE delivers Impact • White Paper identify ICT research directions for the empowerment of citizens in disease prevention and the preservation of health highlighting the need to approach disease prevention from multiple complementary viewpoints. • Articles offered to peer-reviewed journals and to conferences in order to target different stakeholders in disease prevention www.preve-eu.org
  • 5. PREVE impact • “PREVE will suggest ICT research directions in primary prevention. – Thus it will open a new avenue of research in the PHS where the so far traditional concept “a physician in the loop” does not always apply and the participation of the healthcare sector may be indirect. – The lead idea of the project is “having the individual as a co- producer of health” and empowering individuals to take responsibility of their health with personalised ICT enabled PHS technologies and services. – In this way the project paves the way towards a health service environment where individuals and health professionals work jointly towards health goals.” www.preve-eu.org
  • 6. Prevention of diseases WHY www.preve-eu.org
  • 7. The well-known health system challenges PREVE focus • Health expenditure vs. Healthy value At risk © Juha Teperi, STM – What is produced with €’s Ill Under – Quality & Access concerns treated Difficult to – Expectations & Awareness treat Crisis • And the drivers – Ageing & Care ratio – Life styles – Science, Technology and ”Defense lines” Innovation Burden of disease www.preve-eu.org
  • 8. Prevention is the best strategy • According to WHO, – 77% of the disease burden in Europe is accounted for by disorders related to lifestyles. Furthermore, 70% of stroke and colon cancer, 80% of coronary heart disease, and 90% of type II diabetes could be prevented by maintaining healthy lifestyles. • The best prevention strategy is to lead a healthy lifestyle. • But, although we are constantly “bombarded” with health promotion information that we should exercise regularly, eat healthy, control our weight, sleep enough, manage stress, not smoke and use alcohol only moderately etc. as a population we are not doing a good job in acting according to this advice. www.preve-eu.org
  • 9. Clearly, people need assistance • Based on this it should be clear that we as individuals need assistance in primary prevention. • The questions are – What kind of assistance and – How the assistance should be made available / offered and – How to ensure that the assistance provides effective help to the individual in changing and maintaining her lifestyle. www.preve-eu.org
  • 10. Health behaviours, Personalization, Environment Co- producer ICT in Disease Prevention network Networked business models Prevention of diseases Value proposition, validation HOW PREVENTABLE DISEASES  ICT ENABLED PRIMARY PREVENTION www.preve-eu.org
  • 11. PREVE workflow – 3 phases Where we are now Barcelona Workshops Milan 16.3.2010 8.11.2010 Belfast 14.6.2010 M9 31.11.2010 1.12.2009 Select the User White paper Business ICT Research diseases & segments & models and Directions in best Personal validation Primary practices profiles Prevention (T3.1 – 3) (T2.1) (T2.2 – 4) (T3.4) www.preve-eu.org
  • 12. Workflow in more detail Personas Demand (WP2, Completed) Preventable Clinical risk Health Personal Intervention diseases factors behaviours profiling needs Co- Individual + Co-creators producers Environment ”My Health Business Value Business Brokering of Project” cases proposition models best fit Supply (WP3, WIP) www.preve-eu.org
  • 13. Directions for ICT Research in Disease Prevention FP7-ICT-2009.5.1 – Support Action WP2 – Analysis of the Domain Vicente Traver Universidad Politécnica de Valencia vtraver@upvnet.upv.es This project is partially funded under the 7th Framework Programme by the European Commission
  • 14. WP2 goal General objective: TO PERFORM AN IN-DEPTH ANALYSIS OF THE DOMAIN OF PERSONAL HEALTH SYSTEMS (PHS) IN PREVENTION www.preve-eu.org
  • 15. WP2 Original specific objectives To analyze in-depth and refine the framework for PREVE project and of the target domain: boundaries, concepts, basic facts and benchmarking of ongoing initiatives in primary prevention and in PHS. To describe the intervention model for primary prevention considering the citizen as a co-producer of health. To assess the different and similar characteristics of the different population groups that could benefit from primary prevention PHS. To specialize the basic intervention model with the different population groups generating a matrix of intervention models for different user segments. To discuss and refine the findings in two expert workshops www.preve-eu.org
  • 16. Tasks T2.1 Selection of diseases and analysis of best practices in their prevention, incl. lifestyle management & modification (M1-M4) T2.2 Analysis of primary and secondary prevention strategies deployed in ongoing EU funded PHS projects and of the market place (M1-M6) T2.3 Personal profile, motivation, user segmentation (M1-M6) T2.4 User segmented intervention strategies (M1-M7) www.preve-eu.org
  • 17. WP2 alignment within PREVE Workshops Barcelona Milan 16.3.2010 8.11.2010 WP2 Belfast 14.6.2010 31.11.2010 1.12.2009 Select the User White paper Business ICT Research diseases & segments & models and Directions in best Personal validation Primary practices profiles Prevention (T3.1 – 3) (T2.1) (T2.2 – 4) (T3.4) www.preve-eu.org
  • 18. WP2 Outputs and milestones 1st PREVE Workshop, March 16th, 2010, and Advisory Panel Meetings in Barcelona, March 15th and 16th. D2.1 Selection of the D2.2 Selection of the relevant diseases and their relevant diseases and their prevention strategies prevention strategies (final (draft) (M3) version) (M4) 1st milestone www.preve-eu.org
  • 19. WP2 Outputs and milestones 2nd PREVE Workshop, June 14th, 2010, and Advisory Panel Meetings in Belfast, June 13th and 14th. D2.3 User segmented D2.4 User segmented intervention strategies intervention strategies (draft) (M6) (final version) (M7) 2nd milestone www.preve-eu.org
  • 20. Lessons learnt • The most prevalent preventable non-communicable diseases are all lifestyle related • Relationship disease-disorder  risk factor • Through prevention, scientific evidence of impact on risk factors • Citizen as health co-producer • The citizen has the responsibility to manage her health and wellbeing www.preve-eu.org
  • 21. Lessons learnt • A 3D framework for health behaviour and behaviour change has been constructed based on a thorough analysis of existing theories, best practices and other ongoing initiatives • Tailoring vs segmentation. Segmentation only valid when resources for intervention implementation are low and the targeted behaviours are relatively simple • Personas description to illustrate the process of profiling and choosing intervention strategies www.preve-eu.org
  • 22. Directions for ICT Research in Disease Prevention FP7-ICT-2009.5.1 – Support Action Task 2.1 - The Citizen as Co-producer of Health & Conceptual Framework for Chronic Disease Niels Boye University of Aarhus, Denmark This project is partially funded under the 7th Framework Programme by the European Commission
  • 23. The Citizen as Co-producer of Health – enabled by ICT Health Service Delivery Citizen as proactive subject Client Centred Approach Citizen as co-Producer of Patient Centred Medicine Health Disease prevention Disease compensation Model & Concepts (Disease cure) Assisted living Maturity of ICT User as Operator Expert Systems User as User Contemporary Layman Systems Corporate Centred State of the Art Ambient Assisted Living Individual Centred in ICT and Empowerment Citizen as object www.preve-eu.org
  • 24. The “Present Terrain” “Biological age” (“years”) Demand side 100 AAL Supply side 0 100 % (100% Patient Citizen) Tele Prevention med 0 www.preve-eu.org
  • 25. The Future......... “Biological age” (“years”) 100 Chronic Preven- AAL Tele- Disease tion medicine Management and D D Lifestyle (100% Patient Citizen) D D 100 % 0 0 Society Hospital www.preve-eu.org
  • 26. Conceptual Aims of “the Citizen as Co-producer of Health Model" • Information and patients as resources • Nature, Nurture, and collaboration with institutionalized health care • Personalized management of prevention (and care of chronic diseases) – in a citizen context • Multilevel ICT-modeling of health and disease encapsulated in to personal devices – Personal Guidance Services (PGS) From: “Background document for the Consultation meeting on potential European Large scale Action (ELSA) on eHealth” European Commission “ICT for Health Unit, H1, 28.08.2009 www.preve-eu.org
  • 27. The Personal Guidance System • Is a ICT device: based on computer-models of healthy- and preventive-behaviour, achievable evidence-based pathways of cure, compensation, or treatment for disease related conditions • The Personal Guidance System contains computer-models for navigation in health similar to the GPS that contains a model of geography and possibilities in travel • The PGS provides the personal context of health related decisions and is the ICT-platform for the “Citizen as Co- producer of Health”. www.preve-eu.org
  • 28. Decision support information flows Data - and Clinical Information encounter flow EHR HMO/ Research/ Region Pharmaceutical Co Health-PGS Quality (digital avatar) Assurance Healthcare Co-production Research Hospital Patient-NGO www.preve-eu.org
  • 29. Decision Support Present service model • Contemporary service model (provider push) of prevention: • Non-specific lifestyle modifications • Primary prevention (e.g. immunisations) • Secondary prevention – (e.g. screening programs) • Tertiary prevention of complications to disease www.preve-eu.org
  • 30. Prevention in the Co-Producer Model context • From the citizen and co-production of health point of view there is no distinction between primary, secondary and tertiary prevention • It is behaviour planning and execution on the basis of personal-context, evidence-, and knowledge-driven ICT- augmented decisions www.preve-eu.org
  • 31. Evidence Based Associations between Risk Factors and Conditions Diseases and Disorders Risk Factors Type 2-diabetes Tobacco smoking Preventable cancer Alcohol consumption Cardiovascular disease Diet Osteoporosis Physical activity Musculoskeletal disorders Obesity Hypersensitivity disorders Accidents Mental disorders Working environment Chronic obstructive pulmonary disease Environmental factors www.preve-eu.org
  • 32. Co-production of Disease Prevention Connections between Risk Factors and Conditions Citizen Modifiable Risk Factors Tobacco smoking Conditions Citizen Modifiable Risk Factors Type 2-diabetes Alcohol consumption Preventable cancer Diet Cardiovascular disease Physical inactivity Osteoporosis Obesity Non-Modifiable Risk Factors Musculoskeletal disorders Accidents Hypersensitivity disorders Working environment Mental disorders Environmental factors Chronic obstructive pulmonary disease Family history and gender www.preve-eu.org
  • 33. Directions for ICT Research in Disease Prevention FP7-ICT-2009.5.1 – Support Action Task 2.2 – Analysis of primary and secondary prevention strategies deployed in ongoing EU funded PHS projects and of the market place Teresa Meneu UPVLC Universidad Politécnica de Valencia This project is partially funded under the 7th Framework Programme by the European Commission
  • 34. Objectives Revision of research projects of ICT and primary prevention Revision of commercial products, websites and online health promotion organizations Revision of complementary domains: secondary and tertiary prevention, marketing Revision of public health campaigns www.preve-eu.org
  • 35. Main Figures Focus of the prevention projects 40% 35% 30% 25% 20% 15% 10% 5% 0% www.preve-eu.org
  • 36. Main Figures Focus of the prevention websites 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% www.preve-eu.org
  • 37. Main Figures Type of products 18 16 14 4 12 10 Other products 8 1 Videogames 6 12 4 3 7 2 6 2 3 3 2 2 2 0 www.preve-eu.org
  • 38. Main Figures Most Common Risk Factors 50% 45% 40% 35% 30% 25% Projects 20% Websites / 15% Organizations 10% 5% 0% Diet Physical Obesity Others inactivity www.preve-eu.org
  • 39. Public Health Campaigns Dietary Habits, Tobacco Alcohol Physical Melanoma Vaccination Drugs Activity & Obesity www.preve-eu.org
  • 40. www.preve-eu.org On PREVE website it has been created a database to collect all related works: websites, products and projects, focused on prevention of diseases and risk factors. www.preve-eu.org
  • 42. Conclusions Isolation of initiatives • Little signs of interoperability either on a technical or at a conceptual level. • The original purpose of the projects is mainly focused in a specific domain and was not expecting to be used or profited in conjunction with others. The number of secondary prevention experiences is much bigger that those of primary prevention • More mature market • More well defined conditions • More funding allocated to this domain • They could provide some useful information related mainly to motivation • Not applicable to the same extent to business models or technological solutions. General lack of sustainable trustable business models linked to primary prevention • Most successful initiatives are very simple and sold as ’consumer’ products, for leisure, pleasure or beauty . • Interesting models linked to some healthcare initiatives: Kaiser, Mayo Clinic, Healthvault, Google Health, Reduced participation of multiple actors in the co-creator model, most solutions have only the individual and, in some cases, the healthcare system. www.preve-eu.org
  • 43. Conclusions Reduced presence of external influences (society, family, etc) in the picture besides the initiatives linked to web 2.0. Interesting results in peer motivation and support in similar domains that could be applied to primary prevention. The most apparently successful results are based in the physical activity domain. General awareness of main risk factors and potential diseases, aligned with the results of D2.2. Reduced support to practical implementation of strategies but much more provision of semi-personalized guidelines. Most projects just do population based personalization (segmentation) and some tailoring based in a few set of individual parameters (i.e. BMI). www.preve-eu.org
  • 44. Directions for ICT Research in Disease Prevention FP7-ICT-2009.5.1 – Support Action Task 2.3 – Personal profile, motivation, user segmentation Kirsikka Kaipainen VTT Technical Research Centre of Finland Kirsikka.Kaipainen@vtt.fi This project is partially funded under the 7th Framework Programme by the European Commission
  • 45. Objectives • To analyze different motivation strategies proposed in literature and implemented in current activities that are or could be applied to lifestyle management and modification, especially drawing from the experience in advertising and marketing • To assess the cultural and socio-economic issues that could affect the effectiveness of the identified motivation strategies • To analyse user segmentation based on life stages • To develop the concept of personal profile based on life stages, risk factors, motivation and socioeconomic factors • A segmentation analysis over the population groups highlighted in task 2.1 for the different diseases, based in the different dimensions that could influence the intervention model • To match the identified motivation strategies with the user segmentation produced in T2.3 www.preve-eu.org
  • 46. FACTORS THAT INFLUENCE BEHAVIOUR www.preve-eu.org
  • 47. Determinants of health behaviour • Various theories and frameworks were investigated – Psychological theories about individual behaviour and stages of behaviour change – Theories of values and motivation – Developmental theories – Communication theories – Social marketing theories – Behavioural economics – Cognitive-behavioural therapies and persuasive technologies  The theories overlap and complement each other – There is no one theory that completely explains behaviour and behaviour change – A hybrid model to include essential factors and their relationships is needed www.preve-eu.org
  • 48. Determinants of health behaviour Values, Social influences Ability personality, life stages Reasoned Awareness Self-efficacy Intention Public policy behaviour Community Outcome Barriers expectations Organizational Automatic behaviours Interpersonal Environmental contexts Individual www.preve-eu.org
  • 49. PROFILING THE PERSON www.preve-eu.org
  • 50. Constituents of personal profile Dimensions for user segmentation Dynamicity www.preve-eu.org
  • 51. INTERVENTIONS FOR BEHAVIOUR CHANGE www.preve-eu.org
  • 52. Principles of interventions • Primary aims: – Create or strengthen intention through other determinants – Increase abilities and remove barriers • Guiding principles: – Provide immediate, tangible, personally valuable benefits for healthy behaviours – Frame health-promoting messages in an appealing manner – Guide people with appropriate choice architectures – Take advantage of trigger events – Make changes on multiple levels by involving different actors – Identify co-creators of health and involve them in interventions www.preve-eu.org
  • 53. PROFILE Monitor trigger Risk factors events and profile Values & motivators updates Resources Channels Assess current Health behaviour Current behaviours Diet Physical Activity Alcohol consumption OK, no Support Smoking current risks behaviour/ Stress maintenance Sleep Mental well-being Risky/poor, Choosing need for behaviour change Identify determinants to appropriate target Intention per Lack of resources Strengthen interventions Evaluate progress, Strong (external, actual behaviour? resources outcomes and profile abilities)? updates Weak or nonexistent Not aware of risks Discouraging social Unfavourable outcome and benefits / Weak self-efficacy? environment? expectations? misconceptions? Strengthen social Improve self- Improve outcome Educate independence / efficacy and skills expectations increase support Execute the Select methods & tailor intervention the intervention Personal characteristics Problem Values & motivators characteristics Personal resources Co-creators Social environment Service environment Physical environment www.preve-eu.org
  • 54. Personalization of interventions • Targeting vs. tailoring – Targeting: designing interventions for subgroups with common characteristics – Tailoring: fitting an intervention to meet the personal needs and characteristics of a person rather than a group • The most effective approach, but traditionally costly • ICT could enable deeply personalized, cost-efficient interventions – A Do-It-Yourself (DIY) platform for profiling yourself and to select interventions that match your profile – Means for data entry, assessment, monitoring, context- awareness, feedback  personal guidance and motivation www.preve-eu.org
  • 55. Directions for ICT Research in Disease Prevention FP7-ICT-2009.5.1 – Support Action Task 2.4 – User Segmented Intervention Strategies Teresa Meneu UPVLC Universidad Politécnica de Valencia This project is partially funded under the 7th Framework Programme by the European Commission
  • 56. Main Objectives To put together the collected information from the previous tasks by: • Defining the primary prevention intervention model and differentiating its main dimensions. • Describing the disease – best intervention strategies matrix of T2.1 with personalization data resulting in a user segmented disease – best intervention strategies matrix. • Concluding the work in WP2 in valuable outcomes for the next phase of research. www.preve-eu.org
  • 57. Main Inputs T2.4 Intervention Logic and Profile Draft Primary Prevention Intervention Model & PERSONA’s WP3 www.preve-eu.org
  • 58. Primary Prevention Intervention Model DIY Profiler Broker Analyze Plan Trigger event Evaluate Execute PGS PHS www.preve-eu.org
  • 59. Personalized Primary Prevention Intervention Model DIY Which is the risk Profiler of the individual? Broker How to select/choose the intervention Analyze Plan strategy? Trigger event Evaluate Execute PGS How to assess the PHS How to put it in practice in evolution and provide the concrete readjustments? time/location/need? www.preve-eu.org
  • 60. Personalized Intervention Strategies Profiling Matrix Health behaviors Segments that would (and intention) benefit from behavior maintenance interventions No risk Segments in need of lifestyle change with Low risk different levels of urgency Examples of possibly unrealistic segments high High risk Resources low Motivators Life Stages www.preve-eu.org
  • 61. Profiling Matrix Dimensions Health behaviour is any activity undertaken by an individual which influences health outcomes. • Regardless of actual or perceived health status, the intention can be promoting, protecting or maintaining health, but the attitudes and behaviours can also be harmful, unsafe and damaging to health. Motivation must be present for a lifestyle change to happen and it has much to do about sustainability of the change. • The motivation refers to the reason or reasons for engaging in a particular behaviour and it may be intrinsic, extrinsic or both. The Resources are the tools present in the environment surrounding the individual at his disposal to carry out an interactive action. • There are internal and external resources and they can have a positive or negative influence in the intervention. www.preve-eu.org
  • 62. The 4th Dimension: Life Stages • Life Stages www.preve-eu.org
  • 63. From Profiling to Personalized Intervention Tailoring Profiling Personalized Intervention www.preve-eu.org
  • 64. Monitor trigger PROFILE events and profile Risk factors updates Values & motivators Resources Assess current Health behavior Channels Diet Current behaviors Physical Activity Alcohol consumption OK, no Support behavior/ current risks maintenance Smoking Stress Sleep Mental Wellbeing Student, motivated, healthy habits: She is a female. Risky/poor, need for behavior change She is 20 years old and a student. She lives in a city Identify determinants to 1. Student Strengthen and with her boyfriend. Her main values are: Yes target resources achievement, security, power and self-direction. Evaluate progress, outcomes and profile Intention per behavior? Strong Lack of resources (external or actual abilities)? 3. Middle age updates overdoing 2. Corporate Weak or nonexistent wellness Strengthen social Intervention Discouraging social Yes independence / environment? increase support Logic Aware of risks 5. Young old and benefits? person Improve self- Weak self-efficacy? Yes efficacy and skills Not aware / Male Adult, unmotivated, using services of Misconceptions 7. Obese child 4. Housewife community wellness: He is a male. He is 34 years Unfavourable outcome expectations? Yes Improve outcome expectations old and employed. He lives in a city with his wife. 6. Community wellness His main values are: security, tradition and Educate Execute the intervention benevolence. Select methods & tailor the intervention Personal characteristics Values & motivators Problem Personal resources characteristics Co-creators Social environment Service environment Physical environment www.preve-eu.org
  • 65. Conclusions COMPLEXITY OF THE DOMAIN • Specially in relation to the human nature and its natural reluctance to change a preferred, well established health behaviour, and the incredible high amount of factors and dimensions that need and must be considered to design an effective primary prevention intervention model. • This scenario poses a set of challenges where ICT technologies could definitively play a significant role: • acquiring the required information • tracing the evolution and changes of the person, its context and her risk profile • processing the enormous set of information to create practical decision support tools for the individuals. www.preve-eu.org
  • 66. Conclusions FULL PERSONALIZATION • Designing effective and sustainable primary prevention strategies is a very personal issue, even for similar risk profiles, the optimal way to manage to reduce or overcome said risk presents different faces depending on the concrete individual. • Different moments of life, different situations or events, present or past, would imply an instant need to recalibrate the intervention strategy as the things that were effective in the past may no longer be applicable. • The large number of relevant health determinants shows that interventions need to be tailored in order to meet the personal needs and characteristics of a person. In segmentation compromises would have to be made that would limit the potential success of the interventions. www.preve-eu.org
  • 67. Conclusions ICT ENABLING MULTILEVEL STRATEGIES • The number of theories is large but yet no one has proven to be the most suitable for all individuals and all situations. • Different scenarios may need a different approach or even a combination of those. • The inclusion of ICT technologies into the picture and the way it would affect the behaviours has not been extensively studied or validated and could cause differences in the efficacy on the different theories. • The use of ICT to support the interventions could dramatically change the limitations and boundaries that current intervention models have in relation to the selection or one or another strategy for behaviour change. www.preve-eu.org
  • 68. Conclusions PREVENTION ECOSYSTEM • Inclusion of third parties in the intervention cycle: co- creators • Some of the co-creators will truly interact with the individual in co-creating health. Others will participate through the choice architectures and defaults that they set through policies and other actions. • The influence of the environment is very strong and is dynamically present in the prevention model. • Co-creators need to be accommodated into the intervention strategies. www.preve-eu.org
  • 69. Directions for ICT Research in Disease Prevention FP7-ICT-2009.5.1 – Support Action Outlook Months 7 – 12 Niilo Saranummi VTT Technical Research Centre of Finland This project is partially funded under the 7th Framework Programme by the European Commission
  • 70. Completion of 3rd phase Workshops Barcelona Milan 16.3.2010 8.11.2010 Belfast 14.6.2010 31.11.2010 1.12.2009 Select the User White paper Business ICT Research diseases & segments & models and Directions in best Personal validation Primary practices profiles Prevention (T3.1 – 3) (T2.1) (T2.2 – 4) (T3.4) www.preve-eu.org
  • 71. Prevention of diseases CURRENT STATUS (CONTINUED) www.preve-eu.org
  • 72. The health co-production ECO-system Political, social, economic environment Co- Policies producers Incentives Barriers HealthGPS (digital avatar) Platform services (security, ID) PHR www.preve-eu.org
  • 73. The health-co-production ECO-system Three layer ICT Business Model • “App store” - Library of applications for managing health behaviours. – Built by community research and innovation – Maintained and certified by Patient-NGO’s – NEW business opportunity for SMEs • Platform(s) for ICT-services. – Built and maintained by enterprise vendors. – Specified and tested by EC in a (major) CIP-like project • The interoperability and security layer. – Specified by Standards and Directives. www.preve-eu.org
  • 74. Co-producers / co-creators of health personal trainers, restaurants, food markets, school, workplace, media, healthcare professionals ... www.preve-eu.org
  • 75. The environment matters ”Preloading” to create favourable conditions Society ”upstream” Communities Organizations Friends Individual & family ”downstream” www.preve-eu.org
  • 76. Examples of business cases who ”owns” the customer • Worried well & Fitness – Individuals pay out of their own pocket – Third party life insurance companies are interested • Corporate wellness – The company makes H&W services available to employees – Reduction in insurance premiums (sickness, retirement) • Society – policies – School wellness programs • Integrated care providers (e.g. Kaiser Permanente) – If prevention is the best strategy it will be in the interest of IC providers to keep patients out of hospitals • Health-related consumer goods & service industries – Food & beverage – Sports & fitness – Media & edutainment – Consumer electronics www.preve-eu.org
  • 77. PREVE specific impacts • Facilitating the development of prospective aspects of ICT-enabled prevention of diseases – “White Paper” – ICT research directions • Reduced hospitalisation and improved disease management and treatment at the point of need, through more precise assessment of health status – Proactive health management, i.e. Primary prevention • Economic benefits for health systems without compromising quality of care – Freeing scarce resources to the care of the ill • Reinforced leadership and innovation of the industry in the area of Personal Health Systems and medical devices. New business models for health service providers and insurance sectors – Health behaviours, Personalization, Networked business models, N = 1, … • Improved links and interaction between patients and doctors facilitating more active participation of patients in care processes – Co-creator network, Individual + Environment • Accelerating the establishment of interoperability standards and of secure, seamless communication of health data between all involved partners, including patients – Continua, HL7 contacts www.preve-eu.org
  • 78. PREVE partners Valtion teknillinen tutkimuskeskus, VTT Aarhus University Fondazione Centro San Raffaele del Monte Tabor Universidad Politécnica de Valencia