Abstract
This chapter describes the development of a theory-driven and evidence-based digital intervention to facilitate self-care in older adults with Type 2 Diabetes (T2D) and, additionally, its contribution to healthy aging and the individual care plan. T2D is highly prevalent in older adults. Difficulties in adopting and maintaining desirable self-care behaviors is associated with lack of glycemic control and subsequent complications, which significantly burden patients, their families, and the health system. The VASelfCare (Virtual Assistant Self-Care) intervention is a software application that provides an interface with a 3D anthropomorphic virtual assistant targeting three key self-care behaviors: medication-taking, physical activity, and a healthy diet. Other VASelfCare elements are intended for nurses providing diabetes consultations, including a web-based back-office with a patient data dashboard, which streamlines integration of care. The application prototype has been co-produced with older adults with T2D, primary care health professionals, and other stakeholders.
TopIntroduction
The main objective of this chapter is to describe the development of a theory-driven and evidence-based digital intervention to facilitate self-care in older adults with T2D. Secondary objectives are presenting the contribution of the newly developed digital intervention to healthy aging and the individual care plan.
Our current lives are permeated by ‘e-solutions’. Full digitalization is reaching all domains, including healthcare. Chronic conditions and their long-term treatments, such as the highly T2D, place a high burden, both individually and societally. Elderly T2D patients, due to the disease mild symptoms in the first years and its complex approach, tend to impinge on treatment adherence and lifestyle changes. Developing automatic and distant healthcare monitoring ‘e-solution’, tailored to incorporate useful information features as well as to increase motivation, is an excellent opportunity to have a positive impact on patients’ behaviour, care plan outcomes and quality-adjusted life years.
The systematic and structured development of this digital self-care intervention is not only expected to maximize its likelihood of success and facilitate potential replication but may also inspire others researching the field.
Health care professionals may equally find the chapter valuable, as it illustrates how the use of a self-care application can enhance the care plan in face-to-face consultations, through shared clinical data. The fact that behaviour change techniques (BCTs) operationalization is exemplified within the application offers useful insights into its transferability to these consultations.
The chapter is composed of several sections. It starts with a background section, which provides information on healthy aging, as well as the epidemiology of diabetes and its clinical and economic impact, namely in older adults. Next, the evidence on the impact of mobile health in chronic disease management is discussed, focusing then on mobile applications to support diabetes self-management. The background section finishes with a brief description of applications based on relational agents.
The second section is about the VASelfCare project. It puts the project into perspective in the wider context of technology-based interventions, explains the methodological framework and describes the theoretical approach taken.
The third section presents the VASelfCare intervention design. It provides an account of the dialogues structure and creation and details how standardized behaviour change techniques were selected and operationalized.
The fourth section describes the VASelfCare prototype. Firstly, a general description of the prototype is provided, including its different views and the back-office dashboard. Then, the authors offer an overview of the technical aspects of the prototype architecture from an informatics standpoint.
The section that follows reports data on the involvement of target users in defining the application pre-requisites.
The sixth section deals with the potential value of VASelfCare to the individual care plan.
The conclusion section summarizes and discusses key points and elaborates on future research directions.
Throughout the chapter the authors resort to an extensive list of references, offering an overview on contemporary topics related to the development of self-care digital interventions, helpful for those seeking an update in the field. Moreover, the chapter provides visual presentations, including diagrams, VASelfCare print screens and graphs, to make information easily understandable to readers. Furthermore, suggestions on additional readings are offered for those interested in expanding their knowledge. Key terms are succinctly defined in a final section.
Key Terms in this Chapter
Patient Empowerment: Actions aiming to educate an individual about one’s disease, to promote shared decision making with professionals, in the extent desired by the individual, and to encourage self-management.
Electronic Health (e-Health): Provision of health care services or information exchange in the health context through computers devices and related technologies (e.g. the internet).
Mobile Health (M-Health): Provision of health care services or information exchange in the health context via wireless devices (e.g. smartphone, tablet, smart pill boxes) and related technologies (e.g. 3G and 4G systems mobile telecommunications, global positioning system, Bluetooth).
Co-Production of a Digital Health Product: Involvement of primary users (and often other stakeholders) in product design or testing. The degree of involvement may vary from incorporating feedback to participation of users in research and development teams.
Application (App): A computer program or group of programs designed for users, which rely on low-level computer programs to work, such as operating systems.
Digital Health Product: A product with an ultimate therapeutic purpose that works on computers or via the internet.
Relational Agent: Anthropomorphic virtual character designed to build rapport with users over time and establishing long-term relationships.
Older Person: Any individual aged 65 years or more.
Self-Care: Tasks performed by an individual to maintain or restore one’s health and to deal with disease, with or without the support of health professionals. It comprises, but it is not limited, to self-prevention, self-diagnosis, self-medication and self-management of disease and disability.
Self-Management: Tasks performed by an individual to minimize the impact of one’s disease, with or without the support of health professionals. Tasks can holistically be categorized under medical management (e.g., taking medication, adhering to a diet, engaging in physical activity), role management (e.g., redefining life roles in light of a chronic disease) and emotional management (e.g., dealing with anger and frustration), and are related to a set of skills.
Technology: Application of technical processes or scientific knowledge for practical purposes.