Personalized Healthcare Self-management

Using Social Persuasion

Hamid Mukhtar1, Arshad Ali1, Sungyoung Lee2, and Djamel Belaıd3

1 National University of Sciences & Technology (NUST)Islamabad, Pakistan

{hamid.mukhtar,arshad.ali}@seecs.edu.pk2 Department of Computer Engineering, Kyung Hee University

South Koreasylee@oslab.khu.ac.kr

3 Institut Telecom; Telecom SudParis, CNRS UMR SAMOVAREvry Cedex 91011, France

djamel.belaid@it-sudparis.eu

Abstract. In this article we propose our framework for healthcare self-management that combines ubiquitous and social computing as persua-sion media. The framework enables social interactions between the pa-tients, doctors, and other users in their online social community througha web portal as well as through their smartphones. To help users inadopting healthy behavior, they are monitored for various activities andpersuaded using different persuasion strategies that are adaptive and areaccording to user’s behavior. Persuasion strategies are applied using per-suasion profile of a user. A behavior model of each user is created that isbased on Fogg’s behavior model but also encompasses user preferences,health profile and social profile.

1 Introduction

Most of the recent research in healthcare management focuses on self-managementof chronic diseases. Future environments are envisioned to be populated withcomputational technology that adapt to meet the needs of individual users. How-ever, such technologies will be effective only if they can be utilized properly bythe users. For this to happen, the networks, services and devices must be de-signed to be persuasive.

BJ Fogg defines persuasive technology as ”any interactive computing systemdesigned to change people’s attitudes or behaviors” [1]. Persuasive technologyhas been used in healthcare management including self-management of chronicdiseases. For this purpose, various persuasive strategies are devised that areapplied to patients to increase their motivation or change their behavior.

When developing applications and frameworks for healthcare self-management,we must consider additional design requirements in addition to those required bynormal application design [2]. First, the application should strive to encouragethe user to change attitude or behavior toward healthcare management. Second,

M. Donnelly et al. (Eds.): ICOST 2012, LNCS 7251, pp. 66–73, 2012.� Springer-Verlag Berlin Heidelberg 2012

Personalized Healthcare Self-management Using Social Persuasion 67

the application should help the user in determining and specifying healthcare-related goals as well as remind the user of achieving specific goals over time.Third, the application should support the user’s objectives and goals by sharingrelevant experiences from other persons in the user’s social network; this in-cludes user’s family, friends, care takers, and doctors. In this article, we presentour framework for persuasion in healthcare using social interactions. The inter-action with the framework takes place via the most common social interactionplatforms, namely, web and mobile devices.

The rest of the article is organized as follows. In Sect. 2, we provide an overviewof recent work in persuasive healthcare. In Sect. 3, we present our framework forpersuasive healthcare and in Sect. 4 we describe the persuasive strategies usedby our framework. We then briefly describe our implementation in Sect. 5. Weconclude this paper with description of future work in Sect. 6.

2 Related Work

In the domain of healthcare alone, persuasive technologies have been used formotivating healthier behavior using smartphones [3], for motivating elderly in-dividuals to walk [4], for encouraging social and physical activities [5], for self-management of chronic diseases such as diabetes, stroke, Alzheimers, etc. [6].

Another important dimension is the social aspects of healthcare self-management. Due to recent popularity of social networking websites, researchershave found it very useful to use mass interpersonal persuasion strategies for pro-moting positive behavior in people of different age and gender and belonging todifferent cultures [7]. Thereafter, various researchers have used online Web- andsocial-media based strategies for persuasion. For example, using Web to supportself-care of type 2 diabetes [8], preventing school dropouts using online media [9],and bringing web-based interventions for preventing alcohol and smoking [10].Hence, persuasive technology based on social media is a very powerful tool forbringing about positive behavioral changes in individuals’ lives.

Zhang et al. [11] has proposed a comprehensive healthcare infrastructure thatinclude various context-based personalization services as well as a service inter-operability platform. However, personalization does not include patient’s history,expert’s intervention or identification of patient’s target behavior during recom-mendation, all of which are important aspects of our framework.

If we look these different approaches of assisting patients for healthcare self-management, we find emphasis on only monitoring the patient’s data and thensome pre-defined, generic feedback is sent to the patients. A patient is only ad-vised in some traditional way and then it is left to the patient how to adoptthese changes in daily life. Any automated system designed for patients shouldbe able to identify a patient’s lacking behavior and then it should include notonly assistance but help patient motivate in that aspect. It is particularly thisaspect that we have contributed in this article. Compared to the existing ap-proaches, our social persuasion uses adaptive strategies that depend upon theuser’s context, preferences, and his profile. In the remaining article, we will showhow these factors can lead to personalized healthcare self-management.

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Fig. 1. Stages in the Intelligent Healthcare Self-Management

3 Framework for Persuasive Healthcare

The basis for our persuasive healthcare framework is monitoring-assessmentmodel that consists of eight stages as shown in Fig. 1. Figure 2 shows the variouscomponents of the framework that roughly correspond to the different stages ofthe model shown in Fig. 1 and explained as following.

Context. For monitoring of user activities, we need to collect data regardingactivities and behavior from the user on regular basis. In order to be able tolearn about the user behavior and to reason on them, we need to know aboutthe context in which an activity is performed. By context we mean any relevantinformation that can help us in determining the type of activity, the state of theuser and the surrounding environment. Some of the context variables have beenidentified in Fig. 2.

Behavior Modeling. The behavior model of a user not only allows in understand-ing the user, but also helps in proposing him personalized recommendations andpersuasive strategies for behavior change. The behavior model is built usinguser’s preferences, health profile (including diet, exercise and physical activities)and their social profile. In the literature, a number of behavior theories and mod-els have been defined, however, Fogg’s behavior model [12] has been designedprimarily for persuasive behavior design and, being a generic model, is also be-ing used for behavior change in our framework. Fogg has identified three factorsthat are necessary for behavior change in his behavior model. These factors are:motivation, ability and triggers. Our behavior model uses these factors to devisethe appropriate persuasive strategies for behavior change.

Social Interaction. A user’s social profile is constructed from his interaction withother persons in his social network. These include family members, friends, col-leagues, doctors, and other persons having shared interests with the user. Socialinteraction plays an important role in persuasive healthcare management. First,social interactions allow a patient to learn from experiences of other users (orpatients). Second, the behavior of a person is determined and controlled signifi-cantly by others around them and his behavioral intentions are influenced by thesocial norms [13]. Third, social interactions can be very helpful in interpersonalpersuasion [14]. That is why social interaction plays a constituent role in theuser behavior model in our persuasion framework.

Personalized Healthcare Self-management Using Social Persuasion 69

Fig. 2. The Framework for Intelligent Healthcare Self-Management

As shown in Fig. 2, users interact with the framework either through mobiledevices or through a social portal. As we can see, mobile device is primarily usedfor data gathering related to user activities, but it can also be used to conveyvarious persuasive strategies to the user for behavior change. The Web portalis more oriented towards social activities, but it is also a means for the user tolearn from the experiences of others and for experts to analyze the user’s dataand to intervene on need-basis.

Rule-Based Analysis. Analysis in our framework is based on rule-based infer-encing which is a method of generalized knowledge representation that deducesthe proper result by expressing and selecting the knowledge in a way similar tothat of human experts. The system can propose persuasive strategies only if ithas the domain knowledge of a particular chronic disease (e.g., knowledge aboutdiabetes). The domain knowledge is obtained from various clinical guidelines forhealthcare defined by standard bodies such International Diabetes Federation(IDF). For the knowledge to be useful and consistent, it must be validated bythe experts.

Expert’s Intervention and Recommendations. Rules are defined by the experts(doctors). Without experts’ input, the knowledge base cannot be maintainedand verified. As our knowledge base evolves, new rules may be added or existingones may need to be updated by the experts for consistency. For this purpose,experts are provided an interface for adding, updating or deleting rules. Thus,a suggestion to a user is actually the application of a rule previously defined bysome doctor.

Persuasion Profile. Each patient can be persuaded in a way different than others.Persuasion profiling is used to track which mode of argument is most persuasive

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Fig. 3. Persuasion Strategies using System, Social network and Experts

for each person. A persuasion profile is unique to each user and depends onvarious factors such as user preferences, behavior model, social profile and targetbehavior. For some users, persuasion by experts is more beneficial while othersare more persuaded by social means.

4 Persuasion Strategies

A persuasion strategy is used for matching target behaviors with solutions forachieving those behaviors. A number of generic persuasion strategies have beendescribed in the literature, e.g., in [15][16]. Moreover, various specific persuasivestrategies have been used by numerous researchers who have reported positiveresults in areas such as the management of smoking cessation, obesity, asthma,stress and insomnia [17], healthier eating [18] and directing users towards properexercise behaviors [19] among others. All of these approaches target behavioralchanges in the end-users through some persuasion strategies. Figure 3 describesome persuasion strategies and here we briefly outline how these strategies areused in different contexts.

4.1 Persuasion by the System

The persuasion profile of the user is used to propose strategies according touser’s behavior and social profile considering their preferences and activities.The persuasion profile is combined with the context information and rules fromthe rule base to decide on the target behavior. The assessment of user’s previousactions are also analyzed and taken into account before suggesting a targetbehavior. As shown in Fig. 2, a target behavior is translated into a target actionfor the user. A persuasion strategy is then designed that adapts the user interfaceaccordingly.

Let’s consider the example of the commitment strategy, which states thatwhen a user commits to achieve a goal, he is motivated to carry out the related

Personalized Healthcare Self-management Using Social Persuasion 71

(a) The application wid-get running on the homescreen of phone and thedifferent persuasive strate-gies used by the applica-tion

(b) The website for persuasive social inter-action

Fig. 4. Mobile and web interfaces for social persuasion

activities. The system initiates commitment by helping the user to set goals.Similarly, the patient is also persuaded through reminders and context-basedsuggestions so activities can be performed with reduced effort.

4.2 Persuasion in Social Context

Encouraging activity through the social support of friends and family can bea powerful motivator to change behavior and inculcate healthy habits. Somepersuasive strategies applied in the social context are as follows.

People like to hear stories from others. Narrative strategy is used to evoke theconcept of sharing positive things with social contacts. This is also connectedto the achievement strategy whereby describing an achievement, e.g., attaininga goal, excites the patient to do more. Similarly, an example of the social proofstrategy is that the fact that most of the people in the social contacts performregular exercise persuades the patient to start doing the exercise.

4.3 Persuasion by Experts

A recommendation by some official or authority weighs more than the one byfriends or colleagues. Healthy tips and recommendations by doctors are sharedwith more prominence. Similarly, a doctor’s recommendation is personalized ac-cording to the patient’s profile, which gives him more confidence and motivationin achieving the goal.

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5 Framework Implementation

Our implementation consists of a user-end smartphone application for the An-droid platform. The foremost persuasive strategy in the application design isthat the application has been created as a service that runs inside an Androidwidget. Being a widget means that the user does not need to explicitly start theapplication to use it; nor the user needs to remember to use the application. Thisis because the application always remains on the home screen of the smartphone.It starts automatically and is brought onto the screen whenever the user unlocksthe phone for making/receiving calls, sending/receiving SMS, and for checkingemails or agenda. Being a service means that the application continuously moni-tors user activities and updates the user on regular basis about any notificationsor events from the social network or experts. Figure 4(a) shows our applicationwidget and the various persuasion strategies used by the application.

Figure 4(b) shows the social website through which the users interact with oneanother. The users can set their goal for behavior change or the system can pro-pose some persuasive strategies for behavior changes. Similarly, users can viewtheir health status as time-line along with the changes that occurred. Experi-ences from other users are shared in a persuasive mechanism via the previouslydescribed strategies.

6 Conclusions and Future Work

This paper focuses on the usage of two of the most widely used technologies –smartphones and social networks – as a tool for personalized healthcare manage-ment; particularly we considered the case for diabetic patients. Our frameworkcombines the persuasive benefits of the worlds of ubiquitous and social comput-ing to help patients and caregivers healthcare management. The smartphonesare used to monitor the patients, collect the data, and help them in adoptinghealthy behavior through persuasion without the need of some relevant expert.Since social activities are equally important for a patient suffering from a diseaseor illness, our system also makes use of social computing for influencing users toachieve their goals. In this process doctor is also involved in analyzing patient’sdata and then suggesting and motivating them to cover the weaker aspect.

Currently, we have implemented our framework as an integration of our ownAndroid-based mobile application and social portal. We aim to integrate ourframework into existing social networking websites such as Facebook or patient-specific websites such as PatientsLikeMe (www.patientslikeme.com). Moreover,considering the huge amount of data that is generated from users’ activities andthat is to be processed by our system, we need to devise a scalable solution bydeploying our system on a cloud platform.

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