Frontiers in Public Health (Oct 2015)
Digital technologies to generate health awareness
Abstract
Background: It is well known that most chronic diseases are the result of an unhealthy life-style. Nevertheless, it appears to be very difficult to motivate people to adopt more healthy habits. Even after receiving a diagnosis of a chronic disease, these habits seem to be too strong to overcome by most people. This mechanism of strong, stable patterns of behavior can be very well described and explored by using complexity science. This field has come up with concepts and tools to study the dynamical behavior of such patterns. An important example is the critical transition, and the methods to predict the occurrence of such critical transitions. Even more important will be developing methods to generate awareness about these transitions and the trigger points involved, that can be used by patients and consumers to improve their health and prevent chronic diseases from occurring. Awareness about the complexity of interactions between biological, psychological, social and environmental health determinants is also crucial for implementing health promotion programs. This presentation will discuss several tools that we designed to generate health awareness, based on a complexity science approach. Furthermore, the implementation of these tools in three use cases is presented: an integrated overweight treatment program, a systems dynamics model of employer health, and HealthCafé for empowerment and inspiring health. Description: A first step in improving health awareness is to connect the bits and pieces of health information that are out there in the literature. A shift is needed from considering all the separate health determinants towards considering the relationships and dynamics between the determinants. An enriched causal loop diagram was developed related to health and overweight using a TNO tool called MARVEL. MARVEL is specifically designed for group model building purposes with an easy to use interface and the possibility to construct models on the fly. A group of scientists from various disciplines (nutrition, systems biology, mathematical modelling, social psychology, cognitive psychology, physiology, movement sciences) came together in several sessions to construct a biopsychosocial model which could be used to explore the cross-domain interactions, feedback and feed forward loops. This model was presented to a rehabilitation center and used to develop a multidisciplinary program for the treatment of overweight. A team consisting of a psychologist, physician, movement expert, nutritionist and Chinese medicine practitioner prepare a personalized program for each individual, aiming for an optimal motivation of the person to change life-style habits. A pilot study was started in April 2015 with 10 participants. A systems perspective on health in which physiological, mental, psychological, social, and spiritual aspects that are important for the individual are combined into a treatment plan is essential. The first results of the pilot study are now available. A similar approach was taken for addressing workplace health. A groups of companies came to TNO to work on methods to improve the health of personnel. To gain insights into the mechanisms of workplace related health a systems dynamics model was constructed centered around vitality. Vitality consists of three key determinants: motivation, energy and resilience. The resulting model illustrated several important mechanisms. One of these mechanisms is the interaction between conditions and demands and how the balance between the conditions and demands can lead to either to an experience of challenge or stress. The model also shows interactions between physical, mental, emotional and social components of health. These mechanisms were then incorporated into a workshop conducted with one of the companies. This workshop is another tool in which a dynamic set of interactions between several experts and stakeholders is organized with the aim to develop new business cases. In this case the new business cases are designed to improve the health of employers. A third use case for improving health awareness is the launch of a HealthCafé. The aim is to inspire people to measure their own health and measure the effects of interventions on their health, using all sorts of do-it-your-self technologies. The current version of the HealthCafé offers first of all a physical location where people can interact. It also offers devices such as activity trackers, glucose and cholesterol measurement devices, questionnaires, and a personal internet portal to store and analyse the data. The goal is to empower people and give people more control over their own health. Conclusions: Complexity science offers new opportunities to create health awareness. We have shown how a systems dynamics software tool can be used in group model building sessions to generate a shared understanding of a health problem among stakeholders. The resulted in a successful integrative overweight treatment program at a rehabilitation centre in the Netherlands. The HealthCafé was launched as a living lab which can be used by people to explore their own health and conduct studies on themselves. These activities are aiming for a transition in health care towards more awareness as the personal level, empowerment and thereby increasing the chances for successful life-style changes towards more health and happiness.
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