The Prescription Mobile App For Chronic Disease Management

PRESCRIPTIVE APPS: Delivering therapeutic behavioral care to chronic disease patients, enabling personalized self-management of diet, fitness and stress.

Michael Eckersley, PhD

Designing a wellness economy

THE PRESCRIPTION MOBILE APP: Productizing

behavioral care for people managing a chronic

disease and needing behavioral therapeutic

support

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This work is licensed under a Creative Commons Attribution 3.0 Unported License.

http://creativecommons.org/licenses/by/3.0/


Acknowledgements

The following summarizes research and design planning undertaken by Interaction Design and Design Management students at The University of Kansas, over Fall 2012 and Spring of 2013. The project was developed and directed by Michael Eckersley. The initial work was presented December 4, 2012 at the KU Center for Design Research, Lawrence, KS. Subsequent development, editing and integration was undertaken independently by Michael Eckersley thru HumanCentered, an independent research and design-‐planning consultancy, and published online June 12, 2013.

Contributing Authors:

Design Management Team: Peter Henne, Nicolette Niosi, Justin Powell, Todd Register, Adam Roush

Interaction Design Team: Amanda Boyd, Ren-‐Wei Harn, Tyler Lagally, Noah Albro, Casey Franklin, Karen Moore, Nicolette Niosi, Caitlin O'Connor, Trey Toman, Lauren Bock, Kaitlynn Howell, Sera Lanzer, Nicole Luby, Megan Miller, Nick Troll, Whitney Whallon

Scenarios & Simulations Team: Petter Henne, Nicoletta Niosi, Todd Register, Adam Roush

Program Sponsor:

Thanks to Bayer Healthcare for their support of the KU Center for Design Research.

Contact: [email protected] or [email protected]

0. Acknowledgements 2

1. Introduction & Background 3

2. Research Question, Chronic Disease Literature 5

3. The Project Twofold Objective 9

UX Scenario 1: “‘Ben’s’ Story” 10

4. On Human-Centered Design Innovation 11

5. Researching and Modeling the User/Patient 13

UX Scenario 2: “‘Eleanor’s’ Lifestyle Change” 16

6. Market Analysis:Consumer Behavioral Health TrendsPersonal Health Devices Consumer Market MapMarket Analysis: Current Device UX vs. Benchmark UX In Personal Health Devices

17

8. Business Modeling: Stakeholder MapsProposed Managed Care System MapSolution Strategy

20

UX Scenario 3: “‘Joe’s’ Osteoarthritis” 23

9. The Consumer App Suite: Early Development : Top-Level Device UI Wireframe, Navigation

24

10. The Nutrition App: Features, Concept Wireframe, UX Use-Case

25

11. The Stress Management App: Features 27

12. The Fitness App: Features, UX Use-Case

UX Scenario 4: “Adam’s Resolve” 32

13. Bibliography 33

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Contents & Acknowledgements

mailto:[email protected]

mailto:[email protected]

mailto:[email protected]?subject=email%20subject

mailto:[email protected]?subject=email%20subject

1. Introduction Background

This research builds on earlier research and design planning from 2009 involving "Service Tools For Innovating Chronic Disease Management". The present study explores a model and a technology platform for delivering effective personalized behavioral therapeutic care to people suffering from, or at risk for, chronic disease, with the purpose of helping them better self-‐manage their diet, îtness, and stress.

Treatment and prevention of chronic disease is a largely under-‐utilized component of Public Health policy and of the U.S. Affordable Care Act. By modifying the behaviors, lifestyles and cultural norms contributing to excessive rates of chronic disease, overall healthcare demand can be reduced signiîcantly, thereby making health care more efîcient, more affordable and ultimately more humane.

The governing agent in reducing chronic disease generally is consumer behavior. Therefore, effective treatment programs and incentives should be developed by managed care providers to help consumers better govern their behaviors, thus preserving their health and better ensuring their own economic security and quality of life. Modest reductions in preventable risk factors could result in 40 million fewer cases of chronic disease, and an aggregate savings of more than $1 trillion by 2023. Stemming the demand for

avoidable health care services is the silver bullet in any serious, sustainable health care solution.– Michael Eckersley, “Solving The Economics of Health Care: How Employer-Provider Partnerships Are Producing Cost Savings and Healthier People”

CMS

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source: Centers for Disease Control. CDC's Healthy Communities Program. Brochure. Atlanta: Author, 2011. Cdc.gov. 2011. <www.cdc.gov/healthycommunitiesprogram/communities/pdf/hcp_brochure.pdf>.

http://www.slideshare.net/mindcentric/innovating-a-new-health-care-service-compact-1837376

http://www.slideshare.net/mindcentric/innovating-a-new-health-care-service-compact-1837376

http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html

http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html

About Chronic Disease

Chronic diseases comprise a group of noninfectious, long term, often preventable, and their worst effects are often avoidable. For our purposes, they include Cardiovascular Disease, Diabetes, COPD, Cancer, Asthma, and Liver Cirrhosis. Though others, such as Crohn's Disease, Epilepsy, Hypertension, Arthritis, Chronic Pain, and Parkinson's Disease are often included in the list of chronic diseases. Determinants include poor diet, inactivity, obesity, smoking, psychosocial stresses, genetic predisposition. Causes or compounding factors include lifestyle choices and behaviors, lack of regular health checkups and preventive care. Chronic diseases cause over 80% of deaths in the US, according to the National Center for Health Statistics, 2006.

An aggregate focus on chronic disease makes sense from a public health, medical management perspective given how many of the same behaviors or lifestyle features are contributing factors. Though each disease has its own distinguishing pathology and set of expressions, many chronic diseases share many of the same basic treatment elements.

Source: Newsweek Web ExclusiveSource: The Miliken Institute

Source: National Center for Health Statistics, 2006

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Background

Change Motivation and Cognitive Behavioral Therapy

Because behavior and lifestyle factors are common contributors to chronic diseases, appropriate modiîcation of those behaviors can aid in treatment. Cognitive behavioral therapy is a psychotherapeutic approach useful in treating dysfunctional emotions, maladaptive behaviors, and cognitive processes by means of a number of goal-‐oriented, explicit and systematic procedures. Based on a set of basic principles and techniques, cognitive behavioral therapy can be an effective tool in helping anyone reduce body weight, improve diet, and better manage stress.

The is a transformational process for the individual and it typically involves the following goals:

1. Compliance to treatment plan2. Symptom Reduction3. Healthy self perceptions (i.e., lifestyle, activity level, life meaning, spirituality), and perceptions of the illness4. Acceptance of loss of pre-‐illness sense of self, lifestyle-‐-‐both in the patient and his/her partner*

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2. Research Question Q: What kinds of tools or aids could afford chronic disease patients the ability modify the behaviors or lifestyle habits (e.g., poor diet, overeating, inactivity, stress, poor habits) that contribute to their disease and hinder recovery?

A transformational journey

*Treatment of Chronic Medical Conditions, Len Sperry, American Psychological Assn., 2008

Awareness:Knowing what their dietary habits are, and how those are affecting their health.Becoming aware about their ability to control their health through choice.Knowing they aren't alone.

Relevance:Understanding the affects food choices make on their health, and being able to visualize that.Doctors or dieticians being able to interact with patient choices.

ConEidence:Gaining motivation through feedback, friends, and facts.Being in control of their own health and weight.Knowing that they has the tools to make healthy choices.Knowing that they are able to track their information easily in a way which îts their life.

Satisfaction:Seeing results both in numbers, and photos.Being able to connect with others and share their success.

Source: A Persuasive Model for Behavioral Design (Fogg, 2009)

An ethnographic photography of food intake allowed patients and clinicians the opportunity to re^lect on patient’s dietary issues, understand the context of these problems, and gain awareness of habits that contributed to unhealthy diet (Keller, Fleury, & Rivera, 2007).

Another study found that dietary self-‐monitoring(i.e. self-‐weighing and keeping a food journal) was associated with more successful weight loss over a 12-‐month period (Kong, et. al., 2012).

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Behavior ModiEication and Diet What People Need To Break Unhealthy Diet Patterns

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Behavioral Issues • Inadequate breathing patterns• Insufîcient ^luid intake• Poor appetite, eating habits, & nutrition• Sleep disturbances• Substance abuse• Inadequate or inappropriate exercise

Psychological Issues• Fatalism• Chronic Impatience• Sustained stress• Protracted grieving• Depression• Absence of purpose & goals• Lack of self-‐assertiveness• Lack of trusted support• Poor coping ability in times of crisis

Medical Issues• Repeated exposure to sickness• Limited capacity for self-‐care when sick• Limited involvement in health-‐related issues• Passive, uninformed relationship with

primary care providers

Source: Jeffrey M. Leiphart, Ph.D. University of California, San Francisco, HIVInSite: www.hivinsite.ucsf.edu

• Type "A" personalities are encouraged to develop and maintain regular routines of "deep relaxation"

• Patients with chronic high-‐level stress are encouraged to develop a concrete plan to ameliorate the identiEiable sources of stress in their lives

• Patients need to learn to be aggressive about deElecting stress

• Patients with inadequate breathing patterns are instructed to practice simple deep-breathing exercises

• Moderate exercise-‐a walk of 20 minutes' duration three times a week, for example-‐will reduce psychological stress and improve immune function (Fitness Section)

• Patients should be able to discuss their health status on a regular basis

Stress and Chronic Disease

Elements of Stress Reduction Counseling

How Stress Affects the Heart• Heart rate increases• The rate of blood ^low speeds up, increasing blood pressure• Fatty acids are released into the bloodstream for energy,

increasing cholesterol and triglyceride levels• Cortisol is continuously released into the bloodstream during

times of chronic stress, affecting the where the body stores fat -‐ most commonly in the abdomen.

http://www.hivinsite.ucsf.edu

http://www.hivinsite.ucsf.edu

8

Fitness and Chronic Disease BeneEits of Quick Exercise Routines in the Workplace

• Simple cardio routines do not require any equipment at all.

• Exercise can boost endorphin levels, relieving stress and providing a boost to their self-‐conîdence, which can beneît job performance.

• Desk jobs also increase the strain on your back, wrists, eyes and neck.

• Research shows that a quick îve-‐minute workout can have a positive effect on stress, body weight and energy levels.

Fitness is more than losing weight.

• Cardiovascular Fitness reduces chances of heart attack

• Muscular Strength ensures mobility and independence

• Balance reduces fall-‐related injuries

• Flexibility yields freedom of movement in simple tasks

• Body Composition increases more energy and improved mood

Source: http://www.nia.nih.gov/health/publication/exercise-physical-activity-your-everyday-guide-national-institute-aging/chapter-5

“Marty's ‘Exercise Buddies’ Keep Him Going”

"Every morning I head out to the mall — not to shop, but to join my mall-‐walkers group. At 75, I’m one of the youngest members. When I retired, my wife Harriet insisted that we walk every morning. Some of us move at a steady clip through the mall, while others take a slower pace. We count our laps and keep a daily record of our progress — pushing ourselves to go a little faster, a little farther.

When Harriet died unexpectedly, it was quite a blow, but the walkers were my lifeline. They kept me moving when all I wanted to do was sit. At îrst, I walked because it was something to do each morning. But now, I realize that I like how it feels to be moving. Measuring how fast I can walk gives me goals, something to work toward. I walk and feel stronger every day. I often think of Harriet and silently thank her for insisting that we walk together."Source: http://www.nia.nih.gov/health/publication/exercise-‐physical-‐activity-‐your-‐everyday-‐guide-‐national-‐institute-‐aging/chapter-‐5 (2011)

Making Fitness More Social

http://www.nia.nih.gov/health/publication/exercise-physical-activity-your-everyday-guide-national-institute-aging/chapter-5










3. The Project Twofold Objective

Objective 1. Integrated Personalized App Suite. Create a product/service application available by physician’s prescription to chronic disease patients, enabling them to set goals and track progress in relation to physical activity, diet, and stress, thereby improving general health and îtness.

Objective 2. Business Model and Channel Strategy. Introduce a new, high value product/service offering into the personalized health care marketplace as part of a provider-‐deîned medical management plan and treatment formulary that incorporates real-‐time back-‐end connectivity to the patient’s medical record.

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User Experience Scenario 1: “‘Ben’s Story”A user experience scenario*

“downloaded from the future” tells

the story of “Ben”, a 28 year-old

athlete who confronted a personal

health crisis in the form of Type 2

diabetes diagnosis.

https://vimeo.com/61838968

“Ben’s Story”

* Product/service user experience scenarios help teams see the context in which a new idea or offering could play out in the marketplace and in the lives of customers. These advance snapshots enable decision-makers to assess the merits of a value proposition, assess its implications and make better a priori business decisions.


















Design is all about looking carefully at qualities of human experience, understanding the context of practical considerations involved, then designing things–products, services, experiences–that create new value for people, change markets, transform industries. In the words of Tom Peters, "Design is only secondarily about pretty lumpy objects, and primarily about a whole approach to doing business, serving customers, and providing value." Thereby, “(d)esign has become central to enterprise strategy."

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4. On Human-Centered Design Innovation

“The human-centered approach puts people’s needs Eirst, technology second. It focuses upon human activities. It makes the technology invisible, embedded within activity-speciEic information appliances. Simple, powerful, enjoyable.”

–Donald Norman

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On Human-Centered Design Innovation Every business has a front stage and a back stage. The front stage comprises everything about the brand offerings that is discernible to customers and to the public. The back stage is made up of all the people, processes and operations behind the scenes that deliver everything that happens front stage-‐-‐good, bad and in-‐between.

Great product/service experiences must be understood, developed and delivered as an integrated system solution, not as discrete, individual parts. This involves a process of discovery, synthesis, construction, and reînement:

1. Discovery. Identifying the environment, customers, and stakeholders. Understanding essential organizational intent and core competencies. Discerning brand perceptions market conditions. Clarifying points of intersection or interface between company and its various constituencies: e.g., markets, customers, stockholders, competition.

2. Synthesis. Making deep connections with both customers and internal stakeholders. That means clarifying various customer types: i.e., their characteristics, expectations, goals, tasks, options. That means mapping pathways processes, customer journeys, points of friction. It also means getting a clear îx on the organizational culture. Who’s involved and engaged? Who’s not? What are prospects for change?

3. Construction. Great product/services experience means understanding customers deeply: Building user personas and archetypes, stories; understanding crucial service moments; clarifying value aspects; prototyping ideas; creating practical value scenarios; planning and rehearsing customer interactions.

4. ReEinement. Every piece in this performance has to be piloted, assessed, tweaked, communicated, documented, and revised as necessary.

Start here

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5. Researching and Modeling the User/Patient Ethnographic User Research of Chronic Disease Patients

Individuals with one or more chronic disease were interviewed by students to explore the user experience of the disease, symptom management, and assess general and speciîc requirements. Information and insights from these interviews were helpful in constructing basic user persona models of two typical chronic disease patients who we named “Sam” (diagnosed with heart disease) and “Jill” (diagnosed type 2 diabetes). From these descriptive models we were able to embellish with plausible personality features, needs, and user requirements.

Cognitive behavioral psychotherapy (CBT) is a biopsychosocial approach to healing which focuses on how we think and evaluate ourselves, others and the situations we =ind ourselves in. Treatment involves evaluating the patient’s “explanatory model” or personal explanation for the causes of their problems, their symptoms, and impairments.*

*Treatment of Chronic Medical Conditions, Len Sperry, American Psychological Assn., 2008

Situation

Thoughts

Behaviors

Moods/Feelings

Physical Reactions

“Jill”diagnosed

Type2 diabetes

“Sam”diagnosed

heart disease

Patient proEile:• 56 yo white male• Spouse:Margie, a 48 yo female• Children: “Beth” 19yo female (college); “Riley” 23yo male• Formerly prep athlete. Sedentary. Limited social afîliations. No close

friends. Chiefs fan. Used to restore classic cars.• Accountant. Owns own îrm. Works long hours, especially during tax

season.• Financially stressed, lost much of retirement nest egg. Retirement is a

distant, fading dreamDisease context:• Heart attack 2004 (stent), possible mild stroke, high blood pressure,

obese, stress • “I’m a fat guy, have been overweight since high school”• Resistant to lifestyle changes; no idea how or where to start• Struggles with balanced diet. Fast food meals several times a week.

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**Keller (1983) ARCS Model

“Sam”diagnosed

heart disease

awareness relevance confidence satisfaction

“Sam’s” transformational journey

Program intro, familiarization

Goal setting, Aligned motives

Experienced success

Reinforced lifestyle

Gets educated on nutrition, healthy cooking, meal plans. Begins moderate exercise regimen.

Margie accompanies Sam on daily walks. They integrate new diet patterns. Attends yoga and relaxation class. Sam monitors progress on mobile device.

Bioinformatics show improved cholesterol levels, heart rate reduction, weight loss. Their children note the changes.

Key goals are attained. Both Sam and Margie sustain new diet and îtness patterns. Risk factors are signiîcantly reduced.

Musts Reduce weightHeighten activityBetter manage stress

Shoulds Acquire trainer/partnersBroaden social circleImprove self-‐imageEnlist family support

Desires Gain purpose, afîliation

Must Nots

Continue fast food patternRemain sedentaryGive up,ignore condition

“Sam’s” Health Requirements

5. Researching & Modeling the User/Patient: “Sam”

Patient proEile:• 48 yo single mom of three• Children: Ivy 17 (HS); Eva 23 (college); Robert 25• Nurse at physician’s ofîce, Loves her job• Socially active, outgoing with friends, community groups• Good cook, loves entertaining but rarely has time• Facebook user: checks up on kids, friends• Cares for aging parents living nearby (early dimensia). Filing

guardianship papersIllness proEile:• High risk for diabetes. Overweight. High blood pressure, cholesterol. Knee

problems• High calorie diet, “grazer”. Former Weightwachters success story.

Relapsed. Deterred from doing it again.• Self-‐doubts, prone to depression

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“Jill”diagnosed

Type 2 diabetes

awareness relevance confidence satisfaction

“Jill’s” transformational journey

Program intro, familiarization

Goal setting, Aligned motives

Experienced success

Reinforced lifestyle

Receives her MyWellness device. Visits with wellness coach. Assesses life and wellness priorities. Enlists help of friends and family.

Sets modest goals. Schedules weekly yoga class, Weight Watcher class, Healthy Cooking class. Begins tracking îtness, food points.

Begins Jazzercise class with two friends. Exceeds all goals; publishes her success to Facebook. Sets new goals. Buys new wardrobe.

Goals are within reach. Busy with work; caused her to back-‐slide, but she’s back on track. Daughter is now attending classes with her.

Musts Reduce weightIncrease activity levelLower blood pressure

Shoulds Better manage stressIncrease independence and self-‐esteem

Desires Enlarge social circle

Must Nots

Given in to depressionGain more weightOver-‐rely on children

“Jill’s” Health Requirements

5. Researching & Modeling the User/Patient: “Jill”

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User Experience Scenario 2: “‘Eleanor’s’ Lifestyle Change”

Eleanor’s Lifestyle Change

Another user experience scenario*

tells the story of “Eleanor”, a 65

year-old widow diagnosed as pre-

diabetic now adjusts to new lifestyle

habits in order to feel better and to

lower her disease risk.


* Product/service user experience prototypes help teams see the context in which a new idea or offering might play out in the marketplace and in the lives of customers. These advance snapshots enable decision-makers to assess the merits of a value proposition, assess its implications and make better a priori business decisions.


























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Social trends involving health accountability, and particularly increased ability among consumers to quantify and track îtness and health factors fosters increasing consciousness to, and control over, one’s health.

6. Market Analysis: Consumer Behavioral Health Trends

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Bayer Contour

gap value transfer

Personal Health Devices Consumer Market MapFitness and health tracking apps are currently focused on the consumer market. There is a sizable gap between that consumer market to the medical/health care industry.

Market Analysis:

The quality of user experience in many personal medical devices is currently poor: informational, but often burdensome, confusing and even intimidating. Hardly lifestyle-‐friendly. Tracking and monitoring information such as glucose levels and nutrition feel very clinical. Currently, the focus seems to be more about journaling data than changing or improving the quality of experience, behavior or lifestyle.

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Market Analysis: Current Device UX vs. Benchmark UX In Personal Health Devices

• THE USER, with a prescription from his/her physician, downloads the branded app suite from a managed care provider. She gets acquainted with the app, sets very basic goals, and begins to use basic functions

• THE PROVIDER offers programmatic support (e.g., user group sessions, counseling, documentation, social networking and feedback, troubleshooting) to users to build competence and lead to more advanced levels.

• THE PHYSICIAN follow-‐up with patient in subsequent visits offers professional support and encouragement.

• THE EMPLOYER wellness program reinforces program goals and incentivizes employee success

• THE BRANDED APP PROVIDER continues to upgrade product platform, improves usability. Premium custom, personalized services could be offered to “super users”

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8. Business Modeling: Stakeholder MapsThe branded product/

service suite

Physicians

Managed Care Provider

Corporate Wellness Programs

Patients/Insured Lives

effectiveness is assessed and

program is tweaked to maximize performance

continue to upgrade and

expand features

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The Suite: A web and mobile app that focuses on improving the health of people with chronic disease. This app suite will work to condition new behaviors surrounding îtness, nutrition and stress management. These new behaviors will result in increased health and reduced cost of care.

The suite dashboard available by login displays app engagement analytics and health impact in aggregate (to protect privacy). App engagement measurements are used to help project health improvement and projected cost savings.

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Business Modeling: Solution Strategy

1. Incentivize and enable healthy consumer behavior vis-‐a-‐vis stress, nutrition and îtness, thereby improving health and lowering chronic disease risks.2. Promote individual accountability for health insurance biometric tracking.3. Adapt consumer Eitness product innovations to the medical side of the market

9. The Consumer App: Dashboard Interface Concept A

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User Experience Scenario 3: “Joe’s Osteoarthritis”

Another user experience scenario*

featuring “Joe”, a 25 year-old artist/

printmaker learning how to better

manage his health and his

osteoarthritis.

http://www.youtube.com/watch?v=u1KouGJitaE

MyHealth: “Joe’s Osteoarthritis”


















Slide-In NavigationWhen a slide-‐in navigation icon is touched on the top level navigation bar, this menu "slides" in from the left, pushing the current content to the right. This navigation allows the user to quickly navigate to anywhere within the app, down to the secondary, tabbed navigation level. When there are more items to navigate than can ît on one screen the navigation items scroll.

Home ScreenThe home screen offers a quick glimpse of status and progress The three upper circles represent the three apps within the suite application. Each circle show current point information, and touching a circle sends the user to that app. The face indicates status and progress toward each goal. The lower, scrollable section is conîgurable by the user and can contain a log of current events (shown), a photographic timeline, inspirational photos, etc.

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9. The Consumer App: Top-Level Device UI Concept Wireframe, Navigation and Interaction

NavigationPast the home screen, the top level navigation is always present. This bar provides the title of the current section, the name of the user and an icon to activate the slide-‐in navigation. The secondary navigation allows each app section a way to divide content and functions with a common tabbed approach.

1. The app’s main navigation bar lets the user tab through the various screens in the nutrition app (home screen, meal planning, statistics, favorites).

2. "Enter a Meal" lets the user input meal info, or plan future meals.

3. "Point Circle" gives the user a quick reference to their daily point count. The point count correlates to a simpliîed dietary system that represents the nutritional goals in an understandable way.

4. “Tracking Table" lets the user check overall monthly data. The "Points", "Pounds", and "Both" buttons offer alternate views of data.

Nutrition App: Top Screen Concept Wireframe

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10. The Nutrition App: Features

Physician Connection/PrescriptionHealth Information Imported

Existing Health StatisticsDietary Goals

Communicate Updated Statistics

One-Week Nutrition AssessmentPatients Have Time to Learn AppWhat are the Patient's Habits?What are the Patient's Preferences?

Makes Tracking EasySimple Point SystemPhoto Assessment of FoodAsk Siri If Your Meal FitsSave Favorite Meals

Suggests Changes/Tracks ProgressSuggest A MealEnter a MealPoint LimitsPhoto Log of Food ChoicesPhoto Log of Body Image

Offers Goal RemindersVisual RemindersAlerts when Points are ExceededCongratulate Patients When On TargetAbility to Connect SociallyAbility to Plan Meals/Grocery List

Presses "Enter a Meal" Presses "Let Me Tell You" Says, "Chipotle Burrito Bowl" Presses "Yes" to continue.

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The Nutrition App: Use Case Scenario Concept: “Sam” visits Chipotle

Customizes meal and presses "Add"Presses "Log"Pop-‐up alerts user

to options

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11. The Stress Management App: Key Features

A. Tracking and RecordingHeart rateBreathing

B. Stress Management TechniquesBreathing exercises GamesCalming musicInformation and Tips

C. Anticipating and RedirectingPlanning and SchedulingReminders

A. Tracking and Heart Rate and Breathing

• The highly sensitive camera on a smartphone is able to detect the slight change in skin color during a heartbeat.

• For the app to begin tracking heart rate, the user will gently place the pad of their index înger on the camera lens of the phone.

• Continue to hold hand still until the app can get an accurate heart rate reading.• The result will indicate whether the stress level is low, average, or high.

• A result page will follow, detailing the level of stress.• This page will also allow the user to enter in where the sources of stress are in their life.• This data will be recorded and saved for viewing in the Aggregate of the Data section of the app.

SOURCES: Web MD, Human Physiology (McGraw-Hill, 7th edition), The American Institute of Stress, Mayo Clinic, eHealth MD, National Heart, Lung and Blood Institue, American Heart Association, Yale Medical School

Recording Your Data• The data derive both from breathing exercise and heart rate tests.• Presents a "big picture" of recorded stress levels

Graphing Your Data• The app graphs user's past and current stress levels and heart rate• The app offers a look at the past week or month of stress levels and/or heart rate

Identifying Sources of Stress• Helps user identify issues causing stress, and such awareness enables user to make changes to improve coping skills and life balance.

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A. Recording Heart Rate & Breathing

1. Controlled Breathing can reduce stress levels by syncing inhalation/exhalation with you current heart rate.

2. Simple games can distract from stressful situations and activities and create a calming environment.

3. “Stress Tips” offers information to help user become more conscious to the causes and effects of stress in daily life.

4. "Calming Sounds" enable user to tune in and relax while performing other activities. Music Therapy can be helpful coping and easing the progress of some illnesses.

B. Stress Management Techniques


Planning & Scheduling• Conscious awareness about past and present stresses is beneîcial, but stress management is also about anticipating and preparing for inevitable stressful situations (e.g., deadlines, tight scheduling, over-‐booking, holidays).

Reminders• A smart stress-‐management app can sync with your calendar, look at your upcoming schedule, and check-‐in with the user during tightly scheduled and stressful times, reminding her to get sleep, take a break, meditate or reschedule accordingly.

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C. Anticipating and Redirecting Stress


The stress-management app aims to support the user’s long-term health interests and life balance.

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12. The Fitness App: Requirements

Fitness Setup Wizard Use-Case Scenario: “Jill” sets up her Fitness App and does a workout”

The Fitness App employs a îtness wizard to roughly assess a user’s overall îtness level. It begins by asking the user to do some basic physical activities and answer some questions.

Q: How often do you run?

Q: Can you lift 5/10/15 lbs?

Q: How long can you balance on one foot?

Q: How long can you run or do a vigorous walk?

Q: Can you touch your toes?

Q: What is your height? weight?

Impact:• Cardiovascular Fitness• Muscular Strength• Balance• Flexibility• Body Composition

New personalized homepage for îtness app

Review and modify points for daily goal

Fitness App Setup Wizard Queries Setup Completion

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The Fitness App Use-Case Scenario: “Jill” does a workout

“Jill” begins her workout by selecting from three Eitness instructors. Then she selects a series of exercises. For each exercise there is an optional “how to” instructional video clip.

Do you have time to do more?

10 Lunges

More No

13/20

17/20

10/20

19/20

20/20

She check her goal and sees workout history

After completing her workout “Jill” clicks to review progress

On completing the workout the app offers

option for more

She selects jumping jacks and watches the optional video demo

“Jill” selects from a variety of routine

exercises

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User Experience Scenario 4: “Adam’s Resolve”

A final sample UX video* from

“Adam”, a 24 year-old shocked by

news of his high cholesterol levels

and increased risk for diabetes.

“Adam’s Resolve”

http://www.youtube.com/watch?feature=player_detailpage&v=gL8oy16hYXU

























13. Bibliography Fogg, B. (2009). A behavior model for persuasive design. In Proceedings of the 4th International Conference on Persuasive Technology (pp. 40:1–40:7). New York, NY, USA: ACM. doi:10.1145/1541948.1541999

Keller, C., Fleury, J., & Rivera, A. (2007). Visual Methods in the Assessment of Diet Intake in Mexican American Women. Western Journal of Nursing Research, 29(6), 758–773. doi:10.1177/0193945907304471

Kong, A., Beresford, S. A. A., Alfano, C. M., Foster-‐Schubert, K. E., Neuhouser, M. L., Johnson, D. B., … McTiernan, A. (2012). Self-‐Monitoring and Eating-‐Related Behaviors Are Associated with 12-‐Month Weight Loss in Postmenopausal Overweight-‐to-‐Obese Women. Journal of the Academy of Nutrition and Dietetics, 112(9), 1428–1435. doi:10.1016/j.jand.2012.05.014

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PRESCRIPTIVE APPS: Delivering therapeutic behavioral care to chronic disease patients, enabling personalized self-management of diet, fitness and stress.

Michael Eckersley, PhD

Designing a wellness economy

THE PRESCRIPTION MOBILE APP: Productizing

behavioral care for people managing a chronic

disease and needing behavioral therapeutic

support

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This work is licensed under a Creative Commons Attribution 3.0 Unported License.



The Prescription Mobile App For Chronic Disease Management

Health & Medicine

chronic disease management

chronic disease patients

chronic disease literature

prevention of chronic

design research

economics of health

cardiovascular disease

disease control