Elena+ Care for COVID-19, a Pandemic Lifestyle Care Intervention: Intervention Design and Study Protocol
Authors: Ollier Joseph , Neff Simon , Dworschak Christine , Sejdiji Arber , Santhanam Prabhakaran , Keller Roman , Xiao Grace , Asisof Alina , Rüegger Dominik , Bérubé Caterina , Hilfiker Tomas Lena , Neff Joël , Yao Jiali , Alattas Aishah , Varela-Mato Veronica , Pitkethly Amanda , Vara Mª Dolores , Herrero Rocío , Baños Rosa Mª , Parada Carolina , Agatheswaran Rajashree Sundaram , Villalobos Victor , Keller Olivia Clare , Chan Wai Sze , Mishra Varun , Jacobson Nicholas , Stanger Catherine , He Xinming , von Wyl Viktor , Weidt Steffi , Haug Severin , Schaub Michael , Kleim Birgit , Barth Jürgen , Witt Claudia , Scholz Urte , Fleisch Elgar , Wangenheim Florian von , Car Lorainne Tudor , Müller-Riemenschneider Falk , Hauser-Ulrich Sandra , Asomoza Alejandra Núñez , Salamanca-Sanabria Alicia , Mair Jacqueline Louise , Kowatsch Tobias 
Published: October 2021

Background: The current COVID-19 coronavirus pandemic is an emergency on a global scale, with huge swathes of the population required to remain indoors for prolonged periods to tackle the virus. In this new context, individuals' health-promoting routines are under greater strain, contributing to poorer mental and physical health. Additionally, individuals are required to keep up to date with latest health guidelines about the virus, which may be confusing in an age of social-media disinformation and shifting guidelines. To tackle these factors, we developed Elena+, a smartphone-based and conversational agent (CA) delivered pandemic lifestyle care intervention.

Methods: Elena+ utilizes varied intervention components to deliver a psychoeducation-focused coaching program on the topics of: COVID-19 information, physical activity, mental health (anxiety, loneliness, mental resources), sleep and diet and nutrition. Over 43 subtopics, a CA guides individuals through content and tracks progress over time, such as changes in health outcome assessments per topic, alongside user-set behavioral intentions and user-reported actual behaviors. Ratings of the usage experience, social demographics and the user profile are also captured. Elena+ is available for public download on iOS and Android devices in English, European Spanish and Latin American Spanish with future languages and launch countries planned, and no limits on planned recruitment. Panel data methods will be used to track user progress over time in subsequent analyses. The Elena+ intervention is open-source under the Apache 2 license (MobileCoach software) and the Creative Commons 4.0 license CC BY-NC-SA (intervention logic and content), allowing future collaborations; such as cultural adaptions, integration of new sensor-related features or the development of new topics.

Discussion: Digital health applications offer a low-cost and scalable route to meet challenges to public health. As Elena+ was developed by an international and interdisciplinary team in a short time frame to meet the COVID-19 pandemic, empirical data are required to discern how effective such solutions can be in meeting real world, emergent health crises. Additionally, clustering Elena+ users based on characteristics and usage behaviors could help public health practitioners understand how population-level digital health interventions can reach at-risk and sub-populations.