Developing Physical Activity Recommendations in a Mobile Health App for Older People with Chronic Conditions (Preprint)
Authors: Bentlage Ellen , del Río Ponce Alberto , Ahmed Mona , Gangas Pilar , Brach Michael , Kurano Jorge Alfonso , Menéndez José Manuel 
Published: September 2023

UNSTRUCTURED

Background: The European Union funded project “Personalised Integrated Care Promoting Quality of Life for Older People” (PROCare4Life) aimed to develop an integrated care system based on information and communication technology to support older people living with Parkinson’s disease (PD) or Dementia disease (DD). One module focuses on physical activity (PA) recommendations.
Methods: This article describes the development of the PA recommendations based on the health action process approach (HAPA) and factors that are known to activate behaviour changes. A first pilot phase assessed the feasibility of the overall PROCare4Life system (not reported in this manuscript). In a second pilot phase, users evaluated the content of the PA recommendations during 40 intervention days. Due to iterative development, a third pilot phase took place in which users evaluated their satisfaction with the PA recommendation system. Here, participants evaluated the system using a mobile health satisfaction questionnaire.
Results: The PA recommendations were generated as six sets focusing on different aspects of the HAPA model while they simultaneously approached all the three activation factors. Due to technical issues in pilot 2, 43 of the 167 users (26%), mainly affected by PD, evaluated the content of the PA recommendations. Within the intervention time, the number of missing evaluations increased. All in all, the content of the PA recommendations was rated from most users as positive. In pilot 3, 237 from 273 (87%) patients provided answers to the mobile health satisfaction questionnaire. The results indicate that the PA recommendations were generally understandable, interesting and usable and users clearly understood the benefits of PA. Users expressed that they need more support on how to motivate to adapt healthy lifestyle habits and to set personal goals.
Discussion: As stated in previous research, developing the contents on HAPA and approaching the activation factors support the intervention development based on the user needs. However, the main advantage of digital systems, like PROCare4 Life, are the monitoring-functions of the mobile health app and Fitbit wristband. These features need to be more effectively incorporated into the existing recommender engine, combined with more user interaction interfaces, addressing the constructs “Action Planning”, “Action Coping” and “Recovery Self-Efficacy”. Technical difficulties in Pilot 2, primarily related to the setup process, resulted in lower user engagement and incomplete data collection, leading to system modifications in Pilot 3. These changes, including the removal of the mini-PC, simplified the setup and improved user participation and the quality of data collected.
Conclusions: The PA recommendations addressed the three activation factors. All in all, users were positive about the content. Addressing the activation factors can be recommended for researchers and technical developers of other projects. Future adjustments to the design should focus on personalisation to encourage the adoption of a healthier lifestyle.