An Patient Education Framework For Designing Personalized Self-Management Interventions For Home-Based Chronic Disease Management
Authors: Abidi Syed 
Published: November 2013

Patient engagement in their care process, vis-&#224;-vis self-management programs is an important element of the patient&#39;s longitudinal care plan, where the patient is encouraged and expected to achieve self-efficacy in the self-management of the disease through a regime of educational and behavioral modification strategies. To ensure the effectiveness of self-management programs, it is important that the proposed self-management interventions are (a) personalized to the unique needs and constraints of the patient; (b) based on sound theoretical health models; (c) based on validated health and behavior assessment tools to determine the patient&#39;s physical and behavioral dispositions; and (d) readily accessible to the patient through a ubiquitous medium, such as smart phones or the web. In this paper, we present a novel personalized self-management framework that delivers personalized health educational interventions to empower, educate and engage patients/individuals through self-observation, barrier identification, goal setting and action planning to achieve behavioral self-efficacy and self-regulation so that individuals can self-manage their condition. Our personalized self-management framework is guided by Social Cognition Theory, whereby have ensured that self-management programs for chronic disease management not just focus on changing the patient&#39;s awareness of the disease, rather they focus on enhancing the ability of the patient to make the right choices to achieve effective disease management. We present a three-stage personalized self-management framework that comprises: Stage 1: A high-level characterization of an individual with respect to a specific health outcome using validated assessment tools; Stage 2: A behavioral categorization of the individual based on his/her levels of self-efficacy, motivation and self-regulation, etc.; Stage 3: Use the personalized profile of the individual to tailor generic educational and self-management to develop a personalized self-management program that comprises personalized strategies to counter the challenges and barriers faced by the individual to achieving positive self-efficacy and self-regulation which in turn will lead to positive health outcomes. Our personalized self-management framework features (a) a novel self-management oriented individual profiling mechanism that takes into account both the health and psychosocial characteristics of an individual to generate his/her holistic profile; (b) a semantic web based knowledge model that captures the theoretical foundations of the SCT in terms of a Self-Management Program Personalization (SPP) ontology; (c) a semantic web based personalization tool that uses a logic-based execution engine that reasons over the SPP ontology, based on an individual&#39;s profile, to generate personalized self-management interventions; and (d) a mobile messaging platform to deliver the personalized self-management interventions and to monitor the patient&#39;s compliance using smart phones. We take a semantic web approach in designing the personalization approach whereby we have developed the SPP ontology to (a) model the theoretical framework of SCT in terms of SCT concepts; (b) model health assessment tools; (c) model the personalization rules that integrate the health and SCT models with the educational messages to generate a personalized self-management program. We have demonstrated the novel integration of health models, educational content and behavior change strategies to design self-management programs for cardiac risk factors, where the program is delivered through a mobile app.