Personalization of Mobile Health Applications for

Remote Health Monitoring

Pınar Kırcı1, Perin Ünal2

1
Istanbul University, Department of Engineering Sciences, Istanbul, Turkey
[email protected],
2
Teknopar, Ankara, Turkey
[email protected]

Abstract. Mobile technologies have significantly developed in the last two

decades. These technologies are now commonly utilized in many mobile appli-
cations, especially on health. Remote health monitoring including wearable
sensors and various health applications has attracted the attention of communi-
cation and health sectors reducing the cost of patient monitoring and improving
the quality of treatment in hospitals or at home during the period of convales-
cence, thus increasing patients’ quality of life. In addition, behavior change
support features and persuasion strategies are integrated into mobile health ap-
plications to provide more efficient healthcare for patients. In this paper, remote
health monitoring is explored together with behavior change support features
and persuasion strategies used in mobile health applications.

Keywords. Mobile applications · Personalization · Mobile health · Remote

health monitoring ·

1 Introduction

Recently, there has been an increase in the aging population and the number of disa-
bled people, for this reason there are many patients who need long term health moni-
toring and the provision of healthcare solutions especially at home and in hospitals
anywhere and at any time. It has been reported that approximately 14 percent of the
older population in the United States suffer from different types of physical or cogni-
tive disabilities. To provide long-term health monitoring and healthcare solutions,
particularly for the disabled and elderly, mobile and wireless technologies are utilized.
These technologies allow the easy monitoring of patients’ vital signals. Missed doses
of prescribed medicines can be given within a specific time period. Furthermore,
sweating and breathing intensity can be measured during several activities, such as
walking and running as well as sitting and resting including environmental data on
temperature, wind speed and humidity [1].
Sensor networks, telehealth and internet-based electronic health records are used
to reduce the workload of health professionals. In addition, health context-aware algo-
rithms for predictive health assessment and chronic disease management can be im-

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purposes.
In: R. Orji, M. Reisinger, M. Busch, A. Dijkstra, A. Stibe, M. Tscheligi (eds.): Pro-
ceedings of the Personalization in Persuasive Technology Workshop, Persuasive
Technology 2016, Salzburg, Austria, 05-04-2016, published at http://ceur-ws.org
Personalization of Mobile Health Applications for Remote Health Monitoring 121

proved with the integration of health data such as the vital sign measurements of pa-
tients. The data gathered via telehealth can be used in the nursing of patients with
chronic diseases such as depression, diabetes, post-traumatic stress disorder, heart and
respiration problems by monitoring patients’ blood pressure, blood oxygen, blood
sugar and weight [2,3]. One of the most popular health monitor systems are wearable
medical sensors collecting several types of physiologic data such as body tempera-
ture, blood pressure, pulse and heart rate [4,5,6].
With the improvements in communication and informatics, remote health monitor-
ing systems offer easy-to-use cost-effective portable and wireless solutions for the
health sector. These systems allow monitoring patients in their daily life, and inform
doctors, patient relatives and health institutions in case of emergencies. In addition,
since these remote systems keep long-term records of patients, they make it possible
to reach an accurate and early diagnosis of several diseases, thus improving patients’
quality of life [7].
Today, many basic health checks can be performed using the wireless technologies
on a mobile device. Thus, medical and mental data from patients with chronic diseas-
es such as asthma, cardiovascular or cognitive disorders can be easily collected via
wireless sensors and transported to a remote server. This is remarkable in terms of
allowing the integration of information technologies into medical systems. Further-
more, every year, incorrect treatment and patient carelessness concerning the use of
medication result in many deaths. Remote health monitoring is presented as a solu-
tion to these health problems.

2 Discussion

Basically, a healthcare system is concerned with illness, injury, physical and psycho-
logical disorders together with the diagnosis and treatment coordinated by health
workers, dentists, nurses, pharmacist and doctors. Accessing health services depends
on the social and economic status of the population and the level of care provided in
the country. Traditionally, in order to monitor the health status of a patient, the medi-
cal staff, doctor and the nurses should be near to the patient whether in hospital or at
homes. However, in some situations certain patients may face difficulties in travelling
to hospital due to the distance or disability and home medical care for these patients
may be expensive. Thus, real-time and remote health monitoring systems integrated
with wireless sensor networks present an effective solution by automating several
medical procedures [4], [8,9,10,11].
In previous work [12], we developed a patient health monitoring system to detect
the patients’ vital signs at regular intervals during the day. We worked with patients
who required monitoring after their treatment in hospital. Using wearable sensors and
smartphone applications, we gathered, monitored, processed and stored heart rate data
from disabled and elderly patients. This data was then sent to patients’ doctors via
wireless communication to be kept in their permanent records. Furthermore, the gath-
ered data on vitals can be compared with patients’ threshold values determined by
122 Personalization of Mobile Health Applications for Remote Health Monitoring

their doctor and in cases where a significantly higher or lower value is detected, both
the patient and the doctor can be informed through messages [12].
The main structure of the designed health monitoring system [12] worked efficient-
ly, thus we consider it to be useful for patients and doctors. However, we noticed that
the patients using wearable and mobile systems would, after a while, lose interest and
the motivation to monitor themselves over time. Technology that is intentionally de-
signed to change a person’s attitude or behavior is called persuasive technology [13].
Fogg [13] describes persuasive technology as computers being able to change human
attitudes and behaviors. Following Fogg, Oinas-Kukkonen went one step further and
defined the concept of behavior change support systems [14]. Behavior change sup-
port systems (BCSS) benefit from persuasive technology on behalf of individual’s
needs and goals and they are designed to assist users in pursuing their goals [14].
BCSS are widely used in health domain as well as welfare, commerce, education,
energy saving and others [15].
The applications in the mobile health category employ a wide range of persuasive
user interactions to encourage healthy behavior. Persuasive applications are an effec-
tive approach to motivate healthy behavior in an individual, with the use of ubiquitous
technology for tracking and monitoring human behavior and addressing personal
needs and progress.
Many systems have been developed for various purposes such as; assisting indi-
viduals in stopping smoking [16,17], following a healthy diet [18,19,20], reducing
depression [21], managing chronic diseases [22,23,24] or engaging in regular physical
activity [25,26]. The majority of these applications utilize features provided by the
BCSS to encourage physical activity.
Consolvo McDonald and Landy [27] stated that systems that are abstract and re-
flective, unobtrusive and positive are effective in achieving behavior change ends.
They also showed that goal-setting could be an effective way to encourage behavior
change. The application they designed, Ubifit Garden uses virtual gardens in the
background screen of mobile phones, which are enriched by flowers and creatures
that are rewards to the healthy activity of the users. Lin et al [28] developed an appli-
cation named Fish’n’Steps that used fish avatars to reflect the number of steps taken
by users. It used gamification features such as virtual rewards and animated fishes
that grow and change their expressions. Shakra was another mobile application [29]
that used avatars on mobile phones and used social networks to share user’s progress.
Houston [30] presented a mobile application that used a pedometer that provided the
user with options for self-monitoring and personal awareness. Users share their scores
with a group of friends and reflect their activity, and obtain social support from text
messages. Chick Clique [31] also used a pedometer and a mobile phone application
together with text messages to increase the daily steps taken by the user. In recent
studies on mobile health applications, the persuasive effects of mobile features are
further explored. Using reminders and goals is presented as a more effective way of
encouraging certain user activities than rewards [32]. Sharing progress is also consid-
ered beneficial albeit not as effective.
To identify the most effective persuasive features for the development of a promis-
ing system design, we plan to improve our work by integrating persuasive technolo-
 Personalization of Mobile Health Applications for Remote Health Monitoring 123

gies. In our ongoing project, we are going to explore the use of features such as re-
minders, rewards, self-monitoring, goals and sharing progress with other users, visu-
alization of results, self tracking, commitment, competition, social support, social
facilitation, social learning and comparison, expert opinions, tunneling and personal-
ized recommendations in terms of their effect on users’ activities.
Mobile health systems should avoid one-size-fits-all approach to meet different
needs of individuals. Understanding the patterns of mobile device and application use
is significant to reveal user preferences to improve the features of mobile health ap-
plications and personalized mobile services. It can also help tailor for specific needs
and specific populations such as elderly people. When designing and developing mo-
bile and remote health monitoring applications, designers can focus on certain persua-
sive features relevant to the specific group of patients. Personal historical health data,
demographics and user profiles will be considered for a personalized system design.
The theoretical ground in persuasive technologies can be incorporated into health
applications with the help of clinicians and experts to develop better context-aware,
personalized and persuasive healthcare systems.

References

1. Varshney, U.: Managing Wireless Health Monitoring for Patients with Disabilities. IEEE
Computer Society, vol. 8, pp. 12-16 (2006)
2. Popescu, M., Chronis, G., Ohol, R., Skubic, M., Rantz, M.: An Eldercare Electronic Health
Record System for Predictive Health Assessment. In: 13th IEEE International Conference
on e-Health Networking, Applications and Services, pp.193-196. IEEE Press, New York
(2011)
3. Rajba, S., Rajba, T., Raif, P., Mahmud, M.: Wireless Sensor Networks in Application to
Patients Health Monitoring. In: 2013 IEEE Symposium on Computational Intelligence in
Healthcare and E-health (CICARE), pp. 94–98. IEEE Press, New York (2013)
4. Wang, J., Zhang, Z., Xu, K., Yin, Y., Guo, P.: A Research on Security and Privacy Issues
for Patient Related Data in Medical Organization System. International Journal of Security
and Its Applications, vol. 7, pp. 287-298 (2013)
5. Dishongh, T. J., McGrath, M., & Kuris, B. Wireless sensor networks for healthcare applica-
tions. Artech House (2014)
6. Ameen, M. A., Liu, J. W., Kwak, K.: Security and Privacy Issues in Wireless Sensor Net-
works for Healthcare Applications. Journal of Medical Systems, vol. 36, pp. 93-101 (2012)
7. Kirci, P., Kurt, G., Ömercikoğlu M.: Remote Monitoring of Heart Pulses with Smart Phone.
In: Joint International Symposium on the 44th International Conference on Computers &
Industrial Engineering (CIE’44) & the 9th International Symposium on Intelligent Manu-
facturing and Service Systems (IMSS’14), pp.1-5 (2014)
8. Garibaldi-Beltran, J. A., Vazquez-Briseno, M.: Personal Mobile Health Systems for Sup-
porting Patients with Chronic Diseases. In: 9th IEEE Electronics, Robotics and Automotive
Mechanics Conference, pp. 105-110. IEEE Press, New York (2012)
9. Caldeira J. M. L. P., Rodrigues, J. J. P. C., Lorenz, P., Shu, L.: Intra-Mobility Handover
Enhancement in Healthcare Wireless Sensor Networks. In: 14th IEEE International Confer-
 124 Personalization of Mobile Health Applications for Remote Health Monitoring

ence on e-Health Networking, Applications and Services (Healthcom), pp. 261-266. IEEE
Press, New York (2012)
10. World Health Organization (WHO), http://www.who.int/en/
11. Healthcare, https://www.healthcare.gov/
12. Kirci, P., Alan, U., Bıyık, V., Samak Z.: Healthcare Navigation System. In: Science and
Information Conference (SAI), pp. 406-409. IEEE Press, New York (2015)
13. Fogg, B. J.: Persuasive technology. Ubiquity, vol. 2002, no. December, p. 2 (2002)
14. Oinas-Kukkonen, H.: A foundation for the study of behavior change support systems. Pers.
Ubiquitous Comput., vol. 17, no. 6, pp. 1223–1235 (2012)
15. Oinas-Kukkonen, H., Harjumaa, M.: Towards Deeper Understanding of Persuasion in
Software and Information Systems. First International Conference on Advances in Com-
puter-Human Interaction, pp. 200–205 (2008)
16. Rodgers, A., Corbett, T., Bramley, D., Riddell, T., Wills, M., Lin, R.-B., Jones, M.: Do u
smoke after txt? Results of a randomised trial of smoking cessation using mobile phone text
messaging., Tob. Control, vol. 14, no. 4, pp. 255–61 (2005)
17. Ploderer, B., Smith, W., Pearce, J., Borland, R.: A mobile app offering distractions and tips
to cope with cigarette craving: a qualitative study. JMIR mHealth uHealth, vol. 2, no. 2, p.
23 (2014)
18. Linehan, C., Leeman, T., Borrowdale, C., Lawson, S.: Crowd saucing: social technology
for encouraging healthier eating. interactions, vol. 20, no. 1, p. 53 (2013)
19. Orji, R., Vassileva, J., Mandryk, R. L.: LunchTime: a slow-casual game for long-term
dietary behavior change. Pers. Ubiquitous Comput., vol. 17, no. 6, pp. 1211–1221 (2012)
20. Patrick, K., Raab, F., Adams, M. A., Dillon, L., Zabinski, M., Rock, C. L., Griswold, W.
G., and Norman, G. J.: A text message-based intervention for weight loss: randomized con-
trolled trial. J. Med. Internet Res., vol. 11, no. 1, p. e1 (2009)
21. Van Gemert-Pijnen, J. E., Kelders, S. M., Bohlmeijer, E. T.: Understanding the usage of
content in a mental health intervention for depression: an analysis of log data. J. Med. In-
ternet Res., vol. 16, no. 1, p. 27 (2014)
22. Robinson, S., Perkins, S., Bauer, S., Hammond, N., Treasure, J., Schmidt, U.: Aftercare
intervention through text messaging in the treatment of bulimia nervosa--feasibility pilot.
Int. J. Eat. Disord., vol. 39, no. 8, pp. 633–8 (2006)
23. Miloh, T., Annunziato, R., Arnon, R., Warshaw, J., Parkar, S., Suchy, F. J., Iyer, K., Kerk-
ar, N.: Improved adherence and outcomes for pediatric liver transplant recipients by using
text messaging. Pediatrics, vol. 124, no. 5, pp. 844–50 (2009)
24. DeShazo, J., Harris, L., Turner, A., Pratt, W.: Designing and remotely testing mobile diabe-
tes video games. J. Telemed. Telecare, vol. 16, no. 7, pp. 378–82 (2010)
25. Berkovsky, S., Freyne, J., Coombe, M., Physical Activity Motivating Games. ACM Trans.
Comput. Interact., vol. 19, no. 4, pp. 1–41 (2012)
26. Rodríguez, M. D., Roa, J. R., Morán, A. L., Nava-Muñoz, S.: CAMMInA: a mobile ambi-
ent information system to motivate elders to exercise. Pers. Ubiquitous Comput., vol. 17,
no. 6, pp. 1127–1134 (2012)
27. Consolvo, S., Libby, R., Smith, I., Landay, J. A., McDonald, D. W., Toscos, T., Chen, M.
Y., Froehlich, J., Harrison, B., Klasnja, P., LaMarca, A., LeGrand, L.: Activity sensing in
the wild. Proceeding of the twenty-sixth annual CHI conference on Human factors in com-
puting systems - CHI ’08, p. 1797 (2008)
 Personalization of Mobile Health Applications for Remote Health Monitoring 125

28. Lin, J. J., Mamykina, L., Lindtner, S., Delajoux, G., Strub, H. B.: Fish’n’Steps: Encourag-
ing Physical Activity with an Interactive Computer Game. UbiComp 2006: Ubiquitous
Computing, pp. 261–278 (2006)
29. Maitland, J., Sherwood, S., Barkhuus, L., Anderson, I., Hall, M., Brown, B., Chalmers, M.,
Muller, H.: Increasing the Awareness of Daily Activity Levels with Pervasive Computing.
2006 Pervasive Health Conference and Workshops, pp. 1–9 (2006)
30. Consolvo, S., Everitt, K., Smith, I., Landay, J. A.: Design requirements for technologies
that encourage physical activity. Proceedings of the SIGCHI conference on Human Factors
in computing systems - CHI ’06, p. 457 (2006)
31. Toscos, T., Faber, A., Connelly, K., Upoma, A. M.: Encouraging physical activity in teens
Can technology help reduce barriers to physical activity in adolescent girls?. 2008 Second
International Conference on Pervasive Computing Technologies for Healthcare, pp. 218–
221 (2008)
32. Munson, S., Consolvo, S.: Exploring Goal-Setting, Rewards, Self-monitoring, and Sharing
to Motivate Physical Activity. In: 6th International Conference on Pervasive Computing
Technologies for Healthcare, pp. 25-32. IEEE Press, New York (2012)