This paper includes patient and clinician feedback to better understand treatment progress and increase compliance in resistance-based physical activity to mitigate the effects of age-associated losses in muscle mass and strengths. This study aims to develop a mobile app for a novel device through a user-centered design process with both older adults and clinicians while exploring whether data collected through this process can be used in natural language processing (NLP) and sentiment analysis. We used the Bing sentiment library for a sentiment analysis of interview transcripts and then applied NLP-based latent Dirichlet allocation (LDA) topic modeling to identify differences and similarities in patient and clinician participant interviews. To assess utility, we used quantitative assessment questionnaires—System Usability Scale (SUS) and Usefulness, Satisfaction, and Ease of use (USE). We found a positive association with positive sentiment in an interview and SUS score (ß=1.38; 95% CI 0.37 to 2.39; P=.01), but no significant association between sentiment and the USE score. The LDA analysis found no overlap between patients and clinicians in the 8 identified topics. Involving patients and clinicians allowed us to design and build an app that is user friendly for older adults while supporting compliance. This is the first analysis using NLP and usability questionnaires in the quantification of user-centered design of technology for older adults.
Curtis Lee Petersen, Ryan Halter, David Kotz, Lorie Loeb, Summer Cook, Dawna Pidgeon, Brock C. Christensen, and John A. Batsis. Using Natural Language Processing and Sentiment Analysis to Augment Traditional User-Centered Design: Development and Usability Study. JMIR mHealth and uHealth 8(8), page Article#e16862 (13 pages), August 2020. JMIR Publications. DOI: 10.2196/16862
Effective weight-management interventions require frequent interactions with specialised multidisciplinary teams of medical, nutritional and behavioural experts. However, barriers that exist in rural areas, such as transportation and a lack of specialised services, can prevent patients from receiving quality care. We recruited patients from the Dartmouth-Hitchcock Weight & Wellness Center into a single-arm, non-randomised study of a remotely delivered 16-week evidence-based healthy lifestyle programme. Every 4 weeks, participants completed surveys that included their willingness to pay for services like those experienced in the intervention based on commute and copay. Overall, those with a travel duration of 31–45 min had a greater willingness to trade in-person visits for telehealth than any other group. Participants who had a travel duration less than 15 min, 16–30 min and 46–60 min experienced a positive trend in willingness to have telehealth visits until Week 8, where there was a general negative trend in willingness to trade in-person visits for virtual. Participants believed that telemedicine was useful and helpful. In rural areas where patients travel 30–45 min a telemedicine-delivered, intensive weight-loss intervention may be a well-received and cost-effective way for both patients and the clinical care team to connect.
Vanessa K. Rauch, Meredith Roderka, Auden C. McClure, Aaron B. Weintraub, Kevin Curtis, David F. Kotz, Richard I. Rothstein, and John A. Batsis. Willingness to pay for a telemedicine-delivered healthy lifestyle programme. Journal of Telemedicine and Telecare, June 2020. Sage. DOI: 10.1177/1357633X20943337
Few evidence-based strategies are specifically tailored for disparity populations such as rural adults. Two-way video-conferencing using telemedicine can potentially surmount geographic barriers that impede participation in high-intensity treatment programs offering frequent visits to clinic facilities. We aimed to understand barriers and facilitators of implementing a telemedicine-delivered tertiary-care, rural academic weight-loss program for the management of obesity. A single-arm study of a 16-week, weight-loss pilot evaluated barriers and facilitators to program participation, exploratory measures of program adoption, and staff confidence in implementation and intervention delivery. A program was delivered using video-conferencing within an existing clinical infrastructure. Elements of the Consolidated Framework for Implementation Research (CFIR) provided a basis for assessing intervention characteristics, inner and outer settings, and individual characteristics using surveys and semi-structured interview. Using CFIR, the intervention was valuable from a patient participant standpoint; staff equally had positive feelings about using telemedicine as useful for patient care. The RE-AIM framework demonstrated limited reach but willingness to adopt was above average. A significant barrier limiting sustainability was physical space for intervention delivery and privacy and dedicated resources for staff. Scheduling stressors were also a challenge in its implementation. The need to engage staff, enhance organizational culture, and increase reach are major factors for rural health obesity clinics to enhance sustainability of using telemedicine for the management of obesity.
John Batsis, Auden C. McClure, Aaron B. Weintraub, Diane Sette, Sivan Rotenberg, Courtney J. Stevens, Diane Gilbert-Diamond, David F. Kotz, Stephen J. Bartels, Summer B. Cook, and Richard I. Rothstein. Barriers and facilitators in implementing a pilot, pragmatic, telemedicine-delivered healthy lifestyle program for obesity management in a rural, academic obesity clinic. Implementation Science Communications 1, page Article#83 (9 pages), September 2020. BMC. DOI: 10.1186/s43058-020-00075-9
Abstract: Timely detection of an individual’s stress level has the potential to improve stress management, thereby reducing the risk of adverse health consequences that may arise due to mismanagement of stress. Recent advances in wearable sensing have resulted in multiple approaches to detect and monitor stress with varying levels of accuracy. The most accurate methods, however, rely on clinical-grade sensors to measure physiological signals; they are often bulky, custom made, and expensive, hence limiting their adoption by researchers and the general public. In this article, we explore the viability of commercially available off-the-shelf sensors for stress monitoring. The idea is to be able to use cheap, nonclinical sensors to capture physiological signals and make inferences about the wearer’s stress level based on that data. We describe a system involving a popular off-the-shelf heart rate monitor, the Polar H7; we evaluated our system with 26 participants in both a controlled lab setting with three well-validated stress-inducing stimuli and in free-living field conditions. Our analysis shows that using the off-the-shelf sensor alone, we were able to detect stressful events with an F1-score of up to 0.87 in the lab and 0.66 in the field, on par with clinical-grade sensors.
ACM posted a video recording of the presentation of our paper, Experience: Design, Development and Evaluation of a Wearable Device for mHealth, at the annual ACM International Conference on Mobile Computing and Networking (MobiCom) last month in Los Cabos, Mexico.
Abstract: Wrist-worn devices hold great potential as a platform for mobile health (mHealth) applications because they comprise a familiar, convenient form factor and can embed sensors in proximity to the human body. Despite this potential, however, they are severely limited in battery life, storage, bandwidth, computing power, and screen size. In this paper, we describe the experience of the research and development team designing, implementing and evaluating Amulet – an open-hardware, open-software wrist-worn computing device – and its experience using Amulet to deploy mHealth apps in the field. In the past five years the team conducted 11 studies in the lab and in the field, involving 204 participants and collecting over 77,780 hours of sensor data. We describe the technical issues the team encountered and the lessons they learned, and conclude with a set of recommendations. We anticipate the experience described herein will be useful for the development of other research-oriented computing platforms. It should also be useful for researchers interested in developing and deploying mHealth applications, whether with the Amulet system or with other wearable platforms.
George Boateng, Vivian Genaro Motti, Varun Mishra, John A. Batsis, Josiah Hester, and David Kotz. Experience: Design, Development and Evaluation of a Wearable Device for mHealth Applications. In Proceedings of the International Conference on Mobile Computing and Networking (MobiCom), Article #31, October 2019. DOI 10.1145/3300061.3345432.
Although not specifically involving the Amulet device, John Batsis and members of the Amulet team published a recent feasibility study involving the use of wearables, like Amulet, in support of health monitoring for older adults.
John A. Batsis, Auden C. McClure, Aaron B. Weintraub, David F. Kotz, Sivan Rotenberg, Summer B. Cook, Diane Gilbert-Diamond, Kevin Curtis, Courtney J. Stevens, Diane Sette, and Richard I. Rothstein. Feasibility and acceptability of a rural, pragmatic, telemedicine-delivered healthy lifestyle programme. Obesity Science & Practice, 1-10, August 2019. DOI 10.1002/osp4.366.
Abstract: Background: The public health crisis of obesity leads to increasing morbidity that are even more profound in certain populations such as rural adults. Live, two-way video-conferencing is a modality that can potentially surmount geographic barriers and staffing shortages. Methods: Patients from the Dartmouth-Hitchcock Weight and Wellness Center were recruited into a pragmatic, single-arm, nonrandomized study of a remotely delivered 16-week evidence-based healthy lifestyle programme. Patients were provided hardware and appropriate software allowing for remote participation in all sessions, outside of the clinic setting. Our primary outcomes were feasibility and acceptability of the telemedicine intervention, as well as potential effectiveness on anthropometric and functional measures. Results: Of 62 participants approached, we enrolled 37, of which 27 completed at least 75% of the 16-week programme sessions (27% attrition). Mean age was 46.9 +/- 11.6 years (88.9% female), with a mean body mass index of 41.3 +/- 7.1 kg/m2 and mean waist circumference of 120.7 +/- 16.8 cm. Mean patient participant satisfaction regarding the telemedicine approach was favourable (4.48 +/- 0.58 on 1-5 Likert scale–low to high) and 67.6/75 on standardized questionnaire. Mean weight loss at 16 weeks was 2.22 +/- 3.18 kg representing a 2.1% change (P < .001), with a loss in waist circumference of 3.4% (P = .001). Fat mass and visceral fat were significantly lower at 16 weeks (2.9% and 12.5%; both P < .05), with marginal improvement in appendicular skeletal muscle mass (1.7%). In the 30-second sit-to-stand test, a mean improvement of 2.46 stands (P = .005) was observed. Conclusion: A telemedicine-delivered, intensive weight loss intervention is feasible, acceptable, and potentially effective in rural adults seeking weight loss.
A qualitative study to determine whether mHealth devices, like Amulet, could be useful in supporting rural-health interventions.
John Batsis, Stephen Bartels, Rachel Dokko, Alexandra Zagaria, John Naslund, Elizabeth Carpenter-Song, and David Kotz. Opportunities to Improve a Mobile Obesity Wellness Intervention for Rural Older Adults with Obesity. Journal of Community Health, September 2019. DOI 10.1007/s10900-019-00720-y.
Abstract: Older adults with obesity are at a high risk of decline, particularly in rural areas. Our study objective was to gain insights into how a potential Mobile Health Obesity Wellness Intervention (MOWI) in rural older adults with obesity, consisting of nutrition and exercise sessions, could be helpful to improve physical function. A qualitative methods study was conducted in a rural community, community-based aging center. Four community leaders, 7 clinicians and 29 patient participants underwent focus groups and semi-structured interviews. All participants had a favorable view of MOWI and saw its potential to improve health and create accountability. Participants noted that MOWI could overcome geographic barriers and provided feedback about components that could improve implementation. There was expressed enthusiasm over its potential to improve health. The use of technology in older adults with obesity in rural areas has considerable promise. There is potential that this intervention could potentially extend to distant areas in rural America that can surmount accessibility barriers. If successful, this intervention could potentially alter healthcare delivery by enhancing health promotion in a remote, geographically constrained communities. MOWI has the potential to reach older adults with obesity using novel methods in geographically isolated regions.
Another recent paper from John Batsis and the Amulet group, highlighting a custom sensor developed by our team and presented at the International Conference on Body Area Networks (ICBAN):
John A. Batsis, George G. Boateng, Lillian M. Seo, Curtis L. Petersen, Karen L. Fortuna, Emily V. Wechsler, Ronald J. Peterson, Summer B. Cook, Dawna Pidgeon, Rachel S. Dokko, Ryan J. Halter, and David F. Kotz. Development and Usability Assessment of a Connected Resistance Exercise Band Application for Strength-Monitoring. World Academy of Science, Engineering and Technology, 13(5):340-348, June 2019. DOI 10.5281/zenodo.
Abstract: Resistance exercise bands are a core component of any physical activity strengthening program. Strength training can mitigate the development of sarcopenia, the loss of muscle mass or strength and function with aging. Yet, the adherence of such behavioral exercise strategies in a home-based setting is fraught with issues of monitoring and compliance. Our group developed a Bluetooth-enabled resistance exercise band capable of transmitting data to an open-source platform. In this work, we developed an application to capture this information in real-time and conducted three usability studies in two mixed-aged groups of participants (n=6 each) and a group of older adults with obesity participating in a weight-loss intervention (n=20). The system was favorable, acceptable and provided iterative information that could assist in future deployment on ubiquitous platforms. Our formative work provides the foundation to deliver home-based monitoring interventions in a high-risk, older adult population.
The following paper dates to last year, but is an important publication from the Amulet group:
John A. Batsis, Alexandra Zagaria, David F. Kotz, Stephen J. Bartels, George G. Boateng, Patrick O. Proctor, Ryan J. Halter, and Elizabeth A. Carpenter-Song. Usability evaluation for the Amulet wearable device in rural older adults with obesity. Gerontechnology, 17(3):151-159, 2018. DOI 10.4017/gt.2018.17.3.003.00.
Abstract: Mobile health (mHealth) interventions hold the promise of augmenting existing health promotion interventions. Older adults present unique challenges in advancing new models of health promotion using technology including sensory limitations and less experience with mHealth, underscoring the need for specialized usability testing. We use an open-source mHealth device as a case example for its integration in a newly designed health services intervention. We performed a convergent, parallel mixed-methods study including semi-structured interviews, focus groups, and questionnaires, using purposive sampling of 29 older adults, 4 community leaders, and 7 clinicians in a rural setting. We transcribed the data, developed codes informed by thematic analysis using inductive and deductive methods, and assessed the quantitative data using descriptive statistics. Our results suggest the importance of end-users in user-centered design of mHealth devices and that aesthetics are critically important. The prototype could potentially be feasibly integrated within health behavior interventions. Centralized dashboards were desired by all participants and ecological momentary assessment could be an important part of monitoring. Concerns of mHealth, including the prototype device, include the device’s accuracy, its intrusiveness in daily life and privacy. Formative evaluations are critically important prior to deploying large-scale interventions.
Today we presented an “Experience” paper at ACM MobiCom, summarizing the technology, the studies, and the challenges and lessons learned over seven years of research.
George Boateng, Vivian Genaro Motti, Varun Mishra, John A. Batsis, Josiah Hester, and David Kotz. Experience: Design, Development and Evaluation of a Wearable Device for mHealth Applications. In Proceedings of the International Conference on Mobile Computing and Networking (MobiCom), October 2019. DOI 10.1145/3300061.3345432.
Abstract: Wrist-worn devices hold great potential as a platform for mobile health (mHealth) applications because they comprise a familiar, convenient form factor and can embed sensors in proximity to the human body. Despite this potential, however, they are severely limited in battery life, storage, bandwidth, computing power, and screen size. In this paper, we describe the experience of the research and development team designing, implementing and evaluating Amulet? an open-hardware, open-software wrist-worn computing device? and its experience using Amulet to deploy mHealth apps in the field. In the past five years the team conducted 11 studies in the lab and in the field, involving 204 participants and collecting over 77,780 hours of sensor data. We describe the technical issues the team encountered and the lessons they learned, and conclude with a set of recommendations. We anticipate the experience described herein will be useful for the development of other research-oriented computing platforms. It should also be useful for researchers interested in developing and deploying mHealth applications, whether with the Amulet system or with other wearable platforms.