Personalized Web platform for education in healthy lifestyles

Abstract

One of the main difficulties faced by public health management in developed countries is the aging of the population and, consequently, the growing of chronic diseases. Those diseases "contributed approximately to 59% of the total reported deaths in the world and 46% of the global burden of disease". Many of them could be easily prevented improving aspects like therapy compliance, healthy lifestyle, personalised information and patient motivation. This paper contributes to solve this situation by presenting a Web tool that provides the user with information to improve and control his own self-care, through the use of the e- learning technologies. The user is also motivated to take control of his decisions regarding lifestyle.

Full text

Personalized Web platform for education in healthy lifestyles
M. Ortega-Portillo, E. del Hoyo-Barbolla, M.T. Arredondo, E. Carisio, N. Fernández
Life Supporting Technologies
ETSI Telecomunicación
Universidad Politécnica de Madrid
mortega@lst.tfo.upm.es
Abstract
One of the main difficulties faced by public health
management in developed countries is the aging of the
population and, consequently, the growing of chronic
diseases. Those diseases “contributed approximately
to 59% of the total reported deaths in the world and
46% of the global burden of disease”. Many of them
could be easily prevented improving aspects like
therapy compliance, healthy lifestyle, personalised
information and patient motivation. This paper
contributes to solve this situation by presenting a Web
tool that provides the user with information to improve
and control his own self-care, through the use of the e-
learning technologies. The user is also motivated to
take control of his decisions regarding lifestyle.
Keywords:
Motivation on self-care, prevention and promotion
strategies, public health, personalization, portlets.
1. Introduction
Most of the health policies in the European Union,
remark the importance of continuous health promotion
and prevention and focus on actions to improve the
early detection of health crisis situations [1] (such as
the recent avian flu cases in Asia). The World Health
Organization (WHO) states that, “chronic diseases are,
for the most part, entirely preventable. Countries and
people could save precious lives and healthcare
resources by investing in preventing these diseases.
[…] We should all be ready to move for health and to
adopt healthy and active lifestyles” [2].
Near 80% of the cardiovascular diseases, diabetes
mellitus type 2 and the 40% of the cancer incidence
could be prevented by mean of a nutritious diet,
regular exercise and the cessation of tobacco use.
However, the individual is each time more responsible
of his own life quality improvement, making
motivation and easy access to information – as well as
the confidence on it – the main pillars of health
promotion.
Accordingly, it is a key matter to convince citizens
that being responsible of their own health brings
advantages [3] to their health. Being well informed
about health related issues and the services offered by
the institutions result in a greater independence and
better control of their own life, as well as a guide for a
more effective use of such services. Moreover, health
care related information is necessary in a wide variety
of circumstances and situations. Being able to
guarantee the user the quality and appropriateness of
the information received is of prior relevance to
promote this responsibility. In this sense, the Internet
provides a new reliable, interactive medium that is
accessible for the great majority of the European
population.
Thus, e-health systems providing the user with
personalised information must be studied and
implemented in order to encourage him to incorporate
healthy lifestyles in his daily life. Within these
systems, motivational aspects need to be seriously
taken into account and the way the information is
presented must be carefully analyzed. The latter is of
particular importance, as users often are not familiar
with new ICT. Hence, interfaces must be user-friendly,
understandable and transmit information in such a way
that motivates the user to perform a change towards a
healthy lifestyle
The aim of this work is on the first hand, provide
users with a training platform that provides
personalized information and, on the other hand,
motivate them to use an e-health system in order to
create healthy routines. This would provide them with
means for taking control of their lifestyle and manage
their self-care. The development of such a system is
based on the personalization of information, adapting it

to the specific needs and characteristics of the user.
The process begins by harvesting statistical data
using common and specific questionnaires, specifically
designed for this process. This helps classifying the
user regarding several parameters, for example: the
specific pathology (obesity, diabetes, etc.), the attitude
to change healthcare habits, etc. Only the information
related to the specific problematic is used (to
“modulate” the content), adapting the presentation of
the results (to “modulate” the tone, the format, etc.)
and recommendations according to their healthcare
behaviour state, and other key parameters (such as
user’s profiling and main pathology, e-health position,
etc.).
This paper presents a practical example of such
platform, implemented using “portlets”, a novel Web
component based on Java technology that returns
dynamic content to user requests [4], allowing the
highest possible degree of personalization. The use of
new web design technologies, such as Flash [5],
increases also the platform’s dynamism and
interactivity.
Information of very diverse sources is provided by
the platform. In order to personalise this information,
users are enquired about the information content and
layout preferences. The application selects, according
to a set of algorithms, the specific information to be
presented to each user.
A novel, dynamic tool that allows a high degree of
personalisation is presented. This tool instructs and
motivates citizens to improve their lifestyle habits, by
presenting high quality and personalised information.
2. Materials and methods
Personalised Web platform aims at developing
environments adapted to the users according to their
personal characteristics and preferences. The
presentation of the information relevant to the user is
divided in five steps [6]:
• Step 1: Analysing the problem to be addressed
and understanding its determinants.
• Step 2: Developing an assessment tool to
measure a person’s status on these
determinants.
• Step 3: Creating tailored messages that address
individual validation of determinants of the
problem.
• Step 4: Developing algorithms to link responses
from the assessments into specific tailored
messages.
• Step 5: Creating the final health
communication.
This paper focuses on step 4 consisting of the
development of algorithms for the provision of
personalised information through a Web platform. This
is achieved by means of a Web platform. This solution
has an additional advantage, since it makes such
information available to the user through the Internet.
For this purpose, different innovative technologies
relative to dynamic Web development have been
analysed, such as Java Portlet [7], JSP, Oracle
databases, HTML or Macromedia Flash. The selection
of these technologies is based on the following
requirements: interactivity, personalisation, portability
and usability, as well as a potential seamless
integration in any kind of system.
The whole process described in step 4 consists itself
of five different stages. In each stage, different
technologies have been selected to achieve the
required functionalities of the full system. These stages
are: Login, Questionnaires, Personalisation, Storage
and Presentation.
At the Login stage the user’s individual information
is recalled from the database records, which have been
previously stored in the general profiling process.
The Questionnaires about health behaviour and e-
health attitude have been developed in JSP technology.
Their functionality is to define the users' main concern
and to discover their motivation status regarding their
health [8] and their attitude towards new ICT. The
previous steps have been already used to provide
required methodologies to classify the user into each
stage, and to suggest appropriate motivational
techniques for them.
The Personalisation stage adapts the information to
be delivered to the user. The user’s profile is modified
after the questionnaires are filled in. Thus, the system
is personalised according to the user’s preferences and
completed with the most suitable information.
The Storage stage responds to the need of storing
the users’ profiles, with all the corresponding security
and coherence requirements, to be later used all along
the session.
Finally, at the Presentation stage the personalised
information and recommendations according to the
results of the previous stages are presented to the user.
The information shown has been selected in
collaboration with health professionals. To model the
information provided, the structure of a standard

medical intervention for a user suffering any of the
different pathologies studied has been modelled with
the guidance of healthcare professional.
3. Results
The Web platform described has been implemented
with the following features:
1 To offer personalised information in form, tone
and content.
2 To be visual, dynamic and interactive.
3 To be able to be integrated in an e-learning
system.
In this sense, a training activity consists of a
multimedia session through the Internet and presented
by means of a visual and friendly interface. In
particular, the implemented tool is a portlet using many
of the characteristics of the specification JSR 168 [9],
providing the user a three modes portlet: VIEW, EDIT
and HELP.
Figure 1 shows the VIEW mode that allows the user
to enter his login data. These data are matched against
the ones stored in the database to authenticate the user.
If they coincide, the user is presented the
questionnaires regarding health behaviour and attitude
regarding e-health, so he can be classified into a
corresponding stage.
“Figure 1. The authentication page of Training”
The EDIT mode allows the user to select among
diverse presentation styles defined by the
administrator. The HELP mode allows the user to
access a complete documentation to improve the
system’s usability.
Once the user has been classified regarding his
attitude towards healthcare, this information is stored
in the database and personalised information is
presented in terms of form, tone and content. The
personalisation process is performed by using
techniques that, using the adopted methodology [8],
are the most appropriate to instruct, to convince and to
motivate users to improve their lifestyle. Therefore,
users’ awareness to take control of their own health
and to be co-responsible of it, is raised. In this sense,
only relevant information in the appropriate mode
(language, tone, etc.) is delivered to the user through a
personalised interface (avatar, colours, video, images,
etc.).
The database has been structured to offer three
different types of information about the user: profile,
lifestyle characteristics and behaviour towards health
and e-health status. The latter is the most important
since it can be dynamically changed every time a user
accesses the system and modifies any aspect related to
his health behaviour. In this way, if the user has not
changed the information introduced in previous
sessions, the results displayed by the system reflect the
user’s needs and motivation. The information stored in
the database can be modified by the administrator in
order to improve system’s quality, by adding new
information or modifying the existing one. Information
in the database must observe confidentiality and
security requirements. All these requirements of
structure, integrity and coherence suggested the use of
a well known and established relational database such
as Oracle.
“Figure 2. The Training database”
One of the main advantages of this tool is its
portability, due to the use of Portlets, implemented as
Web files (.war) that can be deployed by a Portlet
container (i.e. Pluto portal [10]) being, at the same
time, their content independent from it. The Portlet
container calls the portlets through the Portlet API in
order to retrieve its content through the Container
Invoker API. Therefore, the tool developed can be
used in any other platform without the need of
introducing any modification.

4. Discussion and conclusions
The health sector is experiencing a huge revolution
due to the proliferation of applications that appear as
consequence of the convergence of the technological,
information and communication sectors, such as the
comprised into the group of healthcare services known
as e-Health. The main objectives of such services are
to empower, benefit and improve the health related
activities. The existence of information easily
reachable by means of tools like the one presented in
this paper enables a more fluent professional/patient
relationship, since both parts have access to the same
resources to be informed about diagnostic, therapy and
prognosis. Of course, such tools will never substitute
the role of the doctor in diagnostics and therapy, but
help patients in raising awareness of their conditions
and encouraging them to assume healthier lifestyles.
Health professionals emphasize the importance of
motivation in improving the lifestyle of the individual.
This tool tries to serve as a guide to the user through
the different stages of motivation described in the e-
health model [9] until the desired healthy behaviour is
assumed.
Personalisation and usability are characteristics that
allow this tool to create a healthcare model
user/patient-centred. Their needs and preferences are
considered to allocate healthy habits promotion as a
key issue for the user to start leading a more
independent life. These features are improved by using
specific functionalities of the Portlets.
An interactive and visual tool has been developed
and integrated in an e-learning system in order to offer
personalised information about healthy lifestyles. In
this way, people should have better access to trusted
sources of information, tailored to their individual
requirements. The tool implemented goes further by
adding a motivational feature with the aim of making
users to be responsible of their health.
Future work should aim at multiplatform
applications, with the specific target of mobile devices.
5. Acknowledgements
We would like to thank the PIPS Project (partially
funded by EC, IST 507019), in which this tool is
integrated. Besides, we would like to thank Mr. David
Gil for his contribution to this paper.
6. References
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