Mobile Health Advisor with acronym MOHEAD

Mobile Health Advisor with acronym MOHEAD

¹Alabi, Abdullateef.O., ²Lawal, Mufutau.K.

¹kitfad4u@gmail.com, ^{2lawalmufutau76@gmail.com}

^1,2 Computer Engineering Technology Department, Federal Polytechnic, Offa

ABSTRACT

A Novel E-health Smartphone Application that reduces the risk for cardiovascular diseases (CVD) by measuring the stress level, predicting the evolution of the evolution of the CVD risk and by promoting a healthier lifestyle with personalized advice. The stress is computed using no additional hardware, just the smartphone camera, by measuring the heart rate variability (HRV).

This will require no additional hardware in addition to the Smartphone.

This will be used for predicting the possible evolutions of the users of the application and for giving recommendations related to life-style changes that will help in reducing the cardio risk and stress

Keywords: Cardiovascular disease (CVD), Mobile health (m-health), stress reduction

1.0       INTRODUCTION

WHAT: Mobile Health Advisor is a smartphone application that falls under the umbrella of participatory and prevention medicine supporting tools, by democratizing the health care process, allowing the patient a more active role in his/her prevention and treatment.

MOHEAD will approach two interrelated problems among contemporary citizens: cardiovascular diseases and stress. By measuring different indicators such as lifestyle or heart pressure and variability the application builds a custom profile for each patient and uses the profile to give specialized counsel for a healthier lifestyle. There are no privacy issues as the data is stored locally, on the smartphone and is also encrypted.

WHY: The intended product has very good marketing perspectives by its focus on tackling pressing medical and personal problems for the contemporary population.

Cardiovascular diseases are the number one killer in the world. The causes of CVD are diverse but stress and hypertension are the most common. Nigerians are under serious pressure ranging from economic, employment, welfare, community, peer pressure, political and health challenges. The rise in cardiovascular diseases has risen from 15 percent to 25 percent within a period of 20 years. This applies to stress as well. In the same period, the use of mobile technology has risen to above 60 percent. This means that our stress-reducing software application has a very large potential market, since we aim for the lower-middle income user, with access to smartphone technology and under considerable stress, both in rural and urban areas (Karasek R (1990)).

The aim of this research work is to design and implement a smartphone app which lowers the risk of cardiovascular diseases by measuring the stress level, predicting the evolution of the evolution of the CVD risk and by promoting a healthier lifestyle with personalized advice and to also increase overall health in Nigeria by tackling the number one killer, cardiovascular diseases, while decreasing the pressure on the national healthcare system.

In order to make accurate simulations, the research study will include simulation techniques such as sensitivity analysis and evolutionary simulations that use a profile of the user built from relevant input information and that can predict not only the risk and the stress but the evolution of the risk and stress level over the lifetime of the patient. This will be done by simulating the variation in time of the inputs such as weight or blood pressure and also by predicting different lifestyles choices. The stress will be evaluated by determining heart rate variability measured through the photoplethy smographic acquisition with the video camera of a Smartphone.

RELATED WORKS

Healthcare in Nigeria, while having positive trends in some areas, exhibits some structural deficiencies, such as differentiated quality based on region, an exodus of health care providers, thus affecting its capacity for mitigating CVD risks for most Nigerians.  In addition to the inefficient healthcare provisioning in rural areas, urban areas suffer from environmental and noise pollution, major factors for CVD. As a consequence, life expectancy in Nigeria is very low, at 52.62 years. Our solution mitigates CVD risks, by self-measuring and personalized counsel, decreasing the pressure on the public healthcare and addressing the most important cause of CVD in Nigeria, stress.

HOW: The final product is a Smartphone Application consisting of a personalized cardiovascular risk and stress level detector, simulator and advisor, based on simulations techniques such as sensitivity analysis and evolutionary simulations that uses a profile of the user built from relevant input information and that can predict not only the risk and the stress but the evolution of the risk and stress level over the lifetime of the patient according to (Cliff Note 2014). The users will be presented with possible risk evolutions based on his current lifestyle and possible beneficial changes. In addition, based on the profile and simulator, MOHEAD will give personalized counsel for the reduction of cardiovascular risk level; counsel related to how to change the factors that mostly affects the risk of a given person and other possible corrective actions according to Inner Body 2012. The product’s main modules (profile, simulator) will be generic allowing them, by extending their rule base; to be used for simulating other conditions in future products.

ESTIMATED MARKET SIZE AND EXPECTED MARKET SIZE

MOHEAD targets the fast growing Smartphone e-health applications (apps) market. The apps market has been quickly transformed from a niche market to a mainstream force.  According to a Smartphone app – Global Strategic Business Report from September 2011, from the Research Group, the global market for applications is expected to reach US $101.2 billion by the year 2017. This accelerated growth is motivates by several reason (Murphy L (1995): Mayo Clinic 2013)

Firstly, the advances of IT telecom underlay and support the need of the applications and the market itself.

Secondly, the average price of the apps is significantly low ranging between US $0.99 and $25 – price range in which MOHEAD application is also expected to be sold – which enables customers to download mobile applications even in a frugal economic environment. Thus, its expected that MOHEAD sales will have a fast growth according to the existing tendencies and its price range.

By its regular use, the applications user will be able to have a better understanding of his lifestyle impact on his health and then will be driven to develop and reinforce healthy routines and habits. The software used behavioral change model which allow complex behavioral changes such as a healthy lifestyle which reduces stressors and CVD risk factors, to be informed gradually, by first identifying the risk factors, proposing custom action plans and following the feedback on the commitment to those plans.

3.0       RESEARCH METHOD

In order to construct the application, MOHEAD an Agile Software Engineering Development Method was used with small iterative cycling activities. It will start with a first cycle (activity) where the functional, nonfunctional and high-level architecture will be developed. Then in several activity-cycles - initial, alpha and final prototype - the application will be developed. For the development itself, a simulation technique was adopted such as sensitivity analysis and evolutionary simulations that use a profile of the user built from relevant input information and that can predict not only the risk and the stress but the evolution of the risk and stress level over the lifetime of the patient. 

MOHEAD will use an agile software engineering development method with small iterative cycling activities, simulation techniques by simulating the variation in terms of the input based on methods such as evolutionary computation with the pilot testing of the application on selected group of users and dissemination activities as part of middle and final activity cycle such as Genome, Epigenome, and environment which usually ripe to subclinical diseases from caser agent “ cardiovascular risk factors and biomarkers”, this illustration is shown in Fig 1.

Fig 1: Circulation: Showing Genomic and Precision Medicine

All the components of the application will be deployed on Smartphone. Below are the main components of our applications and their main functionalities:

1.            Application front –end (AF) uses a graphical interface to gather input data directly from the patient, such as regular self-assessments of his/her physical exercise activity, eating habits or any other relevant CVD or stress factor measure.

2.            Personal Profile (PP) is a personal electronic medical record that stores the relevant medical situations of the patient and is based on a health state model focused on storing and interpreting relevant information (health events) for the stress level and CVD risk.

3.            Simulator (SIM) uses the information from the personal profile and the developed models and measurements and based on sensitivity analysis and evolutionary simulations, the program will predict probable evolutions for specific health related attributes of the user. The simulations will also take into consideration different probable lifestyles.

4.            Counselor (CS) uses information from the simulator and profile in order to promote the most efficient lifestyle choices for lowering the CVD risk and stress level. The counsels will be based on notifications which will have a personalized tone and frequency based on the psychological profile of the patient.

5.            Notification agent (NA) forwards the counsels prepared by the counselor to the user.

Together with the development, in each Agile activity cycle, pilot-testing of the application on selected group of users will be carried out. Dissemination activities will be part of middle and final activity-cycles.

Fig 2: Mobile Monitoring and Reasoning Methods to Prevent Cardiovascular Diseases

RESEARCH DESIGN

Requirements and high-level architecture: In this phase, functional and nonfunctional requirements will be gathered. The requirements will be determined through 1) field interviews with medical doctors, potential users, ICT professionals and through 2) extensive literature review. Based on the obtained requirements, the general architecture of the application will be designed.

Initial Prototype of the application: The detailed design of the application will be made. An initial prototype of application will be created, including initial functionality of the application such as personal profile of the user, cardio and stress calculator. Pilot testing will also be carried out with selected group of users. Their feedback will be collected to be incorporated for the later development of the application.

Prototype alpha of the application: Extra features are added such as cardio and stress simulations over time through techniques such as sensitivity analysis and evolutionary simulations that use a profile of the user built from relevant input information and that can predict not only the risk and the stress but the evolution of the risk and stress level over the lifetime of the patient.  Dissemination activities – presentations in academic and general public events will happen also in this phase. Submission of a first series of articles (1-3) is also planned.

Final Prototype: The final features of the applications such as personalized counsels, overall improvements will be implemented. Final pilot testing will also be part of this activity. Dissemination activities will have a large role in this phase, including presentations in selected events, second series of articles (1-3) submission, and community event.

ANALYSIS OF DATA

Analysis of Data is part of each phase starting with Initial Prototype phase till Final Prototype in different forms.

-          Through Piloting: Starting with the Initial Prototype phase, Alpha phase and Final Phase piloting activities are part of each phase: the different prototypes are tested on selected group of users and the user feedback will be incorporated in the application development in the next phase. Analysis of Data is part of piloting activities through the collection and analysis of user feedback from pilot activities for further improvement of the tool.

-          As part of the MOHEAD application: Cardio, Stress and Life Style data collected from the user is analyzed by the application; recommendations related to how to change life-style to reduce the cardio-risk and stress will be displayed on the Smartphone screen.

Below are details on the analysis of data: used methods, principle of operation, etc.

Summary Statistics: There are two ways in which the project will provide summaries:

-          For general public: A registered Domain Name, Web hosting, a database storage, SmarthHealth application, SMS gateway system, e-mail alert  and initialization query data from clients will be used to present summaries of medical results, recommended medical diagnostics and other relevant usages of MOHEAD application through the web-site of the project.

-          For the users of the applications: MOHEAD application will display on the screen of the Smartphones recommendations related to the life-styles changes needed by the users to reduce the cardio risks and stress.

Questionnaires: There are several ways in which questionnaires will be used for the project:

-          While starting to use the application: Initial questionnaire is (see description of Application front–end  module, Section 1.4) displayed by the application for gathered input data directly from the user, such as regular self-assessments of his physical exercise activity, eating habits or any other relevant CVD or stress factor measure. It is also used to create the initial profile.

-          While piloting: In each phase, for the different prototypes of the MOHEAD application, questionnaires will be administered to the selected users that are doing the piloting such that  their feedback will be incorporated in the further development of the system

4.0       Test Result and proposed feature Analysis

4.1       ACADEMIC INNOVATION: A smartphone application to feature a generic simulator for CVD risks and stress level prediction combined with personalized prevention counseling does not exist currently in the market. At International level, there are some products such as “cardiac risk calculator” by Tonic Minds using Framingham Risk score, “Manage CVD Risk in Reduced GFR” by National Kidney Foundation; “Cardiovascular risk calculation” by Reb Edersalud, implementing Framingham, Score and RECICOR algorithms; “Stress Test and CBT Self Help” by Excel at Life; Ithlete etc that touches some of the items of our proposed application, but none have the combination of features described.

As mentioned above, none of these applications cover all the proposed features of MOHEAD nor can they predict the evolution in time. Our approach is a much more personalized solution and has a distinctive new direction of research as it applies simulation algorithms for being able to advice corrective actions for the CVD risk and stress level evolution of the user.

MOHEAD also integrates the CVD and stress profile with the readings from the HRV detector, allowing real-time updates to the stress profile.

4.2       MARKET APPLICATION AND EXPLOITATION:

Novel Mobile Health advisory is a mobile application program that enable user to integrate service intervention to medical practice guidelines, health symptoms and patient health profiles for economic analysis of healthcare service according to Euro WHO (2013: Tand Fonline (2010)). This depends on defined medical parameters (fixed and variable) template for efficient treatments and cure service delivery via a generic template database simulation.

4.3       Evaluation mechanism: state clearly the evaluation mechanism you will adopt in achieving the stated objectives.

The research path is based on a logical and scientifically proved approach, which should be a good assurance for keeping the research in the expected parameters. However, in order to limit the unexpected results, the Lead Researcher will maintain the model as simple as possible, using a modular approach.

The project will involve end-users and stakeholders throughout the whole lifetime of the project, using a flexible approach to the feedback. During the course of the MOHEAD project, the team will organise and manage a number of workshops that will mainly target end-users in Nigeria. Publications in external conferences and journals would be used as good means for reaching academics, researchers, healthcare operators, and the team is committed to make full use of them (Objective Medical System  (2014)). In addition, internet dissemination (such as the development of a web-site and the issuing of electronic newsletters and press releases to relevant Nigerian news channels) will allow a larger community of interested potential users to access MOHEAD for longer times and to keep them informed about the project’s aims and progression.

-           

5.0       Recommendation and Conclusion

The proposed model dissemination strategies: This enables user to indicate the steps to take just to ensure the query outcomes are brought the attention of health professionals.

Therefore the target dissemination activities after full deployment will target industrial and scientific levels including presentations in conference, seminars, workshops etc.

The research path is based on a logical and scientifically proved approach, which will involve the end- users and the stakeholders throughout the whole life time of the project using a flexible approach to the feedback.

References

-          Cliff Note (2014), The Cardiovascular system and functions, Retrieved: March2014, From: http://www.cliffsnotes.com/sciences/anatomy-and-physiology/the-cardiovascular-system/functions-of-the-cardiovascular-system

-          Euro WHO (2013) (How effective are organization level intervention in preventing workplace stress), Retrieved: March 2014, From:  http://www.euro.who.int/en/data-and-evidence/evidence-informed-policy-making/publications/hen-summaries-of-network-members-reports/how-effective-are-organization-level-interventions-in-preventing-workplace-stress

-          Kidshealth (2014), Heart and Circulatory System, retrieved: April 2014, from: http://kidshealth.org/teen/your_body/body_basics/heart.html

-          Inner Body 2012, Cardiovascular System, Retrieved: March 2014, From:  http://www.innerbody.com/image/cardov.html

-          Karasek RA, Theorell T. Healthy work: Stress, productivity, and the reconstruction of working life New York, NY: Basic Books; 1990.

-          Lamontagne AD, Keegel T, Vallance D. Protecting and promoting mental health in the workplace: developing a systems approach to job stress. Health Promotion Journal of Australia 2007 Dec;18(3):221-8.

-          Murphy LR. Occupational stress management: Current status and future Direction . In: Cooper CL, Rousseau D, editors. Trends in Organizational Behavior. Chichester, UK: John Wiley & Sons, Inc.; 1995:1-14.

-          Mayo Clinic 2013, Diseases and Conditions, Retrieved: April 2014, From:  http://www.mayoclinic.org/diseases-conditions/heart-disease/multimedia/circulatory-system/vid-20084745

-          Objective Medical System  (2014), Cardiovascular diagnostics, Retrieved: April 2014, From: http://www.objectivemedicalsystems.com/oms/cardiovascular-diagnostics/

-          Wiki Answer (2013), What is cardiovascular system, Retrieved: April 2014, From: http://wiki.answers.com/Q/What_is_the_cardiovascular_system

-          BILOGRAPHY

-          RTH Foundation (2014), Prevent stroke, Retrieved:  April 2014, From:  http://rthfoundation.org/prevent-stroke

-          Rout U.(2002)  Stress management for primary health care professionals . New York: Kluwer Academic/Plenum; 2002.

-           

-          Sonnentag  S,  Frese M.  Stress in organizations . In: Borman WC, Ilgen DR, Klimoski RJ editors. Comprehensive Handbook of Psychology, Volume 12:  Industrial and organizational Psychology. Hoboken, NJ: John Wiley  & Sons, Inc.; 2003;12:453-91.

-          Sauter S, Murphy L, Colligan M, Swanson N, Hurrell J Jr., Scharf F Jr.,et al., and the NIOSH Working Group.  Stress at work . Cincinati, OH: National Institute for Occupational Safety & Health; 1999. Report No.: 99-101.

-          Stansfeld S, Candy B. Psychosocial work environment and mental health - a meta-analytic review. Scandinavian Journal of Work, Environment, & Health 2006;32(6):443-62.

-           Torgerson R. Not there yet: Improving the working conditions of Canadian  Nurses . Canadian Policy Research Networks; 2007.

-          The circulatory system (2010), The circulatory system, Retrieved: April 2014, From:  http://en.wikipedia.org/wiki/Circulatory_system

-          Tand Fonline (2010) Review of cardiovascular diseases, Retrieved: April 2014, From: http://www.tandfonline.com/doi/abs/10.1300/J075v08n02_14#preview

-          Karasek RA. Job demands, job decision latitude, and mental strain: Implications

-          for job redesign . Administrative Science Quarterly 1979;24(2):285-308.