There is a growing number of eHealth interventionsaiming at enhancing lifestyle to address obesity. However, theexisting interventions do not take the emotional aspects ofobesity into account. Forty percent of the overweight populationis an emotional eater. Emotional eaters gain weight because ofpoor emotion regulation, not just due to bad eating habits. Weaim at developing a personalised virtual coach ‘Denk je zèlf!’providing support for self-regulation of emotions for obeseemotional eaters. This paper presents a research study protocolon validating persuasive coaching strategies in emotionregulation, based on Dialectical Behaviour Therapy, ultimatelytargeting behaviour change. Our goal is to design a personalisedeCoaching framework, allowing us to optimally translatesuccessful behaviour change mechanisms and techniques, suchas dialectical strategies, into personalised persuasive coachingstrategies.
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Obesity is a fast growing societal threat, causing chronic conditions, physical and psychological health problems, as well as absenteeism and large healthcare costs. Despite numerous attempts to promote physical activity and healthy diet, existing interventions do not focus on often occurring emotional causes of obesity. There is a need for self-management support of this vulnerable target group: emotional eaters. This paper presents the results of the design case study focusing on a holistic development of a personalised virtual mHealth coach that provides self-management training ‘Denk je zèlf!’ (Dutch for ‘Develop a wise mind and counsel yourself’). Target group are young adults with emotional eating disorder and obesity. The contextual inquiry study was conducted to get insights into the needs and experiences of the target users, including interviews and questionnaires with emotional eaters, obesity treatment patients and healthcare practitioners. Personas and user stories were derived from these results and translated into a new ‘Denk je zèlf!’ virtual coach, based on Dialectical Behaviour Therapy and experience sampling measures to capture user experience and emotional state. This paper makes two main contributions: (a) combining holistic design with behaviour therapy in one virtual mHealth coaching application for emotional eaters; (b) applying Personas to guide the design. Preliminary results suggest that an online self-management training might be useful for the target group. Future research will be aimed at iterative evaluation and further development of the dialectical dialogues for the virtual coach and content for the education and instruction modules.
OBJECTIVES: Knee osteoarthritis (OA) is characterized by its heterogeneity, with large differences in clinical characteristics between patients. Therefore, a stratified approach to exercise therapy, whereby patients are allocated to homogeneous subgroups and receive a stratified, subgroup-specific intervention, can be expected to optimize current clinical effects. Recently, we developed and pilot tested a model of stratified exercise therapy based on clinically relevant subgroups of knee OA patients that we previously identified. Based on the promising results, it is timely to evaluate the (cost-)effectiveness of stratified exercise therapy compared with usual, "nonstratified" exercise therapy.METHODS: A pragmatic cluster randomized controlled trial including economic and process evaluation, comparing stratified exercise therapy with usual care by physical therapists (PTs) in primary care, in a total of 408 patients with clinically diagnosed knee OA. Eligible physical therapy practices are randomized in a 1:2 ratio to provide the experimental (in 204 patients) or control intervention (in 204 patients), respectively. The experimental intervention is a model of stratified exercise therapy consisting of (a) a stratification algorithm that allocates patients to a "high muscle strength subgroup," "low muscle strength subgroup," or "obesity subgroup" and (b) subgroup-specific, protocolized exercise therapy (with an additional dietary intervention from a dietician for the obesity subgroup only). The control intervention will be usual best practice by PTs (i.e., nonstratified exercise therapy). Our primary outcome measures are knee pain severity (Numeric Rating Scale) and physical functioning (Knee Injury and Osteoarthritis Outcome Score subscale daily living). Measurements will be performed at baseline, 3-month (primary endpoint), 6-month (questionnaires only), and 12-month follow-up, with an additional cost questionnaire at 9 months. Intention-to-treat, multilevel, regression analysis comparing stratified versus usual care will be performed.CONCLUSION: This study will demonstrate whether stratified care provided by primary care PTs is effective and cost-effective compared with usual best practice from PTs.
