mHealth

Wireless and mobile technologies provide an opportunity to connect information in the real-world via wearable sensors and, when coupled with fixed sensors embedded in the environment, produce continuous streams of data on an individual's biology, psychology, behavior and daily environment. Our goals are to enable more patient-centric health care management by designing interventions that leverage mobile health (mHealth) technology to collect real-time health data from patients and their environment; understand preferences and motivations of people to allow them to interact with the health system on their own timeline and in their own environment; and enhance patient-provider communication and collaborative management of health care priorities.

Projects

Duke Balanced Energy Cycling Program (BECP)

The Kraus lab opened the Duke Balanced Energy Cycling Program (BECP), which will examine how patterns of calorie ingestion and expenditure affect participants’ risk for conditions such as obesity, cancer, diabetes and hypertension. The BECP will use mHealth devices to monitor participants’ food intake, daily step counts and sleep, and provide coaching and education. The Kraus lab also contains the Human Physiology Testing Core, which provides clinical procedures related to the biochemical and physical functions of the human body, including wearable mHealth physical activity monitoring services, for Duke researchers throughout the School of Medicine.

For more information, contact: The Kraus Lab

Fitbits for Encouraging Healthy Behaviors

In addition, the Kraus lab is using mHealth platforms for a variety of pilot studies. Two pilot studies led by Brian Duscha, Ph.D., and Lucy Piner will use Fitbit activity trackers to encourage healthy behaviors. One study, which began in June 2015, works with patients who have graduated from cardiac rehabilitation programs. While rehabilitation services help establish healthy behaviors after a cardiac event, cardiac patients often have difficulty maintaining behaviors once their active rehabilitation ceases. Health coaching via a mobile video chatting platform will support participants maintaining regular physical activity and other healthy behaviors they learned and practiced during rehabilitation.

For more information, contact: The Kraus Lab

Diabetes LIVE (Learning in Virtual Environments)©™

Our pilot work developing and testing the feasibility of a virtual environment for diabetes education and support demonstrated that this approach has the potential to improve psychosocial outcomes, self-management and metabolic control. This led to our current randomized controlled trial testing the efficacy of this interactive online environment as compared to a traditional website format for providing diabetes education and support. We built a virtual community on a gaming platform for adults with type 2 diabetes that allows for group information sharing and social networking and individual learning and behavior modification strategies. Participants attend synchronous diabetes education classes with educators and peers in the site, or visit locations (i.e., grocery store or bookstore) for advice and information to support adult learning and health behaviors. Participants may practice real world behaviors, such as grocery shopping and identifying healthy selections based on item-specific feedback on nutritional value, preparation or substitutions, and eating out in a healthier way, even at fast food restaurants. Social networking capabilities within the community include synchronous voice conversation, text chat, forums, and sharing experiences during classes. This trial will allow us to determine whether these aspects of the platform, along with gaming and incentives in the platform to reward positive real-world behaviors (exercise, etc.) and participation in the site, influence self-management behaviors and clinical diabetes outcomes.

For more information, contact: Constance Johnson, PhD

Prompt

Prompt is an interactive digital health system to test and disseminate evidence-based health solutions and improve participant engagement in clinical and observational studies. Prompt can send automated, tailored, scheduled messages to study participants via SMS, interactive voice response (IVR), OS notifications, apps or email. It is optimized for bidirectional, algorithm-driven interactions between users and study team members. These algorithms can include data received by participants via survey or requested as part of an interaction; environmental information like weather and location; and information provided by care providers and registered dietitians. Prompt integrates components useful for research participants, primary care providers, ancillary care providers, and research and clinical study staff. By decreasing staff burden, enhancing protocol fidelity, and improving participant retention, Prompt saves time and resources. Using the mobile phone as the hub, Prompt can extend the ability of clinicians and researchers to design and test innovative behavioral interventions and improve participant engagement in clinical or observational longitudinal panel studies.  

For more information, contact: Duke Global Digital Health Science Center

iOTA

The Interactive Obesity Treatment Approach (iOTA) combines the rigor of a personalized, evidence-based weight loss approach with the ease of simple technology. Developed in 2007 and tested over the past eight years in various populations, iOTA is an effective and highly scalable weight loss program. In iOTA, individuals take a short survey on current nutrition, lifestyle and physical activity habits. An algorithm is applied to these data, and a set of four discrete, personally tailored goals are assigned based on a calculation of need, readiness and self-efficacy. Individuals are prompted on a regular basis (daily or weekly) to self-monitor these goals via text message or automated phone calls. Participants are sent immediate automated feedback on their progress over time after they self-monitor. Goals change every eight weeks to promote a holistic lifestyle change over time and to ensure novelty and prevent habituation to self-monitoring. iOTA has been adapted for use in a wide range of medically vulnerable populations both domestically and abroad, and is an effective, scalable public health approach to both prevent weight gain and promote weight loss.

For more information, contact: Duke Global Digital Health Science Center

Improving Medication Adherence and Clinical Outcomes in Gout Patients

The Division of General Internal Medicine and Improved Patient Outcomes, Inc. are collaborating with Takeda Pharmaceuticals to utilize mHealth interventions to improve gout treatment adherence and outcomes. Gout poses a significant economic burden to the public and the healthcare system with the annual direct and indirect cost estimated to exceed $6 billion. Despite the availability of effective pharmacologic therapies and a "one size fits all" approach, managing gout is often suboptimal in clinical practice. The project, "Utilization of an Innovative Intervention to Improve Medication Adherence and Clinical Outcomes in Gout Patients," will seek to improve adherence to gout medications by reaching patients through a telephonic, community pharmacist-administered program supplemented by text messaging or interactive voice response (IVR) reminders over a 12-month period. Monthly telephone calls by the patient’s community pharmacist will be tailored to that individual’s specific needs (i.e. level of motivation, literacy level and current treatment barriers). Patients will have the option of choosing the most appropriate delivery platform: text messaging or IVR. These two-way messages will contain pertinent gout and medication adherence information. Previous studies have shown that community pharmacists have been able to improve medication adherence and reduce healthcare costs among patients with chronic conditions. Furthermore, mHealth interventions are not only a convenient method of reaching patients but have also successfully improved adherence in patients with diabetes, cardiovascular disease and HIV. To our knowledge, this is the first industry clinical trial to combine both pharmacist-led and mHealth interventions to address medication adherence in patients with gout.  

For more information, contact: Hayden Bosworth, PhD

From Episodic to Real-Time Care in Diabetes Self-Management

This study uses mobile health technologies to identify strategies that help patients and health professionals use patient-generated data to manage and overcome challenges with diabetes. Our team uses novel software to obtain, aggregate, analyze and visualize data that is presented back to clinicians and patients in real-time and longitudinally. Over six months, participants use a phone-tethered glucometer, cellular scale and wrist-worn accelerometer and respond to bi-weekly text message surveys on medication adherence.

For more information, contact: Ryan J. Shaw, PhD, RN

Visualizing Real Time Data from Mobile Health Technologies

A team of Duke data scientists and students will develop data visualizations and algorithms to make use of self-generated diabetes data from multiple mobile technologies. The Data+ team learns how to present longitudinal, time series data back to patients and clinicians and will develop algorithms that will allow us to send predictive alerts to patients to facilitate intervention in near real-time. Students work with an interdisciplinary team including faculty, clinicians and staff that specialize in nursing, medicine, public health, nutrition, biostatistics and health information technology.

For more information, contact: Ryan J. Shaw, PhD, RN

A novel IT weight loss solution to provide variable-ratio rewards in real-time

This study uses automated algorithms to analyze dietary self-monitoring and interim weight loss data from mobile technologies to provide real-time reinforcement using variable-ratio financial incentives. In this study, obese community outpatients participate in a 24-week weight loss program delivered via biweekly group classes. We developed an innovative information technology (IT) solution that collates dietary self-monitoring data via diet apps and weight data from cellular scales. Algorithms classify participants as achieving adequate or inadequate dietary self-monitoring and weight loss to earn intermittent rewards of varying value in real-time. If effective, this approach could reduce the prevalence, adverse outcomes and costs of obesity for millions of Americans.

For more information, contact: Ryan J. Shaw, PhD, RN

Aggregating and Visualizing Environmental Biological, Physiological and Outcome Data in Acute Pediatric Traumatic Brain Injury

This study builds upon a developed prototype (Reuter-Rice, Shaw, et al. 2016 disclosure) to recognize individual responses to acute traumatic brain injury and short-term outcomes. This study will validate the collection of environmental sensor data in acute head-injured children and aggregate that data with biologic ('omic and specific biomarkers), physiologic and outcome data.

For more information, contact: Ryan J. Shaw, PhD, RN

The Sixth Vital Sign Apple ResearchKit App

Project Goals: (1) To examine uptake by the general population and targeted subgroups of adults to participate in the sixth Vital Sign iPhone-based study (consent, walk test, self-reported health). (2) To measure the two-minute-walk-test (2MWT) in an unlimited adult population (spanning the nation, lifespan, continuum of health). (3) To establish mobile-phone based norms for the 2MWT. (4) To increase awareness of the importance of mobility on health, survival and quality of life (indirectly measured)

For more information, contact: Ryan J. Shaw, PhD, RN

Resources

Duke Health Innovation Lab

The Duke Health Innovation Lab serves as an interdisciplinary center to develop and test pioneering innovations in technology and care delivery. By providing an infrastructure and entrepreneurial environment, Duke plans to develop and test innovative scholarship and transformative ideas developed by faculty, staff, students and alumni.  

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Human Physiology Testing Core

Offers wearable physical activity monitoring services as well as other clinical procedures related to the biochemical and physical functions of the human body.

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mHealth@Duke

This program aims to accelerate research on the use of sensors and mobile technology to advance the delivery of health care through improved patient-provider communication and collaborative health care management.

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Vida

Providing health coaching for Balanced Energy Cycling Program (BECP) and post-CR projects.

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Valencell

Collaborator for the validation of a new earbud sensor for energy expenditure, heart rate and VO2max.

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BioIberica

Collaborator for the development of an osteoarthritis patient-education app.

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