1. Directions for ICT Research in Disease Prevention
FP7-ICT-2009.5.1 – Support Action
User profiling and segmentation:
Personalizing interventions for healthy
behavior
Anita Honka, Kirsikka Kaipainen
VTT Technical Research Center of Finland
pHealth 2010, Berlin
Session 11: ICT research directions for disease prevention
This project is partially funded under the 7th Framework Programme by the European Commission

2. Health behavior matters
• Poor lifestyle choices
increasingly are the largest
contributors to common
adverse health outcomes
• WHO: 77% of the disease Non-Modifiable Contributors to Disease
Lifestyle Contributors to Disease
burden in Europe is
accounted for by disorders Hu et al. Diet, lifestyle and the risk of type 2 Diabetes in women.
NEJM 2001 Sep 13;345(11):790-7.
Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary
related to lifestyles prevention of coronary heart disease in women through diet and
lifestyle. N Engl J Med. 2000; 343: 16–22
Life style risk factors
Diet Alcohol consumption Sleep
Physical activity Smoking Stress
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3. Lifestyle change - a challenge
• Education and knowledge are required
– not everyone is aware of their health risks and how to live
healthily
• Lifestyle change is difficult
– often requires people to change their familiar habits and give up
their preferred ways of living
• Motivation is the main challenge
– how to motivate people to take preventive actions against
diseases that might occur in the distant future
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4. Need for assistance and support
In order to empower the citizen to adopt a healthy lifestyle
1. Profile the person and his environment  personal
profile
– Identify health risk factors,
– sources of motivation and
– difficulties and barriers that discourage / prevent behavior
change
2. Provide personalized guidance for behavioral change
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5. PROFILING THE PERSON – FACTORS THAT
INFLUENCE BEHAVIOR
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6. Determinants of health behavior
Values, personality
Social Ability
influences
Reasoned
Awareness Self-efficacy Intention
behavior
Outcome
expectations Barriers
Automatic
behaviors
Environmental contexts
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7. Motivators / Incentives
• emerge from personal
values which are
relatively stable
• guide intentions by
defining the perceived
value for expected
outcomes
• fulfill our needs and are
considered as benefits
Motivational value types by Schwarz
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8. Environmental context
• influences our choices Public policy
through
– the availability of products,
Community
services and facilities that
support / discourage healthy
behaviors
– ways choices are presented Organizational
i.e. the choice architecture
– social norms and public
Interpersonal
regulations
• is built by actors from Individual
multiple levels
Influences on different levels
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9. Life stages and trigger events
Motivators
Resources
Trigger
events
Childhood Adolescence Adulthood Old age
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10. Example Persona, diet & exercise
1. Basic information 10. Outcome expectations 2. Values, personality
Oscar, 28 years, Finnish. I could get into shape, make my wife Hedonism: seeks for pleasure and enjoyment, lives
Lives with her wife, no happy and possibly live longer, in the moment, hates planning, somewhat worried
children. BUT it’s not worth the effort: of his looks.
Education: vocational. Too complicated to plan and cook food Benevolence: helpful and generous, pleased to
Occupation: carpenter. everyday, exercising is hard and makes make people happy.
me feel nauseous. Watching TV is much Self-direction: practical type, wants to create with
8. Social influences more fun. his hands.
Discouraging. Friends have bad Attitude: Better to live a short life of Interests: hunting and motor vehicles
habits, too. Eat out together and enjoyment than a long life with Motivators: enjoyment, appreciation, practicality,
watch sports from TV. Wife tries restrictions. uncomplicatedness, body shape, interests
to push him to change his
habits, which he considers as
nagging. 4. Current health behavior 5. Risk factors
Poor. Eats irregularly. Often Family history of
12. External resources enjoys sugary and fatty foods. hypertension, bad
Fair. Good exercise facilities near, but Gets some physical activity at working ergonomics,
variety of sports lacking. Healthy food work, but that’s about it. slight overweight
varieties available, but unhealthy
products even more. Sufficient time for 9. Self-efficacy 7. Awareness
leisure. Money is not a problem. Strong. Is confident Fair. Is aware of his unhealthy habits,
of his capability to but is not concerned of the future.
11. Abilities change behavior. Discounts the value of health. Thinks
Poor. Low knowledge literacy, draws that in any case the quality of life will
conclusions based on the experiences 13. Channels, services deteriorate significantly after turning 50.
of few people only. Does not have Information sources he considers eligible:
6. Intention
enough patience to follow very internet discussion forums, friends, parents, 3. Quality of life / Health status
Weak. Has thought
complex information. Suffers from a siblings and professionals. Generally good. Occasional back pain
about changing his
panic disorder, which is triggered by Media: TV, hunting, weapon and motorcycle due to bad working ergonomics. Poor
habits, but is not
hard physical effort. Low self-control: magazines. fitness: recognizes this when lifting
ready to take action.
hard to resist temptations. Services: restaurants, movie rentals, hunting heavy things at work, gets rather easily
club. exhausted during hunting trips.
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11. Interventions for Oscar 1/2
Aim: strengthen the weak intention / motivation for healthy diet &
regular exercise
Problem to target Methods to use
Awareness: Education on the long-term health benefits of healthy lifestyle. Pointing out
lack of knowledge, poor reliable health information sources.
knowledge literacy Methods: Images as analogies, Tailoring information
Co-creator: health care
Awareness: Information about personal risk: musculoskeletal problems in the near future,
biased risk assessment, cardiovascular disease, diabetes.
discounting the value of Imaginary time-shifting with loss-frame: plausible future scenarios of his body
health shape and quality of life.
Contacts with older people who had similar thoughts and habits when younger
and their experiences on aging.
Co-creators: health care, Facebook
Social influences: Health education targeted to friends, parents and siblings.
habit for unhealthy Making friends’ health expectations and attitudes visible.
social activities Mobilizing social support: engaging everyone in a common health promotion plan.
Wife to have an encouraging attitude instead of complaining, show special
appreciation when her husband cooks.
Co-creators: health care, psychologists, exercise facility providers, community
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12. Interventions for Oscar 2/2
Problem to target Methods to use
Outcome Arguments for positive images that motivate e.g. good-looking and fit
expectations: motorcyclist, hunting without getting exhausted, energy to apply at work.
disadvantages exceed Providing short-term benefits for healthy behavior e.g. seasonal hunting limit
advantages health behavior dependent, encouragement to use creativity in cooking.
Co-creators: psychologists, hunting club, restaurants, grocery shops, work place
Abilities: Guided practise: training for preparing healthy, but easy meals.
complicated to plan Practical tips to help planning, pre-planned cooking and eating schedule.
and prepare meals Co-creators: nutritionists, restaurants, grocery shops
Abilities: Learning coping strategies. Treatment for the disorder. Support in finding
panic disorder appropriate exercise options that do not trigger the condition.
Co-creators: health care, psychologies
Abilities: Practical tips: e.g. do not storage sugary and fatty foods at home, go shopping
weak self-control to when hungry, or keep TV open in the background. Make a shopping list before
resist temptations entering the shop.
Co-creators: health care, psychologists
External resources: Modifying availability and choice architecture: Unhealthy foods out of direct
unhealthy food readily sight in shops, less in variety. Less fast food places. Increased availability of
available healthy products.
Co-creators: grocery shops, community, government, restaurants
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13. Personal profile
Ability
Profiling variables
Reasoned
Intention
- Current health behaviors and risk factors behavior
- Degree of intention towards healthy behaviors
- Motivators derived from values and interests
Barriers
- Resources
Resources (barriers & abilities)
External resources
Internal resources
Social environment
Psychological abilities
Service environment
Physical abilities
Physical environment
Determinants of intention
Channels and services used
Habits and routines
Time & Monetary resources
Dynamicity
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14. IMPLICATIONS FOR INTERVENTIONS
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15. Main principles
• Primary aims:
– Create or strengthen intention
– Increase abilities and remove barriers
• Consider the environmental contexts of the person
– Remove barriers and create facilitators
– Guide people with appropriate choice architectures
– Offer immediate, tangible benefits for healthy behaviors
Make changes on multiple levels through involving different actors
 Identify co-creators of health and involve them in delivering
interventions (business models)
• Take advantage of trigger events in people’s lives
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16. High-level intervention logic
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17. Targeting vs. tailoring
• Targeting: designing interventions for subgroups with
common characteristics
– Segmentation dimensions: health behavior, motivators and
resources
– Benefits: reach many individuals, fairly affordable
– Challenge: to provide interventions personalized enough
• Tailoring: fitting an intervention to meet the personal
needs and characteristics of a person rather than a group
– The most effective approach, but traditionally costly
• Persuasive technologies as a way of delivering guidance
for individuals
– affordable, accessible, personalized
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18. Concluding Vision:
ICT enabled personalized interventions
• A Do-It-Yourself platform for profiling yourself and to
select interventions that match your profile
– Enables tailored interventions
• ICT could faciliate the execution of interventions
– Bring the co-creators, meaningful interpersonal relations and the
citizen together
– Provide personal guidance e.g. suggestions for healthy options,
reminders, practical tips, feedback
– Context awareness
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19. PREVE partners
Valtion teknillinen tutkimuskeskus, VTT
Aarhus University
Fondazione Centro San Raffaele del
Monte Tabor
Universidad Politécnica de Valencia
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20. Appendix: Investigated theories by their
focus areas
Individual behavior and behavior change Specific behavioral determinants
Theories of individual behavior • Theories of social networks and social
• Social Cognitive Theory (SCT) support
• Health Belief Model (HBM) • Prototype Willingness Model (PWM)
• Theory of Reasoned Action (TRA) • Self-determination Theory (SDT)
• Theory of Planned Behavior (TPB) • Protection Motivation Theory (PMT)
• Integrated Change Model (ICM) • Goal-setting theories
• Attribution theory
Theories of stages of behavior change
• Transtheoretical Model (TTM) Communication
• Precaution Adoption Process Model
(PAPM) • Elaboration Likelihood Model (ELM)
• Health Action Process Approach (HAPA) • Diffusion of Innovations Theory (DIT)
• Persuasion-Communication Matrix (PCM)
Frameworks of behavioral theories
• Social marketing framework Applications of theories
• Behavioral economics
• Psychological therapies
• Persuasive technologies
Theories of automatic behavior and habits
Life stages and profiling
Learning theories
• Developmental theories
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