Personalised social marketing of multi-dimensional physical activity profiles in at risk men & women

Lead Research Organisation: University of Bath
Department Name: Department for Health

Abstract

The NHS Health Check is a major public health initiative targeting men and women aged 40-74 years. The aim of this initiative is to identify people who have an increased risk of diseases such as heart disease, stroke, diabetes and kidney disease. Patients are invited by their healthcare provider approximately every five years and around 2.2 million men and women a year will attend. The intention is to offer personalised advice and support to those identified as at increased risk; and thus help them to help themselves. The costs of this initiative will lead to savings to the NHS if enough people make improvements to their lifestyle and/or receive new medication or treatment that they would not normally have received.

Physical activity is a very important part of lifestyle. For those men and women identified as at risk of chronic disease through the NHS Health Check, physical activity can have a very powerful positive effect on future risk. However, people find it hard to judge their physical activity status. Many people have the perception that they are more active than is actually the case and this prevents them from seeing the need for change. It is also difficult for people to know whether a change in their behaviour has had a meaningful impact on a given aspect of physical activity (some people may overestimate the impact of the introduction of a new behaviour and/or counter forces such as substitution or compensation may lessen the net effect). At present, it is estimated that only 5% of people identified through the NHS Health check will change their physical activity. Physical activity has potentially so much more to offer people who have been told that they have an increased risk of chronic diseases; and thus has much more to offer the NHS and its partners.

We are learning more about physical activity and health all the time. It is becoming increasingly apparent that there are multiple ways to harness the protective properties of physical activity because there are various dimensions to this behaviour that are independently important. Thus, we do not all have to do the same thing (one-size does not fit all). Rapid developments in technology mean that we can now portray simple and/or sophisticated physical activity 'profiles' and personalised illustrations of current physical activity dimensions. In turn, this means that we can promote (market) a smorgasbord of personalised physical activity choices (in the context of existing personalised behaviour) with options tailored to an individual's need and preferences.

In this research, we want to find out how the users (patients and healthcare workers) would like the information provided from technological advances in physical activity measurement to be portrayed (Phase 1). There are various highly-visual ways to depict personalised physical activity profiles and there are many different options and alternatives. The aim is to develop a definitive physical activity profiling tool and approach that we can use in a trial. We will seek external advice in this development phase (e.g., National Social Marketing Centre). After this development work, in a subsequent 12-month trial, we will examine whether personalised social marketing of physical activity profiles is more effective at increasing physical activity and reducing risk than standard care in 216 men and women across the South West (Phase 2). The premise is that most patients do not understand their current physical activity behaviour and the options that are open to them; and that a long-lasting change in physical activity behaviour requires greater empowerment and self-determined engagement (people need to experience an understanding of their behaviour and the options so that they can make informed-decisions about their physical activity).

We aim to translate the investment of resource in the NHS Health Check into a meaningful change in physical activity behaviour in individuals identified as at risk.

Technical Summary

The roll-out of the NHS Health Check through general practice represents a considerable investment of resource in order to identify at risk individuals. This public health initiative is underpinned by the relevance and power of personalised information and physical activity is advocated as a primary strategy for patients to reduce their risk. The major challenge is to develop approaches that are effective at changing behaviour in this priority group and that can be readily implemented in primary care.

Physical activity is a rather complex behaviour. There are multiple dimensions (aspects) to physical activity behaviour that all have the potential to improve health. This can sometimes lead to confusion but it also means that there is the potential to generate novel and exploitable opportunities. We now have the technology to capture this information and thus provide patients with personalised feedback on the multiple dimensions of physical activity behaviour that they can change and use (harness) to play a role in reducing their risk (e.g., physical activity energy expenditure, time engaged in moderate intensity activity, sedentary time etc).

We have piloted different formulations for integrated physical activity profiles that reflect various (multiple) physical activity dimensions. We will work with the users (patients and healthcare practitioners) to generate a preferred option (personalised and visual feedback in the form of a physical activity profile) that represents biologically important dimensions of physical activity behaviour. We will then determine whether we can use feedback from these profiles and social marketing techniques to help patients identified as at risk in the NHS Health Check to understand the problem (their low physical activity) as a step towards becoming self-determined in their engagement (i.e., autonomous).

There is a direct route to implementation of the findings and a change in practice as an adjunct to NHS Health Checks.

Planned Impact

The primary beneficiaries of this research will be patients identified through the NHS Health Check, healthcare practitioners who work with these patients plus the wider UK economy through NHS and employer savings (as well as charities and other relevant organisations). The NHS Health Check represents an innovative strategy to identify people who are at increased risk of chronic disease and this is a central component within a broad public health portfolio. An estimated 2.2 million patients per year will attend for a Health Check with ~1 million or more having one or more risk factor for future chronic disease. The NHS Health Check will cost ~£332 million per year to deliver at full roll-out with a net economic saving of ~£3.5 billion. According to the national impact assessment of the NHS Health Check and the newly-released 'ready reckoner' tool, most of these savings will be derived from the new-diagnosis of people who need treatment. At present, it is estimated that only a rather disappointing 5% of those people identified as at risk will engage in long-term physical activity. Within this context, it is noteworthy that as the NHS Health Check continues into the future there will be fewer cases identified (only those people who reach 40 and new cases that have developed in the population who are invited for a re-test after 5 years will be discovered). The consequence is that there will be a lower health gain at a higher cost. Thus, in the future, it will become even more important to develop evidence-based strategies (such as lifestyle change) to continue to exploit the health and financial gains derived from investment in the NHS Health Check. In short, if we can increase physical activity amongst higher risk individuals identified via the NHS Health Check, this will generate meaningful benefits to patients and healthcare providers now and in the future; as well as reducing healthcare and employer costs.

Technology-enabled personalised social marketing of physical activity profiles could become part of a GPs toolbox and adjunct to the NHS Health Check initiative as a strategy to reduce the future burden of chronic disease. NHS Health Checks will be part of Public Health England and embedded in primary care. Thus, there is a direct pathway to impact and the appropriate systems/procedures and other resources (e.g., people) are available to deliver this impact (via implementation and a change in practice). In the current trial, we will understand the effectiveness of this approach. The resources developed during this trial will be available for evaluation and implementation by other regions (i.e., a change in regional practice). The results will also inform decisions about a possible national, multicentre definitive trial to provide definitive evidence prior to potential rollout (i.e., a change in national policy). Ultimately, this approach will be one tool in an array of bespoke public health strategies to ensure that healthcare practitioners have the right intervention/strategy for the right patient.

The secondary beneficiaries of this research include any other population where physical activity is advocated (but poorly adopted) such as children and the general public. The social marketing of personalised physical activity profiles could become an adjunct to other initiatives and interventions. Furthermore, the concepts, tools and understanding from this project may have broader reach. Innovation in physical activity data handling to generate physical activity profiles using focussed technological development has commercial and public health application (monitor development, integration into websites etc). Furthermore, these concepts may be transferable to other settings (e.g., profiling or labelling certain jobs, recreational activities and so on) to enable mass population-based social marketing alongside the work of other agencies (e.g., food labelling).

Publications

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Emery CA (2019) Establishing outcome measures in early knee osteoarthritis. in Nature reviews. Rheumatology

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Thompson D (2015) Multidimensional physical activity: an opportunity, not a problem. in Exercise and sport sciences reviews

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Thompson D (2013) Towards integrated physical activity profiling. in PloS one

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Thompson Dylan (2015) Multidimensional Physical Activity: An Opportunity, Not a Problem in EXERCISE AND SPORT SCIENCES REVIEWS

 
Description Invited Presentation for the Department of Health and Social Care (DHSC) London
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
 
Description MRC Epidemiology Unit quinquennial review
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
 
Description Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis
Amount £1,998,627 (GBP)
Funding ID 21595 
Organisation Versus Arthritis 
Sector Charity/Non Profit
Country United Kingdom
Start 01/2018 
End 12/2022
 
Title Assessment of laboratory and daily energy expenditure estimates from consumer multi-sensor physical activity monitors-dataset 
Description Wearable physical activity monitors are growing in popularity and provide the opportunity for large numbers of the public to self-monitor physical activity behaviours. The latest generation of these devices feature multiple sensors, ostensibly similar or even superior to advanced research instruments. However, little is known about the accuracy of their energy expenditure estimates. Here, we assessed their performance against criterion measurements in both controlled laboratory conditions (simulated activities of daily living and structured exercise) and over a 24 hour period in free-living conditions. Thirty men (n=15) and women (n=15) wore three multi-sensor consumer monitors (Microsoft Band, Apple Watch and Fitbit Charge HR), an accelerometry-only device as a comparison (Jawbone UP24) and validated research-grade multi-sensor devices (BodyMedia Core and individually calibrated Actiheart™). During discrete laboratory activities when compared against indirect calorimetry, the Apple Watch performed similarly to criterion measures. The Fitbit Charge HR was less consistent at measurement of discrete activities, but produced similar free-living estimates to the Apple Watch. Both these devices underestimated free-living energy expenditure (-394 kcal/d and -405 kcal/d, respectively; P<0.01). The multi-sensor Microsoft Band and accelerometry-only Jawbone UP24 devices underestimated most laboratory activities and substantially underestimated free-living expenditure (-1128 kcal/d and -998 kcal/d, respectively; P<0.01). None of the consumer devices were deemed equivalent to the reference method for daily energy expenditure. For all devices, there was a tendency for negative bias with greater daily energy expenditure. No consumer monitors performed as well as the research-grade devices although in some (but not all) cases, estimates were close to criterion measurements. Thus, whilst industry-led innovation has improved the accuracy of consumer monitors, these devices are not yet equivalent to the best research-grade devices or indeed equivalent to each other. We propose independent quality standards and/or accuracy ratings for consumer devices are required. 
Type Of Material Database/Collection of data 
Year Produced 2017 
Provided To Others? Yes  
 
Title Participant Transcripts 
Description Participant transcripts for "The understanding and interpretation of innovative technology-enabled multidimensional physical activity feedback in patients at risk of future chronic disease" 
Type Of Material Database/Collection of data 
Year Produced 2015 
Provided To Others? Yes  
Impact None 
 
Title Participant transcripts for "The understanding and interpretation of innovative technology-enabled multidimensional physical activity feedback in patients at risk of future chronic disease" 
Description Background: Innovative physical activity monitoring technology can be used to depict rich visual feedback that encompasses the various aspects of physical activity known to be important for health. However, it is unknown whether patients who are at risk of chronic disease would understand such sophisticated personalised feedback or whether they would find it useful and motivating. The purpose of the present study was to determine whether technology-enabled multidimensional physical activity graphics and visualisations are comprehensible and usable for patients at risk of chronic disease. Method: We developed several iterations of graphics depicting minute-by-minute activity patterns and integrated physical activity health targets. Subsequently, patients at moderate/high risk of chronic disease (n=29) and healthcare practitioners (n=15) from South West England underwent full 7-days activity monitoring followed by individual semi-structured interviews in which they were asked to comment on their own personalised visual feedback Framework analysis was used to gauge their interpretation and of personalised feedback, graphics and visualisations. Results: We identified two main components focussing on (a) the interpretation of feedback designs and data and (b) the impact of personalised visual physical activity feedback on facilitation of health behaviour change. Participants demonstrated a clear ability to understand the sophisticated personal information plus an enhanced physical activity knowledge. They reported that receiving multidimensional feedback was motivating and could be usefully applied to facilitate their efforts in becoming more physically active. Conclusion: Multidimensional physical activity feedback can be made comprehensible, informative and motivational by using appropriate graphics and visualisations. There is an opportunity to exploit the full potential created by technological innovation and provide sophisticated personalised physical activity feedback as an adjunct to support behaviour change. 
Type Of Material Database/Collection of data 
Year Produced 2015 
Provided To Others? Yes  
 
Title Training materials and participant handouts for "Multidimensional individualised physical activity (Mi-PACT): a technology-enabled randomised controlled trial to promote physical activity in primary care" 
Description ABSTRACT Background: Low physical activity is a major public health problem. New cost-effective approaches that stimulate meaningful long-term changes in physical activity are required, especially within primary care settings. It is becoming clear that there are various dimensions to physical activity with independent health benefits. Advances in technology mean that it is now possible to generate multidimensional physical activity 'profiles' that provide a more complete representation of physical activity and offer a variety of options that can be tailored to the individual. Mi-PACT is a randomised controlled trial designed to examine whether personalised multidimensional physical activity feedback and self-monitoring alongside trainer-supportive sessions increases physical activity and improves health outcomes in at-risk men and women. Methods/design: We aim to recruit 216 patients from within primary care aged 40 to 70 years and at medium or high risk of cardiovascular disease and/or type II diabetes mellitus. Adopting an unequal allocation ratio (intervention: control) of 2:1, participants will be randomised to one of two groups, usual care or the intervention. The control group will receive usual care from their general practitioner (GP) and standardised messages about physical activity for health. The intervention group will receive physical activity monitors and access to a web-based platform for a 3-month period to enable self-monitoring and the provision of personalised feedback regarding the multidimensional nature of physical activity. In addition, this technology-enabled feedback will be discussed with participants on five occasions during supportive one-to-one coaching sessions across the 3-month intervention. The primary outcome measure is physical activity, which will be directly assessed using activity monitors for a 7-day period. Secondary measures include weight loss, fat mass, and markers of metabolic control, motivation and well-being. All measures will be performed at baseline, post intervention and at 12-month follow-up. Discussion: Results from this study will provide insight into the effects of integrated physical activity profiling and self-monitoring combined with in-person support on physical activity and health outcomes in patients at risk of future chronic disease. Trial registration: Current Controlled Trials ISRCTN18008011. 
Type Of Material Database/Collection of data 
Year Produced 2015 
Provided To Others? Yes  
 
Title KiActiv is now being used in West of England healthcare 
Description We developed a digital platform and personalised behaviour change programme for patients with, or at risk of developing, chronic diseases such as cardiovascular disease and type 2 diabetes. A UK-based SME (Ki Performance Ltd) has commercialised this programme as a product which they have called 'KiActiv'. The NHS and local authorities have now commissioned KiActiv as part of routine care and the programme has already led to meaningful improvements in physical activity in patients with diabetes in Gloucestershire. 
Type Management of Diseases and Conditions
Current Stage Of Development Small-scale adoption
Year Development Stage Completed 2016
Development Status Under active development/distribution
Impact Our research has benefitted a wide range of users including the SME who commercialised the programme (Ki Performance Lifestyle Ltd), the health teams within the NHS who are using this programme as part of their day-to-day practice and the specific patient populations who are using the programme to manage their chronic long-term conditions. 
URL https://www.ahsnnetwork.com/case-study/kiactiv-improving-self-care-through-technology-enabled-behavi...
 
Title Diabetes Digital Coach 
Description The software that was developed as part of this project is now being incorporated into the Diabetes Digital Coach - a platform that is part of an NHS Test Bed in the South West of the UK. 
Type Of Technology Webtool/Application 
Year Produced 2018 
Impact Being tested in the real world during 2018-19 
URL https://www.diabetesdigitalcoach.org/
 
Title Mi-PACT platform 
Description We commissioned an external company (Ki Performance Ltd) to build a web-based platform for the rendering of physical activity data collected using a body-mounted physical activity device. The platform has been designed with the users in order to provide complex information in a readily-accessible format. 
Type Of Technology Webtool/Application 
Year Produced 2014 
Impact The Mi-PACT platform has been developed by Ki Performance Ltd into a commercial product. Ki Performance Ltd have recently been commissioned by the NHS (Gloucestershire CCG) and local authorities to use this product as part of routine care (diabetes), occupational health and community-based programmes in the South West of England. 
 
Description House of Lords 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Meeting with Dame Tanni Grey-Thompson (Chair of UK Active) to discuss the work that we are doing in Mi-PACT
Year(s) Of Engagement Activity 2016
 
Description Press Release 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Our Press Release generated articles in national newspapers (e.g., Times Higher Educational Supplement) and local newspapers (Northern Echo and The Bath Chronicle). The paper was accessed over 1000 times in the first 6 months and 'tweeted' by people from around the world.

The primary impact from this paper and press release was knowledge and awareness.
Year(s) Of Engagement Activity 2013