LvL UP: A Digital Lifestyle Coach for the Prevention of NCDs in Singapore
Non-Communicable Diseases (NCDs) such as cardiovascular disease, diabetes, and cancer, and Common Mental Disorders (CMDs) such as depression or anxiety are the leading causes of death and disability worldwide, causing major health, social, and financial burdens. Similar to other regions of the globe, countries in Southeast Asia, such as Singapore, are facing the challenges arising from the increase of NCDs and CMDs, which pose a significant threat to their healthcare systems.
To address this important problem, our team at the Singapore-ETH Centre, aims to develop and evaluate a scalable digital health intervention for the prevention of NCDs and CMDs. Smartphone-delivered and personalized health interventions may be an effective, low-cost, and scalable solution to prevent these conditions. However, prevention-focused health interventions represent a large unmet need and low user engagement has so far limited the general usefulness of many mobile health interventions. MobileCoach, an open-source platform that is based on an automated conversational agent (chatbot) to deliver scalable, interactive, and engaging mobile health interventions, will be used in this project to address this challenge. In addition, we will leverage an innovative engagement approach that combines storytelling, motivational interviewing, cognitive behavioral therapy, progress feedback visualization, gamification, and builds upon leading evidence- and theory-based frameworks in the areas of behavior change to build our intervention, named LvL UP.
LvL UP will target young and middle-aged adults living in Singapore (including vulnerable individuals) to achieve the following outcomes:
- Increased physical activity and healthy eating
- Improved mood and reduced stress
- Reduced risk of developing NCDs and CMDs
- Improved self-reported quality of life
LvL UP’s digital lifestyle coaches are four characters that portray typical Singaporean lifestyles and who are embedded within an overarching storyline to build a working alliance with intervention users (i.e. a shared understanding about treatment goals and tasks). This attachment bond is robustly linked to treatment success. More specifically, coaching strategies will be personalized according to (1) an individual’s preferences in lifestyle behavior and (2) the current stage of change. In doing so, the coaching will be rooted in psychoeducation, and cognitive behavioral therapy, covering content in the following three areas:
- Move More: focused on physical activity, exercise, and sedentary behavior
- Eat Well: focused on nutrient-rich food, disease-preventing diets, and barriers to healthy eating
- Stress Less: focused on emotional regulation strategies for stress, anxiety, and low mood management
LvL UP will be adapted to the characteristics of the population and the healthcare ecosystem in Singapore. In addition to the digital coaching provided, it will be explored whether adding human support can help to build a therapeutic bond with users and improve adherence to and outcomes of LvL UP.
To carry out this research, we follow the core principles of the multiphase optimization strategy. In the preparation phase, we will conduct literature reviews, interviews and focus group discussions with individuals at high and low risk of developing NCDs and CMDs, experts, health and lifestyle coaches, and (potential) future providers of LvL UP. We will also develop the conceptual model of the intervention and define the optimization criterion to develop a first MobileCoach-based prototype of LvL UP. A feasibility trial will be conducted with adults living in Singapore, without major exclusion criteria for recruitment. Afterwards, the research plan will involve conducting a Micro-Randomized Trial (MRT) to strengthen the core machine learning technologies behind the engagement mechanisms of LvL UP. Finally, a Sequential, Multiple Assignment, Randomized Trial (SMART) will be conducted to inform the implementation of human support in, and evaluate the effectiveness of, LvL UP.