Mobile Health Interventions

Behavioural change is essential in reducing chronic-disease risk in the general population (e.g. obesity prevention), managing chronic diseases (e.g. diabetes) on a day-to-day basis and preventing hospitalisation and long-term complication (e.g. kidney failure).

However, it is often difficult to initiate behavioural change and to maintain them in the long term. While mobile health interventions in the form of smartphone apps that target lifestyle changes are plentiful, many lack a strong theoretical foundation and struggle with low user engagement.

To overcome these challenges, the researchers from ETH Zurich have developed and employed MobileCoach, an open-source platform that relies on an automated conversational agent (chatbot) to deliver interactive and engaging mobile health interventions.

Building on years of experience and success with MobileCoach, the Mobile Health Interventions team, alongside partners in Singapore, are developing LvL UP – a digital lifestyle coaching intervention designed specifically for young and middle-aged adults in Singapore, including those at higher risk of non-communicable disease and common mental disorders. 

Backed by empirical studies and clinical trials, LvL UP combines powerful techniques to boostmotivation and sustained engagement, including:

• Storytelling and relatable characters
• Motivational interviewing-inspired coaching
• Cognitive behavioural therapy strategies
• Visual feedback and progress tracking
• Gamification and habit building tools

LvL UP aims 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 features four digital lifestyle coaches typical each representing a typical Singaporean lifestyle. Embedded within a compelling story, they aim to build a working alliance with users (i.e. a shared understanding about treatment goals and tasks) and guide them through behaviour change at their own pace. More specifically, coaching strategies can be personalised according to (1) an individual’s preferences in lifestyle behaviour 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:

1. Move More: focused on physical activity, exercise, and sedentary behaviour
2. Eat Well: focused on nutrient-rich food, disease-preventing diets, and barriers to healthy eating
3. Stress Less: focused on emotional regulation strategies for stress, anxiety, and low mood management
   

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.

The research is underpinned by the core principles of the multiphase optimisation strategy. In the preparation phase, the team conducted literature reviews, and stakeholder consultations including interviews and focus group discussions with individuals at risk of developing NCDs and CMDs, domain experts and clinicians, and (potential) future providers of LvL UP. The team has published the conceptual model of the intervention and have completed an intensive and iterative cycle to create the LvL UP app.

A feasibility trial has been conducted with adults living in Singapore, without major exclusion criteria for recruitment. . Additionally, a pilot trial with adults at risk of developing noncommunicable diseases or common mental disorders has been carried out to inform a definitive effectiveness trial. The final stages of the research plan will involve a Sequential, Multiple Assignment, Randomised Trial(SMART) with an embedded  Micro-Randomised Trial (MRT) to inform the implementation of human support in, and evaluate the effectiveness and cost-effectiveness of LvL UP.