Perfect Fit: A virtual lifestyle coach to prevent smoking and promote exercise; 2 birds with one stone!

Smoking and insufficient exercise are major risk factors for developing cardiovascular disease. Yet it often proves difficult to stop smoking or to exercise more, even for people who would like to. One reason is that support from a care provider is not always available, especially at times when people need it most.

The Leiden University Medical Center (LUMC) and the National eHealth Living Lab (NeLL)*, as part of a strong national consortium, have been awarded €2 million for the ‘Perfect Fit’ project within the research programme. Perfect Fit is one of four public-private research projects in the Commit2Data round Big Data & Health. In total, Topsector LSH, NWO, ZonMW, De Hartstichting and the Ministry of Health, Welfare and Sport have made €6.58 million available for the research projects. With the money, the consortium led by Prof Niels Chavannes (Professor of General Medicine at LUMC) and Dr Eline Meijer (Assistant Professor at LUMC) is developing a virtual coach (digital app) that will support people in developing a healthy lifestyle, thus reducing the risk of cardiovascular disease. We spoke to Niels in late August 2022 - at the halfway point of the project's duration - about the state of play around Perfect Fit.

Perfect Fit covers several lines of research working on different aspects of the virtual coach in a partnership of academic institutions, private businesses and public sector organisations. The University of Twente and the eScience center are engaged in collecting and combining data as well as developing advanced data analysis ('machine learning') techniques. Leiden University focuses on developing targeted techniques for changing behaviour. These results provide important insights for the development of the virtual coach being developed by Delft University of Technology. After development, the effectiveness and user experience of the virtual coach will be examined by LUMC and NeLL.

"I am especially proud that we managed to connect all these different parties from various fields in this project. It is a very content-driven consortium in which everyone contributes their expertise, an intimate collaboration in a public-private domain in which SMEs (software developers, app builders, therapists) also actively participate. Also unique is the focus on these two major risk areas - smoking and insufficient exercise - together in one challenging study. “If we manage with this to convert a smoking addiction into an exercise addiction, then that is a wonderful outcome, a real double whammy.”

Joe the Plumber

Citizens/patients have also been participating from the beginning of the project, Niels points out. Among other things, prototypes were submitted to panels of end-users to make the interface fit the target audience as well as possible.

“Since the foundation of NeLL, our target audience has been people with low health literacy. That is where by far the biggest impact will be achieved on our care and our healthcare costs. Niels points out that major contributors to many chronic diseases, such as smoking and obesity, are concentrated at above-average levels in people of lower socio-economic status. Intervention using personalised eHealth applications - provided they are eHealth4All-proof - can therefore help in these cases at an above-average level.

"You'd like to reach Joe the Plumber who smokes 2 packs a day, and get him off his couch, that's where actual health gains can be made. It is tricky but previous experience with the Stopcoach app, for example, showed that this target group seemed more loyal to an app than was previously thought. Finally there was someone who understood them.
This target group also appears to be more loyal if their lifestyle is successfully penetrated with an app, because if you like something then you stay loyal to it. Provided we use the right language and form."

Lessons learned:

Niels says great strides have already been made over the past two years. From the scientific literature, reviews were written on what can be found in both domains, and possible blind spots were identified. This is an important part of the foundation of the output. In addition, an intelligent chatbot has been developed to make users feel understood and provide tips that actually help; personalised and flexible. "Gradually we found out that creating this smart personalising coaching was a huge amount of work, really dedicated hard work. We put extra scientists onto it, so that we would end up with good analogies. Those formulations not only had to be understandable but at the same time not too simplistic or irritating. This cost us an awful lot of time.”

In the background, on a technical level, everything was also made compliant with GDPR and compliant with 'informed consent' during this period. "Also the whole data management is almost in place, so then we can get going!"

Persuasive communication approach

The highly personalised and flexible coach offers approachable support at any time. Through sophisticated analysis of existing and new data, the researchers determine which coaching advice works best and for whom.

Eline: "We try to permanently motivate people to change behaviour, by paying attention to identity: 'who are you and who do you want to become', rather than giving advice such as 'smoking is dangerous so you'd better quit'. We also offer many exercises, which are tailored to what works for the client. This also helps to provide people with targeted coaching at times when they are struggling, such as if they nevertheless light up a cigarette. This way, they are guided step by step in the right direction."

Niels: "The feedback loops will soon make this app really unique, people should really feel recognised. The aim of the app is to really coach people and that requires intelligence; people soon realise if it is 'plain AI'. Real feedback addresses what is actually going on. We are therefore trying to create an application that accepts human errors, and which is closely aligned with the individual's personal communication style."
Eline: "The coaching also naturally focuses on how things are going. Movement is measured by sensors and feedback is tailored accordingly. The user is rewarded not only for goals achieved, but also for effort.

“Let's get going”

The main preparations for the Perfect Fit project have now been made.

The project is now entering a phase in which the real trial is coming and the Chatbot will be used, Niels points out. "There are even plans to also prepare in advance for what the valorisation will mean. Imagine a working product coming out that we want to use widely and that can measure long-term effects.... We are already working on that follow-up as well."

To find out more or sign up for the survey, see https://perfectfit-onderzoek.nl/

* NeLL is an independent knowledge platform, offering various services for the development, implementation and scale-up of eHealth solutions.
NeLL's mission is to develop, implement, and scale up sustainable care and health models. The right care for the patient in the right place, at the right price. Efficient, effective and as pleasant as possible for all involved. Scalable eHealth solutions play a key role in achieving this goal.