Empowering Individuals to Improve Their Health and Well-Being in Rural Communities Using

Amanda J Lloyd, Tom Wilson, Dan Steward, Marco Arkesteijn, Rhys Thatcher, Manfred Beckmann, John Draper

IBERS, Diet, Exercise and Health Research Group, Edward LLwyd Building, Penglais Campus, Aberystwyth University, Aberystwyth, Ceredigion, UK SY23 3DA.

Empowering individuals to improve their health and well-being in rural communities using ‘smart’ digital technology and associated apps

An unbalanced diet and physical inactivity are important risk factors in the development of many chronic health conditions such as cardiovascular diseases (CVD), type 2 diabetes, respiratory diseases and many cancers. These chronic conditions, and an increase in obesity prevalence impose a huge financial burden on UK healthcare systems. Although most individuals are aware of what constitutes a healthy diet, encouraging behavior to improve and sustain better eating habits is proving extremely difficult. Constraints due to rural isolation, lack of accessible resources and family and cultural habits make it difficult for individuals to adopt and, most importantly, maintain the appropriate recommended healthy lifestyles.

The ‘Monitoring Well-being and Health at Home’ study (MWH@home) is a randomized controlled trial which aims to empower individuals to improve self- management of their own health at home using telehealth methods over a 12 month period in a community setting. Funded by EIT-Health, this major (~ £3 million) international technology validation project is the first to be undertaken at the Well-being and Health Assessment Research Unit (WARU) on the Aberystwyth University’s Penglais Campus. There are many ‘health apps’ on the market but unfortunately few have been demonstrated unequivocally to improve health enough to allow recommendation by health and social care organisations. MWH@home study is using interactive ‘smart’ digital appliances and associated Bluetooth connected ‘Health Apps’ and validating these in terms of effectiveness of helping individuals to modify their diet, improve their nutritional status, body composition and general well-being in their home-settings. Remote self-monitoring of diet through Food Frequency Questionnaires (FFQ) and diet diaries, together with health, physical activity and quality of life questionnaires is being performed by utilising an online platform, accessible by individual participants. A remote central system at WARU provides frequent electronic contact with participants, together with personalised nutritional feedback and dietary habit coaching. Postable urine sampling kits allow for home-collection and direct mailing to WARU without the need of any special storage conditions during transport. Participants only need to visit WARU 3 x over the year for a full body DXA composition scan, collection of a fasted blood sample and clinical measurements such as blood pressure. By interacting with analytical laboratories in IBERS and at Bronglais Hospital, objective ‘biomarkers’ of key lifestyle behaviours are being monitored in urine and blood samples (including diet, smoking and alcohol consumption). These objective biomarkers will be correlated with altered health and well-being status by using the FFQ, diet records and body mass composition data. A key outcome is disease-relevant information on risk and remedy choice from behavioural data, and routine measurement of biomarker molecules in biofluid samples.

MWH@Home is delivering behavioural coaching and health-sentinel technologies supporting a P4 health care strategy (Predictive, Preventive, Personalized, Participatory) at home. This telehealth validation project aims to give rural Mid-Wales the opportunity to contribute to research to empower individuals to improve their health prospects.