Abstract
Background: The current COVID-19 coronavirus pandemic is an emergency on a global scale, with huge swathes of the population required to remain indoors for prolonged periods to tackle the virus. In this new context, individuals' health-promoting routines are under greater strain, contributing to poorer mental and physical health. Additionally, individuals are required to keep up to date with latest health guidelines about the virus, which may be confusing in an age of social-media disinformation and shifting guidelines. To tackle these factors, we developed Elena+, a smartphone-based and conversational agent (CA) delivered pandemic lifestyle care intervention.Methods: Elena+ utilizes varied intervention components to deliver a psychoeducation-focused coaching program on the topics of: COVID-19 information, physical activity, mental health (anxiety, loneliness, mental resources), sleep and diet and nutrition. Over 43 subtopics, a CA guides individuals through content and tracks progress over time, such as changes in health outcome assessments per topic, alongside user-set behavioral intentions and user-reported actual behaviors. Ratings of the usage experience, social demographics and the user profile are also captured. Elena+ is available for public download on iOS and Android devices in English, European Spanish and Latin American Spanish with future languages and launch countries planned, and no limits on planned recruitment. Panel data methods will be used to track user progress over time in subsequent analyses. The Elena+ intervention is open-source under the Apache 2 license (MobileCoach software) and the Creative Commons 4.0 license CC BY-NC-SA (intervention logic and content), allowing future collaborations; such as cultural adaptions, integration of new sensor-related features or the development of new topics.Discussion: Digital health applications offer a low-cost and scalable route to meet challenges to public health. As Elena+ was developed by an international and interdisciplinary team in a short time frame to meet the COVID-19 pandemic, empirical data are required to discern how effective such solutions can be in meeting real world, emergent health crises. Additionally, clustering Elena+ users based on characteristics and usage behaviors could help public health practitioners understand how population-level digital health interventions can reach at-risk and sub-populations.
Highlights
The emergence of the COVID-19 coronavirus pandemic has created a global health emergency on an unprecedented scale [1]
The Elena+ app is listed on both Apple/Google app stores as “Elena+ Care for COVID-19” (Spanish: “Elena+ cuidados ante la COVID-19”) and may be used on both iOS and Android devices in the United Kingdom, Ireland, Switzerland, and on Android devices only at present in the United States, Spain, Mexico, and Colombia with further launch countries planned
The app is listed in the search index with the following keywords: COVID-19, coronavirus, mental health, sleep, exercise, diet, nutrition, coaching, and a natural amount of organic recruitment occurs by individuals searching for these terms
Summary
The emergence of the COVID-19 coronavirus pandemic has created a global health emergency on an unprecedented scale [1]. Problems related to social isolation requirements have been rising; including flaunting of social distancing rules, lack of health promoting behaviors (physical activity, nutrition, sleep routines) and mental health issues (anxiety, loneliness) [3,4,5] In such circumstances, without additional intervention, individuals’ health and well-being may deteriorate, among at-risk groups with whom a lower level of health literacy, self-efficacy and/or access to resources exists already [6, 7]. The current COVID-19 coronavirus pandemic is an emergency on a global scale, with huge swathes of the population required to remain indoors for prolonged periods to tackle the virus In this new context, individuals’ health-promoting routines are under greater strain, contributing to poorer mental and physical health. We developed Elena+, a smartphone-based and conversational agent (CA) delivered pandemic lifestyle care intervention
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