Table 1 POWERS process for identifying and targeting participant health behavior strategies

1. Progress monitoring (by coach)

After the initial HAP evaluation, participants can access POWERS to log their progress in terms of weight, physical activity (type, duration, frequency), and diet (calorie intake, fat gram intake, and fruit/veg. servings) anywhere 24/7. During each coaching session, a health coach starts with the review of a participant’s progress since last session. The tracking data are displayed in interactive charts facilitating easy detection of progress or areas of concern. If the target BMI goal is reached, the coaching exercise is complete and the participant is referred to a community-based program; otherwise, the main POWERS steps below will be implemented. If the participant has significant health risk issues that are identified during monitoring, the participant will be advised to contact his/her physician.

2. HAP updates (by coach)

A health coach and a participant work together on the phone to update the HAP, a comprehensive assessment tool that includes a participant’s disability status (e.g. health conditions and functional ability), behaviors (e.g. physical activity, nutrition, screen time), and barriers to achieving diet and physical activity health promotion goals (e.g. separated into intrapersonal, interpersonal, community, and organizational barriers).

3. Objective selection (by POWERS)

A large set of “rules,” developed specialists in nutrition, exercise, health behavior, health education, and disability, are used to associate each wellness objective with specific disabilities, demographics, health issues, and a variety of conditions assessed in HAP. When one or more of these HAP conditions is met, the associated objectives are triggered and presented to the coach. For instance, if an adult participant has a BMI ≥ 30, the objectives of “lower calorie intake,” “increase physical activity,” etc. will be triggered because they are associated with the conditions “adult” and “BMI ≥ 30.”

4. Objective calibration (by coach)

The recommended wellness objectives from Step 3 are generic in nature. They need to be refined and calibrated to accommodate the special needs for the participant and be “measurable.” For instance, it is difficult to quantify the progress against a generic objective such as “lower calorie intake.” Instead, the coach and the participant should work together to set a more measurable objective such as “lower calorie intake to 2000 calories per day in 4 weeks.”

5. Strategy selection (by POWERS)

Similar to how wellness objectives are recommended from the POWERS knowledge base, strategies to achieve these objectives are also available in the POWERS knowledge base and triggered by matching HAP conditions. For instance, if “increase intake of fruits/vegetables” is selected as the wellness objective and the participant has indicated “dislikes diet or health food” as a nutrition barrier in HAP, strategy recommendation such as “add fruit to cereal, granola, or yogurt” and “make a fresh fruit smoothie” will be triggered.

6. Strategy enrichment (by POWERS)

POWERS further “enriches” the recommended strategies by providing a set of wellness education resources (both text materials and videos) to help implement the recommended strategies. These NCHPAD educational resources are associated with strategy recommendations in POWERS via keyword searches, instead of directly linked to the strategies, to provide the flexibility for NCHPAD staff to update these educational resources independently of the POWERS operations.

7. Strategy localization (by POWERS)

POWERS can also propose local community resources to help implement a specific wellness strategy. For instance, when proposing to play golf as a way to increase physical activities, POWERS can automatically search in its community resource database for golf courses that have accessible golf carts based on the locations (e.g. home, work, school, etc.) provided by the participant in HAP. POWERS can then display them on a Google Map using Google Map API. To allow POWERS coaches at local communities to maintain and share the information about these local resources themselves, POWERS allows coaches to submit information about these local resources and the system can automatically process them, including geocoding, to make them accessible to Google Map.

8. Strategy calibration (by coach)

Similar to how wellness objectives are calibrated for individual participants, strategies are refined and calibrated to be measurable and realistic. Instead of using the generic system-generated strategies such as “make a fresh fruit smoothie,” the telehealth coach and the participant could revise it to “make 2 fresh fruit smoothies every week” as the actual strategy. Also, note that Steps 6 and 7 above could provide additional support information to help implement the strategy, such as possible recipes from Step 6 and where to buy the ingredients from Step 7 on a map.