Pervasive healthcare and citizen-centered care paradigm are moving the healthcare outside the hospital environment. Healthcare delivery is becoming more personalized and decentralized, focusing on prevention and proactive services with a complete view of health and wellbeing. The concept of wellness has been used to describe this holistic view of health, which focuses on physical, social, and mental well-being. Pervasive computing makes it possible to collect information and offer services anytime and anywhere. To support pervasive healthcare with wellness approaches, semantic interoperability is needed between all actors and information sources in the ecosystem. This study focuses on the domain of personal wellness and analyzes related concepts, relationships, and environments. As a result of this study, we have created an information model that focuses on the citizens’ perspectives and conceptualizations of personal wellness. The model has been created based on empirical research conducted with focus groups.
Healthcare delivery is undergoing a notable shift toward personalized services with distributed care processes that emphasize a more holistic view of health and wellness within a citizen-centered care model [
Such a view of health is not entirely new. The World Health Organization (WHO) defined health as early as 1948 as “a state of complete physical, mental and social well-being and not merely the absence of disease of infirmity” [
Pervasive healthcare can be defined either as the application of pervasive computing—in other words, ubiquitous computing, proactive computing, or ambient intelligence—for healthcare, health, and wellness management, or as making healthcare available anytime and anywhere [
Pervasive healthcare applications are designed to support decentralized and preventive care. Pervasive healthcare will also help citizens manage their personal health and wellness outside the provider network. This model highlights a wellness-centered approach by helping citizens to stay well physically, mentally, and socially and to utilize different self-management and assistive services [
The objective of information modeling is to describe the information in a certain domain or in an organization. Information models can be used to capture users’ perceptions and understanding of system complexities [
With pervasive healthcare and more personalized, holistic, and citizen-centered services, we need a better understanding of the personal wellness domain. This requires more information than typical health records include. To fully support the new ways of managing health and wellness with ICT and pervasive computing, we need to achieve semantic interoperability among different stakeholders, systems, devices, sensors, and other information sources and users. To achieve semantic interoperability, a context-aware personal wellness ontology is needed. This ontology can be used to create shared understandings and allow for sharing of heterogeneous information among all actors and systems in the personal wellness ecosystem.
This study is a part of a research project that examines the trusted use of personal health and wellness information in future ubiquitous computing environments [
The first research objective of this study was to analyze the domain of personal wellness. This includes both how the concept of personal wellness is defined in the literature and how people conceptualize it as well as the scope of the domain. The second objective of this study was to create a high-level personal wellness information model to present related concepts, characteristics, and contextual aspects. With this high-level information model, we can understand the concept of personal wellness and start to create a more formal model, in other words, a personal wellness ontology.
As a guiding framework for our research, we have used a design science research (DSR) approach [
DSR is based on two design processes:
Most of the work done in the domain of personal wellness is related to the measurement or assessment of wellness or well-being. They focus on different things than what we need to develop a personal wellness ontology. These models are high-level descriptions with limited analysis of the concepts or relations. Moreover, environmental factors are defined quite narrowly. In our research, we are more interested in identifying and defining main components, concepts, and relations in the personal wellness domain. We are creating a more complete and conceptually focused model to support the field of pervasive healthcare.
This study had three main methods for information modeling: an analysis of the literature, which explores the conceptualization of personal wellness, personalized healthcare, and a holistic view of health; a context analysis to identify internal and external contexts of personal wellness; focus groups to understand how people understand the concept of personal wellness, how it can be conceptualized, and which factors affect personal wellness.
As a basis for the study, we carried out an analysis of scientific literature concerning personal wellness. The analysis included Google Scholar and different scientific publication databases: Association for Computing Machinery (ACM), ESBCOhost Academic Search Premier, IEEE, PubMed, ScienceDirect, and SpringerLink. For more detailed analysis, we chose articles concerning holistic and multidimensional views on health and wellness that possibly were related to the components of a citizen-centered healthcare paradigm. We manually analyzed around 100 articles concerning these topics.
The context analysis was performed using basic techniques from the requirements elicitation process. Requirements elicitation is a process used to find necessary requirements for computer-based systems [
From the literature and context analysis, we obtained the material that formed the basis of our empirical research, which was performed with focus groups. A focus group is a method for group interviews in which emphasis is on the communication between the participants. The number of groups or participants may vary, but according to Kitzinger [
The total number of focus group meetings in our study was six, with four different groups (see Table
Focus group meetings.
Group | Duration | Participants | Focus |
---|---|---|---|
Group 1 | 2 meetings, 4 hours each | Young, healthy department staff members, open voluntary call to our department’s mailing list (5 and 4 participants) | Identify and describe basic concepts of personal wellness |
| |||
Group 2 | 1 meeting, 2 hours | Internal project meeting (4 participants) | Specification of concepts, redundancy reduction, and abstraction levels |
| |||
Group 3 | 1 meeting, 2 hours | Our university’s health informatics postgraduate students (5 participants) | Concept specification and categorization and external contexts |
| |||
Group 4 | 2 meetings, 2 hours each | Females aged 48–62 (9 and 10 participants); group was formed on a voluntary basis by sending invitations to participants in another well-being-related study | Discussion about participants’ views on personal wellness in general and then our models in more detail |
The results of the first two meetings were documented in a mind map. Mind mapping was chosen because it is an easy way to represent information, simple categorizations, and simple relations between concepts. Moreover, most people are familiar with this technique. Based on the first two focus group meetings and the performed analyses, we started to model the personal wellness domain in a more formal way by using a simplified entity relationship (ER) notation. The idea behind the use of the simplified ER model was that the model could be easily understood and modified by people without any modeling experience. The results and modifications made by the focus group participants were modeled by the researchers. Although we performed the modeling ourselves based on the focus group meetings, we tried, to the extent possible, to keep the model based on the actual discussions, concepts, and views presented by the focus group participants. The modeling work was divided into seven sub-models, which together form the high-level information model of personal wellness. The focus group meetings were organized to support iterative build-evaluate-type process.
Wellness is a multidimensional and multidisciplinary concept. Although definitions may vary depending on the context, generally, wellness is thought to be a balanced state of a healthy body, mind, and spirit [
Some holistic wellness models have been developed in the field of clinical and counseling psychology [
Based on the literature and context analyses, we were able to identify some common concepts, characteristics, and properties of personal wellness. As a result of the analyses, we were able to discover how wellness is defined as a high-level concept, as well as the common characteristics and components wellness is generally thought to have [ It is a holistic, multidimensional, and multidisciplinary view of health and well-being; Wellness is a broader concept than most views on health as defined by healthcare; it takes into account environmental, emotional, intellectual, occupational, social, and spiritual aspects of well-being; It focuses on complete health and well-being, prevention, and proactive services; It is dynamic and context-dependent.
Based on the literature and context analyses and the first two focus group meetings, we created our own view of personal wellness (Figure
Personal wellness domain.
The lifestyle component is a kind of background component that directly affects the other four internal components. The lifestyle component includes concepts regarding activities, behaviors, choices, and risk factors related to person’s lifestyle. Emotional and mental wellness focuses on concepts concerning individual identity, psychological concepts, intellectual wellness, emotions, feelings, and so forth. Emotional and mental wellness also includes a person’s views and values that affect choices and behaviors.
Occupational wellness is about well-being related to people’s occupations, and in this context, occupation can mean that the person is working, studying, unemployed, retired, or an entrepreneur. Occupational wellness considers the actual occupation and its effects on personal wellness. Physiological wellness focuses on information related to health and wellness that is not bound to certain healthcare provider, for example, conditions, disabilities, functioning, genetics, monitoring and measuring data, personal observations, and so forth. The healthcare component is about the healthcare system. It includes providers, medical documents, and services.
All of these internal components of personal wellness are surrounded and affected by external contexts—social networks and environment. Social networks include all social relations that affect a person. Environment describes the digital and physical environments related to the person in question. It includes, for example, living environment, service environment, society, cultural aspects, and regulations. The environment surrounding a person is very dynamic, flexible, and sensitive, and it may change over the course of a lifetime.
From the first two focus group meetings alone, we already had quite a lot of different concepts related to personal wellness. We had gathered these concepts into two mind maps, so we had some categorization and simple relations between these concepts. From these mind maps, we started to categorize concepts into models, loosely based on the simplified ER diagram. We created seven different models to represent all the components of personal wellness. In these models, we focused more on the concepts and their categorization because these are core components of ontology development.
We started going through these models with the different focus groups to get a more detailed view and to discover the necessary concepts related to personal wellness. In the focus group meetings, the participants were encouraged to openly discuss current themes. Between the focus group meetings, we analyzed the discussions and the feedback for the meetings and based on this, we revised the models, analyzed and added new concepts into the models, reduced redundant concepts, and considered different relationships between concepts. The resulting high-level personal wellness information model will be introduced in more detail in the next section.
As a result of the combination of all three methods, we were able to create an information model that describes our view of personal wellness. The lifestyle component describes the domain of personal lifestyle and consists of activities, behaviors, and choices that affect the person’s daily life. It also includes active wellness activities and management concepts. These concepts are such that they can usually be affected, controlled, influenced, or managed by the person herself. Lifestyle focuses on concepts that are quite dependent on the person herself, and their emphasis may vary a lot between people. Listed below are the main concepts and subconcepts of lifestyle: livelihood; nutrition—experiences, history, food diaries, diet; rest/relaxation, sleep; risk factors—behavioral, environmental, inheritable; sexual behavior; wellness activities—objectives, self-development, wellness maintenance (personal responsibility, active actions; self-evaluation), hobbies, leisure, fitness/exercise; Wellness behavior—wellness management (activity management, alternative medicine, behavior management, conditions, devices, medication, non-prescribed medication), health education, prevention.
The emotional and mental component focuses on elements related to people’s minds, feelings, emotions, identities, and personalities (Figure
Emotional and mental wellness.
Occupational wellness describes well-being related to person’s occupation. A person’s occupation can be, for example, work, studying, or being unemployed or retired. The concept of occupation describes the actual occupation, its properties, or how the person feels about it. It has some subconcepts, which include: appreciation, benefits, equality, functioning, meaningful, motivation, performance, responsibilities, respect, rewarding, rights, and type. Occupational wellness includes also following concepts: education, employer, environment, income, occupational safety and health, quality of working life, social relations, vacation, volunteering, work burden, work climate, work culture (including leadership and management), working ability, and working time.
Physiological wellness has to do with health and wellness-related information outside the healthcare provider network. It will help the citizen to collect, observe, and manage her personal health information. It will include different health and wellness devices and their monitoring and measuring of data as well as information about a person’s conditions and functioning. Physiological wellness is closely related to the concept of the personal health record, but the idea is to be more thorough and complete through an emphasis on information and events outside the healthcare provider network. It includes the following concepts: conditions, demographic information, disability, functioning, genetic information, measurement and monitoring data, observation, organ system, vital signs, and wellness devices.
The healthcare component focuses on the clinical side of wellness. It has to do with the regulated healthcare system and the actual care that the person receives. The model consists of two main concepts: service and provider. The service concept is divided into three subconcepts, or types: prevention, diagnosis, and treatment. All of these different services create medical documents, and from these documents, the medical history of a person is created. Providers are divided into four subconcepts, or types: preventive, curative, promotional, and rehabilitative.
The social networks component describes the different social relations and networks that are related to a person. It includes family, relatives, and friends, but also different communities and social environments, and the social participation of a person within these contexts. Most of the external contexts that affect people’s living and personal wellness are located in the environment component. This includes different kinds of environments, such as society, cultural norms, or the media (Figure
The environment component.
All seven components combined create a high-level information model of the personal wellness domain (Figure
The highest level concepts of personal wellness.
As a result of this research, we were able to create a high-level information model of the personal wellness domain. Usually, health-related information models and ontologies are built from the healthcare systems and the service providers’ viewpoint. Here, however, we have instead created our model from the citizens’ viewpoint. The citizens’ viewpoint is based on the empirical research performed with the focus groups. We tried to get a comprehensive view with participants from different age groups with different backgrounds but as the focus groups were created on a voluntary basis from a limited pool of people there can be some limitations in the model. Also the participants can be seen being more interested in their health and wellness than regular citizens as they are willing to participate in this kind of voluntary research. With focus groups we have created a model based on active and conscious people who are not health professionals or representatives of any health organizations.
The model is based on the focus group research, and we have tried to model the domain and the concepts according to the participants. The guiding principles of the modeling work were how citizens see their personal wellness, what they consider to be the important concepts, how they categorize these concepts, and how they understand the notion of complete, holistic health and wellness. The research process was performed iteratively, following the build-evaluate idea of design science research.
We have identified the main components of personal wellness and described related information and its conceptualization. In the model, we have identified the environmental and external contexts related to personal wellness. In our model, we present many important concepts. Based on our categorization of these, we can come to understand the basic relations between concepts, and we can see some is-a relationships. There are still some limitations related to the defined concepts in terms of the development of the ontology, as some of the concepts are quite abstract, and their explicit definition can be challenging. Also, there is a great number of relations and relationship types in the domain, and most of the concepts are interconnected.
Hevner et al. [
The third guideline is about design evaluation. Hevner et al. [
The fifth guideline emphasizes that the research should be conducted with rigorous methods. As the domain in question was complex, multidimensional, quite abstract, and based on citizens’ perspectives, we began with qualitative methods, like focus groups and informal modeling methods. Although, the informal models lacked with formalism we were able to represent the complex and multidimensional domain and the models were rather easy for average citizens with no modeling experience to understand, evaluate, and modify. We had several different focus groups to get more heterogeneous views of personal wellness so that we could tackle the sixth guideline. This guideline emphasizes the importance of an iterative design process and insists that design should be a process of searching such that the design problem becomes more focused and the solution more relevant [
In this research, we have approached complete, holistic health and well-being from the citizens’ perspective. We have further refined the concept of personal wellness through empirical methods. Based on an analysis of the literature, a context analysis, and empirical research, we have created our own view of personal wellness. In order to support interoperable, citizen-centered services with upcoming pervasive wellness tools, we have identified the scope of the personal wellness domain. As a result of this research, we have developed a high-level information model that describes the main concepts and some relationships related to personal wellness. With this information model, we have started to develop a context-aware ontology. Our research brings new knowledge to the field of pervasive healthcare by identifying the citizens’ perspectives and conceptualizations of personal wellness.
Our model describes the domain of personal wellness in more detail than other models that have been developed in clinical and counseling psychology. Such previous models remain general, while we have gone deeper into the personal wellness domain by defining more concepts, relationships, and properties. Moreover, the focus of our model is different from previous work, as we are addressing the problem from an information system science perspective, and we are using a different kind of representation style that is more suitable in our context. We are focusing on the pervasive healthcare field, and our intentions are to support the development of a personal wellness ontology for lifelong personal wellness management and an architecture model for trusted use of multisource heterogeneous information.
The next phases in our research are an assessment of our model and the development of the personal wellness ontology. The assessment phase focuses on the evaluation of the validity and utility of the model and the identification of the impact the shared use of wellness information has on citizens’ wellness management and on how citizens can control and manage the use of their information. In the development of the personal wellness ontology, we have to model the contextual aspects that are related to different concepts to support multiuser and multisystem environments with heterogeneous information sources. Furthermore, we have to consider privacy, confidentiality, and data security issues in the ontology, as most of the information is private and personal, and its processing may be regulated by legislation. By modeling such privacy and security aspects, we can ensure that, in the future, pervasive healthcare will allow citizens to control the processing of their information dynamically.
The authors acknowledge the funding of this Trusted eHealth and eWelfare Space (THEWS) research project by the Finnish Academy of Sciences in the MOTIVE Research Programme during 2009–2012.