A chatbot delivered Mediterranean lifestyle intervention for adults - a feasibility and pilot study (MedLiPal)

This study is a single-arm physical activity and dietary intervention study, delivered through technology (website, virtual assistant, instant messaging service and wearable fitness band). Technology (website, wearable fitness band, instant messaging service, virtual assistant): Participants will receive access to a purpose-built website with information about the Mediterranean diet and physical activity interventions. Participants will also join an instant messaging service (the cloud-based service “Slack”). Through Slack, they will be able to interact with an embedded virtual assistant (chatbot - named Paola), which will be programmed with information about the intervention. 'Paola' will offer advice and instructions and have the ability to answer questions and link particpants to resources and other external websites. Participants will be able to use Slack to communicate with the chatbot and with other participants, using their smartphones or other electronic devices. Study staff will be able to view and monitor the Slack chatroom. Participants will receive a wearable fitness band to track their daily steps. Physical activity intervention: The physical activity intervention will be based on increasing daily step count, through increasing incidental activity as well as exercise and other types of physical activity. Participants will set their own step goal. They will be educated on the average daily step count for their age and gender, and encouraged to increase their step count above this by approximately 2000 steps per day, depending on other factors, such as how many steps they do currently. The focus will be on incorporating physical activity into their lifestyle, and being active in as many ways as possible. This might include walking for transport, taking stairs, doing chores manually, and deliberately incoporating walks or other activities into daily routine. No specific types of physical activity will be prescribed. The wearable fitness band will monitor daily steps. These bands should be worn 24 hours per day, or at the least, during all waking hours. Daily steps are tracked, and an average daily step count for the week is calculated. Each week, Paola will ask participants to review their average daily step count, and report it. This data will be recorded in a spread sheet. They will then review their goal with Paola, who will set the new goal for the next week. At the clinic visits (baseline, week 6 and week 12), participants will complete the Active Australia Survey to report thier physical activity levels. Mediterranean diet intervention: The dietary intervention will be based on a traditional Mediterranean dietary pattern. Participants will be instructed to consume a wide variety of fresh vegetables, fruits, legumes, nuts and wholegrain products, use extra virgin olive oil as their main added fat, choose white meats and fish over red meat, and restrict processed meats, processed foods and sweets. Recommended servings of foods will be as follows: 2-3 Tbsp extra virgin olive oil, 5-6 serves of vegetables, 2-3 serves fruit, 5 serves breads and cereals, 0-2 serves red wine and 2 serves dairy daily, plus 3-4 serves legumes, 2-3 serves fish, 1-2 serves chicken, 5 serves nuts, less than one serve of red meat and processed meat, less than 6 eggs and sweets 3 times or less per week. This information will be provided to participants via a series of short videos, accessible via the website. Paola will introduce them to the study and website, directing them to watch the educational videos. All information about the dietary requirements will also be written on the website, and Paola will be programmed with this information as well, to enable the chatbot to correctly answer questions about topics such as serving size or number of recommended serves. No food or beverages will be provided to participants, however they will be encouraged to utilise a daily log-sheet, which will track their servings of key foods. With regards to interacting with the technology, the compulsory components include watching the videos at the baseline visit, weekly check-ins which Paola will initiate, and wearing the fitness band, at least during all waking hours. Use of Paloa, Slack, the wristband and the website will otherwise be at the users discretion. Both the website and Slack have capabiliites to enable analytics of use, such as number of times accessed. This data will be collected. In addition, use and usefulness of the chatbot will be assessed. Number of times Slack is accessed, and the types of comments and questions being asked will be monitored. To assess the usefulness of the chatbot, a likert scale rating system from 'very bad', 'bad, 'neutral', 'good' and 'very good' will be used. After each interaction with Paola, the participants will be asked to assess her usefulness with this scale. Study structure: The study will comprise 3 clinic visits (baseline, week 6 and week 12) plus weekly check-ins with the chatbot at home. At baseline, participants will set up accounts/logins for Slack and the website. They will be given their wearable wristbands and instructed to download the associated application. While at their baseline appointment, participants will then engage with the technology to educate themselves with the study requirements. They will set their step goal and view educational videos on the Mediterranean diet and lifestyle. The session will be 'run' by Paola, who will guide participants through accessing the website, watching the videos, setting up their fitness bands and setting a step goal. Study staff will be minimally involved with the education. Participants will be expected to undertake the recommendations for 12 weeks, increasing their step count to meet their goal each week and altering their diet to a Mediterranean dietary pattern. The chatbot will assist with weekly check-ins, where participants will be required to report their physical activity (average daily step count) and dietary intake. In between weekly check-ins, particpants will have access to Paola, the website and their fitness band at all times. The chatbot will use a motivational style of questioning and counselling to help participants adhere to the intervention. At baseline, week 6 and 12, participants will attend the clinic and have physical activity and Mediterranean diet adherence assessed. All clinic visits will occur at the Clinical Trials Facility, University of South Australia City East Campus, Frome Rd, Adelaide 5001. Participants will be free living adults and will incorporate the physical activity and dietary changes into their day-to-day lives.