Chronic diseases such as heart disease, cancer, stroke, diabetes etc., are the major causes of mortality and morbidity in general. These diseases are also leading drivers for health care costs. World Health Organization predicts that by 2030, people suffering from Diabetes Mellitus (DM) worldwide will reach to 700 million. In order to reduce the cost and also to improve health outcomes, it is important that individuals suffering from these chronic diseases engage in self-management (SM) behavior. People have started acknowledging that it is their responsibilities to lead a healthier lifestyle and manage their chronic conditions better. It is estimated that half of all Americans are managing a serious chronic health condition at home. 
However, many of these diseases have other associated ailments. For example, diabetes can be linked with cardiovascular problems, nephropathy, retinopathy and neuropathy. Therefore, one is required not only to adhere to strict medication, but also has to maintain proper levels of nutrition, diet, exercise, difficult lifestyle adjustments and engage in effective interactions with health care providers. This is a multi-dimensional problem and individual person for many reasons, may not be able to sustain this initiative for long time. In this paper, we propose a framework which will interactively coach the user, change his habit, help him to continue and see its effect in improved health outcome.
2. Short description of practice change
Existing self-management tools basically take one way approach. It provides important guidance, allows to set goals, and keeps log of all activities regarding self-management. However, it gives very little help to form a new good habit. Furthermore, it doesn’t integrate with the health outcomes as a continuous feedback process. An AI based habit changer coupled with a wellness monitor is implemented to change existing practice of self-managing health conditions.
3. Aim and theory of change
Habit is the intersection of one’s knowledge, skill, and desire. New habits can be formed by instilling relevant knowledge, skill, and generating desire through gamification. Proposed system will first measure one’s existing knowledge or belief about the disease and identify gap areas. Then it will create specific contents and coach him interactively through gamified quiz. In parallel, it will objectively measure his holistic wellness and show how with the change of habit, he is able to adhere to the regimen and thereby keep his chronic issues under control.
4. Targeted population and stakeholders
Clinic, therapist, gym, yoga school, etc.
1. Polly Ryan, PhD, RN, CNS-BC, Associate Professor and Kathleen J. Sawin, DNS, CPNP, FAAN, Professor and Joint Research Chair in the Nursing of Children: The Individual and Family Self-management Theory: Background and Perspectives on Context, Process, and Outcomes