Covid-19 health emergency has focused the attention on digitalization in healthcare systems (EIT Health, 2020). As a fundamental aspect to prepare society for future risks it emerges the needs for innovative approaches for improving  community well-being based on:

-        multidisciplinary research approaches

-        strong support of digital technology 

-        individual and community engagement in preventive practices 

In line with international indications, the Citel (www.citelmedicina.it) Interdepartmental Research Centre at University of Bari (Italy) is working on Telemedicine to respond to current emerging scenarios by applying ICT to health systems for the development of e-health. Educational vision of Citel is to work on Telemedicine as a transdisciplinary paradigm to improve health outcomes but also to work on educational skills integrating digital health innovation with inclusive processes of patient/citizen’s engagement-involvement (Barello et al., 2016), empowerment (Aujuloat, D'hoore, Deccache, 2007), health literacy and digital health literacy.

The working group is working on e-health activities to:

-        develop an educational model aimed at promoting patients/citizens responsibility and critical thinking on health, with results of well-being and quality of life, within a salutogenic perspective on health (Antonovsky, 2017).

-        redefine the active role of the patient / citizen in primary, secondary and tertiary prevention contexts

-        promote health literacy as a holistic approach to health promotion 

-        build a triangulation of empowerment, health literacy and informative-educational processes for the foundation of a modern citizenship itowards sustainable development 

-        connect humanistic and scientific culture in the conceptual paradigm of transdisciplinarity 

-        integrate the evidence-based medicine paradigm with narrative medicine 

-        designing innovative training methodologies for doctors and health professionals

-        test AI applications of digital medicine and LMS in the direction of human-centered medicine

Within these frameworks, with Citel-Uniba we have hypothesized a transdisciplinary project with a European partnership aimed at investigating the clinical transition processes towards obesity and reducing the gap between scientific knowledge and lifestyles. Research questions were: how can education be  more inclusive and fair? How can citizens be engaged in well-being and quality of life in present society?

The project will develop innovative functional food and digital tools and a research-based educational model to prevent obesity and promote healthy behaviors within a vision of person-centered healthcare.

The project is building an European consortium in order to:

-        improve understanding of human health and provide innovative nutritional solutions

-        develop new digital applications and customized intelligent solutions for health promotion

-        promote a virtual patient education model aimed at quality of life and engagement in virtual care

-        develop an educational model for the promotion of digital health literacy for children and families based on digital innovations in the field of gamification

-        design and experiment the Digital Twin as a paradigm for personalization of care treatments that integrates  information on each child-patient for the creation of phenotypic avatars  representing the collected data

-        experience the Personal Coach (PC) or Virtual Assistant implemented as a hybrid / blend technology in which a human coach and an AI will be integrated to support the child in the various phases of his behavioral change also through serious games

-        monitor and evaluate the acceptability and impact of the avatar in the child's mental representations

Ambitions of the project are to:

-        Promote health literacy and healthy lifestyles in prevention contexts by addressing technological challenges of AI, maximizing opportunities offered by new digital solutions and exploiting potential of intelligent solutions in an inclusive and ethical way

-        Innovating gamification through the Digital Twin Avatar approach such as virtual representations that promote interaction with children combined with play and exergaming mechanisms replacing traditional video games.

The overall methodology of the project is built around three main pillars: 1. clinical trials for obesity prevention 2. development of innovative technologies, foods and solutions for healthier lifestyle 3. development of an AI platform for engagement, training and education of citizens and patients. These will be developed through the use of the Personal Coach (PC) supporting behavior changes, healthy eating and recommendations as a mobile Virtual Assistance. The paradigm of virtual patient education (Massaro, Perla, 2021) will be implemented by experience with the PC. School-based research/training activities on health promotion will be carried out with the mediation of digital game-based learning. Staffs students and families will be engaged in quality of life awareness, weight bias and isolation issues. Innovation in gamification, provided by the experience of students involved in serious games mediated by the blended PC will arise from traditional videogame-based learning, as a fully accepted teaching methodology relying on some main objectives: - manage an active interest in the message to be communicated - stimulate active and measurable behavior - give the user continuous feedback As adolescents are technology frontrunners, digital health interventions appear to be a practical modality for dietary behavior change interventions (Rose et al, 2017) and there is evidence that supporting effective engagement in digital interventions is a critical factor in the adoption of healthy dietary behaviors in adolescents within the current digital world’ (Gibson, Sainsbury, 2017) Media literacy education will be also provided to promote capacity of informed decision on food. The project will engage at European level education and sport centres in activities also mediated by gamification to connect citizens with European guidelines on obesity, deconstruct influence of fake news on health choices and develop critical thinking and informed choice on health. Mapping of obesity-related education and training curricula will be followed by integration of obesity in relevant educational curricula, as teachers, educators, healthcare professionas. Stakeholder’s collaboration will contribute to move responsability from individual level (healthy food consumption, low energy income and physical activity) to societal level. The project indeed will consider the influence on well-being represented by individual situations as well as the broader societal context highlighting health education in its function of facing the influence of environmental, behavioral and socio-economic risk factors and let children and families become more resilient against the impact of a rapidly changing society.

Educational and social expected outcomes of the project are a research-based educational competency model on obesity prevention and health promotion and development of school curricula within a European school network, also mediated by game-based learning tools: mobile applications and mobile app games for educational guidelines for diet and obesity education will be designed to develop the educational model and allow citizens to have access to and make use of new tools and services to make informed decisions on lifestyle choices, promote a culture of self-care and inclusion. Families will get in contact with public entities and stakeholders promoting healthy behaviors and citizenship education, reshaping environmental and social elements towards more inclusive contexts, training citizens to participation and initiative on health with empowered-based approaches and addressing inequality aspects of weight discrimination. The project will provide also evaluation studies to measure perception and acceptability of avatars digital twin and impact of the digital twin in the mental representation the child.

Antonovsky, A. (1987). The salutogenic perspective: Toward a new view of health and illness. Advances, 4(1), 47–55. Aujoulat I., d'Hoore W., & Deccache A. (2007). Patient empowerment in theory and practice: Polysemy or cacophony? Patient Education and Counseling, 66(1), 13-20. https://doi.org/10.1016/j.pec.2006.09.008 Barello S., Triberti S., Graffigna G., Libreri C., Serino S., Hibbard J., & Riva G. (2016). eHealth for Patient Engagement: A Systematic Review. Frontiers in psychology, 6, 2013. https://doi.org/10.3389/fpsyg.2015.0201 Gibson A.A., Sainsbury A.: Strategies to improve adherence to dietary weight loss interventions in research and real-world settings. Behav. Sci. 7 doi: 10.3390/bs7030044. Massaro S., Perla L. (2021). Studio esplorativo sulla prevenzione e cura dell’obesità attraverso la Telemedicina: orizzonti transdisciplinari del lavoro educativo. In Ricerca e Didattica per promuovere intelligenza comprensione e partecipazione. SIRD Proceedings 9‐10 aprile 2021, 635-642. Rose T., Barker M., Maria Jacob C., Morrison L., Lawrence W., Strommer S., Vogel C., Woods-Townsend K., Farrell D., Inskip H., et al. (2017). A systematic review of digital interventions for improving the diet and physical activity behaviors of adolescents. J. Adolesc. Health doi: 10.1016/j.jadohealth.2017.05.024 .