CONTEXTUAL ANALYSIS AND MODELING

OF PERSONAL WELLNESS

Antto Seppälä and Pirkko Nykänen

University of Tampere, School of Information Sciences, eHealth Research, Kanslerinrinne 1, Tampere, Finland

Keywords: Personal wellness, Contextual analysis, Information model, Focus group.

Abstract: The healthcare paradigm is progressing towards preventive care and proactive services with holistic and

personalized view on health and wellbeing. The concept wellness has been used to describe this holistic

approach to health and well-being. Different wellness tools have already been introduced and some wellness

applications are available to be used to manage and maintain personal wellness. With the technology

advances like ubiquitous computing the number of different wellness systems will increase rapidly. To

maximize the benefits of the new healthcare paradigm and wellness systems semantic interoperability is a

necessity. Therefore there is a need for a personal wellness ontology which enables sharing of information

between all actors in the wellness ecosystem. This study analyzes the context of personal wellness and starts

the work on the personal wellness ontology by presenting a high-level information model of the domain.

The results of this research help to take into account the different contextual aspects of wellness information

covering also the privacy, confidentiality and security contexts.

1 INTRODUCTION

The healthcare paradigm focused on treatment of

diseases is progressing to the direction of preventive

and proactive care paradigm with distributed

services and a more personalized, holistic and

lifelong view on health and wellness (Nykänen,

2008; Koop et al., 2008). Healthcare delivery is seen

as a broader continuum with empowered citizens

and networked interoperable services. Future

healthcare will focus on health, functioning, and

wellbeing of citizens (Larson, 1999). The current

health information systems and electronic health

records are planned to support hospital-centric care

and thus they are not able to support the

personalized and preventive care paradigm.

The concept wellness has been used to refer to a

holistic approach for health and wellbeing of

citizens. Personalized wellness approaches focus on

improved lifestyle and behavioral choices. Health

promotion and education, and support for wellness

approaches are major trends in the modern world

and are becoming more visible through different

media (Kickbusch and Payne, 2003). Wellness tools

for self-management activities have been widely

studied in different research projects and already

there are several applications intended for

supporting wellness activities (Ahtinen et al., 2009;

Varshney, 2007; Nykänen, 2008).

Wellness informatics focuses on enabling the

citizens to stay well and manage their own health

and wellness even without participation of

healthcare providers. Wellness informatics is a

human-centric approach where citizens are thought

to be both information sources and users (Grinter,

Siek and Grimes, 2010). Wellness informatics aims

at helping citizens to collect their own data from

multiple sources, to reflect their wellness, to support

healthy living, to enable collaboration beyond

provider networks, to allow people to collaborate

with each other and to share their personal wellness

information. Wellness data can include different

measurement data, medical data, behavioral data,

socio-economic and cultural data. It is a challenge to

integrate all this data together and also to

acknowledge the contexts of information (Grinter et

al., 2010).

This study presents research focusing on trusted

personal health and wellness information in

ubiquitous environment (Nykänen et al., 2009). The

aim of this research is to present a trusted context-

aware information model for a lifelong personal

wellness record and a security architecture for

trusted use of multisource heterogeneous personal

202

Seppälä A. and Nykänen P..

CONTEXTUAL ANALYSIS AND MODELING OF PERSONAL WELLNESS.

DOI: 10.5220/0003636902020207

In Proceedings of the International Conference on Knowledge Engineering and Ontology Development (KEOD-2011), pages 202-207

ISBN: 978-989-8425-80-5

 2011 SCITEPRESS (Science and Technology Publications, Lda.)

wellness information. In order to enable semantic

interoperability between the various wellness

systems there is a need to develop an ontology

which creates shared understanding and enables

sharing of heterogeneous information among

different actors and systems (Blobel et al., 2010).

The first objective of our research was to

perform a contextual analysis on the personal

wellness concept, how it is conceptualized and what

kinds of external contexts are related to it. The

second main objective was to create a high-level

information model of personal wellness. In this

paper we present modeling of the wellness concept

and build the basis for the development of a personal

wellness ontology.

2 METHODS

This study had three main methods:

1. A literature analysis to find out how wellness

and personalized health is presented and

defined in the literature and what are the

common characteristics.

2. A contextual analysis to understand what

wellness is and to model the components of

personal wellness.

3. Focus group meetings to understand how

normal healthy people conceptualize personal

wellness and what kind of concepts are related

to their personal wellness management and

maintenance.

First we made a literature analysis to find out

how wellness and a holistic view on health is seen

and defined in the literature to conclude common

characteristics, concepts and components of

wellness. The focus of was on wellness, but because

health, wellness and well-being are used

interchangeably in the literature we had to concern

also holistic health and well-being models (Kirsten

et al., 2009). In the analysis we focused on holistic

health, wellness or well-being, and on the

components of the future health care paradigm.

After the literature analysis, we performed

contextual analysis of the collected materials. This

analysis helped us to understand what information is

related to wellness and how citizens manage their

wellness. The external contexts and other things

affecting personal wellness were also modeled. As a

result we could define the scope and the contents of

the concept wellness.

Next, we organized two half-day meetings for

small focus group to get empirical information about

how personal wellness is understood and what

contexts are related to it. We were interested to

model how normal healthy people conceptualize

personal wellness. The focus group was composed

on the department staff members, healthy young

persons. Participants for the focus group were

collected with an open call, on voluntary basis, and

the number of persons participating in the meetings

was 5 (1

meeting) and 4 (2

meeting).

After the first meeting we created a mind map

based on the discussion. Mind map was chosen as

the tool to represent the information because it is

easy to understand and to follow and most people

are familiar with the technique. Also with the mind

map we were able to do simple categorizations of

concepts and conclude some basic relations in an

understandable format. In the second meeting the

mind map was divided into two, due to the received

feedback that separation of the personal wellness

and the external context would make the mind maps

more understandable.

Based on the performed analyses and the mind

maps we started to elaborate the model into a more

formal representation. We used a modification of the

entity relationship (ER) notation to represent the

necessary concepts, properties and relations. The

model did not follow strictly the ER-modeling

notation because the purpose was to create a model

which would be easy to understand and to modify by

citizens who are not modeling specialists. The

models were then discussed internally with the

project team (4 persons) and based on the feedback

we were able to make some modifications, to reduce

redundancy and the gap in the abstraction levels

between the concepts. The fourth small group

discussion on the models was organized in our

health informatics postgraduate student seminar

where the models were presented and discussed and

the participants (5 persons) were asked to give

feedback and their views on personal wellness.

3 RESULTS

3.1 Literature and Contextual Analyses

In the literature, there exist several wellness

definitions and they vary depending on the context.

Often wellness is thought to be a balanced state of a

healthy body, mind and spirit which creates a

harmonious feeling of complete wellness (Myers

and Sweeney, 2004; Larson, 1999; Oguz-Duran and

Tezer, 2009; Mackey, 2009; Soomlek and

Benedicenti, 2010; Kirsten et al., 2010; Kiefer,

2008). Most wellness models support health

CONTEXTUAL ANALYSIS AND MODELING OF PERSONAL WELLNESS

203

promotion, prevention, and progress towards better

functioning (Larson, 1999; Conrad, 1994; Sterling et

al., 2010). Thus, wellness is seen as a high level

concept integrating multiple domains (Schuster et

al., 2004; Sterling et al., 2010; Kirsten et al., 2010;

Kiefer, 2008). The concept wellness contains

individuals’ functioning as a whole and it

acknowledges lifestyle, behavior, culture, beliefs,

experiences and other issues affecting general life

satisfaction (Oguz-Duran and Tezer, 2009; Mackey,

2009; Soomlek and Benedicenti, 2010; Sterling et

al., 2010; Kiefer, 2008; Ahtinen et al., 2008).

Wellness is described as optimal physical,

psychological and social wellbeing (Els and De La

Rey, 2006; Larson, 1999; Soomlek and Benedicenti,

2010) and it focuses on an individual and on her

specific needs and it may vary depending on the

individual’s age or living culture. Wellness covers

means for changing lifestyles, adopting healthier

behavior, and combining morality and health.

Morality is seen in wellness actions when pursuing

good life one should make decisions between good

and bad actions for their health (Conrad, 1994).

Sweeney and Witmer (1991) developed the

Wheel of Wellness model. Based on existing

theories and research they identified factors

influencing healthy living, quality of life, and

longevity (Sweeney and Witmer, 1991). Myers and

Sweeney (2004) elaborated the model further to a

new one - the Indivisible Self which consists of five

factors and sub-factors:

– The Essential Self: spirituality, self-care, gender

identity, and cultural identity,

– The Social Self; friendship and love,

– The Coping Self; realistic beliefs, stress

management, self-worth, and leisure,

– The Creative Self; thinking, emotions, control,

positive humor, and work,

– The Physical Self; exercise and nutrition (Myers

and Sweeney, 2004).

This model has contextual factors which affect an

individual’s wellness and behavior. These are local

(family, neighborhood and community), institutional

(education, religion, government and

business/industry), global (politics, culture, global

events, environment, media and community), and

chronometrical (perpetual, positive and purposeful)

contexts. Contextual factors are important when

trying to understand human behavior (Myers and

Sweeney, 2004; Myers and Sweeney, 2008).

Saylor (2004) has developed the Circle of Health

model which defines health as optimal functioning,

well-being, and quality of life. The model is divided

into two sides. The light side focusing on activity

and performance consists of energy, strength,

fitness, stamina, happiness, enjoyment, satisfaction,

growth and development, occupational and/or social

role, and performance. The dark side is about

renewal and recovery including rest, relaxation,

peacefulness, nourishment, social support, sense of

purpose and meaning, balance, adaption, and

resiliency. This model tries to combine balance,

harmony, mind-body integration with more

traditional western ideas such as physical, mental,

spiritual, social, and role functioning (Saylor, 2004).

Kirsten et al. (2009) have developed an eco-

systemic approach to health, well-being and

wellness. It is based on two assumptions; Humans

are complete persons with some distinguishable

attributes which cannot be separated; and health,

well-being and wellness should be contemplated

multi-dimensionally and multidisciplinary. This

approach consists of three elements and two outside

contexts. The three elements describing the

functioning of a person are biological, psychological

and spiritual. The outside contexts affecting wellness

are ecological context describing living and non-

living physical environments, and metaphysical

context focusing on symbolic abstract environment.

The eco-systemic approach is a holistic and lifelong

view where people, their health and contexts are

distinguishable but inseparable (Kirsten et al., 2009).

All the four examined models acknowledge the

holistic idea of health and wellness. They created a

good basis for our contextual analysis because they

all had a multidimensional view on wellness. Also

they all emphasized both internal and external

contexts and the relations between them: An

exception is Saylor’s (2004) the Circle of Health

which focuses more on body-mind integration with

balance and harmony and inner actions. Important in

these models is the balance between different

aspects of health, wellness and external contexts so

all of them are much wider than the traditional

concept of health. However, all these models had

some deficiencies. They remain general; we needed

more detailed analysis on the concepts, the

properties and the relations. The models are also

high level descriptions with limited conceptual

analysis and they are presented in quite informal

way. The models are created for different purposes

with the focus more on assessment of wellness.

Our analyses result in that personal wellness

seems to be a combination of physical, emotional,

mental, intellectual, social, behavioral, occupational

and spiritual factors which are affected by the

environment and the external contexts. The concept

of personal wellness is highly dynamic and heavily

dependent on the context and cultural background.

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People may have different views and emphasis on

personal wellness and it may evolve during lifetime

(Ahtinen et al., 2008). Finally, we concluded some

common characteristics of wellness:

– Wellness is a holistic, multidimensional and

multidisciplinary view on health and wellbeing,

– Wellness is a much wider concept than

traditional view on health defined by healthcare;

it acknowledges also environmental, emotional,

intellectual, occupational, social and spiritual

aspects of wellbeing.

– Wellness focuses on complete health and

wellbeing, prevention and proactive services,

– Wellness is a dynamic and context dependent

concept,

– Wellness is heavily affected by internal and

external contexts and it may change over time.

3.2 Focus Group Work

Aforementioned models were introduced to the

focus groups as a background material. Our analyses

results were presented for the focus groups as two

mind maps, the first one focusing on the personal

wellness, things that are dependent on the person

herself and can be affected, controlled, influenced,

or managed by the person herself, and the second

one focusing on the environment or the external

contexts which affect personal wellness.

In the focus groups we elaborated further the

mind maps and started to model the domain of

personal wellness. We focused on the concepts and

their categorization because they were used as a

basis for the list of concepts related to personal

wellness. These concepts were analyzed and revised

to reduce redundancy and the gap between

abstraction levels, and make them more

understandable. As a result we were able to

conclude a high level view on personal wellness.

Our contextual view on the personal wellness

(Figure 1) consists of five main concepts which are

lifestyle, emotional and mental wellness,

occupational wellness, physiological information,

and health. All the concepts are interconnected and

they create a holistic view on personal wellness.

These five main concepts are surrounded by two

external contexts, social networks and the

environment, which heavily influence personal

wellness. So, finally our view is based on the seven

main components which interact together creating a

complete and holistic view of personal wellness. The

analyses and the empirical feedback formed the

basis when we started to categorize the concepts into

our view. We concluded the seven main components

that create a high-level information model of the

personal wellness (Figure 2.).

Figure 1: A contextual view on personal wellness.

4 DISCUSSION

Wellness is a research topic in many different

scientific areas e.g. in medicine, public health, social

work, mental health, health management and

economics, and nursing (Mackey, 2009). The

concept wellness is complex and multidimensional.

Wellness is personal but dependent on the context

and the cultural background. People may define and

emphasize personal wellness differently (Ahtinen et

al., 2008). With the analyses we were able to define

the internal and the external contexts and list some

of the main concepts of personal wellness. Also the

multidimensional and multidisciplinary nature of

wellness became very clear. It was important to start

analyzing from a high-level because it enabled us to

understand the scope and boundaries of the domain

before the empirical research and the modeling.

The focus groups were a good method to approach

the domain of personal wellness. With limited

amount of participants we could approach the huge

and complex domain in an organized manner and

keep the discussions on track. However, the focus

group work had some limitations. The group

consisted of quite homogenous participants who

were all quite young, healthy and educated persons

so our model might lack the needed multi-

perspective view. In the further empirical research

we need to include more heterogeneous participants

CONTEXTUAL ANALYSIS AND MODELING OF PERSONAL WELLNESS

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Figure 2: A high-level model of personal wellness.

to ensure that the model will acknowledge different

needs and perspectives. We need people from

different age groups, with different backgrounds and

with different health statuses. The two mind maps

developed with the focus groups described at a high-

level how wellness can be conceptualized and what

kinds of contexts are related to it. The mind maps

showed how complex the concept is and how it

covers more than just being healthy or free of

diseases. Although the mind maps had their

deficiencies we were able to utilize them with the

analyses and start creating a high-level model of the

personal wellness domain.

Our model divides the domain into seven main

components. We have already categorized many of

the related concepts, but the model is still quite

informal. We need to analyze further and in more

detail the different relations inside components and

how cross-border concepts affect each other. The

domain of personal wellness is challenging to model

because it is dynamic and multidimensional and very

context-dependent, it varies a lot between

individuals and cultures. Our results will shed some

light over the context of personal wellness and we

can see what kinds of concepts exist and how they

can be categorized and attributed.

In our research we have started to analyze the

context of personal wellness with informal models

because they can be understood by people without

modeling experience, though the concepts are quite

abstract and the domain is complex. From these

models we can find the core characteristics and

scope of the personal wellness and we can proceed

with our research into more formal modeling. The

results of this phase enable us to do more empirical

research with more participants in order to define the

concepts and the relationships in more formal and

detailed way. The goal is to integrate heterogeneous

data in the ubiquitous wellness environment and to

give us information how shared use of wellness

information affects citizens’ wellness management

and how citizens can control and manage the use of

their information (Nykänen et al., 2009).

The final objective of this research is to develop

a context aware personal wellness ontology which

takes into account the different contextual aspects of

wellness information and also the privacy,

confidentiality and security aspects. We need to

model these as part of the ontology because most

information is personal, private and confidential, and

their processing is regulated by the legislation. The

contextual aspects of all information entities need to

be covered in the ontology because wellness concept

is related to a multi-user and multi-system

environment with heterogeneous data sources. When

we include the privacy and the security aspects in

the ontology we can ensure that citizens and other

actors can dynamically control processing and

disclosure of their information. An essential part of

our further work is the validation and evaluation of

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the developed models and the resulting ontology.

We need to compare our results with the recent

research results and to perform empirical evaluation

with new participants in real life situations.

ACKNOWLEDGEMENTS

We 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 years 2009-2012.

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