PAL: A social robot and its avatar provide support via a mHealth solution to children with Type 1 Diabetes Mellitus (T1DM) and their parents. Personal goals are set together with health care professionals and pursued by doing different activities together with the robot or the avatar.

This is a guest blog post written by Rosemarijn Looije, PAL project coordinator

T1DM has a huge influence on children and their parents' daily life. Healthcare professionals are still working on the artificial pancreas and on a cure for diabetes. So what can we do to support children, parents and their professional caregivers on their route to independence? T1DM has a prevalence of around 115 thousand children in the age of 0-14 (2011) and it is expected the percentage of children below 15 years will increase with 70% between 2005 and 2020.

The lifetime costs for children with diabetes in the US, diagnosed between 3-9, are an estimated $746 million in medical costs and $1208 million in income loss. This is estimated without the extra costs for the influence of quality of life of the family. Parents, for example, experience high levels of stress, take days off and also change jobs to take care for their child, which means income losses.

The PAL project (Personal Assistant for a healthy Lifestyle) funded by the European Commission, is aimed at supporting independence and confidence in children aged 7-14 yo by helping them acquire the knowledge, skills and habits to follow their tailored diabetes regimen. The innovative part is brought about by Charlie, the robot that bonds with the child, knows the objectives that were set up by the doctor and provides multiple activities to help reaching them.  Charlie comes with his own avatar which can be accessed through an app and can be personalised according to the child's imagination. Furthermore, it is designed to support 2 other end user groups: the parents and health care professionals. Each of them with their own needs, that can differ between users and cultures (Italy and the Netherlands).

The general objective of the first phase of the project was to understand how the first prototype of the app could support children and their parents in their T1DM management, both in hospital and at home.

For this, we have run a very informative experiment. The children interacted with the robot Charlie at the hospital and played a quiz  together (see picture). They also received a tablet to take home with them where they were helped by virtual Charlie to fill out a timeline and continued playing quizzes with the virtual robot. We extrapolated important information from parents, their children and doctors through questionnaires and interviews before and after the experiments.

We received positive feedback regarding the playful aspect of the app. In fact, children wished for more games related to T1DM. Both they and their parents said they learned more on how to manage the disease and enjoyed sharing with each other the daily aspects of diabetes management. These positive reactions were also featured in several press releases, in Dutch (AD), but also via an AFP press release in other languages (e.g. English (Daily Star), Portuguese (Público), French (Ouest France), Slovakian (

In the coming years we will continue to involve the end users at every stage and besides motivation and knowledge, we will focus on attitude change and quality of life. This means that we need smarter interaction with more personalization, to make sure that children, parents and caregivers keep motivated to use the system. An example of smarter interaction is the direct import of glucose values or getting more knowledge on the child’s preferences (interface, presentation etc.) and act accordingly. We will develop new versions of the app including more variation, but to keep the interaction interesting over a longer period of time we need many more apps that contribute to the objectives towards improved self-management.

We cannot make this a success without input from others; be it app developers or pharma, medical technology and eHealth technology companies. If you are interested to contribute to this great project, get in touch with us!

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