1 Introduction

Chronic disease is a global health problem. People often ignore their lethality because they are not so painful nor require hospitalization. According to the WHO, 71% of deaths originate from chronic non-communicable diseases and are recognized as the world’s biggest killer. According to the World Health Organization, 388 million people will die of chronic diseases in the next 10 years. About 300 million people in China suffer from chronic diseases, and China’s chronic disease mortality rate ranks 80th in the world. On the other hand, the first sentence of the newsletter on the Medicalx-press website puts the United Kingdom, the United States and China together, and believes that the three countries can not match the prevention and control of chronic diseases in Italy, France, South Korea and Australia. As we foresee, the proportion of chronic disease deaths will increase. The control and resolution of chronic diseases is a real challenge for all countries; although we have made many efforts to treat chronic diseases, chronic diseases continue to threaten people’s well-being and social development. In this context, the main goal of this study was to develop a service model based on food therapy. This service model includes monitoring of food treatment effects, experience feedback and food treatment recommendations. The service model we designed is an interactive prototype based on service design and artificial intelligence. The purpose is to avoid the uncertainty of food treatment and ensure the treatment effect of food on chronic diseases.

2 Chronic Diseases and Food Therapy in China

Chronic diseases are defined broadly as conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both. Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability in China. According to the official statistics, 75% of people in China have chronic diseases. If we don’t treat chronic diseases, we may get more serious diseases.

On April 10, 2015, the National Health and Family Planning Commission released a report on the progress of China’s disease prevention and control (2015), which was reviewed and summarized with a large amount of detailed data in disease prevention and control in China over the years since the founding of the People’s Republic, especially the last 10 years. According to the report, although we are trying to prevent and control chronic diseases, the situation is still serious. Chronic diseases such as cerebrovascular diseases and malignant tumors have become the main causes of death. The number of deaths caused by chronic diseases has accounted for 86.6% of the total deaths in China, and the disease burden accounts for nearly 70% of the total disease burden. It is predicted that the total number of deaths caused by infectious diseases, maternal and perinatal diseases and nutritional deficiencies will decline by 3% in the next 10 years, while the number of chronic disease deaths will increase by 17% in the same period. Although chronic disease develops slowly, it can cause an acute attack or death. The harm of chronic diseases is mainly the damage of important organs such as brain, heart and kidney, which is easy to cause disability, affecting labor ability and quality of life, and the medical expenses are extremely expensive, which increases the economic burden of society and family.

Most chronic diseases are caused by a short list of risk behaviors: Tobacco use and exposure to secondhand smoke; Poor nutrition, including diets low in fruits and vegetables and high in sodium and saturated fats; Lack of physical activity; Excessive alcohol use. Now many people in cities have chronic diseases, such as hypertension, high blood sugar, qi deficiency, heavy humidity, obesity and so on. According to the theory of traditional Chinese medicine, diseases start from the mouth, and many chronic diseases are caused by the fact that we often eat take-out food, don’t go to the farmers’ market, but go to the supermarket to buy food of any origin and season, etc., which leads to the fact that we can’t get enough of the most seasonal food at the best time and achieve the best physical conditioning, as the traditional Chinese medicine food therapy and health maintenance says.

Food therapy is a method that uses the characteristics of food under the guidance of the theory of traditional Chinese medicine to regulate the function of the body so that it can obtain health or cure diseases. It is generally believed that food is an edible substance that provides various nutrients for human growth, development and healthy survival. In other words, the most important function of food is nutrition. We believe that one way to control chronic diseases is through food therapy. As Zhang Xichun, a modern doctor, pointed out in “Shenxi Lu in the heart of medicine”, food “can not only cure diseases but also satisfy hunger when taken by patients”. Chronic diseases are usually mild diseases. People can treat chronic diseases slowly through the natural “prescription” of food to recuperate their bodies, change their eating habits and lifestyle. This is not only to treat a chronic disease, but also to stay healthy for a long time.

The process of food therapy should constantly obtain feedback information and update the food menu according to different physical conditions and recovery conditions. There are some official TCM institutions that support food therapy, but this is still an area of opportunity for China. As we can see from the above information, the prevention and treatment of chronic diseases is not only a current problem, but also a future problem. That’s why we decide to develop a service model based on traditional Chinese medicine food therapy. This service model includes the monitoring of therapeutic effect, experience feedback and dietary advice. To accomplish this task, it is necessary to explore service design tools; In particular, we chose the method from Jurgen Tanghe, and we found that it is more suitable for use in the context of food therapy in China.

Service design is the design for the system, including stakeholders, touchpoints, service offering and process. In fact, service design is very life-oriented. We cannot live without service in all aspects of clothing, food, housing and transportation, and we also need the intervention of service design to provide better services. For example, the whole process of didi’s car rental service includes a series of contacts such as online booking, car pick-up, car return, etc. Through scientific design methods, car users, staff and car rental companies can easily, efficiently and happily complete the whole process. The participation of users makes the service system form a closed loop. It is one of the important principles of service design to take users as the center, gain insight into users’ needs and optimize the overall service experience.

Jurgen Tanghe’s service design tool is based on four stages: scale, Discovering and Learning, Analysis Framework and Implementation. They are developed through a multidisciplinary process in which business model, UX, TECH, product and other fields are integrated and communicated. The implementation of the service requires an easy-to-apply process, so we chose Leavitt’s Diamond method. In addition, in order to support the real realization of dietary therapy, we have also chosen The transtheoretical model (TTM) of behavioral change, developed by psychologists Carlo DiClemente and James Prochaska, which can support decision makers to choose their own most important tasks in each product application stage.

3 Methodology

We consider that a combination of practical tools: Service Design and Change management, which could contribute significantly to the strategic fulfillment of service innovations, whether are management pitch, service blueprint or a (working, functioning) prototype. For the purpose of this research, we departed from both approaches and developed a Methodology we called as: Service Design for Change Management.

This methodology is composed by 4 stages (Fig. 1):

Fig. 1.
figure 1

Service design process for change management.

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  1. (1)

    Scaling

    We can’t invite the whole organization to join our service, we need to help the organizations to confirm the target users.

  2. (2)

    Discovering and Learning

    While many claim that people hate change, the truth is more complex. We can’t change people, we need to set up the context for change instead. To get the biggest chances of success, first we start with unwillingness; second we find the condition of food therapy; third we need to know the motivation.

  3. (3)

    Analysis Framework: Elements of Change

    Its goal is to draw up the circumstances and context that give people the biggest chance of changing their behavior in a way that is beneficial for the service.

  4. (4)

    Implementation

    In this final step application of the service becomes a reality; the transtheoretical model (TTM) specify how to make the change after we establish the need for change and a minimal level of motivation.

4 Application

4.1 Scaling

It seems that all patients with chronic diseases need food therapy, but in fact, there are many ways to treat chronic diseases, such as medicine, injection, acupuncture, physical therapy, massage, sports and food therapy. According to their lifestyle and conditions, only a small number of people can accept food therapy. We scaled target users through questionnaire survey.

150 questionnaires were sent through WeChat, and 126 valid questionnaires were returned. The summary data is as follows (Fig. 2).

Fig. 2.
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Questionnaire survey: scaling the target users.

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After investigation, we found that white-collar patients suffer from chronic diseases, but they do not want to take medicine or injections for a lifetime. Compared with blue-collar workers, white-collar workers want more food for health. The old man thought it was easy to take the medicine anyway, and he could buy a medicine box to remind himself that he was taking drugs, which was not easy to forget. And many old people do not want to trouble young people, do not want to let their children follow their own to eat some kind of food, so do not want to eat therapy. But the elderly know a lot about food therapy, so they know a lot about it but they don’t like the memory or the purchasing power. The family is relieved. Young people don’t cook much themselves, so fast food and pills are the most convenient way to live. Patients with chronic diseases in the short term feel that taking medicine can cure them faster. Women are more emotional, they feel that this gentle way of food therapy is more in line with the needs of the body.

Therefore, our scaling results showed that female white-collar patients aged 30 to 45 years old with long-term chronic diseases were more likely to prefer food therapy.

4.2 Discovering and Learning

What is the current state of food therapy? Why is food therapy acceptable to people, and why is food therapy unacceptable to some people? How can people receive food therapy? Why do people accept change? We first analyze the characteristics of food therapy objectively. And then to find out what are the points that food therapy and people’s current lifestyle fit into, what are the points that conflict with each other.

Status.

The current status of food therapy is as follows:

  • Mild without irritation;

  • Less side effects;

  • You can take it at any time and you don’t have to follow a set schedule of medications;

  • Check information to buy ingredients for cooking;

  • Not bitter;

  • No Pain;

  • You don’t get poisoned if you eat too much;

  • You don’t have to face a doctor (acupuncture is done by a professional).

Unwillingness.

Through Participation and co-creation, I can identify reasons why people don’t like food therapy:

  • Food therapy effect is slow;

  • Eating certain foods for a long time;

  • Do not know how long to eat before the effect;

  • It is quite possible to eat something for a long time only to find that it has no effect;

  • In case it takes a long time to have no effect, it will delay the course of treatment;

  • I don’t know how long it will take to have an effect;

  • Don’t know how much to eat to have an effect;

  • Do not know when to eat to be able to take effect and make corresponding adjustment according to convalescence condition. (don’t know how much to eat to stop or reduce or increase);

  • Can’t cook food anytime, anywhere;

  • Can’t eat food anywhere at any time, there are requirements for the dining environment;

  • There is no expert advice on what to eat and how much to eat is best for you.

Start with Motivation.

Chances of success are biggest if we can start with motivation. For a long time we thought that the key to getting people to change was answering the question “How can I do this? How can I be good at this? Most of the steps are related to the belief that you are able to make the change.

First, we use the same empathy to get the beliefs as follow:

  • We want to treat chronic diseases effectively;

  • Visualization of efficacy progress;

  • Anytime, anywhere;

  • Know how much and what kind to eat;

  • Don’t take it as a pill, don’t take it as a task.

Second, we need to remember the power of emotions. Emotions are the biggest driver of behavior. That is where the energy comes from and that is where action starts. It can be very hard, or nearly impossible to convince people to take action or change based on pure rational arguments. One of the strengths of designers and design thinkers is being in contact with the emotions of people in an organization. And the strength should be utilized in change management efforts.

We use a human-centered approach to get the emotions from food therapy users. We find that food therapy lovers love food therapy because they have the following feelings about food:

  • advanced;

  • Keeping in good health;

  • Making people live forever;

  • Side effect free;

  • Light luxury;

  • Organic;

  • The filial piety;

  • Caring.

4.3 Analysis Framework: Elements of Change

Task.

What’s the staff expected to do? This paper aims at developing a new system based on experience and service demands, through analyzing unmet demands in food therapy service experience and new opportunities brought by artificial intelligence, thereby a new service system of food therapy experience can be obtained which contains data collection by user participation, OBO (blended online/offline) touch-point, food therapy service experience scene and experience feedback. In this manner, the uncertainty of food therapy can be avoided and the food therapy’s effect of People with chronic diseases can be guaranteed.

What is the job of each of the roles in the organization? Analysis stakeholder’s organizational positions and establish a relationship with a group of people accustomed to that behavior (Fig. 3).

Fig. 3.
figure 3

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  • Farmers provide fresh quality ingredients.

  • Food identification experts identify ingredients to ensure quality.

  • The courier is responsible for the fresh-keeping delivery of the ingredients. The courier ensures that the nutrients and moisture of all ingredients are minimally lost, equipped with a standard-standard refrigerator (0–4 ℃) and a freezer (−18 ℃). The logistics personnel are separately stored according to the unique fresh-keeping needs of each product, and the whole-chain cold chain distribution is provided for more than 8 h.

  • Nutrition experts analyze body data and provide recommendations for diet menus.

  • R&D and production of medical wearable devices for the research and design of wearable devices for various chronic diseases.

  • System operators continue to update the system design.

  • Food manufacturers and chefs design food packages for chronically ill patients.

People.

Think about the people we need in our organization. Analysis the knowledge and skills do they need, and make sure if they require any formal training or education (Fig. 3).

  • Farmers: there is little demand for knowledge from farmers. They need to grow good vegetables.

  • Food identification expert: it is necessary to know very well about organic standards, food freshness and food additive ingredients. Otherwise, how to identify the quality level of food and identify the quality of cultivation?

  • Courier: They don’t leave the food in the cold chain truck halfway and eat it secretly.

  • Nutrition expert: I understand very well, at least at the postgraduate level. I have 8–10 years of working experience, which can guide users to eat for what kind of chronic diseases and how long and guide their diet according to their recovery.

  • R&d and manufacturer of medical wearable devices: very familiar with AI and design.

  • System operator: very familiar with IPM, system design, user psychology, product design and service design.

  • Food manufacturers and cooks: can cook good dishes and make delicious gadgets.

  • Chronic disease patients: can have chronic disease, do not like to take medicine, do not like injections, interested in traditional Chinese medicine, very concerned about health.

Structure.

Structure is about how the organization is organized. This includes how departments are structured, but also what is measured and monitored. We can analyze existing one (Fig. 4) and design a new one (Fig. 5).

Fig. 4.
figure 4

Current system map

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Fig. 5.
figure 5

New system map.

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Technology.

Medical equipment monitoring technology, artificial intelligence, such as: wisdom gene detection, AI images, medical and health management, hospital management, intelligent monitoring and testing, blood pressure monitor, blood glucose meter, infant abdominal movement monitor, intelligent sleep alarm clock, a food allergy source detector, the micro spectrometer (detect the fruit is fresh, food calories, whether you need the tire cheer, recently did meat), etc.

4.4 Implementation

Based on the analysis, we design the prototype and testing. We design a simple model of the stages of change based on the Transtheoretical model (TTM) of behavioral change as it follows.

Behavioral change contains 6 parts: Chronic disease detection, food list recommendations (from dietitian), custom convenience packs (from chefs and manufacturers), eating, sensory experiences, emotional experiences, body detection, new food list recommendations, and new meal packages. Behavioral change is in this circle (Fig. 6)

Fig. 6.
figure 6

The transtheoretical model (TTM) of behavioral change. A new food therapy experience service system.

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5 Conclusion

In this paper, a new food therapy service system based on chronic disease is proposed in order to improve food therapy experience and to mine innovative points of people with chronic diseases. User experience is the key to verify the market and the service. However, food nutrition is always concerned while user’s sensory experience, emotional experience and food treatment effect feedback are ignored.

A food therapy service system prototype is established by extracting food therapy interaction mode through the difference table of user’s experiencing process, which is obtained by comparing food experiencing and body feedback process from people with different chronic disease. The implicit demands based on their experience process can be transformed into knowledge elements of system designing by establishing the mapping relationships between service design tool and the special experience of people with chronic disease. The service design tool can be used to guide food therapy experience system and product design innovation. Upon this point of view, an innovative system design prototype based on service design is proposed in order to solve the problem of mismatches between demands of people with chronic disease and food therapy experience mode. In this paper, an investigation into designing progress focused on treatment process for three typical chronic diseases is performed. Implicit demands are discovered in order to realize service system designing of food therapy experience for people with chronic disease and to enhance users’ experience.