A Systematic literature review on Health Recommender

Systems

Jagruti Prajapati1 and Keyur N. Brahmbhatt2

1 Gujarat Technological University, Ahemdabad , India
2 Gujarat Technological University, Ahemdabad , India
jagruti.eyetea@gmail.com

Abstract. In the present computerized world medical care is one of the signifi-
cant region of the clinical space. A medical services framework is needed to
break down a lot of patient information which assists with determining experi-
ences and help the prediction of diseases and treatments. Subsequently, this
framework ought to be astute enough so as to anticipate a medical issue by dis-
secting a patient's way of life, physical wellbeing records and social activities.
Hence, Health recommender systems (HRS) have developed as a driver for giv-
ing patient-driven customized medical care services. The principle target of
recommender frameworks is to give recommendations dependent on recorded
data on the clients' inclinations. In the case of HRS, rich health information
gathered through wearable gadgets and different sensors to survey the physical
and mental condition of the patient. Hence, to comprehend the best in class ad-
vancements in the medical care area, this paper gives an extensive overview on
Health recommender systems. This study additionally gives the comprehensive
survey on the Health recommender systems and the types of Health recom-
mender systems. At last, the open issues and challenges associated with the
HRS are discussed.

Keywords: Recommendation systems, Collaborative Filtering, Health Recom-

mender systems, Deep Learning.

1 Introduction
Recommender Systems (RSs) gather data on the preferences of its users for a lot
of things (e.g., movies, songs, books, jokes, gadgets, applications, websites, travel
destinations and e-learning material). The data can be acquired explicitly (typically by
collecting users’ ratings) or implicitly (typically by observing users’ behavior, for
example songs heard, applications downloaded, web sites visited and books read)[1].
RS may use demographic features of users (such as age, nationality, gender). Social
information, such as followers, followed, twits, and posts, is commonly used in rec-
ommendation techniques. This part gives an outline of recommender systems from
alternate points of view. In particular, recommender systems can be classified based
on the recommendation strategies, tasks and outputs, as shown in Table. I [4].
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Table 1.Classification of Recommender Systems

Strategies Task output

Content-based filtering General Rating Prediction
Collaborative filtering Temporal Item Ranking
Hybrid Methods Sequential

1.1 Classification by strategies

Recommendation strategies can ordinarily be grouped into three categories: (1)
content-based filtering, (2) collaborative filtering and (3) Hybrid methods. More de-
tailed descriptions of the three types of strategies are introduced as follows:
The main aim of content-based filtering technique is to analyze features and at-
tributes of products to generate predictions. Content-based filtering is usually utilized
in document recommendation. In this filtering technique, user content determines
recommendations. The user content deals with various attributes of items along-
side the user’s past purchasing history. Users give their preferences in terms of
ratings, which are positive, negative, or neutral in nature. In this technique, the
system recommends top-rated items to the user[2]. Rather than thinking about
features and attributes of items to decide their comparability, collaborative filtering
(CF) utilizes user-based ratings to discover similarity between items. Subsequent to
gathering all user ratings, the system compares these ratings with other users with the
help of a utility matrix and recommends top-rated items to the user. It uses various
distance measures, for example, Jaccard’s distance, cosine distance, and Pearson’s
coefficient and so forth to find a user’s degree of similarity. This filtering method is
normally used in e-commerce websites to recommend items based on users’ ratings
[2].
Generally, there are two sorts of CF-based techniques: memory- and model-based
strategies. The previous strategies normally exploit original user-item interaction data
(e.g., rating matrices) to predict unobserved ratings by aggregating the preferences of
alike users or similar items. The latter assume that the preference of a user or the
characteristic of an item can be represented by a low-dimensional latent vector. All
the more explicitly, model-based methods learn the latent feature vectors of users and
items from user-item matrices, and predict the recommendations by computing the
dot product of the latent vectors of the user and item [1]. Observational investigations
have demonstrated that model-based methods outperform memory-based ones much
of the time. At last, Hybrid technique consolidates the over two strategies to rein-
force the presentation and precision of the recommendation system. Hybrid filter-
ing technique can be achieved by using any of the following ways: building a rec-
ommendation system that combines both of the above two techniques, applying
some collaborative filtering in a content-based approach, and utilizing some con-
tent-based filtering in the collaborative approach [1,2,4].
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1.2 Classification by tasks

Regarding whether to consider time information (e.g., the order of historical
interactions), recommender systems can be categorized by general, temporal
and sequential recommendation tasks. In case of General recommendation, it
ordinarily utilizes global user-item interaction data to recommend the top-N
items for users. The algorithms, such as matrix factorization and its inferred
models can successfully show user preferences, thus providing a static list of
recommendations reflecting long-term interests of each user [2,4]. While tem-
poral recommendation generally captures user preferences given a timestamp or
a time-frame. More specifically, some methods (e.g., TimeSVD++) split time into
several segments, and model the user-item interactions in each segment. To
build an effective temporal recommender system, the key is to model the dynam-
ics of user preferences that exhibit significant (short- or long-term) temporal
drift (e.g., ‘what users prefer to have for Dinner’ or ‘which places users want to
visit on weekends?’).On the other hand, Sequential recommendation (or next-
item recommendation) predicts users’ next preferences based on their most
recent activities. In other words, sequential recommendation tries to display
sequential patterns among successive items, and generate well-timed recom-
mendations for users.

1.3 Classification by Output

A further category is based on the form of outputs, and there generally are two
types of tasks: rating-based and ranking-based item recommendation tasks. Rat-
ing-based recommendation (rating prediction) predicts users’ explicit prefer-
ence scores towards items, which is usually considered as a regression task
[4].Conversely, ranking-based recommendation (item ranking) focuses on the
(relative) ranking positions of items and usually generates a top-N item recom-
mendation list to each user.

2 Health Recommender System

Health Information Systems are turning into a significant stage for medical
care administrations. . In this specific situation, Health Recommender Systems
(HRSs) are introduced as complementary tools in decision making processes in
medical care administrations [2]. Health Recommender Systems increase usabil-
ity of technologies and reduce information overload in processes. In this paper, a
writing audit was directed by following a survey strategy. Significant methodolo-
gies in HRS were plot and discoveries were examined. The paper presents cur-
rent improvements in the market, challenges and opportunities regarding to HRS
and emerging approaches.
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2.1 The main Determinants of Health

Wellbeing starts where we live, work, learn, and play some time before we vis-
it the specialist's office or stroll in our nearby drug stores. Our health is largely
determined by the social, economic, cultural, and physical environments we live
in everything from where we work and live to our level of education and our
access to healthy food and water [3, 5]. These conditions are known as social
determinants of health: the social and financial assets, for example, lodging, in-
struction, food access, and transportation that help wellbeing and can decide
length and quality of life. Over and over again, admittance to these wellbeing
deciding assets stays outside of people 'control. Numerous health inequities ex-
perienced by communities of color, low-income individuals, and other vulnerable
populations are due to the lack of appropriate distribution of social resources,
rooted in a history of discrimination at the individual, institutional, and structur-
al levels These social and financial elements significantly affect individual and
community-level health. The Fig. 1 shows how those factors impact health [3].

Fig.1. The main Determinants of Health [3]

2.2 Architecture of HRS

The generalized architecture of health care recommender system is shown in

Fig. 2[6]. In this framework, various recommendations are produced for the us-
ers on the basis of the diverse health factors and crucial clinical parameters. This
design involves a medical care specialist organization, a physical director, a pa-
tient,a system administrator, and a user. The information created by these ele-
ments is kept up by an centralized server. This server also maintains and pro-
 5

cesses the recorded data in order to generate the recommendation. These rec-
ommendations are provided to the users through web-Portals, e-healthcare
websites, health care applications, or mobile-based applications. The function of
the system administrator is to develop the recommendation logics for generating
the most relevant recommendation for the users. The web portal system is used
by the users to transfers the health-related substance to the centralized sever so
that more reliable and accurate recommendations could be generated in the fu-
ture [6].

Fig.2 Architecture of a generalized health care recommendation system [6]

2.3 Types of HRS

The fundamental errand of the recommendation framework is to comprehend the

suggested items. The various kinds of recommendations provided in the health care
recommender systems are appeared in fig. 3[12].

Diet/nutritional recommendations: This class alludes to the suggestions offered to

enhance nourishment, which may be additionally used to give balanced eating regi-
men, reduce weight, or forestall any food-explicit ailment. Recommendations could
be in any way similar to food substitution items, various meals or supplement to the
eating regimen. Customized diet recommendation system dissects the day by day
schedule of user and give diet recommendations accordingly [2,6].

Exercise/physical work out: Nowadays, offering proposals about the physical activi-
ties is additionally popular. This assists with finding the exercises that are interesting
or inspiring and besides facilitate the customers' essentials and requirements [2,7].
6

The recommendation framework examines the physical exercise to foresee the appli-
cable health hazard. Based on recognized danger, customized services for users re-
garding exercise rules are suggested from that point.

Disease prediction/ recommendations: In earlier decade, the center has moved toward
the disease prediction, diagnosis and prevention. For this reason, disease recommen-
dations guarantee the efficient decision making [6,8].For representation, a smart rec-
ommender framework conjecture and gauge the malady hazard for cardiovascular
breakdown patients.

Fig.3 Types of Health care recommendation

Therapy/ medication Recommendation: Providing recommendations with respect to

the collection of possible choices that may be significant are likewise practical. A
recommender structure could attest either persistent or potentially a specialist in look-
ing through a patient-explicit treatment. This gives the best strategies to coordinating
the client's wellbeing suggestions with a potential health treatment through reliable
recommendations dependent on people's decision and wellbeing conditions [2,8].

In light of the above conversation, the various sorts of health care recommendation
frameworks have been examined in the current work that can be extensively arranged
into content-based, collaborative filtering-based, and hybrid systems. These classified
health care recommendation systems are examined in the ensuing sections.
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3 Related Work

We have considered the distinctive sort of health care recommendations in above

section. In this part we will dissect the various methods used to distinguish medical
problems and difficulties in an intelligent health recommender system in detail. This
segment presents the key viable advancements, ideas, and the most famous strategies
utilized in HRSs.
To begin with, E. Ezin and E. Kim [7] introduced 'Wellness that Fits', a model for
suggesting physical exercise videos upon labeled video data from the Youtube-8M
dataset. Likewise they have coordinated essential content-based and collaborative
filtering systems, in the proposed recommender model dependent on client profile and
ongoing survey conduct. Moreover, an iterative substitution methodology motivated
by neighborhood- collaborative filtering is acquainted with advance broadened rec-
ommendation records for users to improve with various sorts of fitness exercises as
appeared in fig. 4 [7].

Fig.4. Workout video recommendation[7]

Person’s health is equally depends on mental health. Therefore, F. Alqahtani and G.

Al Khalifah [8] have examined the preliminary list of 437 mobile applications (258
applications from App Store and 179 applications from Google Play). For the exami-
nation, they have included applications whose primary objective as per the applica-
tion's depiction and the demo of the application show that they are focused at psycho-
8

logical well-being, and applications that have more than five reviews (comments)
altogether. Different Mobile applications were examined, which have demonstrated
promising outcomes in individuals with emotional well-being issues to receive
healthy lifestyles utilizing different convincing techniques. The majority of the mental
health applications focused on a blend of emotional well-being issues which make it
difficult to tell which powerful methodologies are more viable for a particular psycho-
logical health issue. In any case, personalization, self-observing and reminder remain
the most utilized enticing procedures in different mental health issues. Anxiety, stress,
sadness, and general psychological wellness issues were the most issues the applica-
tions in this review target [8].

M-Health applications are primarily intended for smart gadgets to give health re-
lated administrations. Naseer and Jeon [11] have broke down different M-Health Ap-
plication, both Android and iOS based and proposed complete M-Health model in-
corporated with a protected android application, secure cloud modes and AI based
prescient examination for additional diagnosis. The information are gathered from
sensor nodes and sent to nearby data sets through new innovations that empower cel-
lular organizations and afterward store the information in distributed cloud storage
system. The information are gathered from cloud or clinical centers , for additional
analysis[11]. Additionally, AI procedures are utilized for their exactness in the fore-
cast of illness examination and have likewise been received for characterization.

One later and exhaustive investigation about the flow status of exploration in
health recommender frameworks drops by Pincay and Teran[12]. In this work, the
creators carried out survey of significant HRSs distributions and characterized a mul-
tidisciplinary scientific categorization to evaluate four angles: domain, philosophy
and methodology, wellbeing advancement techniques, and specialized perspectives.
An aggregate of 890 publications were gathered, and after the assessment process, 19
research articles were chosen. With respect to field area, the creators found that the
greater part of the investigations focused on nutrition and way of life.

Privacy is the major issue in HRS. Therefore, Sahoo and Pradhan[13],have com-
pared different privacy-preserving collaborative filtering methods, along with the
deep learning method and found that integration of an RBM(restricted Boltzmann
machine) with CNN(convolutional neural network) in a deep learning environment
provides a better recommendation quality for hospital recommendation to a patient.
They have have demonstrated that the proposed RBM-CNN has better accuracy of the
health recommender system as compared to other profound methods. Deepa and Pan-
diaraja[16] have build up a Hybrid Context Aware Recommendation System for E-
Health Care (HCARS-EHC) using soft computing techniques. The proposed model
has new privacy preserving phase to increase the security of the patient’s reports as
well as their ratings. Additionally,, the model is efficient based on the privacy preser-
vation, recommendation and ranking with less computation and communication com-
plexity.
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Another research article addresses privacy issue, which is proposed by Calero

Valdez and M. Ziefle [14] . They have reviewed work done in privacy-aware recom-
mendation and personalized recommendation and found that despite accessibility of
technologies such as k-anonymity, differential privacy, Privacy-aware recommenda-
tion techniques, and personalized privacy trade-offs, , little exploration has been con-
ducted on the users' willingness to share health data for utilization in such frame-
works. . In two conjoint-choice examinations (test size n = 521), they have explored
significance and utility of privacy-preserving techniques identified with sharing of
individual wellbeing information utilizing k-anonymity and differential privacy tech-
niques.

The Large use of social networks provides opportunities for people to enhance
their health knowledge and share their health-related information with others. Hence,
Forouzandeh and Aghdam[15] developed the Health Recommender System (HRS) to
users of a Facebook social network site to evaluate their health status. Their method-
ology includes two phases, in the first phase, they have collected 1428 patients’ data
from 4 hospitals in Tehran and, in the second phase, recommendation system provides
some suggestions for users based on their current health status. The results show the
effectiveness of suggested HRS in predicting the health status of Facebook users.
Additionally, customizing healthy status and lifestyle for users using HRS can help
them to stay in a healthy condition, reducing the costs of medicine. The outcome of
this research can be beneficial for health organizations to enhance individuals’ health
knowledge in order to preventions diseases.

Because of the ongoing fashion trend of wearable sensors and smart gadgets with
admittance to web-based media, migrating health services from the customary focus
based wellbeing framework to personal health care is unavoidable. Regarding this
reality Çelik Ertuğrul and A. Elçi[17] has reviewed many research articles and dis-
covered that different AI, machine learning, data mining, information retrieval, graph
theory, heuristics, and probabilistic approaches utilized in HRSs. Various Personal
HRSs were evaluated, examined, looked at and modeled on clustering, classifying and
regression, graph theory, knowledge-based, context-aware based, similarity matching,
and matrix factorization techniques.
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Fig.5. System architecture of emHealth [18]

With the advancement of internet business, , intelligent recommender framework

has carried new chances to customized wellbeing observing for the clients with emo-
tional distress. Therefore, Yang and Zhou[18] set forward the emHealth framework,
which is a clever health recommendation system with depression prediction for emo-
tion health. Framework design of emHealth is appeared in fig. 5. They have planned
customized cell phone Apps to gather emotional data of users with tendentious de-
pressive mood, and found the five principle external characteristics of depression by
Pearson correlation analysis. They have partitioned 1047 volunteers information into
training set and test set, and built prescient model of predictive model of depression
using decision tree and support vector machine algorithms. emHealth framework,
which is an intelligent health recommendation system for patients with emotional
distress. The framework utilizes smart cell phones to gather and investigate client
information whenever and anyplace, and anticipate emotional ailments, at that point
give successful intercession measures to the treatment and medical services of pa-
tients.

Most of the investigations utilized content based techniques and similarity analysis
to assemble their recommendation engine, which is somewhat common while imple-
menting RSs. Nevertheless, a noteworthy level of the activities utilized artificial intel-
ligence, fuzzy logic and machine learning techniques as a method of accomplishing
more significant levels of exactness and performance of the frameworks.
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4 Deep Learning for HRS

There are numerous reasons of applying deep learning strategies to health recom-
mender frameworks. It is clear that various deep recommender systems have been
proposed in a short span of several years.. The field is for sure clamoring with devel-
opment. Additionally, deep neural networks are likewise composite as in numerous
neural structures can be formed into a single differentiable function and trained end-
to-end. The key favorable position here is when managing content-based suggestion.
This is unavoidable when modeling users/items on the web, where multi-modular
information is basic spot. For example, when managing textual information (reviews,
tweets and so forth.), image data (social posts, item pictures), CNNs/RNNs become
key neural structure blocks [17]. Here, the conventional option turns out to be funda-
mentally less appealing and thus, the recommender framework can't exploit joint
(start to finish) representation learning [9]. In some sense, improvements in the field
of recommender frameworks are likewise firmly combined with propel research in
related modalities, (for example, vision or language networks). For instance, to deal
with reviews, one would need to perform exorbitant preprocessing (e.g., key expres-
sion extraction, theme displaying and so forth.) while more up to date deep learning-
based approaches can ingest all textual data start to finish. All things considered, the
capacities of deep learning in this viewpoint can be viewed as outlook changing and
the ability to speak to pictures, text and communications in a bound together joint
system is unimaginable without these ongoing advances. The scientific classification
of of deep learning strategies utilized in health recommender system is appeared in
fig. 6.
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Fig.6. Deep Learning techniques used in Health Recommendation systems

5 Open Issues and Challenges

In this comprehensive study, we reviewed recent developments in health care rec-

ommendation. Notwithstanding all the advancement, there are numerous challenges
that ought to be taken care of in a viable way for the effective design of health care
system. A portion of the proposed open issues and challenges are recorded as under-
neath.

Integration of electronic clinical records: The information identified with the clinical
records is gathered from various sources like patients, sensors, wearable gadgets,
implantable types of gear, IoT gadgets and some more. The mix of the information
gathered from these different sources into a typical electronic wellbeing record is a
challengeable issue. The whole exhibition of any medical services arrangement relies
carefully upon the information.
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Information assortment and monitoring frameworks: The most troublesome assign-

ment is the data collection, observing, and feedback systems on the off chance that
these are ineffectively planned and actualized, at that point it will be extremely diffi-
cult to analyze problem.
Convincing patients that there is an issue and the arrangement picked is correct: It is
a challenge to persuade the patients about the genuine issue and their answers utiliz-
ing a recommender framework. This is because of the absence of trust or mindfulness
about the applicability of health care systems.
Moral difficulties: A serious deal is the moral/ethical difficulties in health care do-
main. To assemble the agreeableness of brilliant medical care framework, initially,
fundamental methodology ought to be straightforward and trustworthy. Medical dele-
gates ought to comprehend that the advancement of any association legitimately de-
pends on the individual moral conduct.
Accuracy of health recommendations: Accuracy of results in health recommender
framework is most significant viewpoint than anything since it is answerable for tol-
erant' life. It is significant in medical domain that outcomes ought to be extensively
exact and near real condition and this can be conceivable if colossal informational
collection of data will be accessible to foresee precise recommendations.

6 Conclusion and Future work

This paper adds to the present state-of-art review on recommendation systems used
in the health domain, also known as health recommender systems (HRSs). Different
research articles have been assessed by examining significant ideas and methods ap-
plied in HRSs. Based on this survey of recent research in HRS, it is classified in three
main groups in terms of their filtering techniques namely, content based, collabora-
tive-based, hybrid filtering. A scope of machine learning, data mining, information
retrieval, cloud based and deep learning approaches utilized in HRSs were investigat-
ed under these principle groups. Most examinations were focused to improve the
prosperity of the users, by recommending diets and exercise plans. Most investiga-
tions were targeted to improve the well-being of the users, by means of recommend-
ing diets and exercise plans. However, a significant number of creators put endeavors
in planning frameworks fit for helping doctors in the undertaking of diagnosing of
illnesses and endorsing medicine. Notwithstanding all the works that have been di-
rected in the most recent years, this is an exploration zone that is still in its outset and
more thorough examinations are required. Managing wellbeing related issues is per-
plexing and there is certainly not an exceptional strategy skilled to handle all the is-
sues that HRSs present these days. From the research works considered and from our
point of view, we can reason that we are still a long way from having a completely
utilitarian and reliable health recommender framework. Also, efforts ought to be
pointed towards addressing the uncertainty that making health-related decisions im-
14

plies and defining more suitable testing mechanisms that will permit to appropriately
evaluate the accuracy and performance of the implementations.

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