Lost in Translation: Transforming Behaviour Change Techniques into Engaging Digital Content and Design for the StopApp.

Emily Fulton,Sue Wild,Katherine Brown,Kayleigh Kwah

doi:10.3390/healthcare6030075

Emily Fulton, Sue Wild + Show 2 more

Open Access

https://doi.org/10.3390/healthcare6030075

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Abstract

Frameworks to support the application of behaviour change theory to the choice of behaviour change techniques (BCTs) in designing digital behaviour change interventions (DBCIs) are becoming well established, and have been employed by the authors in the development of StopApp. However, guidance on the next stage—effective operationalisation (translation) of these BCTs to a digital context, including the precise delivery and design of “behavioural intervention technology” (BIT) elements, is still in its infancy. This is despite growing recognition of the need to optimise engagement and usability, alongside a theoretical basis, for intervention effectiveness. The aim of this study was to explore methods to translate BCTs into digital content in an accurate and systematic manner. We describe the process of using co-creation (user-led) rather than expert-driven methods in the development of user-facing features and design in StopApp, including the iterative “bottom-up” and “top-down processes” necessary for accurate BCT translation. We found a small disparity between the intended and actual BCT content, reflecting the difficulties of translating BCTs into digital intervention content and the need for better guidance and methodical approaches to enhance this under-researched process. The involvement of our Patient and Public Involvement (PPI) group throughout these processes is described.

Highlights

It is well recognised that despite the ongoing proliferation of digital behaviour change interventions (DBCIs), relatively few have a clear theoretical basis, designed and developed methodically to optimise user uptake, engagement, and sustained behaviour change
A late prototype of the StopApp was subject to a re-coding of behaviour change techniques (BCTs) content by two independent researchers who were blind to the intended BCT content, and had not been involved in the StopApp development process
It was agreed that no further BCTs could or should be applied, especially given that this “top-down” approach meant their inclusion was not based on the results of the behavioural analysis

Summary

Introduction

It is well recognised that despite the ongoing proliferation of digital behaviour change interventions (DBCIs), relatively few have a clear theoretical basis, designed and developed methodically to optimise user uptake, engagement, and sustained behaviour change. Users of health apps typically decide whether to engage with them in a mere 50–500 milliseconds [1], regularly ceasing use shortly after download [2]. Identifying what leads potential users to develop interest with a DBCI (uptake), and what enhances usability so they “stay with it” (engage) enough to activate the target behaviour change, is imperative. Understanding the minimal engagement with a DBCI (level and pattern of usage) necessary to establish the desired behaviour change outcome is essential, in order to maximise success [3]. In order to achieve this, evaluations of DBCIs should collect real-time objective

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