Health Behavior Change Support Systems Research Articles

Opportunities and challenges of behavior change support systems for enhancing habit formation: A qualitative study

The formation of healthy habits is considered to play a fundamental role in health behavior change. A variety of studies on Health Behavior Change Support Systems (HBCSS) have been conducted recently, in which individuals use such systems to influence their own attitudes or behaviors to achieve their personal goals. However, comparatively much less research has been devoted to studying how the users of these systems form habits with the help of HBCSS, or to understanding how to design these systems to support habit formation. ObjectiveThe objective of this article is to study HBCSS user experiences regarding habit formation through an intervention study targeted at establishing a healthier lifestyle. This study also aims to map habit formation stages, as suggested by Lally and Gardner, with the Persuasive System Design (PSD) model. The application domain is the prevention of metabolic syndrome, in which 5% weight loss can significantly reduce the prevalence of the syndrome. MethodsThis study employs a web-based HBCSS named Onnikka, a lifestyle intervention designed for the prevention of metabolic syndrome for participants who are at risk of developing a metabolic syndrome or are already suffering from it. The system under investigation was designed according to the principles of the PSD model and Behavior Change Support System framework. Lally and Gardner’s research on the stages of habit formation were used to study the extent to which the Onnikka system was able to enhance the development of new habits. A total of 43 Onnikka users were interviewed for this study during and after a 52-week intervention period. The research approach employed here was hermeneutics, which leans ontologically toward the social construction of reality, gained through language, consciousness, and shared meaning. In addition, the system’s login data and participants’ weight measurements were utilized to build an interpretation of the results. ResultsThe findings of this study suggest that IT habits appear to have a strong linkage with use adherence, whereas lifestyle habits did not seem to be directly related to the 5% weight loss among study participants. Moreover, habit formation stages provide a possible explanation for why self-monitoring, reminders, and tunneling were perceived as especially valuable features in this study. ConclusionsFor sustainable weight management, holistic e-health interventions are required, and the PSD model offers a practical approach for designing and developing them. Recognizing the stages of habit formation provides additional valuable guidance for designing systems that help shape an individual’s habits.

Health Behavior Change Support Systems as a research discipline; A viewpoint

As research on Health Behavior Change Support Systems (HBCSS) proliferates, meaningful management of the different findings is becoming a challenge. We argue that for the field to evolve, it is important to establish the study of HBCSSs as an independent research area, which means that instead of only applying theories from related disciplines to HBCSSs, we need to significantly extend and adapt these theories, or develop new theories, to explain the phenomena that are encountered.Current research in HBCSSs is carried out in different disciplines, with a different approach in each of these disciplines. However, both the CeHRes roadmap and the Persuasive System Design Model show that HBCSSs are complex and the development and evaluation of these systems need to deal with this complexity to be successful. Therefore, an integrative approach is needed to study the combination of content, system, and context. Although research into the separate areas has yielded important findings that are discussed in this paper, we argue that an integrated approach of HBCSSs is useful. We discuss two examples to show how a truly integrative approach can be utilized to enhance the field involving tailoring, personalization, and support. In conclusion we present three practical and relatively easy–to-implement recommendations for researchers who want to contribute to this discipline: Avoid the black box, be specific about the terms used, and look past the borders of one’s own discipline.

Persuasive user experiences of a health Behavior Change Support System: A 12-month study for prevention of metabolic syndrome

BackgroundObesity has become a severe health problem in the world. Even a moderate 5% weight loss can significantly reduce the prevalence of metabolic syndrome, which can be vital for preventing comorbidities caused by the obesity. Health Behavior Change Support Systems (hBCSS) emphasize an autogenous approach, where an individual uses the system to influence one’s own attitude or behavior to achieve his or her own goal. Regardless of promising results, such health interventions technology has often been considered merely as a tool for delivering content that has no effect or value of its own. More research on actual system features is required. ObjectivesThe objective of this study is to describe how users perceive persuasive software features designed and implemented into a support system. MethodsThe research medium in this study is a web-based information system designed as a lifestyle intervention for participants who are at risk of developing a metabolic syndrome or who are already suffering from it. The system was designed closely following the principles of the Persuasive Systems Design (PSD) model and the Behavior Change Support Systems (BCSS) framework. A total of 43 system users were interviewed for this study during and after a 52 week intervention period. In addition, the system's login data and subjects’ Body Mass Index (BMI) measures were used to interpret the results. ResultsThis study explains in detail how the users perceived using the system and its persuasive features. Self-monitoring, reminders, and tunneling were perceived as especially beneficial persuasive features. The need for social support appeared to grow along the duration of the intervention. Unobtrusiveness was found to be very important in all stages of the intervention rather than only at the beginning. ConclusionsPersuasive software features have power to affect individuals’ health behaviors. Through their systematicity the PSD model and the BCSS framework provide effective support for the design and development of technological health interventions. Designers of such systems may choose, for instance, to implement more self-monitoring tools to help individuals to adjust their personal goals with the system’s offerings better.

Understanding persuasion contexts in health gamification: A systematic analysis of gamified health behavior change support systems literature

BackgroundGamification is increasingly used as a design strategy when developing behavior change support systems in the healthcare domain. It is commonly agreed that understanding the contextual factors is critical for successful gamification, but systematic analyses of the persuasive contexts have been lacking so far within gamified health intervention studies. Objectives and methodsThrough a persuasion context analysis of the gamified health behavior change support systems (hBCSSs) literature, we inspect how the contextual factors have been addressed in the prior gamified health BCSS studies. The implications of this study are to provide the practitioners and researchers examples of how to conduct a systematic analysis to help guide the design and research on gamified health BCSSs. The ideas derived from the analysis of the included studies will help identify potential pitfalls and shortcomings in both the research and implementations of gamified health behavior change support systems. ResultsWe systematically analyzed the persuasion contexts of 15 gamified health intervention studies. According to our results, gamified hBCSSs are implemented under different facets of lifestyle change and treatments compliance, and use a multitude of technologies and methods. We present a set of ideas and concepts to help improve endeavors in studying gamified health intervention through comprehensive understanding of the persuasive contextual factors. ConclusionsFuture research on gamified hBCSSs should systematically compare the different combinations of contextual factors, related theories, chosen gamification strategies, and the study of outcomes to help understand how to achieve the most efficient use of gamification on the different aspects of healthcare. Analyzing the persuasion context is essential to achieve this. With the attained knowledge, those planning health interventions can choose the ‘tried-and-tested’ approaches for each particular situation, rather than develop solutions in an ad-hoc manner.

Examining the Persuasive Potential of Web-based Health Behavior Change Support Systems

Understanding the persuasive potential of systems to support behavior change is increasingly important. If systems are not designed properly, their persuasive potential is not fulfilled. Previous research has shown that persuasive system design has a significant impact on adherence. Moreover, persuasive system features are likely to be advantageous in boosting effective user engagement with the technology and keeping the users motivated in their endeavors. In this study, we identify persuasive system features used in a selection of Web-based health behavior change support systems targeting excessive alcohol use and weight loss. We conducted en expert-based evaluation using the persuasive systems design model as a lens to view the twelve selected Web-based systems. The evaluation included a hands-on approach in which we used the systems for at least one month each and evaluated in terms of four categories: primary task support, computer-human dialogue support, system credibility, and social support. The results suggest that the systems harness a decent number of persuasive features. However, they had room for improvement (e.g., in terms of tailoring). Further research is needed to increase our understanding of how and under what conditions specific persuasive system features, either in isolation or collectively, lead to positive health outcomes in behavior change support systems across diverse contexts and populations. This study adds to the body of knowledge on designing persuasive health behavior change support systems.