Persuasive System Design Principles Research Articles

Combining Persuasive System Design Principles and Behavior Change Techniques in Digital Interventions Supporting Long-term Weight Loss Maintenance: Design and Development of eCHANGE

BackgroundLong-term weight maintenance after weight loss is challenging, and innovative solutions are required. Digital technologies can support behavior change and, therefore, have the potential to be an effective tool for weight loss maintenance. However, to create meaningful and effective digital behavior change interventions that support end user values and needs, a combination of persuasive system design (PSD) principles and behavior change techniques (BCTs) might be needed.ObjectiveThis study aimed to investigate how an evidence-informed digital behavior change intervention can be designed and developed by combining PSD principles and BCTs into design features to support end user values and needs for long-term weight loss maintenance.MethodsThis study presents a concept for how PSD principles and BCTs can be translated into design features by combining design thinking and Agile methods to develop and deliver an evidence-informed digital behavior change intervention aimed at supporting weight maintenance. Overall, 45 stakeholders participated in the systematic and iterative development process comprising co-design workshops, prototyping, Agile development, and usability testing. This included prospective end users (n=17, 38%; ie, people with obesity who had lost ≥8% of their weight), health care providers (n=9, 20%), healthy volunteers (n=4, 9%), a service designer (n=1, 2%), and stakeholders from the multidisciplinary research and development team (n=14, 31%; ie, software developers; digital designers; and eHealth, behavior change, and obesity experts). Stakeholder input on how to operationalize the design features and optimize the technology was examined through formative evaluation and qualitative analyses using rapid and in-depth analysis approaches.ResultsA total of 17 design features combining PSD principles and BCTs were identified as important to support end user values and needs based on stakeholder input during the design and development of eCHANGE, a digital intervention to support long-term weight loss maintenance. The design features were combined into 4 main intervention components: Week Plan, My Overview, Knowledge and Skills, and Virtual Coach and Smart Feedback System. To support a healthy lifestyle and continued behavior change to maintain weight, PSD principles such as tailoring, personalization, self-monitoring, reminders, rewards, rehearsal, praise, and suggestions were combined and implemented into the design features together with BCTs from the clusters of goals and planning, feedback and monitoring, social support, repetition and substitution, shaping knowledge, natural consequences, associations, antecedents, identity, and self-belief.ConclusionsCombining and implementing PSD principles and BCTs in digital interventions aimed at supporting sustainable behavior change may contribute to the design of engaging and motivating interventions in line with end user values and needs. As such, the design and development of the eCHANGE intervention can provide valuable input for future design and tailoring of evidence-informed digital interventions, even beyond digital interventions in support of health behavior change and long-term weight loss maintenance.Trial RegistrationClinicalTrials.gov NCT04537988; https://clinicaltrials.gov/ct2/show/NCT04537988

Promoting Health Behavior Change in the Preconception Period: Combined Approach to Intervention Planning.

BackgroundHalf of women begin pregnancy above the healthy weight range, increasing the risk of complications and adversely affecting the lifelong health of their babies. Maternal obesity remains the strongest risk factor for offspring obesity across childhood, adolescence, and adulthood. Previous research suggests that women should be encouraged to be within a healthy weight range before conception to improve health outcomes.ObjectiveWe outlined the intervention planning and design process to develop an evidence-informed eHealth intervention to promote weight management. The intervention, based on psychological theories and behavior change techniques, has been developed for women affected by overweight or obesity who intend to become pregnant. The Begin Better web application is part of an integrated program being evaluated in a clinical trial to assess if weight management before pregnancy can influence clinical outcomes for mothers and babies.MethodsOur intervention development process was guided by intervention mapping and person-based methods. This study documents steps 2 to 4 of a 6-step iterative intervention mapping approach informed by the Information-Motivation-Behavioral Skills model and the findings of a previous interview study. We defined behavior change objectives for each of the Information-Motivation-Behavioral Skills behavioral determinants as well as theory-based behavior change techniques and practical strategies. We also used persuasive system design principles to assist in translating these strategies into a digital environment.ResultsThe resultant intervention comprises nutritional and physical activity content along with psychological strategies, which are notably absent from mainstream weight management programs. Strategies to increase motivation, garner social support, and promote self-care are integral to maintaining engagement with the intervention, which aims to improve lifestyle behaviors and enhance well-being. Important elements include tracking mechanisms for percentage progress toward goals to enable feedback on behaviors and outcomes; in-application messages of praise on entry of goals or habits; and strategies to prompt habit formation and action planning via small, easily achievable steps toward positive change.ConclusionsDesign decisions and processes for idea generation about intervention content, format, and delivery are often not reported. In this study, we respond to this gap in the literature and outline a process that is potentially transferable to the development of other interventions.

Standardized evaluation of the quality and persuasiveness of mobile health applications for diabetes management

This study evaluates diabetes self-management mobile health applications available from European app stores with respect to quality, concordance with recommended self-management tasks and implementation of persuasive system design principles. The European Play Store and Apple App Store were systematically searched and relevant apps were tested. Two raters independently assessed app quality using the Mobile Application Rating Scale and conducted a content analysis of provided persuasive system design principles and self-management tasks. A total of 2,269 mobile health applications were identified and 120 could be included in the evaluation. The overall quality was rated as moderate M = 3.20 (SD = 0.39, min = 2.31, max = 4.62), with shortcomings in the subcategories of engagement (M = 2.80, SD = 0.67) and information quality (M = 2.26, SD = 0.48). Scientific evidence is available for 8% of the apps. The reviewed apps implemented a median of three persuasive system design principles (range 0–15) and targeted a median of 4.5 (range 1–8) self-management tasks, however, with a lack of information about psychosocial coping strategies. Most available diabetes self-management apps lack a scientific evidence base. Persuasive system design features are underrepresented and may form a promising tool to improve app quality. Furthermore, the interaction of physical and behavioral health should be improved in existing diabetes self-management mobile health applications.

The Evaluation of Online Persuasion Criteria on E-Commerce Website using Persuasive System Design (PSD) Model

Persuasive technology in online shopping is proven to assist people while purchasing online. It is crucial to study how was the implementation of such successful persuasive technology in the e-commerce domain. Also, there are certain marketing strategies against consumers from different generational cohorts. Each generation has unique lifestyles, generational history, demographics, experiences, expectations and values that influence their buying behaviours. The persuasive design of e-commerce websites is related to the website conversion rate and is shown to support people throughout the online purchasing process. The objective of this research study is to evaluate the online persuasion criteria on two largest e-commerce websites in Malaysia; Lazada and Shopee through Persuasive System Design (PSD) principles. The four main categories of design technique applied in PSD are primary task support, dialogue support, credibility support and social support. The result shows that both selected e-commerce websites have applied 71.43% of the PSD principles. The most emphasize design technique in Lazada and Shopee is primary task support, followed by dialogue support. Most of the persuasive features in this model has implemented in both e-commerce websites. However, this research proved that the success of the e-commerce websites is related with the implemented persuasive feature which can be manipulated and implemented by other e-commerce websites.

Identifying Persuasive Design Principles and Behavior Change Techniques Supporting End User Values and Needs in eHealth Interventions for Long-Term Weight Loss Maintenance: Qualitative Study.

BackgroundAn increasing number of eHealth interventions aim to support healthy behaviors that facilitate weight loss. However, there is limited evidence of the effectiveness of the interventions and little focus on weight loss maintenance. Knowledge about end user values and needs is essential to create meaningful and effective eHealth interventions, and to identify persuasive system design (PSD) principles and behavior change techniques (BCTs) that may contribute to the behavior change required for successful long-term weight loss maintenance.ObjectiveThis study aimed to provide insight into the design of eHealth interventions supporting behavior change for long-term weight maintenance. The study sought to identify the values and needs of people with obesity aiming to maintain weight after weight loss, and to identify PSD principles, BCTs, and design requirements that potentially enable an eHealth intervention to meet end user values and needs.MethodsThis study presents the concept of integrating PSD principles and BCTs into the design process of eHealth interventions to meet user values and needs. In this study, individual interviews and focus groups were conducted with people with obesity (n=23) and other key stakeholders (n=27) to explore end user values and needs related to weight loss maintenance. Design thinking methods were applied during the focus group sessions to identify design elements and to explore how eHealth solutions can support the needs to achieve sustainable weight loss maintenance. The PSD model and behavior change taxonomy by Michie were used to identify PSD principles and BCT clusters to meet end user values and needs.ResultsA total of 8 key end user values were identified, reflecting user needs for weight loss maintenance support: self-management, personalized care, autonomy, feel supported, positive self-image, motivation, happiness, and health. Goals and planning, feedback and monitoring, repetition and substitution, shaping knowledge, social support, identity, and self-belief were some of the BCT clusters identified to address these concepts, together with PSD principles such as personalization, tailoring, self-monitoring, praise, and suggestions.ConclusionsThe process of translating end user values and needs into design elements or features of eHealth technologies is an important part of the design process. To our knowledge, this is the first study to explore how PSD principles and BCTs can be integrated when designing eHealth self-management interventions for long-term weight loss maintenance. End users and other key stakeholders highlighted important factors to be considered in the design of eHealth interventions supporting sustained behavior change. The PSD principles and BCTs identified provide insights and suggestions about design elements and features to include for supporting weight loss maintenance. The findings indicate that a combination of BCTs and PSD principles may be needed in evidence-based eHealth interventions to stimulate motivation and adherence to support healthy behaviors and sustained weight loss maintenance.Trial RegistrationClinicalTrials.gov NCT04537988; https://clinicaltrials.gov/ct2/show/NCT04537988

Extensive Review of Persuasive System Design Categories and Principles: Behavioral Obesity Interventions.

In this extensive review of behavioral digital obesity interventions, we reviewed randomized control trials aimed at weight loss or maintaining weight loss and identifying persuasive categories and principles that drive these interventions. The following databases were searched for long-term obesity interventions: Medline, PsycINFO, Academic Search Complete, CINAHL and Scopus. The inclusion criteria included the following search terms: obesity, overweight, weight reduction, weight loss, obesity management, and diet control. Additional criteria included randomized control trial, ≥ 6months intervention, ≥ 100 participants and must include persuasive technology. Forty-six publications were in the final review. Primary task support was the most frequently utilized persuasive system design (PSD) category and self-monitoring was the most utilized PSD principle. Behavioral obesity interventions that utilized PSD with a behavior change theory more frequently produced statistically significant weight loss findings. Persuasive technology and PSD in digital health play a significant role in the management and improvement of obesity especially when aligned with behavior change theories. Understanding which PSD categories and principles work best for behavioral obesity interventions is critical and future interventions might be more effective if they were based on these specific PSD categories and principles.

Developing and testing a mobile application for breastfeeding support: The Milky Way application

BackgroundSupporting women to continue breastfeeding is a global challenge. The Milky Way Program is an effective face to face intervention to increase breastfeeding rates up to six months postpartum. The sustainability and access to the Milky Way Program could be enhanced by transforming it into a mobile application allowing women to access relevant information from their own place at a convenient time. AimTo explore the process of transforming the Milky Way Program into an acceptable and usable mobile health application. MethodStakeholders including multidisciplinary researchers and end-users designed the application based on the Milky Way Program by using Persuasive System Design principles. A mixed-method approach was used in the development and evaluation process. Seven women were recruited through convenience sampling to pilot test the application. The women’s feedback was collected through an online survey six weeks after birth and individual interviews at four months postpartum. FindingsWomen in the pilot study reported that the breastfeeding application was well designed, easy to use, interactive, reassuring and evidence-based with credible sources of information. ConclusionThe Persuasive System Design model combined with end-user engagement can feasibly inform the development of an acceptable and usable mobile health application for breastfeeding based on a proven clinical intervention. Further rigorous testing is required to evaluate the effectiveness of the application on breastfeeding initiation and duration.

Persuasive System Design Principles that Impact the Usability of Smartphone Applications

The study examines the impact of persuasive system design principles (PSD) on the continued use of WhatsApp users. A cross-sectional survey was employed to collect data from 488 participants living in Germany, the Kingdom of Saudi Arabia, the Netherlands, and Malaysia, representing varying cultural backgrounds.

Persuasive System Design Principles and Behavior Change Techniques to Stimulate Motivation and Adherence in Electronic Health Interventions to Support Weight Loss Maintenance: Scoping Review.

BackgroundMaintaining weight after weight loss is a major health challenge, and eHealth (electronic health) solutions may be a way to meet this challenge. Application of behavior change techniques (BCTs) and persuasive system design (PSD) principles in eHealth development may contribute to the design of technologies that positively influence behavior and motivation to support the sustainable health behavior change needed.ObjectiveThis review aimed to identify BCTs and PSD principles applied in eHealth interventions to support weight loss and weight loss maintenance, as well as techniques and principles applied to stimulate motivation and adherence for long-term weight loss maintenance.MethodsA systematic literature search was conducted in PsycINFO, Ovid MEDLINE (including PubMed), EMBASE, Scopus, Web of Science, and AMED, from January 1, 2007 to June 30, 2018. Arksey and O’Malley’s scoping review methodology was applied. Publications on eHealth interventions were included if focusing on weight loss or weight loss maintenance, in combination with motivation or adherence and behavior change.ResultsThe search identified 317 publications, of which 45 met the inclusion criteria. Of the 45 publications, 11 (24%) focused on weight loss maintenance, and 34 (76%) focused on weight loss. Mobile phones were the most frequently used technology (28/45, 62%). Frequently used wearables were activity trackers (14/45, 31%), as well as other monitoring technologies such as wireless or digital scales (8/45, 18%). All included publications were anchored in behavior change theories. Feedback and monitoring and goals and planning were core behavior change technique clusters applied in the majority of included publications. Social support and associations through prompts and cues to support and maintain new habits were more frequently used in weight loss maintenance than weight loss interventions. In both types of interventions, frequently applied persuasive principles were self-monitoring, goal setting, and feedback. Tailoring, reminders, personalization, and rewards were additional principles frequently applied in weight loss maintenance interventions. Results did not reveal an ideal combination of techniques or principles to stimulate motivation, adherence, and weight loss maintenance. However, the most frequently mentioned individual techniques and principles applied to stimulate motivation were, personalization, simulation, praise, and feedback, whereas associations were frequently mentioned to stimulate adherence. eHealth interventions that found significant effects for weight loss maintenance all applied self-monitoring, feedback, goal setting, and shaping knowledge, combined with a human social support component to support healthy behaviors.ConclusionsTo our knowledge, this is the first review examining key BCTs and PSD principles applied in weight loss maintenance interventions compared with those of weight loss interventions. This review identified several techniques and principles applied to stimulate motivation and adherence. Future research should aim to examine which eHealth design combinations can be the most effective in support of long-term behavior change and weight loss maintenance.

Towards personalized persuasive strategies for active ageing

As Europe is ageing, the healthcare system is experiencing dramatic strain. Increasing physical activities is important to promote independent living among seniors due to its impact in preventing chronic diseases and long-term care. Smart wearable technologies have been already developed to support citizens to be more physically active. However, the impact of these wearable technologies on seniors is still requires more research. Persuasive system design (PSD) strategies may be applied to motivate seniors to adopt a more active lifestyle. This paper examines 12 student team design concepts which aim to add values to one existing wearable product by redesigning the accompanying application to suit an elderly user group using the PSD principles. From clustering the resulting re-design concepts, we identified themes, suggesting values suitable for an elderly user group that aim to stimulate a more active lifestyle. Furthermore, we identified common persuasive principles applied to redesign concepts in each value theme so as to create design guidelines for active ageing lifestyle.

Building it better: Applying human–computer interaction and persuasive system design principles to a monetary limit tool improves responsible gambling

In two studies, we aimed to improve the responsible gambling (RG) utility of monetary limit tools for non-disordered Electronic Gambling Machine (EGM) players – the target population for such prevention-oriented RG tools. To this end, based on feedback from focus groups with non-disordered EGM players, we created a new monetary limit tool that incorporated EGM players’ desired functionality coupled with design fundamentals of Human Computer Interaction (HCI) and Persuasive Systems Design (PSD; Study 1). We then tested the newly created HCI and PSD inspired tool and compared its RG utility (limit adherence) against a standard monetary limit tool (Study 2). Non-disordered EGM players were randomly assigned to experience the HCI and PSD inspired or the standard monetary tool prior to gambling in a virtual realty casino. As predicted, participants adhered to their pre-set monetary limits more (92%), when exposed to the HCI and PSD inspired pop-up tool than the standard monetary limit tool (62.2%). Improving RG tools through the use of HCI and PSD principles is discussed.

Designing and Using Carbon Management Systems to Promote Ecologically Responsible Behaviors

With the hope of mitigating the harmful impacts of climate change, many organizations are taking actions to reduce their carbon footprints. Carbon-reducing initiatives in organizations are varied: they range from green product innovations to encouraging behavioral changes by customers and employees. Green IS can play an important role in environmental sustainability by supporting a number of these strategies. Drawing on theories of persuasive systems design, this paper explores how one category of Green IS, carbon management systems (CMS), can be designed and used in order to persuade employees to perform ecologically responsible behaviors. The results from three organizational case studies suggest that CMS can be effective at changing employees’ environmental behaviors, demonstrate the extent to which persuasive system design principles (including an emergent category of Integration) are reflected in CMS, and highlight the importance of understanding the persuasion context. The findings of the study are used to inform the development of four propositions, which can serve as a foundation for further research in the Green IS domain.