Persuasive Systems Design Research Articles

Activity Monitors as Support for Older Persons' Physical Activity in Daily Life: Qualitative Study of the Users' Experiences.

BackgroundFalls are a major threat to the health and independence of seniors. Regular physical activity (PA) can prevent 40% of all fall injuries. The challenge is to motivate and support seniors to be physically active. Persuasive systems can constitute valuable support for persons aiming at establishing and maintaining healthy habits. However, these systems need to support effective behavior change techniques (BCTs) for increasing older adults’ PA and meet the senior users’ requirements and preferences. Therefore, involving users as codesigners of new systems can be fruitful. Prestudies of the user’s experience with similar solutions can facilitate future user-centered design of novel persuasive systems.ObjectiveThe aim of this study was to investigate how seniors experience using activity monitors (AMs) as support for PA in daily life. The addressed research questions are as follows: (1) What are the overall experiences of senior persons, of different age and balance function, in using wearable AMs in daily life?; (2) Which aspects did the users perceive relevant to make the measurements as meaningful and useful in the long-term perspective?; and (3) What needs and requirements did the users perceive as more relevant for the activity monitors to be useful in a long-term perspective?MethodsThis qualitative interview study included 8 community-dwelling older adults (median age: 83 years). The participants’ experiences in using two commercial AMs together with tablet-based apps for 9 days were investigated. Activity diaries during the usage and interviews after the usage were exploited to gather user experience. Comments in diaries were summarized, and interviews were analyzed by inductive content analysis.ResultsThe users (n=8) perceived that, by using the AMs, their awareness of own PA had increased. However, the AMs’ impact on the users’ motivation for PA and activity behavior varied between participants. The diaries showed that self-estimated physical effort varied between participants and varied for each individual over time. Additionally, participants reported different types of accomplished activities; talking walks was most frequently reported. To be meaningful, measurements need to provide the user with a reliable receipt of whether his or her current activity behavior is sufficient for reaching an activity goal. Moreover, praise when reaching a goal was described as motivating feedback. To be useful, the devices must be easy to handle. In this study, the users perceived wearables as easy to handle, whereas tablets were perceived difficult to maneuver. Users reported in the diaries that the devices had been functional 78% (58/74) of the total test days.ConclusionsActivity monitors can be valuable for supporting seniors’ PA. However, the potential of the solutions for a broader group of seniors can significantly be increased. Areas of improvement include reliability, usability, and content supporting effective BCTs with respect to increasing older adults’ PA.

Design and Evaluation of a Pervasive Coaching and Gamification Platform for Young Diabetes Patients.

Self monitoring, personal goal-setting and coaching, education and social support are strategies to help patients with chronic conditions in their daily care. Various tools have been developed, e.g., mobile digital coaching systems connected with wearable sensors, serious games and patient web portals to personal health records, that aim to support patients with chronic conditions and their caregivers in realizing the ideal of self-management. We describe a platform that integrates these tools to support young patients in diabetes self-management through educational game playing, monitoring and motivational feedback. We describe the design of the platform referring to principles from healthcare, persuasive system design and serious game design. The virtual coach is a game guide that can also provide personalized feedback about the user’s daily care related activities which have value for making progress in the game world. User evaluations with patients under pediatric supervision revealed that the use of mobile technology in combination with web-based elements is feasible but some assumptions made about how users would connect to the platform were not satisfied in reality, resulting in less than optimal user experiences. We discuss challenges with suggestions for further development of integrated pervasive coaching and gamification platforms in medical practice.

A Tailored Web-Based Intervention to Improve Parenting Risk and Protective Factors for Adolescent Depression and Anxiety Problems: Postintervention Findings From a Randomized Controlled Trial.

BackgroundDepression and anxiety disorders in young people are a global health concern. Parents have an important role in reducing the risk of these disorders, but cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking.ObjectiveThis study aimed to examine the postintervention effects of the Partners in Parenting (PiP) program on parenting risk and protective factors for adolescent depression and anxiety, and on adolescent depression and anxiety symptoms.MethodsA two-arm randomized controlled trial was conducted with 359 parent-adolescent dyads, recruited primarily through schools across Australia. Parents and adolescents were assessed at baseline and 3 months later (postintervention). Parents in the intervention condition received PiP, a tailored Web-based parenting intervention designed following Persuasive Systems Design (PSD) principles to target parenting factors associated with adolescents’ risk for depression and anxiety problems. PiP comprises a tailored feedback report highlighting each parent’s strengths and areas for improvement, followed by a set of interactive modules (up to nine) that is specifically recommended for the parent based on individually identified areas for improvement. Parents in the active-control condition received a standardized package of five Web-based factsheets about adolescent development and well-being. Parents in both conditions received a 5-min weekly call to encourage progress through their allocated program to completion. Both programs were delivered weekly via the trial website. The primary outcome measure at postintervention was parent-reported changes in parenting risk and protective factors, which were measured using the Parenting to Reduce Adolescent Depression and Anxiety Scale (PRADAS). Secondary outcome measures were the adolescent-report PRADAS, the parent- and child-report Short Mood and Feelings Questionnaire (depressive symptoms), and parent- and child-report Spence Children’s Anxiety Scale (anxiety symptoms).ResultsParents in the intervention condition completed a mean of 73.7% of their intended personalized PiP program. A total of 318 parents (88.6%, 318/359) and 308 adolescents (92.8%, 308/332) completed the postintervention assessment. Attrition was handled using mixed model of repeated measures analysis of variance. As hypothesized, we found a significant condition-by-time interaction on the PRADAS, with a medium effect size, Cohen d=0.57, 95% CI 0.34-0.79. No significant differences between conditions were found at postintervention on any of the secondary outcome measures, with adolescent depressive (parent-report only) and anxiety (both parent- and adolescent-report) symptoms decreasing significantly from baseline to postintervention in both conditions.ConclusionsThe fully automated PiP intervention showed promising short-term effects on parenting behaviors that are associated with adolescents’ risk for depression and anxiety. Long-term follow-up is required to ascertain whether these effects translate into reduced adolescent depression and anxiety problems. The intervention may be useful as a low-cost universal public health program to increase parenting practices believed to benefit adolescents’ mental health.Trial RegistrationAustralia New Zealand Clinical Trials Registry: ACTRN12615000328572; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx? id=368274 (Archived by WebCite at http://www.webcitation.org/6qgsZ3Aqj)

Partners in Parenting: A Multi-Level Web-Based Approach to Support Parents in Prevention and Early Intervention for Adolescent Depression and Anxiety.

Depression and anxiety disorders in young people are a global health concern. Various risk and protective factors for these disorders are potentially modifiable by parents, underscoring the important role parents play in reducing the risk and impact of these disorders in their adolescent children. However, cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking. In this paper, we propose a multi-level public health approach involving a Web-based parenting intervention, Partners in Parenting (PIP). We describe the components of the Web-based intervention and how each component was developed. Development of the intervention was guided by principles of the persuasive systems design model to maximize parental engagement and adherence. A consumer-engagement approach was used, including consultation with parents and adolescents about the content and presentation of the intervention. The PIP intervention can be used at varying levels of intensity to tailor to the different needs of parents across the population. Challenges and opportunities for the use of the intervention are discussed. The PIP Web-based intervention was developed to address the dearth of evidence-based resources to support parents in their important role in their adolescents’ mental health. The proposed public health approach utilizes this intervention at varying levels of intensity based on parents’ needs. Evaluation of each separate level of the model is ongoing. Further evaluation of the whole approach is required to assess the utility of the intervention as a public health approach, as well as its broader effects on adolescent functioning and socioeconomic outcomes.

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.

Health behavior models for informing digital technology interventions for individuals with mental illness.

Theoretical models offer valuable insights for designing effective and sustainable behavioral health interventions, yet the application of theory for informing digital technology interventions for people with mental illness has received limited attention. We offer a perspective on the importance of applying behavior theories and models to developing digital technology interventions for addressing mental and physical health concerns among people with mental illness. In this commentary, we summarize prominent theories of human behavior, highlight key theoretical constructs, and identify opportunities to inform digital health interventions for people with mental illness. We consider limitations with existing theories and models, and examine recent theoretical advances that can specifically guide development of digital technology interventions. Established behavioral frameworks including health belief model, theory of planned behavior, transtheoretical model, and social cognitive theory consist of important and overlapping constructs that can inform digital health interventions for people with mental illness. As digital technologies continue to evolve and enable longitudinal data collection, real-time behavior monitoring, and adaptive features tailored to users' changing needs over time, there are new opportunities to broaden our understanding of health behaviors and mechanisms of behavior change. Recent advances include dynamic models of behavior, persuasive system design, the behavioral intervention technology model, and behavioral models for just-in-time adaptive interventions. Behavior theories offer advantages for guiding use of digital technologies. Future researchers must explore how theoretical models can effectively advance efforts to develop, evaluate, and disseminate digital health interventions targeting individuals with mental illness. (PsycINFO Database Record

How do eHealth Programs for Adolescents With Depression Work? A Realist Review of Persuasive System Design Components in Internet-Based Psychological Therapies.

BackgroundMajor depressive disorders are common among adolescents and can impact all aspects of their daily life. Traditional therapies, cognitive behavioral therapy (CBT), and interpersonal psychotherapy (IPT) have been delivered face-to-face. However, Internet-based (online) delivery of these therapies is emerging as an option for adolescents. Internet-based CBT and IPT involve therapeutic content, interaction between the user and the system, and different technological features embedded into the online program (eg, multimedia). Studies of Internet-based CBT and IPT for adolescent depression differ on all three aspects, and variable, positive therapy effects have been reported. A better understanding of the treatment conditions that influence therapy outcomes is important to designing and evaluating these novel therapies.ObjectiveOur aim was to examine the technological and program delivery features of Internet-based CBT and IPT for adolescent depression and to document their potential relation to treatment outcomes and program use.MethodsWe performed a realist synthesis. We started with an extensive search of published and gray literature. We included intervention studies that evaluated Internet-based CBT or IPT for adolescent depression. We included mixed-methods and qualitative studies, theoretical papers, and policy/implementation documents if they included a focus on how Internet-based psychological therapy is proposed to work for adolescents with depression/depressive symptoms. We used the Mixed-Methods Appraisal Tool to assess the methodological quality of studies. We used the Persuasive System Design (PSD) model as a framework for data extraction and analysis to examine how Internet-based CBT and IPT, as technology-based systems, influence the attitudes and behaviors of system users. PSD components described for the therapies were linked to reported outcomes using a cross-case comparison method and thematic synthesis.ResultsWe identified 19 Internet-based CBT programs in 59 documents. Of those, 71% (42/59) were of moderate to high quality. The PSD features surface credibility (competent “look and feel”), dialogue support (online program + in-person support), liking and similarity (esthetics and content appeal to adolescent users), the reduction and tunneling of therapeutic content (reducing online content into simple tasks, guiding users), and use of self-monitoring were present in therapies that resulted in improved therapy engagement, satisfaction, and adherence, as well as symptom and functional impairments.ConclusionsWhen incorporated into Internet-based CBT for adolescent depression, PSD features may improve adolescent adherence, satisfaction, and depression-related outcomes. Testing of these features using hypothesis-driven dismantling approaches is recommended to advance our understanding of how these features contribute to therapy effectiveness.

Theoretical Perspectives of Adherence to Web-Based Interventions: a Scoping Review.

The purpose of this paper is to review the literature as this relates to theoretical perspectives of adherence to web-based interventions, drawing upon empirical evidence from the fields of psychology, business, information technology and health care. A scoping review of the literature utilising principles outlined by Arksey and O'Malley was undertaken. Several relevant theoretical perspectives have emerged, eight of which are charted and discussed in this review. These are the Internet Intervention Model, Persuasive Systems Design, the 'PERMA' framework, the Support Accountability Model, the Model of User Engagement, the Technology Acceptance Model, the Unified Theory of Acceptance and Use of IT and the Conceptual Model of User Engagement. The findings of the review indicate that an interdisciplinary approach, incorporating a range of technological, environmental and individual factors, may be needed in order to comprehensively explain user adherence to web-based interventions.

Discovering Design Principles for Health Behavioral Change Support Systems

Behavioral Change Support Systems (BCSSs) aim to change users’ behavior and lifestyle. These systems have been gaining popularity with the proliferation of wearable devices and recent advances in mobile technologies. In this article, we extend the existing literature by discovering design principles for health BCSSs based on a systematic analysis of users’ feedback. Using mobile diabetes applications as an example of Health BCSSs, we use topic modeling to discover design principles from online user reviews. We demonstrate the importance of the design principles through analyzing their existence in users’ complaints. Overall, the results highlight the necessity of going beyond the techno-centric approach used in current practice and incorporating the social and organizational features into persuasive systems design, as well as integrating with medical devices and other systems in their usage context.

Using Persuasive Technology to Increase Physical Activity in People With Chronic Obstructive Pulmonary Disease by Encouraging Regular Walking: A Mixed-Methods Study Exploring Opinions and Preferences.

BackgroundPeople with chronic obstructive pulmonary disease (PwCOPD) often experience breathlessness and fatigue, making physical activity challenging. Although many persuasive technologies (such as mobile phone apps) have been designed to support physical activity among members of the general population, current technologies aimed at PwCOPD are underdeveloped and only use a limited range of persuasive technology design principles.ObjectiveThe aim of this study was to explore how acceptable different persuasive technology design principles were considered to be in supporting and encouraging physical activity among PwCOPD.MethodsThree prototypes for mobile apps using different persuasive technology design principles as defined by the persuasive systems design (PSD) model—namely, dialogue support, primary task support, and social support—were developed. Opinions of these prototypes were explored through 28 interviews with PwCOPD, carers, and the health care professionals (HCPs) involved in their care and questionnaires completed by 87 PwCOPD. Participants also ranked how likely individual techniques (eg, competition) would be to convince them to use a technology designed to support physical activity. Data were analyzed using framework analysis, Friedman tests, and Wilcoxon signed rank tests and a convergent mixed methods design was used to integrate findings.ResultsThe prototypes for mobile apps were received positively by participants. The prototype that used a dialogue support approach was identified as the most likely to be used or recommended by those interviewed, and was perceived as more persuasive than both of the other prototypes (Z=−3.06, P=.002; Z=−5.50, P<.001) by those who completed the questionnaire. PwCOPD identified dialogue support and primary task support techniques as more likely to convince them to use a technology than social support techniques (Z=−5.00, P<.001; Z=−4.92, P<.001, respectively). Opinions of social support techniques such as competition and collaboration were divided.ConclusionsDialogue support and primary task support approaches are considered to be both acceptable and likely to be persuasive by PwCOPD, carers, and HCPs. In the future, these approaches should be considered when designing apps to encourage physical activity by PwCOPD.

Persuading to Reflect: Role of Reflection and Insight in Persuasive Systems Design for Physical Health

Mobile applications and self-tracking devices help us to maintain health and support our goals in changing our behaviors. Most of these tools aim to increase our self-knowledge by providing information upon which to reflect. However, merely spending time reflecting does not always lead to insightful outcomes. In this study surveying users of mobile health and fitness applications (N = 147), we have used structural equation modeling to explore the need for and roles of reflection and insight in the persuasive systems design model. The findings suggest that both dialogue support and primary task support features influence the need for reflection, paving the way to personal insight. The perceived credibility of the system played different roles for women and men and seemed to originate from different sources. In addition, we found significant roles for the attitude and unobtrusiveness of the system. This article contributes to positioning the reflective capabilities of a system in the design framework of persuasive systems and makes preliminary suggestions regarding how to transform the need for reflection into insights. It also exemplifies how to evaluate behavior change technologies by assessing the psychological outcomes of the intervention.

An m-Health system for education and motivation in cardiac rehabilitation: the experience of HeartCycle guided exercise

Introduction Home-based programmes for cardiac rehabilitation play a key role in the recovery of patients with coronary artery disease. However, their necessary educational and motivational components have been rarely implemented with the help of modern mobile technologies. We developed a mobile health system designed for motivating patients to adhere to their rehabilitation programme by providing exercise monitoring, guidance, motivational feedback, and educational content. Methods Our multi-disciplinary approach is based on mapping “desired behaviours” into specific system’s specifications, borrowing concepts from Fogg’s Persuasive Systems Design principles. A randomised controlled trial was conducted to compare mobile-based rehabilitation (55 patients) versus standard care (63 patients). Results Some technical issues related to connectivity, usability and exercise sessions interrupted by safety algorithms affected the trial. For those who completed the rehabilitation (19 of 55), results show high levels of both user acceptance and perceived usefulness. Adherence in terms of started exercise sessions was high, but not in terms of total time of performed exercise or drop-outs. Educational level about heart-related health improved more in the intervention group than the control. Exercise habits at 6 months follow-up also improved, although without statistical significance. Discussion Results indicate that the adopted design methodology is promising for creating applications that help improve education and foster better exercise habits, but further studies would be needed to confirm these indications.

Data model for health telemonitoring and persuasive system design

Data model for health telemonitoring and persuasive system design

A Conceptual Design and Evaluation Framework for Mobile Persuasive Health Technologies (Usability Approach)

Persuasive techniques are recently being explored by computer science researchers as an effective strategy towards creating applications that are aimed at positive attitudinal changes especially in the health domain but finding effective evaluation approaches for these technologies remain an herculean task for all stakeholders involved and in order to overcome this limitation, the Persuasive System Design (PSD) model was designed but researchers claim that the model is too theoretical in nature and some of its design principles are too subjective as they cannot be measured quantitatively. Hence, the focus of this paper is to critically review the PSD model and popular models currently being used to evaluate the usability of information systems as usability has been identified as an important requirement currently used to evaluate the overall success of persuasive technologies. To achieve the stated objectives, the systematic review method of research was done to objectively analyze the PSD model, its applicability as an evaluation tool was tested on a popular mobile health application installed on the Samsung Galaxy Tablet using android Operation system. Exhaustive evaluation of the application was performed by 5 software usability researchers using the method of cognitive walkthrough. From the analysis, it was realized that the PSD model is a great tool at designing persuasive technologies but as an evaluation tool, it is too theoretical in nature, its evaluation strategies are too subjective in nature and the 28 principles described in it overlap with one another. As a result, the PSD model was extended with an integrated usability model and the fuzzy Analytic Hierarchical Technique was proposed theoretically to evaluate usability constructs so as to make evaluation of persuasive technologies more quantitative in nature and easier for researchers to analyze their design early enough to minimize developmental efforts and other resources.

Data model for health telemonitoring and persuasive system design

The health telemonitoring systems are expected to accomplish two basic tasks: continuously collect data from data sources wherever they may be; and allow remote communication between the stakeholders to access data. This data is further used by decision making systems to infer a patient's condition and possibly to motivate a patient to follow a healthy lifestyle by using persuasive system approach. The implementation and maintenance of such systems require specific attention of software engineers for data management because of the complexity involved in the management of various data sources and privacy-related issues of personal data. In this paper, we propose a data model that is generic enough to describe and to support many kinds of telemonitoring applications. These applications include data mining applications which analyse and combine sensor data for a decision making, and persuasive systems which motivate a patient to follow a healthy lifestyle. We show that our data model is useful for a smooth management of data mining outputs and that it avoids the integration efforts in dealing with heterogeneous storage mechanisms. We also show that our data model eases the management of the granularity of data and that it facilitates software designers' tasks for the implementation of privacy protection mechanisms.

A Review of Persuasive Principles in Mobile Apps for Chronic Arthritis Patients: Opportunities for Improvement.

BackgroundChronic arthritis (CA), an umbrella term for inflammatory rheumatic and other musculoskeletal diseases, is highly prevalent. Effective disease-modifying antirheumatic drugs for CA are available, with the exception of osteoarthritis, but require a long-term commitment of patients to comply with the medication regimen and management program as well as a tight follow-up by the treating physician and health professionals. Additionally, patients are advised to participate in physical exercise programs. Adherence to exercises and physical activity programs is often very low. Patients would benefit from support to increase medication compliance as well as compliance to the physical exercise programs. To address these shortcomings, health apps for CA patients have been created. These mobile apps assist patients in self-management of overall health measures, health prevention, and disease management. By including persuasive principles designed to reinforce, change, or shape attitudes or behaviors, health apps can transform into support tools that motivate and stimulate users to achieve or keep up with target behavior, also called persuasive systems. However, the extent to which health apps for CA patients consciously and successfully employ such persuasive principles remains unknown.ObjectiveThe objective of this study was to evaluate the number and type of persuasive principles present in current health apps for CA patients.MethodsA review of apps for arthritis patients was conducted across the three major app stores (Google Play, Apple App Store, and Windows Phone Store). Collected apps were coded according to 37 persuasive principles, based on an altered version of the Persuasive System Design taxonomy of Oinas-Kukkonen and Harjuma and the taxonomy of Behavior Change Techniques of Michie and Abraham. In addition, user ratings, number of installs, and price of the apps were also coded.ResultsWe coded 28 apps. On average, 5.8 out of 37 persuasive principles were used in each app. The most used category of persuasive principles was System Credibility with an average of 2.6 principles. Task Support was the second most used, with an average of 2.3 persuasive principles. Next was Dialogue Support with an average of 0.5 principles. Social Support was last with an average of 0.01 persuasive principles only.ConclusionsCurrent health apps for CA patients would benefit from adding Social Support techniques (eg, social media, user fora) and extending Dialogue Support techniques (eg, rewards, praise). The addition of automated tracking of health-related parameters (eg, physical activity, step count) could further reduce the effort for CA patients to manage their disease and thus increase Task Support. Finally, apps for health could benefit from a more evidence-based approach, both in developing the app as well as ensuring that content can be verified as scientifically proven, which will result in enhanced System Credibility.

Incorporating Principles of Persuasive System Design into the Development of a Consumer-Focussed E-health Strategy Targeting Lifestyle Behaviour Change

Incorporating Principles of Persuasive System Design into the Development of a Consumer-Focussed E-health Strategy Targeting Lifestyle Behaviour Change

Designing a persuasive physical activity application for older workers: understanding end-user perceptions

ABSTRACTAmong the factors known to encourage healthy ageing is routine physical activity, a behaviour that is not common among the older age group. A Persuasive System Design (PSD) model offers guidelines for designing and evaluating systems aimed at reinforcing, changing or shaping underlying human behaviour and attitudes. The objective of this study was to investigate the perceptions of older workers towards persuasive principles of PSD that was integrated into an application specifically designed to encourage physical activity. Ten older workers aged 50–64 years with different physical activity levels participated in this study. Using a think-aloud technique, the participants interacted with a physical activity application, while verbally expressing their perceptions towards the persuasive elements. The results indicated that the older worker participants had positive views towards persuasive design principles that fell under the categories of primary task, dialogue support and credibility support. However, the persuasive principle of the social support category received contradictory views. Further, it was discovered that the personalisation of persuasive principles, the credibility of tailored contents and the establishment of a sense of similarity are imperative in the designing of effective persuasive physical activity applications targeting older workers.

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.

The relationship between persuasive technology principles, adherence and effect of web-Based interventions for mental health: A meta-analysis

BackgroundResearch has shown that web-based interventions concerning mental health can be effective, although there is a broad range in effect sizes. Why some interventions are more effective than others is not clear. Persuasive technology is one of the aspects which has a positive influence on changing attitude and/or behavior, and can contribute to better outcomes. According to the Persuasive Systems Design Model there are various principles that can be deployed. It is unknown whether the number and combinations of principles used in a web-based intervention affect the effectiveness. Another issue in web-based interventions is adherence. Little is known about the relationship of adherence on the effectiveness of web-based interventions. ObjectiveThis study examines whether there is a relationship between the number and combinations of persuasive technology principles used in web-based interventions and the effectiveness. Also the influence of adherence on effectiveness of web-based interventions is investigated. MethodsThis study elaborates on the systematic review by [37] and therefore the articles were derived from that study. Only web-based interventions were included that were intended to be used on more than one occasion and studies were excluded when no information on adherence was provided. 48 interventions targeted at mental health were selected for the current study. A within-group (WG) and between-group (BG) meta-analysis were performed and subsequently subgroup analyses regarding the relationship between the number and combinations of persuasive technology principles and effectiveness. The influence of adherence on the effectiveness was examined through a meta-regression analysis. ResultsFor the WG meta-analysis 40 treatment groups were included. The BG meta-analysis included 19 studies. The mean pooled effect size in the WG meta-analysis was large and significant (Hedges’ g=0.94), while for the BG meta-analysis this was moderate to large and significant (Hedges’ g=0.78) in favor of the web-based interventions. With regard to the number of persuasive technology principles, the differences between the effect sizes in the subgroups were significant in the WG subgroup analyses for the total number of principles and for the number of principles in the three categories Primary Task Support, Dialogue Support, and Social Support. In the BG subgroup analyses only the difference in Primary Task Support was significant. An increase in the total number of principles and Dialogue Support principles yielded larger effect sizes in the WG subgroup analysis, indicating that more principles lead to better outcomes. The number of principles in the Primary Task Support (WG and BG) and Social Support (WG) did not show an upward trend but had varying effect sizes. We identified a number of combinations of principles that were more effective, but only in the WG analyses. The association between adherence and effectiveness was not significant. ConclusionsThere is a relationship between the number of persuasive technology principles and the effectiveness of web-based interventions concerning mental health, however this does not always mean that implementing more principles leads to better outcomes. Regarding the combinations of principles, specific principles seemed to work well together (e.g. tunneling and tailoring; reminders and similarity; social learning and comparison), but adding another principle can diminish the effectiveness (e.g. tunneling, tailoring and reduction). In this study, an increase in adherence was not associated with larger effect sizes. The findings of this study can help developers to decide which persuasive principles to include to make web-based interventions more persuasive.