Persuasive Systems Design Research Articles

Persuasive design principle of social support in digital interventions targeting mental health symptoms: a systematic review and meta-analysis

ObjectiveThis systematic review and meta-analysis evaluates the available evidence on efficacy of social support strategies, as defined by the persuasive system design framework, in internet-based and mobile-based interventions (IMI) targeting...

Digital behaviour change intervention for weight loss maintenance in adults with obesity: a feasibility pilot study of eCHANGE

ABSTRACT Successful weight maintenance after weight loss is challenging. Digital interventions may facilitate behaviour change to prevent weight regain, however little is known about the acceptance and use of digital interventions in support of weight maintenance. This mixed methods study aims to evaluate user experiences, system use, and preliminary efficacy of eCHANGE, an application based self-management intervention for weight loss maintenance. A 3-month multi-site single group feasibility pilot study was conducted among adults (N = 60) with BMI ≥30 kg/m2, aiming to maintain weight after weight loss of ≥8%. User experiences and system use were examined through validated questionnaires, system use log data, and individual interviews (n = 15). Preliminary efficacy testing included body weight and patient reported outcome measures. Participants rated eCHANGE usability and usefulness as good in support of weight maintenance, with variation in usage. Analysis indicated that higher behavioural engagement scores were statistically significantly associated with frequency of technology usage. Weight loss was maintained by 83% of the participants at 3-months (i.e. defined as weight change of <3% of baseline body weight (kg)). Digital interventions, combining persuasive system design principles and behaviour change techniques, supporting self-regulation and maintenance of health behaviours, have the potential to facilitate weight maintenance after weight loss. Trial Registration: ClinicalTrials.gov NCT04537988 https://clinicaltrials.gov/ct2/show/NCT04537988

The digital cumulative complexity model: a framework for improving engagement in digital mental health interventions.

Mental health disorders affect a substantial portion of the global population. Despite preferences for psychotherapy, access remains limited due to various barriers. Digital mental health interventions (DMHIs) have emerged to increase accessibility, yet engagement and treatment completion rates are concerning. Evidence across healthcare where some degree of self-management is required show that treatment engagement is negatively influenced by contextual complexity. This article examines the non-random factors influencing patient engagement in digital and face-to-face psychological therapies. It reviews established models and introduces an adapted version of the Cumulative Complexity Model (CuCoM) as a framework for understanding engagement in the context of digital mental health. Theoretical models like the Fogg Behavior Model, Persuasive System Design, Self-Determination Theory, and Supportive Accountability aim to explain disengagement. However, none adequately consider these broader contextual factors and their complex interactions with personal characteristics, intervention requirements and technology features. We expand on these models by proposing an application of CuCoM's application in mental health and digital contexts (known as DiCuCoM), focusing on the interplay between patient burden, personal capacity, and treatment demands. Standardized DMHIs often fail to consider individual variations in burden and capacity, leading to engagement variation. DiCuCoM highlights the need for balancing patient workload with capacity to improve engagement. Factors such as life demands, burden of treatment, and personal capacity are examined for their influence on treatment adherence. The article proposes a person-centered approach to treatment, informed by models like CuCoM and Minimally Disruptive Medicine, emphasizing the need for mental healthcare systems to acknowledge and address the unique burdens and capacities of individuals. Strategies for enhancing engagement include assessing personal capacity, reducing treatment burden, and utilizing technology to predict and respond to disengagement. New interventions informed by such models could lead to better engagement and ultimately better outcomes.

Preferences for Text Messaging Supports During Youth Transition to Adult Mental Health Services: Theory-Informed Modified e-Delphi Study.

For many young people, the transition from child to adult mental health services is a vulnerable time associated with treatment disengagement and illness progression. Providing service information and options to youth, appealing to them, and tailoring to their needs during this period could help overcome systematic barriers to a successful transition. We know little about how SMS text message-based interventions might be leveraged to support the motivational, informational, and behavioral needs of youth during this time. Ascertaining youth preferences for the content and functionality of an SMS text message service could inform prototype development. This study investigated consensus preferences among youth on important content, technology features, and engagement supports to inform a transition-focused SMS text message service. A modified e-Delphi survey design was used to collect demographics, current levels of technology use, importance ratings on message content, preferred technical features, and barriers and enablers to engagement for youth in Canada aged 16-26 years who have accessed mental health services within the past 5 years. Survey items on content were categorized according to the information-motivation-behavioral skills (IMB) model. Survey items on technical features were categorized according to the persuasive system design (PSD) model. A predefined consensus rating matrix and descriptive statistics were used to characterize the sample. The high consensus threshold was 70%. A total of 100 participants, predominantly non-White (n=47, 47%), aged 20-26 years (n=59, 59%), and who had first accessed mental health services between the ages of 13 and 19 years (n=60, 60%), were selected. The majority (n=90, 90%) identified as daily SMS text message users. A high level of consensus on importance ratings was reported in 45% (9/20) of content items based on the IMB model. There were higher levels of consensus on importance ratings related to behavior domain items (3/3, 100%) than information domain items (4/9, 44%) or motivation domain items (2/8, 25%). A high level of consensus on importance ratings was reported in only 19% (4/21) of feature and functionality items based on the PSD model. Among PSD model categories, there was a high level of consensus on importance ratings in 8% (1/12) of the primary task support domain items and 100% (3/3) of the system credibility support domain items. None of the dialogue-support and social-support domain items met the high level of consensus thresholds. In total, 27% (27/100) of youth indicated that the most significant enabler for engaging with a transition-focused SMS text message intervention was the personalization of text messages. Scientists developing next-generation SMS text messaging interventions for this population need to consider how levels of consensus on different features may impact feasibility and personalization efforts. Youth can (and should) play an integral role in the development of these interventions.

Designing social media to foster user engagement in challenging misinformation: a cross-cultural comparison between the UK and Arab countries

Challenging others who post misinformation is a type of social correction that complements algorithm-based approaches. However, participation rates in such social acts remain limited. In this paper, we study design techniques that leverage principles of persuasive system design and communication theories to foster such prosocial behaviour across two distinct cultural contexts: the British and the Arab. A total of 462 participants completed an online survey (250 UK, 212 Arabs). The study compared the two cultural contexts regarding willingness to challenge misinformation and the persuasiveness of seven design techniques to increase that willingness, namely predefined question stickers, thinking face reaction, sentence openers, fact checker badge, social norm messages, tone detector, and private commenting. Moreover, it explores the impact of individuals’ characteristics on their perception of the techniques as being more or less persuasive than a standard comment box. The study found that the willingness to challenge misinformation was significantly higher in the Arab context than in the UK context. Moreover, except for the private commenting, all techniques were more impactful in the Arab context than in the UK context. Some techniques, such as predefined question stickers, were more effective in both cultures compared to the standard comment box, while others, like the fact checker badge, were more effective only in the Arab context. However, in the UK, sentence openers had a lower impact. Furthermore, personality traits, age, and perspective-taking showed the potential but also the varying impacts on the persuasiveness of the techniques on users’ correction of misinformation across both cultural contexts while pointing to the need for considering both personal and cultural factors in designing social-correction-based solutions.

How online pro-environmental games affect users’ pro-environmental behavioural intentions? — Insights from Ant Forest

Information technology has created new ways for people to participate in environmental protection. Ant Forest, a pro-environmental game that actively encourages users to take part in offline environmental activities through online gaming content, has gained great popularity. However, research in this area is still limited, and the effect of playing such games on users' pro-environmental intentions in real life and the underlying mechanisms are unknown. Therefore, this research draws from Persuasive Systems Design model and value theory and examines the relationships between design features of Ant Forest, users' values and their pro-environmental behavioural intentions. The research model is empirically tested by survey data from 428 Ant Forest users. Results indicate that users' self-enhancement values, including utilitarian, hedonic and social values, and self-transcendence values, including altruistic and biospheric values, all positively affect their continued gameplay intentions and therefore affect their pro-environmental behavioural intentions. Additionally, the primary task support, social support, dialogue support, and system credibility of Ant Forest have varying positive effects on users’ perceived values.

Designing data-informed support for building learning habits in the Japanese K12 context

While building proper learning habits has been said to enhance academic performance, it is challenging to give long-term support for building habits in educational contexts due to the lack of continuous tracing of one’s habitual behaviors. With the accumulation of learning logs and the advancement of Learning Analytics (LA) techniques, this paper illustrates the data-informed support for building learning habits, which involves persuading one to change behaviors. Specifically, we tackled 2 research objectives following the Persuasive Systems Design (PSD) model. First, we defined indicators of learning habits from log data and analyzed 115,340 learning logs of 96 learners from a Japanese junior high school. As a result, the learners’ types of habits could be detected even though some might not be efficient and the stages of habits fluctuated over time. We also identified differences when comparing the learning habits extracted from the log data with those reported in the questionnaire. Second, based on the understanding of the learner profiles, we designed elements of an LA dashboard to support habit-building by applying the design principles from the PSD model. Overall, the learners recognized the feasibility of integrating data-informed support into their daily learning. Therefore, we look forward to the evidence of its effectiveness on the behavior change that can be depicted by the transition between stages of different types of learning habits.

Strategies for Combating Adversarial Information Operations: Theory and Practical Applications

In the contemporary information landscape, the proliferation of disinformation and propaganda poses a significant challenge to societal discourse and democratic processes. This paper proposes a multi-disciplinary approach to combatting adversarial information operations, drawing upon theoretical frameworks and practical applications. Theoretical foundations are established through an examination of the Persuasive System Design (PSD) model (Oinas-Kukkonen, 2013) and its parallels with propaganda tactics. By analyzing the shared flaws and vulnerabilities, insights emerge into the manipulation techniques employed by threat actors in online information spaces. Building upon this theoretical framework, the paper presents a proactive strategy for countering disinformation: the development of Early Warning and Control Systems (EWACS). These systems leverage AI-assisted narrative discovery to monitor the digital information landscape continuously. By identifying emerging threats and inauthentic activity, strategic communicators gain valuable insights for crafting counter-narratives and pre-emptive communication strategies. Key components of the proposed approach include deterrence by denial and resilience-building measures. By shifting the cost-gain calculation of adversaries and enhancing societal resilience, the aim is to create an environment where propagandists face increased challenges in achieving their objectives. This paper emphasizes the importance of collaboration between diverse stakeholders, including governmental organizations, academia, NGOs, and journalists. By harnessing the collective expertise from multiple fields, more effective strategies can be developed to safeguard information integrity and restore public trust. In conclusion, this paper advocates for a convergence of theory and practice in addressing the complex challenges posed by adversarial information operations. By integrating theoretical insights with practical applications, the proposed approach offers a holistic framework for countering disinformation and propaganda in contemporary information environments.

Persuasive Systems Design Trends in Coronary Heart Disease Management: Scoping Review of Randomized Controlled Trials.

Behavior change support systems (BCSSs) have the potential to help people maintain healthy lifestyles and aid in the self-management of coronary heart disease (CHD). The Persuasive Systems Design (PSD) model is a framework for designing and evaluating systems designed to support lifestyle modifications and health behavior change using information and communication technology. However, evidence for the underlying design principles behind BCSSs for CHD has not been extensively reported in the literature. This scoping review aims to identify existing health BCSSs for CHD, report the characteristics of these systems, and describe the persuasion context and persuasive design principles of these systems based on the PSD framework. Using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, 3 digital databases (Scopus, Web of Science, and MEDLINE) were searched between 2010 to 2022. The major inclusion criteria for studies were in accordance with the PICO (Population, Intervention, Comparison, and Outcome) approach. Searches conducted in the databases identified 1195 papers, among which 30 were identified as eligible for the review. The most interesting characteristics of the BCSSs were the predominant use of primary task support principles, followed by dialogue support and credibility support and the sparing use of social support principles. Theories of behavior change such as the Social Cognitive Theory and Self-Efficacy Theory were used often to underpin these systems. However, significant trends in the use of persuasive system features on par with behavior change theories could not be established from the reviewed studies. This points to the fact that there is still no theoretical consensus on how best to design interventions to promote behavior change in patients with CHD. Our results highlight key software features for designing BCSSs for the prevention and management of CHD. We encourage designers of behavior change interventions to evaluate the techniques that contributed to the success of the intervention. Future research should focus on evaluating the effectiveness of the interventions, persuasive design principles, and behavior change theories using research methodologies such as meta-analysis.

Toward the design of persuasive systems for a healthy workplace: a real-time posture detection.

Persuasive technologies, in connection with human factor engineering requirements for healthy workplaces, have played a significant role in ensuring a change in human behavior. Healthy workplaces suggest different best practices applicable to body posture, proximity to the computer system, movement, lighting conditions, computer system layout, and other significant psychological and cognitive aspects. Most importantly, body posture suggests how users should sit or stand in workplaces in line with best and healthy practices. In this study, we developed two study phases (pilot and main) using two deep learning models: convolutional neural networks (CNN) and Yolo-V3. To train the two models, we collected posture datasets from creative common license YouTube videos and Kaggle. We classified the dataset into comfortable and uncomfortable postures. Results show that our YOLO-V3 model outperformed CNN model with a mean average precision of 92%. Based on this finding, we recommend that YOLO-V3 model be integrated in the design of persuasive technologies for a healthy workplace. Additionally, we provide future implications for integrating proximity detection taking into consideration the ideal number of centimeters users should maintain in a healthy workplace.

Systematic Literature Review on Augmented Reality with Persuasive System Design: Application and Design in Education and Learning

Augmented Reality (AR) is an innovative technology that has gained significant scholarly attention. It uses computer-generated sensory inputs like visuals, sounds, and touch to enhance how we perceive the real world, providing a transformative impact on human sensory experiences. Motivated by the possibilities of augmented reality (AR) in the realm of the educational learning environment, this research aims to document the evolving landscape of augmented reality (AR) applications in education and training, with a specific emphasis on the incorporation of persuasive system design (PSD) elements. The study also explores the diverse technologies and methodologies for developing these applications. A systematic literature review was conducted, analyzing 44 articles following the protocol for PRISMA assessments. Four research questions were formulated to investigate trends in AR applications. Between 2016 and 2023, publications on AR applications doubled, with a significant focus on the educational field. Marker-based AR methods dominated (68.49%), while markerless methods constituted 31.51%. Unity and Vuforia were the most used platforms, accounting for 77.27% of applications. Most research papers assessed application effectiveness subjectively through custom-made questionnaires. University students were identified as the primary target users of AR applications. Only a few applications integrated persuasive elements, even for adult users. This highlights the need for further studies to fully grasp the possibilities of combining persuasive system design with augmented reality applications in education

Understanding Crisis Preparedness: Insights from Personal Values, Beliefs, Social Norms, and Personal Norms

In disasters and crises, crisis preparation at the household level is crucial for societal resilience. However, motivating citizens to take personal responsibility and to implement preparedness measures remains challenging. This study investigates the impact of values, beliefs and norms on preparedness. Through a survey in Germany on resource-oriented crisis preparedness and participants’ values, a group of more prepared and less prepared individuals was differentiated. We quantitatively analyzed the correlation between values and crisis preparedness. A quantitative analysis revealed a significant association between the value of benevolence and higher preparedness. Follow-up interviews (N=30) explored participants' beliefs and norms, showing minimal group differences. Although crisis preparedness is generally viewed positively, strong negativity exists towards perceived “hoarders”. The study discusses implication for crisis communication and the design of nudges and persuasive systems, emphasizing intervention that can trigger benevolence to foster preparedness and appeal to the social benefits to counter the narrative of anti-social crisis preparedness.

Low-Fidelity Prototype of a Sensor-Dependent Interaction Platform: Formative Evaluation With Informal Caregivers of Older Adults With Cognitive Impairment.

Unobtrusive sensing technologies developed for monitoring deviant behaviors in older adult care require integration with an interaction platform to facilitate the flow of information between older adults and their caregivers. However, the continuous monitoring capabilities generate a considerable amount of data that must be interpreted, filtered, and personalized before being communicated to the informal caregivers based on their specific care needs and requirements. For the effective implementation of unobtrusive sensing solutions (USSs) in the care of older adults with cognitive impairment, we aimed to explore the expectations and preconditions regarding the implementation of USSs from the perspective of informal caregivers. Subsequently, we designed and evaluated a low-fidelity prototype of an interaction platform for its conceptual workflow and usability, incorporating persuasive system design features based on the needs and requirements of informal caregivers. Overall, 6 informal caregivers of older adults with cognitive impairment living alone participated in this qualitative interview study. We explored the expectation and preconditions regarding implementation through open-ended questions and conducted a formative evaluation (usability study with a think-aloud approach) to evaluate the conceptual workflow and used persuasive system design features in the interaction platform. Overall, a combination of inductive and thematic analyses was used to analyze the interviews. The results of this study present both positive and negative outcome expectations regarding the implementation of USSs, highlighting benefits such as objective decision-making and peace of mind and concerns about information overload and the potential substitution of human contact. Strategic information communication agreements between informal and formal caregivers were deemed crucial for the successful implementation of USSs in care. Overall, informal caregivers had a positive experience with the low-fidelity prototype of the interaction platform, particularly valuing the personalization feature. In conclusion, to achieve successful implementation, a holistic design approach is necessary, and equal consideration should be given to the personalization-privacy paradox to balance users' needs and privacy.

Can Your Smartphone Save A Life? A Systematic Review of Mobile-Based Interventions For Suicide Prevention

Mobile health (mHealth) apps are handy tools for tackling stigmatized mental health issues, including suicide. Mobile-based interventions for suicide prevention are easily accessible, increase the likelihood of honest reporting on sensitive topics and reduce stigma as compared to face-to-face or traditional interventions. Many mHealth apps for suicide prevention exist. However, the persuasive strategies employed in these apps and their efficacy remains unknown. To address this gap, we reviewed 80 suicide prevention apps available on app stores and in academic journals. We identified different persuasive strategies implemented in these apps using the Persuasive System Design (PSD) model. We also identified current trends within these apps, most and least-dominant implementations of persuasive strategies, effectiveness of apps, evaluation methods, and app content. We found that Personalization (n = 32) and Self-monitoring (n = 29) were the most-dominant strategies and Social Comparison, Social Role were the least-dominant strategies in suicide prevention apps. Based on our findings we discuss three major concerns in developing suicide prevention apps and offer recommendations for mitigating them. Our results show that persuasive strategies are a promising tool that can be used for designing suicide prevention apps. Our conclusions and recommendations will guide future work in suicide prevention app development and enhance the usability, effectiveness, and user-experience of such apps.

Effects of a mobile health intervention on health-related outcomes in Japanese office workers: a pilot study.

The purpose of the current study was to explore the effects of a mobile health (mHealth) intervention based on the Persuasive System Design (PSD) model on health-related outcomes among office workers. The authors conducted a trial that consisted of a 4-week baseline and an 8-week intervention period by reference to 23 office workers in a private research company. The mHealth application was developed to improve these workers' daily step count, decrease their sedentary time, and increase their sleep duration in accordance with the PSD model. The app features included at least 1 principal factor from each of the 4 main categories of the PSD model (primary task support, dialogue support, system credibility support, and social support). The objective health-related variables were measured using a smartwatch (Fitbit Luxe) that was synchronized with the application using the Fitbit Web Application Programming Interface. Subjects used the app, which included self-monitoring, personalized messages, education, and a competition system for users, during the intervention period. Sedentary time exhibited a significant decrease (a median reduction of 14 min/day, p < 0.05) during the intervention period. No significant differences in daily step count and sleep duration were observed between the baseline and intervention periods. This study suggests that the mHealth intervention based on the PSD model was useful for reducing sedentary time among office workers. Given that many previous studies on this topic have not been based on any theories, future studies should investigate the impact of structured selection behavior change theories on health-related outcomes among office workers. Int J Occup Med Environ Health. 2024;37(2):153-64.

Connection at your fingertips: A first look at the Agapé app's contributions to healthy relationships.

Although a range of relationship enhancement interventions have shown benefits, programs involving trained facilitators are difficult to scale and self-directed programs tend to suffer from low rates of adherence (i.e., nonuse/disuse attrition). The present study evaluated Agapé, a relationship wellness smartphone app optimized for broad dissemination through 4 years of persuasive system design driven by user feedback. Agapé builds moments of connection by providing daily prompts to couples and then showing them one another's answers when both partners have responded. To evaluate Agapé, a single-arm, pilot study followed 405 couples (n = 810 partners; 68% non-Latinx White; 50% female; Mage = 29; 50% cohabiting; 31% married; 33% dissatisfied/distressed) through their first month of using the app. Agapé had high engagement (99%, completing M = 27 daily prompts dyadically) and 88% of couples provided follow-up data. The results among completers supported the acceptability, feasibility, and utility of Agapé, suggesting that partners found the app easy (74%) and enjoyable (93%) to use, particularly if they perceived their partners to be responsive. Most partners saw improvement in their relationships (80%) and in their individual well-being (70%). Repeated-measures analyses of variance (ANOVAs) revealed significant within-person improvement on relationship functioning (decreases in relationship negative qualities and increases in relationship satisfaction, relationship positive qualities, and dedication) and on individual functioning (increases in vitality and quality of life with decreases in psychological distress and depressive symptoms) among completers (Cohen's ds ranging from |.14 to .42|). Dosage effects demonstrated that gains in relationship quality were stronger for couples completing more daily prompts. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Collaborative Model in Persuasive Web Design: Multiple case study of Lazada and Shopee

This study examined online persuasion through website design by using the Elaboration Likelihood Model (ELM) and Persuasive System Design (PSD). This study investigates the phenomenon of the success of Lazada and Shopee to provide guidelines for website designers and local sellers to enhance the e-commerce website's persuasiveness. The persuasive design features in Lazada's and Shopee's e-commerce websites were evaluated based on the design criteria of the ELM and the PSD model. This study has examined (1) the influence of central route elements (Dialogue Support and Primary Task Support) towards Lazada and Shopee user's attitude change, (2) the influence of Lazada and Shopee user's attitude change towards behavioral intention and (3) the influence of Lazada and Shopee user's behavioral intention towards actual online buying behavior. A total of 414 samples were analyzed using Partial Least Square Structural Equation Modelling (PLS-SEM) technique. The results from the analysis indicated that Primary task support through navigation design (PTN) was found to be the most influential persuasive design criteria, followed by Social support through connectedness (SSC), and Dialogue support through argument quality (DSA).

EXPLORING THE PERSUASIVE DESIGN ELEMENTS OF INSTAGRAM: A FRAMEWORK-BASED EVALUATION OF USER ENGAGEMENT AND BEHAVIOUR INFLUENCE THROUGH PERSUASIVE SYSTEM DESIGN (PSD)

Existing literature has established that social media can be highly persuasive on a broader scale, yet comprehensive evaluation of persuasive strategies on Instagram remains scarce despite its widespread usage. Instagram, a globally popular social networking platform, lacks thorough academic examination regarding its persuasive technological strategies despite its significant impact on user behaviour and interaction patterns is already realised. The platform's emphasis on visual content, interactive features, and evolving engagement tools presents a unique landscape for studying persuasive strategies. This study aims to fill this gap by assessing the integration of persuasive technological strategies within Instagram, focusing on behaviour change and user motivation. Employing the 'Persuasive Systems Design (PSD)' framework, widely recognized for developing and evaluating persuasive systems, this study dissects persuasive elements in Instagram. The evaluation reveals an effective utilization of persuasive techniques to engage and captivate users on Instagram. This evaluation not only contributes academically but also holds implications for industrial practices, offering insights into how persuasive designs influence user behaviour on a highly influential social media platform.

Designing a Mobile e-Coaching App for Immigrant Informal Caregivers: Qualitative Study Using the Persuasive System Design Model.

Informal caregivers are vital in caring for their family and friends at home who may have illnesses or disabilities. In particular, the demands for caregiving can be even more challenging for those with limited resources, support systems, and language barriers, such as immigrant informal caregivers. They face complex challenges in providing care for their relatives. These challenges can be related to sociocultural diversity, language barriers, and health care system navigation. Acknowledging the global context of the increasing number of immigrants is essential in designing inclusive mobile health apps. This study aims to investigate the needs of immigrant informal caregivers in Sweden and discuss the application of the Persuasive System Design Model (PSDM) to develop an e-coaching prototype. By addressing the unique challenges faced by immigrant informal caregivers, this study will contribute to the development of more effective and inclusive mobile health apps. The participants were considered immigrants and included in the study if they and their parents were born outside of Sweden. Through various channels, such as the National Association of Relatives, rehabilitation departments at municipalities, and immigrant groups, we recruited 13 immigrant informal caregivers. These immigrant informal caregivers were primarily women aged 18 to 40 years. Most participants belonged to the Middle Eastern region whereas some were from North Africa. However, all of them spoke Arabic. We used semistructured interviews to gather data from the participants in Arabic, which were translated into English. Data were analyzed using thematic analysis and discussed in relation to the extended PSDM. The needs of the caregivers were compared with the description of persuasive design principles, and a design principle was chosen based on the match. The PSDM was extended if the need description did not match any principles. Several brainstorming and prototyping sessions were conducted to design the mobile e-coaching app. Immigrant informal caregivers have various needs in their caregiving role. They reported a need for training on the illness and future caregiving needs, assistance with understanding the Swedish language and culture, and help with accessing internet-based information and services. They also required recognition and appreciation for their efforts, additional informal support, and easy access to health care services, which can be important for their mental health. The PSDM was adapted to the informal caregiving context by adding "facilitating conditions" and "verbal encouragement" as additional persuasive design principles. This study also presents the subsequent mobile e-coaching app for immigrant informal caregivers in Sweden. This study revealed important immigrant informal caregivers' needs based on which design suggestions for a mobile e-coaching app were presented. We also proposed an adapted PSDM, for the informal caregiving context. The adapted PSDM can be further used to design digital interventions for caregiving.

Exploring the Needs and Requirements of Informal Caregivers of Older Adults With Cognitive Impairment From Sensor-Based Care Solutions: Multimethod Study.

With the increase in the older adult population, sensor-based care solutions that can monitor the deviations in physical, emotional, and physiological activities in real-time from a distance are demanded for prolonging the stay of community-dwelling older adults with cognitive impairment. To effectively develop and implement these care solutions, it is important to understand the current experiences, future expectations, perceived usefulness (PU), and communication needs of the informal caregivers of older adults with cognitive impairment regarding such solutions. This comprehensive study with informal caregivers of older adults with cognitive impairment aims to (1) highlight current experiences with (if any) and future expectations from general sensor-based care solutions, (2) explore PU specifically toward unobtrusive sensing solutions (USSs), (3) determine the information communication (IC) needs and requirements for communicating the information obtained through USSs in different care scenarios (fall, nocturnal unrest, agitation, and normal daily life), and (4) elicit the design features for designing the interaction platform in accordance with the persuasive system design (PSD) model. A multimethod research approach encompassing a survey (N=464) and in-depth interviews (10/464, 2.2%) with informal caregivers of older adults with cognitive impairment was used. The insights into past experiences with and future expectations from the sensor-based care solutions were obtained through inductive thematic analysis of the interviews. A convergent mixed methods approach was used to explore PU and gather the IC needs from USSs by using scenario-specific questions in both survey and interviews. Finally, the design features were elicited by using the PSD model on the obtained IC needs and requirements. Informal caregivers expect care infrastructure to consider centralized and empathetic care approaches. Specifically, sensor-based care solutions should be adaptable to care needs, demonstrate trust and reliability, and ensure privacy and safety. Most informal caregivers found USSs to be useful for emergencies (mean 4.09, SD 0.04) rather than for monitoring normal daily life activities (mean 3.50, SD 0.04). Moreover, they display variations in information needs including mode, content, time, and stakeholders involved based on the care scenario at hand. Finally, PSD features, namely, reduction, tailoring, personalization, reminders, suggestions, trustworthiness, and social learning, were identified for various care scenarios. From the obtained results, it can be concluded that the care scenario at hand drives PU and IC design needs and requirements toward USSs. Therefore, future technology developers are recommended to develop technology that can be easily adapted to diverse care scenarios, whereas designers of such sensor-driven platforms are encouraged to go beyond tailoring and strive for strong personalization while maintaining the privacy of the users.