Persuasive Systems Design Research Articles

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.

The Extraction Process of Durative Persuasive System Design Characteristics for Healthcare-related Mobile Applications

In the field of Human-Computer Interaction design, persuasive design has gradually been applied to the system development and design process, especially for mobile application design. However, most mobile applications have hitherto a very short using lifecycle. Especially, design features with long-term persuasive effectiveness remain to be further researched and developed. In this study, we focused on investigating and identifying the durative persuasive design characteristics through a data mining process and evaluating the durative effectiveness through a long-term observation process. Total five hundred healthcare-related mobile applications were selected from Apple iTunes Store and a mixed method was conducted to extract the most common persuasive design characteristics. Based on the results of extraction, a representative healthcare-related mobile application was selected as experimental subject. Total one hundred and twenty participants were observed during a six-months experiment and the monitoring data of app usage of all participants was collected once a week. According to the evaluation model for behavior change identification process, participants with habit formation features were proved to have a significant long-term perception level for ten persuasive design characteristics. Further interview research was performed to investigate the participant’s long-term perceptions on those characteristics for the purpose of identifying the durative persuasions. The results indicated that a long-term durative effectiveness can be observed and healthcare-related apps designed with those characteristics could have durative effectiveness. This study may contribute to the improvement of future mobile application designs in user experience and durative persuasion, as well as bringing future benefits for both mobile application developers and users.

Committing to change: a persuasive systems design analysis of user commitments for a behaviour change support system

ABSTRACT Persuasive systems in different domains have been used to support people in changing their behaviours. These systems motivate desirable behaviour in users by providing relevant information, tracking user progress, and giving them feedback. This study investigates the persuasive features of a web-based information system that supports the enforcement of user commitments. A structural equation modelling approach and analysis of open text responses are used to identify the factors that affect the intention to continue to use the system, to gather users’ perspectives on how the system helps them to stick to their goals and the improvements that could be made. Data (N = 227) collected from the system's users is tested against the proposed research model. The results show that 30% of users’ continuance intention is explained by the implemented persuasive software feature categories (computer-human dialogue support, primary task support, perceived credibility, and social support) and perceived competence. Of these categories, primary task support has the strongest effect on perceived competence and continuance intention. The results also reveal how the system helps users to be consistent in their goals and the lack of specialised social support features. The study concludes with a discussion and recommendations for future research.

Social Media Element for Persuasive B2c E-Commerce

Persuasive communication is a form of communication that encourages or changes consumer behaviour towards a certain product or service. Several researches have been conducted to understand the efficiency and effectiveness of persuasive communication. Among these researches is the development of the persuasive system design model that guides the development of e-commerce websites with persuasive features. However, the persuasive system design model does not take into consideration the effect of social media as it was developed when the social media world is coming into being. Considerations were not given to the social media element in the model development. Hence the need to incorporate the social media features that will extend the persuasive system design model to become all-encompassing and comprehensive. The aim of this study is to extend the persuasive system design model in business to consumer (B2C) e-Commerce. We employed a systematic literature review to identify the factors that will extend the persuasive system design model in a comprehensive manner. This study develops measurement items that will lead to the examination of the proposed model. These items were investigated for their reliability and validity using 30 respondents in Malaysia. The results showed that the items are a good representation of the constructs and hence can be used to assess the proposed model. This study will help in changing business trends that will lead to a successful implementation of persuasive communication in B2C e-commerce in Malaysia.

Design and Delivery Features That May Improve the Use of Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Anxiety: A Realist Literature Synthesis With a Persuasive Systems Design Perspective.

BackgroundInternet-based cognitive behavioral therapy (iCBT) is a persuasive system as its design combines therapeutic content, technological features, and interactions between the user and the program to reduce anxiety for children and adolescents. How iCBT is designed and delivered differs across programs. Although iCBT is considered an effective approach for treating child and adolescent anxiety, rates of program use (eg, module completion) are highly variable for reasons that are not clear. As the extent to which users complete a program can impact anxiety outcomes, understanding what iCBT design and delivery features improve program use is critical for optimizing treatment effects.ObjectiveThe objectives of this study were to use a realist synthesis approach to explore the design and delivery features of iCBT for children and adolescents with anxiety as described in the literature and to examine their relationship to program use outcomes.MethodsA search of published and gray literature was conducted up to November 2017. Prespecified inclusion criteria identified research studies, study protocols, and program websites on iCBT for child and adolescent anxiety. Literature was critically appraised for relevance and methodological rigor. The persuasive systems design (PSD) model, a comprehensive framework for designing and evaluating persuasive systems, was used to guide data extraction. iCBT program features were grouped under 4 PSD categories—Primary task support, Dialogue support, System credibility support, and Social support. iCBT design (PSD Mechanisms) and delivery features (Context of use) were linked to program use (Outcomes) using meta-ethnographic methods; these relationships were described as Context-Mechanism-Outcome configurations. For our configurations, we identified key PSD features and delivery contexts that generated moderate-to-high program use based on moderate-to-high quality evidence found across multiple iCBT programs.ResultsA total of 44 documents detailing 10 iCBT programs were included. Seven iCBT programs had at least one document that scored high for relevance; most studies were of moderate-to-high methodological rigor. We developed 5 configurations that highlighted 8 PSD features (Tailoring, Personalization [Primary task supports]; Rewards, Reminders, Social role [Dialogue supports]; and Trustworthiness, Expertise, Authority [System credibility supports]) associated with moderate-to-high program use. Important features of delivery Context were adjunct support (a face-to-face, Web- or email-based communications component) and whether programs targeted the prevention or treatment of anxiety. Incorporating multiple PSD features may have additive or synergistic effects on program use.ConclusionsThe Context-Mechanism-Outcome configurations we developed suggest that, when delivered with adjunct support, certain PSD features contribute to moderate-to-high use of iCBT prevention and treatment programs for children and adolescents with anxiety. Standardization of the definition and measurement of program use, formal testing of individual and combined PSD features, and use of real-world design and testing methods are important next steps to improving how we develop and deliver increasingly useful treatments to target users.

Integrating Taxonomies Into Theory-Based Digital Health Interventions for Behavior Change: A Holistic Framework.

Digital health interventions (DHIs) have been emerging in the last decade. Due to their interdisciplinary nature, DHIs are guided and influenced by theories (eg, behavioral theories, behavior change technologies, and persuasive technology) from different research communities. However, DHIs are always coded using various taxonomies and reported in insufficient perspectives. This inconsistency and incomprehensiveness will cause difficulty in conducting systematic reviews and sharing contributions among communities. Therefore, based on existing related work, we propose a holistic framework that embeds behavioral theories, behavior change technique taxonomy, and persuasive system design principles. Including four development steps, two toolboxes, and one workflow, our framework aims to guide DHI developers to design, evaluate, and report their work in a formative and comprehensive way.

Persuasive System Design: Social Support Elements to Influence the Malaysian Wellness in Social Media

Obesity is a significant problem in Southeast Asia, especially in Malaysia, where the report by The National Health and Morbidity Survey of 2015 emphasized that the country has the highest proportion of obese and overweight population in the region and it is increasing by the year. Recently, it was observed that the social media could be leveraged for influencing healthier lifestyle. It is believed that, to motivate people to engage with social media or any wellness system, social support is important. However, research indicated that the understanding of social support from the perspectives of system design is still lacking. This study aims to fill these gaps and have better understanding of social support through the Persuasive System Design (PSD). The objectives of this research are (i) to identify the social support elements within the persuasive design elements (ii) to qualitatively verify the social support elements for Malaysian wellness in social media. Qualitative data collection was conducted through social media content observations and focus group interviews with selected respondents. Five PSD elements in social support were identified. They are: social learning, social facilitation, social comparison, recognition and normative influence. The relevancy and significance of these elements towards the health and wellness motivation among Malaysian were also identified.

Persuasive System Design for Global Acceptance of Smartphone Apps

The study examines the impact of PSD principles on the customer acceptance of Smartphone apps, in context of WhatsApp Instant Messenger. The theoretical framework draws on Oinas-Kukkonen & Harjumaa’s persuasive systems design principles. The study involves 488 participants from Malaysia, the Netherlands, Germany, and the Kingdom of Saudi Arabia. A cross-sectional survey was adopted to collect primary data. The research has used multiple regression analysis, one-way ANOVA, and Tukey’s HSD test for analyzing the data. Analyses have revealed that PSD and the customer acceptance are significantly related. Except system credibility, the PSD elements have different impact on customer acceptance depending on country. The study findings suggest that app designers benefit by employing PSD to target global users with minimal localization implementation. Consequently, resulting in an app which appeals to users across national boundaries while reducing the app development and support cost.

Understanding Students’ Motivation and Learning Strategies to Redesign Massive Open Online Courses based on Persuasive System Development

Electronic learning or E-learning is currently flourishing immensely in areas such as secondary and tertiary education, lifelong learning programs and adult education. Within recent years, massive open online courses (MOOCs) have received profound attention within the field of E-learning. Persuasive principles can be implemented to enhance the system design and motivate students to engage with the system. The aim of this study is to identify students’ motivation and learning strategies that affect their academic performance in using MOOCs among tertiary education students. 40 students enrolled in the Ethnic Relations course participated in the online survey. Motivated Strategies for Learning Questionnaire (MSLQ) is the instrument used in this study while Automatic Linear Modelling (ALM) and Multiple Linear Regression (MLR) were used in the analysis. The result shows that there is a correlation between students’ motivation, learning strategies and their academic performance. It is found that resource management, cognitive and metacognitive and value component are the main scales that influenced their motivation and learning strategies towards excellent academic performance. The results can be used to fulfil the first phase of designing a persuasive system based on the Persuasive System Design (PSD) model which is to understand the issues behind a system.

Best Practices and Recommendations for Digital Interventions to Improve Engagement and Adherence in Chronic Illness Sufferers

Abstract. Chronic illnesses cause considerable burden in quality of life, often leading to physical, psychological, and social dysfunctioning of the sufferers and their family. There is a growing need for flexible provision of home-based psychological services to increase reach even for traditionally underserved chronic illness sufferer populations. Digital interventions can fulfill this role and provide a range of psychological services to improve functioning. Despite the potential of digital interventions, concerns remain regarding users’ engagement, as low engagement is associated with low adherence rates, high attrition, and suboptimal exposure to the intervention. Human–computer interaction (e.g., theoretical models of persuasive system design, gamification, tailoring, and supportive accountability) and user characteristics (e.g., gender, age, computer literacy) are the main identified culprits contributing to engagement and adherence difficulties. To date, there have not been any clear and concise recommendations for improved utilization and engagement in digital interventions. This paper provides an overview of user engagement factors and proposes research informed recommendations for engagement and adherence planning in digital intervention development. The recommendations were derived from the literature and consensualized by expert members of the European Federation of Psychology Associations, Psychology and Health Standing Committee, and e-Health Task Force. These recommendations serve as a starting point for researchers and clinicians interested in the digitalized health field and promote effective planning for engagement when developing digital interventions with the potential to maximize adherence and optimal exposure in the treatment of chronic health conditions.

Investigation of persuasive system design predictors of competitive behavior in fitness application: A mixed-method approach.

Fitness applications aimed at behavior change are becoming increasingly popular due to the global prevalence of sedentary lifestyles and physical inactivity, causing countless non-communicable diseases. Competition is one of the most common persuasive strategies employed in such applications to motivate users to engage in physical activity in a social context. However, there is limited research on the persuasive system design predictors of users’ susceptibility to competition as a persuasive strategy for motivating behavior change in a social context. To bridge this gap, we designed storyboards illustrating four of the commonly employed persuasive strategies (reward, social learning, social comparison, and competition) in fitness applications and asked potential users to evaluate their perceived persuasiveness. The result of our path analysis showed that, overall, users’ susceptibilities to social comparison (βT = 0.48, p < 0.001), reward (βT = 0.42, p < 0.001), and social learning (βT = 0.29, p < 0.01) predicted their susceptibility to competition, with our model accounting for 41% of its variance. Social comparison partially mediated the relationship between reward and competition, while social learning partially mediated the relationship between social comparison and competition. Comparatively, the relationship between reward and social learning was stronger for females than for males, whereas the relationship between reward and competition was stronger for males than for females. Overall, our findings underscore the compatibility of all four persuasive strategies in a one-size-fits-all fitness application. We discuss our findings, drawing insight from the comments provided by participants.

Applying Persuasive Design Techniques to Influence Data-Entry Behaviors in Primary Care: Repeated Measures Evaluation Using Statistical Process Control.

BackgroundPersuasive design is an approach that seeks to change the behaviors of users. In primary care, clinician behaviors and attitudes are important precursors to structured data entry, and there is an impact on overall data quality. We hypothesized that persuasive design changes data-entry behaviors in clinicians and thus improves data quality.ObjectiveThe objective of this study was to use persuasive design principles to change clinician data-entry behaviors in a primary care environment and to increase data quality of data held in a family health team’s reporting system.MethodsWe used the persuasive systems design framework to describe the persuasion context. Afterward, we designed and implemented new features into a summary screen that leveraged several persuasive design principles. We tested the influence of the new features by measuring its impact on 3 data quality measures (same-day entry, record completeness, and data validity). We also measured the impacts of the new features with a paired pre-post t test and generated XmR charts to contextualize the results. Survey responses were also collected from users.ResultsA total of 53 users used the updated system that incorporated the new features over the course of 8 weeks. Based on a pre-post analysis, the new summary screen successfully encouraged users to enter more of their data on the same day as their encounter. On average, the percentage of same-day entries rose by 10.3% for each user (P<.001). During the first month of the postimplementation period, users compensated by sacrificing aspects of data completeness before returning to normal in the second month. Improvements to record validity were marginal over the study period (P=.05). Statistical process control techniques allowed us to study the XmR charts to contextualize our results and understand trends throughout the study period.ConclusionsBy conducting a detailed systems analysis and introducing new persuasive design elements into a data-entry system, we demonstrated that it was possible to change data-entry behavior and influence data quality in a reporting system. The results show that using persuasive design concepts may be effective in influencing data-entry behaviors in clinicians. There may be opportunities to continue improving this approach, and further work is required to perfect and test additional designs. Persuasive design is a viable approach to encourage clinician user change and could support better data capture in the field of medical informatics.

Deconstructing persuasiveness of strategies in behaviour change systems using the ARCS model of motivation

ABSTRACTPersuasive technologies (PTs) motivate behaviour change using various persuasive strategies. However, there is still a dearth of knowledge on how PTs motivate behaviour change and how to design systems to increase their persuasiveness. To provide empirical insight into the mechanism through which PTs persuade, we conducted a large-scale study with 543 participants to investigate the relation between Attention, Relevance, Confidence, and Satisfaction constructs from the ARCS model of motivation and 10 strategies that are commonly used in persuasive systems design. Our results show that the ARCS constructs collectively explain between 82% and 91% of the variance in persuasiveness across the ten strategies. Relevance, followed by Attention, has the strongest association with persuasiveness. The result generalises across gender groups. Therefore, to increase a system’s persuasiveness, designers should focus on designing to increase relevance and to capture user’s attention, while also promoting confidence and a feeling of satisfaction. We contribute to Human–Computer Interaction (HCI) and Persuasive Technology by offering design guidelines for PTs to increase their persuasiveness and hence efficacy.

Persuasive System Practices in Mobile Application Development

Mobile application development is at swift pace of growth across the globe. This industry also creates financial opportunities towards entrepreneurs also independent software developers. Yet, with the exponential growth of mobile applications released daily, hundreds of these software programs were being abandoned and neglected. The development of high quality mobile applications also requires the understanding of requirements needed associated with the development of the software products in order to fulfil the special needs of the products. This research was conducted with the aim to qualitative explore the persuasive technology practices followed and the processes involved which able to enhance the success level of the mobile applications. For this study, semi-structured interviews were conducted with the involvement of seven software developers and fifteen mobile applications as the case studies for the research. It has been shown that persuasive system design is appropriate to be incorporated in the process of software development as it provides a structural guideline that reflects users’ requirements in the context of attitudes and behaviours. Based on this assumption, it is identified that the incorporation of persuasive context at the initial stage of software development may affect the quality of the mobile applications in a long term.

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

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

A Survey on the Design of Gamified Systems for Energy and Water Sustainability

In a world affected by the constant growth and concentration of the population in urban areas, the problem of preserving natural resources has become a priority. A promising approach to resource conservation is demand management, i.e., the ability to positively influence the behaviour of the population towards more sustainable consumption. Information and Communication Technology (ICT) tools have shown a great potential in influencing consumers’ behaviour, which could be exploited for the common good. However, the design of so-called persuasive systems for environmental purposes is a challenging task, because it cannot be based solely on the utilitarian motivation of users, but must be able to trigger a broader range of engagement factors deeply rooted in the human psychology. In this paper, we review the main design principles and models at the base of a class of persuasive system that exploits gamification and Games with a Purpose (GWAPs) to engage users towards sustainability; we identify the most commonly used incentive mechanisms for inducing behavioural changes; and present a selection of gamified systems for energy and water conservation. From such a survey, we distill design guidelines to be applied in the design of demand management socio-technical systems.

Persuasive technology in reducing prolonged sedentary behavior at work: A systematic review

Prolonged sedentary behavior is prevalent among office workers and has been found to be detrimental to health. Preventing and reducing prolonged sedentary behavior require interventions, and persuasive technology is expected to make a contribution in this domain. In this paper, we use the framework of persuasive system design (PSD) principles to investigate the utilization and effectiveness of persuasive technology in intervention studies at reducing sedentary behavior at work. This systematic review reveals that reminders are the most frequently used PSD principle. The analysis on reminders shows that hourly PC reminders alone have no significant effect on reducing sedentary behavior at work, while coupling with education or other informative session seems to be promising. Details of deployed persuasive technology with behavioral theories and user experience evaluation are expected to be reported explicitly in the future intervention studies.

Web-Based Intervention for Women With Type 1 Diabetes in Pregnancy and Early Motherhood: Critical Analysis of Adherence to Technological Elements and Study Design.

BackgroundNumerous Web-based interventions have been implemented to promote health and health-related behaviors in persons with chronic conditions. Using randomized controlled trials to evaluate such interventions creates a range of challenges, which in turn can influence the study outcome. Applying a critical perspective when evaluating Web-based health interventions is important.ObjectiveThe objective of this study was to critically analyze and discuss the challenges of conducting a Web-based health intervention as a randomized controlled trial.MethodThe MODIAB-Web study was critically examined using an exploratory case study methodology and the framework for analysis offered through the Persuasive Systems Design model. Focus was on technology, study design, and Web-based support usage, with special focus on the forum for peer support. Descriptive statistics and qualitative content analysis were used.ResultsThe persuasive content and technological elements in the design of the randomized controlled trial included all four categories of the Persuasive Systems Design model, but not all design principles were implemented. The study duration was extended to a period of four and a half years. Of 81 active participants in the intervention group, a maximum of 36 women were simultaneously active. User adherence varied greatly with a median of 91 individual log-ins. The forum for peer support was used by 63 participants. Although only about one-third of the participants interacted in the forum, there was a fairly rich exchange of experiences and advice between them. Thus, adherence in terms of social interactions was negatively affected by limited active participation due to prolonged recruitment process and randomization effects. Lessons learned from this critical analysis are that technology and study design matter and might mutually influence each other. In Web-based interventions, the use of design theories enables utilization of the full potential of technology and promotes adherence. The randomization element in a randomized controlled trial design can become a barrier to achieving a critical mass of user interactions in Web-based interventions, especially when social support is included. For extended study periods, the technology used may need to be adapted in line with newly available technical options to avoid the risk of becoming outdated in the user realm, which in turn might jeopardize study validity in terms of randomized controlled trial designs.ConclusionsOn the basis of lessons learned in this randomized controlled trial, we give recommendations to consider when designing and evaluating Web-based health interventions.

A Web-Based Intervention to Reduce Distress After Prostate Cancer Treatment: Development and Feasibility of the Getting Down to Coping Program in Two Different Clinical Settings.

BackgroundDistress after prostate cancer treatment is a substantial burden for up to one-third of men diagnosed. Physical and emotional symptoms and health service use can intensify, yet men are reticent to accept support. To provide accessible support that can be cost effectively integrated into care pathways, we developed a unique, Web-based, self-guided, cognitive-behavior program incorporating filmed and interactive peer support.ObjectiveTo assess feasibility of the intervention among men experiencing distress after prostate cancer treatment. Demand, acceptability, change in distress and self-efficacy, and challenges for implementation in clinical practice were measured.MethodsA pre-post, within-participant comparison, mixed-methods research design was followed. Phase I and II were conducted in primary care psychological service and secondary care cancer service, respectively. Men received clinician-generated postal invitations: phase I, 432 men diagnosed <5 years; phase II, 606 men diagnosed <3.5 years. Consent was Web-based. Men with mild and moderate distress were enrolled. Web-based assessment included demographic, disease, treatment characteristics; distress (General Health Questionnaire-28); depression (Patient Health Questionnaire-9); anxiety (General Anxiety Disorder Scale-7); self-efficacy (Self-Efficacy for Symptom Control Inventory); satisfaction (author-generated, Likert-type questionnaire). Uptake and adherence were assessed with reference to the persuasive systems design model. Telephone interviews explored participant experience (phase II, n=10); interviews with health care professionals (n=3) explored implementation issues.ResultsA total of 135 men consented (phase I, 61/432, 14.1%; phase II, 74/606, 12.2%); from 96 eligible men screened for distress, 32% (30/96) entered the intervention (phase I, n=10; phase II, n=20). Twenty-four completed the Web-based program and assessments (phase I, n=8; phase II, n=16). Adherence for phase I and II was module completion rate 63% (mean 2.5, SD 1.9) versus 92% (mean 3.7, SD 1.0); rate of completing cognitive behavior therapy exercises 77% (mean 16.1, SD 6.2) versus 88% (mean 18.6, SD 3.9). Chat room activity occurred among 63% (5/8) and 75% (12/16) of men, respectively. In phase I, 75% (6/8) of men viewed all the films; in phase II, the total number of unique views weekly was 16, 11, 11, and 10, respectively. The phase II mood diary was completed by 100% (16/16) of men. Satisfaction was high for the program and films. Limited efficacy testing indicated improvement in distress baseline to post intervention: phase I, P=.03, r=−.55; phase II, P=.001, r=−.59. Self-efficacy improved for coping P=.02, r=−.41. Service assessment confirmed ease of assimilation into clinical practice and clarified health care practitioner roles.ConclusionsThe Web-based program is acceptable and innovative in clinical practice. It was endorsed by patients and has potential to positively impact the experience of men with distress after prostate cancer treatment. It can potentially be delivered in a stepped model of psychological support in primary or secondary care. Feasibility evidence is compelling, supporting further evaluative research to determine clinical and cost effectiveness.

Kick.it: The development of an evidence-based smoking cessation smartphone app.

Currently, the evidence for mobile health (mHealth) smoking cessation interventions is limited and heterogeneous, warranting the need for innovative rigorously developed solutions. The aim of this study was to describe the development of a smoking cessation smartphone application (app) developed using evidence-based principles. The app (Kick.it) was designed using the Intervention Mapping framework, incorporating an extensive literature review and qualitative study, in combination with the Behavioural Change Taxonomy v1, the Theoretical Domains Framework, and the Persuasive System Design framework. Kick.it provides quit smoking education, skills training, motivational content and self-regulation functionality for smokers, as well as their social support network. By logging cravings and cigarettes smoked, users will create their own smoking profile, which will be used to provide tailored interventions. It hosts a social network to allow 24/7 social support and provides in-app tools to help with urges to smoke. The app aims to motivate smokers to retry if they slip-up or relapse, allowing them to learn from previous smoking cessation attempts. Rather than basing the app on a singular behavioral change approach, Kick.it will use elements stemming from a variety of behavioral approaches by combining methods of multiple psychological theories. The use of best-practice intervention development frameworks in conjunction with evidence-based behavioral change techniques is expected to result in a smartphone app that has an optimal chance of helping people to quit smoking.