Behavior Change Technology Research Articles

Evaluation of mobile applications for fitness training and physical activity in healthy low-trained people - A modular interdisciplinary framework

Abstract Numerous mobile applications are available that aim at supporting sustainable physical activity and fitness training in sedentary or low-trained healthy people. However, the evaluation of the quality of these applications often suffers from severe shortcomings such as reduction to selective aspects, lack of theory or suboptimal methods. What is still missing, is a framework that integrates the insights of the relevant scientific disciplines. In this paper, we propose an integrative framework comprising four modules: training, behavior change techniques, sensors and technology, and evaluation of effects. This framework allows to integrate insights from training science, exercise physiology, social psychology, computer science, and civil engineering as well as methodology. Furthermore, the framework can be flexibly adapted to the specific features of the mobile applications, e.g., regarding training goals and training methods or the relevant behavior change techniques as well as formative or summative evaluation.

Engaging Senior Adults with Technology for Behavior Change

Amidst today’s ever-expanding waistlines there is a clear need to investigate technology’s potential to support behavior change and stimulate increased physical activity. Physical activity has also been shown to increase the independence and well-being of older adults, yet an important segment of this community is often excluded from the necessary in-context research due to the barriers they face to technology acceptance. Currently, there is limited knowledge on how to overcome these barriers to participation. We created a specific Product Service System that supports older adults to engage with the proposed technological interventions to enable important in-context behavior change research. Our approach converges knowledge from the domains of living laboratories, co-design, and existing experience of design research with older adults. From our experiences with this Product Service System, we provide guidelines to support other researchers setting-up a living laboratory study with older adults to explore technology’s potential to motivate behavior change.

The Continued Use of Mobile Health Apps: Insights From a Longitudinal Study.

BackgroundMobile health (mHealth) apps that support individuals pursuing health and wellness goals, such as weight management, stress management, smoking cessation, and self-management of chronic conditions have been on the rise. Despite their potential benefits, the use of these tools has been limited, as most users stop using them just after a few times of use. Under this circumstance, achieving the positive outcomes of mHealth apps is less likely.ObjectiveThe objective of this study was to understand continued use of mHealth apps and individuals’ decisions related to this behavior.MethodsWe conducted a qualitative longitudinal study on continued use of mHealth apps. We collected data through 34 pre- and postuse interviews and 193 diaries from 17 participants over two weeks.ResultsWe identified 2 dimensions that help explain continued use decisions of users of mHealth apps: users’ assessment of mHealth app and its capabilities (user experience) and their persistence at their health goals (intent). We present the key factors that influence users’ assessment of an mHealth app (interface design, navigation, notifications, data collection methods and tools, goal management, depth of knowledge, system rules, actionable recommendations, and user system fit) and relate these factors to previous literature on behavior change technology design. Using these 2 dimensions, we developed a framework that illustrated 4 decisions users might make after initial interaction with mHealth apps (to abandon use, limit use, switch app, and continue use). We put forth propositions to be explored in future research on mHealth app use.ConclusionsThis study provides insight into the factors that shape users’ decisions to continue using mHealth apps, as well as other likely decision scenarios after the initial use experience. The findings contribute to extant knowledge of mHealth use and provide important implications for design of mHealth apps to increase long-term engagement of the users.

Rethinking Technologies for Behavior Change

Human-Computer Interaction researchers are increasingly designing technologies aimed at supporting “behavior change.” The model of change, which most of these works embrace, focuses on the idea that change occurs on the behavioral level and that it is externalistic, monistic, mechanistic, fragmented, and episodic. We think that a different take, focusing on the internal aspects of change, may integrate and extend what has been done using this behavioral model. We conducted 20 interviews exploring how individuals live, account for, and manage life changes. Then, we outlined five tentative patterns we identified across different kinds of changes reported by the interviewees, pointing out that change might be internalistic, multiple, intentional, holistic, and continuous. This led us to propose a set of design considerations for the evolution of the current behavior change technologies. Finally, we suggested some preliminary lines of future research, which aim to open the design space of technologies for change.

Technology to encourage meaningful activities following brain injury

Background: Cognitive and behavioural difficulties after acquired brain injury (ABI) may lead to reduced engagement in leisure and social activities. Increasing participation is a goal of neuropsychological rehabilitation and assistive and behaviour change technology can play an important role in this. Focus groups and interviews were conductive with brain injury rehabilitation stakeholders (n = 24): people with ABI (n = 9), family members (n = 3) and care providers (n = 12) in order to understand the barriers to engaging in meaningful activities and what helps to overcome these barriers. A collaborative thematic analysis was performed by a multi-disciplinary research team using an approach based on Grounded Theory. Results: Four central, interlinked, barriers were found: Access, Cognitive Difficulties, Anticipation (of Physical or Cognitive Difficulties) and Motivation. To overcome these barriers, participants cited themes such as External Motivation from both Other People and Technology, Maintaining Momentum and different aspects of Being Planful. Conclusions: The results point to future directions for the purposeful development of effective assistive technology for this user group. Technology that is social, persuasive, adapts to individual needs and supports people to plan activities are likely to be particularly useful within neuropsychological rehabilitation. Implications For Rehabilitation Adults with ABI and their carers describe problems accessing activities, cognitive difficulties, anticipationof physical or cognitive difficulties and low motivation as the key barriers to undertaking meaningfulactivities. Current solutions are external prompting, maintaining momentum and being planful. This detailed qualitative analysis of a diverse group of carers and service users allows insight into theassistive technologies that could aid rehabilitation.

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.

Design fictions for behaviour change: exploring the long-term impacts of technology through the creation of fictional future prototypes

ABSTRACTHuman–computer interaction researchers are increasingly designing behaviour change technologies for a variety of purposes, from promoting healthier lifestyles to support sustainable habits. These technologies are commonly assessed in terms of their effectiveness in modifying human behaviour. Nevertheless, the multifaceted social and psychological long-term consequences of these kinds of artifacts are often forgotten. To explore their design space, we involved 48 students asking them to envision and design future behaviour change systems. Following the recent interest in design fictions, which present ‘fantasy prototypes’ in plausible near futures, we investigated how designs might help people think of the presuppositions and implications of technology. Then, we analyzed four design fictions to explore themes that are often forgotten in the current behaviour change debate. We finally discussed the empirical and methodological outcomes of our study and presented a series of design considerations and research questions that could stimulate further reflections on behaviour change technologies and the method we employed.

A protocol for a cluster randomized trial comparing strategies for translating self-management support into primary care practices

BackgroundAdvanced primary care models emphasize patient-centered care, including self-management support (SMS), but the effective use of SMS for patients with type 2 diabetes (T2DM) remains a challenge. Interactive behavior-change technology (IBCT) can facilitate the adoption of SMS interventions. To meet the need for effective SMS intervention, we have developed Connection to Health (CTH), a comprehensive, evidence-based SMS program that enhances interactions between primary care clinicians and patients to resolve self-management problems and improve outcomes. Uptake and maintenance of programs such as CTH in primary care have been limited by the inability of practices to adapt and implement program components into their culture, patient flow, and work processes. Practice facilitation has been shown to be effective in helping practices make the changes required for optimal program implementation. The proposed research is designed to promote the translation of SMS into primary care practices for patients with T2DM by combining two promising lines of research, specifically, (a) testing the effectiveness of CTH in diverse primary-care practices, and (b) evaluating the impact of practice facilitation to enhance implementation of the intervention.MethodsA three-arm, cluster-randomized trial will evaluate three discrete strategies for implementing SMS for patients with T2DM in diverse primary care practices. Practices will be randomly assigned to receive and implement the CTH program, the CTH program plus practice facilitation, or a SMS academic detailing educational intervention. Through this design, we will compare the effectiveness, adoption and implementation of these three SMS practice implementation strategies. Primary effectiveness outcomes including lab values and evidence of SMS will be abstracted from medical records covering baseline through 18 months post-baseline. Data from CTH assessments and action plans completed by patients enrolled in CTH will be used to evaluate practice implementation of CTH and the impact of CTH participation. Qualitative data including field notes from encounters with the practices and interviews of practice personnel will be analyzed to assess practice implementation of SMS.DiscussionThis study will provide important information on the implementation of SMS in primary care, the effectiveness of an IBCT tool such as CTH, and the use of practice facilitation to assist implementation.Trial registrationRegistered with ClinicalTrials.gov – ClinicalTrials.gov ID: NCT01945918, date 08/27/2013. Modifications have been updated.

Editorial of the Special Issue on Quantified Self and Personal Informatics

In recent years, we witnessed the spreading of a plethora of wearable and mobile technologies allowing for a continuous and “transparent” gathering of personal data [...]

Wow - How World of Warcraft Can Change Behaviour & Habits

The paper ‘Drawing inspiration from World of Warcraft: Gamification design elements for behavior change technologies’ by Amon Rapp, published in Interacting with Computers: The Interdisciplinary Journal of Human-Computer Interaction, discusses how, by conducting ethnography, WoW enabled its author to find out how the game influences its players through its design. Justin Richards MBCS reports.

EHR: a Sensing Technology Readiness Model for Lifestyle Changes

Interest in developing user-centered sensing technologies for personalized behavior change has gained significant momentum. However, very little research work has been done to understand issues relative to user readiness and adoption of the sensing technologies to change their behaviors, especially the motivations as well as the concerns and impediments for adoption. We have developed a model called EHR (e-health readiness), to understand and explain the relationship between user habits, perceived healthiness and beliefs towards sensing technologies, and how these factors influence user readiness to use sensing technologies to manage their wellness. We then validate the model using psychometric methods by a large-scale user study (N = 541). Results show overall readiness to sensing technologies is positively influenced by readiness to monitor health conditions, share data within social networks, and receive recommendations. Additionally, readiness is significantly impacted by perceptions of healthiness, technology satisfaction and usefulness of such technology. Finally, we summarize user motivations and concerns for pervasive sensing tools through qualitative analysis on their comments. We present this model and the results of this survey to shed light on designing future sensing technologies for behavior change.

Toward Usable Evidence: Optimizing Knowledge Accumulation in HCI Research on Health Behavior Change.

Over the last ten years, HCI researchers have introduced a range of novel ways to support health behavior change, from glanceable displays to sophisticated game dynamics. Yet, this research has not had as much impact as its originality warrants. A key reason for this is that common forms of evaluation used in HCI make it difficult to effectively accumulate-and use-knowledge across research projects. This paper proposes a strategy for HCI research on behavior change that retains the field's focus on novel technical contributions while enabling accumulation of evidence that can increase impact of individual research projects both in HCI and the broader behavior-change science. The core of this strategy is an emphasis on the discovery of causal effects of individual components of behavior-change technologies and the precise ways in which those effects vary with individual differences, design choices, and contexts in which those technologies are used.

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.

Drawing Inspiration from World of Warcraft: Gamification Design Elements for Behavior Change Technologies

Human–computer interaction (HCI) researchers are increasingly designing technologies for behavior change, drawing on different perspectives, theories and models. In recent years, a new approach has started to be explored within the HCI community: gamification is more and more used by researchers and designers to drive users’ behaviors toward specific directions. However, this design technique has showed several limits, especially for the choice of game elements to be employed. Drawing inspiration from the videogame world, this research wants to suggest the employment of game elements that could contribute and support behavior change processes in different settings. Looking at the Massively Multi Player Online Role-Playing Games (MMORPGs) as a source of inspiration, an ethnographic study in World of Warcraft (WoW) has been conducted. We found that WoW is capable of driving its players’ behavior by employing incentives and penalties, as well as by providing social support and favoring mentorship. By creating a persistent world, supporting the recollection of players’ past memories, leveraging narratives and designing the time of play, WoW further affects players’ habits, increasing their retention in the game world. Findings from the fieldwork grounded the development of a set of design strategies that suggest how to use such elements in the design of interactive systems addressed to change users’ behaviors: for example, they recommend to design incentive systems that exploit different scheduling, as well as to create digital mementos to trigger positive memories that may support the change. Such strategies were then compared with game elements that can be found in other MMORPGs to allow for a greater generalization, and discussed with reference to HCI literature.

Adolescents’ Perspectives on Using Technology for Health Behavior Change and Provider Communication

Adolescents’ Perspectives on Using Technology for Health Behavior Change and Provider Communication

Mortality salience in virtual reality experiences and its effects on users’ attitudes towards risk

Virtual reality (VR) is increasingly used as a persuasive technology for attitude and behavior change. This paper considers Terror Management Theory (TMT), one of the notable theories that have not been considered so far in persuasive technology, and aims at exploring its use in VR experiences. First, we show that a VR experience can be used to effectively elicit mortality salience (MS), which makes TMT applicable. Then, we evaluate the effects of the VR experience on attitudes towards risk. Wearing a head-mounted display (HMD), participants explored one of two virtual environments (VEs). In a first group of participants, the VE represented a cemetery with MS cues like tombs and burial recesses. In a second group of participants, the MS cues were removed, and the VE looked like a public park. Results show that the MS cues manipulation changed the effects of the VR experience on users’ attitudes towards risk, as TMT would predict. Moreover, results revealed a relationship between MS elicited through VR and physiological correlates of arousal. Finally, we show that user's personality traits can moderate the effects of the VR experience on attitudes towards risk.

Temporal Trends of Psychosociobehavioral Factors Underlying Tobacco Use: A Semi-Automated Exploratory Analysis of Peer-to-Peer Communication in a Health-Related Online Community.

Online communities have been an integral part of tobacco cessation programs. They are rich in content, and offer insights into factors affecting an individual's behavior change efforts. We used word representation techniques to infer implicit meaning embedded in messages exchanged in a health-related online community. Our analysis of peer interactions revealed that individuals factor in safety, glamour, expense, and media projection when choosing a form of nicotine intake. When choosing pharmacotherapy techniques, individuals focus on brands, dosage, and side effects associated with each form (e.g. gums, patches). Our analysis sheds light on factors embedded in peer interactions, which might lead to opinion formation based on peer influence and knowledge dissemination in these social platforms. Such understanding enables design of high-engagement behavior change technologies, through personalization of content delivery by factoring in individual-level beliefs, behavioral state, and community-level influences.

Technology for Behavior Change – Potential, Challenges, and Ethical Questions

Technology for Behavior Change – Potential, Challenges, and Ethical Questions

Persuasive technology for health and wellness: State-of-the-art and emerging trends.

The evolving field of persuasive and behavior change technology is increasingly targeted at influencing behavior in the area of health and wellness. This paper provides an empirical review of 16 years (85 papers) of literature on persuasive technology for health and wellness to: (1.) answer important questions regarding the effectiveness of persuasive technology for health and wellness, (2.) summarize and highlight trends in the technology design, research methods, motivational strategies, theories, and health behaviors targeted by research to date, (3.) uncover pitfalls of existing persuasive technological interventions for health and wellness, and (4.) suggest directions for future research.

Affective and Motivational Responses to 3D Body Imaging

Common body weight and composition testing has been shown to impact emotional, motivational, and behavioral responses. Three-dimensional body imaging is a relatively new technology to be utilized in medical and fitness settings to provide detailed body image feedback to the patient or client, while encouraging motivation to control body weight, fat, and shape. However, such responses to 3D body imaging have not been examined. PURPOSE: To examine the acute affective and motivational responses to 3D body imaging (Fit3D) in a sample of college-aged women (N = 32), classified as either normal weight (NW; n = 13) or overweight/obese (OWOB; n = 19). METHODS: Positive and negative affect were assessed with the Positive (PA) and Negative Affect (NA) Schedule (PANAS; range: 1-5), and one item assessed motivation to lose weight (range: 1-10). These variables were assessed immediately before and after a single 3D body imaging session. Participants had 1-minute to examine their 3D body scan, and then continued to examine their scan during all post-measures. RESULTS: Overall, PA did not change pre- to post-scan (3.11 ± .98 to 3.18 ± 1.07, p > .05), nor did NA (1.52 ± .58 to 1.63 ± .89, p > .05). In addition, there was not a time by BMI (NW versus OWOB) interaction for both PA and NA. Overall, motivation to lose weight slightly increased (6.41 ± 2.78 to 7.09 ± 2.75, p = .001). There was not an interaction of time by BMI, with both groups increasing over time. However, there was a between-subjects effect with OWOB holding higher pre-motivation to lose weight than NW participants (7.63 versus 4.62, respectively; p < .01). CONCLUSIONS: Within the present sample of college-aged women, a 3D body image scanning session did not appear impact PA or NA responses, but did produce a slight increase in motivation to lose body weight in participants classified as NW or OWOB. This research provides foundational insight to future research and the use of this novel technology for health behavior change in fitness and clinical settings.