Socially-driven persuasive health intervention design: Competition, social comparison, and cooperation

Social features in internet-based programs to prevent alcohol consumption among adolescents: a scoping review

Alcohol consumption among adolescents is a social and public health issue. School-based programs are needed to prevent the onset of alcohol consumption during adolescence. Information and communication technologies offer new promising approaches to deliver preventive programs to these populations. The most traditional, successful programs use group dynamics within the classroom. However, the usefulness of social interaction features (SIF) within internet-based interventions remains unclear. The current scoping review aims to identify and evaluate the effectiveness of online and mobile psychosocial preventive interventions that use SIF, and that target adolescents. Web of Science, Scopus and Google Scholar were electronically searched for all articles published between January 2011 and December 2020. Articles reporting on school-based, web-based interventions for adolescents to prevent alcohol consumption and that encouraged any kind of interaction between users ('social interactions') were eligible for inclusion. Fourteen articles were included in the review. These articles assessed eight preventive programs. Six programs showed positive results on outcome variables. In two of them, it was possible to determine that their success was partially due to the SIF. SIF seem to be useful to enhance the receptivity and usefulness of web-based prevention programs, but the current evidence of their effectiveness is scarce. More evidence is required to assess the effectiveness of these features and to improve programs having the objective of preventing the consumption of alcohol among young people.

Design suggestions for a persuasive e-coaching application: A study on informal caregivers' needs

Objective

Informal caregivers such as relatives or close friends of patients are essential for caregiving at home. However, caregiving is a complex experience that may affect the caregivers' well-being. Therefore, there is a need to provide support for caregivers, which we address in this article by proposing design suggestions for an e-coaching application. This study identifies the unmet needs of caregivers in Sweden and provides design suggestions for an e-coaching application using the persuasive system design (PSD) model. The PSD model offers a systematic approach to designing IT interventions.

Methods

A qualitative research design was used, and semi-structured interviews were conducted with 13 informal caregivers from different municipalities in Sweden. A thematic analysis was performed to analyze the data. The PSD model was used to map the needs emerging from this analysis to propose design suggestions for an e-coaching application for caregivers.

Results

Six needs were identified, and based on them, we proposed design suggestions for an e-coaching application using the PSD model. These unmet needs are monitoring and guidance, assistance to avail formal care services, access to practical information without being overwhelmed, feeling of community, access to informal support, and grief acceptance. The last two needs could not be mapped using the existing PSD model, resulting in an extended PSD model.

Conclusion

This study revealed the important needs of informal caregivers based on which design suggestions for an e-coaching application were presented. We also proposed an adapted PSD model. This adapted PSD model can be further used for designing digital interventions in caregiving.

Regional implementation of atrial fibrillation screening: benefits and pitfalls

Aims

Despite general awareness that screening for atrial fibrillation (AF) could reduce health hazards, large-scale implementation is lagging behind technological developments. As the successful implementation of a screening programme remains challenging, this study aims to identify facilitating and inhibiting factors from healthcare providers' perspectives.

Methods and results

A mixed-methods approach was used to gather data among practice nurses in primary care in the southern region of the Netherlands to evaluate the implementation of an ongoing single-lead electrocardiogram (ECG)-based AF screening programme. Potential facilitating and inhibiting factors were evaluated using online questionnaires (N = 74/75%) and 14 (of 24) semi-structured in-depth interviews (58.3%). All analyses were performed using SPSS 26.0. In total, 16 682 screenings were performed on an eligible population of 64 000, and 100 new AF cases were detected. Facilitating factors included 'receiving clear instructions' (mean ± SD; 4.12 ± 1.05), 'easy use of the ECG-based device' (4.58 ± 0.68), and 'patient satisfaction' (4.22 ± 0.65). Inhibiting factors were 'time availability' (3.20 ± 1.10), 'insufficient feedback to the practice nurse' (2.15 ± 0.89), 'absence of coordination' (54%), and the 'lack of fitting policy' (32%).

Conclusion

Large-scale regional implementation of an AF screening programme in primary care resulted in a low participation of all eligible patients. Based on the perceived barriers by healthcare providers, future AF screening programmes should create preconditions to fit the intervention into daily routines, appointing an overall project lead and a General Practitioner (GP) as a coordinator within every GP practice.

The Intersection of Persuasive System Design and Personalization in Mobile Health: Statistical Evaluation

Background

Persuasive technology is an umbrella term that encompasses software (eg, mobile apps) or hardware (eg, smartwatches) designed to influence users to perform preferable behavior once or on a long-term basis. Considering the ubiquitous nature of mobile devices across all socioeconomic groups, user behavior modification thrives under the personalized care that persuasive technology can offer. However, there is no guidance for developing personalized persuasive technologies based on the psychological characteristics of users.

Objective

This study examined the role that psychological characteristics play in interpreted mobile health (mHealth) screen perceived persuasiveness. In addition, this study aims to explore how users’ psychological characteristics drive the perceived persuasiveness of digital health technologies in an effort to assist developers and researchers of digital health technologies by creating more engaging solutions.

Methods

An experiment was designed to evaluate how psychological characteristics (self-efficacy, health consciousness, health motivation, and the Big Five personality traits) affect the perceived persuasiveness of digital health technologies, using the persuasive system design framework. Participants (n=262) were recruited by Qualtrics International, Inc, using the web-based survey system of the XM Research Service. This experiment involved a survey-based design with a series of 25 mHealth app screens that featured the use of persuasive principles, with a focus on physical activity. Exploratory factor analysis and linear regression were used to evaluate the multifaceted needs of digital health users based on their psychological characteristics.

Results

The results imply that an individual user’s psychological characteristics (self-efficacy, health consciousness, health motivation, and extraversion) affect interpreted mHealth screen perceived persuasiveness, and combinations of persuasive principles and psychological characteristics lead to greater perceived persuasiveness. The F test (ie, ANOVA) for model 1 was significant (F9,6540=191.806; P<.001), with an adjusted R2 of 0.208, indicating that the demographic variables explained 20.8% of the variance in perceived persuasiveness. Gender was a significant predictor, with women having higher perceived persuasiveness (P=.008) relative to men. Age was a significant predictor of perceived persuasiveness with individuals aged 40 to 59 years (P<.001) and ≥60 years (P<.001). Model 2 was significant (F13,6536=341.035; P<.001), with an adjusted R2 of 0.403, indicating that the demographic variables self-efficacy, health consciousness, health motivation, and extraversion together explained 40.3% of the variance in perceived persuasiveness.

Conclusions

This study evaluates the role that psychological characteristics play in interpreted mHealth screen perceived persuasiveness. Findings indicate that self-efficacy, health consciousness, health motivation, extraversion, gender, age, and education significantly influence the perceived persuasiveness of digital health technologies. Moreover, this study showed that varying combinations of psychological characteristics and demographic variables affected the perceived persuasiveness of the primary persuasive technology category.

The Effect of Persuasive Design on the Adoption of Exposure Notification Apps: Quantitative Study Based on COVID Alert

BACKGROUND

The adoption of contact tracing apps worldwide has been low. Although considerable research has been conducted on technology acceptance, little has been done to show the benefit of incorporating persuasive principles.

OBJECTIVE

This research aimed to investigate the effect of persuasive features in the COVID Alert app, created by Health Canada, by focusing on the no-exposure status, exposure status, and diagnosis report interfaces.

METHODS

We conducted a study among 181 Canadian residents, including 65 adopters and 116 nonadopters. This study was based on screenshots of the 3 interfaces, of which each comprised a persuasive design and a control design. The persuasive versions of the first two interfaces supported self-monitoring (of exposure levels), and that of the third interface supported social learning (about how many other users have reported their diagnosis). The 6 screenshots were randomly assigned to 6 groups of participants to provide feedback on perceived persuasiveness and adoption willingness.

RESULTS

A multivariate repeated-measure ANOVA showed that there is an interaction among interface, app design, and adoption status regarding the perceived persuasiveness of the interfaces. This resulted in a 2-way ANOVA for each interface. For the no-exposure interface, there was an interaction between adoption status and app design. Among adopters, there was no significant difference P=.31 between the persuasive design (mean 5.36, SD 1.63) and the control design (mean 5.87, SD 1.20). However, among nonadopters, there was an effect of app design (P<.001), with participants being more motivated by the persuasive design (mean 5.37, SD 1.30) than by the control design (mean 4.57, SD 1.19). For the exposure interface, adoption status had a main effect (P<.001), with adopters (mean 5.91, SD 1.01) being more motivated by the designs than nonadopters (mean 4.96, SD 1.43). For the diagnosis report interface, there was an interaction between adoption status and app design. Among nonadopters, there was no significant difference P=.99 between the persuasive design (mean 4.61, SD 1.84) and the control design (mean 4.77, SD 1.21). However, among adopters, there was an effect of app design (P=.006), with participants being more likely to report their diagnosis using the persuasive design (mean 6.00, SD 0.97) than using the control design (mean 5.03, SD 1.22). Finally, with regard to willingness to download the app, pairwise comparisons showed that nonadopters were more likely to adopt the app after viewing the persuasive version of the no-exposure interface (13/21, 62% said yes) and the diagnosis report interface (12/17, 71% said yes) than after viewing the control versions (3/17, 18% and 7/16, 44%, respectively, said yes).

CONCLUSIONS

Exposure notification apps are more likely to be effective if equipped with persuasive features. Incorporating self-monitoring into the no-exposure status interface and social learning into the diagnosis report interface can increase adoption by >30%.

Personality-targeted persuasive gamified systems: exploring the impact of application domain on the effectiveness of behaviour change strategies

Persuasive gamified systems for health are interventions that promote behaviour change using various persuasive strategies. While research has shown that these strategies are effective at motivating behaviour change, there is little knowledge on whether and how the effectiveness of these strategies vary across multiple domains for people of distinct personality traits. To bridge this gap, we conducted a quantitative study with 568 participants to investigate (a) whether the effectiveness of the persuasive strategies implemented vary within each domain (b) whether the effectiveness of various strategies vary across two distinct domains, (c) how people belonging to different personality traits respond to these strategies, and (d) if people high in a personality trait would be influenced by a persuasive strategy within one domain and not in the other. Our results show that there are significant differences in the effectiveness of various strategies across domains and that people's personality plays a significant role in the perceived persuasiveness of different strategies both within and across distinct domains. The Reward strategy (which involves incentivizing users for achieving specific milestones towards the desired behaviour) and the Competition strategy (which involves allowing users to compete with each other to perform the desired behaviour) were effective for promoting healthy eating but not for smoking cessation for people high in Conscientiousness. We provide design suggestions for developing persuasive gamified interventions for health targeting distinct domains and tailored to individuals depending on their personalities.

Designing Better Exposure Notification Apps: The Role of Persuasive Design

BACKGROUND

Digital contact tracing apps have been deployed worldwide to limit the spread of COVID-19 during this pandemic and to facilitate the lifting of public health restrictions. However, due to privacy-, trust-, and design-related issues, the apps are yet to be widely adopted. This calls for an intervention to enable a critical mass of users to adopt them.

OBJECTIVE

The aim of this paper is to provide guidelines to design contact tracing apps as persuasive technologies to make them more appealing and effective.

METHODS

We identified the limitations of the current contact tracing apps on the market using the Government of Canada's official exposure notification app (COVID Alert) as a case study. Particularly, we identified three interfaces in the COVID Alert app where the design can be improved. The interfaces include the no exposure status interface, exposure interface, and diagnosis report interface. We propose persuasive technology design guidelines to make them more motivational and effective in eliciting the desired behavior change.

RESULTS

Apart from trust and privacy concerns, we identified the minimalist and nonmotivational design of exposure notification apps as the key design-related factors that contribute to the current low uptake. We proposed persuasive strategies such as self-monitoring of daily contacts and exposure time to make the no exposure and exposure interfaces visually appealing and motivational. Moreover, we proposed social learning, praise, and reward to increase the diagnosis report interface's effectiveness.

CONCLUSIONS

We demonstrated that exposure notification apps can be designed as persuasive technologies by incorporating key persuasive features, which have the potential to improve uptake, use, COVID-19 diagnosis reporting, and compliance with social distancing guidelines.

Relationship between Perceived UX Design Attributes and Persuasive Features: A Case Study of Fitness App

Research shows that a well-designed user interface is more likely to be persuasive than a poorly designed one. However, there is a limited understanding of the relationship between user-experience (UX) design attributes and users’ receptiveness to the persuasive features of a persuasive technology aimed at motivating behavior change. To bridge this gap, we carried out an online case study among 228 participants from Canada and the United States to investigate the relationship between perceived UX design attributes and users’ receptiveness to persuasive features. The study serves as exploratory work by focusing on a single prototype (homepage of a fitness app); four commonly researched UX design attributes (perceived aesthetics, perceived usability, perceived credibility, and perceived usefulness); and six commonly employed persuasive features (Goal-Setting/Self-Monitoring, Reward, Cooperation, Competition, Social Comparison, and Social Learning) illustrated on storyboards. The results of the Partial Least Square Path Modeling show that perceived usefulness, followed by perceived aesthetics, has the strongest relationship with users’ receptiveness to the persuasive features of a fitness app. Specifically, perceived usefulness and perceived aesthetics have a significant relationship with users’ receptiveness to all but two of the six persuasive features, respectively, as well as with the overall perceived persuasiveness of the fitness app. These findings are supported by participants’ comments on the perceived UX design attributes of the fitness app and the persuasive features illustrated on the storyboards. However, perceived usability and perceived credibility have weak or non-significant relationships with users’ receptiveness to the six persuasive features. The findings suggest that designers should prioritize utilitarian benefits (perceived usefulness) and hedonic benefits (perceived aesthetics) over perceived usability and perceived credibility when designing fitness apps to support behavior change.

Conceptual validation of an innovative remote pulmonary rehabilitation solution for Chronic Obstructive Pulmonary Disease

INTRODUCTION

Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in the world. Pulmonary rehabilitation (PR) reduces COPD hospitalisations, although its use is low. Telerehabilitation is effective; however, in Chile the development of remote PR technology is incipient. Therefore, the aim of the study was to validate conceptual aspects of an innovative remote PR solution for COPD.

METHODS

This mixed study used a nonprobabilistic sample of PR professionals and people with COPD (PwCOPD) from Santiago. The perception of a conceptual solution for PR through a semi-structured interview was determined. Professionals were also asked about willingness to use technology using a questionnaire designed and validated in 75 professionals in this study. The study was approved by the Ethics Committee and data were collected after informed consent.

RESULTS

Twenty-two participants were recruited, of which 14 were professionals and eight were PwCOPD. Among professionals and patients, the willingness to use the solution is positive because it would reduce visits and improve self-management, although it should include a remote/in-person combination, training, and user-friendly interface. Most of the professionals were willing to use technology for pulmonary rehabilitation.

CONCLUSIONS

The development of telehealth technologies should consider the expectations of patients and professionals and may incorporate elements of persuasive technologies in the design. The results could contribute to the development of digital solutions for remote PR in PwCOPD.

Persuasive Features that Drive the Adoption of a Fitness Application and the Moderating Effect of Age and Gender

Fitness apps equipped with various persuasive features have become popular worldwide due to the physical inactivity crisis. However, there is a limited understanding of the most important persuasive features that drive their adoption and the moderating effect of age and gender. To bridge this gap, we designed storyboards illustrating six of the commonly employed persuasive strategies in persuasive health applications: Goal-Setting/Self-Monitoring, Reward, Social Learning, Social Comparison, Competition and Cooperation. We conducted an empirical study in which we asked the participants to evaluate their receptiveness to the six persuasive features and their intention to use a fitness app that features them. The result of our Partial Least Square Path Modeling (PLSPM) shows that, overall, Goal-Setting/Self-Monitoring is the strongest predictor of the intention to use a fitness app, followed by Reward and Competition, both of which are in second place. However, Social Learning and Social Comparison turn out to be non-predictors of intention to use. Based on these findings, we recommend that a minimally viable (one-size-fits-all) fitness app, in a personal setting, should support a Goal-Setting/Self-Monitoring feature, coupled with a Reward feature, to increase its appeal to a wide audience. Moreover, in a social setting, it should support a Competition feature to increase its appeal to a wide audience. We discuss these findings and the gender and age differences in the relationships between users’ receptiveness to the six persuasive features and their intention to use a fitness app that support them.

Development of an individualized asynchronous sensor-based telerehabilitation program for patients undergoing total knee replacement: Participatory design

Telerehabilitation programs can be employed to establish communication between patients and healthcare professionals and empower patients performing their training remotely. This study aimed to identify patients’ requirements after a total knee replacement following a self-training rehabilitation program, leading to the design and development of a telerehabilitation program that can meet the stakeholders’ actual needs. System design, development, and testing were conducted in five iterations based on a participatory design approach. Data collection was performed using interviews, observations, prototyping, and questionnaires. It was found that the main barriers facing the existing rehabilitation program were a lack of clear communication, lack of relevant information, and healthcare professional’s feedback. The participants emphasized the main themes of communication, information, training, and motivation in the process of design and development. In using the telerehabilitation program, the patients reported a high level of user-friendliness, flexibility, and a sense of security. This study has identified obstacles in the current rehabilitation program and revealed the potential effectiveness of using asynchronous communication and sensor-based technologies by employing participatory design and development. A higher level of portability and flexibility were observed. However, future studies and development are required to investigate the overall usability and reliability of the telerehabilitation program.

mHealth Apps as Effective Persuasive Health Technology: Contextualizing the "Necessary" Functionalities

Persuasive health technology (PHT) is any technology purposely designed to influence, reinforce, change, or shape health-related attitudes or behaviors. Behavioral interventions can be developed for the purpose of maintaining or improving a person's health status. Delivering behavioral interventions via PHTs is a promising approach for encouraging healthy behaviors among individuals and populations. Important attributes of all PHTs include their functionalities. A functionality refers to any useful features, functions, capabilities, or technologies associated with computer hardware or software. Creating effective PHTs requires a deliberate selection of appropriate functionalities for supporting specific behavioral interventions. The number and types of functionalities necessary to create an effective PHT will be specific to the context of each project, influenced by project objectives, stakeholder goals, behavioral interventions, and a variety of real-world constraints. Selecting appropriate functionalities can be challenging. Fortunately, there are frameworks and models developed specifically for guiding the design of PHTs. The Persuasive Systems Design model describes 4 categories, and 28 design principles for creating effective persuasive interventions. These same design principles could also be useful for guiding the selection of appropriate functionalities.

Investigation of the Moderating Effect of Culture on Users’ Susceptibility to Persuasive Features in Fitness Applications

Persuasive technologies have been identified as a potential motivational tool to tackle the rising problem of physical inactivity worldwide, with research showing they are more likely to be successful if tailored to the target audience. However, in the physical activity domain, there is limited research on how culture moderates users’ susceptibility to the various persuasive features employed in mobile health applications aimed to motivate behavior change. To bridge this gap, we conducted an empirical study among 256 participants from collectivist (n = 67) and individualist (n = 189) cultures to determine their culture-specific persuasion profiles with respect to six persuasive features commonly employed in fitness applications on the market. The persuasive features include two personal features (goal-setting/self-monitoring and reward) and four social features (competition, cooperation, social learning and social comparison). We based our study on the rating of storyboards (on which each of the six persuasive features is illustrated) and the ranking of the six persuasive features in terms of perceived persuasiveness. The results of our analysis showed that users from individualist and collectivist cultures significantly differ in their persuasion profiles. Based on our rating measure, collectivist users are more likely to be susceptible to all six persuasive features (personal and social) than individualist users, who are only likely to be susceptible to personal features. However, based on our ranking measure, individualist users are more likely to be susceptible to personal features (goal-setting/self-monitoring and reward) than collectivist users. In contrast, collectivist users are more likely to be susceptible to social features (cooperation and social learning) than individualist users. Based on these findings, we provide culture-specific persuasive technology design guidelines. Our study is the first to uncover the moderating effect of culture on users’ susceptibility to commonly employed persuasive features in fitness applications.

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 (β_T = 0.48, p < 0.001), reward (β_T = 0.42, p < 0.001), and social learning (β_T = 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.

Gender, Age and Subjective Well-Being: Towards Personalized Persuasive Health Interventions

(1) Background: Subjective well-being (SWB) is an individual’s judgment about their overall well-being. Research has shown that high subjective well-being contributes to overall health. SWB consists of both Affective and Cognitive dimensions. Existing studies on SWB are limited in two major ways: first, they focused mainly on the Affective dimension. Second, most existing studies are focused on individuals from the Western and Asian nations; (2) Methods: To resolve these weaknesses and contribute to research on personalizing persuasive health interventions to promote SWB, we conducted a large-scale study of 732 participants from Nigeria to investigate what factors affect their SWB using both the Affective and Cognitive dimensions and how distinct SWB components relates to different gender and age group. We employed the Structural Equation Model (SEM) and Confirmatory Factor Analysis (CFA) to develop models showing how gender and age relate to the distinct components of SWB; (3) Results: Our study reveals significant differences between gender and age groups. Males are more associated with social well-being and satisfaction with life components while females are more associated with emotional well-being. As regards age, younger adults (under 24) are more associated with social well-being and happiness while older adults (over 65) are more associated with psychological well-being, emotional well-being, and satisfaction with life. (4) Conclusions: The results could inform designers of the appropriate SWB components to target when personalizing persuasive health interventions to promote overall well-being for people belonging to various gender and age groups. We offer design guidelines for tailoring persuasive intervention to increase SWB based on an individual’s age and gender group. Finally, we map SWB components to possible persuasive technology design strategies that can be employed to implement them in persuasive interventions design.

Social cognitive determinants of exercise behavior in the context of behavior modeling: a mixed method approach

Research has shown that persuasive technologies aimed at behavior change will be more effective if behavioral determinants are targeted. However, research on the determinants of bodyweight exercise performance in the context of behavior modeling in fitness apps is scarce. To bridge this gap, we conducted an empirical study among 659 participants resident in North America using social cognitive theory as a framework to uncover the determinants of the performance of bodyweight exercise behavior. To contextualize our study, we modeled, in a hypothetical context, two popular bodyweight exercise behaviors - push ups and squats - featured in most fitness apps on the market using a virtual coach (aka behavior model). Our social cognitive model shows that users' perceived self-efficacy (βT = 0.23, p < 0.001) and perceived social support (βT = 0.23, p < 0.001) are the strongest determinants of bodyweight exercise behavior, followed by outcome expectation (βT = 0.11, p < 0.05). However, users' perceived self-regulation (βT = -0.07, p = n.s.) turns out to be a non-determinant of bodyweight exercise behavior. Comparatively, our model shows that perceived self-efficacy has a stronger direct effect on exercise behavior for men (β = 0.31, p < 0.001) than for women (β = 0.10, p = n.s.). In contrast, perceived social support has a stronger direct effect on exercise behavior for women (β = 0.15, p < 0.05) than for men (β = -0.01, p = n.s.). Based on these findings and qualitative analysis of participants' comments, we provide a set of guidelines for the design of persuasive technologies for promoting regular exercise behavior.