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Rouleau G, Wu K, Ramamoorthi K, Boxall C, Liu RH, Maloney S, Zelmer J, Scott T, Larsen D, Wijeysundera HC, Ziegler D, Bhatia S, Kishimoto V, Steele Gray C, Desveaux L. Mapping Theories, Models, and Frameworks to Evaluate Digital Health Interventions: Scoping Review. J Med Internet Res 2024; 26:e51098. [PMID: 38315515 PMCID: PMC10877497 DOI: 10.2196/51098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/10/2023] [Accepted: 12/27/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Digital health interventions (DHIs) are a central focus of health care transformation efforts, yet their uptake in practice continues to fall short of their potential. In order to achieve their desired outcomes and impact, DHIs need to reach their target population and need to be used. Many factors can rapidly intersect between this dynamic of users and interventions. The application of theories, models, and frameworks (TMFs) can facilitate the systematic understanding and explanation of the complex interactions between users, practices, technology, and health system factors that underpin research questions. There remains a gap in our understanding of how TMFs have been applied to guide the evaluation of DHIs with real-world health system operations. OBJECTIVE This study aims to map TMFs used in studies to guide the evaluation of DHIs. The objectives are to (1) describe the TMFs and the constructs they target, (2) identify how TMFs have been prospectively used (ie, their roles) in primary studies to evaluate DHIs, and (3) to reflect on the relevance and utility of our findings for knowledge users. METHODS This scoping review was conducted in partnership with knowledge users using an integrated knowledge translation approach. We included papers (eg, reports; empirical quantitative, qualitative, and mixed methods studies; conference proceedings; and dissertations) if primary insights resulting from the application of TMFs were presented. Any type of DHI was eligible. Papers published from 2000 and onward were mainly identified from the following databases: MEDLINE (Ovid), CINAHL Complete (EBSCOhost), PsycINFO (Ovid), EBM Reviews (Ovid), and Embase (Ovid). RESULTS A total of 156 studies published between 2000 and 2022 were included. A total of 68 distinct TMFs were identified across 85 individual studies. In more than half (85/156, 55%) of the included studies, 1 of following 6 prevailing TMFs were reported: Consolidated Framework for Implementation Research (n=39); the Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework (n=17); the Technology of Acceptance Model (n=16); the Unified Theory on Acceptance and Use of Technology (n=12); the Diffusion of Innovation Theory (n=10); and Normalization Process Theory (n=9). The most common intended roles of the 6 TMFs were to inform data collection (n=86), to inform data analysis (n=69), and to identify key constructs that may serve as barriers and facilitators (n=52). CONCLUSIONS As TMFs are most often reported to be applied to support data collection and analysis, researchers should consider more clearly synthesizing key insights as practical use cases to both increase the relevance and digestibility of their findings. There is also a need to adapt or develop guidelines for better reporting DHIs and the use of TMFs to guide evaluation. Hence, it would contribute to ensuring ongoing technology transformation efforts are evidence and theory informed rather than anecdotally driven.
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Affiliation(s)
- Geneviève Rouleau
- Nursing department, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
- Institute for Health System Solutions and Virtual Care Toronto, Women's College Hospital, Toronto, ON, Canada
- Institut du Savoir Montfort, Montfort Hospital, Ottawa, ON, Canada
| | - Kelly Wu
- Institute for Health System Solutions and Virtual Care Toronto, Women's College Hospital, Toronto, ON, Canada
| | - Karishini Ramamoorthi
- Institute for Health System Solutions and Virtual Care Toronto, Women's College Hospital, Toronto, ON, Canada
| | - Cherish Boxall
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Rebecca H Liu
- Institute for Health System Solutions and Virtual Care Toronto, Women's College Hospital, Toronto, ON, Canada
| | | | | | - Ted Scott
- School of Nursing, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Darren Larsen
- Telus Healthcare Delivery, Women's College Hospital, Toronto, ON, Canada
- Women's College Hospital Family Health Team, Women's College Hospital, Toronto, ON, Canada
| | | | - Daniela Ziegler
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Sacha Bhatia
- Ontario Health, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Vanessa Kishimoto
- Institute for Health System Solutions and Virtual Care Toronto, Women's College Hospital, Toronto, ON, Canada
| | - Carolyn Steele Gray
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Laura Desveaux
- Institute for Health System Solutions and Virtual Care Toronto, Women's College Hospital, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Toronto, ON, Canada
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López-Torrecillas F, Ramírez-Uclés I, Rueda MDM, Cobo-Rodríguez B, Castro-Martín L, Urrea-Castaño SA, Muñoz-López L. Use of the Therapy App Prescinde for Increasing Adherence to Smoking Cessation Treatment. Healthcare (Basel) 2023; 11:3121. [PMID: 38132011 PMCID: PMC10742439 DOI: 10.3390/healthcare11243121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Tobacco use poses major health risks and is a major contributor to causes of death worldwide. Mobile phone-based cessation apps for this substance are gaining popularity, often used as a component of traditional interventions. This study aimed to analyze adherence to an intervention using a mobile phone application (App-therapy Prescinde (v1)) as a function of sociodemographic variables (age, gender, educational level, and profession) as well as the primary activities supported by the app (reducing tobacco or cannabis use and increasing physical exercise). The participants were recruited through the web pages of the Occupational Risk Prevention Service and the Psychology Clinic of the University of Granada during the COVID-19 confinement period. The application's contents include three components (self-report, motivational phrases, and goal setting). Our findings indicate that being male, being aged between 26 and 62, having a high school education, and being unemployed increase the likelihood of adherence to the Prescinde therapy app three months after usage. Our findings highlight the importance of developing new therapeutic approaches and conducting in-depth studies on the factors associated with adherence to tobacco cessation and cannabis cessation treatments via mobile phone applications.
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Affiliation(s)
| | - Isabel Ramírez-Uclés
- Department of Personality, Assessment and Psychological Treatment, National Distance Education University (UNED), 28040 Madrid, Spain
| | - María del Mar Rueda
- Department of Statistics and Operations Research, University of Granada, 18071 Granada, Spain; (M.d.M.R.); (S.A.U.-C.)
| | - Beatriz Cobo-Rodríguez
- Department of Quantitative Methods for Economics and Business, University of Granada, 18071 Granada, Spain;
| | - Luis Castro-Martín
- Health and Consumption Counseling, Andalusian School of Public Health, 18011 Granada, Spain;
| | - Sabina Arantxa Urrea-Castaño
- Department of Statistics and Operations Research, University of Granada, 18071 Granada, Spain; (M.d.M.R.); (S.A.U.-C.)
| | - Lucas Muñoz-López
- Department of Personality, Assessment and Psychological Treatment, University of Granada, 18071 Granada, Spain
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Al-Dhahir I, Breeman LD, Faber JS, Reijnders T, van den Berg-Emons HJG, van der Vaart R, Janssen VR, Kraaijenhagen R, Visch VT, Chavannes NH, Evers AWM. An overview of facilitators and barriers in the development of eHealth interventions for people of low socioeconomic position: A Delphi study. Int J Med Inform 2023; 177:105160. [PMID: 37549501 DOI: 10.1016/j.ijmedinf.2023.105160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/05/2023] [Accepted: 07/21/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE eHealth interventions can improve the health outcomes of people with a low socioeconomic position (SEP) by promoting healthy lifestyle behaviours. However, developing and implementing these interventions among the target group can be challenging for professionals. To facilitate the uptake of effective interventions, this study aimed to identify the barriers and facilitators anticipated or experienced by professionals in the development, reach, adherence, implementation and evaluation phases of eHealth interventions for people with a low SEP. METHOD We used a Delphi method, consisting of two online questionnaires, to determine the consensus on barriers and facilitators anticipated or experienced during eHealth intervention phases and their importance. Participants provided open-ended responses in the first round and rated statements in the second round. The interquartile range was used to calculate consensus, and the (totally) agree ratings were used to assess importance. RESULTS Twenty-seven professionals participated in the first round, and 19 (70.4%) completed the second round. We found a consensus for 34.8% of the 46 items related to highly important rated barriers, such as the lack of involvement of low-SEP people in the development phase, lack of knowledge among professionals about reaching the target group, and lack of knowledge among lower-SEP groups about using eHealth interventions. Additionally, we identified a consensus for 80% of the 60 items related to highly important rated facilitators, such as rewarding people with a low SEP for their involvement in the development phase and connecting eHealth interventions to the everyday lives of lower-SEP groups to enhance reach. CONCLUSION Our study provides valuable insights into the barriers and facilitators of developing eHealth interventions for people with a low SEP by examining current practices and offering recommendations for future improvements. Strengthening facilitators can help overcome these barriers. To achieve this, we recommend defining the roles of professionals and lower-SEP groups in each phase of eHealth intervention and disseminating this study's findings to professionals to optimize the impact of eHealth interventions for this group.
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Affiliation(s)
- Isra Al-Dhahir
- Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands
| | - Linda D Breeman
- Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands
| | - Jasper S Faber
- Faculty of Industrial Design Engineering, Delft University of Technology, the Netherlands
| | - Thomas Reijnders
- Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands
| | - H J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands; Capri Cardiac Rehabilitation, Rotterdam, the Netherlands
| | - Rosalie van der Vaart
- Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands
| | - Veronica R Janssen
- Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands; Department of Cardiology, Leiden University Medical Center, the Netherlands
| | - Roderik Kraaijenhagen
- Vital10, Amsterdam, the Netherlands; NDDO Institute for Prevention and Early Diagnostics (NIPED), Amsterdam, the Netherlands
| | - Valentijn T Visch
- Faculty of Industrial Design Engineering, Delft University of Technology, the Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, the Netherlands; National eHealth Living Lab, Leiden University Medical Centre, the Netherlands
| | - Andrea W M Evers
- Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands; Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands; Medical Delta, TU Delft, Erasmus University, Leiden University, the Netherlands
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Mansour MB, Busschers WB, Crone MR, van Asselt KM, van Weert HC, Chavannes NH, Meijer E. Use of the Smoking Cessation App Ex-Smokers iCoach and Associations With Smoking-Related Outcomes Over Time in a Large Sample of European Smokers: Retrospective Observational Study. J Med Internet Res 2023; 25:e45223. [PMID: 37606969 PMCID: PMC10481207 DOI: 10.2196/45223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/24/2023] [Accepted: 06/30/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Digital interventions are increasingly used to support smoking cessation. Ex-smokers iCoach was a widely available app for smoking cessation used by 404,551 European smokers between June 15, 2011, and June 21, 2013. This provides a unique opportunity to investigate the uptake of a freely available digital smoking cessation intervention and its effects on smoking-related outcomes. OBJECTIVE We aimed to investigate whether there were distinct trajectories of iCoach use, examine which baseline characteristics were associated with user groups (based on the intensity of use), and assess if and how these groups were associated with smoking-related outcomes. METHODS Analyses were performed using data from iCoach users registered between June 15, 2011, and June 21, 2013. Smoking-related data were collected at baseline and every 3 months thereafter, with a maximum of 8 follow-ups. First, group-based modeling was applied to detect distinct trajectories of app use. This was performed in a subset of steady users who had completed at least 1 follow-up measurement. Second, ordinal logistic regression was used to assess the baseline characteristics that were associated with user group membership. Finally, generalized estimating equations were used to examine the association between the user groups and smoking status, quitting stage, and self-efficacy over time. RESULTS Of the 311,567 iCoach users, a subset of 26,785 (8.6%) steady iCoach users were identified and categorized into 4 distinct user groups: low (n=17,422, 65.04%), mild (n=4088, 15.26%), moderate (n=4415, 16.48%), and intensive (n=860, 3.21%) users. Older users and users who found it important to quit smoking had higher odds of more intensive app use, whereas men, employed users, heavy smokers, and users with higher self-efficacy scores had lower odds of more intensive app use. User groups were significantly associated with subsequent smoking status, quitting stage, and self-efficacy over time. For all groups, over time, the probability of being a smoker decreased, whereas the probability of being in an improved quitting stage increased, as did the self-efficacy to quit smoking. For all outcomes, the greatest change was observed between baseline and the first follow-up at 3 months. In the intensive user group, the greatest change was seen between baseline and the 9-month follow-up, with the observed change declining gradually in moderate, mild, and low users. CONCLUSIONS In the subset of steady iCoach users, more intensive app use was associated with higher smoking cessation rates, increased quitting stage, and higher self-efficacy to quit smoking over time. These users seemed to benefit most from the app in the first 3 months of use. Women and older users were more likely to use the app more intensively. Additionally, users who found quitting difficult used the iCoach app more intensively and grew more confident in their ability to quit over time.
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Affiliation(s)
- Marthe Bl Mansour
- Department of General Practice, Academic Medical Centre Amsterdam, Amsterdam University Medical Centres, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Wim B Busschers
- Department of General Practice, Academic Medical Centre Amsterdam, Amsterdam University Medical Centres, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Mathilde R Crone
- Department of Public Health & Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Kristel M van Asselt
- Department of General Practice, Academic Medical Centre Amsterdam, Amsterdam University Medical Centres, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Henk C van Weert
- Department of General Practice, Academic Medical Centre Amsterdam, Amsterdam University Medical Centres, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Niels H Chavannes
- Department of Public Health & Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Eline Meijer
- Department of Public Health & Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
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Ma Y, Zhou M, Yu W, Zou Z, Ge P, Ma ZF, Tong Y, Li W, Li Q, Li Y, Zhu S, Sun X, Wu Y. Using the Unified Theory of Acceptance and Use of Technology (UTAUT) and e-health literacy(e-HL) to investigate the tobacco control intentions and behaviors of non-smoking college students in China: a cross-sectional investigation. BMC Public Health 2023; 23:765. [PMID: 37098499 PMCID: PMC10127360 DOI: 10.1186/s12889-023-15644-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 04/10/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Non-smoking college students are starting to smoke in increasing numbers, which shows that their tobacco control situation seems not optimistic. The UTAUT and e-HL are commonly used models and theories to predict health behaviors, while there are few studies on tobacco control. This paper aims to study the influencing factors of tobacco control intention and behavior of non-smoking college students in China by combining the UTAUT and e-HL. METHODS Based on the stratified sampling method, 625 college students from 12 universities were selected. Data were collected using a self-made questionnaire designed based on the UTAUT and e-health literacy scales. Data were analyzed by SPSS 22 and AMOS 26, including descriptive statistics, one-way variance analysis and structural equation model analysis. RESULTS The results of one-way variance analysis showed that there were significant differences in the score of non-smoking college students' tobacco control intention or behavior by hometowns, monthly living expenses, and parents' smoking history. Performance expectancy, effort expectancy, social influence had direct positive effects on behavioral intention. Facilitating condition, behavioral intention had direct positive impacts on use behavior and e-HL had an indirect positive impact on use behavior. CONCLUSIONS The combination of the UTAUT and e-HL can be used as an appropriate framework to predict the influencing factors of non-smoking college students' intention and behavior of tobacco control. Improving performance expectancy, effort expectancy, and e-HL among non-smoking college students, creating positive social environments, and providing facilitating condition are key aspects of increasing their tobacco control intention and behavior. It is also beneficial to promote the implementation of smoke-free campus and smoke-free family projects.
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Affiliation(s)
- Yuanyuan Ma
- School of Public Health, Shandong University, Jinan, 250012, China
| | - Mengxia Zhou
- School of Media and Communication, Shanghai Jiaotong University, Shanghai, 201100, China
| | - Wenli Yu
- School of Foreign Languages, Weifang University of Science and Technology, Shouguang, 262700, China
| | - Ziyue Zou
- School of Public Health, Shandong University, Jinan, 250012, China
| | - Pu Ge
- School of Management, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Zheng Feei Ma
- Centre for Public Health and Wellbeing, School of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Bristol, BS16 1QY, UK
| | - Yuting Tong
- School of Public Health, Shandong University, Jinan, 250012, China
| | - Wei Li
- Department of Second Clinical Medical School, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Qiyu Li
- School of Humanities and Health Management, Jinzhou Medical University, Jinzhou, 121000, China
| | - Yunshan Li
- School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Siya Zhu
- School of Foreign Languages, Anhui University of Technology, Anhui, 243000, China
| | - Xinying Sun
- School of Public Health, Peking University, Haidian District, 38 Xueyuan Road, Beijing, 100191, China.
| | - Yibo Wu
- School of Public Health, Peking University, Haidian District, 38 Xueyuan Road, Beijing, 100191, China.
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Rangachari P, Mushiana SS, Herbert K. A scoping review of applications of the Consolidated Framework for Implementation Research (CFIR) to telehealth service implementation initiatives. BMC Health Serv Res 2022; 22:1450. [PMID: 36447279 PMCID: PMC9708146 DOI: 10.1186/s12913-022-08871-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The Consolidated Framework for Implementation Research (CFIR), introduced in 2009, has the potential to provide a comprehensive understanding of the determinants of implementation-effectiveness of health service innovations. Although the CFIR has been increasingly used in recent years to examine factors influencing telehealth implementation, no comprehensive reviews currently exist on the scope of knowledge gained exclusively from applications of the CFIR to telehealth implementation initiatives. This review sought to address this gap. METHODS PRISMA-ScR criteria were used to inform a scoping review of the literature. Five academic databases (PUBMED, PROQUEST, SCIDIRECT, CINAHL, and WoS) were searched for eligible sources of evidence from 01.01.2010 through 12.31.2021. The initial search yielded a total of 18,388 records, of which, 64 peer-reviewed articles met the inclusion criteria for the review. Included articles were reviewed in full to extract data, and data collected were synthesized to address the review questions. RESULTS Most included articles were published during or after 2020 (64%), and a majority (77%) were qualitative or mixed-method studies seeking to understand barriers or facilitators to telehealth implementation using the CFIR. There were few comparative- or implementation-effectiveness studies containing outcome measures (5%). The database search however, revealed a growing number of protocols for implementation-effectiveness studies published since 2020. Most articles (91%) reported the CFIR Inner Setting domain (e.g., leadership engagement) to have a predominant influence over telehealth implementation success. By comparison, few articles (14%) reported the CFIR Outer Setting domain (e.g., telehealth policies) to have notable influence. While more (63%) telehealth initiatives were focused on specialty (vs primary) care, a vast majority (78%) were focused on clinical practice over medical education, healthcare administration, or population health. CONCLUSIONS Organized provider groups have historically paid considerable attention to advocating for telehealth policy (Outer Setting) reform. However, results suggest that for effective telehealth implementation, provider groups need to refocus their efforts on educating individual providers on the complex inter-relationships between Inner Setting constructs and telehealth implementation-effectiveness. On a separate note, the growth in implementation-effectiveness study protocols since 2020, suggests that additional outcome measures may soon be available, to provide a more nuanced understanding of the determinants of effective telehealth implementation based on the CFIR domains and constructs.
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Affiliation(s)
- Pavani Rangachari
- grid.266831.80000 0001 2168 8754Department of Population Health and Leadership, School of Health Sciences, University of New Haven, 300 Boston Post Road, West Haven, CT 06516 USA
| | - Swapandeep S. Mushiana
- grid.410372.30000 0004 0419 2775Veterans Affairs (VA) Quality Scholars Program - San Francisco VA Healthcare System, San Francisco, CA 94121 USA
| | - Krista Herbert
- Portland Veterans Affairs (VA) Healthcare System, Portland, OR 97239 USA
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Albers N, Neerincx MA, Penfornis KM, Brinkman WP. Users' needs for a digital smoking cessation application and how to address them: A mixed-methods study. PeerJ 2022; 10:e13824. [PMID: 36003307 PMCID: PMC9394512 DOI: 10.7717/peerj.13824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/10/2022] [Indexed: 01/18/2023] Open
Abstract
Background Despite their increasing prevalence and potential, eHealth applications for behavior change suffer from a lack of adherence and from dropout. Advances in virtual coach technology provide new opportunities to improve this. However, these applications still do not always offer what people need. We, therefore, need a better understanding of people's needs and how to address these, based on both actual experiences of users and their reflections on envisioned scenarios. Methods We conducted a longitudinal study in which 671 smokers interacted with a virtual coach in five sessions. The virtual coach assigned them a new preparatory activity for quitting smoking or increasing physical activity in each session. Participants provided feedback on the activity in the next session. After the five sessions, participants were asked to describe barriers and motivators for doing their activities. In addition, they provided their views on videos of scenarios such as receiving motivational messages. To understand users' needs, we took a mixed-methods approach. This approach triangulated findings from qualitative data, quantitative data, and the literature. Results We identified 14 main themes that describe people's views of their current and future behaviors concerning an eHealth application. These themes relate to the behaviors themselves, the users, other parties involved in a behavior, and the environment. The most prevalent theme was the perceived usefulness of behaviors, especially whether they were informative, helpful, motivating, or encouraging. The timing and intensity of behaviors also mattered. With regards to the users, their perceived importance of and motivation to change, autonomy, and personal characteristics were major themes. Another important role was played by other parties that may be involved in a behavior, such as general practitioners or virtual coaches. Here, the themes of companionableness, accountability, and nature of the other party (i.e., human vs AI) were relevant. The last set of main themes was related to the environment in which a behavior is performed. Prevalent themes were the availability of sufficient time, the presence of prompts and triggers, support from one's social environment, and the diversity of other environmental factors. We provide recommendations for addressing each theme. Conclusions The integrated method of experience-based and envisioning-based needs acquisition with a triangulate analysis provided a comprehensive needs classification (empirically and theoretically grounded). We expect that our themes and recommendations for addressing them will be helpful for designing applications for health behavior change that meet people's needs. Designers should especially focus on the perceived usefulness of application components. To aid future work, we publish our dataset with user characteristics and 5,074 free-text responses from 671 people.
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Affiliation(s)
- Nele Albers
- Department of Intelligent Systems, Delft University of Technology, Delft, The Netherlands
| | - Mark A. Neerincx
- Department of Intelligent Systems, Delft University of Technology, Delft, The Netherlands,Department of Perceptual and Cognitive Systems, Nederlandse Organisatie voor Toegepast Natuurwetenschappelijk Onderzoek (TNO), Soesterberg, The Netherlands
| | - Kristell M. Penfornis
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Willem-Paul Brinkman
- Department of Intelligent Systems, Delft University of Technology, Delft, The Netherlands
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