Engaging Users in the Behavior Change Process With Digitalized Motivational Interviewing and Gamification : Development and Feasibility Testing of the Precious App

Background: Most adults do not engage in sufficient physical activity to maintain good health. Smartphone apps are increasingly used to support physical activity but typically focus on tracking behaviors with no support for the complex process of behavior change. Tracking features do not engage all users, and apps could better reach their targets by engaging users in reflecting their reasons, capabilities, and opportunities to change. Motivational interviewing supports this active engagement in self-reflection and self-regulation by fostering psychological needs proposed by the self-determination theory (ie, autonomy, competence, and relatedness). However, it is unknown whether digitalized motivational interviewing in a smartphone app engages users in this process. Objective: This study aimed to describe the theory- and evidence-based development of the Precious app and to examine how digitalized motivational interviewing using a smartphone app engages users in the behavior change process. Specifically, we aimed to determine if use of the Precious app elicits change talk in participants and how they perceive autonomy support in the app. Methods: A multidisciplinary team built the Precious app to support engagement in the behavior change process. The Precious app targets reflective processes with motivational interviewing and spontaneous processes with gamified tools, and builds on the principles of self-determination theory and control theory by using 7 relational techniques and 12 behavior change techniques. The feasibility of the app was tested among 12 adults, who were asked to interact with the prototype and think aloud. Semistructured interviews allowed participants to extend their statements. Participants’ interactions with the app were video recorded, transcribed, and analyzed with deductive thematic analysis to identify the theoretical themes related to autonomy support and change talk. Results: Participants valued the autonomy supportive features in the Precious app (eg, freedom to pursue personally relevant goals and receive tailored feedback). We identified the following five themes based on the theory-based theme autonomy support: valuing the chance to choose, concern about lack of autonomy, expecting controlling features, autonomous goals, and autonomy supportive feedback. The motivational interviewing features actively engaged participants in reflecting their outcome goals and reasons for activity, producing several types of change talk and very little sustain talk. The types of change talk identified were desire, need, reasons, ability, commitment, and taking steps toward change. Conclusions: The Precious app takes a unique approach to engage users in the behavior change process by targeting both reflective and spontaneous processes. It allows motivational interviewing in a mobile form, supports psychological needs with relational techniques, and targets intrinsic motivation with gamified elements. The motivational interviewing approach shows promise, but the impact of its interactive features and tailored feedback needs to be studied over time. The Precious app is undergoing testing in a series of n-of-1 randomized controlled trials. KEYWORDS health app; mHealth; human-computer interaction; prevention; service design; usability design; intrinsic motivation; reflective processes; spontaneous processes; engagement; self-determination theory; autonomous motivation; gamification; physical activityPeer reviewe

Healthcare Provider Influence on Health Behavior Modification in Gestational Diabetics

The overall aim was to understand the process of healthcare provider influence by exploring associations between professional influence measures and patient engagement in health behavior modification in women with Gestational Diabetic Mellitus (GDM). An integrative literature review resulted in defining and developing the Healthcare Provider Influence (HPI) conceptual model based on the Integrated Theory of Health Behavior Change and Transformational Leadership theory. HPI is defined as a process wherein a purposeful interpersonal interactive, collaborative, and transformative relationship develops between a patient and a healthcare provider working together toward a specific focus of health behavior modification outcomes. Measures for testing the HPI conceptual model were identified, modified, translated, and content validated. Using an observational, prospective, longitudinal, correlational and exploratory design, participants in control, non-GDMs (N=117) and study, GDMs (N=78) groups completed questionnaires at an initial high-risk GDM screening and subsequently at 34-36 weeks gestational age. To test the relationships in GDM patients, eight healthy eating, physical activity, and glucose monitoring behaviors were separately regressed on professional influence variables (social/professional influence, quality of information and interaction). Patient and healthcare provider characteristics were included in regression models to test for moderating effects. Self-efficacy was examined for a mediating effect. Differences in health behavior modification outcomes, by time and group (GDM, non-GDM) were explored. Professional influence by maternity healthcare providers (HPs), and quality of information and interaction during teaching encounters by HPs and diabetic nurse-educators were significantly associated with increased breakfast frequency/weekly and self-efficacy (p ≤ .10). Gender, race and language concordance and HP leadership style and specialty influenced healthy eating, physical activity and glucose monitoring behaviors (p ≤ .10). Three healthy eating and one physical activity outcomes differences were found by group and time, for which variance was explained with small effects (2-9%) by language, race, and GDM history. Patients’ perception of their healthcare providers’ influence, quality of information and interaction in teaching encounters and leadership style, and race, language, and gender concordance influence GDM patients’ engagement in health behavior modifications. Self-reflection on practice, interaction, and leadership style could impact individual professional transformation and increase influencing potential for patient engagement in health behaviors

Changing my life one step at a time – using the Twelve Step program as design inspiration for long term lifestyle change

To explore how people manage and maintain life style change, we conducted interviews with eight members of different Twelve Step Fellowships with 2-23 years of recovery about how they maintain and develop their recovery in everyday life. They reported how identification, sharing, and routines are keys to recovery. Our lessons for design concerns how these concepts support recovery in a long term perspective: Sharing to contribute in a broader sense to the fellowship and to serve as an example for fellow members created motivation even after 20 years of recovery; reflecting over routines in recovery was essential since life is constantly changing and routines need to fit into everyday life; concrete gestures were helpful for some of the abstract parts of the recovery work, such as letting go of troubling issues. Design aimed to support maintenance of lifestyle change needs to open up for ways of sharing that allow users to contribute their experiences in ways that create motivation, and support users in reflecting over their routines rather than prompting them on what to do

A Trip to the Moon: Personalized Animated Movies for Self-reflection

Self-tracking physiological and psychological data poses the challenge of presentation and interpretation. Insightful narratives for self-tracking data can motivate the user towards constructive self-reflection. One powerful form of narrative that engages audience across various culture and age groups is animated movies. We collected a week of self-reported mood and behavior data from each user and created in Unity a personalized animation based on their data. We evaluated the impact of their video in a randomized control trial with a non-personalized animated video as control. We found that personalized videos tend to be more emotionally engaging, encouraging greater and lengthier writing that indicated self-reflection about moods and behaviors, compared to non-personalized control videos

Time preferences and risk aversion: tests on domain differences

The design and evaluation of environmental policy requires the incorporation of time and risk elements as many environmental outcomes extend over long time periods and involve a large degree of uncertainty. Understanding how individuals discount and evaluate risks with respect to environmental outcomes is a prime component in designing effective environmental policy to address issues of environmental sustainability, such as climate change. Our objective in this study is to investigate whether subjects' time preferences and risk aversion across the monetary domain and the environmental domain differ. Crucially, our experimental design is incentivized: in the monetary domain, time preferences and risk aversion are elicited with real monetary payoffs, whereas in the environmental domain, we elicit time preferences and risk aversion using real (bee-friendly) plants. We find that subjects' time preferences are not significantly different across the monetary and environmental domains. In contrast, subjects' risk aversion is significantly different across the two domains. More specifically, subjects (men and women) exhibit a higher degree of risk aversion in the environmental domain relative to the monetary domain. Finally, we corroborate earlier results, which document that women are more risk averse than men in the monetary domain. We show this finding to, also, hold in the environmental domain

Wearable Computing for Health and Fitness: Exploring the Relationship between Data and Human Behaviour

Health and fitness wearable technology has recently advanced, making it easier for an individual to monitor their behaviours. Previously self generated data interacts with the user to motivate positive behaviour change, but issues arise when relating this to long term mention of wearable devices. Previous studies within this area are discussed. We also consider a new approach where data is used to support instead of motivate, through monitoring and logging to encourage reflection. Based on issues highlighted, we then make recommendations on the direction in which future work could be most beneficial

Co-creating a tailored public health intervention to reduce older adults’ sedentary behaviour

Objective: The increasing health care costs associated with an ageing population and chronic disease burden are largely attributable to modifiable lifestyle factors that are complex and vary between individuals and settings. Traditional approaches to promoting healthy lifestyles have so far had limited success. Recently, co-creating public health interventions with end-users has been advocated to provide more effective and sustainable solutions. The aim of this study was to document and evaluate the co-creation of a public health intervention to reduce sedentary behaviour in older adults. Design: Community-dwelling older adults (N = 11, mean age = 74 years) and academic researchers attended 10 interactive co-creation workshops together. Setting: Workshops took place on university campus and the co-creators completed fieldwork tasks outside the workshops. Method: Workshops were informed by the Participatory and Appreciative Action and Reflection methodology. Data were collected using field notes, video recording and worksheet tasks. Analysis was conducted using a qualitative content analysis approach. Results: The co-creators developed a tailored intervention delivered through a mode congruent with older adults' lives. Key elements of the intervention included (1) education on sedentary behaviour, (2) resources to interrupt sedentary behaviour, (3) self-monitoring, (4) action planning and (5) evaluating the benefits of interrupting sedentary behaviour. Conclusion: Co-creation is a feasible approach to develop public health interventions; however, it is limited by the lack of a systematic framework to guide the process. Future work should aim to develop principles and recommendations to ensure co-creation can be conducted in a more scientific and reproducible way. The effectiveness and scalability of the intervention should be assessed

License to chill!: how to empower users to cope with stress

There exists today a paucity of tools and devices that empower people to take control over their everyday behaviors and balance their stress levels. To overcome this deficit, we are creating a mobile service, Affective Health, where we aim to provide a holistic approach towards health by enabling users to make a connection between their daily activities and their own memories and subjective experiences. This construction is based upon values detected from certain bodily reactions that are then visualized on a mobile phone. Accomplishing this entailed figuring out how to provide real-time feedback without making the individual even more stressed, while also making certain that the representation empowered rather than controlled them. Useful design feedback was derived from testing two different visualizations on the mobile in a Wizard of Oz study. In short, we found that a successful design needs to: feel alive, allow for interpretative openness, include short-term history, and be updated in real-time. We also found that the interaction did not increase our participants stress reactions

Emotional Biosensing: Exploring Critical Alternatives

Emotional biosensing is rising in daily life: Data and categories claim to know how people feel and suggest what they should do about it, while CSCW explores new biosensing possibilities. Prevalent approaches to emotional biosensing are too limited, focusing on the individual, optimization, and normative categorization. Conceptual shifts can help explore alternatives: toward materiality, from representation toward performativity, inter-action to intra-action, shifting biopolitics, and shifting affect/desire. We contribute (1) synthesizing wide-ranging conceptual lenses, providing analysis connecting them to emotional biosensing design, (2) analyzing selected design exemplars to apply these lenses to design research, and (3) offering our own recommendations for designers and design researchers. In particular we suggest humility in knowledge claims with emotional biosensing, prioritizing care and affirmation over self- improvement, and exploring alternative desires. We call for critically questioning and generatively re- imagining the role of data in configuring sensing, feeling, ‘the good life,’ and everyday experience