Persuasive system design does matter: a systematic review of adherence to web-based interventions

Background: Although web-based interventions for promoting health and health-related behavior can be effective, poor adherence is a common issue that needs to be addressed. Technology as a means to communicate the content in web-based interventions has been neglected in research. Indeed, technology is often seen as a black-box, a mere tool that has no effect or value and serves only as a vehicle to deliver intervention content. In this paper we examine technology from a holistic perspective. We see it as a vital and inseparable aspect of web-based interventions to help explain and understand adherence. Objective: This study aims to review the literature on web-based health interventions to investigate whether intervention characteristics and persuasive design affect adherence to a web-based intervention. Methods: We conducted a systematic review of studies into web-based health interventions. Per intervention, intervention characteristics, persuasive technology elements and adherence were coded. We performed a multiple regression analysis to investigate whether these variables could predict adherence. Results: We included 101 articles on 83 interventions. The typical web-based intervention is meant to be used once a week, is modular in set-up, is updated once a week, lasts for 10 weeks, includes interaction with the system and a counselor and peers on the web, includes some persuasive technology elements, and about 50% of the participants adhere to the intervention. Regarding persuasive technology, we see that primary task support elements are most commonly employed (mean 2.9 out of a possible 7.0). Dialogue support and social support are less commonly employed (mean 1.5 and 1.2 out of a possible 7.0, respectively). When comparing the interventions of the different health care areas, we find significant differences in intended usage (p = .004), setup (p < .001), updates (p < .001), frequency of interaction with a counselor (p < .001), the system (p = .003) and peers (p = .017), duration (F = 6.068, p = .004), adherence (F = 4.833, p = .010) and the number of primary task support elements (F = 5.631, p = .005). Our final regression model explained 55% of the variance in adherence. In this model, a RCT study as opposed to an observational study, increased interaction with a counselor, more frequent intended usage, more frequent updates and more extensive employment of dialogue support significantly predicted better adherence. Conclusions: Using intervention characteristics and persuasive technology elements, a substantial amount of variance in adherence can be explained. Although there are differences between health care areas on intervention characteristics, health care area per se does not predict adherence. Rather, the differences in technology and interaction predict adherence. The results of this study can be used to make an informed decision about how to design a web-based intervention to which patients are more likely to adher

A theoretical and practical approach to a persuasive agent model for change behaviour in oral care and hygiene

There is an increased use of the persuasive agent in behaviour change interventions due to the agent‘s features of sociable, reactive, autonomy, and proactive. However, many interventions have been unsuccessful, particularly in the domain of oral care. The psychological reactance has been identified as one of the major reasons for these unsuccessful behaviour change interventions. This study proposes a formal persuasive agent model that leads to psychological reactance reduction in order to achieve an improved behaviour change intervention in oral care and hygiene. Agent-based simulation methodology is adopted for the development of the proposed model. Evaluation of the model was conducted in two phases that include verification and validation. The verification process involves simulation trace and stability analysis. On the other hand, the validation was carried out using user-centred approach by developing an agent-based application based on belief-desire-intention architecture. This study contributes an agent model which is made up of interrelated cognitive and behavioural factors. Furthermore, the simulation traces provide some insights on the interactions among the identified factors in order to comprehend their roles in behaviour change intervention. The simulation result showed that as time increases, the psychological reactance decreases towards zero. Similarly, the model validation result showed that the percentage of respondents‘ who experienced psychological reactance towards behaviour change in oral care and hygiene was reduced from 100 percent to 3 percent. The contribution made in this thesis would enable agent application and behaviour change intervention designers to make scientific reasoning and predictions. Likewise, it provides a guideline for software designers on the development of agent-based applications that may not have psychological reactance

Assessing the effect of mobile word-of-mouth on consumers : the physical, psychological and social influences

Mobile technologies enable users to discover and research products anytime, anywhere. Mobile devices allow consumers to create and share content based on physical location, facilitate seamless interactions, and provide context-relevant information that can better satisfy users’ needs and enhance their shopping experience. As consumers increasingly rely on mobile devices to search information and purchase products, they need immediate, updated, informative and credible opinions in concise forms. Meanwhile, marketers face unprecedented opportunities for mobile marketing, making ever important for them to understand the mobile word-of-mouth and its effect on the purchase behaviors of consumers on the mobile platform vs. those on other devices. Drawing from the media richness theory and the principle of compensatory adaptation, study one performs sentiment analysis of online product reviews from both mobile and desktop devices by analyzing over one million customer reviews from Dianping.com. We find that mobile reviews are naturally shorter, contain more adverbs and adjectives, and have smaller readership and less votes of helpfulness. The product ratings from mobile reviews are more polarized yet the average valence of mobile reviews is higher. By comparison, desktop reviews contain more pictures and are rated more helpful. Lastly, pricy products receive more desktop reviews than mobile ones. Study two draws from the construal level theory and posit that WOM from mobile devices reflects closer psychological distances (temporal and social), thus constitutes a lower construal level than that from desktop computers. Using a dataset of over one million product reviews from Dianping.com, we assess the value of online product reviews from mobile devices in comparison with those from the desktop computers. Our findings show that WOM is more helpful when it is socially and temporally closer to the users and this effect is amplified when using mobile devices, which bring the mental construal to a low level and make others’ opinions more relevant. Further, we show that product type moderates the effect of online reviews in that m-WOM is more influential for hedonic products and its value for the utilitarian consumption is the lowest. Study three deploys the observational learning theory to examine the effect of WOM across the mobile and desktop devices on the purchase behavior of online promotional offers. The findings suggest that the effect of WOM on the purchase of promotion offers varies significantly across the platforms, product categories, and discount rates. These findings help better understand the strengths, limitations and the effect of m-WOM as marketers attempt to offer consumers context-sensitive and time-critical promotions through mobile devices and make a significant contribution to the literature on interactive marketing. These studies render meaningful implications for theory development about the role of mobile technologies in marketing and can assist practitioners formulating effective promotional strategies through the electronic channels via mobile and desktop devices

The observing self as a catalyst for behaviour change and wellbeing: Effective personal informatics system design to promote behaviour change in the changing health paradigm

The current study is a user-centred enquiry into how wellness-related personal informatics (PI) systems can be more effectively designed to better promote lasting behaviour change and sustained wellbeing in the context of the changing health paradigm. Until recently, the Western biomedical model with its disease focus has been effective in delivering health care; however, this paradigm does not efficiently support a system in crises - the contemporary health care system which is confronted with complex challenges of modern lifestyle diseases and behavioural disorders. Enabled by the technological revolution, a Systems Medicine model - a preventative, personalised, predictive and participatory (P4) approach - is emerging and PI systems play a significant role in realising this pre-clinical, patient-centric, behaviour-focussed shift in health care. This viewpoint paper argues that design strategies applied in PI systems to promote behaviour change play a vital role in supporting health outcomes, specifically, persuasive and mindful user experience (UX) strategies. By applying a phenomenographic research methodology, a user-centred approach is taken to understand qualitatively different ways in which PI systems (and their inherent design strategies) are experienced by users, to inform more intuitive design of PI systems that balance behaviour change strategies to support more lasting shifts and sustainable states of wellbeing. Drawing together ideas from systems medicine, complexity theory, persuasive and mindful design approaches in conjunction with phenomenography, this study aims to understand experiential nuances to offer implications for the future design of health care through PI systems. The theory built through the research process is applied in a prototype design, which is presented as an example of a PI system design that balances persuasive and mindful strategies and aims to promote lasting behaviour change and enduring states of wellbeing more effectively