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

Development and Validation of the Behavioral Tendencies Questionnaire

At a fundamental level, taxonomy of behavior and behavioral tendencies can be described in terms of approach, avoid, or equivocate (i.e., neither approach nor avoid). While there are numerous theories of personality, temperament, and character, few seem to take advantage of parsimonious taxonomy. The present study sought to implement this taxonomy by creating a questionnaire based on a categorization of behavioral temperaments/tendencies first identified in Buddhist accounts over fifteen hundred years ago. Items were developed using historical and contemporary texts of the behavioral temperaments, described as “Greedy/Faithful”, “Aversive/Discerning”, and “Deluded/Speculative”. To both maintain this categorical typology and benefit from the advantageous properties of forced-choice response format (e.g., reduction of response biases), binary pairwise preferences for items were modeled using Latent Class Analysis (LCA). One sample (n1 = 394) was used to estimate the item parameters, and the second sample (n2 = 504) was used to classify the participants using the established parameters and cross-validate the classification against multiple other measures. The cross-validated measure exhibited good nomothetic span (construct-consistent relationships with related measures) that seemed to corroborate the ideas present in the original Buddhist source documents. The final 13-block questionnaire created from the best performing items (the Behavioral Tendencies Questionnaire or BTQ) is a psychometrically valid questionnaire that is historically consistent, based in behavioral tendencies, and promises practical and clinical utility particularly in settings that teach and study meditation practices such as Mindfulness Based Stress Reduction (MBSR)

Qualitative investigation of wellness program implementation strategies, A

2021 Summer.Includes bibliographical references.The prevalence of occupational stress has been on the rise for decades. Now, with the emergence of COVID-19, employees face even more challenges that can lead to increased levels of occupational stress. To buffer against the negative health outcomes and costs associated with occupational stress, organizations often implement wellness programs. However, the way in which wellness programs are implemented can have significant effects on their success. Although various implementation models have been proposed, researchers have little understanding as to the extent to which practitioners implementing wellness programs use the prescribed steps and sequences provided. Additionally, with the nature of work rapidly evolving due to COVID-19, it is important for researchers to understand how the pandemic impacts program implementation. Thus, the current study explores: (1) the extent to which the steps and sequences characterized by both an occupational health model and an organizational change model are used by practitioners implementing wellness programs in the workplace; and (2) how the COVID-19 pandemic impacted wellness program implementation. Results suggest both models describe valuable steps practitioners use when implementing wellness programs, these processes are not linear, and COVID-19 affected wellness implementation by forcing wellness to the forefront of organizations, encouraging a greater emphasis be placed on a wider definition of wellness, and by introducing volatility in the workplace and in wellness programming

How contextual constraints shape mid-career high school teachers’ stress management and use of digital support tools: A qualitative study

Background: Persistent psychosocial stress is endemic in the modern workplace, including among midcareer high school (secondary comprehensive) teachers in England. Understanding contextual influences on teachers' self-management of stress along with their use of digital health technologies could provide important insights into creating more usable and accessible stress support interventions. Objective: The aim of this study was to investigate the constraints on stress management and prevention among teachers in the school environment and how this shapes the use of digitally enabled stress management tools. Methods: Semistructured interviews were conducted with 14 teachers from southern England. The interviews were analyzed using thematic analysis. Results: Teachers were unanimous in their recognition of workplace stress, describing physical (such as isolation and scheduling) and cultural (such as stigma and individualism) aspects in the workplace context, which influence their ability to manage stress. A total of 12 participants engaged with technology to self-manage their physical or psychological well-being, with more than half of the participants using consumer wearables, but Web-based or smartphone apps were rarely accessed in school. However, digital well-being interventions recommended by school leaders could potentially be trusted and adopted. Conclusions: The findings from this study bring together both the important cultural and physical contextual constraints on the ability of midcareer high school teachers to manage workplace stress. This study highlights correlates of stress and offers initial insight into how digital health interventions are currently being used to help with stress, both within and outside high schools. The findings add another step toward designing tailored digital stress support for teachers

Using school performance feedback: perceptions of primary school principals

The present study focuses on the perception of primary school principals of school performance feedback (SPF) and of the actual use of this information. This study is part of a larger project which aims to develop a new school performance feedback system (SPFS). The study builds on an eclectic framework that integrates the literature on SPFSs. Through in-depth interviews with 16 school principals, 4 clusters of factors influencing school feedback use were identified: context, school and user, SPFS, and support. This study refines the description of feedback use in terms of phases and types of use and effects on school improvement. Although school performance feedback can be seen as an important instrument for school improvement, no systematic use of feedback by school principals was observed. This was partly explained by a lack of skills, time, and support

Acceptance and Commitment Therapy with Ecological Systems Theory: Addressing Muslim Mental Health Issues and Wellbeing

Muslims across the word underutilize mental health services for addressing their wellbeing and biopsychosocial, spiritual, and contextual issues. By 2030, the global Muslim population is expected to reach 2.2 billion people. This indicates that Muslim mental health is gaining importance and would require contextually (i.e., spiritually, culturally, empirically) more effective services. Practitioners used Acceptance and Commitment Therapy (ACT) and Ecological Systems Theory (EST) to promote wellbeing and address psychopathology for diverse groups. However, rigorous and comprehensive literature from 1986 to 2019 did not produce research addressing how ACT could be consumed to serve Muslims. Researchers in Muslim mental health have suggested benefitting from EST yet only few have mentioned using ACT. ACT is one of the most effective therapies based on randomized control trials to enhance wellbeing and address psychopathology. The main purposes of this paper are to (a) explain how ACT is one of the most appropriate counseling approaches to be utilized with Muslims because ACT and Islam have many commonalities and (b) propose ACT with EST perspective to enable a much more contextual perspective of ACT so that mental health professionals could promote wellbeing and address psychopathology at all ecological levels for all, starting with Muslims. With the arrival of third and fourth wave of counseling approaches, the use of positive psychology in research and practice has increased dramatically. ACT, Islam, and EST also highly stress a positive approach perspective thus considering of ACT and EST together might promise more effective research and practice in positive and abnormal psychology

Contradictions Between How Students Are Taught to Write And What They Are Expected To Read In General Education Courses

This study explored the relationship between how students are taught to write in first-year English composition classes and what they are expected to read as part of the general education requirements at a publically-funded large university in the southeast (PLUS), and then to determine whether a gap exists. If a gap is found to exist between the preparation of students and their ability to read material that has been assigned by the teaching faculty, these students are less likely to be considered information literate by any rubric. This study uses a mixed-methods approach. Content analysis is employed to examine the assigned readings students encounter, and interviews are conducted to explore how students make sense of the academic writings assigned in general education classes. Research questions included (1) What are the overall structures of both (a) instruction composition and (b) scholarly journal articles assigned for reading in subsequent general education classes in the disciplines of psychology and history at PLUS? (2) How can these structures be identified? (3) What are the top-level structural patterns of composition within these two academic disciplines and how do they differ? and (4) Do these differences create contradictions in how students are taught to write in freshmen composition courses and the composition of the journal articles they are expected to read in their required general education classes? Thirty-one texts taken from general education syllabi were analyzed for incidence and placement of specific structural elements such as topic sentences and signal words. This study also explored perceptions of these differences from the standpoint of college students. Interviews of twenty-two students were conducted using Dervin’s Sense Making Methodology. These interviews were analyzed in terms of situations, gaps, bridges, outcomes, as well as thematic concepts that consistently arose during the interviews. Significant differences existed between readings from English Composition classes and assigned scholarly journal articles in history and psychology in incidence and placement of topic sentences, use of signal words or phrases, and readability. In addition, thematic analysis of the interviews of students found that they experienced gaps between their expectations of text composition and their experience reading assigned journal articles

Proceedings of the International Workshop on EuroPLOT Persuasive Technology for Learning, Education and Teaching (IWEPLET 2013)

"This book contains the proceedings of the International Workshop on EuroPLOT Persuasive Technology for Learning, Education and Teaching (IWEPLET) 2013 which was held on 16.-17.September 2013 in Paphos (Cyprus) in conjunction with the EC-TEL conference. The workshop and hence the proceedings are divided in two parts: on Day 1 the EuroPLOT project and its results are introduced, with papers about the specific case studies and their evaluation. On Day 2, peer-reviewed papers are presented which address specific topics and issues going beyond the EuroPLOT scope. This workshop is one of the deliverables (D 2.6) of the EuroPLOT project, which has been funded from November 2010 – October 2013 by the Education, Audiovisual and Culture Executive Agency (EACEA) of the European Commission through the Lifelong Learning Programme (LLL) by grant #511633. The purpose of this project was to develop and evaluate Persuasive Learning Objects and Technologies (PLOTS), based on ideas of BJ Fogg. The purpose of this workshop is to summarize the findings obtained during this project and disseminate them to an interested audience. Furthermore, it shall foster discussions about the future of persuasive technology and design in the context of learning, education and teaching. The international community working in this area of research is relatively small. Nevertheless, we have received a number of high-quality submissions which went through a peer-review process before being selected for presentation and publication. We hope that the information found in this book is useful to the reader and that more interest in this novel approach of persuasive design for teaching/education/learning is stimulated. We are very grateful to the organisers of EC-TEL 2013 for allowing to host IWEPLET 2013 within their organisational facilities which helped us a lot in preparing this event. I am also very grateful to everyone in the EuroPLOT team for collaborating so effectively in these three years towards creating excellent outputs, and for being such a nice group with a very positive spirit also beyond work. And finally I would like to thank the EACEA for providing the financial resources for the EuroPLOT project and for being very helpful when needed. This funding made it possible to organise the IWEPLET workshop without charging a fee from the participants.

Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments

BACKGROUND: The number of mental health apps (MHapps) developed and now available to smartphone users has increased in recent years. MHapps and other technology-based solutions have the potential to play an important part in the future of mental health care; however, there is no single guide for the development of evidence-based MHapps. Many currently available MHapps lack features that would greatly improve their functionality, or include features that are not optimized. Furthermore, MHapp developers rarely conduct or publish trial-based experimental validation of their apps. Indeed, a previous systematic review revealed a complete lack of trial-based evidence for many of the hundreds of MHapps available. OBJECTIVE: To guide future MHapp development, a set of clear, practical, evidence-based recommendations is presented for MHapp developers to create better, more rigorous apps. METHODS: A literature review was conducted, scrutinizing research across diverse fields, including mental health interventions, preventative health, mobile health, and mobile app design. RESULTS: Sixteen recommendations were formulated. Evidence for each recommendation is discussed, and guidance on how these recommendations might be integrated into the overall design of an MHapp is offered. Each recommendation is rated on the basis of the strength of associated evidence. It is important to design an MHapp using a behavioral plan and interactive framework that encourages the user to engage with the app; thus, it may not be possible to incorporate all 16 recommendations into a single MHapp. CONCLUSIONS: Randomized controlled trials are required to validate future MHapps and the principles upon which they are designed, and to further investigate the recommendations presented in this review. Effective MHapps are required to help prevent mental health problems and to ease the burden on health systems