Evaluation of the Perceived Persuasiveness Questionnaire:User-Centered Card-Sort Study

Background: eHealth technologies aim to change users’ health-related behavior. Persuasive design and system features can make an eHealth technology more motivating, engaging, or supportive to its users. The Persuasive Systems Design (PSD) model incorporates software features that have the possibility to increase the persuasiveness of technologies. However, the effects of specific PSD software features on the effectiveness of an intervention are still largely unknown. The Perceived Persuasiveness Questionnaire (PPQ) was developed to gain insight into the working mechanisms of persuasive technologies. Although the PPQ seems to be a suitable method for measuring subjective persuasiveness, it needs to be further evaluated to determine how suitable it is for measuring perceived persuasiveness among the public. Objective: This study aims to evaluate the face and construct validity of the PPQ, identify points of improvement, and provide suggestions for further development of the PPQ. Methods: A web-based closed-ended card-sort study was performed wherein participants grouped existing PPQ items under existing PPQ constructs. Participants were invited via a Massive Open Online Course on eHealth. A total of 398 people (average age 44.15 years, SD 15.17; 251/398, 63.1% women) completed the card sort. Face validity was evaluated by determining the item-level agreement of the original PPQ constructs. Construct validity was evaluated by determining the construct in which each item was placed most often, regardless of the original placement and how often 2 items were (regardless of the constructs) paired together and what interitem correlations were according to a cluster analysis. Results: Four PPQ constructs obtained relatively high face validity scores: perceived social support, use continuance, perceived credibility, and perceived effort. Item-level agreement on the other constructs was relatively low. Item-level agreement for almost all constructs, except perceived effort and perceived effectiveness, would increase if items would be grouped differently. Finally, a cluster analysis of the PPQ indicated that the strengths of the newly identified 9 clusters varied strongly. Unchanged strong clusters were only found for perceived credibility support, perceived social support, and use continuance. The placement of the other items was much more spread out over the other constructs, suggesting an overlap between them. Conclusions: The findings of this study provide a solid starting point toward a redesigned PPQ that is a true asset to the field of persuasiveness research. To achieve this, we advocate that the redesigned PPQ should adhere more closely to what persuasiveness is according to the PSD model and to the mental models of potential end users of technology. The revised PPQ should, for example, enquire if the user thinks anything is done to provide task support but not how this is done exactly

The concept of engagement in eHealth

Background : Engagement can be seen as the emotional involvement or commitment with an intervention. This concept is often used as the reason why an intervention is effective for one individual and not another. In theory, engagement could be used to assess, early on in an eHealth intervention, whether the selected intervention has a high chance of being effective. Based on this assessment, when needed, participants may be redirected to other, more fitting, interventions, increasing the overall effectiveness of the intervention process. However, the term engagement is ill-defined and has been used in many different ways. As a first step in making the concept of engagement more useful for selecting the right intervention for each individual, two studies are carried out to clarify the concept. Methods : First, 19 engaged health-app users are interviewed about what engagement means to them. Second, a systematic review is conducted, focusing on the definition of engagement and the theories behind the concept. Findings : First results from the interviews indicate that engaged users really feel that the health app is important to them and fits with them as a person. Second, it is important that using the app yields positive results. The systematic review points towards a very broad use of the term engagement (e.g. work engagement, patient engagement, engagement to online health interventions), but all with some commonalities. More results will be available at the time of the conference. Discussion : Engagement is a concept that may be very important in understanding and increasing the use and effectiveness of eHealth interventions. This study sheds light on the meaning of the concept from both a theoretical and user side. Future research should focus on how to measure engagement early on in eHealth interventions to use this as a way to select the right intervention for each individual

Investigating the Direct Impact of a Gamified Versus Nongamified Well-Being Intervention: An Exploratory Experiment

Gamification is a promising strategy to increase the effectiveness of Web-based mental health interventions by enhancing engagement. However, because most studies focus on the longer term effects of gamification (eg, effectiveness or adherence at the end of the intervention period), there is limited insight into how gamification may enhance engagement. Research implies that gamification has a direct impact at the time of use of the intervention, which changes the experience of the users, and thereby motivates users. However, it is unclear what this direct impact of gamification might be and how it can be measured