Persuasive System Design Principles and Behavior Change Techniques to Stimulate Motivation and Adherence in Electronic Health Interventions to Support Weight Loss Maintenance: Scoping Review

BACKGROUND Maintaining weight after weight loss is a major health challenge, and eHealth (electronic health) solutions may be a way to meet this challenge. Application of behavior change techniques (BCTs) and persuasive system design (PSD) principles in eHealth development may contribute to the design of technologies that positively influence behavior and motivation to support the sustainable health behavior change needed. OBJECTIVE This review aimed to identify BCTs and PSD principles applied in eHealth interventions to support weight loss and weight loss maintenance, as well as techniques and principles applied to stimulate motivation and adherence for long-term weight loss maintenance. METHODS A systematic literature search was conducted in PsycINFO, Ovid MEDLINE (including PubMed), EMBASE, Scopus, Web of Science, and AMED, from January 1, 2007 to June 30, 2018. Arksey and O’Malley’s scoping review methodology was applied. Publications on eHealth interventions were included if focusing on weight loss or weight loss maintenance, in combination with motivation or adherence and behavior change. RESULTS The search identified 317 publications, of which 45 met the inclusion criteria. Of the 45 publications, 11 (24%) focused on weight loss maintenance, and 34 (76%) focused on weight loss. Mobile phones were the most frequently used technology (28/45, 62%). Frequently used wearables were activity trackers (14/45, 31%), as well as other monitoring technologies such as wireless or digital scales (8/45, 18%). All included publications were anchored in behavior change theories. Feedback and monitoring and goals and planning were core behavior change technique clusters applied in the majority of included publications. Social support and associations through prompts and cues to support and maintain new habits were more frequently used in weight loss maintenance than weight loss interventions. In both types of interventions, frequently applied persuasive principles were self-monitoring, goal setting, and feedback. Tailoring, reminders, personalization, and rewards were additional principles frequently applied in weight loss maintenance interventions. Results did not reveal an ideal combination of techniques or principles to stimulate motivation, adherence, and weight loss maintenance. However, the most frequently mentioned individual techniques and principles applied to stimulate motivation were, personalization, simulation, praise, and feedback, whereas associations were frequently mentioned to stimulate adherence. eHealth interventions that found significant effects for weight loss maintenance all applied self-monitoring, feedback, goal setting, and shaping knowledge, combined with a human social support component to support healthy behaviors. CONCLUSIONS To our knowledge, this is the first review examining key BCTs and PSD principles applied in weight loss maintenance interventions compared with those of weight loss interventions. This review identified several techniques and principles applied to stimulate motivation and adherence. Future research should aim to examine which eHealth design combinations can be the most effective in support of long-term behavior change and weight loss maintenance.

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Identifying Persuasive Design Principles and Behavior Change Techniques Supporting End User Values and Needs in eHealth Interventions for Long-Term Weight Loss Maintenance: Qualitative Study (Preprint)

10.2196/preprints.22598 ◽

2020 ◽

Author(s):

Rikke Aune Asbjørnsen ◽

Jobke Wentzel ◽

Mirjam Lien Smedsrød ◽

Jøran Hjelmesæth ◽

Matthew M Clark ◽

...

Keyword(s):

Weight Loss ◽

Behavior Change ◽

Weight Loss Maintenance ◽

End User ◽

Behavior Change Techniques ◽

Design Elements ◽

Healthy Behaviors ◽

Key Stakeholders ◽

And Behavior

BACKGROUND An increasing number of eHealth interventions aim to support healthy behaviors that facilitate weight loss. However, there is limited evidence of the effectiveness of the interventions and little focus on weight loss maintenance. Knowledge about end user values and needs is essential to create meaningful and effective eHealth interventions, and to identify persuasive system design (PSD) principles and behavior change techniques (BCTs) that may contribute to the behavior change required for successful long-term weight loss maintenance. OBJECTIVE This study aimed to provide insight into the design of eHealth interventions supporting behavior change for long-term weight maintenance. The study sought to identify the values and needs of people with obesity aiming to maintain weight after weight loss, and to identify PSD principles, BCTs, and design requirements that potentially enable an eHealth intervention to meet end user values and needs. METHODS This study presents the concept of integrating PSD principles and BCTs into the design process of eHealth interventions to meet user values and needs. In this study, individual interviews and focus groups were conducted with people with obesity (n=23) and other key stakeholders (n=27) to explore end user values and needs related to weight loss maintenance. Design thinking methods were applied during the focus group sessions to identify design elements and to explore how eHealth solutions can support the needs to achieve sustainable weight loss maintenance. The PSD model and behavior change taxonomy by Michie were used to identify PSD principles and BCT clusters to meet end user values and needs. RESULTS A total of 8 key end user values were identified, reflecting user needs for weight loss maintenance support: self-management, personalized care, autonomy, feel supported, positive self-image, motivation, happiness, and health. Goals and planning, feedback and monitoring, repetition and substitution, shaping knowledge, social support, identity, and self-belief were some of the BCT clusters identified to address these concepts, together with PSD principles such as personalization, tailoring, self-monitoring, praise, and suggestions. CONCLUSIONS The process of translating end user values and needs into design elements or features of eHealth technologies is an important part of the design process. To our knowledge, this is the first study to explore how PSD principles and BCTs can be integrated when designing eHealth self-management interventions for long-term weight loss maintenance. End users and other key stakeholders highlighted important factors to be considered in the design of eHealth interventions supporting sustained behavior change. The PSD principles and BCTs identified provide insights and suggestions about design elements and features to include for supporting weight loss maintenance. The findings indicate that a combination of BCTs and PSD principles may be needed in evidence-based eHealth interventions to stimulate motivation and adherence to support healthy behaviors and sustained weight loss maintenance. CLINICALTRIAL ClinicalTrials.gov NCT04537988; https://clinicaltrials.gov/ct2/show/NCT04537988

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Identifying Persuasive Design Principles and Behavior Change Techniques Supporting End User Values and Needs in eHealth Interventions for Long-Term Weight Loss Maintenance: Qualitative Study

Journal of Medical Internet Research ◽

10.2196/22598 ◽

2020 ◽

Vol 22 (11) ◽

pp. e22598

Author(s):

Rikke Aune Asbjørnsen ◽

Jobke Wentzel ◽

Mirjam Lien Smedsrød ◽

Jøran Hjelmesæth ◽

Matthew M Clark ◽

...

Keyword(s):

Weight Loss ◽

Behavior Change ◽

Weight Loss Maintenance ◽

End User ◽

Behavior Change Techniques ◽

Design Elements ◽

Healthy Behaviors ◽

Key Stakeholders ◽

And Behavior

Background An increasing number of eHealth interventions aim to support healthy behaviors that facilitate weight loss. However, there is limited evidence of the effectiveness of the interventions and little focus on weight loss maintenance. Knowledge about end user values and needs is essential to create meaningful and effective eHealth interventions, and to identify persuasive system design (PSD) principles and behavior change techniques (BCTs) that may contribute to the behavior change required for successful long-term weight loss maintenance. Objective This study aimed to provide insight into the design of eHealth interventions supporting behavior change for long-term weight maintenance. The study sought to identify the values and needs of people with obesity aiming to maintain weight after weight loss, and to identify PSD principles, BCTs, and design requirements that potentially enable an eHealth intervention to meet end user values and needs. Methods This study presents the concept of integrating PSD principles and BCTs into the design process of eHealth interventions to meet user values and needs. In this study, individual interviews and focus groups were conducted with people with obesity (n=23) and other key stakeholders (n=27) to explore end user values and needs related to weight loss maintenance. Design thinking methods were applied during the focus group sessions to identify design elements and to explore how eHealth solutions can support the needs to achieve sustainable weight loss maintenance. The PSD model and behavior change taxonomy by Michie were used to identify PSD principles and BCT clusters to meet end user values and needs. Results A total of 8 key end user values were identified, reflecting user needs for weight loss maintenance support: self-management, personalized care, autonomy, feel supported, positive self-image, motivation, happiness, and health. Goals and planning, feedback and monitoring, repetition and substitution, shaping knowledge, social support, identity, and self-belief were some of the BCT clusters identified to address these concepts, together with PSD principles such as personalization, tailoring, self-monitoring, praise, and suggestions. Conclusions The process of translating end user values and needs into design elements or features of eHealth technologies is an important part of the design process. To our knowledge, this is the first study to explore how PSD principles and BCTs can be integrated when designing eHealth self-management interventions for long-term weight loss maintenance. End users and other key stakeholders highlighted important factors to be considered in the design of eHealth interventions supporting sustained behavior change. The PSD principles and BCTs identified provide insights and suggestions about design elements and features to include for supporting weight loss maintenance. The findings indicate that a combination of BCTs and PSD principles may be needed in evidence-based eHealth interventions to stimulate motivation and adherence to support healthy behaviors and sustained weight loss maintenance. Trial Registration ClinicalTrials.gov NCT04537988; https://clinicaltrials.gov/ct2/show/NCT04537988

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Clinical Effectiveness of Weight Loss and Weight Maintenance Interventions for Men: A Systematic Review of Men-Only Randomized Controlled Trials (The ROMEO Project)

American Journal of Men s Health ◽

10.1177/1557988315587550 ◽

2015 ◽

Vol 11 (4) ◽

pp. 1096-1123 ◽

Cited By ~ 13

Author(s):

Clare Robertson ◽

Alison Avenell ◽

Fiona Stewart ◽

Daryll Archibald ◽

Flora Douglas ◽

...

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Weight Loss ◽

Confidence Interval ◽

Behavior Change ◽

Randomized Controlled Trials ◽

Controlled Trials ◽

Behavior Change Techniques ◽

Randomized Controlled ◽

And Behavior

Men are underrepresented in obesity services, suggesting current weight loss service provision is suboptimal. This systematic review evaluated evidence-based strategies for treating obesity in men. Eight bibliographic databases and four clinical trials’ registers were searched to identify randomized controlled trials (RCTs) of weight loss interventions in men only, with mean/median body mass index of ≥30 kg/m2 (or ≥28 kg/m2 with cardiac risk factors), with a minimum mean/median duration of ≥52 weeks. Interventions included diet, physical activity, behavior change techniques, orlistat, or combinations of these; compared against each other, placebo, or a no intervention control group; in any setting. Twenty-one reports from 14 RCTs were identified. Reducing diets produced more favorable weight loss than physical activity alone (mean weight change after 1 year from a reducing diet compared with an exercise program −3.2 kg, 95% confidence interval −4.8 to −1.6 kg, reported p < .01). The most effective interventions combined reducing diets, exercise, and behavior change techniques (mean difference in weight at 1 year compared with no intervention was −4.9 kg, 95% confidence interval −5.9 to −4.0, reported p < .0001). Group interventions produced favorable weight loss results. The average reported participant retention rate was 78.2%, ranging from 44% to 100% retention, indicating that, once engaged, men remained committed to a weight loss intervention. Weight loss for men is best achieved and maintained with the combination of a reducing diet, increased physical activity, and behavior change techniques. Strategies to increase engagement of men with weight loss services to improve the reach of interventions are needed.

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Integrating Taxonomies Into Theory-Based Digital Health Interventions for Behavior Change: A Holistic Framework (Preprint)

10.2196/preprints.8055 ◽

2017 ◽

Author(s):

Yunlong Wang ◽

Ahmed Fadhil ◽

Jan-Philipp Lange ◽

Harald Reiterer

Keyword(s):

Behavior Change ◽

System Design ◽

Systematic Reviews ◽

Digital Health ◽

Design Principles ◽

Health Interventions ◽

Change Technique ◽

Behavioral Theories ◽

Interdisciplinary Nature ◽

Behavior Change Technique

UNSTRUCTURED Digital health interventions (DHIs) have been emerging in the last decade. Due to their interdisciplinary nature, DHIs are guided and influenced by theories (eg, behavioral theories, behavior change technologies, and persuasive technology) from different research communities. However, DHIs are always coded using various taxonomies and reported in insufficient perspectives. This inconsistency and incomprehensiveness will cause difficulty in conducting systematic reviews and sharing contributions among communities. Therefore, based on existing related work, we propose a holistic framework that embeds behavioral theories, behavior change technique taxonomy, and persuasive system design principles. Including four development steps, two toolboxes, and one workflow, our framework aims to guide DHI developers to design, evaluate, and report their work in a formative and comprehensive way.

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Barriers and Facilitators That Influence Providers’ Ability to Educate, Monitor, and Treat Substance Use in First-Episode Psychosis Programs Using the Theoretical Domains Framework

Qualitative Health Research ◽

10.1177/1049732321993443 ◽

2021 ◽

pp. 104973232199344

Author(s):

Oladunni Oluwoye ◽

Elizabeth Fraser

Keyword(s):

Substance Use ◽

Behavior Change ◽

Theoretical Domains Framework ◽

First Episode Psychosis ◽

Barriers And Facilitators ◽

First Episode ◽

Evidence Based ◽

Behavior Change Techniques ◽

Episode Psychosis ◽

And Behavior

In this qualitative study, we explore providers’ experiences with addressing substance use among individuals with first-episode psychosis (FEP) enrolled in coordinated specialty care (CSC) programs. Three focus groups were conducted with 24 providers from CSC programs for FEP in Washington. Questions were focused on barriers and facilitators to addressing substance use using the Theoretical Domains Framework (TDF) as a guide. Thematic analysis was used to code all transcripts. Identified TDF domains were then mapped onto the COM-B (Capability, Opportunity, Motivation, Behavior) intervention functions and behavior change techniques. Seven theoretical domains were identified as the most relevant to addressing substance use: “Knowledge,” “Skills,” “Environmental Context and Resources,” “Social Influences,” “Social and Professional Role and Identity,” “Beliefs about Capabilities,” and “Reinforcement.” The use of the TDF provides a framework to explore barriers and facilitators for targeting substance use and suggestions for behavior change techniques when considering implementation of evidence-based strategies to enhance CSC models.

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Motivating Adolescents to Participate in Literacy Intervention: A Case Example From Telepractice

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2021_persp-21-00071 ◽

2021 ◽

pp. 1-15

Author(s):

Ginger G. Collins

Keyword(s):

Behavior Change ◽

Self Determination Theory ◽

Literacy Skills ◽

Language Intervention ◽

Self Determination ◽

Literacy Intervention ◽

Behavior Change Techniques ◽

Language Interventions ◽

And Behavior ◽

Motivation To Participate

Purpose: Motivation declines as children reach adolescence. Poor motivation inhibits participation and engagement in language-based interventions. The purpose of this tutorial is to demonstrate how intervention can be designed to increase client motivation to participate while improving language-based literacy skills. Method: Motivation and behavior change techniques based on self-determination theory are presented, as are examples of how to integrate these techniques into contextualized language intervention with adolescent clients. Conclusion: Incorporating motivation and behavior change techniques into contextualized language interventions with adolescents promotes self-determination and motivation through satisfaction of their need for autonomy, relatedness, and competence while simultaneously addressing language-based literacy deficits.

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Effectiveness of behavioral interventions and behavior change techniques for reducing soft drink intake in disadvantaged adolescents: A systematic review and meta‐analysis

Obesity Science & Practice ◽

10.1002/osp4.452 ◽

2020 ◽

Vol 6 (6) ◽

pp. 708-734

Author(s):

S. S. Shagiwal ◽

E. Groenestein ◽

A. Schop‐Etman ◽

J. Jongerling ◽

J. Waal ◽

...

Keyword(s):

Systematic Review ◽

Behavior Change ◽

Behavioral Interventions ◽

Soft Drink ◽

Meta Analysis ◽

Behavior Change Techniques ◽

And Behavior

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Improving Attendance and Behavior Change in a Weight Loss Program for Veterans: Feasibility and Acceptability of the HERO Intervention

Cognitive and Behavioral Practice ◽

10.1016/j.cbpra.2019.07.008 ◽

2020 ◽

Vol 27 (2) ◽

pp. 136-148

Author(s):

Gina Evans-Hudnall ◽

Elyse Thakur ◽

Amy Amspoker ◽

Patricia Dubbert ◽

Lisa H. Trahan ◽

...

Keyword(s):

Weight Loss ◽

Behavior Change ◽

Weight Loss Program ◽

And Behavior

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Multiple Health Behavior Change for Weight Loss: A Scoping Review

American Journal of Health Behavior ◽

10.5993/ajhb.44.5.2 ◽

2020 ◽

Vol 44 (5) ◽

pp. 559-571

Author(s):

Megan S. Maisano ◽

Eleanor T. Shonkoff ◽

Sara C. Folta

Keyword(s):

Weight Loss ◽

Health Behavior ◽

Behavior Change ◽

Scoping Review ◽

Transtheoretical Model ◽

Cognitive Theory ◽

Health Behavior Change ◽

Risk Level ◽

Multiple Health Behavior Change ◽

Multiple Health

Objectives: In this scoping review, we examine the current state of literature on weight-related Multiple Health Behavior Change (MHBC). Specifically, we investigate: (1) MHBC versus single health behavior change (SHBC) interventions and (2) simultaneous versus sequential MHBC approaches. Secondarily, we explore (3) attributes that predict success in MHBC, and (4) the utilization of theoretical frameworks. Methods: We retrieved studies from PubMed, Web of Science, and Google Scholar within the 2000 to 2018 range. Results: MHBC interventions proved superior for long-term weight loss when compared to SHBC approaches. However, the literature is limited. Studies investigating simultaneous and sequential MHBC approaches are also limited and have mixed results. Predictive characteristics of MHBC include behavior adherence, risk level, stage of change, self-efficacy, social support, environmental barriers, and treatment approaches. Whereas evidence evaluating theory in MHBC programs remains scant, there is promising research on constructs from the Transtheoretical Model and Social Cognitive Theory. Conclusions: MHBC approaches may better support weight loss efforts. However, further research is needed to understand the effects of behavior change order and timing, predictive features of participants and interventions, and theoretical framework utilization in these weight-loss programs.

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