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

Rikke A. Asbjornsen, Mirjam Lien Smedsrød, Lise Solberg Nes, Jobke Wentzel, Cecilie Varsi, Jøran Hjelmesæth, Lisette J.E.W.C. van Gemert-Pijnen

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

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.

Original languageEnglish
Article numbere14265
Number of pages23
JournalJournal of medical internet research
Volume21
Issue number6
DOIs
Publication statusPublished - 21 Jun 2019

Fingerprint

Motivation
Weight Loss
Maintenance
Health
Publications
Technology
Social Support
Weights and Measures
Cell Phones
Health Behavior
Reward
PubMed
MEDLINE
Habits
Cues

Keywords

  • Weight maintenance
  • Behavior change
  • Persuasive design
  • eHealth
  • Self-management
  • Health behaviors
  • Healthy lifestyle

Cite this

@article{992b6c053a1d49f38d2d9cb5a59dd8bf,
title = "Persuasive System Design Principles and Behavior Change Techniques to Stimulate Motivation and Adherence in Electronic Health Interventions to Support Weight Loss Maintenance: Scoping Review",
abstract = "Background: Maintaining weight after weight loss is a major health challenge, and eHealth (electronic health) solutions maybe a way to meet this challenge. Application of behavior change techniques (BCTs) and persuasive system design (PSD) principlesin eHealth development may contribute to the design of technologies that positively influence behavior and motivation to supportthe sustainable health behavior change needed.Objective: This review aimed to identify BCTs and PSD principles applied in eHealth interventions to support weight loss andweight loss maintenance, as well as techniques and principles applied to stimulate motivation and adherence for long-term weightloss 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 wasapplied. Publications on eHealth interventions were included if focusing on weight loss or weight loss maintenance, in combinationwith 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{\%}) focusedon 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 aswireless or digital scales (8/45, 18{\%}). All included publications were anchored in behavior change theories. Feedback andmonitoring 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 inweight loss maintenance than weight loss interventions. In both types of interventions, frequently applied persuasive principleswere self-monitoring, goal setting, and feedback. Tailoring, reminders, personalization, and rewards were additional principlesfrequently applied in weight loss maintenance interventions. Results did not reveal an ideal combination of techniques or principlesto stimulate motivation, adherence, and weight loss maintenance. However, the most frequently mentioned individual techniquesand principles applied to stimulate motivation were, personalization, simulation, praise, and feedback, whereas associations werefrequently mentioned to stimulate adherence. eHealth interventions that found significant effects for weight loss maintenance allapplied self-monitoring, feedback, goal setting, and shaping knowledge, combined with a human social support component tosupport healthy behaviors.Conclusions: To our knowledge, this is the first review examining key BCTs and PSD principles applied in weight lossmaintenance interventions compared with those of weight loss interventions. This review identified several techniques andprinciples applied to stimulate motivation and adherence. Future research should aim to examine which eHealth design combinationscan be the most effective in support of long-term behavior change and weight loss maintenance.",
keywords = "Weight maintenance, Behavior change, Persuasive design, eHealth, Self-management, Health behaviors, Healthy lifestyle",
author = "Asbjornsen, {Rikke A.} and Smedsr{\o}d, {Mirjam Lien} and {Solberg Nes}, Lise and Jobke Wentzel and Cecilie Varsi and J{\o}ran Hjelmes{\ae}th and {van Gemert-Pijnen}, {Lisette J.E.W.C.}",
year = "2019",
month = "6",
day = "21",
doi = "10.2196/14265",
language = "English",
volume = "21",
journal = "Journal of medical internet research",
issn = "1439-4456",
publisher = "JMIR Publications",
number = "6",

}

Persuasive System Design Principles and Behavior Change Techniques to Stimulate Motivation and Adherence in Electronic Health Interventions to Support Weight Loss Maintenance : Scoping Review. / Asbjornsen, Rikke A.; Smedsrød, Mirjam Lien; Solberg Nes, Lise; Wentzel, Jobke; Varsi, Cecilie; Hjelmesæth, Jøran ; van Gemert-Pijnen, Lisette J.E.W.C.

In: Journal of medical internet research, Vol. 21, No. 6, e14265, 21.06.2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Persuasive System Design Principles and Behavior Change Techniques to Stimulate Motivation and Adherence in Electronic Health Interventions to Support Weight Loss Maintenance

T2 - Scoping Review

AU - Asbjornsen, Rikke A.

AU - Smedsrød, Mirjam Lien

AU - Solberg Nes, Lise

AU - Wentzel, Jobke

AU - Varsi, Cecilie

AU - Hjelmesæth, Jøran

AU - van Gemert-Pijnen, Lisette J.E.W.C.

PY - 2019/6/21

Y1 - 2019/6/21

N2 - Background: Maintaining weight after weight loss is a major health challenge, and eHealth (electronic health) solutions maybe a way to meet this challenge. Application of behavior change techniques (BCTs) and persuasive system design (PSD) principlesin eHealth development may contribute to the design of technologies that positively influence behavior and motivation to supportthe sustainable health behavior change needed.Objective: This review aimed to identify BCTs and PSD principles applied in eHealth interventions to support weight loss andweight loss maintenance, as well as techniques and principles applied to stimulate motivation and adherence for long-term weightloss 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 wasapplied. Publications on eHealth interventions were included if focusing on weight loss or weight loss maintenance, in combinationwith 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%) focusedon 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 aswireless or digital scales (8/45, 18%). All included publications were anchored in behavior change theories. Feedback andmonitoring 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 inweight loss maintenance than weight loss interventions. In both types of interventions, frequently applied persuasive principleswere self-monitoring, goal setting, and feedback. Tailoring, reminders, personalization, and rewards were additional principlesfrequently applied in weight loss maintenance interventions. Results did not reveal an ideal combination of techniques or principlesto stimulate motivation, adherence, and weight loss maintenance. However, the most frequently mentioned individual techniquesand principles applied to stimulate motivation were, personalization, simulation, praise, and feedback, whereas associations werefrequently mentioned to stimulate adherence. eHealth interventions that found significant effects for weight loss maintenance allapplied self-monitoring, feedback, goal setting, and shaping knowledge, combined with a human social support component tosupport healthy behaviors.Conclusions: To our knowledge, this is the first review examining key BCTs and PSD principles applied in weight lossmaintenance interventions compared with those of weight loss interventions. This review identified several techniques andprinciples applied to stimulate motivation and adherence. Future research should aim to examine which eHealth design combinationscan be the most effective in support of long-term behavior change and weight loss maintenance.

AB - Background: Maintaining weight after weight loss is a major health challenge, and eHealth (electronic health) solutions maybe a way to meet this challenge. Application of behavior change techniques (BCTs) and persuasive system design (PSD) principlesin eHealth development may contribute to the design of technologies that positively influence behavior and motivation to supportthe sustainable health behavior change needed.Objective: This review aimed to identify BCTs and PSD principles applied in eHealth interventions to support weight loss andweight loss maintenance, as well as techniques and principles applied to stimulate motivation and adherence for long-term weightloss 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 wasapplied. Publications on eHealth interventions were included if focusing on weight loss or weight loss maintenance, in combinationwith 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%) focusedon 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 aswireless or digital scales (8/45, 18%). All included publications were anchored in behavior change theories. Feedback andmonitoring 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 inweight loss maintenance than weight loss interventions. In both types of interventions, frequently applied persuasive principleswere self-monitoring, goal setting, and feedback. Tailoring, reminders, personalization, and rewards were additional principlesfrequently applied in weight loss maintenance interventions. Results did not reveal an ideal combination of techniques or principlesto stimulate motivation, adherence, and weight loss maintenance. However, the most frequently mentioned individual techniquesand principles applied to stimulate motivation were, personalization, simulation, praise, and feedback, whereas associations werefrequently mentioned to stimulate adherence. eHealth interventions that found significant effects for weight loss maintenance allapplied self-monitoring, feedback, goal setting, and shaping knowledge, combined with a human social support component tosupport healthy behaviors.Conclusions: To our knowledge, this is the first review examining key BCTs and PSD principles applied in weight lossmaintenance interventions compared with those of weight loss interventions. This review identified several techniques andprinciples applied to stimulate motivation and adherence. Future research should aim to examine which eHealth design combinationscan be the most effective in support of long-term behavior change and weight loss maintenance.

KW - Weight maintenance

KW - Behavior change

KW - Persuasive design

KW - eHealth

KW - Self-management

KW - Health behaviors

KW - Healthy lifestyle

U2 - 10.2196/14265

DO - 10.2196/14265

M3 - Article

VL - 21

JO - Journal of medical internet research

JF - Journal of medical internet research

SN - 1439-4456

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M1 - e14265

ER -