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How to Increase Reach and Adherence of Web-Based Interventions: A Design Research Viewpoint.

Ludden GD, van Rompay TJ, Kelders SM, van Gemert-Pijnen JE - J. Med. Internet Res. (2015)

Bottom Line: However, analyses of current Web-based interventions show that many systems are only used by a specific group of users (eg, women, highly educated), and that even they often do not persist and drop out as the intervention unfolds.In this paper, we assess the impact of design features of Web-based interventions on reach and adherence and conclude that the power that design can have has not been used to its full potential.Finally, we discuss the future of persuasive eHealth interventions and suggest avenues for follow-up research.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Design, Faculty of Engineering Technology, University of Twente, Enschede, Netherlands. g.d.s.ludden@utwente.nl.

ABSTRACT
Nowadays, technology is increasingly used to increase people's well-being. For example, many mobile and Web-based apps have been developed that can support people to become mentally fit or to manage their daily diet. However, analyses of current Web-based interventions show that many systems are only used by a specific group of users (eg, women, highly educated), and that even they often do not persist and drop out as the intervention unfolds. In this paper, we assess the impact of design features of Web-based interventions on reach and adherence and conclude that the power that design can have has not been used to its full potential. We propose looking at design research as a source of inspiration for new (to the field) design approaches. The paper goes on to specify and discuss three of these approaches: personalization, ambient information, and use of metaphors. Central to our viewpoint is the role of positive affect triggered by well-designed persuasive features to boost adherence and well-being. Finally, we discuss the future of persuasive eHealth interventions and suggest avenues for follow-up research.

No MeSH data available.


The Web-based intervention, Down Your Drink.
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Related In: Results  -  Collection

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figure2: The Web-based intervention, Down Your Drink.

Mentions: To further illustrate how low adherence may follow from ill-suited design, consider the Web-based intervention in Figure 2, aimed at reducing alcohol consumption. This intervention consists of six lessons, which are intended to be completed during 6 weeks [24,25]. Although some of the capabilities of technology are employed (eg, the provision of tailored feedback), the intervention is text based and technology seems to be mostly used as a medium to deliver the text. An analysis revealed that only 16.5% (of the first 10,000 registered users of the intervention) completed all 6 weeks of this intervention. A reason for nonadherence may well relate to a lack of attention to design and the resulting dissatisfying user experience. Limited reach of mobile and Web-based interventions could be explained by the fact that many of these interventions are aimed at a wide demographic group (eg, men and women, young and old, highly and less educated). Think, for example, of the range of track-and-trace systems aimed at keeping a healthy diet, losing weight, or increasing physical activity (eg, Lifesum, LosIt, MyFitnessPal). However, as we have argued in our introduction, most interventions reach a limited group only, mainly highly educated women—see, for example, Kelders et al [15]. In one way, this is a good thing, since this group in particular can be hard to reach with traditional treatment. However, this selective reach is not intended and, in many cases, seems to strengthen the "inverse care and information law" (ie, people in urgent need for care are the ones who are least likely to receive care [26,27]).


How to Increase Reach and Adherence of Web-Based Interventions: A Design Research Viewpoint.

Ludden GD, van Rompay TJ, Kelders SM, van Gemert-Pijnen JE - J. Med. Internet Res. (2015)

The Web-based intervention, Down Your Drink.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4526989&req=5

figure2: The Web-based intervention, Down Your Drink.
Mentions: To further illustrate how low adherence may follow from ill-suited design, consider the Web-based intervention in Figure 2, aimed at reducing alcohol consumption. This intervention consists of six lessons, which are intended to be completed during 6 weeks [24,25]. Although some of the capabilities of technology are employed (eg, the provision of tailored feedback), the intervention is text based and technology seems to be mostly used as a medium to deliver the text. An analysis revealed that only 16.5% (of the first 10,000 registered users of the intervention) completed all 6 weeks of this intervention. A reason for nonadherence may well relate to a lack of attention to design and the resulting dissatisfying user experience. Limited reach of mobile and Web-based interventions could be explained by the fact that many of these interventions are aimed at a wide demographic group (eg, men and women, young and old, highly and less educated). Think, for example, of the range of track-and-trace systems aimed at keeping a healthy diet, losing weight, or increasing physical activity (eg, Lifesum, LosIt, MyFitnessPal). However, as we have argued in our introduction, most interventions reach a limited group only, mainly highly educated women—see, for example, Kelders et al [15]. In one way, this is a good thing, since this group in particular can be hard to reach with traditional treatment. However, this selective reach is not intended and, in many cases, seems to strengthen the "inverse care and information law" (ie, people in urgent need for care are the ones who are least likely to receive care [26,27]).

Bottom Line: However, analyses of current Web-based interventions show that many systems are only used by a specific group of users (eg, women, highly educated), and that even they often do not persist and drop out as the intervention unfolds.In this paper, we assess the impact of design features of Web-based interventions on reach and adherence and conclude that the power that design can have has not been used to its full potential.Finally, we discuss the future of persuasive eHealth interventions and suggest avenues for follow-up research.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Design, Faculty of Engineering Technology, University of Twente, Enschede, Netherlands. g.d.s.ludden@utwente.nl.

ABSTRACT
Nowadays, technology is increasingly used to increase people's well-being. For example, many mobile and Web-based apps have been developed that can support people to become mentally fit or to manage their daily diet. However, analyses of current Web-based interventions show that many systems are only used by a specific group of users (eg, women, highly educated), and that even they often do not persist and drop out as the intervention unfolds. In this paper, we assess the impact of design features of Web-based interventions on reach and adherence and conclude that the power that design can have has not been used to its full potential. We propose looking at design research as a source of inspiration for new (to the field) design approaches. The paper goes on to specify and discuss three of these approaches: personalization, ambient information, and use of metaphors. Central to our viewpoint is the role of positive affect triggered by well-designed persuasive features to boost adherence and well-being. Finally, we discuss the future of persuasive eHealth interventions and suggest avenues for follow-up research.

No MeSH data available.