Persuasive system design does matter: a systematic review of adherence to web-based interventions

• Published in: Journal of medical Internet research 2012-11, Vol.14 (6), p.e152-e152
• Main Authors: Kelders, Saskia M, Kok, Robin N, Ossebaard, Hans C, Van Gemert-Pijnen, Julia E W C
• Format: Article
• Language: English
• Subjects: Adherence; Computer based; Computer mediated communication; Employment; Feedback; Guideline Adherence; Health Behavior; Health care; Health promotion; Human-computer interaction; Humans; Information Storage and Retrieval; Internet; Intervention; Interventions; Literature reviews; Medicine; Multimedia; Original Paper; Persuasion; Persuasive Communication; Regression analysis; Social support; Systematic review; Systems design; Technology; User behaviour; Web site design
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/jmir.2104

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. 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. 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. 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