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Predicting user adherence to behavioral eHealth interventions in the real world: examining which aspects of intervention design matter most
Abstract
Existing frameworks have identified a range of intervention design features that may facilitate adherence to eHealth interventions; however, empirical data are lacking on whether intervention design features can predict user adherence in the real world-where the public access available tools-and whether some design aspects of behavioral eHealth interventions are more important than others in predicting adherence. This study examined whether intervention design qualities predict user adherence to behavioral eHealth interventions in real-world use and which qualities matter the most. We correlated the online activities of users of 30 web-based behavioral interventions-collected from a proprietary data set of anonymized logs from consenting users of Microsoft Internet Explorer add-on-with interventions' quality ratings obtained by trained raters prior to empirical examination. The quality ratings included: Usability, Visual Design, User Engagement, Content, Therapeutic Persuasiveness (i.e., persuasive design and incorporation of behavior change techniques), and Therapeutic Alliance. We found Therapeutic Persuasiveness (i.e., the incorporation of persuasive design/behavior change principles) to be the most robust predictor of adherence (i.e., duration of use, number of unique sessions; 40 ≤ rs ≤ .58, ps ≤ .005), explaining 42% of the variance in user adherence in our regression model. Results indicated up to six times difference in the percentage of users utilizing the interventions for more than a minimum amount of time and sessions based on Therapeutic Persuasiveness. Findings suggest the importance of persuasive design and behavior change techniques incorporation during the design and evaluation of digital behavioral interventions.
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“However, the scope of IMIs seems to be limited by a low uptake and intervention adherence of individuals (Baumel and Yom-Tov, 2018; Baumel et al., 2017).”
From Feasibility of a Software agent providing a brief Intervention for Self-help to Uplift psychological wellbeing (“SISU”). A single-group pretest-posttest trial investigating the potential of SISU to act as therapeutic agent (2021) · cites this paper as Baumel and Yom-Tov, 2018
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Knauer, J., Baumeister, H., Schmitt, A., & Terhorst, Y. (2024) · Frontiers in Digital Health · doi:10.3389/fdgth.2024.1352762 · Cited by 2
“Within this context, user engagement and usability play a crucial role, warranting further investigation into personal habits that may facilitate the utilization of smart sensing (85, 86).”
BackgroundBaumel, A., & Aderka, I. M. (2025) · JMIR Research Protocols · doi:10.2196/71238 · Cited by 2
Self-citationChanging Behavior Using Control Theory
Mansell, W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.009 · Cited by 11
Metadata
- Authors
- Baumel, A., & Yom-Tov, E.
- Affiliations
- Northwell Health (US)
- Microsoft Research, Herzeliya, Israel
- Corresponding author
- Baumel, Amit
- ORCID
- Baumel, Amit
- Venue
- Translational Behavioral Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-02-17
- Volume
- 8
- Issue
- 5
- Pages
- 793-798
- ISSN
- 1613-9860 (ISSN-L)
- 1869-6716
- OpenAlex
- W2790152727
- Cited by
- 128
- References
- 32
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 14 · 2023: 8 · 2022: 6 · 2021: 14 · 2020: 59 · 2019: 10 · 2018: 3
- FWCI
- 27.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Translational Behavioral Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Physical Sciences › Computer Science › Human-Computer Interaction › Innovative Human-Technology Interaction
- Keywords
- user adherence, intervention design, persuasive design, behaviour change techniques, therapeutic relationship, usability, user engagement, online intervention, real-world applications
- MeSH terms
- Therapeutic Alliance, Adult, Behavior Therapy, Mental Disorders, Humans, Outcome and Process Assessment, Health Care, Patient Compliance, Persuasive Communication, Telemedicine, Internet
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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