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Cited by 151Mobile Health and mHealth ApplicationsDigital Mental Health InterventionsInnovative Human-Technology Interaction

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

Open access
Asbjørnsen, Rikke Aune, Smedsrød, Mirjam Lien, Solberg Nes, Lise, Wentzel, Jobke, Varsi, Cecilie, Hjelmesæth, Jøran, van Gemert-Pijnen, Julia EWC·2019·Journal of Medical Internet Research
DOI 10.2196/14265PMC PMC6611151

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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.

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  • Multiple authors indicated that it is always important to use a systematic approach when planning and executing any sort of literature review to ensure completeness of the results.

    “multiple authors indicated that it is always important to use a systematic approach when planning and executing any sort of literature review to ensure completeness of the results”

    From Methods for Human-Centered eHealth Development: Narrative Scoping Review (2022) · cites this paper as [159]

  • Because many literature studies in the contextual inquiry have a broad setup, it is often not possible or desirable to include a quality appraisal or only include experimental studies.

    “Third, because many literature studies in the contextual inquiry have a broad setup, it is often not possible or desirable to include a quality appraisal or only include experimental studies.”

    From Methods for Human-Centered eHealth Development: Narrative Scoping Review (2022) · cites this paper as [159]

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Research works printed but not linked: 3

  1. [26]Fogg B Persuasive Technology: Using Computers To Change What We Think And Do 2002 San Francisco Morgan Kaufmann
  2. [32]Lehto T Oinas-Kukkonen H Persuasive features in six weight loss websites: a qualitative evaluation Persuasive Technology: 5th International Conference, Persuasive 2010, Copenhagen, Denmark, June 7-10, 2010, Proceedings (lecture Notes In Computer Science) 2019 Berlin Springer
  3. [40]Michie S Richardson M Johnston M Abraham C Francis J Hardeman W Eccles MP Cane J Wood CE The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions Ann Behav Med 2013 8 46 1 81 95 10.1007/s12160-013-9486-6 23512568 23512568 · DOI · Paper page

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Authors
Asbjørnsen, R. A., Smedsrød, M. L., Solberg Nes, L., Wentzel, J., Varsi, C., Hjelmesæth, J., & van Gemert-Pijnen, J. E.
Affiliations
  • Oslo University Hospital (NO)
  • Sørlandet Sykehus (NO)
  • Saxion (NL)
Corresponding author
Asbjørnsen, Rikke Aune
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2019-06-21
Volume
21
Issue
6
Pages
e14265
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/14265
PMC
PMC6611151
OpenAlex
W2943889054
Cited by
150
References
97
Citations by year
2026: 23 · 2025: 20 · 2024: 26 · 2023: 22 · 2022: 25 · 2021: 21 · 2020: 11 · 2019: 1
FWCI
2.67
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, cc-by)
  • University of Twente Research Information (publishedVersion, cc-by)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
  • University of Twente Research Information (submittedVersion, cc-by)
Funders
  • University of Twente
  • Sykehuset i Vestfold
Topics
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Physical Sciences › Computer Science › Human-Computer Interaction › Innovative Human-Technology Interaction
Keywords
weight loss maintenance, weight loss, digital health interventions, persuasive system design, behaviour change techniques, motivation, adherence, self-monitoring, feedback, goal setting, social support, mobile health, wearable activity trackers, digital scale, personalization, reward, habit formation, behaviour change theory, long-term weight maintenance, dietary habits, sleep behavior, physical activity, sedentary behavior
MeSH terms
Behavior Therapy, Electronics, Humans, Motivation, Persuasive Communication, Weight Loss, Telemedicine

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