A systematic review of nudge theories and strategies used to influence adult health behaviour and outcome in diabetes management

Kwan, Yu Heng; Cheng, Tuoyuan; Yoon, Sungwon; Ho, Li-Hsien; Huang, Caleb; Chew, Eng‐Hui; Thumboo, Julian; Østbye, Truls; Low, Lian Leng

doi:10.1016/j.diabet.2020.04.002

Cited by 73 publications

(71 citation statements)

References 52 publications

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“…The codes were independently applied to all transcripts, and coding discrepancies were resolved by iterative discussions. Lastly, for mHealth features, themes were mapped against the nudge strategies to assess participants' preferences for particular features and their reasoning [34]. For rigor and transparency, we anchored our methodology according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist (Multimedia Appendix 1) [37].…”

Section: Discussionmentioning

confidence: 99%

“…During the interview, various visual materials, collated from existing mHealth app features for wellness promotion, were presented to facilitate the discussion. These materials were organized according to key nudge strategies commonly used for mHealth app development [33,34]. They included, but were not limited to, the following strategies: framing, tailoring, reminders, social influence, guidance, social modeling, gamification, and resources [19].…”

Section: Data Collectionmentioning

confidence: 99%

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Perceptions of Mobile Health Apps and Features to Support Psychosocial Well-being Among Frontline Health Care Workers Involved in the COVID-19 Pandemic Response: Qualitative Study

Yoon¹,

Goh²,

Nadarajan³

et al. 2021

J Med Internet Res

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Background Frontline health care workers are experiencing a myriad of physical and psychosocial challenges amid the COVID-19 pandemic. There is growing recognition that digital technologies have the potential to improve the well-being of frontline workers. However, there has been limited development of wellness interventions using mobile health (mHealth) technology. More importantly, little research has been conducted on how frontline workers perceive mHealth-based support to promote their well-being. Objective This study aimed to explore frontline workers’ experience of conventional psychological wellness programs and their perceptions of the usefulness of mHealth apps and features for promoting well-being. It also sought to identify factors that could potentially influence uptake and retention of an mHealth-based wellness program. Methods We conducted semistructured interviews using purposive sampling with frontline workers involved in the COVID-19 response. Various visual materials, collated from existing mHealth app features, were presented to facilitate discussion. Interviews were audio-recorded and transcribed verbatim. Thematic analysis based on grounded theory was undertaken. Themes were subsequently mapped to key nudge strategies—those commonly used for mHealth development—to assess participants’ preferences for particular features and their reasoning. Results A total of 42 frontline workers participated in 12 one-on-one interviews or focus group discussions. Frontline workers generally had a limited ability to identify their own psychological problems and liked the reminders functionality of the app to track their mood over time. A personalized goal-setting feature (ie, tailoring) and in-app resources were generally valued, while frequent coaching and messages (ie, framing) were seen as a distraction. The majority of participants desired a built-in chat function with a counselor (ie, guidance) for reasons of accessibility and protection of privacy. Very few participants appreciated a gamification function. Frontline workers commonly reported the need for ongoing social support and desired access to an in-app peer support community (ie, social influence). There were, however, concerns regarding potential risks from virtual peer interactions. Intrinsic motivational factors, mHealth app technicality, and tangible rewards were identified as critical for uptake and retention. Conclusions Our study highlights the potential of mHealth apps with relevant features to be used as wellness tools by frontline health care workers. Future work should focus on developing a nonintrusive and personalized mHealth app with in-app counseling, peer support to improve well-being, and tangible and extrinsic rewards to foster continued use.

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Section: Discussionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Perceptions of Mobile Health Apps and Features to Support Psychosocial Well-being Among Frontline Health Care Workers Involved in the COVID-19 Pandemic Response: Qualitative Study

Yoon¹,

Goh²,

Nadarajan³

et al. 2021

J Med Internet Res

View full text Add to dashboard Cite

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“…HCPs were also prompted to indicate any missing features that were essential to self-management in patients with diabetes but was not discussed. The prototype mHealth platform, guided by behavioral change wheel ( 37 ) and nudge theory ( 38 ), consists of 5 key features: daily logs and report for diet, physical activity, blood glucose and medication; personalized nudges and reminders generated based on user’s inputs; gamification; goal setting; and educational resources. In addition, we presented several visual materials collated from existing mHealth app features.…”

Section: Methodsmentioning

confidence: 99%

Healthcare Professionals’ Views of Factors Influencing Diabetes Self-Management and the Utility of a mHealth Application and Its Features to Support Self-Care

Yoon

Kwan

et al. 2022

Front. Endocrinol.

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IntroductionThe perspectives of healthcare professionals (HCPs) are pivotal to co-development of self-management strategies for patients with diabetes. However, literature has been largely limited to perspectives of patients within the context of a Western healthcare setting. This study aims to explore factors influencing diabetes self-management in adult patients with diabetes from the perspectives of HCPs and their views of the value of mHealth application for diabetes self-management.Materials and MethodsWe conducted focus group discussions (FGD) with purposively selected HCPs in Singapore. All FGDs were audio-recorded and transcribed verbatim. Thematic analysis was conducted using NVivo 12.ResultsA total of 56 HCPs participated in the study. Barriers to self-management included limited patient commitment to lifestyle changes, suboptimal adherence to medication and treatment, patient resistance to insulin initiation and insufficient rapport between patients and HCPs. Patients’ perceived susceptibility to complications, social support from family and community, multidisciplinary team care and patient’s understanding of the benefits of self-care were viewed as facilitating self-management. HCPs saw mHealth apps as a vital opportunity to engage patients in the self-management of conditions and empower them to foster behavior changes. Yet, there were concerns regarding patient’s limited digital literacy, lack of integration into routine electronic system and reluctance.DiscussionWe identified a set of factors influencing self-management in adult patients with diabetes and useful app features that can empower patients to manage their conditions. Findings will inform the development of a mHealth application, and its features designed to improve self-care.

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“…Carey et al provide a website where app developers and change agents can find links between behavior change theories and mechanisms of action [40]. Although this is an excellent service, using behavior change theories that have already been proven for a particular disease may be a much better approach than trying to pick theories based on conjecture or putative mechanisms of action [41,42].…”

Section: Health Behavior Change Is a Critical Component Of Mhealth Appsmentioning

confidence: 99%

Designing Disease-Specific mHealth Apps for Clinical Value

Keshavjee¹,

Johnston-Jewell²,

Lee³

et al. 2022

Smart and Pervasive Healthcare

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mHealth apps for patient use are promising but continue to face a plateau in usage. Current apps work for a limited segment of the patient population, i.e., those who enjoy tracking for intrinsic rewards. There are many opportunities to support patient care in between health care provider visits that are not currently being met for many diseases and patient types (personas). This is an area of great potential growth for mHealth apps and could contribute greatly to patient health and wellness. In this chapter, we propose a framework for how to think about the between-visit needs of patients that would motivate continued use of mhealth apps. We view the app design process from the following perspectives: 1) disease-specific needs, 2) non-disease specific needs, 3) behavioral theoretical aspects of app usage and 4) app-intrinsic usage motivators. Myasthenia gravis serves as the use case for illustrating these perspectives and how to use them in designing a disease-specific mHealth app.

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A systematic review of nudge theories and strategies used to influence adult health behaviour and outcome in diabetes management

Cited by 73 publications

References 52 publications

Perceptions of Mobile Health Apps and Features to Support Psychosocial Well-being Among Frontline Health Care Workers Involved in the COVID-19 Pandemic Response: Qualitative Study

Perceptions of Mobile Health Apps and Features to Support Psychosocial Well-being Among Frontline Health Care Workers Involved in the COVID-19 Pandemic Response: Qualitative Study

Healthcare Professionals’ Views of Factors Influencing Diabetes Self-Management and the Utility of a mHealth Application and Its Features to Support Self-Care

Designing Disease-Specific mHealth Apps for Clinical Value

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