Engaging Users in the Behavior Change Process With Digitalized Motivational Interviewing and Gamification: Development and Feasibility Testing of the Precious App

Abstract

Background Most adults do not engage in sufficient physical activity to maintain good health. Smartphone apps are increasingly used to support physical activity but typically focus on tracking behaviors with no support for the complex process of behavior change. Tracking features do not engage all users, and apps could better reach their targets by engaging users in reflecting their reasons, capabilities, and opportunities to change. Motivational interviewing supports this active engagement in self-reflection and self-regulation by fostering psychological needs proposed by the self-determination theory (ie, autonomy, competence, and relatedness). However, it is unknown whether digitalized motivational interviewing in a smartphone app engages users in this process. Objective This study aimed to describe the theory- and evidence-based development of the Precious app and to examine how digitalized motivational interviewing using a smartphone app engages users in the behavior change process. Specifically, we aimed to determine if use of the Precious app elicits change talk in participants and how they perceive autonomy support in the app. Methods A multidisciplinary team built the Precious app to support engagement in the behavior change process. The Precious app targets reflective processes with motivational interviewing and spontaneous processes with gamified tools, and builds on the principles of self-determination theory and control theory by using 7 relational techniques and 12 behavior change techniques. The feasibility of the app was tested among 12 adults, who were asked to interact with the prototype and think aloud. Semistructured interviews allowed participants to extend their statements. Participants’ interactions with the app were video recorded, transcribed, and analyzed with deductive thematic analysis to identify the theoretical themes related to autonomy support and change talk. Results Participants valued the autonomy supportive features in the Precious app (eg, freedom to pursue personally relevant goals and receive tailored feedback). We identified the following five themes based on the theory-based theme autonomy support: valuing the chance to choose, concern about lack of autonomy, expecting controlling features, autonomous goals, and autonomy supportive feedback. The motivational interviewing features actively engaged participants in reflecting their outcome goals and reasons for activity, producing several types of change talk and very little sustain talk. The types of change talk identified were desire, need, reasons, ability, commitment, and taking steps toward change. Conclusions The Precious app takes a unique approach to engage users in the behavior change process by targeting both reflective and spontaneous processes. It allows motivational interviewing in a mobile form, supports psychological needs with relational techniques, and targets intrinsic motivation with gamified elements. The motivational interviewing approach shows promise, but the impact of its interactive features and tailored feedback needs to be studied over time. The Precious app is undergoing testing in a series of n-of-1 randomized controlled trials.

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“…Engagement-based adaptation, common in digital and Internet behavioural treatment, adjusts the treatment to optimize a patient's participation or interaction with the intervention; these could include adjustments to increase either intrinsic or extrinsic (incentive-based) motivation. 76…”

“…Engagement-based adaptation, common in digital and Internet behavioural treatment, adjusts the treatment to optimize a patient’s participation or interaction with the intervention; these could include adjustments to increase either intrinsic or extrinsic (incentive-based) motivation. 76 Adaptive interventions are meant to maximize individual response in the short term by overcoming barriers to treatment engagement, and in the long term by early detection of clinical deterioration, leading to intensification or change of the intervention to strengthen response. The scientific motivation behind adaptive treatment is to optimize treatment capacity by providing the right amount of treatment at the right time, while eliminating treatment parameters that are not beneficial to an individual patient.…”

Smartphone‐Delivered Progressive Muscle Relaxation for the Treatment of Migraine in Primary Care: A Randomized Controlled Trial

“…Lastly, as with all mHealth studies, there should be continued work on how to improve adherence to the mHealth intervention. 47,48 Study Strengths.-This appears to be the first randomized controlled study to examine a scalable accessible form of PMR to help patients in the primary care setting. The study may shed light on this easy to access level A evidence-based migraine preventive therapy.…”

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“…Patient satisfaction is generally considered to be the most attenuated outcome measure for patient-centered mHealth technologies and thus can likely be assessed from a purely descriptive [69] quantitative point of view, devoid of any thematic nuancing that qualitative measures can afford. There are numerous quantitative measures available to evaluate patient satisfaction, although the validity and reliability of the instruments have been a point of debate [69][70][71][72][73][74][75][76][77][78][79][80]. Table 1 outlines a common pathway linking definitions with outcomes and methodologies.…”