Identifying Persuasive Design Principles and Behavior Change Techniques Supporting End User Values and Needs in eHealth Interventions for Long-Term Weight Loss Maintenance: Qualitative Study

Abstract

Background An increasing number of eHealth interventions aim to support healthy behaviors that facilitate weight loss. However, there is limited evidence of the effectiveness of the interventions and little focus on weight loss maintenance. Knowledge about end user values and needs is essential to create meaningful and effective eHealth interventions, and to identify persuasive system design (PSD) principles and behavior change techniques (BCTs) that may contribute to the behavior change required for successful long-term weight loss maintenance. Objective This study aimed to provide insight into the design of eHealth interventions supporting behavior change for long-term weight maintenance. The study sought to identify the values and needs of people with obesity aiming to maintain weight after weight loss, and to identify PSD principles, BCTs, and design requirements that potentially enable an eHealth intervention to meet end user values and needs. Methods This study presents the concept of integrating PSD principles and BCTs into the design process of eHealth interventions to meet user values and needs. In this study, individual interviews and focus groups were conducted with people with obesity (n=23) and other key stakeholders (n=27) to explore end user values and needs related to weight loss maintenance. Design thinking methods were applied during the focus group sessions to identify design elements and to explore how eHealth solutions can support the needs to achieve sustainable weight loss maintenance. The PSD model and behavior change taxonomy by Michie were used to identify PSD principles and BCT clusters to meet end user values and needs. Results A total of 8 key end user values were identified, reflecting user needs for weight loss maintenance support: self-management, personalized care, autonomy, feel supported, positive self-image, motivation, happiness, and health. Goals and planning, feedback and monitoring, repetition and substitution, shaping knowledge, social support, identity, and self-belief were some of the BCT clusters identified to address these concepts, together with PSD principles such as personalization, tailoring, self-monitoring, praise, and suggestions. Conclusions The process of translating end user values and needs into design elements or features of eHealth technologies is an important part of the design process. To our knowledge, this is the first study to explore how PSD principles and BCTs can be integrated when designing eHealth self-management interventions for long-term weight loss maintenance. End users and other key stakeholders highlighted important factors to be considered in the design of eHealth interventions supporting sustained behavior change. The PSD principles and BCTs identified provide insights and suggestions about design elements and features to include for supporting weight loss maintenance. The findings indicate that a combination of BCTs and PSD principles may be needed in evidence-based eHealth interventions to stimulate motivation and adherence to support healthy behaviors and sustained weight loss maintenance. Trial Registration ClinicalTrials.gov NCT04537988; https://clinicaltrials.gov/ct2/show/NCT04537988

Designing the Optimal Digital Health Intervention for Patients’ Use Before and After Elective Orthopedic Surgery: Qualitative Study

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A Conceptual Model of Long-Term Weight Loss Maintenance: The Importance of Cognitive, Empirical and Computational Approaches

“…Social support has been identified as a contributing factor that differentiates between people who do and do not maintain weight loss over time [ 52 ]. People are at greater risk of weight regain after weight loss if they experience social stress or stressful life events (e.g., [ 54 ]) and research points toward social support as an important component to successful weight loss maintenance [ 55 , 56 , 57 ], likely primarily due to its role in psychosocial stress regulation [ 50 ]. Individuals who participate in weight loss maintenance social groups, either online or face-to-face, consisting of their peers, typically have high levels of weight loss maintenance success [ 54 , 58 ].…”

What goes on in digital behaviour change interventions for weight loss maintenance targeting physical activity: A Scoping Review

“…A comprehensive literature search was conducted in 5 electronic databases: PubMed; Embase; CINHAL; PsycINFO, and Web of Science. In addition, we performed a manual cross-referencing of bibliographies cited in previous reviews [14,22,23,27]. The search strategy included terms related with i) the concept (DBCIs designed to support weight loss maintenance, defined as interventions containing at least one component delivered via the internet) and ii) the context (DBCIs for weight loss maintenance targeting physical activity).…”

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