Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Nov 24, 2018
Date Accepted: Oct 22, 2019
Date Submitted to PubMed: Jan 31, 2020
(closed for review but you can still tweet)
Engaging users in the behavior change process with digitalized motivational interviewing and gamification: Development and feasibility testing of the Precious physical activity app
ABSTRACT
Background:
Most adults do not engage in sufficient physical activity for their health. Smartphone apps are increasingly used to support physical activity and other health enhancing behaviors, but typically focus on activity tracking with no support for the complex process of behavior change. Tracking features do not engage all users, and apps could reach their targets better 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 the psychological needs proposed by self-determination theory (i.e. autonomy, competence, relatedness). We do not know, however, if digitalized motivational interviewing in a smartphone app engages users in this process.
Objective:
This study describes the theory- and evidence-based development of the Precious app and examines how digitalized motivational interviewing in a smartphone app engages users in the behavior change process. Specifically, we study the extent to which the Precious app use elicits change talk in participants, and how they address autonomy support in the app.
Methods:
A multidisciplinary team built the Precious app to support engagement in the behavior change process. Precious targets reflective processes with motivational interviewing, spontaneous processes with gamified tools, and builds on the principles of self-determination theory and control theory using seven relational techniques and twelve behavior change techniques. The app was feasibility tested among twelve adults, who were asked to interact with the prototype and to think aloud. Semi-structured 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 change talk and autonomy support.
Results:
Participants valued the autonomy supportive features in Precious (e.g. freedom to pursue personally relevant goals and receive tailored feedback). We identified five themes around 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. Types of change talk identified were Desire, Need, Reasons, Ability, Commitment, and Taking steps toward change.
Conclusions:
Understanding the effectiveness of user engagement with apps and the behavioral process is the key for supporting sustained behavior change. The Precious app takes a unique approach to promoting change. It brings motivational interviewing into a mobile form and targets engagement with psychological need support. The motivational interviewing approach shows promise, but the impact of its interactive features and feedback needs to be studied over time. The Precious app is undergoing testing in a series of n-of-1 randomized controlled trials.
Citation
