JMIR Publications

ABSTRACT

Background:

An increasing amount of electronic health (eHealth) interventions aim to support healthy behaviors that facilitate weight loss. However, there is limited evidence of effects and little focus on maintenance of weight after weight loss. To create meaningful and effective eHealth interventions, knowledge about end-user values and needs is essential to identify persuasive design principles (PSDs) and behavior change techniques (BCTs) that may contribute to the behavior change required for successful long-term weight loss maintenance.

Objective:

The overall aim of the current study was to provide insight into the design of eHealth interventions aiming to support behavior change for long-term weight maintenance. The study sought to identify; a) the values and needs of people with obesity aiming to maintain weight after weight loss, and b) PSDs, BCTs and design requirements potentially enabling an eHealth intervention to meet end-user values and needs for long-term weight loss maintenance.

Methods:

This study presents a concept of integrating PSDs 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 groups sessions to identify design elements, and to explore how eHealth solutions can support end-user needs in order to achieve sustainable weight loss maintenance. The Persuasive System Design-model and Michie´s Behavior Change Taxonomy were used to identify PSD principles and BCT clusters to meet end-user values and needs.

Results:

Eight 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 PSDs 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 personalized eHealth interventions supporting sustained behavior change. The PSDs and BCTs identified provide insights and suggestions about design elements and features to include supporting weight loss maintenance. The findings indicate that a combination of BCTs and PSDs may be needed in evidence-based eHealth interventions in order to stimulate motivation and adherence to support healthy behaviors and sustained weight loss maintenance.