JMIR Publications

ABSTRACT

The majority of digital health interventions lean on the promise of bringing health and self-care into people’s homes and hands. However, these interventions are delivered while people are in their triggering environment, which places competing demands on their attention. Individuals struggling to change or learn a new behavior have to work hard to achieve even a minor change because of the automatic forces propelling them back to their habitual behaviors. Scholars have invested much more effort in investigating content development and the general user experience than in asking how digital products can reduce users’ effort to help them stay engaged in a demanding behavior change regime. This paper posits that effort and burden should be explored at the outset and throughout the digital intervention development process as a core therapeutic mechanism, beyond the context of design or user experience testing. An effort-focused conceptualization assumes that, even though goals are rational and people want to achieve them, they are overtaken by competing cognitive, emotional and environmental processes. We offer the term “effort-optimized intervention” (EOI) to describe interventions that focus on sustained engagement in the face of competing demands. We describe design components based on a three-step process in the planning of an EOI sequence: 1) nurturing effortless cognitive and environmental salience to help people keep effort-related goals prominent despite competition; 2) making it as effortless as possible to complete therapeutic activities to avoid ego depletion and self-efficacy reductions; and 3) turning the necessary effortful activities into sustainable assets. We conclude by presenting an example of designing a digital health intervention based on the EOI model.