JMIR Publications

ABSTRACT

Background:

Long-term weight maintenance after weight loss is challenging, and innovative solutions are called for. Digital technologies can support behavior change and therefore have the potential to be an effective tool for weight loss maintenance. To create meaningful and effective digital behavior change interventions that support end user values and needs, however, a combination of Persuasive System Design (PSD) principles and Behavior Change Techniques (BCTs) might be needed.

Objective:

The aim of this study was to investigate how an evidence-informed digital behavior change intervention can be designed and developed, combining PSD principles and BCTs into design features, to support end user values and needs for long-term weight loss maintenance.

Methods:

The study presents a concept for how PSD principles and BCTs can be translated into design features by combining design thinking and agile methods to develop and deliver an evidence-informed digital behavior change intervention aiming to support weight maintenance. Overall, 45 stakeholders participated in the systematic and iterative development process, consisting of co-design workshops, prototyping, agile development, and usability testing. This included prospective end users (n=17), that is, people with obesity who had lost 8% of their weight, health care providers (n=9), healthy volunteers (n=4), a service designer (n=1) and stakeholders from the multidisciplinary research and development team (n=14) (ie, including software developers, digital designer, eHealth-, behavior change- and obesity experts). Stakeholder input on how to operationalize the design features and optimize the technology was examined through formative evaluation and qualitative analyses with rapid and in-depth analysis approaches.

Results:

A total of 17 design features, combining PSD principles and BCTs, were identified as important to support end user values and needs based on stakeholder input during the design and development of eCHANGE, a digital intervention to support long term weigh loss maintenance. The design features were combined into four main intervention components: 1) Week Plan, 2) My Overview, 3) Knowledge and Skills, and 4) Virtual Coach and Smart Feedback System. To support healthy lifestyle and continued behavior change to maintain weight, PSD principles such as tailoring, personalization, self-monitoring, reminders, rewards, rehearsal, praise, and suggestions were combined and implemented into the design features together with BCTs from the clusters goals and planning, feedback and monitoring, social support, repetition and substitution, shaping knowledge, natural consequences, associations, antecedents, identity, and self-belief.

Conclusions:

Combining and implementing PSD principles and BCTs in digital interventions aiming to support sustainable behavior change may contribute to design of engaging and motivating interventions in line with end user values and needs. The design and development of the eCHANGE intervention can as such provide valuable input for future design and tailoring of evidence-informed digital interventions, even beyond digital interventions in support of health behavior change and long-term weight loss maintenance. Clinical Trial: https://clinicaltrials.gov/ct2/show/NCT04537988