JMIR Publications

ABSTRACT

Background:

Digital health behavior change interventions have the potential to change and maintain healthy lifestyles as well as the self-management of various preventable health conditions such as coronary heart disease (CHD). The persuasive systems design (PSD) is a framework for designing and evaluating systems designed support to lifestyle modifications and health behavior change using information and communication technology. However, evidence of the underlying design principles behind these interventions has not been extensively reported in the literature.

Objective:

This systematic review aims to identify existing health behavior change support systems, report the characteristics of these systems, and describe the persuasion context and persuasive design principles of identified behavior change support systems for CHD by using the PSD model.

Methods:

Using the PRISMA guidelines, 3 digital databases (Scopus, Web of Science, and Medline) were searched between 2010 to 2022. The major inclusion criteria for studies were as follows: digital interventions for behavior change, randomized controlled trials, and CHD. Two researchers independently double-reviewed the papers for eligibility, extracted data, and assessed quality. Any conflicts were resolved by the third researcher.

Results:

Searches conducted in the databases identified 1195 papers and 30 were identified as eligible for the review. The most interesting characteristics of the interventions were the predominant use of primary task support principles, followed by dialogue support and credibility support, and the sparing use of social support principles. Theories of behavior change such as the Social Cognitive Theory and Self-Efficacy theory were used often to underpin interventions. However, significant trends in the use of persuasive system feature on par behavior change theories could not be established from the reviewed RCTs. This points to the fact that there is still no theoretical consensus on how best to design interventions to promote behavior change in patients with CHD.

Conclusions:

Our results highlight key software features for designing digital health behavior change interventions toward the prevention and (or) management of CHD. We discuss behavior change theories and persuasive design guidelines for designing interventions that can enable users to self-manage and prevent CHD conditions. We encourage designers of behavior change interventions to evaluate the techniques that contributed to the success of the intervention. Future research should focus on evaluating the effectiveness of the interventions and persuasive design principles and behavior change theories using research methodologies such as meta-analysis.