JMIR Publications

ABSTRACT

Background:

Behavioral health interventions often use testimonials, or personal narratives, as part of their didactic approach, which typically also includes psychoeducation and skill-based trainings. Testimonials can facilitate connection between an individual and health message, and are often more engaging and memorable than non-narrative messages. When integrated within interventions, testimonials can yield behavioral benefits including increased uptake of health-promoting behaviors. These advantages are especially relevant to digital health interventions, which frequently have low user engagement and offer few opportunities for interpersonal connection.

Objective:

We sought to learn how to design and deliver testimonials within multi-session digital health interventions to support behavior change and engagement.

Methods:

We applied human-centered design methods to learn user preferences for testimonial speakers, interface, messaging, and delivery over time. We recruited target users of our multi-session intervention to complete design sessions to help design the app. Adults (N=22, 64% self-identified as female; 32% as non-Hispanic Black, 41% as non-Hispanic White, 27% as Hispanic) with recurrent binge eating and obesity completed individual interviews. Data were analyzed using methods from thematic analysis.

Results:

Most participants preferred designs with testimonials (versus without) for their motivation and validation of the intervention’s efficacy. They said testimonials foster connection between current and former users. A few distrusted testimonials for appearing too “commercial” or personally irrelevant. For speakers, participants preferred sociodemographically tailored testimonials to improve relevance, and were willing to report data in the intervention to facilitate identity-based matching. For interface, participants preferred testimonials with varying multimedia to encourage engagement and connection. For messaging, they were differentially motivated by testimonials with “how to” advice and “big picture” success stories. For delivery, participants preferred testimonials from new speakers over time to promote engagement. When the intervention allows users to choose between actions (e.g., behavioral strategies), they preferred testimonials be available across all actions, but said that selectively delivering a testimonial with the optimal action could motivate them to select it.

Conclusions:

Delivering sociodemographically tailored testimonials could yield behavioral and engagement benefits. To tailor testimonials to users, interventions can assess users’ preferences and characteristics; this can be facilitated by their willingness to report personal information in the intervention. Future design work should examine user tolerance for longitudinal testimonial personalization, which could feel increasingly targeted, and identify methods to assess user preferences over time, given their potential to change. To improve the credibility of testimonials, which some distrusted, interventions could consider inviting current users to submit testimonials for future integration in the intervention. When choice between actions is possible, testimonials may “nudge” users to select the optimal action. Future work should test if exclusively delivering a testimonial for the optimal action improves its uptake. Further research is needed to validate these design ideas in practice.