JMIR Publications

ABSTRACT

Background:

It is unclear why some smartphone applications designed for people with psychosis are successful in engaging users, while others are not. One possible explanation is the choices app development teams make in selecting persuasive strategies, and the varying operationalization and implementation of these strategies.

Objective:

This systematic review set out to quantify and describe the persuasive features used in smartphone applications for psychosis, investigate whether there was any association between persuasive features and attrition or adherence rates and document the quality of the included apps.

Methods:

We searched electronic databases (PsycINFO, Pubmed, Google Scholar) for eligible papers published between the years of 2013 and 2025. Hand searches of reference lists were completed. Apps were selected if they were designed for people with psychosis and there were published empirical studies investing the apps. Two reviewers independently screened papers and extracted data on adherence and attrition, as well as rating apps for evidence of persuasive features according to the Persuasive Systems Design model. Available data was synthesized descriptively and narratively. We attempted to access apps via app stores, or by correspondence with the research team.

Results:

We found 22 apps for psychosis, with 31 associated published papers. The most common persuasive features were personalization, reminders, suggestion, tunnelling, and self-monitoring. Features in the categories of primary task support and dialogue support were well represented, while social support and system credibility support were underutilized in the apps assessed. It was found that there was no association between the number of persuasive features and attrition; and association between persuasive features and adherence could not be assessed. The quality of the apps could not be judged due to 20 of the 22 apps being inaccessible either through the research papers’ authors, or through app stores.

Conclusions:

Our findings indicate that in psychosis apps there is potential to include a broader range of persuasive features which might maximize engagement. Psychosis apps may benefit from incorporating more features which leverage the persuasive impact of having users interact (social support) and incorporating features that emphasize system credibility and trustworthiness. It is not clear whether an increase in number of persuasive features has an impact on app engagement, and further empirical work is required to determine which features are most impactful in this context. Clinical Trial: Not applicable.