Apps for Mental Health: An Evaluation of Behavior Change Strategies and Recommendations for Future Development

Mobile applications have shown promise in supporting people with mental health issues to adopt healthy lifestyles using various persuasive strategies. However, the extent to which mental health apps successfully employ various persuasive strategies remains unknown. Hence, it is important to understand the persuasive strategies integrated into mental health applications (apps) and how they are implemented to promote mental health. This paper aims to achieve three main objectives. First, we review 103 mental health apps and identify distinct persuasive strategies incorporated in them using the Persuasive Systems Design (PSD) model and Behaviour Change Techniques (BCTs). We further classify the persuasive strategies based on the type of mental health issues the app is focused on. Second, we reveal the various ways that the persuasive strategies are implemented/operationalized in mental health apps to achieve their intended objectives. Third, we examine the relationship between apps effectiveness (measured by user ratings) and the persuasive strategies employed. To achieve this, two researchers independently downloaded and used all identified apps to identify the persuasive strategies using the PSD model and BCTs. Next, they also examine the various ways that these strategies are implemented in mental health apps. The results show that the apps employed 26 distinct persuasive strategies and a range of 1 to 10 strategies per app. Self-monitoring (n=59), personalization (n=55), and reminder (n=49) were the most frequently employed strategies. We also found that anxiety, stress, depression, and general mental health issues were the common mental health issues targeted by the apps. Finally, we offer some design recommendations for designing mental health apps based on our findings.

[1]  Julita Vassileva,et al.  Improving the Efficacy of Games for Change Using Personalization Models , 2017, ACM Trans. Comput. Hum. Interact..

[2]  Antti Oulasvirta,et al.  Habits make smartphone use more pervasive , 2011, Personal and Ubiquitous Computing.

[3]  Charles Abraham,et al.  THE BEHAVIOR CHANGE TECHNIQUE TAXONOMY (V1) OF 93 HIERARCHICALLY-CLUSTERED TECHNIQUES: TESTING RELIABILITY OF THE TAXONOMY , 2013 .

[4]  Rita Orji,et al.  How Effective Are Social Influence Strategies in Persuasive Apps for Promoting Physical Activity?: A Systematic Review , 2019, UMAP.

[5]  G. Andersson,et al.  Individually-tailored, Internet-based treatment for anxiety disorders: A randomized controlled trial. , 2011, Behaviour research and therapy.

[6]  Christian Skalka,et al.  Usability Evaluation of a Mobile Monitoring System to Assess Symptoms After a Traumatic Injury: A Mixed-Methods Study , 2016, JMIR mental health.

[7]  Julita Vassileva,et al.  LunchTime: a slow-casual game for long-term dietary behavior change , 2013, Personal and Ubiquitous Computing.

[8]  Julita Vassileva,et al.  Modeling the efficacy of persuasive strategies for different gamer types in serious games for health , 2014, User Modeling and User-Adapted Interaction.

[9]  Harri Oinas-Kukkonen,et al.  Persuasive Technology in Mobile Applications Promoting Physical Activity: a Systematic Review , 2016, Journal of Medical Systems.

[10]  Kiemute Oyibo,et al.  A Comparison of System-Controlled and User-Controlled Personalization Approaches , 2017, UMAP.

[11]  B. J. Fogg,et al.  A behavior model for persuasive design , 2009, Persuasive '09.

[12]  Rita Orji,et al.  Usability Issues in Mental Health Applications , 2019, UMAP.

[13]  John Torous,et al.  Needed Innovation in Digital Health and Smartphone Applications for Mental Health: Transparency and Trust. , 2017, JAMA psychiatry.

[14]  B. Gardner,et al.  How to reduce sitting time? A review of behaviour change strategies used in sedentary behaviour reduction interventions among adults , 2015, Health psychology review.

[15]  Luc Geurts,et al.  A Review of Persuasive Principles in Mobile Apps for Chronic Arthritis Patients: Opportunities for Improvement , 2016, JMIR mHealth and uHealth.

[16]  Rita Orji,et al.  Personalizing Persuasive Strategies in Gameful Systems to Gamification User Types , 2018, CHI.

[17]  H. Oinas-Kukkonen,et al.  Persuasive Features in Web-Based Alcohol and Smoking Interventions: A Systematic Review of the Literature , 2011, Journal of medical Internet research.

[18]  Harri Oinas-Kukkonen,et al.  Persuasive Systems Design: Key Issues, Process Model, and System Features , 2009, Commun. Assoc. Inf. Syst..

[19]  C. Abraham,et al.  A taxonomy of behavior change techniques used in interventions. , 2008, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[20]  Nicholas J Schork,et al.  Clickotine, A Personalized Smartphone App for Smoking Cessation: Initial Evaluation , 2017, JMIR mHealth and uHealth.

[21]  Eija Kaasinen,et al.  Persuasive Design in Mobile Applications for Mental Well-Being: Multidisciplinary Expert Review , 2012, MobiHealth.

[22]  Per F. V. Hasle,et al.  Persuasive Design , 2008, Handbook of Research on Computer Mediated Communication.

[23]  R. Orji,et al.  DESIGN FOR BEHAVIOUR CHANGE: A MODEL-DRIVEN APPROACH FOR TAILORING PERSUASIVE TECHNOLOGIES , 2014 .

[24]  Gina Wildeboer,et al.  The relationship between persuasive technology principles, adherence and effect of web-Based interventions for mental health: A meta-analysis , 2016, Int. J. Medical Informatics.

[25]  Kiemute Oyibo,et al.  Personalizing health theories in persuasive game interventions to gamer types: an African perspective , 2018, AfriCHI.

[26]  S. Michie,et al.  Behavior Change Techniques in Popular Alcohol Reduction Apps: Content Analysis , 2015, Journal of medical Internet research.

[27]  J. Carlin,et al.  Bias, prevalence and kappa. , 1993, Journal of clinical epidemiology.

[28]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[29]  Per Carlbring,et al.  Individually Tailored Internet-Based Treatment for Young Adults and Adults With Panic Attacks: Randomized Controlled Trial , 2012, Journal of medical Internet research.

[30]  B. Kable.  Mental health. , 2005, Australian family physician.

[31]  Chrysanne Di Marco,et al.  Towards Personality-driven Persuasive Health Games and Gamified Systems , 2017, CHI.

[32]  Kiemute Oyibo,et al.  Tracking feels oppressive and ‘punishy’: Exploring the costs and benefits of self-monitoring for health and wellness , 2018, Digital health.

[33]  J. McGonigal,et al.  Randomized Controlled Trial of SuperBetter, a Smartphone-Based/Internet-Based Self-Help Tool to Reduce Depressive Symptoms. , 2015, Games for health journal.

[34]  David C. Atkins,et al.  The Use and Effectiveness of Mobile Apps for Depression: Results From a Fully Remote Clinical Trial , 2016, Journal of medical Internet research.

[35]  N. Rickard,et al.  Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments , 2016, JMIR mental health.

[36]  C. Keyes,et al.  Mental illness and/or mental health? Investigating axioms of the complete state model of health. , 2005, Journal of consulting and clinical psychology.

[37]  S. Kelders,et al.  Persuasive System Design Does Matter: A Systematic Review of Adherence to Web-Based Interventions , 2012, Journal of medical Internet research.

[38]  Harri Oinas-Kukkonen,et al.  Persuasive Systems Design , 2018, Routledge Handbook of Policy Design.

[39]  C. Abraham,et al.  The Behavior Change Technique Taxonomy (v1) of 93 Hierarchically Clustered Techniques: Building an International Consensus for the Reporting of Behavior Change Interventions , 2013, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[40]  Harri Oinas-Kukkonen,et al.  Persuasive Systems Design features in Promoting Medication Management for consumers , 2017, HICSS.