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Assessment of persuasive manipulations to increase adherence to e-health technology: a mental health case: Voluit Leven

Wiggers, J.M.R. (2011) Assessment of persuasive manipulations to increase adherence to e-health technology: a mental health case: Voluit Leven.

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Abstract:Summary 3 Background The calculations of the National Compass of Dutch Health Care show that the costs for treatment for people with depression and anxiety are growing. The widespread use of web based applications, based on the principles of persuasive technology, show promising results in reducing these costs. However, it is also known that the adherence to these kinds of technologies is not very high. To increase adherence and decrease attrition persuasive manipulations will be useful. Objective The aim of this study is an assessment of five persuasive manipulations: personal/automatic feedback, text messages, multimedia, tailoring and personalisation, integrated in the nine-week lasting course Voluit Leven on three different adherence levels: adherence to the course (user preferences for manipulations), adherence to the lessons (amount of completed lessons) and adherence to the technology defined as the difference between intended and actual usage (times of logging in and manipulation use). Methods Users (n=239) with mild onto moderate depressive or anxiety symptoms were randomly assigned to eight different designs of Voluit Leven. They received all five manipulations in different combinations. Most users were highly educated (78.7%, 188/239), aged 45 and female (70.7%, 169/239). A mixed- methods research design was used. An assessment is done based on the online Analytic Hierarchy Process questionnaire from which patient preferences for the five manipulations could be derived (adherence to the course). Log files were used, with the following main outcome measures: (1) site usage measures like amount of completed lessons (adherence to the lessons), (2) times of logging in and times of clicking on manipulations (adherence to the technology), (3) dropout rates (attrition). Also, fifteen telephone depth interviews were done, to collect information on the reasons for adherence and attrition. Results 126 out of 239 users filled in the AHP questionnaire from which 79 questionnaires were consistent. The most preferred manipulations were personal feedback and text messages. It was personal feedback that appealed users: it was motivating because of the personal content and the frequency of receiving. The designs that had integrated personal feedback and text messages were both neither the triggers for the highest percentage of users that completed all nine lessons nor the triggers that scores the highest average amount of completed lessons. Also, none of the other designs with the other combinations of manipulations did show a significant difference. Just like the log files, that did not show an influence or correlation of the manipulations in all eight designs on adherence to the lessons or the technology. Also the influence of activity degree (continues/discontinued/non-user), activity pattern (high/low) and age do not show any correlation with the manipulation received. The usage patterns per manipulation show a decline in amount of log-ins in week 4 –from an average amount of log-ins of 1.7 a week to average 1.2 – and a variable use that every week raises and falls, probably caused by the content of the lessons. All users that are still in the course after week 9 (45%, 80/179) are the continuous users, from which 12% represent the hard core users (28/179). The attrition pattern is a constant attrition with a constant proportion of users that drop out each week. The most users drop out in week 1 (26 of the 99 drop outs) and a rise of drop outs (n=14 against an average of 8.4 all other weeks) can be seen in week 4. Because of the small amount of users spread over eight designs, it was not possible to connect –statistically reliable– the data to manipulations that were received. None of the drop outs has signed up for a telephone interview what makes it impossible to support the data with qualitative results. Non related persuasive technology factors, indicated by users, influencing their adherence were costs and the strength of the complaints. Users can not give an estimation of their willingness to pay. Conclusion For all combinations of manipulations that were integrated in this study, none of these combinations shows a great influence on adherence with regard to Voluit Leven. None of the designs with a specific combination of manipulations show a unusually high or low amount of log-ins in comparison with the other designs, differences in usage patterns in comparison with the other designs, or differences in amount of completed lessons in comparison with the other designs. Statements about which individual manipulation has the possibility to increase adherence –as represented in usage by times of logging in and amount of completed lessons– cannot be done. However, it is possible to derive the users preferences for individual manipulations. Personal feedback is evaluated by users as the most important manipulation to keep using Voluit Leven, followed by text messages. Tailoring, automatic response and multimedia are evaluated as less important. Personalisation is evaluated as unimportant to keep using Voluit Leven. In the future, more research is needed focusing on the individual influence of personal feedback and text messages without integrating them in multiple manipulation designs.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:85 business administration, organizational science
Programme:Health Sciences MSc (66851)
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