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In the past decade, the use of technologies to persuade, motivate, and activate individuals’ health behavior change has been a quickly expanding field of research. The use of the Web for delivering interventions has been especially relevant. Current research tends to reveal little about the persuasive features and mechanisms embedded in Web-based interventions targeting health behavior change.
The purpose of this systematic review was to extract and analyze persuasive system features in Web-based interventions for substance use by applying the persuasive systems design (PSD) model. In more detail, the main objective was to provide an overview of the persuasive features within current Web-based interventions for substance use.
We conducted electronic literature searches in various databases to identify randomized controlled trials of Web-based interventions for substance use published January 1, 2004, through December 31, 2009, in English. We extracted and analyzed persuasive system features of the included Web-based interventions using interpretive categorization.
The primary task support components were utilized and reported relatively widely in the reviewed studies. Reduction, self-monitoring, simulation, and personalization seem to be the most used features to support accomplishing user’s primary task. This is an encouraging finding since reduction and self-monitoring can be considered key elements for supporting users to carry out their primary tasks. The utilization of tailoring was at a surprisingly low level. The lack of tailoring may imply that the interventions are targeted for too broad an audience. Leveraging reminders was the most common way to enhance the user-system dialogue. Credibility issues are crucial in website engagement as users will bind with sites they perceive credible and navigate away from those they do not find credible. Based on the textual descriptions of the interventions, we cautiously suggest that most of them were credible. The prevalence of social support in the reviewed interventions was encouraging.
Understanding the persuasive elements of systems supporting behavior change is important. This may help users to engage and keep motivated in their endeavors. Further research is needed to increase our understanding of how and under what conditions specific persuasive features (either in isolation or collectively) lead to positive health outcomes in Web-based health behavior change interventions across diverse health contexts and populations.
In the past decade, the use of technologies to persuade, motivate, and activate individuals’ health behavior change has been a quickly expanding field of research [
There is no consensus on the terminology used to designate the activities conducted over the Internet for mental and physical health purposes. According to Barak et al [
Considerable variety exists in terms of types of program content, interactivity, functionality, and level of multimedia of Web-based interventions. In addition, intensity is a major variable; some Web-based interventions are long-term, automated, interactive, tailored, multicomponent programs whereas others are brief online screening instruments with tailored feedback. Finally, participant attrition and exposure rates may vary widely (eg, [
The purpose of the present review was to extract and analyze persuasive system features of the included Web-based alcohol and smoking interventions use by applying the PSD model [
Research on persuasive technology has been introduced relatively recently [
Persuasive systems may be defined as computerized software or information systems designed to reinforce, change, or shape attitudes or behaviors or both without using coercion or deception [
Changing people’s behavior is at the heart of health promotion. An individual’s behavior has a significant impact on, for example, cancer and heart disease, which are common causes of premature mortality. The Internet is transforming health care [
Examples of persuasive technology can be found quite easily, as there are a variety of websites promoting healthier lifestyles. One of the strongest domains of innovation for persuasive technology in the near future will be preventive health care [
According to Fogg [
In the present study, the persuasive systems design model (PSD) [
We conducted electronic literature searches in five databases (Academic Search Premier [EBSCO Publishing, Herts, England], Cochrane Central Register of Controlled Trials, ISI Web of Knowledge, Medline [Ovid], and Scopus) to identify randomized controlled trials of Web-based interventions for substance use published January 1, 2004, through December 31, 2009, in English.
Study identification process
The following terms were used in the database searches: (1) online*, Internet*, web* and (2) intervention, self-help, treatment, trial. To identify alcohol interventions we used the following additional search terms: drink*, alcohol*. For smoking interventions we utilized the terms: smoke*, smoking, cigarette, tobacco, cessation. An asterisk (*) denotes a wildcard. We also screened the bibliographies of relevant articles, including systematic reviews [
Articles were included if they: (1) focused on Web-based alcohol or smoking (tobacco) interventions, (2) assessed behavioral outcomes or program utilization, (3) were randomized controlled trials or quasi-experimental designs, and (4) were peer-reviewed full research articles.
Follow-up studies that used data from the same cohort of participants were excluded. Both Danaher et al [
In total, 23 studies were included in the review and coded. The methodological quality of the included studies was evaluated by applying the CONSORT (Consolidated Standards of Reporting Trials) 2010 checklist [
Information technology always influences people’s attitudes and behavior in one way or another [
Although the PSD model is yet relatively unknown, we consider its use to be justified for this context. In our view, it is the most sophisticated persuasive design and evaluation method available. Many of the principles in the PSD model have been adopted and modified from the seminal work of Fogg [
The PSD model presents a way to analyze, design, and evaluate the persuasion context and related techniques. Persuasion context analysis includes recognizing the intent, the event, and the strategy for persuasion. Dey [
In the PSD model [
PSD Model (adapted from Oinas-Kukkonen and Harjumaa [
The intent includes the persuader and the target behavior change type that the system is to cause in the user. The persuader is the initiator for the development of the system. The event contains the use, user, and technology contexts.
The use context refers to the problem domain dependent features. The use context, in particular problem domain dependent features, is relevant to the persuasion event. The use context can be determined by answering the following questions [
The user context refers to the individual users characteristics. The user context includes, but is not limited to, users’ (patient, research participant, consumer [
There is an obvious need for depicting the technology context when describing a Web-based intervention. The technology context refers to the features and requirements of the technological platform and/or application.
The strategy in the PSD model emphasizes two elements, namely the message and the route. The message refers to the form and/or content selected to deliver the intended transformation (eg, behavior or attitude change). The content could be, for instance, statistical data about the health risks of drinking, but the information could be presented to the user in plain text, streaming video, or it could be embedded in a game. The route for persuasion can be direct, indirect, or both. A direct approach provides one or a few solid and convincing arguments, whereas an indirect route is based on a number of facts rather than a single strong argument (compare
The persuasive design dimensions and principles are discussed and exemplified below.
The characteristics of the included studies are presented in
Characteristics of the included studies
Study |
Problem |
Primary Objective |
User Context |
Use and Technology |
Summary of Findings |
An et al (2008) |
Smoking | To determine whether an online intervention with college smokers could increase self-reported 30-day abstinence rates at the end of a 2-semester intervention | College smokers at the University of Minnesota (517) | Online college life magazine that provided personalized smoking cessation messages and peer email support (RealU) | The rate of 30-day abstinence at week 30 was higher for the intervention compared with the control group. (41% vs 23%, |
Bersamin et al (2007) |
Problem drinking | To assess whether a new online alcohol misuse prevention course is more effective at reducing alcohol use and related consequences among drinkers and nondrinkers | Incoming college freshmen at a northern California public university (622) | Web-based college alcohol education course (College Alc) | Among freshmen who were regular drinkers before college, College Alc reduced the frequency of heavy drinking (d = 0.15), drunkenness (d = 0.09), and negative alcohol-related consequences (d = 0.18). Freshmen who did not report any past 30-day alcohol use before college, College Alc did not experience any beneficial effects. |
Brendryen et al (2008) [ |
Smoking | To assess the long-term efficacy of a fully automated digital multimedia smoking cessation intervention | People willing to quit smoking, aged 18 years or older, smoked 10 or more cigarettes daily, and had access to the Internet, email and a cell phone on a daily basis (290) | Fully automated, digital smoking cessation intervention including Web pages, SMS, interactive voice response, emails (Happy Ending) | Participants in the treatment group reported clinically and statistically significantly higher repeated point abstinence rates than control participants. (20% treatment vs 7% control, odds ratio [OR] = 3.43, 95% confidence interval [CI] = 1.60 - 7.34, |
Brendryen et al (2008) [ |
Smoking | To assess the long-term efficacy of a fully automated digital multimedia smoking cessation intervention |
People willing to quit smoking, aged 18 years or older, smoked 10 or more cigarettes daily and had access to the Internet, email, and a cell phone on a daily basis (396) | Fully automated, digital smoking cessation intervention including Web pages, SMS, interactive voice response, emails (Happy Ending) | Participants in the treatment group reported clinically and statistically significantly higher repeated point abstinence rates than control participants. (22.3% treatment vs 13.1% control; OR = 1.91, 95% CI 1.12 - 3.26, |
Buller et al (2008) [ |
Smoking | To reduce smoking by children in grades 6 through 9 by convincing those who had not smoked not to start and persuading those who had already tried smoking to stop | Sixth to ninth graders from Australia and the United States (2077) | Tailored, Web-delivered smoking prevention program for adolescents (Consider This) | No statistically significant differences between groups were found |
Danaher et al (2006) [ |
Smokeless tobacco use | To define participant exposure measures to a Web-based program for smokeless tobacco cessation | Recruited smokeless tobacco users (2523) | Web-based smokeless tobacco cessation intervention (ChewFree.com, enhanced) | Participants in the enhanced condition made more visits and spent more time accessing their assigned website than did participants assigned to the basic condition website. |
Escoffery et al (2004) [ |
Smoking | To develop and conduct a process evaluation of a Web-based smoking cessation intervention for college smokers | College smokers (70) | Web-based smoking cessation program for college smokers (Kick It!) | No statistically significant differences between groups |
Etter (2005) [ |
Smoking | To compare the efficacy of two Internet-based, computer-tailored smoking cessation programs | College smokers (11,969) | Web-based, computer-tailored smoking cessation (Stop-tabac.ch) | Statistically significant differences in quit rates in smokers in the contemplation stage favoring the original program. (OR = 1.54, 95% CI = 1.18 - 2.02, |
Finfgeld-Connett and Madsen (2008) [ |
Problem drinking | To evaluate the effectiveness of a Web-based, self-guided treatment program for women with problem drinking habits who live in rural areas of Missouri | Adult women with problem drinking habits living in Missouri counties (44) | Web-based, self-guided treatment program for problem drinking (intervention name not reported) | No statistically significant results |
Hester et al (2009) [ |
Drinking moderation | To evaluate the effectiveness of a Web-based moderation training | Heavy drinkers (84) who responded to a newspaper recruitment ad (Albuquerque, New Mexico) |
Internet-based program and use of the online resources of Moderation Management (MM) | At 3-month follow-up both groups significantly reduced their drinking. Both groups also significantly reduced their alcohol-related problems. Relative to the control, the experimental group had better outcomes on percent days abstinent. |
Japuntich et al (2006) [ |
Smoking | To evaluate the impact of the program in an efficacy evaluation context | Smokers (at least 18 years old) motivated to quit smoking, 134 participants were recruited in a research center in Milwaukee, Wisconsin; 150 participated in a research center in Madison, Wisconsin (284) | Web-based smoking cessation and relapse prevention intervention (CHESS SCRP) | No statistically significant differences between groups |
Matano et al (2007) [ |
Problem drinking | To pilot test an interactive Web-based intervention for reducing alcohol consumption | Employees of a work site in the Silicon Valley region of California, categorized as low or moderate risk for alcohol problems (145) | Interactive Web-based intervention for reducing alcohol consumption (CopingMatters) | The sample size was inadequate for evaluating treatment effects on drinking [ |
McKay et al (2008) [ |
Smoking | To describe the 6-month follow-up results of an RCT where participants were randomly assigned to either a Web-based smoking cessation program or a Web-based exercise enhancement program | Smokers at least 18 years of age interested in quitting within the next 30 days, willing to engage in moderate physical activity, access to the Internet (2318) | Web-based tailored smoking cessation (Quit Smoking Network; QSN) | No between-condition differences in smoking abstinence were found at 3- and 6-month follow-up assessments. |
Muñoz et al (2006) [ |
Smoking | To compare a standard smoking cessation intervention to the same guide plus a mood management intervention | English- or Spanish-speaking smokers; ≥ 18 years old, smoking ≥ 5 cigarettes/day, using email at least once weekly and intending to quit in the next month; recruited from general population in USA (568) | Web-based intervention providing standard cessation information, tailored advice; individually timed educational messages (ITEMs); online mood management (MM) course (Guía) | ITEMs increased the effectiveness of the Guía. However, MM reduced quit rates, at times significantly so. |
Muñoz et al (2009) [ |
Smoking | To examine abstinence rates of an Internet smoking cessation intervention and whether providing additional elements to a static Internet stop-smoking guide increases them | Spanish- and English-speaking participants (worldwide) were recruited using online campaigns; |
Condition 1 was the “Guía Para Dejar de Fumar,” a static National Cancer Institute evidence-based stop smoking guide; Condition 2 consisted of Condition 1 plus ITEMs; Condition 3 consisted of Condition 2 plus MM; and Condition 4 consisted of Condition 3 plus a “virtual group” (an asynchronous bulletin board) | No significant differences among the four conditions were found. |
Patten et al (2006) |
Smoking | To test the efficacy of a home-based, Internet-delivered treatment for adolescent smoking cessation | Adolescent smokers aged 11-18 years (139) | Web-based smoking cessation intervention tailored to adolescents (Stomp Out Smokes; SOS) | No statistically significant differences between groups were found. |
Riper et al (2007) [ |
Problem drinking | To determine the effectiveness of a self-help intervention for adult problem drinkers | Adult Dutch problem drinkers (261) | Web-based self-help intervention (Drink Less) | At follow-up, 17.2% of the intervention group participants had reduced their drinking within the guideline norms; in the control group this was 5.4% (OR = 3.66, 95% CI = 1.3-10.8, |
Severson et al (2008) [ |
Smokeless tobacco use | To test the impact of an interactive, tailored Web-based intervention versus a more linear, text-based website | Recruited smokeless tobacco users (2523) | Interactive, tailored Web-based intervention (ChewFree.com, enhanced) | Participants in the enhanced condition quit at significantly higher rates (vs basic condition). Abstinence was 40.6% in the enhanced condition vs 21.2% in the basic condition ( |
Stoddard et al (2008) [ |
Smoking | To determine the use and satisfaction with two versions of a smoking cessation website, one of which included an asynchronous bulletin board | Adult federal employees or contractors to the federal government who responded to an email and indicated a willingness to quit smoking in 30 days (1375) | Smoking cessation website (Smokefree.gov, added bulletin board) | No statistically significant differences between groups were found.(Time spent on the website was significantly longer for the intervention subjects than for the control subjects.) |
Strecher et al (2005) [ |
Smoking | To assess the efficacy of Web-based tailored behavioral smoking cessation program among nicotine patch users | Smokers in the United Kingdom and Republic of Ireland who purchased a certain patch and connected to a website (3971) | Web-based tailored behavioral smoking cessation (CQ Plan) | Continuous abstinence rates at 6 weeks were 29.0% in the tailored condition vs 23.9% in the nontailored condition (OR = 1.30, |
Strecher et al (2008) [ |
Smoking | To determine (1) whether engagement in a Web-based smoking cessation intervention predicts 6-month abstinence, (2) whether certain groups are more likely to have lower engagement, and (3) whether particular program components influence engagement | Smokers, participants from two large health maintenance organizations (1866) | Web-based program for smoking cessation and relapse prevention (intervention name not reported) | The total number of Web sections opened was related to subsequent smoking cessation. More personalized source and high-depth tailored self-efficacy components were related to a greater number of Web sections opened. |
Swartz et al (2006) [ |
Smoking | To test the short-term efficacy of an automated behavioral intervention for smoking cessation delivered via a website | 18 years or older, smoking cigarettes on a daily basis, considering quitting smoking in the next 30 days, and being able to access the website. (351) | Video-based website (1-2-3-Smokefree) | At 90 days, the cessation rate was 24.1% for treatment group versus 8.2% for the control group ( |
Woodruff et al (2007) [ |
Smoking | To test an innovative approach to smoking cessation that might be particularly attractive to adolescent smokers | Adolescent smokers in high school (136) | Web-based counseling program, virtual world chat room for adolescent smoking cessation (Breathing Room) | At the immediate postintervention assessment, intervention group participants were significantly more likely to report that they had abstained from smoking during the past week ( |
All of the articles stated a primary objective of the study (see
In 8 of the articles, the intended change type was explicated. There were examples of reporting the intended change type in a simple and clear manner. For example,
“The self-help program proceeds in four successive stages: (1) preparing for action; (2) goal setting; (3) behavioral change; and (4) maintenance of gains and relapse prevention” [
Our findings confirm the claim put forward by Griffiths and colleagues [
The user context refers to characteristics of the individual user. All articles reported the user context to some extent. The authors of published articles may possess detailed information about users and their individual characteristics, but for some reason it does not seem to be clearly reflected in the dissemination.
The interventions included in the review were Web-based, and all of them aimed at persuading the users in some way. The majority of the research articles (14 out of 23) presented the technology context concisely. Screenshots are worthwhile, even though they do not reveal the backbone of the system, the information architecture, or the flow between parts of the system and its content. Escoffery et al [
All of the reviewed studies seemed to rely on indirect routes for persuasion. However, due to the limited descriptions of the route utilized, it was not possible to confirm this fully. Of the studies reviewed, 14 revealed the underlying theories or methods behind the intervention to some extent. The most common theories were social cognitive theory (in 5 studies) and stages of change (in 4 studies), while in 5 of the studies the application of cognitive-behavioral methods was reported.
One of the key decision points in developing interventions is the selection of messages for the intervention [
The functionalities in the primary task category support the carrying out of the user’s primary task. Persuasion techniques in this category [
All of the reviewed articles described functionality countable as reduction, that is, the system reduces complex behavior into simple tasks helping users to perform the target behavior. This is important because a system that guides users through a process or experience provides opportunities to persuade along the way. For instance, in spite of the alcohol treatment program described in Finfgeld-Connett and Madsen [
A system keeping track of the user’s performance or status supports achieving one’s goals. Not surprisingly, this type of self-monitoring functionality was found in all of the included articles. For example, the system described in Escoffery et al [
Enabling users to observe the link between the cause and its effect is regarded as simulation. Simulations that educate users about certain topics can leave a lasting impact that transfers to the real world [
A persuasive system may offer personalized content and services for its users. In order for the content to be personalized, the user has to disclose some personal information about herself, for example, through registration or by creating a personal profile [
According to Rimer and Kreuter [
Tunneling may enhance the change process since the user is led through a predetermined sequence of steps and receives the most appropriate content, particularly at a proper time [
Rehearsing a behavior can enable people to change their attitudes or behavior in the real world. Only 1 article reported this type of functionality; virtual locations (in the “Breathing Room” virtual world) such as a teen dance club and a fast food restaurant provided settings to discuss social influence to smoke and relapse, and an amphitheater was available for additional virtual meetings and discussions [
Dialogue support defines the key principles in keeping the user active and motivated in using the system and helping the user to reach the intended behavior. The principles in the dialogue support category are
A persuasive system should remind users of their target behavior during the use of the intervention. A recent systematic review showed that the use of periodic prompts could be effective in behavior change interventions [
A system adopting a social role (eg, doctor or teacher) may be more persuasive. None of the reported interventions seemed to utilize social role per se. However, 9 of the articles described ask-an-expert service, which is related to social role (but also falls under expertise and authority in credibility support).
A system should provide the user with fitting suggestions at proper moments during the system use. This kind of suggestion was featured in 4 articles. In Japuntich et al [
Individuals are more readily persuaded through systems resembling themselves in some meaningful way. For example, a system aimed at teenagers should employ youthful phrases and imagery. This principle is known as similarity (compare
An attractive system is likely to be more persuasive. This principle is known as
The system should reward the user for achieving self-set goals, for example [
A system could praise users via words, images, symbols, or sounds based on their behaviors. By offering praise, a system can make users more open to persuasion. Quite surprisingly, this technique was not featured in any of the reviewed studies.
Credibility is a persuasive element (eg, [
The PSD model describes seven principles for supporting system credibility:
Naturally, evaluating perceived credibility is more or less subjective. People make initial assessments of the system credibility based on a firsthand inspection. This principle is called
A persuasive system could also provide endorsements from respected and renowned sources, for example, a recommendation by an authoritative health organization, an award for excellence in usability, or a privacy seal to ensure confidentiality. However, none of the articles reported utilizing third party endorsements.
According to Uchino [
The social learning principle means that individuals may be more motivated to perform a target behavior if they can observe others performing the behavior while using the system. A closely related principle is social comparison: users will be more motivated to perform the target behavior if they can compare their performance with the performance of others. Users are also more likely to perform target behavior if they are able to observe others performing the behavior or are being observed by others. This principle is called
The most common means to providing social support were asynchronous peer discussion forums and synchronous chat rooms. A variety of other online social support features were also utilized. For a full description of studies regarding social learning, social comparison social facilitation, and normative influence, see
Social support in the Web-based interventions
Study Author (Year) | Social Learning, Comparison and/or Facilitation | Normative Influence | Other Support |
An et al (2008) [ |
No | Not reported | Email exchange with peer coach |
Bersamin et al (2007) [ |
Discussion forum | Streaming video clips, College Alcohol Use unit | Not reported |
Brendyen et al (2008) |
No | Not reported | Pre-recorded audio messages for relapse prevention, Interactive Voice Response-based craving helpline |
Buller et al (2008) [ |
No | Prevention content focused on social influence and aimed, for example, to correct inexact perceptions of tobacco use norms | Not reported |
Danaher et al (2006) [ |
Peer-to-peer forum | Testimonial videos | Ask-an-expert forum |
Escoffery et al (2004) [ |
Stage-matched discussion forums | Shared personal stories area | Not reported |
Etter (2005) [ |
Discussion forums, chat rooms | Personal stories written by current and former smokers | Not reported |
Finfgeld-Connett and Madsen (2008) [ |
Asynchronous bulletin board, synchronous chat featured | Not reported | Private messaging to the researcher and other users |
Hester et al (2009) [ |
Online mutual-help support community | Not reported | Online and face-to-face meetings |
Japuntich et al (2006) [ |
Discussion group, chat room (trained counselor available) | The smoking-related topics included facts about smokers, smoking, and cigarette companies | Ask-an-expert service |
Matano et al (2007) [ |
No | Individualized feedback with normative data | Not reported |
McKay et al (2008) [ |
Peer-to-peer forum | Not reported | Ask-an-expert forum |
Muñoz et al (2006, 2009) [ |
Asynchronous bulletin board | Not reported | Mood management online course |
Patten et al (2006) [ |
Discussion support group | Videos of personal |
Private email service with an expert |
Riper et al (2008) [ |
Moderated peer-to-peer discussion forum | Streaming video (quitting |
Not reported |
Stoddard et al (2008) [ |
Asynchronous bulletin board | Not reported | Ask-an-expert forum |
Strecher et al (2005) [ |
No | Not reported | Behavioral support email messages |
Strecher et al (2008) [ |
No | A section with a narrative success story | Not reported |
Swartz et al (2006) [ |
No | Personalized video segments | Not reported |
Woodruff et al (2007) [ |
Virtual world chat room, virtual locations | Topics covered, for example, peer influence; virtual locations in “Breathing Room” virtual world | Smokers interacted with each other as well as with the counselor |
A system can apply normative influence, in other words, positive peer pressure to enhance the likelihood that an individual will adopt a target behavior. Buller et al [
In addition to the aforementioned ways for providing social support, a system can persuade users to adopt a target attitude or behavior by leveraging human beings’ natural drive to compete and cooperate. Competition was reported in 2 and cooperation in 1 of the analyzed papers. In An et al [
By offering public recognition to an individual or a group, a system can increase the likelihood that a person and/or group will adopt a target behavior. Only 1 of the articles presented functionality countable as recognition. In Woodruff et al [
Of the 23 articles included in the review, 20 primarily measured health behavior outcomes. Of these articles, 12 reported statistically significant differences between groups. Overall, 3 articles assessed program utilization, and 2 of them reported positive findings (see
The primary task support components were reported relatively widely in the reviewed studies. Reduction, self-monitoring, simulation, and personalization seem to be the most used ways to support accomplishing a user’s primary task. This is an encouraging finding because reduction and self-monitoring can be considered as the key elements of primary task support. The utilization of tailoring was surprisingly low. The lack of tailoring may imply that the interventions are targeted for too broad an audience. It would be reasonable to assume that different approaches were needed for different kinds of user groups. Elements of dialogue support were mostly underutilized in the interventions. Leveraging reminders [
Credibility issues are crucial in website engagement as users will engage with sites they perceive credible and navigate away from those they do not find credible. Based on the textual descriptions of the interventions, we cautiously suggest that most of them were relatively credible. Nevertheless, it seems to be, as Danaher and Seeley [
The prevalence of social support in the reviewed interventions was encouraging (see
Evaluating the effectiveness of specific persuasive features within Web-based interventions is difficult since the features are not usually explicitly tested. According to Kypri and Lee [
Due to these issues, the application of the PSD model turned out to be relatively laborious. In the present review, we relied on textual descriptions of the interventions, thus being able to provide only a limited synthesis. Regardless of its wide coverage, the PSD model is not an exhaustive list of persuasive features, and also some of the features are overlapping (eg, social learning/comparison/facilitation and liking/similarity) and thus rather difficult to analyze. New persuasion techniques may also be identified in the future. The PSD model has been built in such a manner that it may evolve, but even as it stands now, it is an important asset for any health behavior change system developer.
Analyzing persuasive design is a challenging task. When conducting an analysis such as described in the present review, potential bias lies in the interpretation of the articles. Nevertheless, in extracting and categorizing persuasive features, we rigorously observed if the authors clearly stated the described variables. Obviously, the articles did not necessarily follow the very same terminology as found in the PSD Model. Thus, the analysis was based on interpretive categorization.
This systematic review focused on randomized controlled trials, thus excluding potentially meritorious studies. (Quasi-experimental studies were not found in the search process.) A meta-analysis was not conducted due to the heterogeneity of the studies. Overall, there are already several reviews on Web-based (or similar) interventions. To our knowledge, the present review is the first systematic review to address persuasive system features in Web-based interventions for substance use.
In this review we examined the persuasive system features of the included Web-based interventions. We think that this type of novel approach is useful for current and future research for recognizing what kind of tactics in present systems have been utilized to motivate people in achieving better health.
However, at this point, linking specific persuasive features to outcomes is difficult, relying only on brief textual descriptions of the interventions. Also, it is not possible to determine the (perceived) credibility of a Web-based intervention based on reading an article. We acknowledge that many studies have examined, for example, the role of tailoring in health behavior change interventions [
We are not implying that the mere presence of persuasive features is enough. The development of Web-based and other similar interventions is a highly elaborate and a multifaceted issue. Still, it is relevant to consider the technological aspects since the Web and related technologies are being used as a delivery channel. Atienza and colleagues [
We wish to thank the Graduate School on Software Systems and Engineering (SoSE), the Finnish Funding Agency for Technology and Innovation (TEKES) and the RichWeb and Eliksiiri/Salwe projects for funding this research. The second author would like to thank the Academy of Finland. We also express our gratitude to the reviewers for their constructive comments.
None declared
Excluded articles (N=39): Alcohol
Excluded articles (N=14): Smoking
Alcohol Use Disorders Identification Test
confidence interval
Consolidated Standards of Reporting Trials
individually timed educational message
mood management
number needed to treat
odds ratio
persuasive system design
randomized controlled trial
Graduate School on Software Systems and Engineering
Finnish Funding Agency for Technology and Innovation