Background/Purpose: Recently, we witnessed a steep increase in the amount of mobile applications (apps) in the category of “Health & Fitness”. Most popular examples of such apps are RunKeeper GPS Track Run Walk, HealthTap, Sworkit Workout Trainer and iTriage Health. These apps all have between 1 and 50 million downloads and a rating of 4.4 or more out of 5, significantly higher than the average 3.9 rating for this category of apps. Possibly, this above average rating can be explained by their usage of so-called persuasive design techniques to engage users in using the app. The same principles can be employed for apps that target a specific disease. The aim of this study is to investigate which of these persuasive design principles are prevalent in apps that aid in the management of arthritis. It is our aspiration that these insights may help experts and app developers to build more effective patient support and may result in increasing the use of apps in arthritis management.

Methods: A systematic search was conducted in all three major app stores (Google Play, iTunes App Store and Windows Phone Store) using keywords related to arthritis. Criteria for inclusion were that the app (1) should target one or more arthritis related diseases, (2) provides tracking or monitoring of arthritis related disease factors or provides information about arthritis, (3) targeted adult patients. Exclusion criteria were (1) apps intended for medical personnel, (2) magazines, general pain trackers or food guides in app format. There were no language restrictions. Apps were coded by two independent raters using an adapted version of the Persuasive System Design (PSD) model by Harjumaa and Oinas-Kukkonen (2009) and the taxonomy of behavior change by Abraham and Michie (2008).

Results: Twenty-eight apps met the inclusion criteria. The most used task support principle (n=15) was to solely provide information to patients. Other common task support principles were reduction (reducing complex behavior into simple tasks) and self-monitoring (being able to (re)view your own data); many apps (n=11) offer reduction as the calculation of the Disease Activity Score (DAS) and visualized to evolution as self-monitoring. Goal setting and ways to support self-efficacy beliefs (e.g. recognition, rewards) were less prevalent (n=2). In addition, principles to influence system credibility were limited to offering a level of surface credibility and perceived expertise in the information provided but lacked other system credibility measures such as figures of authority and third-party endorsements. Surprisingly, techniques to influence normative beliefs or to include social support were lacking.

Conclusion: The results of this study are an indication that current apps for arthritis patients are mostly designed to calculate DAS scores and convey information on the disease. There is a remarkable lack of other persuasive principles to engage patients in digital management of their disease. Although these persuasive principles such as social support and dialogue support contribute to the success of other fitness and health apps, apps for arthritis patients rarely use them.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-systematic-review-of-the-persuasive-design-principles-used-in-health-apps-for-arthritis/