Content uploaded by Rita Orji
Author content
All content in this area was uploaded by Rita Orji on Apr 09, 2018
Content may be subject to copyright.
Content uploaded by Rita Orji
Author content
All content in this area was uploaded by Rita Orji on Apr 09, 2018
Content may be subject to copyright.
Content uploaded by Rita Orji
Author content
All content in this area was uploaded by Rita Orji on Apr 09, 2018
Content may be subject to copyright.
Persuasive Technology to Support Chronic
Health Conditions: Investigating the Optimal
Persuasive Strategies for Persons with COPD
Beatrix Wais-Zechmann
1(&)
, Valentin Gattol
1
, Katja Neureiter
1
,
Rita Orji
2
, and Manfred Tscheligi
1,3
1
AIT Austrian Institute of Technology, Vienna, Austria
{beatrix.wais-zechmann,valentin.gattol,
katja.neureiter,manfred.tscheligi}@ait.ac.at
2
Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
rita.orji@dal.ca
3
University of Salzburg, Salzburg, Austria
manfred.tscheligi@sbg.ac.at
Abstract. Persuasive technology can support persons with chronic conditions
to comply with their treatment plan. For persons with chronic obstructive pul-
monary disease (COPD), staying physically active is crucial to prevent deteri-
orations of their health status. However, most persons with COPD do not reach
and maintain recommended levels of physical activity goals. Although COPD is
expected to become the third most common cause of death worldwide, research
on how to design persuasive systems for motivating specifically persons with
COPD to engage in regular physical activity is still scarce. To bridge this gap,
we conducted a study involving persons with COPD (n= 115) to investigate the
perceived persuasiveness of 17 strategies (i.e., ratings of their concrete imple-
mentation) and individual susceptibility to persuasion (i.e., an underlying dis-
position to be more receptive to certain persuasive strategies). Based on our
analysis, the following strategies were perceived as most persuasive: person-
alization,reminder,commitment, self-monitoring, rewards,customization,au-
thority, and scarcity. Interestingly, the data revealed differences between
perceived persuasiveness and individual susceptibility to persuasion, indicating
that both constructs measure distinct aspects of persuasiveness. Our results are
relevant to designers and developers of persuasive systems by providing valu-
able insights about the most promising persuasive strategies and their practical
implementation when designing for persons with COPD.
Keywords: Chronic obstructive pulmonary disease (COPD)
Persuasive strategies Perceived persuasiveness
Individual susceptibility to persuasion
1 Introduction
Chronic obstructive pulmonary disease (COPD) is a chronic progressive lung disease
with symptoms like breathlessness, muscle weakness, and chronic cough that leads (in
severe stages) to the dependence on external oxygen supply. About 10% of adults
©Springer International Publishing AG, part of Springer Nature 2018
J. Ham et al. (Eds.): PERSUASIVE 2018, LNCS 10809, pp. 255–266, 2018.
https://doi.org/10.1007/978-3-319-78978-1_21
above the age of 40 are affected [1] and COPD is expected to become the third most
common cause of death worldwide in 2030 [2]. Within the European Union, health care
costs of COPD are estimated to be about 23.3 billion Euro [3]. COPD is not curable,
thus, patients have to deal with it throughout their lifetime and there is no getting
around without a successful self-management process. Mitigating the disease pro-
gression significantly is possible through lifestyle changes [4,5]. In particular, frequent
physical activity is considered to be one of the most effective measures to prevent
decline [6]. However, many patients lack motivation and do not reach the recom-
mended physical activity level leading to increased hospitalizations, mortality, reduced
quality of life and loss of productivity [6,7]. Thus, a solution is required that motivates
persons with COPD (PwCOPD) to engage in frequent physical activity as a preventive
measure. While the use of persuasive technology has been broadly investigated in
training applications for the general population [8], little work has been done regarding
the use of persuasive technology to motivate PwCOPD to exercise more [9].
The aim of our research is to investigate how persuasive systems should be
designed for PwCOPD. In this paper, we contribute to the existing research by
answering the following research question: Which persuasive strategies (PS) are most
effective in motivating PwCOPD to engage in more physical activity?
Findings of this research allow for a more effective design and adaptation of
persuasive systems for PwCOPD. The paper is structured as follows: we start with
reviewing the related work, followed by a description of the methods, the analysis of
the results, their discussion including implications and conclusions for designers and
developers of persuasive systems for PwCOPD.
2 Related Work
Persuasive technologies have been successfully applied in a wide range of contexts to
trigger behavior change, such as increased physical activity [10]. However, the
applications focus mainly on the general population without considering
disease-related circumstances of PwCOPD. In those few applications that focus on
motivating PwCOPD for physical activities, only little work has been done to inves-
tigate the use of persuasive design strategies and principles for this target group [9].
Thus, the scientific literature in the context of PS in COPD treatment reveals knowl-
edge gaps. Behavioral interventions that aim at increasing physical activity in
PwCOPD mainly use conventional approaches such as counselling and education [11].
However, the effectiveness of individual PS has not been evaluated specifically for
PwCOPD.
Voncken-Brewster et al. [12] evaluated the usability of an online self-management
intervention for COPD patients in a lab setting that included eight behavioural change
techniques (based on the I-Change Model [13]). However, they provide few insights on
how PwCOPD experience behavioral change strategies. Instead, the paper focuses
chiefly on usability aspects of the overall intervention and does not investigate the
effectiveness of the strategies. Similarly, other studies include various PS in their
interventions but do not evaluate the comparative effectiveness of the individual
strategies per se (e.g. [14]).
256 B. Wais-Zechmann et al.
Bartlett et al. [9] investigated the acceptance of different persuasive design prin-
ciples for technologies that aim at encouraging physical activity among PwCOPD.
They investigated three different prototypes using the three design principles dialogue
support, primary task support, and social support and investigated acceptance and
persuasiveness of the technologies. Although the authors account for design principles,
each of them incorporating several PS, their work does not assess the persuasiveness of
the individual strategies.
It is essential to evaluate the effectiveness of various PS before implementing them
in an intervention. In a review involving 17 randomized controlled trials, four tech-
niques were associated with significantly larger effect sizes related to smoking cessa-
tion in COPD patients: facilitate action planning/develop treatment plan, prompt self-
recording, advise on methods of weight control, and advise on/facilitate use of social
support [15]. This review also points out that the most frequently used strategy (boost
motivation and self-efficacy; used in 70.6% of interventions) was associated with very
low effectiveness.
To develop suitable persuasive systems for PwCOPD, our paper investigates which
of the PS are perceived as most persuasive by PwCOPD to increase their physical
activity.
3 Method
To answer the research question, we conducted an online survey involving 118
PwCOPD. The goals of the survey were to assess whether the participants differed in
their perceived persuasiveness towards the 17 implemented strategies and in their
individual susceptibility to persuasion as measured by the STPS scale [16]. The
detailed methodology is described in this chapter.
3.1 Persuasive Strategies and Storyboards
We chose to employ ten widely-used strategies by Oinas-Kukkonen and Fogg in
our study, which have been used in the health context earlier [17–19]: comparison,
competition, cooperation, customization, personalization, punishment, rewards, self-
monitoring, simulation, and suggestion. In addition, we employed the strategy
reminder, which is an important strategy in fitness applications to increase physical
activity [10].
To allow for a comparison with the STPS scale, we employed the six
well-established strategies by Cialdini: reciprocity, scarcity, authority, commitment,
consensus, and liking [20].
To communicate the PS in a visually appealing way, we created storyboards for all
17 PS, each consisting of three individual illustrations that represent the strategy as a
scripted interaction between the user and the smartphone application (see Fig. 1as an
example of the storyboard representing the competition strategy). The storyboards were
based on those used in the work of Orji et al. [17,19].
Persuasive Technology to Support Chronic Health Conditions 257
We validated our storyboards prior to the main study to make sure that the visu-
alizations accurately represented each of the PS as intended. We first made two internal
rounds of evaluation and adaptation of the storyboards. After that we sent out the
storyboards to seven researchers in the field of human–computer interaction familiar
with persuasive technology and asked them to allocate the correct storyboard to the 17
strategies. Additionally, we asked the experts to provide further feedback about the
storyboards. Following this procedure, the storyboards were further refined and
finalized.
3.2 Questionnaire Measures
Perceived Persuasiveness. To measure the perceived persuasiveness of the 17
strategies, each storyboard was followed by four questions of the perceived persua-
siveness scale by Drozd et al. [21], as also used in the work of Orji et al. [19]. The
participants were asked to indicate on a 7-point Likert scale to which degree the
strategy (a) would influence them, (b) would be convincing, (c) would be personally
relevant for them, and (d) would make them reconsider their physical activity habits.
Individual Susceptibility to Persuasion. In addition to perceived persuasiveness,
which represents the participants’ratings of external stimuli (i.e., the storyboards), we
assessed also their individual susceptibility to persuasion. The key distinction between
the two constructs is that the former is a person’s evaluation of external stimuli,
whereas the latter can be understood as a trait that resides within the person. In other
words, individual susceptibility to persuasion describes a person’s underlying dispo-
sition to be more or less receptive to certain PS. To measure the individual suscepti-
bility of participants, we included the Susceptibility to Persuasion Scale (STPS) [16].
The scale measures the participant’s susceptibility towards Cialdini’s six strategies
[20]: reciprocity,scarcity,authority,commitment,consensus and liking.
Fig. 1. Example storyboard of the PS competition translated to English.
258 B. Wais-Zechmann et al.
3.3 Procedure of the Online Survey
Recruitment of potential participants in Austria and Germany was first done through
asking COPD self-support groups to distribute the survey in their network of PwCOPD.
As an incentive, participants who finalized the survey could win an Amazon voucher.
The survey was additionally distributed via a recruiting panel based in Austria. Par-
ticipants who completed the survey received credit points via the panel that could be
exchanged for money or vouchers. After the potential participants opened the survey
link that they received either via mail or the recruiting panel, they first read a short
introduction about the aims of the study. Two screening questions assessed the presence
or absence of COPD and the age of the person. Each of the subsequent pages showed in
randomized order one of the 17 PS, presented as storyboards, followed by four questions
assessing the participant’sperceived persuasiveness of the respective strategies [21].
The next part of the survey contained the STPS items in randomized order followed by
sociodemographic questions such as gender, education, height, weight, the presence of
other diseases, their physical activity level as well as their stage of change towards doing
more physical activity. The entire survey was conducted in German.
3.4 Participants
Given that PwCOPD are typically older, the majority of participants recruited for the
study were above the age of 40 (97%). The survey was completed by a total of 118
participants. Three participants were excluded from the analysis because they com-
pleted the survey in a time that we deemed unrealistic (i.e., below 5 min); for com-
parison, participants took 18.77 min on average (SD = 12.99). The remaining 115
participants included 30 women and 85 men. More details on sociodemographic data is
shown in Table 1.
3.5 Data Analysis
The data analysis was conducted with SPSS version 22. Boxplot figures were created
with the statistics software Wessa.net (Wessa, 2017). To assess which of the 17 PS are
most effective for PwCOPD, we first calculated an average score per participant across
the four items measuring the perceived persuasiveness for each strategy. Similarly, we
calculated an average score per participant for the items measuring individual suscep-
tibility to persuasion, separately for Cialidini’s six strategies: five items were averaged
for the strategy of reciprocity, another five for scarcity, four items for authority, another
Table 1. Sociodemographic data of participants
Sample size 115
Gender 30 women/85 men (26%/74%)
Age <40 (3%), 40–49 (11%), 55–59 (28%), 60–69 (36%), >69 (23%)
Education Compulsory school (3%), Professional school (16%), Vocational training
(24%), High school (36%), University (or similar) (21%)
Other diseases no other (35%), 1 other (37%), 2 other (18%), 3–5 other diseases (10%)
Persuasive Technology to Support Chronic Health Conditions 259
five for commitment, another four for consensus, and three items for liking. We con-
ducted altogether two repeated-measures ANOVAs (analysis of variance), separately for
the two within-subject factors perceived persuasiveness (i.e., the 17 strategies imple-
mented as storyboards) and individual susceptibility to persuasion (i.e., an underlying
disposition to be more receptive to certain PS). Comparing the average values of the
study sample per strategy allows gaining insights specifically for the target group of
PwCOPD in terms of their underlying dispositions (individual susceptibility to per-
suasion) and their perceptions of implemented strategies (perceived persuasiveness).
Moreover, we generated notched boxplots that depict the data descriptively and provide
a visual gauge of potentially significant differences for each of the 17 strategies with the
neutral mid-point of the perceived persuasiveness scale [18].
4 Results
4.1 Perceived Persuasiveness of the 17 Strategies
In order to identify the most suitable PS for PwCOPD, we compared the means of the
perceived persuasiveness scores of the 17 strategies. Results from the repeated-
measures ANOVA revealed a significant effect for the within-subjects factor PS, (F(16,
1824) = 16.15, p< .001, partial eta squared = .124). This indicates that there is a
significant difference in the perceived persuasiveness between the PS. Figure 2below
shows notched boxplots of the perceived persuasiveness for all 17 strategies. Notches
indicate the 95% confidence interval of the median and allow estimating significant
differences between the strategy and the neutral mid-point of the persuasiveness scale
[18]. The neutral mid-point for perceived persuasiveness (i.e., the value ‘4’on the
7-point Likert scale) indicates that a strategy is perceived as rather neutral (i.e., neither
persuasive nor unpersuasive). Out of the 17 strategies, PwCOPD perceived eight
strategies as significantly more persuasive than the neutral mid-point—in the following
listed from highest (most persuasive) to lowest (least persuasive): personalization,
reminder, commitment, self-monitoring, rewards, customization, authority, and scar-
city (see Fig. 2and Table 2). Interestingly, two PS were perceived as significantly less
persuasive than the neutral mid-point, namely liking and reciprocity.
Fig. 2. Perceived persuasiveness (y-axis) of the 17 PS (x-axis) on a Likert-type scale ranging
from 1 to 7 (higher scores indicate a higher persuasiveness; the horizontal line at 4 indicates the
neutral mid-point, the eight underlined strategies are perceived as significantly more persuasive
than the neutral mid-point).
260 B. Wais-Zechmann et al.
4.2 Individual Susceptibility to Persuasion
In order to examine the individual susceptibility to persuasion of PwCOPD to different
strategies, we compared the mean scores for each of the strategies that we calculated
from the Susceptibility to Persuasion Scale (STPS).
Results from the repeated-measures ANOVA revealed a significant effect for the
within-subjects factor individual susceptibility to persuasion,(F(5, 545) = 89.00,
p< .001, partial eta squared = .449), indicating that people’s self-assessment of indi-
vidual susceptibility differed for Cialidini’s six PS.
As illustrated in Fig. 3and Table 3below, PwCOPD had a significantly higher
individual susceptibility towards reciprocity, commitment and liking, than to scarcity,
authority and consensus.
Table 2. Means and standard deviations of perceived persuasiveness towards the 17 strategies
Strategy M(SD) Strategy M(SD) Strategy M(SD)
Authority 4.3 (±1.9) Customization 4.3 (±1.9) Rewards 4.4 (±2.0)
Commitment 4.4 (±1.9) Liking 3.2 (±2.0) Scarcity 4.1 (±1.9)
Comparison 3.6 (±2.1) Personalization 4.6 (±1.9) Self-monitoring 4.4 (±1.8)
Competition 3.7 (±2.1) Punishment 3.7 (±2.1) Simulation 3.8 (±1.9)
Consensus 3.7 (±2.0) Reciprocity 3.3 (±2.0) Suggestion 4.1 (±1.9)
Cooperation 3.7 (±2.0) Reminder 4.4 (±2.0)
Note. M = mean, SD = standard deviation.
Fig. 3. Individual susceptibility (y-axis) towards Cialdini’s six strategies (x-axis) on a
Likert-type scale ranging from 1 to 7 (higher scores indicate a higher susceptibility; the
horizontal line at 4 indicates the neutral mid-point).
Table 3. Means and standard deviation of individual susceptibility to persuasion
Strategy M(SD) Strategy M(SD) Strategy M(SD)
Reciprocity 5.4(±1.3) Authority 3.6 (±1.5) Consensus 4.2 (±1.3)
Scarcity 3.9 (±1.5) Commitment 5.6 (±1.1) Liking 5.4 (±1.2)
Note. M = mean, SD = standard deviation.
Persuasive Technology to Support Chronic Health Conditions 261
5 Discussion
In the following section, we first discuss the perceived persuasiveness of the 17
strategies by elaborating on the most interesting strategies (i.e., the most and least PS as
well as a group of strategies that rely on social interaction). We follow up by addressing
individual susceptibility to persuasion and how it differs from participants’perceived
persuasiveness.
Perceived persuasiveness of the 17 strategies. The analysis of our online survey data
revealed a significant difference in the perceived persuasiveness of the 17 PS. Per-
sonalization was perceived as the most PS for PwCOPD. This could suggest a need to
account for individual requirements due to individual-specific disease conditions. This
highlights the need to establish an appropriate activity plan in line with each person’s
physical abilities. Liking, on the other hand, was perceived as the least PS for
PwCOPD. This strategy rests on the principle that people like people, who are familiar
and similar to them [22]. Therefore, the strategy might work only for PwCOPD when
the other person understands what it means to be living with this disease and be
physically active (e.g., when the other person is also affected by the disease or familiar
with COPD). Hence, further investigations are required to see if the social context
might have an influence on the PS liking. Moreover, a worsening of the disease can
make it difficult to maintain, let alone surpass past activity levels for which they might
have previously received acknowledgement in the form of likes from others. Getting
likes for underperforming could be perceived as demotivating for them. Thus, relying
on ‘social gratification’might put them on the spot what they rather like to avoid.
Those PS that rely on some kind of interaction with other persons (i.e., comparison,
competition or cooperation) showed to be averagely persuasive for PwCOPD. Bartlett
et al. [9] found in their qualitative interviews, that PwCOPD had very diverse opinions
about those social strategies with, for example, some people liking the idea of com-
petitive activities and others not. Similarly, as can be seen from our own data (Fig. 2),
the ratings of perceived persuasiveness varied greatly for the social strategies, resulting
in an overall persuasiveness score close to the neutral mid-point of the scale. Inter-
estingly, competition and comparison are increasingly used and widely appreciated in
persuasive systems for the general population [17]. PwCOPD, who feel stressed by
their symptoms, may disfavor the two strategies, giving them the feeling of losing
control and drawing them out of the comfort zone [17].
Individual susceptibility to persuasion and how it differs from perceived persua-
siveness. We found significant differences in participants’individual susceptibility to
persuasion. PwCOPD showed high susceptibility to reciprocity (M= 5.4) and liking
(M= 5.4). These two strategies, however, were the least persuasive ones when eval-
uating the respective storyboard implementations in terms of their perceived persua-
siveness (M= 3.3 and M= 3.2, for reciprocity and liking respectively). Similarly,
authority had the lowest susceptibility score (M= 3.6) but was perceived as slightly
above average persuasive in the storyboard implementation (M= 4.3). It appears that
262 B. Wais-Zechmann et al.
the perceived persuasiveness, as measured by the scale of Drozd et al. [21], and
individual susceptibility to persuasion, as measured by the STPS [16], both assess
distinct aspects of persuasiveness and are more diverse as expected.
5.1 Implications for Designing Persuasive Systems for PwCOPD
Based on the results from our study in which we investigated the perceived persua-
siveness and individual susceptibility to persuasion of PwCOPD, we can derive several
implications for the future development of persuasive systems targeting specifically
PwCOPD. In the following we provide examples of how the strategies could be
implemented. These are based on our experiences from working with PwCOPD. Our
analysis shows which PS were perceived as significantly above (below) average with
respect to their persuasiveness by PwCOPD and are thus most (least) suitable in the
design of persuasive systems targeting the group. Based on the experience from run-
ning the study and the evaluation results, we provide the following suggestions:
(1) A physical activity plan and suggestions for physical activity that are personalized
to the individual needs of PwCOPD are more effective than generic recommen-
dations. Physical activity recommendations should especially account for each
person’s health status as this hugely affects their motivation to engage in physical
activity (personalization).
(2) In addition, the persuasive technology should be designed to allow the PwCOPD
to adapt the suggested physical activity plan to her/his individual needs (cus-
tomization). A defined daily or weekly physical activity goal could be presented
as a virtual contract by the persuasive system. Our findings reveal that there is a
higher motivation to comply to the plan when the person committed
herself/himself to a goal (commitment). However, additional reminders to meet
their physical activity goals are useful (reminder). Ideally, those reminders should
account for the person’s current symptoms, which could vary on a day-to-day
basis. Specifically, exacerbations, which are acute deteriorations of the disease,
have to be considered when giving recommendations or reminders. The detection
of an exacerbation in clinical practice relies on the patient’s self-reporting of
symptoms, such as dyspnea, cough and increased sputum. Assessing those indi-
cators allows a technology to recognize upcoming exacerbations, thus, give rec-
ommendations and reminders accordingly [23].
(3) Setting time limits to achieve goals is further motivating for PwCOPD. This could
be implemented by informing them about how much time they have left to
achieve this goal (scarcity). This strategy is suited to be combined with reminders
or rewards, which both showed to motivate PwCOPD (reminder,reward).
(4) A persuasive system that provides the person’s activity data and feedback in a
visually appealing and understandable way is further motivating. For PwCOPD,
not only their activity data but also their subjectively indicated symptoms and
physiological data (e.g., oxygen saturation, pulse) could be presented. Overviews
and retrospectives as well as correlations of data (e.g., the more you walk, the
better you feel) could help them to understand the importance of regular physical
activity (self-monitoring).
Persuasive Technology to Support Chronic Health Conditions 263
(5) Information and suggestions coming from an authority figure are more persuasive
for PwCOPD (compared to information that is not provided by an authority figure).
In case of COPD, recommendations could be presented in a persuasive system not
only from physicians but also from acknowledged COPD institutions such as the
Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) [24], the
European Respiratory Society or the American Thoracic Society [25](authority).
(6) Two of the 17 PS were perceived as below average in persuasiveness by
PwCOPD and are thus not suitable for this target group: liking and reciprocity.
Thus, we would recommend avoiding these two strategies when designing per-
suasive systems for PwCOPD.
6 Conclusions
With this research, we extend the existing literature of persuasive technology in
healthcare by presenting findings from an online study that investigated perceived
persuasiveness of widely-used PS for PwCOPD (who have been majorly neglected by
researchers), with the goal of increasing their physical activity level. To the best of our
knowledge, this study is the first research in the domain of persuasion that is focused on
PwCOPD.
Our results have several implications for the future development of persuasive
systems for PwCOPD. Our research shows that PwCOPD perceive the individual
strategies to be significantly different in their persuasiveness. Thus, it is beneficial to
employ only those strategies that were rated above average in perceived persuasive-
ness. Based on our findings, we offer some suggestions on how the strategies can be
implemented to motivate PwCOPD.
Further research is necessary to see if those findings apply only to the target
behavior of increasing physical activity or if the outcomes can be generalized to other
target behaviors. Our findings additionally need to be verified in the real-life context of
PwCOPD to investigate their validity and reliability and to gather more details on the
impact of persuasive systems for PwCOPD. Further research should investigate if the
ascertained differences in perceived persuasiveness and individual susceptibility to
persuasion pertain also to people without COPD. A limitation is that the results are
based on implementations of PS in the form of storyboards, which differ from
real-world implementations in the form of applications for mobile devices.
Acknowledgements. This research has partly been funded by the Vienna Business Agency
under contract no. ID 1605387 (SmartCOPDTrainer).
References
1. Buist, A.S., McBurnie, M.A., Vollmer, W.M., Gillespie, S., Burney, P., Mannino, D.M.,
Menezes, A.M.B., Sullivan, S.D., Lee, T.A., Weiss, K.B., Jensen, R.L., Marks, G.B.,
Gulsvik, A., Nizankowska-Mogilnicka, E.: International variation in the prevalence of COPD
(the BOLD Study): a population-based prevalence study. Lancet 370(9589), 741–750 (2007)
2. World Health Organization (WHO): Burden of COPD. http://www.who.int/respiratory/copd/
burden/en/. Accessed 31 Jan 2018
264 B. Wais-Zechmann et al.
3. Gibson, G.J., Loddenkemper, R., Lundbäck, B., Sibille, Y.: Respiratory health and disease in
Europe: the new European lung white book. Eur. Respir. J. 42(3), 559–563 (2013)
4. Wilkinson, T.M.A., Donaldson, G.C., Hurst, J.R., Seemungal, T.A.R., Wedzicha, J.A.: Early
therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Am.
J. Respir. Crit. Care Med. 169, 1298–1303 (2004)
5. Halpin, D.M.G., Laing-Morton, T., Spedding, S., Levy, M.L., Coyle, P., Lewis, J., Newbold,
P., Marno, P.: A randomised controlled trial of the effect of automated interactive calling
combined with a health risk forecast on COPD using EXACT PRO. Prim. Care Respir. J. 20
(3), 324–331 (2011)
6. Watz, H., Pitta, F., Rochester, C.L., Garcia-Aymerich, J., ZuWallack, R., Troosters, T.,
Vaes, A.W., Puhan, M.A., Jehn, M., Polkey, M.I., Vogiatzis, I., Clini, E.M., Toth, M.,
Gimeno-Santos, E., Waschki, B., Esteban, C., Hayot, M., Casaburi, R., Porszasz, J.,
McAuley, E., Singh, S.J., Langer, D., Wouters, E.F., Magnussen, H., Spruit, M.A.: An
official European respiratory society statement on physical activity in COPD. Eur. Respir.
J. 44, 1521–1537 (2014)
7. van Boven, J.F.M., Chavannes, N.H., van Der Molen, T., Rutten-van Mölken, M.P.M.H.,
Postma, M.J., Vegter, S.: Clinical and economic impact of non-adherence in COPD: a
systematic review. Respir. Med. 108(1), 103–113 (2014)
8. Matthews, J., Win, K.T., Oinas-Kukkonen, H., Freeman, M.: Persuasive technology in
mobile applications promoting physical activity: a systematic review. J. Med. Syst. 40(3), 1–
13 (2016)
9. Bartlett, Y.K., Webb, T.L., Hawley, M.S.: Using persuasive technology to increase physical
activity in people with chronic obstructive pulmonary disease by encouraging regular
walking: a mixed-methods study exploring opinions and preferences. JMIR 19(4), e124
(2017)
10. Yoganathan, D., Kajanan, S.: Persuasive technology for smartphone fitness. In: PACIS 2013
Proceedings, Paper 185 (2013)
11. Leidy, N.K., Kimel, M., Ajagbe, L., Kim, K., Hamilton, A., Becker, K.: Designing trials of
behavioral interventions to increase physical activity in patients with COPD: insights from
the chronic disease literature. Respir. Med. 108, 472–481 (2014)
12. Voncken-Brewster, V., Moser, A., van der Weijden, T., Nagykaldi, Z., De Vries, H., Tange,
H.: Usability evaluation of an online, tailored self-management intervention for chronic
obstructive pulmonary disease patients incorporating behavior change techniques. JMIR
Res. Protoc. 2(1), e3 (2013)
13. De Vries, H., Mesters, I., Van De Steeg, H., Honing, C.: The general public’s information
needs and perceptions regarding hereditary cancer: an application of the integrated change
model. Patient Educ. Couns. 56, 154–165 (2005)
14. Van Der Weegen, S., Verwey, R., Spreeuwenberg, M., Tange, H., Van Der Weijden, T., De
Witte, L.: The development of a mobile monitoring and feedback tool to stimulate physical
activity of people with a chronic disease in primary care: a user-centered design. JMIR
Mhealth Uhealth 1(2), e8 (2013)
15. Bartlett, Y.K., Sheeran, P., Hawley, M.S.: Effective behaviour change techniques in smoking
cessation interventions for people with chronic obstructive pulmonary disease: a
meta-analysis. Br. J. Health. Psychol. 19, 181–203 (2014)
16. Kaptein, M., De Ruyter, B., Markopoulos, P., Aarts, E.: Adaptive persuasive systems. ACM
Trans. Interact. Intell. Syst. 2(2), 25p (2012). Article 10
17. Orji, R., Vassileva, J., Mandryk, R.L.: Modeling the efficacy of persuasive strategies
for different gamer types in serious games for health. User Model. User-Adap. Inter. 24,
453–498 (2014)
Persuasive Technology to Support Chronic Health Conditions 265
18. Busch, M., Mattheiss, E., Reisinger, M., Orji, R., Fröhlich, P., Tscheligi, M.: More than sex:
the role of femininity and masculinity in the design of personalized persuasive games. In:
Meschtscherjakov, A., De Ruyter, B., Fuchsberger, V., Murer, M., Tscheligi, M. (eds.)
PERSUASIVE 2016. LNCS, vol. 9638, pp. 219–229. Springer, Cham (2016). https://doi.
org/10.1007/978-3-319-31510-2_19
19. Orji, R., Nacke, L.E., DiMarco, C.: Towards personality-driven persuasive health games and
gamified systems. In: Proceedings SIGCHI Conference on Human Factors Computer System
(2017)
20. Cialdini, R.B.: Harnessing the science of persuasion. Harv. Bus. Rev. 79(9), 72–81 (2001)
21. Drozd, F., Lehto, T., Oinas-Kukkonen, H.: Exploring perceived persuasiveness of a behavior
change support system: a structural model. In: Bang, M., Ragnemalm, E.L. (eds.)
PERSUASIVE 2012. LNCS, vol. 7284, pp. 157–168. Springer, Heidelberg (2012). https://
doi.org/10.1007/978-3-642-31037-9_14
22. Cialdini, R.B.: The science of persuasion. Sci. Am. 284(2), 76–81 (2004)
23. Leidy, N.K., Wilcox, T.K., Jones, P.W., Jones, P., Roberts, L., Powers, J.H., Sethi, S., Donohue,
J., Eremenco, S., Erickson, P., Martinez, F., Patrick, D., Rennard, S., Rodriguez-Roisin, R.,
Schünemann, H.: Standardizing measurement of chronic obstructive pulmonary disease
exacerbations: reliability and validity of a patient-reported diary. Am. J. Respir. Crit. Care
Med. 183(3), 323–329 (2011)
24. Vestbo, J., Hurd, S.S., Agustí, A.G., Jones, P.W., Vogelmeier, C., Anzueto, A., Barnes, P.J.,
Fabbri, L.M., Martinez, F.J., Nishimura, M., Stockley, R.A., Sin, D.D., Rodriguez-Roisin,
R.: Global strategy for the diagnosis, management, and prevention of chronic obstructive
pulmonary disease GOLD executive summary. Am. J. Respir. Crit. Care Med. 187(4),
347–365 (2013)
25. Celli, B.R., Decramer, M., Wedzicha, J.A, Wilson, K.C., Agustí, A., Criner, G.J., MacNee, W.,
Make, B.J., Rennard, S.I., Stockley, R.A., Vogelmeier, C., Anzueto, A., Au, D.H., Barnes, P.J.,
Burgel, P.R., Calverley, P.M., Casanova, C., Clini, E.M., Cooper, C.B., Coxson, H.O., Dusser,
D.J., Fabbri, L.M., Fahy, B., Ferguson, G.T., Fisher, A., Fletcher, M.J., Hayot, M., Hurst, J.R.,
Jones, P.W., Mahler, D.A., Maltais, F., Mannino, D.M., Martinez, F.J., Miravitlles, M., Meek,
P.M., Papi, A., Rabe, K.F., Roche, N., Sciurba, F.C., Sethi, S., Siafakas, N., Sin, D.D., Soriano,
J.B., Stoller, J.K., Tashkin, D.P., Troosters, T., Verleden, G.M., Verschakelen, J., Vestbo, J.,
Walsh, J.W., Washko, G.R., Wise, R.A., Wouters, E.F., ZuWallack, R.L.: An official
American Thoracic Society/European Respiratory Society statement: research questions in
COPD. Eur. Respir. J. 45, 879–905 (2015)
266 B. Wais-Zechmann et al.
