Persuasive features for patient engagement through mHealth applications in managing chronic conditions: A systematic literature review and meta-analysis

ABSTRACT

Patient engagement is currently considered the cornerstone of a revolution in healthcare for its positive impact on health outcomes, health behaviors and healthcare costs. Patient engagement is focused on personalized care to consumers through providing knowledge, skills and confidence. Mobile health (mHealth) applications are an innovative means to facilitate patient engagement. Nevertheless, the extent to which the current mHealth applications are designed to engage patients in managing their chronic diseases is unclear. This paper aims to identify the Persuasive System Design (PSD) features present in current mHealth applications that increased the engagement of patients with chronic diseases. This review also aims to identify patient engagement-related outcomes of these features. This paper conducted a systematic literature review and meta-analysis to find relevant studies published from all years up to 2020 through six databases: PubMed, Scopus, Web of Science, Cinahl plus with full text, MEDLINE with full text, and Cochrane Library (Central register of controlled trials). The database search returned 4939 articles; after applying the inclusion and exclusion criteria, the number of included articles for the final review was 13. A qualitative content analysis was performed to identify PSD model features and their patient engagement-related outcomes. The quality assessment has been done through the Cochrane Risk of Bias tool for RCTs. The systematic literature review and meta-analysis identified eleven PSD features that can increase patient engagement through using mHealth applications. The identified PSD features have been shown to have various patient engagement-related outcomes. Behavior Change Techniques (BCTs) were combined with the identified PSD features. This paper identified persuasive features of mHealth application design that influence the engagement of patients with chronic diseases toward changing their behavior. The impact of these features is also analyzed in this review. The results show that an mHealth technology-mediated patient engagement model is needed.

KEYWORDS:

• Patient engagement
• mHealth
• engagement features
• persuasive system design
• behavior change techniques

Abbreviations

mHealth = Mobile health

eHealth = Electronic health

HIMSS = The Healthcare Information and Management Systems Society

EHR = Electronic health records

EMR = Electronic medical records

PHR = Personal health records

BCT = Behavior change techniques

PSD model = Persuasive System Design model

Acknowledgments

The first author NA would like to thank the Saudi Cultural Mission in Australia and the University of Hail for sponsoring his PhD study at the University of Wollongong.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Summary Points

What was already known:

• Engagement features are required in the design of mHealth applications to increase patient engagement.

• Recent studies suggest providing persuasive features of mHealth applications to increase the engagement of chronic patients

• Less consideration has been devoted to understanding the impact of mHealth applications on patient engagement and evaluation of their involvement

• The PSD is a model for designing and evaluating systems that impact the attitudes or behaviours of users.

• The PSD features have been applied in eHealth design to trigger health behaviour change, motivate patients, and increased their engagement.

What this study has added:

• The PSD model has been used as a theoretical framework for classifying mHealth application features of chronic diseases.

• This review identified eleven of the PSD features that were utilised in mHealth applications for patients with different chronic conditions, which can facilitate patients’ engagement in different ways towards changing their health behaviour.

• This review showed that the majority of persuasive patient engagement features of mHealth applications were from dialogue support (Praise, Rewards, Reminders, Suggestions, and Social role); some from primary task support (Tailoring, Personalization, and Self-monitoring), system credibility support (Trustworthiness), and social support (Social learning, Social comparison, and Normative influence).

• In this review, some features of the PSD were found to be aligned with the BCTs.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17538157.2023.2165083

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.