Persuasive E-Health Design for Behavior Change

  • Harald BaumeisterEmail author
  • Robin Kraft
  • Amit Baumel
  • Rüdiger Pryss
  • Eva-Maria Messner
Part of the Studies in Neuroscience, Psychology and Behavioral Economics book series (SNPBE)


At a time, in which people are more and more suffering from lifestyle-related diseases such as cardiovascular diseases, diabetes, or obesity, changing health behavior and preserving a healthy lifestyle are salient factors of any public health effort. Hence, research on predictors and pathways of health behavior change is increasingly important. Following this, new ways of implementing behavior change interventions become possible based on internet technologies, allowing for technological approaches fostering behavior change. Such union of media informatics and psychology is denoted as persuasive design and refers to all technological intervention components, which help people to take, regularly use and re-take (after relapses into unwanted behavior) interventions. Along this trend, the present chapter introduces (1) theories of health behavior change and summarizes (2) present persuasive design approaches, thereby ending with (3) future directions in the field.


Persuasive design Health behavior change E-health Lifestyle interventions 


  1. Ajzen I (1985) From intentions to actions: a theory of planned behavior. In: Kuhl J, Beckmann J (eds) Action control: From cognition to behavior. Springer, Heidelberg, pp 11–39CrossRefGoogle Scholar
  2. Anagnostopoulou E, Bothos E, Magoutas B, Schrammel J, Mentzas G (2018) Persuasive interventions for sustainable travel choices leveraging users’ personality and mobility type. In: Ham J, Karapanos E, Morita PP, Burns CM (eds) Persuasive technology. Springer, Cham, pp 229–241.
  3. Bandura A (2001) Social cognitive theory: an agentic perspective. Ann Rev Psychol 52:1–26. Scholar
  4. Baumeister H, Krämer L, Brockhaus B (2008) Grundlagen psychologischer Interventionen zur Änderung des Gesundheitsverhaltens. Klinische Verhaltensmedizin und Rehabilitation 82:254–264Google Scholar
  5. Baumeister H, Reichler L, Munzinger M, Lin J (2014) The impact of guidance on Internet-based mental health interventions—a systematic review. Internet Interv 1:205–215. Scholar
  6. Baumel A, Yom-Tov E (2018) Predicting user adherence to behavioral eHealth interventions in the real world: Examining which aspects of intervention design matter most. Trans Behav Med 8(5):793–798. Scholar
  7. Baumel A, Birnbaum ML, Sucala M (2017) A systematic review and taxonomy of published quality criteria related to the evaluation of user-facing eHealth programs. J Med Syst 41(128).
  8. Becker MH (1947) The health belief model and personal health behavior. Slack, Thorofare, NJGoogle Scholar
  9. Bendig E, Bauereiß N, Ebert DD, Snoek F, Andersson G, Baumeister H (2018) Internet-based interventions in chronic somatic disease. Deutsches Aerzteblatt Int 115:659–665. Scholar
  10. Bengio Y, Courville A, Vincent P (2013) Representation learning: a review and new perspectives. IEEE Trans Pattern Anal Mach Intell 35:1798–1828. Scholar
  11. Ben-Zeev D, Scherer EA, Wang R, Xie H, Campbell AT (2015) Next-generation psychiatric assessment: using smartphone sensors to monitor behavior and mental health. Psychiatry Rehabil J 38(3):218–226. Scholar
  12. Bogg T, Roberts BW (2004) Conscientiousness and health-related behaviors: a meta-analysis of the leading behavioral contributors to mortality. Psychol Bull 130:887–919. Scholar
  13. Brunette MF, Ferron JC, Gottlieb J, Devitt T, Rotondi A (2016) Development and usability testing of a web-based smoking cessation treatment for smokers with schizophrenia. Internet Interv 4:113–119. Scholar
  14. Chow KKN (2018) Time off: designing lively representations as imaginative triggers for healthy smartphone use. In: Ham J, Karapanos E, Morita PP, Burns CM (eds) Persuasive technology. Springer, Cham, pp 135–146.
  15. Christensen H, Griffiths KM, Farrer L (2009) Adherence in internet interventions for anxiety and depression: Systematic review. J Med Internet Res 11:e13. Scholar
  16. Cloninger R, Svrakic D, Przybeck T (1994) A psychobiological model of temperament and character. Arch Gen Psychiatry 50:975–990CrossRefGoogle Scholar
  17. Conner M (2008) Initiation and maintenance of health behaviors. Appl Psychol Int Rev 57:42–50. Scholar
  18. Day JJ, Sanders MR (2018) Do parents benefit from help when completing a self-guided parenting program online? a randomized controlled trial comparing triple p online with and without telephone support. Behav Ther 49:1020–1038. Scholar
  19. Domhardt M, Steubl L, Baumeister H (2018) Internet-and mobile-based interventions for mental and somatic conditions in children and adolescents. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 1–14.
  20. Domhardt M, Geßlein H, von Rezori RE, Baumeister H (2019) Internet- and mobile-based interventions for anxiety disorders: A meta-analytic review of intervention components. Depress Anxiety 36:213–224. Scholar
  21. Ebert DD, Cuijpers P, Munoz RF, Baumeister H (2017) Prevention of mental health disorders using internet and mobile-based interventions: a narrative review and recommendations for future research. Front Psychiatry 8:116. Scholar
  22. Ebert DD, Daele T, Nordgreen T, Karekla M, Compare TA, Zarbo C, Brugnera A, Oeverland S, Trebbi G, Jensen KL, Kaehlke F, Baumeister H (2018) Internet and mobile-based psychological interventions: applications, efficacy and potential for improving mental health. a report of the EFPA e-health taskforce. Eur Psychol 23:167–187. Scholar
  23. Ferrer RA, Klein WMP (2015) Risk perceptions and health behavior. Curr Opin Psychol 5:85–89. Scholar
  24. Fogg BJ (1998) Persuasive computers: perspectives and research directions. In: Proceedings of the SIGCHI conference on human factors in computing systems. ACM Press/Addison-Wesley Publishing Co., pp 225–232Google Scholar
  25. Fry JP, Neff RA (2009) Periodic prompts and reminders in health promotion and health behavior interventions: Systematic review. J Med Internet Res 11(2):e16. Scholar
  26. Gollwitzer PM (1999) Implementation intentions: Strong effects of simple plans. Am Psychol 54(7):493–503CrossRefGoogle Scholar
  27. Hamari J, Koivisto J, Pakkanen T (2014) Do persuasive technologies persuade? a review of empirical studies. In: International conference on persuasive technology, pp 118–136Google Scholar
  28. Hammelstein P (2006) Sexuelles Kontaktverhalten. In: Renneberg B, Hammelstein P (eds) Gesundheitspsychologie. Springer, Heidelberg, pp 229–244.
  29. Hammelstein P, Pohl J, Reimann S, Roth M (2006) Persönlichkeitsmerkmale. In: Renneberg B, Hammelstein P (eds) Gesundheitspsychologie. Springer, Heidelberg, pp 61–101CrossRefGoogle Scholar
  30. Hardcastle SJ, Hancox J, Hattar A, Maxwell-Smith C, Thøgersen-Ntoumani C, Hagger MS (2015) Motivating the unmotivated: how can health behavior be changed in those unwilling to change? Front Psychol 6:1–4. Scholar
  31. Heckhausen J (2007) Motivation und Handeln. Springer, BerlinGoogle Scholar
  32. Kaprio J, Pulkkinen L, Rose RJ (2002) Genetic and environmental factors in health-related behaviors: studies on Finnish twins and twin families. Twin Res 5:366–371. Scholar
  33. Kauer SD, Reid SC, Crooke AHD, Khor A, Hearps SJC, Jorm AF, Patton G et al (2012) Self-monitoring using mobile phones in the early stages of adolescent depression: randomized controlled trial. J Med Internet Res 14:e67.
  34. Knoll N, Scholz U, Rieckmann N (2005) Einführung in die Gesundheitspsychologie. Reinhardt, MünchenGoogle Scholar
  35. Kok G, Schaalma H, Ruiter RAC, Van Empelen P, Brug J (2004) Intervention mapping: a protocol for applying health psychology theory to prevention programmes. J Health Psychol 9:85–98. Scholar
  36. Lally P, van Jaarsveld CHM, Potts HWW, Wardle J (2010) How are habits formed: modelling habit formation in the real world. Eur J Soc Psychol 40:998–1009. Scholar
  37. Lanata A, Valenza G, Nardelli M, Gentili C, Scilingo EP (2015) Complexity index from a personalized wearable monitoring system for assessing remission in mental health. IEEE J Biomed Health Inform 19:132–139. Scholar
  38. Längkvist M, Karlsson L, Loutfi A (2014) A review of unsupervised feature learning and deep learning for time-series modeling. Pattern Recognit Lett 42:11–24. Scholar
  39. Lin J, Paganini S, Sander L, Lüking M, Ebert DD, Buhrman M, Baumeister H et al (2017a) An internet-based intervention for chronic pain: a three-arm randomized controlled study of effectiveness of guided and unguided acceptance and commitment therapy. Deutsches Aerzteblatt Int 114:681–688.
  40. Lin J, Sander L, Paganini S, Schlicker S, Ebert D, Berking M, Baumeister H et al (2017b) Effectiveness and cost-effectiveness of a guided internet- and mobile-based depression intervention for individuals with chronic back pain: protocol of a multi-centre randomised controlled trial. BMJ Open 7:e015226.
  41. Ludden G, Van Rompay T, Van Gemert-Pijnen J (2015) How to increase reach and adherence of web-based interventions: A design research viewpoint. J Med Internet Res 17:e172. Scholar
  42. McDade-Montez E, Cvengros J, Christensen A (2007) Persönlichkeitseigenschaften und Unterschiede. In: Kerr J, Weitkunat R, Moretti M (eds) ABC der Verhaltensänderung: Der Leitfaden für erfolgreiche Prävention und Gesundheitsförderung. Urban & Fischer, München, pp 60–74Google Scholar
  43. Miotto R, Danieletto M, Scelza JR, Kidd BA, Dudley JT (2018) Reflecting health: smart mirrors for personalized medicine. Npj Digit Med 1(62).
  44. Montag C, Baumeister H, Kannen C, Sariyska R, Meßner E-M, Brand M (2019) Concept, possibilities and pilot-testing of a new smartphone application for the social and life sciences to study human behavior including validation data from personality psychology. Multidiscip Sci J 2:102–115. Scholar
  45. Muench F, Baumel A (2017) More than a text message: dismantling digital triggers to curate behavior change in patient-centered health interventions. J Med Internet Res 19:e147. Scholar
  46. Mylonopoulou V, Väyrynen K, Stibe A, Isomursu M (2018) Rationale behind socially influencing design choices for health behavior change. In: Ham J, Karapanos E, Morita PP, Burns CM (eds) Persuasive technology. Springer Cham, pp 147–159
  47. Naslund JA, Kim SJ, Aschbrenner KA, Mcculloch LJ, Brunette MF, Dallery J, Marsch LA et al (2017) Systematic review of social media interventions for smoking cessation. Addict Behav 73:81–93.
  48. Oinas-Kukkonen H, Harjumaa M (2009) Persuasive systems design: key issues, process model, and system features. Commun Assoc Inform Syst 24:485–500.
  49. Orji R, Moffatt K (2018) Persuasive technology for health and wellness: state-of-the-art and emerging trends. Health Inform J 24:66–91. Scholar
  50. Perski O, Blandford A, West R, Michie S (2017) Conceptualising engagement with digital behaviour change interventions: a systematic review using principles from critical interpretive synthesis. Trans Behav Med 7:254–267. Scholar
  51. Prochaska JO, Velicer WF (1997) The transtheoretical model of health behavior change. Am J Health Promot 12:38–48. Scholar
  52. Rathner E-M, Djamali J, Terhorst Y, Schuller B, Cummins N, Salamon G, Baumeister H et al (2018a) How did you like 2017? detection of language markers of depression and narcissism in personal narratives. Interspeech 3388–3392.
  53. Rathner E-M, Terhorst Y, Cummins N, Schuller B, Baumeister H (2018b) State of mind: classification through self-reported affect and word use in speech. Interspeech 2018:267–271.
  54. Reddy V, Bushree B, Chong M, Law M, Thirani M, Yan M, Joshi A et al (2018) Influencing participant behavior through a notification-based recommendation system. In: Ham J, Karapanos E, Morita PP, Burns CM (eds) Persuasive technology. Springer, Cham, pp 113–119
  55. Renneberg B, Hammelstein P (2006) Gesundheitspsychologie. Springer Medizin, HeidelbergCrossRefGoogle Scholar
  56. Riley WT, Rivera DE, Atienza AA, Nilsen W, Allison SM, Mermelstein R (2011) Health behavior models in the age of mobile interventions: are our theories up to the task? Trans Behav Med 1:53–71. Scholar
  57. Roberts BW, Walton KE, Bogg T (2005) Conscientiousness and health across the life course. Rev Gen Psychol 9:156–168. Scholar
  58. Ryan RM, Lynch MF, Vansteenkiste M, Deci EL (2011) Motivation and autonomy in counseling, psychotherapy, and behavior change: A look at theory and practice. The Counseling Psychologist 39:193–260. Scholar
  59. Sander L, Paganini S, Lin J, Schlicker S, Ebert DD, Buntrock C, Baumeister H (2017) Effectiveness and cost-effectiveness of a guided internet- and mobile-based intervention for the indicated prevention of major depression in patients with chronic back pain-study protocol of the PROD-BP multicenter pragmatic RCT. BMC Psychiatry 17:1–13. Scholar
  60. Sariyska R, Reuter M, Bey K, Sha P, Li M, Chen YF, Montag C et al (2014) Self-esteem, personality and internet addiction: a cross-cultural comparison study. Pers Individ Differ 61–62:28–33.
  61. Schwarzer R (2004) Psychologie des Gesundheitsverhaltens. Einführung in die Gesundheitspsychologie. Hogrefe, GöttingenGoogle Scholar
  62. Schwarzer R (2008) Modeling health behavior change: how to predict and modify the adoption and maintenance of health behaviors. Appl Psychol Int Rev 57(1):1–29. Scholar
  63. Sheeran P, Webb TL (2016) The intention-behaviour gap. Soc Pers Psychol Compass 10:503–518. Scholar
  64. Sheeran P, Maki A, Montanaro E, Avishai-Yitshak A, Bryan A, Klein WMP, Rothman AJ et al (2016) The impact of changing attitudes, norms, or self-efficacy on health intentions and behavior: a meta-analysis. Health Psychol 35:1178–1188Google Scholar
  65. Singh K, Drouin K, Newmark LP, Jae HL, Faxvaag A, Rozenblum R, Bates DW et al (2016) Many mobile health apps target high-need, high-cost populations, but gaps remain. Health Affairs 35:2310–2318.
  66. Sniehotta FF, Schwarzer R, Scholz U, Schüz B (2005) Action planning and coping planning for long-term lifestyle change: theory and assessment. Eur J So Psychol 35(54):565–576. Scholar
  67. Spelt H, Westerink J, Ham J, IJsselsteijn W (2018) Cardiovascular reactions during exposure to persuasion principles. In: Ham J, Karapanos E, Morita PP, Burns CM (eds) Persuasive technology. Springer, Cham, pp 267–278
  68. Sutton S (2008) How does the Health Action Process Approach (HAPA) bridge the intention-behavior gap? An examination of the model’s causal structure. Appl Psychol Int Rev 57:66–74. Scholar
  69. Tikka P, Laitinen M, Manninen I, Oinas-Kukkonen H (2018) Reflection trough gaming: reinforcing health message response through gamified rehearsal. In: Ham J, Karapanos E, Morita PP, Burns CM (eds) Persuasive technology. Springer, Cham, pp 200–212
  70. Van Ballegooijen W, Cuijpers P, Van Straten A, Karyotaki E, Andersson G, Smit JH, Riper H (2014) Adherence to internet-based and face-to-face cognitive behavioural therapy for depression: a meta-analysis. PLoS ONE 9:e100674. Scholar
  71. Venkatesh V, Morris MG, Davis GB, Davis FD (2003) User acceptance of information technology: toward a unified view. MIS Q 27:425–478. Scholar
  72. Wais-Zechmann B, Gattol V, Neureiter K, Orji R, Tscheligi M (2018) Persuasive technology to support chronic health conditions: investigating the optimal persuasive strategies for persons with COPD. In: Ham, J Karapanos E, Morita PP, Burns CM (eds) Persuasive technology. Springer, Cham, pp 255–266
  73. Wangberg SC, Bergmo TS, Johnsen J-AK (2008) Adherence in internet-based interventions. Patient Preference Adherence 2:57–65. Retrieved from
  74. Wunsch M, Stibe A, Millonig A, Seer S, Dai C, Schechtner K, Chin RCC (2015) What makes you bike? exploring persuasive strategies to encourage low-energy mobility. In: MacTavish T, Basapur S (eds) Persuasive technology. Springer, Cham, pp 53–64
  75. Zhang C-Q, Zhang R, Schwarzer R, Hagger MS (2019) A meta-analysis of the health action process approach. Health Psychol
  76. Zhu J (2004) Understanding volition. Philoso Psychol 17(2):247–273. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Harald Baumeister
    • 1
    Email author
  • Robin Kraft
    • 1
  • Amit Baumel
    • 3
  • Rüdiger Pryss
    • 2
  • Eva-Maria Messner
    • 1
  1. 1.Department of Clinical Psychology and PsychotherapyInstitute of Psychology and Education, Ulm UniversityUlmGermany
  2. 2.Institute of Databases and Information SystemsUlm UniversityUlmGermany
  3. 3.Department of Community Mental HealthUniversity of HaifaHaifaIsrael

Personalised recommendations