Counselling techniques can be built into health apps to help users to get more physically active, say researchers after initial tests on a prototype called the Precious app. The tests were carried out by a research team including University of Cambridge researcher, Johanna Nurmi.
Drawing from behavioural science, the Precious app aims to support the basic psychological needs that are necessary for human motivation. Having the chance to choose meaningful goals and activities, setting achievable goals, and receiving empathetic support can help individuals internalise motivation.
Developed by a cross-European research team including social psychologists, computer scientists, and sensor engineers, the app uses counselling techniques, in particular an approach called motivational interviewing, to guide and motivate the user. Motivational Interviewing is a person-centred counselling method that focuses on individuals’ personal reasons to change.
The initial tests show that the app helps users to reflect on their life goals and find reasons for physical activity.
Hundreds of thousands of smartphone health tracker apps are now available but in scientific studies they struggle to deliver sustained increases in physical activity. Digital services face the challenge of engaging users who often download an app and use it once.
Yet programmes delivered in person, face to face, can more reliably boost physical activity.
If app developers could find ways to replicate the effectiveness of the in-person programmes, apps might help drive widespread behavioural change towards more physically active lifestyles.
This matters, because adopting a physically active lifestyle dramatically cuts the risk of contracting cardiovascular diseases, type-2 diabetes, and many cancers. So measures to improve the rates of physical activity are key to improving health around the world.
The tests on the Precious app show that it successfully utilises a key mechanism of Motivational Interviewing, called change talk, prompting users themselves to identify their need or desire to change.
The researchers in the study, published in JMIR mHealth and uHealth, asked a sample of 12 participants to ‘think aloud’ as they individually tried out the app. The participants engaged in reflection on the potential for change and they expressed their own reasons to change their behaviour as well as the desire and need to change.
Apps need to take into account that healthy behaviours are part of our everyday life. Time taken for exercise might be time away from something else. We want to help users to remember why they want to exercise, how it helps them to achieve things that matter to them.”
– Johanna Nurmi, social psychologist from the University of Helsinki and visiting researcher at the University of Cambridge.
The Precious app guides users to reflect on the reasons why they would increase their physical activity: what kind of life goals will I achieve by making this change? How would I feel if physical activity was part of my life? Do I have any positive experiences from being active, and could I do it again?
The Precious app also includes game-based content that is meant to create fun and challenges.
Behaviour change does not need to be serious. “Physical activity is just as good for you, whether you do it with your well-being in mind or if you just enjoy looking for Pokémons or running away from digital Zombies,” added Nurmi.
The two approaches build on motivation research, which has found that individuals are best motivated when they receive intrinsic pleasure from the behaviour, and when they find that the behaviour corresponds to their values and identities.
Nurmi said: “There are already lots of apps out there for users who are already showing some interest in changing their lifestyle. The big challenge for digital health apps is to actively engage people who do not have that motivation. The Precious app targets those users with supportive language, relational techniques, and gamification.”
Precious users were happy with the opportunity to choose life-goals and activities that mattered to them. At the same time, they did not want to be limited by a user profile.
During the usability test, we realised that we need to make it crystal clear that users can always change their goals and their preferences. Tailoring should not mean that a choice you make once dictates your options in the future.”
– Johanna Nurmi
Read Johanna’s blog post at UCL Digihub for more about the Precious app and her research.
Nurmi J, Knittle K, Ginchev T, Khattak F, Helf C, … Haukkala A. (2019) ‘Engaging users in the behavior change process with digitalized motivational interviewing and gamification: Development and feasibility testing of the Precious app‘. JMIR Mhealth Uhealth 2019
Image: created by the authors of the paper, licensed for Creative Commons usage
This project has received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no 611366 and Johanna Nurmi’s research is supported by the University of Helsinki
Media queries: Lucy Lloyd, Primary Care Unit Communications Manager