Persuasive Systems Design Trends in Coronary Heart Disease Management: Scoping Review of Randomized Controlled Trials

Background Behavior change support systems (BCSSs) have the potential to help people maintain healthy lifestyles and aid in the self-management of coronary heart disease (CHD). The Persuasive Systems Design (PSD) model is a framework for designing and evaluating systems designed to support lifestyle modifications and health behavior change using information and communication technology. However, evidence for the underlying design principles behind BCSSs for CHD has not been extensively reported in the literature. Objective This scoping review aims to identify existing health BCSSs for CHD, report the characteristics of these systems, and describe the persuasion context and persuasive design principles of these systems based on the PSD framework. Methods Using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, 3 digital databases (Scopus, Web of Science, and MEDLINE) were searched between 2010 to 2022. The major inclusion criteria for studies were in accordance with the PICO (Population, Intervention, Comparison, and Outcome) approach. Results Searches conducted in the databases identified 1195 papers, among which 30 were identified as eligible for the review. The most interesting characteristics of the BCSSs were the predominant use of primary task support principles, followed by dialogue support and credibility support and the sparing use of social support principles. Theories of behavior change such as the Social Cognitive Theory and Self-Efficacy Theory were used often to underpin these systems. However, significant trends in the use of persuasive system features on par with behavior change theories could not be established from the reviewed studies. This points to the fact that there is still no theoretical consensus on how best to design interventions to promote behavior change in patients with CHD. Conclusions Our results highlight key software features for designing BCSSs for the prevention and management of CHD. We encourage designers of behavior change interventions to evaluate the techniques that contributed to the success of the intervention. Future research should focus on evaluating the effectiveness of the interventions, persuasive design principles, and behavior change theories using research methodologies such as meta-analysis.


INTRODUCTION Rationale
3 Describe the rationale for the review in the context of existing knowledge.
Line 6-65 Objectives 4 Provide an explicit statement of the objective(s) or question(s) the review addresses.

METHODS
Eligibility criteria 5 Specify the inclusion and exclusion criteria for the review and how studies were grouped for the syntheses.
Line 117-123 Information sources 6 7 Specify all databases, registers, websites, organisations, reference lists and other sources searched or consulted to identify studies.Specify the date when each source was last searched or consulted.
Present the full search strategies for all databases, registers and websites, including any filters and limits used.

Selection process 8 9
Specify the methods used to decide whether a study met the inclusion criteria of the review, including how many reviewers screened each record and each report retrieved, whether they worked independently, and if applicable, details of automation tools used in the process.
Specify the methods used to collect data from reports, including how many reviewers collected data from each report, whether they worked independently, any processes for obtaining or confirming data from study investigators, and if applicable, details of automation tools used in the process.

Data collection process
Line None

Study selection
16a Describe the results of the search and selection process, from the number of records identified in the search to the number of studies included in the review, ideally using a flow diagram.
Line 92-98 16b 17 Cite studies that might appear to meet the inclusion criteria, but which were excluded, and explain why they were excluded.
Cite each included study and present its characteristics.

Study characteristics
Line 174-189 For all outcomes, present, for each study: (a) summary statistics for each group (where appropriate) and (b) an effect estimate and its precision (e.g.confidence/credible interval), ideally using structured tables or plots.

Risk of bias in studies
For each synthesis, briefly summarise the characteristics and risk of bias among contributing studies.
Present results of all statistical syntheses conducted.If meta-analysis was done, present for each the summary estimate and its precision (e.g.confidence/credible interval) and measures of statistical heterogeneity.If comparing groups, describe the direction of the effect.Discuss any limitations of the review processes used.

None
Discuss implications of the results for practice, policy, and future research.

Eligibility criteria
3 Specify the inclusion and exclusion criteria for the review.Yes Information sources 4 Specify the information sources (e.g.databases, registers) used to identify studies and the date when each was last searched.

6
Specify the methods used to assess risk of bias in the included studies.
Specify the methods used to present and synthesize results.

Included studies 7
Give the total number of included studies and participants and summarise relevant characteristics of studies.

8
Present results for main outcomes, preferably indicating the number of included studies and participants for each.If meta-analysis was done, report the summary estimate and confidence/credible interval.If comparing groups, indicate the direction of the effect (i.e. which group is favoured). No all investigations of possible causes of heterogeneity among study results.Present results of all sensitivity analyses conducted to assess the robustness of the synthesized results.risk of bias due to missing results (arising from reporting biases) for each synthesis assessed.Present assessments of certainty (or confidence) in the body of evidence for each outcome assessedof the evidence included in the review.

132-139 Topic No. Item Location where item is reported
NoneStudy risk of bias assessmentNoneEffect measures12 Specify for each outcome the effect measure(s) (e.g.risk ratio, mean difference) used in the synthesis or presentation of results.NoneSynthesis methods 13a 13b 13cDescribe the processes used to decide which studies were eligible for each synthesis (e.g.tabulating the study intervention characteristics and comparing against the planned groups for each synthesis (item 5)).Describe any methods used to explore possible causes of heterogeneity among study results (e.g.subgroup analysis, meta-regression).