1. Persuading people 01.09.2013 - 02.01.2014 Using technology to change health behaviour

2. Group: i901e13 Lars Christian Vagner Lichon Umachanger Brinthaparan Nirojan Srikandarajah Stephan Vinther Smedegaard Rasmussen Informatics, 9th semester (Pre-specialisation) 2 /50

3. Table of content Introduction Litterature review DesignField studyFindingsConclusion IntroductionLitterature reviewDesignField studyFindingsConclusion 3 /50

4. Introduction Litterature reviewDesignField studyFindingsConclusion

5. Introduction The University of Melbourne, Australia 01.09.2013 – 02.01.2014 Ongoing research Social Networks Sites for Ambivalent Socialisers: The Case of Smoking Cessation With Dr Bernd Ploderer, Dr Wally Smith, Dr Greg Wadley & Dr Jon Pearce Collaboration with IntroductionLitterature reviewDesignField studyFindingsConclusion 5 /50

6. The case of smoking cessation The rate of people killed by smoking is higher than people killed in car accidents, alcohol and other drugs combined (Victoria, Australia) Nearly 6 million killed each year Health issues Cancer, lung disease, heart disease and poor blood circulation Economy within social welfare Governments and anti-smoking organizations Using persuasive technologies IntroductionLitterature reviewDesignField studyFindingsConclusion 6 /50

7. Problem area Gather and discuss knowledge on health behaviour changing research Applying a mobile technology probe to persuade users The study introduces: 3 content types: Stories, Tips and Motivators 2 sources of recommendation: Experts and Community. IntroductionLitterature reviewDesignField studyFindingsConclusion 7 /50

8. Understanding Litterature Review Analysis Research Design App design Expert evaluation Design 3-week Field Study Interviews Field Study Coding Affinity Diagram Data Analysis

9. Litterature review IntroductionLitterature reviewDesignField studyFindingsConclusion

10. Themes IntroductionLitterature reviewDesignField studyFindingsConclusion Major themesHCI papers Mobile platform Tracking/Self-monitoring Reminding/Interrupting Games Social networks/Social support online Use of agents Guidelines/Strategies Evaluating health behaviour change systems Total: x56 10 /50

11. Tracking/Self-monitoring Focus on physical activity and healthy eating Manual data entries Auto data tracking Challenges Using smartphone sensors Using the data in new ways IntroductionLitterature reviewDesignField studyFindingsConclusion 11 /50

12. Social Network / Social Support Online Tracking health data Sharing personal health information Storytelling seems to be unexplored Using existing SN or create your own? IntroductionLitterature reviewDesignField studyFindingsConclusion 12 /50

13. Reminding/Interrupting SMS messages Alarm/push notifications Only few studies have tried to explore this area Tailored, personalized messages are most effective Polite vs Annoying Interruption IntroductionLitterature reviewDesignField studyFindingsConclusion 13 /50

14. Design IntroductionLitterature reviewDesignField studyFindingsConclusion

15. Research design Principles of persuasion Social proof Community Expertise Expert Stories Recomended based on community Stories Recomended based on expert Tips Recomended based on community Tips Recomended based on expert Motivators Recomended based on community Motivators Recomended based on expert IntroductionLitterature reviewDesignField studyFindingsConclusion 15 /50

16. http://tiny.cc/Quitty IntroductionLitterature reviewDesignField studyFindingsConclusion 16 /50

17. Field study IntroductionLitterature reviewDesignField studyFindingsConclusion

18. The study Survey 3 weeks of use The participants commenced their participation at various points 1 push message each day 3 types of content each day Randomized recommenders Data collected: Clicks Ratings and comments IntroductionLitterature reviewDesignField studyFindingsConclusion 18 /50

19. Participants 2324263133373842363747 34 avg Total of 11 Average nicotine dependence: 2 Most of them are at least at the stage of ”Preparing to quit” 4 (0) 2 (1- 2 = very low dependence) 2 (3 = low to mod dependence) 2 (4 = moderate dependence) 1 (5+ = high dependence) IntroductionLitterature reviewDesignField studyFindingsConclusion 19 /50

20. Interviews Pilot interview 10 interviews (all transcribed) Each interview lasting approximately 45 minutes Gathering impressions of the system Discussing comments and ratings with participants IntroductionLitterature reviewDesignField studyFindingsConclusion 20 /50

22. Coding Participant/Researc her UmachangerNirojanLarsStephan P1XX P2X X P3X X P4 XX P5 XX P6XX P7 XX P8X X P9 XX P10 X X IntroductionLitterature reviewDesignField studyFindingsConclusion 22 /50

24. Findings IntroductionLitterature reviewDesignField studyFindingsConclusion

25. 8 major themes Content types Gain and loss framed content Genuine/fake Sources of recommendation Text messages Relatability and tailoring Tracking Social IntroductionLitterature reviewDesignField studyFindingsConclusion 25 /50

26. The app Easily accesible on phone: ”I prefer it on the phone. It is like maybe if you are in a bar and you like, you can actually ask, what do I do if I actually see someone smoking and I am in craving….” Keep it a private: ”Qutting smoking is a private thing.... And having an app on your phone means you can kind of look at it, secretly” IntroductionLitterature reviewDesignField studyFindingsConclusion 26 /50

27. Content preference IntroductionLitterature reviewDesignField studyFindingsConclusion 27 /50

28. Content Most participants prefered gain framed content rather then loss framed content “That makes me happy. Positive future. Like the light at the end of the tunnel.” “So yeah, I would much prefer something that got that positive “this good thing is gonna happen if you do this”.” Some participants also liked a mix of both or purely loss framed content 6 participants wanted to get more information than what was provided by the app on a daily basis. IntroductionLitterature reviewDesignField studyFindingsConclusion 28 /50

29. Condescending Content 4 participants felt some of the content was condescending “…and that was as well condescending that I felt like. Yeah, you know having tried it or like, you know “Good little smokie you get a sweetie” “…almost a little condescending towards smokers” IntroductionLitterature reviewDesignField studyFindingsConclusion 29 /50

30. Fake/Genuine Content 5 participants talked about the importance of the content feeling genuine 3 participants said the stories in the app seemed fake “some of the stories I found to be, almost to the degree that they read as if they were just made up. “Today I am going to quit, I’ve decided I am going to quit today” “I don’t know if the stories were actually true and comes from people who try to quit or have quit, but they just sort of seemed a bit artificial.” IntroductionLitterature reviewDesignField studyFindingsConclusion 30 /50

31. Stories Personal experiences and stories ”So you know, I can’t relate to this, but, I’m listening to someone, whose not trying to scare me into something, ‘I’m not trying to do this’, just telling me her experience, and sharing that with me, and encouraging me to go on my own journey. So, I respond to that positively.” Opportunity to relate Can offer hope (small hopes helps) Offers emotional content Bad grammar made some take them less seriously IntroductionLitterature reviewDesignField studyFindingsConclusion 31 /50

32. Stories  Unrelatable  Scare tactics does not work  Unrealistic ”Just sort of, not like ‘I could and it was so easy, I can’t believe I didn’t do it sooner’, because it is not realistic to me. I have tried to quit a lot of times and that is not easy at all.” “All that all of a sudden I felt beautiful after getting up… it’s, it’s, it’s too… I am not denying it’s legitimize, it’s just too over the top exaggeration.” IntroductionLitterature reviewDesignField studyFindingsConclusion Grab your attention Offer something different Stories should describe the struggle Explain the process of quitting Have to be edgy Inspiring Real Emotional GoodBad 32 /50

33. Tips Easy implementation “Probably a tip might not work for everybody. When it comes to tips and it comes to quitting smoking I think really basic things are quite good, because you are not necessarily… you don’t necessarily think of them, you don’t necessarily think “If I really want a cigarette, If I just takes some deep breaths and just wait that minute, that might help”, you don’t necessarily actively think that.” Consice Practical Simple Reinforcing behaviors “I suppose its something that you kind of thought of yourself and its also really forcing it. To change your routine, go for a walk, take your mind off it, do something else. Most of the time you have a cigarette because you’re bored as well. So, its kind of reinforcing behaviours that you already know you should be doing, but to actually see it written there as well it also reiterates it.” Another focus: Getting healthy again IntroductionLitterature reviewDesignField studyFindingsConclusion 33 /50

34. Tips  Not much detail  No relevance  Not seeing it happening in their life  Not on a psychological level  Not easy to implement “You know and I mean once you go and do it, you do feel better, but you know, that fairly common tip “Just go for a walk or something” initially when you quit smoking, that’s the last thing you feel like doing, because you don’t feel right. Tips like that it’s like “no! I am not gonna go and do any exercise, this is hard!”  Makes you think of smoking IntroductionLitterature reviewDesignField studyFindingsConclusion Easily implemented Realistic Practical Instructions and examples Relatable/achievable Useful reminder Original thoughts GoodBad 34 /50

35. Motivators Factual Money is the biggest motivator New knowledge Helps on a subconscious level Reminds of what you already know “A good motivator is things like knowing that, things I already know that I sort of needs to be reminded of, if I quit smoking I could exercise more easily and I wouldn’t get puffed walking on the street or whatever.” IntroductionLitterature reviewDesignField studyFindingsConclusion 35 /50

36. Motivators  Should not be negative  Not motivating  Cheesy  Not long-term focused “15 years seems like a very long time, you know and to think like, it’s like in 15 years I will be 50 or something. It’s too far away, it’s not like… it’s kind of discouraging to think that I have done that much damage and that is gonna take that long to get any kind of benefit.”  Not relatable IntroductionLitterature reviewDesignField studyFindingsConclusion Positive “The good ones I found in that were positive saying like “after a week..” or whatever you know “these are the health benefits” you know, the positive effects that you can get rather than the necessarily shock tactics.” Gains Gives confidence Has to be up-to-date Relatable Short-term focused GoodBad 36 /50

37. Recommenders Recommenders were often not noticed due to the participant not reading the briefing well enough or due to app design. Community generally preffered Some noticed a difference between recommenders IntroductionLitterature reviewDesignField studyFindingsConclusion 37 /50

38. Recommenders Most participants felt that people from the community had firsthand experience which they believed an expert did not have “I don’t know if being expert requires having experience of reality addiction but it doesn’t necessarily imply that they have been through it. Maybe they know the facts and figures, but they haven’t lived it. Experts do not know how it is” High expectations from an expert “Um, I don’t know, I don’t think I’d respond to that in general; like first of all I’d say well, why do you include tips that aren’t going to work? You know, why aren’t they all just good tips then?” IntroductionLitterature reviewDesignField studyFindingsConclusion 38 /50

39. Text messages 9 participants said that the messages made them use the app more. “These were good reminders. So If did not check it that day so it was like ‘oh yeah that’s what I have to do’. Because you do forget especially if you are busy or you are tired”. IntroductionLitterature reviewDesignField studyFindingsConclusion 39 /50

40. Text messages Texts from real people as motivation: “After that, knowing that there were someone there, I found the messages encouraging and positive and friendly and that was my main motivation for checking the app, was getting that text message” Reflecting on smoking habits: ”No, generally if I would receive a text message and I was having a cigarette or I just had a cigarette it would make me feel a little bit guilty” Good to get notified at different times The messages should be interesting and funny IntroductionLitterature reviewDesignField studyFindingsConclusion 40 /50

41. Relatability All participants mentioned relatability as being important Unrelatable content was disliked ”… I don’t care about 18 years old kids. I don’t care about this mother who has two kids and harming her to give up smoking. It’s not my life it is your life honey.” IntroductionLitterature reviewDesignField studyFindingsConclusion 41 /50

42. Relatability 4 out of the 5 participants said that demographics weren’t a key factor to determine relatability. In some cases it just had to be genuine “Whilst a lot of them didn’t relate to me directly in anyway, because I don’t have children or I don’t have this… it felt genuine enough that I could access it. It felt that there was enough in it that I felt I could make an emotional connection, it wasn’t preachy, it wasn’t this… it was just an experience that someone was sharing. “ IntroductionLitterature reviewDesignField studyFindingsConclusion 42 /50

43. Tailoring Quitting Stage: 6 participants found this important ”Some of them I found frustrating to read, because, hearing other people having succeeded, when you are still struggling is difficult.” Demographics: 2 participants found this important ”I think I would probably prefer not to know too much about them just so that I could relate it to myself.” IntroductionLitterature reviewDesignField studyFindingsConclusion 43 /50

44. Tracking and feedback “If there was a way, that I could either log days or times that I haven’t had a cigarette or probably another way would be to log a time where I put off a cigarette when I have gone ‘rather than having a cigarette I am going to log into the system and say I am not having this cigarette now’…” “If I have put off a certain amount each day then I was like getting a badge or a recognition or something back from the system” IntroductionLitterature reviewDesignField studyFindingsConclusion 44 /50

45. Social Interest in interacting with other people through app Authors of stories/tips/motivators Experts (from Quit Vic) Better potential for using app as substitute for cigarette Interest in being a parts of a community Online Meeting – Social activities Share IntroductionLitterature reviewDesignField studyFindingsConclusion 45 /50

46. Reflected on smoking habits 7 participants had reflected on own smoking habits in one way or another Thought about how he or she should really quit 3 participants had not reflected on own smoking habits The content in the app wasn’t ”news” IntroductionLitterature reviewDesignField studyFindingsConclusion 46 /50

47. Conclusion IntroductionLitterature reviewDesignField studyFindingsConclusion

48. Insight of the health behaviour change domain Content types Small differences Elements necessary Tailoring and relatability Genuine content Gain/loss-framed content Push messaging Mobile platform IntroductionLitterature reviewDesignField studyFindingsConclusion 48 /50

49. Future work Tailored information Push messaging Content types Social networks Other domains Longitudinal study – Quitty v2? Theoretical/analytic study IntroductionLitterature reviewDesignField studyFindingsConclusion 49 /50

50. Now, let’s talk! ;)