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Persuasive Decision Support Systems

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Discuss about the Persuasive Decision Support Systems for Self-Care.



Health Behavior Change Support Systems (HBCSSs) refers to socio-technical information systems designed to perform or change the behavioral or psychological systems of an individual such as attitude or behavior. This implies that the system has been developed with the intention to influence the users’ behavior. Persuasive decision support system aims at influencing or changing behavior and attitude of patients using socio-technical tool HBCSSs. Persuasive decision support systems for self-care. Self-care is another important part of patient health care. There are many kinds of literature that explain various aspects of persuasive decision support system that enable patients especially chronic disease patients take behavioral and attitude change. Some of the fundamental aspects of persuasive decision support system are attitude, compliance, behavior and patient education. The main focus of this paper is to provide literature on persuasive decision support system for self-care patients.

Review process

Persuasive decision support system is the tool that is used to involve patients in decision making through persuasion. Persuasive component of the system plays an important role in the development, design, and implementation. Users of the system need to be part of the development of the system according to Bensley et al (2010, pp 206–213). Moreover, as Harjumaa, Segerståhl and Oinas-Kukkonen (2009, vol. 350), explains patients with chronic diseases need to be part of the development as the main stakeholders as this also help in decision making. According to Davis (2010, pp 262–273), the three aspects of the persuasive in health are attitude, compliance and behavior. These three aspects of persuasive decision support system are key determinants of self-care of most patients. Similarly, Räisänen and Lehto (2010, pp 185–192) highlight engagement and involvement as the key most important component of the persuasive decision support system that facilitates game intervention. Oinas-Kukkonen and Harjumaa (2008a, pp 164–176), conclude the persuasive decision support context of HBCSSs by indicating that persuasive decision support system highly influences behavior patients towards self-care. Another part of persuasive decision support system that is also part of HBCSSs is the implementation of the system. Involvement of patients in implementation process play role in evaluating the adoption of HBCSSs in self-care.


Results, critical analysis of literature

The result of the literature review reveals some key factors that are considered in the implementation of the HBCSSs. Persuasive decision support tool is mostly patient support tool that looks into personal traits such as attitude, behavior, and compliance. Several examinations of literature further reveal the various interrelated factors affecting adoption and usage of HBCSSs. Another important aspect of the persuasive decision support system is the implementation of the HBCSSs. Gamified health BCSSs forms an important facet that monitors lifestyle that forms part of HBCSSs. Gamified health strategy remains a crucial aspect of behavior change system since it is one of the factors that are considered when designing the system. Another factor that is used in Gamified health BCSSs is the study of outcomes of the behavior change.


Attitude as an aspect of HBCSSs forms the basis of implementation of HBCSSs in the health system. According to Bensley et al (2010, pp1–13), the attitude of the client on the usefulness of the system is part of the decision on the usage or implementation of HBCSSs. The attitude is also cited by Bensley et al (2004, pp1–13), may also determine the success of HBCSSs given that persuasions target the change of attitude in the positive adoption of the system. Attitude is also connected to the patient’s perspective on adoption and implementation of HBCSSs. Moreover, attitude also forms part of the personal care that is able to increase patients view and their ability to embrace self-care system. Lehto and Oinas-Kukkonen (2010, pp 62–173) shows that attitude is also indicated by the client’s perspective on the system.

Persuasive decision support system normally considers patients perspective on the usage of the HBCSSs. The perspective of a persuasive system according to Bates (2000, pp 788–791), is to measure an individual body physical activities and medication. A study on the personal experience on the use of HBCSSs indicates that patients with the HBCSSs system do good during medication as compared to those patients that use other medication monitoring methods. Miller (2002, pp 3–16) shows that the success of the HBCSSs system also depends on the patient’s voluntariness to use HBCSSs. This implies that patient should also volunteer to implement the system.

Another study by Bates (2000, pp 788–791), shows that persuasive HBCSSs works best with mobile tools that assist in the decision of medication. Getting views of patients on their ability to use mobile devices in using HBCSSs play role in compliance with HBCSSs. This further indicates that current increase in mobile technology users is also accompanied with many online users. Mobile devices currently form part of life as many patients possess the device making it convenient for use in daily life. Making the mobile technology part of HBCSSs is ideal for use and monitoring of physical health especially for those patients with chronic disease.



Behaviour is another critical aspect of the development of HBCSSs. The behavior change support system is an important persuasive support system that enables patient to have a healthy health system. According to Kraft, Drozd and Olsen (2009, 24), HBCSSs is a multidisciplinary or interdisciplinary system that uses many skills from various fields coherently to assist the patient has proper self-health care. O'donoghue and Herbert (2012, pp 5) indicate that the incorporation of persuasive coaching system is projecting high societal impact on individual patients. In addition, the BCSSs enable coaching of patients toward better self-care and life. For instance, a good persuasive system involves the use of social, technical and health system from a system that monitors physical, health and behavioral activities in the body of patients. Oinas-Kukkonen and Harjumaa (2009, pp 485–500) also confirms the multidisciplinary nature of the HBCSSs that enable a persuasive decision on the usage of the system. Strecher (2007, pp 53–76), conclude the multidisciplinary approach for this persuasive decision support system influences indicating some disciplines that are used in the decision.


According to Midden and Ham (2009), self-reminders is another valuable feature of the HBCSSs persuasive system. In the monitoring and self-care, medication plays an important role in ensuring that proper and timely medication is possible. In dealing with chronic disease self-care best work with a reminder and this work when patient is under medication. Compliance work in hand with the attitude of the patient as those patients with a positive attitude has shown full compliance with the implementation of the system. In addition, Lehto and Oinas-Kukkonen (2010, pp 62–173) shows that compliance often associated with positive feedback and this play an important role in the evaluation of the whole system in decision making. However, Oinas-Kukkonen and Harjumaa (2008a, pp 164–176) cites a different view on the compliance as recopies for persuasive decision support system. The author indicates that compliance come at the end of the implementation of the system and therefore should not be used for development of HBCSSs. O'donoghue, and Herbert (2012) conclude the compliance by indicating that compliance is the backbone for persuasive decision making since it enables the developers to determine the attitude of clients on self-care.


Patient education

Patient education according to Lehto and Oinas-Kukkonen (2009, pp 316–327), is another aspect of persuasive decision support system that helps in usage. Educating patients on the usage and importance of HBCSSs to patients especially in monitoring health has proved critical. Moreover, patients education work in hand with various context such as feedback as customer view also play role in improvement of the system. Patient education is also part of client involvement in decision-making process since when educating patients they are able to bring on board patient’s view on the HBCSSs (Bish, Sutton & Golombok 2000, pp 35–50).


HBCSSs remain an important persuasive health monitoring system especially on self-care with many kinds of literature revealing various aspects of the system. As cited by Oinas-Kukkonen (2010 pp 26–27), HBCSSs being incorporated with mobile monitoring unit is currently embraced by many users for its main persuasive aspect. The literature further revealed that notification or reminder facet is also important for medication of patients with chronic disease. The study critically explains the position that cares givers or practitioners have in the in the usage of HBCSSs. The remainder aspect of the HBCSSs also concurs with the uses of the mobile platform in persuasive medical HBCSSs. The two main features of the HBCSSs makes the system to works at personal level since the mobile platform and application of the system is overwhelming used for notifying the patient in correct medication. Oinas-Kukkonen and Harjumaa (2008b, pp 200–205), also agree with the ideas of usage of the mobile platform with the main rating of HBCSSs that currently can be seen in health throughout Australia and globally. The study Davis (2010, pp 262–273) conclude that use of a mobile application that is developed from the system can be useful in everyday life of chronic disease patients such as diabetes patients.

Persuasive decision support system as the context of HBCSSs is critical for adoption and implementation. As highlighted by Bish and Golombok (2000, pp 35–50), there are three main components of HBCSSs that assist in persuasive decision support hence aid in patient self-care. These three components are attitude, compliance, behavior, and patient. This does not contradict a similar study by Räisänen and Lehto 2010, pp 185–192) that indicate user experience is another part of the system that exhibits advantages of HBCSSs. Attitude is an essential recipe for behavioral change that triggers patient to adopt and use the technology in monitoring their health and behavior. During self-care attitude determines the effectiveness of the care and is important in deciding on the HBCSSs strategy. Compliance is another aspect of the persuasive decision support system that facilitates the implementation and usage of HBCSSs. Some of the behavior changes target personal lifestyle habits such as physical activities, health habits, and self-care. Changing these behaviors is monitored through monitoring data on mood, individual behaviors thereby sending feedback to patients for the areas that need some improvement. Modern technologies such as mobile phone technologies are some example of technologies that are used in the monitoring of the data on health. This data are used to persuade the patient on behavior change. Mobile technologies help and form part of client education that is used for influencing patient behavioral changes since it helps reminding and notification of patient.

Persuasive decision support system also works with a focus on the involvement of patients in the implementation of HBCSSs in monitoring their health for facilitating self-care. The measure of the level of behavior change, attitude or compliance is depicted with the ability of the patient to fully implement the HBCSSs. In addition, implementation of the HBCSSs also is connected to the evaluation of the HBCSSs and the patient’s self-care involvement. The evaluation is an important step of the patient's response to the whole system, therefore, evaluation is done after implementation of HBCSSs. Self-care has been made easy with the implementation of mobile enabled HBCSSs and this determines the effectiveness of the persuasive decision support system in HBCSSs. Midden and Ham (2009, vol 35), when commenting on steps for adoption and usage of HBCSSs indicate that implementation is as important as development and should highly consider persuasive decision support system.



In conclusion, the persuasive decision support system is a critical step of the design, adoption, and usage of HBCSSs. This is based on the involvement of the patient in decision making when there is the development of HBCSSs. Some components of persuasive decision support system are attitude, behavior, compliance and patient education. At the final stage of the adoption and usage of HBCSSs is the implementation that should also be predetermined by the developers by involving patients. HBCSSs through persuasive decision support system help in self-care of patients especially those with chronic disease. One tool that has highly help in persuasive decision support system more so at the implementation stage is mobile technologies. Mobile technologies are close to patients hence good in determining the usability of patient persuasive decision support system.



Bensley RJ, et al 2004, The eHealth behavior management model: a stage-based approach to behavior change and management. Prev Chronic Dis Pub Health Res Pract Pol vol.1, no.4, pp1–13

Bensley RJ, et al 2010, Key principles in Internet-based weight management systems. American Journal of Health Behav vol.34, no.2, pp 206–213

Bates DW, 2000, Using information technology to reduce rates of medication errors in hospitals. British Medical Journal, vol.320, no.7237, pp 788–791.

Bish A, Sutton S, & Golombok S 2000, Predicting uptake of a routine cervical smear test: a comparison of the health belief model and the theory of planned behavior. Psychol Health vol.15, no.1, pp 35–50

Davis, J, 2010, Generating directions for persuasive technology design with the inspiration card workshop. Lecture notes in computer science, persuasive technology, vol 6137, pp 262–273

Harjumaa, M, Segerståhl K, & Oinas-Kukkonen H, 2009, Understanding persuasive system functionality in practice: a field trial of polar FT60. In: Proceedings of the fourth international conference on persuasive technology, ACM international conference proceeding series, vol 350, Claremont, CA, USA, 26–29 Apr 2009

Kraft, P, Drozd F, & Olsen E, 2009, psychology: designing theory-based health promotion interventions. Commun Assoc Inf Syst 24, Article 24

Lehto T, & Oinas-Kukkonen H, 2009, The persuasiveness of web-based alcohol interventions: a qualitative evaluation. IFIP advances in information and communication technology, Software Services for e-Business and e-Society, vol 305, pp 316–327

Lehto T, & Oinas-Kukkonen H, 2010, Persuasive features in six weight loss websites: a qualitative evaluation. Lecture notes in computer science, persuasive, vol 6137, pp 62–173

Midden C, & Ham J, 2009, Using negative and positive social feedback from a robotic agent to save energy. In: Proceedings of the fourth international conference on persuasive technology, ACM international conference proceeding series, vol 35, Claremont, CA, USA, 26–29 Apr 2009

Miller GR, 2002, On being persuaded: some basic distinctions. In: Dillard JP, Pfau M (eds) The persuasion handbook: Developments in theory and practice. Sage Publications, Thousand Oaks, pp 3–16

Donoghue, J & Herbert, J, 2012, Data management within mHealth environments: Patient sensors, mobile devices, and databases. Journal of Data and Information Quality (JDIQ), vol.4, no.1, pp 5.

Oinas-Kukkonen H, & Harjumaa M, 2009, Persuasive systems design: key issues, process model, and system features. Commun Assoc Inf Syst 2, Article 28: pp 485–500

Oinas-Kukkonen H, 2010 Discipline of information systems: a natural strategic alliance for web science. In: Proceedings of the second international on web science conference (WebSci 10), Raleigh, NC, USA, pp 26–27 Apr 2010

Oinas-Kukkonen H, & Harjumaa M, 2008a, A systematic framework for designing and evaluating persuasive systems. Lecture notes in computer science, vol 5033. Springer, Heidelberg, pp 164–176

Oinas-Kukkonen H, & Harjumaa M, 2008b, Towards a deeper understanding of persuasion in software and information systems. In: The first international conference on advances in human-computer interaction (ACHI’2008), Sainte Luce, Martinique, 10–15 Feb 2008, ISBN 978-0-7695-3086-4, pp 200–205, Best Paper Award

Räisänen T, & Lehto T, 2010, Practical findings from applying the PSD model for evaluating software design specifications. Lecture notes in computer science, persuasive, vol 6137. Springer, pp 185–192

Strecher V, 2007, Internet methods for delivering behavioral and health-related interventions (eHealth). Annu Rev Clin Psychol 3:53–76


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