SUMMARY DIGITAL HEALTH
COMMUNICATION
TILBURG UNIVERSITY
SPRING 2021
DR. IR. NYNKE VAN DER LAAN
DR. NADINE BOL
1
,INHOUDSOPGAVE
week 1: 01-02-21 t/m 07-02-21 ........................................................................................................................... 4
Theory lecture 1: persuasive technology part 1 ............................................................................................... 4
Learning goal 1: Understand the main factors increasing and decreasing the impact of digital health
applications. .................................................................................................................................................... 4
Learning goal 2: Understand and explain the importance of theory use in the development of digital
health applications ......................................................................................................................................... 7
Important concepts theory lecture 1 ........................................................................................................... 11
Design lecture 1: contextual inquiry................................................................................................................ 12
week 2: 08-02-21 t/m 14-02-2021 .................................................................................................................... 13
theory lecture 2: persuasive technology part 2 .............................................................................................. 13
Learning goal 1: understand the main characteristics and assumptions of rational models of health
behavior. know the main behavioral determinants of these models and how to influence these by
digital health communication ...................................................................................................................... 13
Learning goal 2: understand what the intention-behavior gap is and how can this be bridged by digital
health communication strategies ................................................................................................................ 14
Learning goal 3: explain the most important NON-RATIONAL theories of health behavior, know the
accompanying subconsious behavioral determnatns and how to influence these by digital health
communication ............................................................................................................................................. 17
Important concepts theory lecture 2 ........................................................................................................... 20
Design lecture 2: value specification .............................................................................................................. 22
Week 3: 15-02-21 t/m 21-02-21 ........................................................................................................................ 23
Design leture 3: design (approaches and prototyping workshop) ................................................................ 23
week 4: 22-02-21 t/m 28-02-21 ......................................................................................................................... 24
Theory lecture 3: social aspects ...................................................................................................................... 24
Learning goal 1: social norms theory à social norms approach.............................................................. 25
Learning goal 2: social cognitive theory: modeling, outcome expectancies, self-efficacy ...................... 31
Learning goal 3: parasocial interaction and wishful identification ........................................................... 31
Learning goal 4: social support ................................................................................................................... 32
Learning goal 5: competition ....................................................................................................................... 34
Important concepts theory lecture 3 ........................................................................................................... 34
Design lecture 4: design (intermediate evaluation techniques) ................................................................... 37
week 5: 01-03-21 t/m 07-03-21 ......................................................................................................................... 38
Theory lecture 4: user characteristics............................................................................................................. 38
Learning goal 1: understand and describe various theoretical perspectives to understand engagement
with and use of digital health technologies and recognize their different types of approaches (i.e.,
media oriented vs. user oriented) ............................................................................................................... 38
Learning goal 2: Understand the impact of individual differences and know how to identify relevant
user characteristics for digital health communication .............................................................................. 43
Learning goal 3: understand what personas are and how to use them to understand characteristics,
motivations and abilities of your target audience and how to use these for digital health
communciaton development ....................................................................................................................... 45
Important concepts theory lecture 4 ........................................................................................................... 46
Design lecture 5: Operationalization ............................................................................................................... 49
2
,week 6: 08-03-21 t/m 13-03-21 ......................................................................................................................... 50
Theory lecture 5: Experiental aspects of DHC and immersive media for health ......................................... 50
Learning goal 1: know the role of temporal distance, social distance, (un)certainty/risk and personal
relevance in decisions about health-related behaviors ............................................................................. 50
Learning goal 2: health messages incorporated into immersive media may affect health behavior by
visualizing and/or allowing the user to experience the future consequences of unhealthy behavior .. 52
Learning goal 3: immersive media may affect health behavior through changing the experience of he
body (e.g., body size) .................................................................................................................................... 54
Important concepts theory lecture 5 ........................................................................................................... 54
Design lecture 6: evaluation ............................................................................................................................ 56
week 7: 15-03-21 t/m 21-03-21 ......................................................................................................................... 57
Theory lecture 6: mode effects and personalization ..................................................................................... 57
learning goal 1: recognize and describe different types of modalities and understand the impact of
different modalities on the processing of digital health information ....................................................... 57
Learning goal 2&3: understand and describe different tailoring strategies as well as different types of
tailoring input and examples of tailored output that can be used in digital health communciation &
explain the mechanisms underlying the effectiveness of tailoring in digital health communication .... 59
Learning goal 4: undersatnd how to combine modality and tailoring in digital health communication
applications ................................................................................................................................................... 61
important concepts theory lecture 6 ........................................................................................................... 62
Week 8: 22-03-21 t/m 28-03-21 ........................................................................................................................ 64
Theory lecture 7: computer-mediated docter-patient communication ......................................................... 64
learning goal 1: explain why communication is important in healthcare and describe three purposes of
docter-patient communication .................................................................................................................... 64
Learning goal 2: describe the potential of video consultations and discuss conditions under which
video consultations may or may not be appropriate ................................................................................. 66
Important concepts theory lecture 7 ........................................................................................................... 70
Overview of all learning goals + short answers .................................................................................................. 71
Theory lecture 1 ................................................................................................................................................ 71
Theory lecture 2 ................................................................................................................................................ 71
Theory lecture 3 ................................................................................................................................................ 72
theory lecture 4 ................................................................................................................................................. 73
Theory lecture 5 ................................................................................................................................................ 75
theory lecture 6 ................................................................................................................................................. 76
Theory Lecture 7 ............................................................................................................................................... 77
3
,WEEK 1: 01-02-21 T/M 07-02-21
THEORY LECTURE 1: PERSUASIVE TECHNOLOGY PART 1
Learning goals
1. Understand the main factors increasing and decreasing the impact of digital health applications
2. Understand and explain the importance of theory use in the development of digital health
applications
LEARNING GOAL 1: UNDERSTAND THE MAIN FACTORS INCREASING AND
DECREASING THE IMPACT OF DIGITAL HEALTH APPLICATIONS.
How impactful are digital health applications?
- There are a lot of eHealth applications out there
- eHealth technologies in different domains
- Many people use them to monitor their own health
- Cost effective à health insurance
Impact – What is evidence? – Physical activity
• Article by Romeo et al. (2019): Can smartphone apps increase physical activity? Systematic review
and meta-analysis.
Aim: This systematic review and meta-analysis aimed to determine the effectiveness of
smartphone apps for increasing objectively measured physical activity in adults.
Current status:
- Which health behavior theories are employed most often?
- Which features are employed most often?
Romeo et al. (2019) included 7 apps in this meta-analysis
Theory use and implemented features in apps targeting physical activity.
> App based on recognized behavior-change theory
o Social cognitive theory (e.g., theory of planned behavior) (3 apps)
o Principles or reinforcement (1 app)
o Social influencers’ perspective (1 app)
o Taxonomy of behavior change (1 app)
> App features of the 7 included studies.
o Visible display of steps (all apps)
o Physical activity performance summary (4 apps)
o Goal setting (4 apps)
o Visual display of goal achievement (4 apps)
o Motivational prompts (4 apps)
The results of Romeo et al. (2019)
> No significant effect of app-based physical activity interventions
> BUT: interventions were effective (significant) when the intervention duration was 3 months or
less (compared with longer interventions)
> AND: physical activity apps that targeted physical activity in isolation were more effective than
apps targeted physical activity in combination with diet.
4
,Impact – What is evidence? – healthy eating behavior
• Article by Villinger et al. (2019): The effectiveness of app-based mobile interventions on nutrition
behaviors and nutrition-related health outcomes: a systematic review and meta-analysis.
Aim: this systematic review and meta-analysis aimed to determine the effectiveness of smartphone
apps for changing nutrition behaviors and nutrition-related health outcomes.
Current status:
> which health behavior change techniques are employed most often?
Most implemented features in apps targeting eating behavior:
> Goals & Planning
> Feedback & Monitoring
> Social support
> Shaping knowledge
> Comparison of Behavior
> Associations
> Reward & Threat
> etc. …
à Most apps included four different behavior change techniques.
Results of Villinger et al. (2019)
> Overall, a small significant of app-based mobile interventions on nutrition behaviors and
nutrition-related outcomes
> Only studies targeting short term (< 3 months) and/or intermediate-term (3-6 months) follow-up
intervals yielded significant (small) effect sizes; effects of long term (>6 months) follow up not
significant.
• Other meta-analysis reviews
o Medicine adherence: 7/11 studies mobile app increased medicine adherence (Perez-
Jover et al., 2019)
o Alcohol intake: brief web-based interventions decreased the number of alcoholic drinks
consumed (Oosterveen et al., 2017)
o Digital (web) school-based behavior change interventions increased fruit and vegetable
intake and physical activity and reduced screen time in adolescents immediately after the
intervention; effects not sustained at follow up and no effects for alcohol intake and
smoking (Champion et al., 2019).
Quality of studies/evidence low – very low
We cannot say that digital health applications are generally effective. What you can say that most results
are mixed. This is the current state of the field.
5
, The uptake and impact of eHealth technologies
There is no clear evidence for the impact yet, but which impacts are interesting to consider?
Maximizing the impact of digital health applications: two main factors
1. Effective ingredient: the effective components should be evidence-based
a. The application employs features that target determinants from health
behavior theories / features that are based on established behavioral
change techniques.
2. Effective dose: the uptake of the application should be sufficient
a. The app should be designed based on scientific theories of technology
acceptance and engagement. The app should be human-centered
A holistic framework to improve the uptake and impact of eHealth technologies
3. “High-tech with low impact”
4. “Low impact” not because technology does not work
§ Low support health care professionals
§ Not designed with user in mind
5. Real impact of eHealth technologies unknown
The CeHRes Roadmap serves as a guideline for eHealth development, implementation and evaluation.
Existing evidence-based activities, models, frameworks and methods derived from persuasive design,
participatory development, human centered design and business modelling serve as the theoretical
background of the Roadmap. All of this is translated into five intertwined phases and connecting cycles.
These phases are the
- contextual inquiry
- value specification
- design
- operationalization
- summative evaluation
The connecting cycles represent the formative evaluation cycles, which ensures that activities during a
phase are related to the stakeholder perspective, the context, and the outcomes of previous phases. The
CeHRes Roadmap assists the development team in planning, coordinating, and executing the development
process of eHealth technologies.
It’s all about effective ingredients and effective use!
6
COMMUNICATION
TILBURG UNIVERSITY
SPRING 2021
DR. IR. NYNKE VAN DER LAAN
DR. NADINE BOL
1
,INHOUDSOPGAVE
week 1: 01-02-21 t/m 07-02-21 ........................................................................................................................... 4
Theory lecture 1: persuasive technology part 1 ............................................................................................... 4
Learning goal 1: Understand the main factors increasing and decreasing the impact of digital health
applications. .................................................................................................................................................... 4
Learning goal 2: Understand and explain the importance of theory use in the development of digital
health applications ......................................................................................................................................... 7
Important concepts theory lecture 1 ........................................................................................................... 11
Design lecture 1: contextual inquiry................................................................................................................ 12
week 2: 08-02-21 t/m 14-02-2021 .................................................................................................................... 13
theory lecture 2: persuasive technology part 2 .............................................................................................. 13
Learning goal 1: understand the main characteristics and assumptions of rational models of health
behavior. know the main behavioral determinants of these models and how to influence these by
digital health communication ...................................................................................................................... 13
Learning goal 2: understand what the intention-behavior gap is and how can this be bridged by digital
health communication strategies ................................................................................................................ 14
Learning goal 3: explain the most important NON-RATIONAL theories of health behavior, know the
accompanying subconsious behavioral determnatns and how to influence these by digital health
communication ............................................................................................................................................. 17
Important concepts theory lecture 2 ........................................................................................................... 20
Design lecture 2: value specification .............................................................................................................. 22
Week 3: 15-02-21 t/m 21-02-21 ........................................................................................................................ 23
Design leture 3: design (approaches and prototyping workshop) ................................................................ 23
week 4: 22-02-21 t/m 28-02-21 ......................................................................................................................... 24
Theory lecture 3: social aspects ...................................................................................................................... 24
Learning goal 1: social norms theory à social norms approach.............................................................. 25
Learning goal 2: social cognitive theory: modeling, outcome expectancies, self-efficacy ...................... 31
Learning goal 3: parasocial interaction and wishful identification ........................................................... 31
Learning goal 4: social support ................................................................................................................... 32
Learning goal 5: competition ....................................................................................................................... 34
Important concepts theory lecture 3 ........................................................................................................... 34
Design lecture 4: design (intermediate evaluation techniques) ................................................................... 37
week 5: 01-03-21 t/m 07-03-21 ......................................................................................................................... 38
Theory lecture 4: user characteristics............................................................................................................. 38
Learning goal 1: understand and describe various theoretical perspectives to understand engagement
with and use of digital health technologies and recognize their different types of approaches (i.e.,
media oriented vs. user oriented) ............................................................................................................... 38
Learning goal 2: Understand the impact of individual differences and know how to identify relevant
user characteristics for digital health communication .............................................................................. 43
Learning goal 3: understand what personas are and how to use them to understand characteristics,
motivations and abilities of your target audience and how to use these for digital health
communciaton development ....................................................................................................................... 45
Important concepts theory lecture 4 ........................................................................................................... 46
Design lecture 5: Operationalization ............................................................................................................... 49
2
,week 6: 08-03-21 t/m 13-03-21 ......................................................................................................................... 50
Theory lecture 5: Experiental aspects of DHC and immersive media for health ......................................... 50
Learning goal 1: know the role of temporal distance, social distance, (un)certainty/risk and personal
relevance in decisions about health-related behaviors ............................................................................. 50
Learning goal 2: health messages incorporated into immersive media may affect health behavior by
visualizing and/or allowing the user to experience the future consequences of unhealthy behavior .. 52
Learning goal 3: immersive media may affect health behavior through changing the experience of he
body (e.g., body size) .................................................................................................................................... 54
Important concepts theory lecture 5 ........................................................................................................... 54
Design lecture 6: evaluation ............................................................................................................................ 56
week 7: 15-03-21 t/m 21-03-21 ......................................................................................................................... 57
Theory lecture 6: mode effects and personalization ..................................................................................... 57
learning goal 1: recognize and describe different types of modalities and understand the impact of
different modalities on the processing of digital health information ....................................................... 57
Learning goal 2&3: understand and describe different tailoring strategies as well as different types of
tailoring input and examples of tailored output that can be used in digital health communciation &
explain the mechanisms underlying the effectiveness of tailoring in digital health communication .... 59
Learning goal 4: undersatnd how to combine modality and tailoring in digital health communication
applications ................................................................................................................................................... 61
important concepts theory lecture 6 ........................................................................................................... 62
Week 8: 22-03-21 t/m 28-03-21 ........................................................................................................................ 64
Theory lecture 7: computer-mediated docter-patient communication ......................................................... 64
learning goal 1: explain why communication is important in healthcare and describe three purposes of
docter-patient communication .................................................................................................................... 64
Learning goal 2: describe the potential of video consultations and discuss conditions under which
video consultations may or may not be appropriate ................................................................................. 66
Important concepts theory lecture 7 ........................................................................................................... 70
Overview of all learning goals + short answers .................................................................................................. 71
Theory lecture 1 ................................................................................................................................................ 71
Theory lecture 2 ................................................................................................................................................ 71
Theory lecture 3 ................................................................................................................................................ 72
theory lecture 4 ................................................................................................................................................. 73
Theory lecture 5 ................................................................................................................................................ 75
theory lecture 6 ................................................................................................................................................. 76
Theory Lecture 7 ............................................................................................................................................... 77
3
,WEEK 1: 01-02-21 T/M 07-02-21
THEORY LECTURE 1: PERSUASIVE TECHNOLOGY PART 1
Learning goals
1. Understand the main factors increasing and decreasing the impact of digital health applications
2. Understand and explain the importance of theory use in the development of digital health
applications
LEARNING GOAL 1: UNDERSTAND THE MAIN FACTORS INCREASING AND
DECREASING THE IMPACT OF DIGITAL HEALTH APPLICATIONS.
How impactful are digital health applications?
- There are a lot of eHealth applications out there
- eHealth technologies in different domains
- Many people use them to monitor their own health
- Cost effective à health insurance
Impact – What is evidence? – Physical activity
• Article by Romeo et al. (2019): Can smartphone apps increase physical activity? Systematic review
and meta-analysis.
Aim: This systematic review and meta-analysis aimed to determine the effectiveness of
smartphone apps for increasing objectively measured physical activity in adults.
Current status:
- Which health behavior theories are employed most often?
- Which features are employed most often?
Romeo et al. (2019) included 7 apps in this meta-analysis
Theory use and implemented features in apps targeting physical activity.
> App based on recognized behavior-change theory
o Social cognitive theory (e.g., theory of planned behavior) (3 apps)
o Principles or reinforcement (1 app)
o Social influencers’ perspective (1 app)
o Taxonomy of behavior change (1 app)
> App features of the 7 included studies.
o Visible display of steps (all apps)
o Physical activity performance summary (4 apps)
o Goal setting (4 apps)
o Visual display of goal achievement (4 apps)
o Motivational prompts (4 apps)
The results of Romeo et al. (2019)
> No significant effect of app-based physical activity interventions
> BUT: interventions were effective (significant) when the intervention duration was 3 months or
less (compared with longer interventions)
> AND: physical activity apps that targeted physical activity in isolation were more effective than
apps targeted physical activity in combination with diet.
4
,Impact – What is evidence? – healthy eating behavior
• Article by Villinger et al. (2019): The effectiveness of app-based mobile interventions on nutrition
behaviors and nutrition-related health outcomes: a systematic review and meta-analysis.
Aim: this systematic review and meta-analysis aimed to determine the effectiveness of smartphone
apps for changing nutrition behaviors and nutrition-related health outcomes.
Current status:
> which health behavior change techniques are employed most often?
Most implemented features in apps targeting eating behavior:
> Goals & Planning
> Feedback & Monitoring
> Social support
> Shaping knowledge
> Comparison of Behavior
> Associations
> Reward & Threat
> etc. …
à Most apps included four different behavior change techniques.
Results of Villinger et al. (2019)
> Overall, a small significant of app-based mobile interventions on nutrition behaviors and
nutrition-related outcomes
> Only studies targeting short term (< 3 months) and/or intermediate-term (3-6 months) follow-up
intervals yielded significant (small) effect sizes; effects of long term (>6 months) follow up not
significant.
• Other meta-analysis reviews
o Medicine adherence: 7/11 studies mobile app increased medicine adherence (Perez-
Jover et al., 2019)
o Alcohol intake: brief web-based interventions decreased the number of alcoholic drinks
consumed (Oosterveen et al., 2017)
o Digital (web) school-based behavior change interventions increased fruit and vegetable
intake and physical activity and reduced screen time in adolescents immediately after the
intervention; effects not sustained at follow up and no effects for alcohol intake and
smoking (Champion et al., 2019).
Quality of studies/evidence low – very low
We cannot say that digital health applications are generally effective. What you can say that most results
are mixed. This is the current state of the field.
5
, The uptake and impact of eHealth technologies
There is no clear evidence for the impact yet, but which impacts are interesting to consider?
Maximizing the impact of digital health applications: two main factors
1. Effective ingredient: the effective components should be evidence-based
a. The application employs features that target determinants from health
behavior theories / features that are based on established behavioral
change techniques.
2. Effective dose: the uptake of the application should be sufficient
a. The app should be designed based on scientific theories of technology
acceptance and engagement. The app should be human-centered
A holistic framework to improve the uptake and impact of eHealth technologies
3. “High-tech with low impact”
4. “Low impact” not because technology does not work
§ Low support health care professionals
§ Not designed with user in mind
5. Real impact of eHealth technologies unknown
The CeHRes Roadmap serves as a guideline for eHealth development, implementation and evaluation.
Existing evidence-based activities, models, frameworks and methods derived from persuasive design,
participatory development, human centered design and business modelling serve as the theoretical
background of the Roadmap. All of this is translated into five intertwined phases and connecting cycles.
These phases are the
- contextual inquiry
- value specification
- design
- operationalization
- summative evaluation
The connecting cycles represent the formative evaluation cycles, which ensures that activities during a
phase are related to the stakeholder perspective, the context, and the outcomes of previous phases. The
CeHRes Roadmap assists the development team in planning, coordinating, and executing the development
process of eHealth technologies.
It’s all about effective ingredients and effective use!
6
