Apps for Mental Health: An Evaluation of Behavior Change Strategies and Recommendations for Future Development

Felwah Alqahtani · Ghazayil Alkhalifah · Oladapo Oyebode · Rita Orji

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Digital Mental Health Interventions Mobile Health and mHealth Applications Innovative Human-Technology Interaction

Abstract

Mobile applications have shown promise in supporting people with mental health issues to adopt healthy lifestyles using various persuasive strategies. However, the extent to which mental health apps successfully employ various persuasive strategies remains unknown. Hence, it is important to understand the persuasive strategies integrated into mental health applications (apps) and how they are implemented to promote mental health. This paper aims to achieve three main objectives. First, we review 103 mental health apps and identify distinct persuasive strategies incorporated in them using the Persuasive Systems Design (PSD) model and Behaviour Change Techniques (BCTs). We further classify the persuasive strategies based on the type of mental health issues the app is focused on. Second, we reveal the various ways that the persuasive strategies are implemented/operationalized in mental health apps to achieve their intended objectives. Third, we examine the relationship between apps effectiveness (measured by user ratings) and the persuasive strategies employed. To achieve this, two researchers independently downloaded and used all identified apps to identify the persuasive strategies using the PSD model and BCTs. Next, they also examine the various ways that these strategies are implemented in mental health apps. The results show that the apps employed 26 distinct persuasive strategies and a range of 1 to 10 strategies per app. Self-monitoring (n=59), personalization (n=55), and reminder (n=49) were the most frequently employed strategies. We also found that anxiety, stress, depression, and general mental health issues were the common mental health issues targeted by the apps. Finally, we offer some design recommendations for designing mental health apps based on our findings.

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References

1977The Measurement of Observer Agreement for Categorical Data 2013The Behavior Change Technique Taxonomy (v1) of 93 Hierarchically Clustered Techniques: Building an International Consensus for the Reporting of Behavior Change Interventions 2005Mental Illness and/or Mental Health? Investigating Axioms of the Complete State Model of Health.2008A taxonomy of behavior change techniques used in interventions.1993Bias, prevalence and kappa 2012Persuasive System Design Does Matter: a Systematic Review of Adherence to Web-based Interventions 2011Habits make smartphone use more pervasive 2016Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments

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2020Co-Designing a Mobile App to Improve Mental Health and Well-Being: Focus Group Study 2023Gamification: a Novel Approach to Mental Health Promotion 2021Personality-based approach for tailoring persuasive mental health applications 2022A Systematic and Comparative Review of Behavior Change Strategies in Stress Management Apps: Opportunities for Improvement 2023

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