In the past decade, the use of technologies to persuade, motivate, and activate individuals’ health behavior change has been a quickly expanding field of research [1
]. The use of the Web (and related technologies) for delivering interventions has been especially relevant. Automated health behavior interventions have the potential of high reach and low cost [14
]. A recent meta-analysis of 75 randomized controlled trials (RCTs) provided support for their effectiveness in changing knowledge, attitudes, and behavior in the health promotion area [15
There is no consensus on the terminology used to designate the activities conducted over the Internet for mental and physical health purposes. According to Barak et al [16
], a Web-based intervention is “a primarily self-guided intervention program that is executed by means of a prescriptive online program operated through a website and used by consumers seeking health- and mental health-related assistance.”
The intervention in itself is aimed at creating a positive change and/or improving knowledge, awareness, or understanding by providing sound health-related material to the user through an interactive Web-based information system.
Considerable variety exists in terms of types of program content, interactivity, functionality, and level of multimedia of Web-based interventions. In addition, intensity is a major variable; some Web-based interventions are long-term, automated, interactive, tailored, multicomponent programs whereas others are brief online screening instruments with tailored feedback. Finally, participant attrition and exposure rates may vary widely (eg, [18
]). Technological applications integrating health information with online peer support, decision support, and/or help with behavior change provides an alternative for helping people to achieve better health [20
]. However, relatively little is known of designing effective Web-based interventions to support sustained behavior change and improved well-being (eg, [4
The purpose of the present review was to extract and analyze persuasive system features of the included Web-based alcohol and smoking interventions use by applying the PSD model [26
]. Suggestions for further research and development are provided for this expanding field of research.
Persuasive Technology and Health Behavior Change
Research on persuasive technology has been introduced relatively recently [27
]. Briñol and Petty [29
] outline persuasion as follows: “In the typical situation where persuasion is possible, a person or a group of people (ie, the recipient
) receives an intervention (eg, a persuasive message
) from another individual or group (ie, the source
) in a particular setting (ie, the context
Persuasive systems may be defined as computerized software or information systems designed to reinforce, change, or shape attitudes or behaviors or both without using coercion or deception [26
]. Successful persuasion takes place when the target of change (eg, attitudes or beliefs) is modified in the desired direction [29
Changing people’s behavior is at the heart of health promotion. An individual’s behavior has a significant impact on, for example, cancer and heart disease, which are common causes of premature mortality. The Internet is transforming health care [30
] and can be seen as a prime candidate for the application of key behavioral science theories and principles to promote healthier behaviors. There are several advantages in Internet-delivered interventions, for example, reducing cost and increasing convenience for users, reduction of health service costs, reduction of stigma and isolation of users, the need for timely information, and increased user and supplier control of the intervention [31
]. Internet-based resources, in particular the Web, have many of the characteristics necessary for persuasive communication, and they may provide a channel which integrates the positive attributes of interpersonal and mass communication [34
]. Web-based systems can give immediate feedback and match the information with the respondent's level of awareness, beliefs, and motivations at that particular time [10
]. Additionally, Web-based interventions may overcome isolation of time, mobility, and geography. It has to be noted that Web-based interventions still may be no substitute for face-to-face contact [31
Persuasive Technology: Designing Systems That Aim at Behavior Change
Examples of persuasive technology can be found quite easily, as there are a variety of websites promoting healthier lifestyles. One of the strongest domains of innovation for persuasive technology in the near future will be preventive health care [37
]. On a par with health behavior change, persuasive technology has the potential for significant breakthroughs in many areas of human well-being, such as education and environmental conservation. Nevertheless, the use of persuasive technology in the health arena is still in its infancy. While the field is expanding, it is evident that more research is needed to better determine how the persuasiveness of the systems affects users’ intended behavior.
According to Fogg [38
], attempts to create persuasive systems often fail because many projects are too ambitious, being set up for failure. For example, a design team might select a challenging behavior as the target, for example, smoking cessation, but without having ever before created such a persuasive system, the success rate might be low. Zhang [39
] stated: "A large number of health information system projects fail. Most of these failures are not due to flawed technology but rather due to the lack of systematic considerations of human and other nontechnology issues in the design and implementation processes." Thus, designing systems that aim at behavior change requires thorough understanding of the problem domain and the underpinning theories and strategies of persuasive systems design. Usually, an interdisciplinary team of professionals is also needed. The main decision points in developing interventions include defining the primary goal of the intervention, defining the target population, and selecting the messages for the intervention [40
In the present study, the persuasive systems design model (PSD) [26
] was applied as the framework for identifying various persuasive techniques that have been incorporated into the Web-based substance use interventions. The PSD model provides a recent and extensive conceptualization of technology-mediated persuasion.