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Thesis on Persuasive Design
Working closely with asthma care specialists to explore the young asthmatic experience and how it can motivate self-management
1 Problem definition
Asthma is the most common chronic disease among children worldwide, but mobile apps aimed at self-management are often not designed for younger patients' unique contexts and abilities.
AsthmaTuner is a Stockholm-based digital health startup helping people with asthma live symptom-free. I'd been working there for about a year when I started my Master’s Thesis. During that year, I noticed how rarely we had a chance to do research with our younger users (AsthmaTuner is clinically approved for 6 years and up). We knew children engaged with AsthmaTuner from clinical studies and the opportunities we’d had to observe these users, but we saw an opportunity to explore how the experience could be improved for them.
When I looked into wider trends in children’s mobile health apps, I was disappointed by what I saw. In the context of chronic diseases, adherence to self-management through digital apps is low. What’s more, apps for younger patients are often not designed for their unique context and abilities. There is a gap in mobile health for child-centered design, which could point to challenges to improved treatment adherence.
AsthmaTuner app with companion digital spirometer
2 Persuasive design
Example of Reward principle in the Duolingo app
Example of Social Comparison principle in the Duolingo app
I used Oinas-Kukkonen and Harjumaa's Persuasive Systems Design (PSD) model to explore acceptable persuasive design for 10-12 year olds with asthma.
We encounter persuasive design everyday: whether it’s comparing distances with friends on a running app or getting rewarded for reaching another level in a game, most apps use some combination of persuasive principles to affect our behavior or attitudes. Persuasive principles are design choices that motivate a target behavior; for example, rewarding a user for their behavior is called the Reward principle - this persuades them to continue doing it in hopes of being rewarded again.
Persuasive design has already been recommended as a solution to poor adherence rates in mobile health apps. However, applying it effectively relies on a thorough understanding of user context. Oinas-Kukkonen and Harjumaa recognized this when they came up with the PSD model, which sets context definition as the first step in designing a persuasive system. I used their model as a guide for exploring the experiences of 10-12 year old asthmatics, in the hope of identifying which persuasive principles would be effective in motivating them to self-management.
Phases in Persuasive Systems Design (PSD) model
3 Interviews and context definition
I interviewed physicians who specialize in pediatric asthma care about their experiences and observations of younger patients.
Ideally, I would have interviewed 10-12 year olds with asthma instead of expert proxies. However, discussing sensitive health information with children would have required ethical approval, and the time was outside the scope of the thesis. Nevertheless, the physicians had experience with a wider range of patients than I would have had access to if I had interviewed them directly.
Previous research shows that major predictors of treatment adherence in children are consistent physician-patient relationships, familial attitudes towards treatment, and patients’ understanding of their condition. Some interview questions explored the participants’ observations on these predictors from their own work, but they could also contribute with challenges they’d seen.
Many interesting insights emerged from affinity diagramming the interviews, most of which I integrated into three personas (if you're curious to read more, check out my report). The personas cover some of the motivations and challenges faced by 10-12 year olds in self-managing their asthma. These serve as a red thread throughout the rest of the study, to help trigger physicians' pre-understanding of the target group when evaluating the design.
That messy, 'no one needs to see this' part of data analysis
4 Physician workshop
Click me to see all the cards!
After defining the user context, it was time to select which persuasive principles may be acceptable for the personas that emerged. I did this together with two pediatric asthma care specialists in a 1.5 hour workshop.
Oinas-Kukkonen and Harjumaa identify 28 distinct persuasive principles in their PSD model. Not all of these will be effective or relevant in every design, so I had to narrow down those that would be acceptable for an asthma self-management app for children. Based on the interview insights, I chose 9 principles that were relevant for the context. The participants got a deck of cards defining these 9 before the workshop (see on the left).
During the workshop, participants placed stickers representing the personas onto the principles they thought would help motivate them to self-manage their asthma. After discussing inconsistencies between the choices, 6 principles emerged as the most promising.
The Figjam file post-workshop
5 Ideation and prototyping
I redesigned the primary treatment tool flow in the AsthmaTuner app to include the persuasive principles chosen during the workshop.
Personalization appears as theme and character customization. The user can choose between a light or dark theme and the design of an ‘asthma avatar.’
Simulation appears as a storyline between treatment steps that shows how triggers can lead to poorer lung function and more symptoms, which are remedied with regular treatment.
Social role appears as subtle messages to the user from the system. For example, when the user records their asthma triggers, “Got it!” and “Tell me more…” fade in at the top of the screen.
Similarity is limited to the symptom questions, which are divided into individual, swipeable cards that include simpler summaries alongside the phrasing set by international guidelines.
Authority appears towards the end, when the doctor’s role in the medication recommendation is emphasized.
Praise is already present at certain points in the original design, however the redesign praises the user for having controlled asthma.
6 Findings and final report
Click me to read the report!
I evaluated the acceptability of the persuasive redesign with new asthma care specialists. The results suggest that the Personalization and Simulation principles may be most acceptable at motivating 10-12 year olds to asthma self-management.
After think aloud walkthroughs of the prototype and follow-up interview questions, the participants noted that the asthma storyline and avatar would help the target users understand their asthma and engage them in treatment.
Though this would have to be confirmed by evaluating with 10-12 year olds, the findings offer AsthmaTuner alternative design considerations when engaging younger users. Furthermore, other digital, self-management solutions for children can also integrate the Personalization and Simulation principles into their designs in order to motivate based on user context.