Table 5 Prevalence and examples of persuasive design principles used in digital mental health apps: percentage of studies reporting each principle
From: A meta-analysis of persuasive design, engagement, and efficacy in 92 RCTs of mental health apps
Persuasive design principle | Studies % (n) | Example of use in app |
|---|---|---|
Tunnelling | 88% (81) | “This intervention has modules that cover a variety of topics and can be accessed in any order, including coping effectively with depression and anxiety, enhancing happiness, improving sleep quality, and practising mindfulness.”74 |
Rehearsal | 84% (77) | “In each web session, participants were encouraged to practice the prescribed strategies via several homework exercises. These homework exercises were presented in the app component of the intervention, which allowed users to practice these skills digitally and in their daily life.”75 |
Trustworthiness | 80% (74) | “The healthy minds programme (HMP) smartphone-based meditation intervention was constructed around the awareness, connection, insight, and purpose (ACIP) model of well-being proposed by Dahl and colleagues (2020).”76 |
Reminders | 55% (51) | “As in the treatment condition, the app emits an alarm prompting participants to access the app at 3 pseudo-randomized time points per day, 6 days a week between 10.00 and 22.00 for 12 weeks alongside usual treatment.”66 |
Personalisation | 50% (46) | “Guided by the individual formulation, clinicians sent each client weekly tailored content suggestions.”26 |
Self-monitoring | 49% (45) | “Participants rated their anxiety before and after relaxation sessions using a visual analogue scale.”77 |
Suggestion | 48% (44) | “The main component of the app is a 30-day intervention involving one 5–10 min ‘challenge’ per day.”46 |
Expertise | 43% (40) | “Coaches were two bachelor’s degree–level individuals who received training in the coaching manual and weekly supervision with a clinical psychologist.“78 |
Reduction | 32% (29) | “Besides written materials, all contents have also been audio-recorded to facilitate users to listen to the content if they are unable to read the materials on the go.”79 |
Rewards | 25% (23) | “The app includes gamification entailing an ad hoc character named TIVA—from the Spanish word “posiTIVA,” meaning “positive.” This character grows up and changes every time the caregiver performs the daily activity.”80 |
Simulation | 11% (10) | “In the “Lesson” phase, the core skills of the day are introduced via case examples in which the main character experiences the most commonly reported depressive and/or anxiety symptoms.”81 |
Praise | 10% (9) | “Following the completion of six levels pertaining to two beliefs, users may see an encouraging statement such as “Excellent! Now you’ve learned how to better deal with your thoughts and to better recognize the way you overestimate threat.”43 |
Normative influence | 10% (9) | “A peer-support community that is not moderated by professionals, but is rather a place where users can post their thoughts, challenges, and questions and receive support from others using the app.”68 |
Social learning | 9% (8) | “After challenge completion, users may choose to anonymously share a short written reflection about the challenge with another user. The app randomly selects another user and sends the written reflection.”82 |
Social role | 7% (6) | “Each skill is taught in a tutorial format by an avatar named “Dr. Joy”, who introduces the player to the game, and explains the processes and skills involved.”83 |
Third-party endorsements | 7% (6) | “Calm is an award-winning mindfulness app that’s available for iOS, Android, and desktop. Developed in 2012, Calm has over 100 million downloads and more than 700,000 five-star reviews.”63 |
Social facilitation | 5% (5) | “Individuals are also able to choose positive messages (“message in a bottle”) to send out to other (anonymous) users.”84 |
Authority | 4% (4) | “The mobile programme complied with the United States Health Insurance Portability and Accountability Act (HIPAA).”44 |
Tailoring | 3% (3) | Users input their current emotional distress and MoodMission provides a tailored list of five CBT-based activities, called “Missions.”85 |
Cooperation | 3% (3) | “Mothers can also reply and answer each other’s questions.”86 |
Surface-credibility | 2% (2) | “Sleep stories narrated by celebrities like Matthew McConaughey and LeBron James.”62 |
Social comparison | 2% (2) | “Immediately after each response, a bar graph of the response rate of others is displayed, allowing the participant to see the answers most people chose (i.e., the correct answers).”87 |
