Persuasive Technology in an mHealth App Designed for Pelvic Floor Muscle Training Among Women: Systematic Review

Abstract

Background Pelvic floor muscle training (PFMT) is one of the first-line treatments for stress urinary incontinence among pregnant women. Mobile health (mHealth) technology is potentially effective for delivering PFMT to pregnant women. Persuasive technology in the development of such mobile apps may facilitate behavior change by improving adherence to the exercises. The Capability, Opportunity, and Motivation–Behavior (COM-B) model is potentially useful in selecting the appropriate interventions to be incorporated into the apps. Objective This review of mHealth apps for PFMT aims to describe the principles of persuasion used for each app and to propose mHealth app design features based on the COM-B model. Methods A systematic literature search was conducted to answer three main research questions: what are the available mHealth apps for PFMT in the published literature, what persuasive strategies were used in their studies how were they mapped to the COM-B model, and how effective were the selected persuasive strategies for PFMT adherence? We searched PubMed, CINAHL, Web of Science, Scopus, and local Malaysian databases such as MyCite and MyMedR for articles reporting mHealth apps used for the delivery of PFMT. We included original articles reporting experimental and cross-sectional studies, including pilot or feasibility trials. Systematic and narrative reviews were excluded. Narrative and thematic syntheses were conducted on the eligible articles based on the research questions. The Cochrane risk of bias tool and the Risk of Bias Assessment Tool for Non-randomized Studies were used to assess study bias. Results Of the 169 records from the initial search, 10 (5.9%) articles meeting the selection criteria were included in this review. There were 8 mHealth apps designed for the delivery of PFMT. The Tät, which used 3 categories of persuasive system design, improved PFMT adherence and was cost-effective. Only 1 app, the iBall app, used all categories of persuasive system design, by including social support such as "competition" in its design. The Diário Saúde app was the only app developed using operant conditioning. All apps incorporated Tailoring and Expertise as part of their PSD strategies. Only 3 apps, the Diário Saúde, Tät, and Pen Yi Kang demonstrated improved PFMT adherence. Conclusions Persuasive technology used in mobile apps may target desired behavior change more effectively. The persuasive system design can be mapped to the COM-B model to explain its effectiveness on behaviour change outcomes.

Exploring Adherence to Pelvic Floor Muscle Training in Women Using Mobile Apps: Scoping Review

“…Digital "prompts and cues" are a BCT that target the core behavior opportunity according to the COM-B model. Digital reminders are a "persuasive" behavioral intervention that may be valuable when it comes to changing women's behavior around PFMT, since women commonly associate poor adherence with forgetting to complete PFMT [14,28]. Persuasive behavioral interventions can help women overcome known barriers to PFMT by creating more positive attitudes toward the exercises [28].…”

“…However, it is unclear how they work. The aim of one study [28] was to determine the encouraging features of PFMT mobile apps using persuasive system design to suggest features for new PFMT mobile apps that incorporate the COM-B model. However, to date, no review has mapped the core behaviors targeted by PFMT mobile apps through the identification of BCTs using the COM-B model.…”

Examining behaviour change techniques (BCTs) in technology-based interventions for enhancing social participation in people with mild cognitive impairment (MCI) or dementia: a scoping review protocol

“…Additionally, the review aims to evaluate the diverse BCTs employed within technological interventions and assess their success in improving social participation outcomes since the BCTs, like persuasive technology, may target selective behaviour change more effectively. 56 57 Current research reports intervention features like goal setting and feedback as practical BCTs. 58 This evaluation will offer valuable insights into the most promising strategies integrated into future interventions to enhance social engagement and interaction.…”

Sports Medicine and the Pelvic Floor

“…This can be built into a wider training program; however, some athletes may find PFM training more achievable when implemented as a daily habit whereby they engage in three sets of 8 to 12 sustained PFM contractions plus one to two ballistic repetitions everyday (31). Furthermore, there are ample digital applications that could be considered useful within Femtech (93) to prompt reminders and reinforce educational components of PFM training directly from an athletes smart phone or device (94,95).…”