University of Oulu

Pasi Karppinen, Harri Oinas-Kukkonen, Tuomas Alahäivälä, Terhi Jokelainen, Anna-Maria Teeriniemi, Tuire Salonurmi, Markku J. Savolainen. Opportunities and challenges of behavior change support systems for enhancing habit formation: A qualitative study. In Journal of Biomedical Informatics, Volume 84, 2018, Pages 82-92, ISSN 1532-0464.

Opportunities and challenges of behavior change support systems for enhancing habit formation : a qualitative study

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Author: Karppinen, Pasi1; Oinas-Kukkonen, Harri1; Alahäivälä, Tuomas1;
Organizations: 1Oulu Advanced Research on Service and Information Systems, Faculty of Information Technology and Electrical Engineering, University of Oulu, Finland
2Research Center for Internal Medicine, University of Oulu, Oulu, Finland
3Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
4Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.4 MB)
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Language: English
Published: Elsevier, 2018
Publish Date: 2019-06-21


The formation of healthy habits is considered to play a fundamental role in health behavior change. A variety of studies on Health Behavior Change Support Systems (HBCSS) have been conducted recently, in which individuals use such systems to influence their own attitudes or behaviors to achieve their personal goals. However, comparatively much less research has been devoted to studying how the users of these systems form habits with the help of HBCSS, or to understanding how to design these systems to support habit formation.

Objective: The objective of this article is to study HBCSS user experiences regarding habit formation through an intervention study targeted at establishing a healthier lifestyle. This study also aims to map habit formation stages, as suggested by Lally and Gardner, with the Persuasive System Design (PSD) model. The application domain is the prevention of metabolic syndrome, in which 5% weight loss can significantly reduce the prevalence of the syndrome.

Methods: This study employs a web-based HBCSS named Onnikka, a lifestyle intervention designed for the prevention of metabolic syndrome for participants who are at risk of developing a metabolic syndrome or are already suffering from it. The system under investigation was designed according to the principles of the PSD model and Behavior Change Support System framework. Lally and Gardner’s research on the stages of habit formation were used to study the extent to which the Onnikka system was able to enhance the development of new habits. A total of 43 Onnikka users were interviewed for this study during and after a 52-week intervention period. The research approach employed here was hermeneutics, which leans ontologically toward the social construction of reality, gained through language, consciousness, and shared meaning. In addition, the system’s login data and participants’ weight measurements were utilized to build an interpretation of the results.

Results: The findings of this study suggest that IT habits appear to have a strong linkage with use adherence, whereas lifestyle habits did not seem to be directly related to the 5% weight loss among study participants. Moreover, habit formation stages provide a possible explanation for why self-monitoring, reminders, and tunneling were perceived as especially valuable features in this study.

Conclusions: For sustainable weight management, holistic e-health interventions are required, and the PSD model offers a practical approach for designing and developing them. Recognizing the stages of habit formation provides additional valuable guidance for designing systems that help shape an individual’s habits.

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Series: Journal of biomedical informatics
ISSN: 1532-0464
ISSN-E: 1532-0480
ISSN-L: 1532-0464
Volume: 84
Issue: August
Pages: 82 - 92
DOI: 10.1016/j.jbi.2018.06.012
Type of Publication: A1 Journal article – refereed
Field of Science: 113 Computer and information sciences
3121 General medicine, internal medicine and other clinical medicine
Funding: We wish to thank the anonymous reviewers of this article for their insightful comments. We would like to express our gratitude to the PrevMetSyn research consortium, including professor Maija-Leena Huotari, PhD Heidi Enwald, and Kreetta Askola. We also thank PhD Hannu Vähänikkilä for his help to improve the manuscript. HOK wishes to thank the Finnish Cultural Foundation for supporting this research.
Copyright information: © 2018 Published by Elsevier Inc. This manuscript version is made available under the CC-BY-NC-ND 4.0 license