Captology's Effect On Electronic Health Portals

This project was undertaken as a crucial component of my master's program, demonstrating a comprehensive process encompassing design development, rigorous testing methodologies, meticulous statistical analysis, and informed conclusions.

Background

Many users who see the value in having and engaging with electronic health records portals do so because they have an existing need that would be met by utilizing an EHR portal. Their context dictates whether they create and in turn engage with a portal. The goal of discovering underlying feelings or beliefs surrounding EHR portals is to underscore key aspects of EHRs that can be crucial to modifying an individual perspective of EHRs portals, facilitating user adoption regardless of health circumstance.  

Hypothesis

The use of multiple persuasive design features used in conjunction with one another across categories illustrated in the persuasive system design model would increase the intention of individuals to create an online patient portal, increase the participants’ acceptance of EHR systems, and increase the participants’ perceived persuasion compared to when no persuasive design techniques were used. 

Project Details

  • Tools

    -Figma

    -Axure

    -SPSS

    -Qualtrics

    -Excel

    -SJSU SONA

    -DocuSign

  • Team

    -1 UX designer and researcher

    -1 Project advisor

  • My Role

    UX designer, researcher, writer, and analyzer.

  • Timeline

    -Overall: 9 months

    -Discovery & Research: 4 weeks

    -Design, testing, and analysis: 5 months

The Process

Create the study methodology, variables, conditions, and documentation.

Compile previous research to understand gap in what had already been studied.

Run participants and analyze data.

Incorporate validated designs and questionnaire methods.

Present research findings.

Determine outcomes.

Published literature examines the incorporation of persuasive design, known as health-captology, in the healthcare field to promote healthier behaviors. While BJ Fogg predicted that captology in healthcare would be extensively studied due to the increasing use of interactive systems, current literature indicates limited research in this area. Existing studies primarily focus on developing and testing persuasive models and frameworks, with few providing design recommendations. The context of persuasion, user perceptions, and the application of persuasive techniques in electronic health record portals is also rarely explored. The review emphasizes the need to understand users' motivations, barriers, and perceptions to effectively design persuasive systems in healthcare.

Literature Review

 Experiment Design

  • -42 participants

    -18-30 years of age

    -Fluent in speaking and reading English

    -Normal or corrected-to-normal vision

  • -Dialogue Support (praise and authority)

    -System Credibility Support (suggestion and surface credibility)

  • -Time to decide

    -Perceived Persuasion

    -Technology acceptance

    -Intent to create a patient portal

  • Condition 1: No persuasion

    Condition 2: Suggestion/surface credibility

    Condition 3: Suggestion/authority

    Condition 4: Praise/surface credibility

    Condition 5: Praise/authority

    Condition 6: Suggestion/praise/surface credibility/ authority

  • -Read initial instruction and scenario description

    -View and read through designed screen

    -Fill out questionnaires

    -Participant debrief

Designs

Below are the prototype designs fitted with the different experimental conditions. While it might seem like 6 of the same designs - look closer. Each incorporates different captology principles that were being tested in this experiment. Since only certain elements of the design were being investigated, components such as the format, layout, and color pallet mimic Standford Health's webpage design.

Surveys

Participants began by filling out a screening survey to ensure they were eligible to participate. They then signed the consent document and were able to sign up to participate in the study. At their convenience they were able to take the second survey where they were randomly presented with their test condition.

Reasons participants gave for not having an electronic health record system

Data Analysis

The TAM and PPQ questionnaires were used to measure perceived persuasion and technology acceptance. Intention to create a patient portal was also determined. These were displayed to participants in a randomized order. All tests that were conducted were compared to a 0.05 significance level and are listed below:

  • A non-parametric Kruskal Wallis test to compare differences among tests groups.

  • A post-hoc Dunn test to get specific information on the difference between individual factors.

  • Multiple one-way ANOVAs tests on the response time data with a post-hoc Bonferroni test was then run to clarify the specific differences between factor levels.

Results

Findings

This study centered around the persuasive system design model and its proposed design techniques’ impact on several variables namely perceived persuasion, technology acceptance, and intent to create an electronic health record portal. Unfortunately, no significance was found regarding the different persuasive techniques’ impacts on the perceived persuasion of the participants or their intent to create an electronic health record portal. The data collected regarding the participant’s technology acceptance demonstrated significance between conditions however there was no significance between condition number four and condition number one which was the control condition with no persuasive factors within the design.

Limitations

  • Participants were pulled from a student university population

  • University time constraints

  • Specific functionalities of the prototype were intentionally limited to just the necessities of the research

Future Research

01

Incorporate additional persuasive design factors found in the persuasive system design model.

02

Branch into the different categories of features as well as take a deeper look into how the combination of factors affects persuasion.

03

Persuasion techniques to encourage users to interact more frequently with the portal or with more of the features within the portal once it is established. 

The outcomes of studies like this one will generate further knowledge on design recommendations regarding persuasive techniques as well as an understanding of the type of persuasive methods that could be of merit in the healthcare field. Furthermore, an increase in this type of research could provide understanding on how persuasive technology can be implemented into electronic health record portal creation and its worth in pursuing subsequent design interventions that expand on the current design recommendations.

Conclusions

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