Behavior Change Support Systems: A Research Model and Agenda

Abstract

This article introduces the concept of a behavior change support system and suggests it as a key construct for research on persuasive systems design, technologies, and applications. Key concepts for behavior change support systems are defined and a research agenda for them is outlined. The article suggests that a change in complying, a behavior change, and an attitude change (C-, B- or A-Change) constitute the archetypes of a behavioral change. Change in itself is either of a forming, altering or reinforcing outcome (F-, A- or R-Outcome). This research model will become helpful in researching and designing persuasive technology.

Full text

T. Ploug, P. Hasle, H. Oinas-Kukkonen (Eds.): PERSUASIVE 2010, LNCS 6137, pp. 4–14, 2010.
© Springer-Verlag Berlin Heidelberg 2010
Behavior Change Support Systems: A Research Model
and Agenda
Harri Oinas-Kukkonen
University of Oulu, Department of Information Processing Science
Rakentajantie 3, 90570 Oulu, Finland
Harri.Oinas-Kukkonen@oulu.fi
Abstract. This article introduces the concept of a behavior change support
system and suggests it as a key construct for research on persuasive systems
design, technologies, and applications. Key concepts for behavior change
support systems are defined and a research agenda for them is outlined. The
article suggests that a change in complying, a behavior change, and an attitude
change (C-, B- or A-Change) constitute the archetypes of a behavioral change.
Change in itself is either of a forming, altering or reinforcing outcome (F-, A-
or R-Outcome). This research model will become helpful in researching and
designing persuasive technology.
Keywords: Socio-technical system, behavioral outcomes, psychological
outcomes, behavioral change, persuasive technology.
1 Introduction
The emergence of web 2.0 concepts and technologies to create, access, and share
information in new ways has opened up opportunities for also developing new kinds
of information systems for influencing users. For instance, one of the most prominent
areas for future healthcare improvement is the role of the web in fostering improved
health and healthier lifestyles [1]. Researchers have reported positive results in areas
such as the management of smoking cessation, hazardous drinking, obesity, diabetes,
asthma, tinnitus, stress, anxiety and depression, complicated grief, and insomnia [2].
Other application areas include directing users towards proper exercise behaviors [3],
better sitting habits [4], healthier eating [5], and greener energy behaviors [6], among
others. All these target behavioral changes in the end-users.
Both software developers and the general audience should be aware of the various
ways of and approaches to how people may be, are being, and will be influenced
through the information technology (IT) designs. Moreover, the contemporary and
future web will keep opening up a myriad of opportunities for building various kinds
of software applications and benefiting from them. In this article, we define behavior
change support systems (BCSS) as a key construct for research in persuasive

Behavior Change Support Systems: A Research Model and Agenda 5
technology [7].1 For achieving better outcomes from BCSSs, they should be designed
by using persuasive systems design frameworks and models [8].
This article is conceptual and theory-creating by its nature. The article is structured
as follows: Section 2 will discuss the related research. Section 3 will define and
discuss the concept of a behavior change support system. Section 4 will discuss the
research implications and future research directions. Finally, section 5 will draw
conclusions based on the earlier sections. In general, the article lays ground for future
research in this new frontier of research on BCSSs.
2 Related Research
The study of users’ attitudes and behavior has a long history in information systems
(IS) research [9]. Lessons have been drawn from social psychology [10, 11] and
cognitive psychology [12], and new models and frameworks have been developed,
such as the Technology Acceptance Model [13] and the Unified Theory of Use and
Acceptance of Technology [14]. These theories are useful for understanding attitudes
and behaviors related to information systems and their use, and some of them are
well-known among IS researchers. Besides these general attitude and behavior-related
theories, there are also useful attitude and/or behavior change related theories such as
the Elaboration Likelihood Model [15]. These change-related theories are not very
well-known among IS researchers, however.
A key element in behavior and attitude change is persuasion. Persuasive design and
technology has received growing interest among researchers for a little over a decade
now [cf. 16].2 Fogg’s seminal book [18] was the first conceptualization suggested for
software designers, stating that information technology may play the role of a tool, a
medium, or a social actor for its users.3 Bogost [20] proposed an approach to
developing persuasive games. More elaborate conceptual and design frameworks for
on and off-the-Web information systems have been suggested, such as the Persuasive
Systems Design model [21, 22]. Recently, one of the major development trends has
been the persuasion patterns of social network based information systems, in
particular in conjunction with Facebook.
A wide variety of BCSSs have been developed, such as an easy-to-use password
creation mechanism to help create stronger passwords [23], an interactive picture
frame for adopting better sitting habits while working at the computer [4], a
ubiquitous sensor-based kitchen application for improving home cooking by
providing calorie awareness regarding the food ingredients used in the meals prepared
[5], and a personal health information system to influence the health behaviors of
rural women in India through offering them information for increasing their
awareness about menses and maternal health [24].
1 Persuasive technology is the field of research, whereas a BCSS is an object of study within
the field.
2 Affective computing [17] may be recognized as a sister-field of persuasive technology, or
perhaps from the persuasive viewpoint as a sub-field of it, which directly focuses on the
emotions information technologies evoke.
3 Sharp criticism of persuasive technology and Fogg’s book has been offered by Atkinson [19].

6 H. Oinas-Kukkonen
3 Behavior Change Support Systems
Even if the web and other information technologies are often considered as just tools
to accomplish goals, they are never neutral. Rather, they are ‘always on.’ This means
that people are constantly being persuaded in a similar manner to how teachers
persuade students in schools, and there is nothing bad in this in itself, of course. To
put it simply, information technology always influences people’s attitudes and
behaviors in one way or another. In some cases, the influence may even be an
unintentional side effect of the design. Thus, software designers but also the general
audience should be well aware of the various ways and approaches how people may
be, are being, and will be influenced through IT design. Moreover, there is a plethora
of applications that can be developed with the purpose of behavioral change.4 For
these reasons, it is important to define and adopt into use the concept of a behavior
change support system.
In our definition, persuasive technology is the field of research, whereas a BCSS is
an object of study within the field. The main research interests in BCSSs include not
only human-computer interaction and computer-mediated communication, but also
topics such as approaches, methodologies, processes and tools to develop such
systems and ways for studying the organizational, social, and end-user impacts of
them. The research emphasizes software qualities and characteristics, systems
analysis and design, and end-user behavior and perceptions. Technologically, the
research may tackle socio-technical platforms, systems, services or applications, or
the software features in them, developed for persuasive purposes.
A BCSS is defined here as follows:
A behavior change support system (BCSS) is an information system designed to
form, alter or reinforce attitudes, behaviors or an act of complying without using
deception, coercion or inducements.
Persuasion relies on the user’s voluntary participation in the persuasion process.
Naturally, in addition to persuasion, other forms of attempts at influence do also exist.
For instance, a pop-up window or a hyperlink may be purposefully deceitful; coercion
implies force and the possibly economic sanctions; inducements are exchanges of
money, goods, or services for actions by the person being influenced. By definition,
these are not persuasive elements.
3.1 Types of Change
In this article, we divide behavioral changes into three categories, namely a change in an
act of complying, a behavior change or an attitude change.5 Respectively, these may be
called C-, B-, and A-Change, in ascending order of difficulty. Different persuasive goals
and strategies may be needed for applications supporting different types of changes.
4 It should be noted that even if we speak about behavioral changes, we do not posit a
behaviorist or any mechanistic psychological view towards human beings. End-users may use
these applications to support achieving their goals, maintaining a constructivist view (cf., the
field of education) towards human behavior.
5 For the sake of simplicity, we use the term “behavior” change rather than “behavioral”
change even if the BCSS covers all three behavioral change types.

Behavior Change Support Systems: A Research Model and Agenda 7
3.1.1 C-Change
With a C-Change, the goal of the behavioral change is simply to make sure that the
end-user complies with the requests of the system. For instance, the goal of a
healthcare application may be to guarantee that its users take their daily blood
pressure medication. The users may or may not have the proper motivation for doing
so, but, nevertheless, the key in this approach is to provide triggers for the user to take
action and to comply with the requests of the application. First achieving a C-Change
may help achieve a B-Change later.
It should also be noted that a myriad of software applications that have been
created for purposes other than a behavioral change per se utilize, in the micro scale,
the same design principles and techniques as systems supporting behavior changes.
3.1.2 B-Change
The goal of systems supporting a B-Change is to elicit a more enduring change than
simple compliance once or a few times. A one-time behavior change may be achieved
more easily, whereas long-term behavior change (not to even speak about a
permanent behavior change) is much more difficult to achieve.
3.1.3 A-Change
The goal of systems supporting an A-Change is to influence the end-users’ attitudes
rather than behavior only. An attitude change that directs behavior may be the most
difficult type of change to achieve but we maintain that persuasion-in-full occurs only
when attitude change takes place, and that a sustainable B-Change happens only
through an A-Change. In some cases, behavior change support systems should aim
bolstering both an A-Change and a B-Change simultaneously. This is particularly
important in areas such as providing support for overcoming addictive behaviors,
where users in spite of high motivation and proper attitudes may lack the skills to put
their knowledge and attitudes into practice (a B-Change is needed), but at the same
time their motivation and self-efficacy may need further strengthening (an A-Change
is needed).
3.2 Outcome/Change Design Matrix
In the abovementioned definition, three potential, successful voluntary outcomes are
the formation, alteration or reinforcement of attitudes, behaviors or complying. A
forming outcome (F-Outcome) means the formulation of a pattern for a situation
where one did not exist beforehand, e.g., abstaining from substance abuse. An altering
outcome (A-Outcome) means changes in a person’s response to an issue, e.g.,
increasing the level of exercise, decreasing the amount of drinking, or stopping
smoking. A reinforcing outcome (R-Outcome) means the reinforcement of current
attitudes or behaviors, making them more resistant to change.
A design matrix can be constructed from the intended outcomes and the types of
change. See Table 1. When designing a BCSS, the developers should carefully think
about which of these nine different goals the application will be built for. The
persuasion context may change dramatically when moving from one slot to another.

8 H. Oinas-Kukkonen
Table 1. Outcome/Change Design Matrix
C-Change B-Change A-Change
F-Outcome Forming an act of
complying (F/C)
Forming a behavior
(F/B)
Forming an attitude
(F/A)
A-Outcome Altering an act of
complying (A/C)
Altering a behavior
(A/B)
Altering an attitude
(A/A)
R-Outcome Reinforcing an act
of complying (R/C)
Reinforcing a
behavior (R/B)
Reinforcing an
attitude (R/A)
3.3 Design of Software System Qualities
Behavior change support systems utilize either computer-mediated or computer-
human persuasion. Computer-mediated persuasion means that people are persuading
others through computers, e.g., e-mail, instant messages, or social network systems.
Even if the web cannot communicate in the same way as humans do, some patterns of
interaction similar to social communication may be utilized also in computer-human
persuasion. In the case of BCSSs, there must exist other stakeholders who have the
intention of influencing someone’s attitudes or behavior, as computers do not have
intentions of their own. These stakeholders are those who create or produce BCSSs,
those who give access to or distribute them to others, or the very person adopting or
using such a system [18]. BCSSs emphasize – but are not limited to – autogenous
approaches in which people use information technology to change their own attitudes
or behaviors through building upon their own motivation or goal. They also request a
positive user experience and stickiness, which encourage the user to engage with them
regularly over an extended period of time.
Building BCSSs requires insight from software and information systems design as
well as psychology. Lessons learned from psychology include: (1) the fact that people
like their views about the world to be organized and consistent, (2) that persuasion is
often incremental, and (3) that the direct and indirect routes are key persuasion
strategies [22]. Important software design requirements to be always kept in mind
when developing BCSSs are that: (1) behavior change support systems should be both
useful and easy to use, and (2) persuasion through behavior change support systems
should always be transparent. Quite understandably, if a system is useless or difficult
to use, it is unlikely that it could be very persuasive. The transparency requirement
emphasizes the need for revealing the designer bias behind a BCSS.
The Persuasive Systems Design model [21, 22] is the state of the art
conceptualization for designing and developing BCSSs. According to the PSD model,
careful analysis of the persuasion context (the intent, event, and strategy of persuasion)
is needed to discern opportune and/or inopportune moments for delivering the
message(s). Many design aspects in developing BCSSs are general software design
issues rather than specific to BCSSs only. These include, for instance, usefulness, ease
of use, ease of access, high information quality, simplicity, convenience, attractiveness,
lack of errors, responsiveness, high overall positive user experience, and user loyalty.
The PSD model suggests a set of design principles under four categories, namely
primary task, human-computer dialogue, perceived system credibility, and social
influence. See Figure 1. The design principles of the primary task category focus on
supporting the carrying out of the user’s primary activities. Design principles related

Behavior Change Support Systems: A Research Model and Agenda 9
to human-computer dialogue help move towards achieving the goal set for using the
BCSS. The perceived system credibility design principles relate to how to design a
system so that it is more believable and thereby more persuasive. The design
principles in the social influence category describe how to design the system so that it
motivates users by leveraging social influence.
Other users
User
Social
influence
Perceived
system credibility
Human-compute
r
dialogue
Primary task
support
!
Fig. 1. Four categories of design principles for BCSSs
Tørning and Oinas-Kukkonen [25] have analyzed the scientific research publications
in the PERSUASIVE conferences during 2006-2008 as regards the software system
features and the abovementioned categories. According to their study, the most utilized
features have been tailoring, tunneling, reduction, and self-monitoring (representing the
primary task category), suggestion (for supporting human-computer dialogue), surface
credibility (in support of perceived system credibility), and social comparison, normative
influence, and social learning (relating to social influence).
Many types of research on software system features have been conducted. For
instance, Harper et al. [26] studied the roles that social influence and social
comparison may play in online communities for motivating members rather than
editors to contribute and moderate content. Andrew et al. [27] studied the challenges
in implementing suggestion and how it differs from and overlaps with other
techniques, in particular tunneling, reduction, and self-monitoring. Räisänen et al.
[28] studied the right-time suggestions of messages. Cugelman et al. [29]
demonstrated that system credibility, in particular the system’s trustworthiness,
affects a user’s behavioral intent. Gamberini et al. [30] showed that in some situations
a persuasive strategy based on reciprocity is more effective than one based on reward,
as well as that the presence of social proof features seems counterproductive when
using a reciprocity strategy, whereas it seems to improve compliance with a request
when using a reward strategy. At a more general level, Zhu [8] conducted a meta-
study of persuasive techniques in BCSSs motivating for regular physical activity. The
results of this study suggest that very few previous studies resulted in achieving the
intended goal. Only a few studies took advantage of any persuasive techniques, and

10 H. Oinas-Kukkonen
none of these interventions were conceptually designed through persuasive design
frameworks. The conclusion of this study was that designing a new generation of
BCSSs should be based on such frameworks.
4 Research Agenda for BCSS
Tørning and Oinas-Kukkonen [25] report some interesting findings regarding the
current state of research on BCSSs:
Thus far there has been much more research on C- and B-Change than on A-
Change. Only about 16% of the research has addressed A-Change. This may due to
the fact that C- and B-Change are in most cases easier to study than A-Change.
Nevertheless, in the future more emphasis should be placed on A-Change.
In the current research literature, there seems to be a tendency of describing the
software systems and the persuasion context (use, user, and technology contexts) at
too general a level. Black-box thinking of the software systems – with no actual
description of what was implemented and how – may make the research results
obsolete. The differences between problem domains are so huge that very general
claims can be seldom argued for. For instance, in most of the experimental research
students are regarded as a homogenous mass. More specific information is often
limited to gender and age. Yet, a deep understanding of the user segments is highly
important for designing successful persuasive systems. Specific target audiences may
request very different kinds of software features. Just consider the differences
between small schoolchildren, tweens, teens, and perhaps even young adults in
comparison to lumping them all together as students.
When describing a persuasive system, a very clear description of the technology
context is needed. After all, much of the success or failure of an application can be
attributed in many cases to the fluent navigation and smooth interaction arising from
the technological infrastructure rather than to the design of the system. Relying on
black-box thinking is a symptom of a severe misunderstanding of conducting BCSS
research.
The message and route for persuasion are also often not described at such a level of
detail that it would be possible to determine whether a direct or indirect approach
actually has been applied and whether that has played a role in the success or failure
of the system. Moreover, it should be clearly defined whether one or multiple
arguments were presented, and what kinds of arguments were presented.
Often, the empirical and experimental research does not reveal much about the
motives behind the system under study. The designer bias should necessarily be
revealed much more clearly.
Admittedly, space is often too limited in scientific papers to provide many details
about the system. For this reason, the actual system descriptions easily become
radically shortened or are even cut out from the papers. Moreover, the field would
benefit from a shift in research emphasis from proof of concept approaches into
theorizing for persuasive systems design.
Quite surprisingly, ethical considerations have remained largely unaddressed in
persuasive technology research. Many important issues need to be recognized, such as
the actual voluntariness for change in using the application and potential ways for

Behavior Change Support Systems: A Research Model and Agenda 11
abusing the system. There may also be situations where computer-mediated
persuasion takes place without the user being aware of it. These ‘grey areas’ should
be carefully considered.
Open research questions to be tackled in future research include the following:
• How can “change” be measured? Are there differences in measuring C-,
B- and A-Changes?
• What challenges do A-, B- and C-Change pose for BCSS research? What
are the connections between C-, B- and A-Change?
• How can we conduct experiments in such a manner that it will be really
possible to pinpoint a change to have been caused by a BCSS, or even
more precisely, by a specific software feature in it?
• How do the BCSSs developed for R-, A- and F-Outcomes differ from
each other?
• How can we build BCSSs in such a manner that they will be unobtrusive
with users’ primary tasks?
• What are the roles of cognition and emotion in BCSSs?
• What is the relationship between convincing and persuasion in BCSSs?
• What is the role of goal setting in different kinds of BCSSs? How can the
change in the user’s goals be supported?
• When should a BCSS use a direct/indirect persuasion strategy?
• Which software features have the greatest impact in different settings?
Which combinations of software features have the greatest impact?
• Which modes of interaction are more persuasive than others? How can the
fit between these interaction modes and catering for certain types of
behaviors be recognized and measured?
• What are the differences between problem domains (e.g., increased
exercising vs. weight management, or reduced energy consumption vs.
overcoming addictions)?
• What are the challenges in the development of persuasive platforms/
systems/services/applications/features?
• What is the difference between developing a BCSS as a software system
vs. as a software service (e.g., a mash-up)?
• What challenges result from the requirement for a service to be available
24/7?
• How can we cope with it when the technological platform which the
BCSS has been built upon changes dramatically?
• What is the difference between persuasiveness and perceived
persuasiveness? How should perceived persuasiveness be studied?
• How and to what extent should the bias behind a BCSS be explicated?
• How can we map psychological and behavioral theories within BCSS
research?
• What research issues (other than ones relating to the user interface) need
to be tackled?
• What are viable business models for BCSSs?

12 H. Oinas-Kukkonen
• What are the cultural and gender differences in BCSSs?
• How can we recognize and analyze the unintended side-effects of using a
BCSS? What kind of abuses of a BCSS can be recognized and how?
As can be seen above, many questions remain to be addressed. Indeed, even if many
research efforts have already been conducted thus far, we are still in the very early
steps of research into persuasive technology and behavior change support systems.
In sum, what distinguishes research into BCSSs from research into other
information systems and technologies is that BCSSs are inherently transformative,
deliberately attempting to cause a cognitive and/or an emotional change in the mental
state of a user to transform the user’s current state into another planned state.
Empirical BCSS research provides a unique opportunity for quantifying measures for
system success. This requires explicitly stating the aim of the system, how the success
was to be measured, and the extent to which the system succeeded in achieving this
measure. It has to be explicitly defined what really takes place through the software
system to be able to demonstrate to what extent an outcome/change is really due to
the system, or a feature or a set of features in it. Thus, sound ways of defining the
systems and their goals clearly are needed. Otherwise, it will be difficult or perhaps
even impossible to translate lessons learned from the results into related problem and
application domains.
5 Conclusions
Human-computer interaction and social interaction through information systems can
be used to influence people’s behavior. Yet, even the relatively well-known
persuasion techniques need to be adapted to match computing specificities. Moreover,
the development of BCSSs is much more than just a user interface issue. It relates to
technological services, applications, platforms, and functionality, the quality and
content of information, personal goals set by the end-users, and social environments,
among other issues. In many cases, the BCSSs must be available 24/7, they have to
address global and cultural issues with a multitude of standards, habits, and beliefs,
and they have to be adaptable into a variety of business models.
Persuasive technology as a field has the responsibility of educating the general
audience about the pros and cons of people’s behaviors being influenced by
information systems, whereas web and other software developers must realize that
they exercise enormous power over the users because their designs always influence
them in one way or another, whether they intend them to or not. Moreover, the
contemporary and future web will keep opening up a myriad of opportunities for
building various kinds of behavior change support systems and benefiting from them.
Acknowledgements
I wish to thank the Academy of Finland and the National Technology Agency of
Finland for financial support for this research, and my doctoral students Marja
Harjumaa, Tuomas Lehto, Teppo Räisänen, Katarina Segerståhl and Donald Steiny
for their collaborations in my research endeavors within persuasive technology.

Behavior Change Support Systems: A Research Model and Agenda 13
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