Persuasive Features in Technology-Based Interventions for Older Adults with Chronic Diseases: A Systematic Review of the Literature

Background and Purpose: According to the U.S. Department of Health and Human Services, health communication strategies and health information technology (HIT) are essential in improving health outcomes and health care quality in the United States. Although social workers regularly engage with chronically ill older adults, they are not noticeably involved with the research and development of HIT-based chronic disease management. As such, the efficacy of HIT-based chronic disease management is not well established for marginalized populations, specifically older adults.  Informed by persuasive systems design (PSD) theory, this systematic review examined features and outcomes of HIT interventions for older adults managing chronic diseases.

Methods: We searched for experimental and quasi-experimental articles published prior to January 2015 using several databases including: ERIC, PsychINFO, PubMed, Academic Search Premier, and CINAHL.  Search terms included chronic disease, chronic illness, self-care, self-management, HIT, Internet and website. To prevent exclusions of studies of older adults aged 50 and older, the terms “older adult” or “elderly” were not included in the search vocabulary. After three cycles of screening, we narrowed 3,381 articles to 24 studies for review.

Results: Interventions presented in the final 24 studies were designed to improve health outcomes such as self-efficacy, self-care, and physical activity among participants with a chronic health condition such as diabetes, COPD, and arthritis. Among the 24 studies, tailoring, self-monitoring, and personalization were the most commonly used primary task support principals in web-based interventions with older adults. Reminders were the most frequently used dialogue support within the studies, while praise, suggestion, rewards, liking and similarity were the dialogue support principals used the least. Among the seven principals under systems credibility support category, expertise was most commonly used within the studies. Social supports were used less frequently than persuasive task support, dialogue support, and systems credibility support in order to increase persuasion among participants. Of the 24 studies included in our systematic review, 13 reported success in all measured outcomes and 10 reported a mix of both positive and unsuccessful outcomes pertaining to improvements in healthier lifestyles, self-management, chronic disease knowledge, blood pressure, and daily functioning. Only two of the studies included in our review found no improvement in health outcomes and experienced high attrition rates after implementation of the intervention.

Conclusion: It is important to identify specific PSD features within interventions as we found PSD features are linked to successful outcomes. With a rich history of promoting healthcare services and improving public health conditions, social workers have the unique knowledge and skills to assist in the management of chronic disease among older adults, particularly when combined with HIT. Due to social work’s distinctive understanding of aging issues and digital disparities, social workers must take a leadership role in the evaluation, design, and implementation of HIT for older adults.