Exploring Preferences to Behavioral Science Infused Digital Health Content Targeting Annual Visits, Chronic Care, Preventive Screenings, Patient Portals & Vaccinations

Theoretical Background and research questions/hypothesis: Digital health communications can reach diverse audiences and deliver tailored messages at scale. Health communications elicit gut reactions from recipients that can inhibit or facilitate both engagement with the communication and completion of the target behavior. Infusing behavioral science (e.g., behavior change techniques [BCTs]) into health communications can support engagement and behavior change by helping the recipient overcome barriers for the target behavior. However, individual preferences also impact motivations and intentions for completing health-related behaviors. Understanding if these preferences are associated with the target health behavior, the BCT, or other factors allows more effective content tailoring for individual recipients. The purpose of these studies was to capture reported preferences to digital health content (e.g., email subject lines, body copy, images) across a variety of health topics (e.g., diabetes, COVID-19 vaccinations, mammograms). This work was exploratory and therefore specific a priori hypotheses were not listed for every research question. In general, we expected individuals would prefer positive over negative messaging and BCTs would not be considered equally engaging.

Methods: We administered two surveys through Amazon’s Mechanical Turk (MTurk) in June 2022 and March 2023. Digital health content was sourced from commercial interventions that leverage artificial intelligence to deliver personalized behavioral communications. Each content item leveraged a specific BCT to facilitate engagement with the communication and completion of the target behavior. Questions assessed preferences, including level of engagement, with digital message components. Descriptive statistics explored preferential ratings and, when applicable, correlation tests were run.

Results: Across two studies, 1,363 participants completed the surveys. All participants were over 18, approximately evenly distributed across sex, and the majority were Caucasian, non-Hispanic, and highly educated. Participants rated content consistently across health topics in that if someone rated the first content item as engaging, they would rate all other content items as engaging. Subject lines and body copy were typically rated favorably (i.e., somewhat engaging). Content items leveraging positively framed BCTs were preferred (e.g., gain frame vs loss frame). When participants rated visuals as uninteresting, reasons listed included lack of relevance (i.e., not being a woman and needing a mammogram) or resistance to the target behavior (i.e., not believing in the COVID-19 vaccine). The most positively rated body copy items were those promoting annual wellness visits, the most broadly relevant health topic.

Conclusions: Digital content infused with behavioral science was largely accepted and viewed as engaging regardless of the health topic being addressed. Content that focused on positive aspects of the health behavior (benefits of the behavior and fulfilling commitments vs. unintended consequences or dissonance from acting outside of one’s values) was received more favorably. Finally, in instances where the individual perceives the health problem as personally irrelevant, the content was rated poorly.

Implications for research and/or practice: Results from these exploratory studies suggest that certain strategies (i.e., positively framed BCTs) may be received well across all health topics. Further, additional support may be required in cases where the individual has strong beliefs about a health topic such as vaccinations.