Health Informatics Report: Decision Support Systems for Self-Care

This report provides a comprehensive literature review on persuasive decision support systems (PDSS) designed to enhance self-care in health informatics, particularly for patients with chronic diseases. It explores Health Behavior Change Support Systems (HBCSSs) and their role in influencing patient attitudes, compliance, and behavior through socio-technical tools. The review emphasizes key aspects like patient involvement in system development, the significance of attitude and behavior change, and the importance of patient education. It examines factors affecting the adoption and usage of HBCSSs, including gamified health strategies, the impact of attitude on system implementation, and the role of mobile technology in patient monitoring and medication adherence. The report concludes that persuasive decision support systems are crucial for the design, adoption, and usage of HBCSSs, contributing significantly to patient self-care, especially for those managing chronic conditions. The study highlights the importance of patient involvement in the development, implementation, and evaluation of these systems, ultimately improving patient outcomes and quality of life.

Running head: Health Informatics 1
HEALTH INFORMATICS
Student Name
Institution

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Persuasive Decision Support Systems for Self-Care
Introduction
Health Behavior Change Support Systems (HBCSSs) refers to socio-technical
information systems designed to perform or change the behavioral or psychological systems of
an individual such as attitude or behavior. This implies that the system has been developed with
the intention to influence the users’ behavior. Persuasive decision support system aims at
influencing or changing behavior and attitude of patients using socio-technical tool HBCSSs.
Persuasive decision support systems for self-care. Self-care is another important part of patient
health care. There are many kinds of literature that explain various aspects of persuasive decision
support system that enable patients especially chronic disease patients take behavioral and
attitude change. Some of the fundamental aspects of persuasive decision support system are
attitude, compliance, behavior and patient education. The main focus of this paper is to provide
literature on persuasive decision support system for self-care patients.
Review process
Persuasive decision support system is the tool that is used to involve patients in decision
making through persuasion. Persuasive component of the system plays an important role in the
development, design, and implementation. Users of the system need to be part of the
development of the system according to Bensley et al (2010, pp 206–213). Moreover, as
Harjumaa, Segerståhl and Oinas-Kukkonen (2009, vol. 350), explains patients with chronic
diseases need to be part of the development as the main stakeholders as this also help in decision
making. According to Davis (2010, pp 262–273), the three aspects of the persuasive in health are

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attitude, compliance and behavior. These three aspects of persuasive decision support system are
key determinants of self-care of most patients. Similarly, Räisänen and Lehto (2010, pp 185–
192) highlight engagement and involvement as the key most important component of the
persuasive decision support system that facilitates game intervention. Oinas-Kukkonen and
Harjumaa (2008a, pp 164–176), conclude the persuasive decision support context of HBCSSs by
indicating that persuasive decision support system highly influences behavior patients towards
self-care. Another part of persuasive decision support system that is also part of HBCSSs is the
implementation of the system. Involvement of patients in implementation process play role in
evaluating the adoption of HBCSSs in self-care.
Results, critical analysis of literature
The result of the literature review reveals some key factors that are considered in the
implementation of the HBCSSs. Persuasive decision support tool is mostly patient support tool
that looks into personal traits such as attitude, behavior, and compliance. Several examinations of
literature further reveal the various interrelated factors affecting adoption and usage of HBCSSs.
Another important aspect of the persuasive decision support system is the implementation of the
HBCSSs. Gamified health BCSSs forms an important facet that monitors lifestyle that forms part
of HBCSSs. Gamified health strategy remains a crucial aspect of behavior change system since it
is one of the factors that are considered when designing the system. Another factor that is used in
Gamified health BCSSs is the study of outcomes of the behavior change.
Attitude

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Attitude as an aspect of HBCSSs forms the basis of implementation of HBCSSs in the
health system. According to Bensley et al (2010, pp1–13), the attitude of the client on the
usefulness of the system is part of the decision on the usage or implementation of HBCSSs. The
attitude is also cited by Bensley et al (2004, pp1–13), may also determine the success of HBCSSs
given that persuasions target the change of attitude in the positive adoption of the system.
Attitude is also connected to the patient’s perspective on adoption and implementation of
HBCSSs. Moreover, attitude also forms part of the personal care that is able to increase patients
view and their ability to embrace self-care system. Lehto and Oinas-Kukkonen (2010, pp 62–
173) shows that attitude is also indicated by the client’s perspective on the system.
Persuasive decision support system normally considers patients perspective on the usage
of the HBCSSs. The perspective of a persuasive system according to Bates (2000, pp 788–791),
is to measure an individual body physical activities and medication. A study on the personal
experience on the use of HBCSSs indicates that patients with the HBCSSs system do good
during medication as compared to those patients that use other medication monitoring methods.
Miller (2002, pp 3–16) shows that the success of the HBCSSs system also depends on the
patient’s voluntariness to use HBCSSs. This implies that patient should also volunteer to
implement the system.
Another study by Bates (2000, pp 788–791), shows that persuasive HBCSSs works best
with mobile tools that assist in the decision of medication. Getting views of patients on their
ability to use mobile devices in using HBCSSs play role in compliance with HBCSSs. This
further indicates that current increase in mobile technology users is also accompanied with many
online users. Mobile devices currently form part of life as many patients possess the device

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making it convenient for use in daily life. Making the mobile technology part of HBCSSs is ideal
for use and monitoring of physical health especially for those patients with chronic disease.
Behaviour
Behaviour is another critical aspect of the development of HBCSSs. The behavior change
support system is an important persuasive support system that enables patient to have a healthy
health system. According to Kraft, Drozd and Olsen (2009, 24), HBCSSs is a multidisciplinary
or interdisciplinary system that uses many skills from various fields coherently to assist the
patient has proper self-health care. O'donoghue and Herbert (2012, pp 5) indicate that the
incorporation of persuasive coaching system is projecting high societal impact on individual
patients. In addition, the BCSSs enable coaching of patients toward better self-care and life. For
instance, a good persuasive system involves the use of social, technical and health system from a
system that monitors physical, health and behavioral activities in the body of patients. Oinas-
Kukkonen and Harjumaa (2009, pp 485–500) also confirms the multidisciplinary nature of the
HBCSSs that enable a persuasive decision on the usage of the system. Strecher (2007, pp 53–76),
conclude the multidisciplinary approach for this persuasive decision support system influences
indicating some disciplines that are used in the decision.
Compliance
According to Midden and Ham (2009), self-reminders is another valuable feature of the
HBCSSs persuasive system. In the monitoring and self-care, medication plays an important role
in ensuring that proper and timely medication is possible. In dealing with chronic disease self-
care best work with a reminder and this work when patient is under medication. Compliance

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work in hand with the attitude of the patient as those patients with a positive attitude has shown
full compliance with the implementation of the system. In addition, Lehto and Oinas-Kukkonen
(2010, pp 62–173) shows that compliance often associated with positive feedback and this play
an important role in the evaluation of the whole system in decision making. However, Oinas-
Kukkonen and Harjumaa (2008a, pp 164–176) cites a different view on the compliance as
recopies for persuasive decision support system. The author indicates that compliance come at
the end of the implementation of the system and therefore should not be used for development of
HBCSSs. O'donoghue, and Herbert (2012) conclude the compliance by indicating that
compliance is the backbone for persuasive decision making since it enables the developers to
determine the attitude of clients on self-care.
Patient education
Patient education according to Lehto and Oinas-Kukkonen (2009, pp 316–327), is
another aspect of persuasive decision support system that helps in usage. Educating patients on
the usage and importance of HBCSSs to patients especially in monitoring health has proved
critical. Moreover, patients education work in hand with various context such as feedback as
customer view also play role in improvement of the system. Patient education is also part of
client involvement in decision-making process since when educating patients they are able to
bring on board patient’s view on the HBCSSs (Bish, Sutton & Golombok 2000, pp 35–50).
Discussion
HBCSSs remain an important persuasive health monitoring system especially on self-care
with many kinds of literature revealing various aspects of the system. As cited by Oinas-

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Kukkonen (2010 pp 26–27), HBCSSs being incorporated with mobile monitoring unit is
currently embraced by many users for its main persuasive aspect. The literature further revealed
that notification or reminder facet is also important for medication of patients with chronic
disease. The study critically explains the position that cares givers or practitioners have in the in
the usage of HBCSSs. The remainder aspect of the HBCSSs also concurs with the uses of the
mobile platform in persuasive medical HBCSSs. The two main features of the HBCSSs makes
the system to works at personal level since the mobile platform and application of the system is
overwhelming used for notifying the patient in correct medication. Oinas-Kukkonen and
Harjumaa (2008b, pp 200–205), also agree with the ideas of usage of the mobile platform with
the main rating of HBCSSs that currently can be seen in health throughout Australia and
globally. The study Davis (2010, pp 262–273) conclude that use of a mobile application that is
developed from the system can be useful in everyday life of chronic disease patients such as
diabetes patients.
Persuasive decision support system as the context of HBCSSs is critical for adoption and
implementation. As highlighted by Bish and Golombok (2000, pp 35–50), there are three main
components of HBCSSs that assist in persuasive decision support hence aid in patient self-care.
These three components are attitude, compliance, behavior, and patient. This does not contradict
a similar study by Räisänen and Lehto 2010, pp 185–192) that indicate user experience is another
part of the system that exhibits advantages of HBCSSs. Attitude is an essential recipe for
behavioral change that triggers patient to adopt and use the technology in monitoring their health
and behavior. During self-care attitude determines the effectiveness of the care and is important
in deciding on the HBCSSs strategy. Compliance is another aspect of the persuasive decision

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support system that facilitates the implementation and usage of HBCSSs. Some of the behavior
changes target personal lifestyle habits such as physical activities, health habits, and self-care.
Changing these behaviors is monitored through monitoring data on mood, individual behaviors
thereby sending feedback to patients for the areas that need some improvement. Modern
technologies such as mobile phone technologies are some example of technologies that are used
in the monitoring of the data on health. This data are used to persuade the patient on behavior
change. Mobile technologies help and form part of client education that is used for influencing
patient behavioral changes since it helps reminding and notification of patient.
Persuasive decision support system also works with a focus on the involvement of
patients in the implementation of HBCSSs in monitoring their health for facilitating self-care.
The measure of the level of behavior change, attitude or compliance is depicted with the ability
of the patient to fully implement the HBCSSs. In addition, implementation of the HBCSSs also
is connected to the evaluation of the HBCSSs and the patient’s self-care involvement. The
evaluation is an important step of the patient's response to the whole system, therefore,
evaluation is done after implementation of HBCSSs. Self-care has been made easy with the
implementation of mobile enabled HBCSSs and this determines the effectiveness of the
persuasive decision support system in HBCSSs. Midden and Ham (2009, vol 35), when
commenting on steps for adoption and usage of HBCSSs indicate that implementation is as
important as development and should highly consider persuasive decision support system.
Conclusion

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In conclusion, the persuasive decision support system is a critical step of the design,
adoption, and usage of HBCSSs. This is based on the involvement of the patient in decision
making when there is the development of HBCSSs. Some components of persuasive decision
support system are attitude, behavior, compliance and patient education. At the final stage of the
adoption and usage of HBCSSs is the implementation that should also be predetermined by the
developers by involving patients. HBCSSs through persuasive decision support system help in
self-care of patients especially those with chronic disease. One tool that has highly help in
persuasive decision support system more so at the implementation stage is mobile technologies.
Mobile technologies are close to patients hence good in determining the usability of patient
persuasive decision support system.
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