| Literature DB >> 30684435 |
Ian Warren1, Andrew Meads1, Robyn Whittaker2,3, Rosie Dobson3, Shanthi Ameratunga4.
Abstract
BACKGROUND: The over-representation of youth in road crash injury and fatality rates is a major public health issue globally. In New Zealand, youth drivers are most vulnerable in the restricted license period when they can drive without the requirement for supervision by an experienced adult. Behavioral change interventions delivered using mobile phone technology to young drivers could serve as a useful mechanism to develop safe driving skills, but this potential remains to be fully explored.Entities:
Keywords: public health; smartphone; telemedicine; telemetry
Year: 2018 PMID: 30684435 PMCID: PMC6334699 DOI: 10.2196/formative.9660
Source DB: PubMed Journal: JMIR Form Res ISSN: 2561-326X
Behavior change technique categories.
| Category | Description |
| 1. Goals and planning | Setting goals for the target behavior, making plans to achieve goals, and dealing with any barriers |
| 2. Feedback and monitoring | Monitoring progress toward goals and providing feedback to users |
| 3. Social support | Providing social support, from friends, family, colleagues, and professionals to help meet goals |
| 4. Shaping knowledge | Assisting users to better understand their behavior and how to perform target behaviors |
| 5. Natural consequences | Highlighting consequences of performing particular behaviors, enabling users to see that they would regret not changing behavior |
| 6. Comparison of behavior | Comparing participants’ behavior with that of others and leading users to consider whether others approve (norms in a psychological model) |
| 7. Associations | Associating target behavior with positive things and reminding users to perform the behavior |
| 8. Repetition and substitution | Enabling users to practice and develop skills so that target behavior becomes habitual |
| 9. Comparison of outcomes | Allowing users to explore the outcomes of exhibiting or not exhibiting the behavior |
| 10. Reward and threat | Rewarding the target behavior and punishing unwanted behavior |
| 11. Regulation | Easing the task of performing the behavior, for example, by reducing negative emotions that result from the target behavior |
| 12. Antecedents | Understanding what triggers unwanted behavior, taking steps to avoid the triggers, and changing the physical environment |
| 13. Identity | Encouraging users to believe that the target behavior is right for them |
| 14. Scheduled consequences | Arranging a schedule of punishments and rewards for users performing the target behavior and not the unwanted behavior |
| 15. Self-belief | Building user confidence that a participant can perform the target behavior |
| 16. Covert learning | Enabling users to imagine consequences arising from performing a behavior and observing the consequences to others as they perform behaviors |
Behavior change techniques that have generally featured in successful interventions.
| Behavior change technique | Description |
| 1.1 Goal setting (behavior) | Set or agree a goal defined in terms of the target behavior |
| 2.2 Feedback on behavior | Monitor or observe behavior and provide feedback on performance of the target behavior |
| 2.3 Self-monitoring of behavior | Establish a method for the person to monitor and record their behavior(s) |
| 3.1 Social support | Advise on, arrange, or provide social support or encouragement for performing the target behavior |
| 4.1 Instruction on how to perform the behavior | Agree or advise on how to perform the target behavior |
| 5.1 Information about health consequences | Provide information about the consequences of performing the target behavior |
Key findings from stakeholder engagement to inform app development.
| Finding category | Young drivers | Parents of teen drivers | Relevant organizations |
| Risks to adoption | Threats to privacy; Negative or inaccurate feedback on driving; Battery and mobile data consumption; Excess use of push notification or audio alerts; Cost | App being used as a source of distraction; Appeal of app to most at-risk drivers; Potential to subvert intervention; Cost | |
| Gain enablers | Constructive feedback; Safe driving education; Peer competition | Ability to monitor teens’ driving and behavior; Automated deactivation of phone while driving; Suggestions to improve driving | Sticky intervention; Data analytics based on crowd-sourced data |
| Incentives | Recognition of achievements; Use of app data as proof of safe driving; Endorsement by relevant organizations, for example, NZTAa; Esthetics and ease of use | Integration with licensing process | Material rewards schemes, for example, fuel discounts; Automated starting or stopping of journey monitoring |
aNZTA: New Zealand Transport Agency.
Mapping objectives to behavioral elements and behavior change technique categories.
| Objective | Behavioral elements | Behavior change categories |
| 1. Improve driving skills | Emotions; Control; Barriers | 2. Feedback and monitoring; 4. Shaping knowledge; 7. Associations; 8. Repetition and substitution |
| 2. Strengthen intentions to perform target behaviors | Facilitators | 1. Goals and planning; 10. Reward and threat; 13. Identity |
| 3. Increase positive attitudes toward performing target behaviors | Attitudes; Norms; Barriers; Facilitators | 3. Social support; 5. Natural consequences; 6. Comparison of behavior |
| 4. Manage self-identity | Self-identity | 4. Natural consequences |
| 5. Address the mismatch between perceived and actual driving skills | Facilitators | 13. Identity |
Relevant behavior change techniques (BCTs). There is strong evidence that the BCTs shown in italics (outlined in Table 2) have generally featured in successful interventions.
| Behavior change technique | Description |
| Mutually agree on short-term goals to be achieved, such as “This week I will brake more gently.” | |
| 1.2 Problem solving | Prompt participants to analyze behaviorally influencing factors and develop strategies for overcoming barriers. For example, “So it seems you’ve been having trouble with your speed. How do you think you could try to change that next time you go out?” |
| 1.3 Goal setting (outcome) | Facilitate longer-term goals, such as “Be a safe driver,” “Get my full license,” and “Avoid accidents.” |
| 1.4 Action planning | Prompt participants to plan their driving, including factors such as context, frequency, and duration. |
| 1.5 Review behavior (goals) | Review behavioral goals together with the participant and consider modifying them based on progress. For BPDa, goals can be reviewed and modified by the app. |
| 2.1 Monitoring without feedback | Record behavior with the participant’s knowledge. Driving behavior data captured by the app could be made available to a participant’s parents. The knowledge that their driving behavior is being observed can influence their behavior. |
| Monitor and provide informative feedback on performance. BPD could provide feedback in terms of poor driving behavior, suggestions on how to improve, and recognition of good behavior. | |
| Establish a method for participants to monitor their own behavior. BPD could provide the ability to review earlier feedback and to identify behavioral trends. | |
| 2.7 Feedback on outcomes | After periods of prolonged safe driving, BPD might inform participants that they are now statistically less likely to be involved in an accident than when they started the intervention. |
| Arrange for participants to receive support from others. In BPD, this could take the form of a social network connecting participants and friends. | |
| Provide advice on how to perform a behavior. BPD could present how-to messages, describing techniques, and practices that help participants to perform the target driving behaviors. | |
| 4.2 Information about antecedents | Provide information about situations, events, or emotions likely to cause poor performance of the target driving behaviors. |
| Provide information about the positive or negative health consequences of wanted or unwanted behavior. BPD could deliver messages concerning the benefits associated with target behaviors. | |
| 5.2 Salience of consequences | Use methods to emphasize consequences for |
| 5.5 Anticipated regret | Have participants imagine how regretful they would feel if they perform unwanted behavior, for example, speeding and something negative happens. |
| 6.2 Social comparison | Draw attention to performers of good behavior to allow comparison with a participant’s own performance. For example, BPD could maintain a |
| 6.3 Information about others’ approval | Provide information about what other people think about good and bad behavior. BPD could provide informational messages about the negative social perception of unsafe drivers (or vice versa). |
| 7.1 Prompts or cues | Introduce stimuli to encourage good behavior. BPD might provide NFCb sticker tags that participants can place in their vehicles to remind them to use the app and put their phone away. |
| 8.3 Habit formation | Prompt rehearsal and repetition of good behavior in the same context repeatedly, so the context elicits the behavior. Having finished using BPD, participants should continue to perform the target behaviors they have developed habitually. |
| 8.7 Graded tasks | Set easy tasks and then gradually make them harder as participants improve. BPD could offer goals at varying difficulty levels and ensure that participants make progress through the more challenging goals. |
| 10.1 Material incentive (behavior) | Inform participants that a material reward ( eg, money or vouchers) will be given in exchange for demonstration of the target behavior. BPD might seek partnership with businesses and organizations to provide such rewards. |
| 10.4 Social reward | Similar to 10.1, but rather than a material incentive, the incentive would enhance a participant’s standing in some way. Performing target behaviors in BPD could earn participants achievements. |
| 10.11 Future punishment | Inform participants that punishment or loss of reward occurs if poor behavior continues. BPD might simply raise awareness of legal or social punishments in response to detecting prolonged poor driving behavior. |
| 13.1 Identification of self as role model | Inform participants that their good behavior is an example to others. BPD could promote demonstrably safe drivers to others, offering a level to aspire to. |
| 13.3 Incompatible beliefs | Draw attention to discrepancies between current or past behavior and self-image to create discomfort. BPD could use messaging to highlight differences in actual versus perceived driving skills and incompatible beliefs over driving practices. |
aBPD: BackPocketDriver.
bNFC: near field communication.
Sample messages derived from objectives and behavior change techniques (BCTs).
| Message | Objective | BCTa |
| 1 | 4.1 | |
| 1 | 4.1 | |
| 1 | 4.2 | |
| 1 | 4.2 | |
| 1 | 4.2 | |
| 1 | 4.2 | |
| 1 | 7.1 | |
| 3, 4 | 5.1 | |
| 3, 4 | 5.5 | |
| 3, 4 | 6.3 | |
| 4 | 5.5 | |
| 4 | 4.2 | |
| 5 | 13.3 |
aBCT: behavior change technique.
Feature wish list for BackPocketDriver (BPD).
| Feature | Behavior change techniques applied | |
| Location and speed detectiona | —b | |
| Acceleration, braking, and turning detectiona | — | |
| Phone usage detectiona | — | |
| Achievements | BCT 10.4 | |
| Goal setting | BCT 1.1 | |
| Journey summaries | BCT 1.5 | |
| Messaging | BCT 2.7 | |
| Journey detection | BCT 7.1 | |
| Friends | BCT 3.1 | |
| Leaderboards | BCT 6.2 | |
| Detection of driving conditions | — | |
| Additional driving behavior detection | — | |
| Rewards scheme | BCT 10.1 | |
| Parental interface | BCT 2.1 | |
aNecessary for target behaviors: 1 (drive within speed limits); 2 (perform maneuvers safely and in a controlled manner); 3 (not use a mobile phone while driving).
bNot applicable.
Figure 1Screenshots of the BackPocketDriver app.
Behavior change technique feature matrix for popular youth driving apps.
| Behavior change technique | LifeSaver | TrueMotion Family | Mojo | DriveSmart | EverDrive | Steer Clear | |
| 1.1 Goal setting (behavior) | |||||||
| 1.3 Goal setting (outcome) | ✓ | ||||||
| 2.2 Feedback on behavior | ✓ | ✓ | ✓ | ✓ | ✓ | ||
| 2.3 Self-monitoring of behavior | ✓ | ✓ | ✓ | ||||
| 3.1 Social support | ✓ | ✓ | ✓ | ||||
| 4.1 Instruction on how to perform the behavior | ✓ | ✓ | |||||
| 5.1 Information about health consequences | |||||||
| 4.2 Information about antecedents | |||||||
| 5.5 Anticipated regret | |||||||
| 7.1 Prompts or cues | |||||||
| 8.3 Habit formation | ✓ | ✓ | ✓ | ✓ | ✓ | ||
| 13.3 Incompatible beliefs | |||||||
| 6.2 Social comparison | ✓ | ✓ | ✓ | ✓ | |||
| 6.3 Information about others’ approval | |||||||
| 10.4 Social reward | ✓ | ✓ | ✓ | ✓ | |||
| 13.1 Identification of self as role model | ✓ | ✓ | ✓ | ✓ | |||
| 1.8 Behavioral contract | ✓ | ||||||
| 2.1 Monitoring of behavior by others without feedback | ✓ | ✓ | ✓ | ||||
| 10.2 Material reward | ✓ | ✓ | ✓ | ||||
| 10.11 Future punishment | ✓ | ||||||