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Background  Maintaining weight after weight loss is a major health challenge, and eHealth (electronic health) solutions may be a way to meet this challenge. Application of behavior change techniques (BCTs) and persuasive system design (PSD) principles in eHealth development may contribute to the design of technologies that positively influence behavior and motivation to support the sustainable health behavior change needed.    Objective  This review aimed to identify BCTs and PSD principles applied in eHealth interventions to support weight loss and weight loss maintenance, as well as techniques and principles applied to stimulate  motivation  and  adherence  for long-term weight loss maintenance.    Methods  A systematic literature search was conducted in PsycINFO, Ovid MEDLINE (including PubMed), EMBASE, Scopus, Web of Science, and AMED, from January 1, 2007 to June 30, 2018. Arksey and O’Malley’s scoping review methodology was applied. Publications on eHealth interventions were included if focusing on weight loss or weight loss maintenance, in combination with motivation or adherence and behavior change.    Results  The search identified 317 publications, of which 45 met the inclusion criteria. Of the 45 publications, 11 (24%) focused on weight loss maintenance, and 34 (76%) focused on weight loss. Mobile phones were the most frequently used technology (28/45, 62%). Frequently used wearables were activity trackers (14/45, 31%), as well as other monitoring technologies such as wireless or digital scales (8/45, 18%). All included publications were anchored in behavior change theories.  Feedback and monitoring  and  goals and planning  were core behavior change technique clusters applied in the majority of included publications.  Social support  and  associations  through prompts and cues to support and maintain new habits were more frequently used in weight loss maintenance than weight loss interventions. In both types of interventions, frequently applied persuasive principles were  self-monitoring ,  goal setting , and  feedback .  Tailoring ,  reminders ,  personalization,  and  rewards  were additional principles frequently applied in weight loss maintenance interventions. Results did not reveal an  ideal  combination of techniques or principles to stimulate motivation, adherence, and weight loss maintenance. However, the most frequently mentioned individual techniques and principles applied to stimulate motivation were,  personalization ,  simulation ,  praise,  and  feedback , whereas  associations  were frequently mentioned to stimulate adherence. eHealth interventions that found significant effects for weight loss maintenance all applied  self-monitoring ,  feedback ,  goal setting , and  shaping knowledge , combined with a human  social support  component to support healthy behaviors.    Conclusions  To our knowledge, this is the first review examining key BCTs and PSD principles applied in  weight loss maintenance  interventions compared with those of  weight loss  interventions. This review identified several techniques and principles applied to stimulate motivation and adherence. Future research should aim to examine which eHealth design combinations can be the most effective in support of long-term behavior change and weight loss maintenance.

jmir. journal of medical internet research/journal of medical internet research

Persuasive System Design Principles and Behavior Change Techniques to Stimulate Motivation and Adherence in Electronic Health Interventions to Support Weight Loss Maintenance: Scoping Review