<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Archiving and Interchange DTD v1.0 20120330//EN" "JATS-archivearticle1.dtd">
<article xmlns:xlink="http://www.w3.org/1999/xlink">
  <front>
    <journal-meta />
    <article-meta>
      <title-group>
        <article-title>BCD Cards: A Tool for Designing Theory-based Behavior Change Technologies</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Chrysanthi Konstanti</string-name>
          <email>konstanti.chrysanthi@gmail.com</email>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Evangelos Karapanos</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Panos Markopoulos</string-name>
          <email>P.Markopoulos@tue.nl</email>
          <xref ref-type="aff" rid="aff1">1</xref>
        </contrib>
        <aff id="aff0">
          <label>0</label>
          <institution>Cyprus University of Technology</institution>
          ,
          <addr-line>Limassol</addr-line>
          ,
          <country country="CY">Cyprus</country>
        </aff>
        <aff id="aff1">
          <label>1</label>
          <institution>Eindhoven University of Technology</institution>
          ,
          <addr-line>Eindhoven</addr-line>
          ,
          <country country="NL">Netherlands</country>
        </aff>
      </contrib-group>
      <abstract>
        <p>There is a wealth of theoretical knowledge around behavior change theories and strategies. However, due to the lack of accessibility of that knowledge to designers, designing theory-based behavior change technological interventions can be challenging. Card-based design tools can make academic knowledge accessible to designers, providing a structured and creative design process. In this study, we present the Behavior Change Design Cards (BCD Cards) - a card deck developed from two behavior change theoretical models, the Transtheoretical Model of Behavior Change and a Taxonomy of 93 Behavior Change Techniques. Through an empirical study, we aim at evaluating the impact of the tool on designers' creativity, their capacity to create theoreticallygrounded designs, as well as the perceived usefulness and ease of use of the BCD cards as a supporting tool in the design of behavior change technologies.</p>
      </abstract>
      <kwd-group>
        <kwd>Behavior Change</kwd>
        <kwd>Behavior Change Technologies</kwd>
        <kwd>Design Cards</kwd>
        <kwd>Design Tools</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>-</title>
      <p>
        Applying behavior change theory on design practice can be challenging due to the
vast amount of theories, models, and techniques. HCI researchers and designers
increasingly engage in the design of technological interventions for behavior change;
however, recent studies have revealed that only a limited number of behavior change
technologies have used theory in their design process, have implemented behavior
change techniques and undergone scientific research [
        <xref ref-type="bibr" rid="ref1 ref2">1,2</xref>
        ]. Thus a question arises:
How can designers gain access to behavior change literature and therefore design
theory-based technological interventions?
      </p>
      <p>
        Design cards have been a popular design tool, supporting the translation of
research findings from one discipline into another [
        <xref ref-type="bibr" rid="ref7">7</xref>
        ] through a simple and easy way. It
has been argued that they can make the design process visible and less abstract,
communicate knowledge between the members of a group and increase creativity and idea
generation [
        <xref ref-type="bibr" rid="ref3">3</xref>
        ].
      </p>
      <p>
        The goal of this work-in-progress is the development of a card deck named as
Behavior Change Design Cards (BCD Cards) based on two behavior change theoretical
models, the Transtheoretical Model of Behavior Change (TTM) [
        <xref ref-type="bibr" rid="ref4">4</xref>
        ] and a Taxonomy
of 93 Behavior Change Techniques (BCTs) [
        <xref ref-type="bibr" rid="ref5">5</xref>
        ] with the aim to teach designers the
appropriate knowledge when it comes to designing behavior change technologies.
2
      </p>
    </sec>
    <sec id="sec-2">
      <title>Background</title>
      <p>
        According to the Transtheoretical Model (TTM), an individual moves through a series
of stages and processes when modifying a behavior. The core of the model consists of
five stages of behavior change: pre-contemplation, contemplation, preparation, action,
and maintenance [
        <xref ref-type="bibr" rid="ref4">4</xref>
        ]. One can think of the five stages either as different times in the
process, either as actions that a person takes or is willing to take at each stage;
relapses to previous stages are possible to happen anytime.
      </p>
      <p>
        An assumption of the TTM is that individuals can apply a set of processes of a
specific behavior. Cognitive, affective and evaluative processes are more used in the
early stages, while commitments, conditioning, contingencies, environmental controls
and support for achieving maintenance, are more used in the later stages. For the BCD
cards development, we focus on three out of ten processes of change that involve the
acquisition of new information and insights of the sort that might be obtained through
Personal Informatics (PI) [
        <xref ref-type="bibr" rid="ref6">6</xref>
        ]: consciousness raising, outcome expectancies and
selfmonitoring and contingency management; and the self-efficacy construct of the
theory (i.e. the situation-specific confidence that the individual can cope with
challenging situations).
      </p>
      <p>
        Recent work by Michie et. al [
        <xref ref-type="bibr" rid="ref5">5</xref>
        ] has synthesized existing behavior change
techniques into a hierarchically, cross-domain, organized taxonomy based on an
international consensus process. The Behavior Change Techniques (BCTs) Taxonomy
consists of 93 behavior change techniques, clustered in 16 categories, which can be
used in multiple behavioral interventions.
      </p>
      <p>Both, the TTM and the BCTs have been expanded, validated, applied and
challenged by researchers all over the world and are considered of the most
potentially useful models applied in multiple health risk behavior interventions.
3</p>
    </sec>
    <sec id="sec-3">
      <title>Designing the BCD cards</title>
      <p>From the 93 BCTs, we chose and combined into 23 groups those that are easy to
implement in technological interventions; each group represents a technique card of
the BCD deck (see Figure 1). Then, each of those 23 techniques was classified into
the five stages of behavior change (see Table 1).</p>
      <p>The BCD cards consist of 31 two-sided cardboard cards in total; including, among
others, five stages cards describing the different stages of behavior change and 23
techniques cards describing each of the behavior change techniques. The cards
contain definitions, possible design directions, hints, questions, and pictured examples
for supporting the design process (see Figure 2 for an example).
93 Behavior Change</p>
      <p>Techniques
61 Remaining</p>
      <p>Techniques
32 exluded: dificcult to be
implemented in technological
interventions
23 Groups of</p>
      <p>Techniques
Techniques per category:</p>
      <p>Min = 1 Max = 8</p>
      <p>Classification of the 23
techniques to the five stages
of behavior change</p>
      <p>Through an empirical study, we aim at evaluating the impact of the tool on
designers’ creativity, their capacity to create theoretically-grounded designs, as well
as the perceived usefulness and ease of use of the BCD cards as a supporting tool in
the design of behavior change technologies.</p>
    </sec>
  </body>
  <back>
    <ref-list>
      <ref id="ref1">
        <mixed-citation>
          1.
          <string-name>
            <surname>Conroy</surname>
            ,
            <given-names>D. E.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Yang</surname>
            ,
            <given-names>C. H.</given-names>
          </string-name>
          , &amp;
          <string-name>
            <surname>Maher</surname>
            ,
            <given-names>J. P.</given-names>
          </string-name>
          :
          <article-title>Behavior change techniques in top-ranked mobile apps for physical activity</article-title>
          .
          <source>American journal of preventive medicine</source>
          ,
          <volume>46</volume>
          (
          <issue>6</issue>
          ),
          <fpage>649</fpage>
          -
          <lpage>652</lpage>
          (
          <year>2014</year>
          ).
        </mixed-citation>
      </ref>
      <ref id="ref2">
        <mixed-citation>
          2.
          <string-name>
            <surname>Rivera</surname>
            ,
            <given-names>J.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>McPherson</surname>
            ,
            <given-names>A.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Hamilton</surname>
            ,
            <given-names>J.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Birken</surname>
            ,
            <given-names>C.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Coons</surname>
            ,
            <given-names>M.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Iyer</surname>
            ,
            <given-names>S.</given-names>
          </string-name>
          , ... &amp;
          <string-name>
            <surname>Stinson</surname>
            ,
            <given-names>J.</given-names>
          </string-name>
          :
          <article-title>Mobile apps for weight management: a scoping review</article-title>
          .
          <source>JMIR mHealth and uHealth</source>
          ,
          <volume>4</volume>
          (
          <issue>3</issue>
          ), (
          <year>2016</year>
          ).
        </mixed-citation>
      </ref>
      <ref id="ref3">
        <mixed-citation>
          3.
          <string-name>
            <surname>Wölfel</surname>
            ,
            <given-names>C.</given-names>
          </string-name>
          , &amp;
          <string-name>
            <surname>Merritt</surname>
            ,
            <given-names>T.</given-names>
          </string-name>
          :
          <article-title>Method card design dimensions: a survey of card-based design tools</article-title>
          .
          <source>In: IFIP Conference on Human-Computer Interaction</source>
          , pp.
          <fpage>479</fpage>
          -
          <lpage>486</lpage>
          . Springer, Berlin, Heidelberg (
          <year>2013</year>
          ).
        </mixed-citation>
      </ref>
      <ref id="ref4">
        <mixed-citation>
          4.
          <string-name>
            <surname>Prochaska</surname>
            ,
            <given-names>J.O.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Velicer</surname>
            ,
            <given-names>W.F.</given-names>
          </string-name>
          :
          <article-title>The transtheoretical model of health behavior change</article-title>
          .
          <source>American journal of health promotion.</source>
          <volume>12</volume>
          (
          <issue>1</issue>
          ),
          <fpage>38</fpage>
          -
          <lpage>48</lpage>
          (
          <year>1997</year>
          ).
        </mixed-citation>
      </ref>
      <ref id="ref5">
        <mixed-citation>
          5.
          <string-name>
            <surname>Michie</surname>
            ,
            <given-names>S.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Richardson</surname>
            ,
            <given-names>M.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Johnston</surname>
            ,
            <given-names>M.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Abraham</surname>
            ,
            <given-names>C.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Francis</surname>
            ,
            <given-names>J.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Hardeman</surname>
            ,
            <given-names>W.</given-names>
          </string-name>
          , ... &amp;
          <string-name>
            <surname>Wood</surname>
            ,
            <given-names>C. E.</given-names>
          </string-name>
          :
          <article-title>The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions</article-title>
          .
          <source>Annals of behavioral medicine</source>
          ,
          <volume>46</volume>
          (
          <issue>1</issue>
          ),
          <fpage>81</fpage>
          -
          <lpage>95</lpage>
          (
          <year>2013</year>
          ).
        </mixed-citation>
      </ref>
      <ref id="ref6">
        <mixed-citation>
          6.
          <string-name>
            <surname>Kersten-van Dijk</surname>
            ,
            <given-names>E. T.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Westerink</surname>
            ,
            <given-names>J. H.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Beute</surname>
            ,
            <given-names>F.</given-names>
          </string-name>
          , &amp;
          <string-name>
            <surname>IJsselsteijn</surname>
          </string-name>
          , W. A.:
          <article-title>Personal informatics, self-insight, and behavior change: A critical review of current literature</article-title>
          .
          <source>HumanComputer Interaction</source>
          ,
          <volume>32</volume>
          (
          <issue>5-6</issue>
          ),
          <fpage>268</fpage>
          -
          <lpage>296</lpage>
          (
          <year>2017</year>
          ).
        </mixed-citation>
      </ref>
      <ref id="ref7">
        <mixed-citation>
          7.
          <string-name>
            <surname>Rogers</surname>
            ,
            <given-names>Y.</given-names>
          </string-name>
          :
          <article-title>New theoretical approaches for human‐computer interaction</article-title>
          .
          <source>Annual review of information science and technology</source>
          ,
          <volume>38</volume>
          (
          <issue>1</issue>
          ),
          <fpage>87</fpage>
          -
          <lpage>143</lpage>
          (
          <year>2004</year>
          ).
        </mixed-citation>
      </ref>
    </ref-list>
  </back>
</article>