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| Targeted determinant | Theory-based method | Definition | Parameters for use | Application/Messages |
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| Basic methods for individual change/methods shared by all profiles | Tailoring (trans-theoretical model) | Match the intervention to previously measured individual characteristics | The variables to act on are those related to determinants in the theory of planned behavior and level of intention | The intervention sequence is selected based on the individual profile determined by a preprogrammed algorithm. Users with low attitude (profile 1) must complete 7 sessions. Users with high intention must complete 3 sessions (lower intensity) |
| Modeling (social cognitive theory, theories of learning) | Provide a suitable role model to reinforce the target behavior/action | Identification with a role model, coping model | Identification with a role model who successfully identified advantages, overcame difficult situations, and applied the action plan:
“I realized that for me the positive side of exercising was burning energy. If I burnt energy, I would increase the oxygen flow to my brain and would have better concentration at work. Besides, exercise would help my appearance.” (Daniel’s story) “IF I lack the time to engage in physical activity, THEN I will… Use my bicycle to go visit my daughter. Take my dog for a walk 3 times a day. Take the stairs instead of the elevator in my building.” (Mr. Sullivan’s story) |
| Feedback/reinforcement | Provide participants with information on how they are doing with adopting the behavior | Feedback must be personalized and must track the behavior over time | Individualized messages are selected by the computer from a bank of messages depending on the reported determinant. For example, if one participant identifies barriers to stop smoking and another establishes an action plan, the virtual nurse will respond accordingly:
“Well done! Being aware of the obstacles and difficult situations that can prevent you from quitting smoking is an important step towards achieving your goal.” “Excellent! Setting a specific, measurable, achievable, realistic and timely action plan will help you move into action. Remember that you can use the SMART approach at all times to help and motivate you to become more active. Having an action plan increases your chances of success.” |
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| To change attitude | Belief selection (theory of planned behavior, theory of reasoned action) | Use messages that strengthen positive behavioral beliefs, weaken negative ones, and introduce new beliefs | Requires solid knowledge of behavioral, normative, and control beliefs before selecting which beliefs to intervene on | The virtual nurse asks participants to identify the advantages and disadvantages of adopting the target behavior and to focus on positive beliefs:
“I invite you to identify the advantages and disadvantages that you perceive in regards to exercising. Realizing what motivates you or discourages you is a step in the right direction. The important thing is not so much the number of advantages or disadvantages you find, but rather the weight you assign to each one! You can also discuss this with someone close to you, a friend, a family member or a health professional. It could help with your awareness of the potential benefits.” |
| Persuasive communication (social cognitive theory) | Guide participants in adopting an idea, attitude, or action by using arguments | Messages must be related to the individual’s beliefs. They must be meaningful, surprising, repeated, spaced over time, and easy to understand. Requires cognitive skills | The virtual nurse’s messages used in the intervention take these parameters into account. In the following case, the user did not identify the advantages of adopting a behavior:
“You know, changing your attitude or perception towards a habit like exercising is a difficult task. But I know you are capable of doing it! For the time being, it seems that the disadvantages of exercising are tipping your scale. Rest assured, you are not alone in this situation. I encourage you to refocus on the advantages of being active. For example, exercise will help you keep in shape and make you feel good about yourself. It can also reduce the risk of heart disease and diabetes as well as contribute to your overall good health.” |
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| To improve perceived control (or sense of personal efficacy) | Belief selection (theory of planned behavior, theory of reasoned action) | Use messages that strengthen positive control beliefs, weaken negative ones, and introduce new beliefs | Requires solid knowledge of behavioral, normative, and control beliefs before selecting which beliefs to intervene on | The virtual nurse asks participants to identify difficult situations in adopting the behavior as well as favorable factors:
“As you know, quitting smoking is a complex task. Some situations, obstacles or barriers can make quitting difficult. It is therefore important to identify these obstacles so that an immediate solution can be found to overcome them. For example, it could be that cigarettes give you a certain pleasure and you don’t want to give that up. It is also possible that you dread the symptoms of nicotine withdrawal. Maybe you are presently under great stress and going through big changes in your life. The important thing is to identify the difficulties, barriers or obstacles that you face in quitting the habit. It will then be possible to find solutions or ways to help…” “There are things that could help or make it easier for you to quit smoking. This is what people living with HIV answered when I asked them the following question: ‘What could help you stop smoking?’”
“What would help me stop smoking would be to be supported either by a group, a program, a counsellor, or a health professional with regular follow-ups.” (patient’s story) |
| Coping planning (self-regulation theory) | The participant must identify potential barriers and ways to deal with them | Identify risk situations and find solutions | The nurse invites participants to identify the barriers that prevent them from making good choices regarding fat, stopping smoking, or being physically active. She suggests applying the DECIDE process, which is a problem-solving strategy to overcome barriers: Describe the difficult situation/barrier or obstacle, draw up a list of strategies, choose a strategy, imagine yourself using this strategy, decide to go into action, and evaluate the result. |
| Verbal persuasion (social cognitive theory) | Use messages that suggest to participants that they have the ability to adopt the behavior | Credible source | The virtual nurse says the following:
“In this session, we saw the importance of finding ways to overcome obstacles preventing you from making healthy choices regarding dietary fat. I invite you to pursue the process and identify the strategies that could help you. Remember that you are capable of doing it!” |
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| To act on intention | Implementation of intention (theories of goal-directed behavior) | Encourage participants to make an “IF/THEN” plan that will be triggered at the critical moment in order to attain the behavioral objective | Requires a positive intention | The virtual nurse and PLHIV invite the participant to draw up an action plan and give examples (case story). The “IF/THEN” technique is used: The participant identifies an obstacle (IF this happens) and finds a solution by answering: THEN I will do the following.
“IF I am too tired at the end of the day to do my exercises, THEN I will remember that being active gives me energy and reduces my stress.” |
| Goal setting (self-regulation theory) | Lead participants to plan what they need to do (set a goal) if they are to adopt the behavior | Commit to achieving the objective, which may be difficult though within the participant’s capabilities | The virtual nurse invites participants to set an achievable behavioral objective (where, when, and how) by using a SMART (specific, measurable, achievable, realistic, and timely) objective. For example,
“In short, this is how a SMART plan of action can be devised: On my way home from work I’ll get off the bus before my regular stop so that I can take a 30-minute brisk walk (how), in the park (where) every evening after work, starting next week (when).” |
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