36495 Systematic Review of Information Architecture of Web-Based Interventions to Improve Health Outcomes

Jillian Pugatch, MPH1, Emily Grenen, BS1, Heather Cole-Lewis, PhD, MPH1, Mary Schwarz, BA1, Yvonne M. Hunt, PhD, MPH2 and Erik Augustson, PhD, MPH3, 1ICF International, Rockville, MD, 2Tobacco Control Research Branch, BRP, DCCPS, National Cancer Institute, Rockville, MD, 3Tobacco Control Research Branch, BRP, DCCPS, National Cancer Institute

Theoretical Background and research questions/hypothesis:  Information architecture—the coherent display and structure of digital content—influences users’ experience of a website. Many information architecture best practices exist, but there is a dearth of empirical evidence for the role that information architecture plays on influencing behavior change and health outcomes. This systematic review synthesizes the existing literature on website information architecture and its effect on health outcomes, behavioral outcomes, and website engagement. 

Methods:  To identify all existing information architecture and health behavior literature, we searched for articles published in English in the following databases (all years/months were considered, i.e., filters restricting years of publication were not used):  ACM Digital Library, CINAHL, Cochrane Library, Google Scholar, Ebsco, and PubMed. The search terms used included information terms (e.g. information architecture, interaction design, persuasive design), behavior terms (e.g. health behavior, behavioral intervention, ehealth), and health terms (e.g., smoking, physical activity, diabetes). The search results were subsequently reviewed to determine if they met predetermined inclusion and exclusion criteria created to identify empirical research that studied the effect of information architecture on health outcomes, behavioral outcomes, or website engagement.  

Results:  The initial literature search yielded 688 results, which was narrowed down to three empirical research publications that looked at the effect of information architecture on health outcomes, behavioral outcomes, or website engagement. The manipulation of only information architecture was studied in one publication, while the other two manipulated information architecture, website features (e.g. interactivity, email prompts, and forums) and tailored content. These three publications looked at websites for hepatitis information, chronic disease support for type 2 diabetes and chronic low back pain, and smokeless tobacco cessation. The outcomes assessed included knowledge, patient empowerment, decisional conflict, preparation for decision making, perceptions of user control, number of website visits, and page views.

Conclusions:  No clear conclusion can be made about the relationship between information architecture and health outcomes, but there is limited evidence connecting information architecture to behavioral outcomes and website engagement. Only one of the articles reviewed explicitly and empirically looked at information architecture by itself while the others included manipulations to the websites’ features and tailoring, making it difficult to attribute the results to the difference in information architecture. None of the articles addressed health outcomes, one addressed behavioral outcomes, one addressed website engagement, and one addressed both behavioral outcomes and engagement. The results indicate that a tunneled design may increase website use and knowledge gained, although these findings may not be generalizable to various audiences, health topics, and health behaviors.

Implications for research and/or practice:  Recommendations are made for improving the scientific evidence base specific to information architecture and health and behavior outcomes. Additionally, information from gray literature and expert opinion are summarized to identify commonly accepted practices. This synthesis of information will provide guidance to practitioners designing websites for health behavior and health outcomes and also provide a starting point for hypothesis generation to improve empirical evidence on information architecture and health and behavior outcomes.