Developing culturally relevant design guidelines for encouraging healthy eating behavior

• We conducted a cross-cultural evaluation of the influence of the determinants identified by HBM on healthy eating behavior.
• We examined the moderating effect of age and gender, creating 10 unique models for different populations of users.
• Various cultural groups and sub-groups show significant variations with respect to the influence of the determinants on their health behavior.
• Persuasive health intervention designers should tailor their intervention to individual's cultural orientation to increase their relevance, appeal, and effectiveness.
• We propose data-driven and culturally relevant (individualist or collectivist) design approaches for developing and tailoring persuasive technological interventions.

Unhealthy eating behavior is a major contributing factor to the onset of several diseases and health conditions (e.g., obesity, type 2 diabetes). It is therefore not surprising that health interventions aimed at modifying dietary behavior have been identified as the cornerstone treatment for many health conditions. Interventions that use persuasive technology can be effective for motivating healthy eating behavior, and recent years have witnessed an increasing number of persuasive technologies with the purpose of promoting healthy eating behavior or attitude by manipulating various determinants of healthy behavior. However, these applications generally take a one-size-fits-all approach that is biased toward individualistic cultures. To resolve this problem, we propose culturally relevant design approaches for tailoring persuasive technology interventions to collectivists and individualistic cultures. Our guidelines are based on a large-scale survey of 554 participants' (collectivist=306 and individualist=247) eating behavior and associated determinants – identified by Health Belief Model – to understand how healthy eating behavior relates to various cultural groups and sub-groups. We developed two models of healthy eating behavior for the collectivist and individualistic cultural groups identified by Hofstede, and an additional eight models to investigate the moderating effect of gender and age on healthy eating behavior. We then explored the similarities and differences between the models and developed persuasive profiles of motivators of healthy eating behavior for each group. Additionally, we proposed two approaches for designing culturally relevant persuasive applications based on our results. The first is a one-size-fits-all approach that will motivate the majority of the population, while not demotivating any user. The second is a personalized approach that will best motivate a particular cultural group. Finally, to make our approaches actionable in persuasive intervention design, we map the theoretical determinants of healthy eating behavior as identified by Health Belief Model to common persuasive system design strategies.