Implementing change in healthcare with different personalities

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Measurement invariance in the models is a statistical property that indicates that the same underlying construct is being measured across the domains Adolf et al. We established 1 configural invariance which ensures that the same basic factor structure exists in all the groups, 2 compositional invariance i.

To examine, for significant differences in path coefficient Beta across the two domains, we followed the method in Clogg et al. After establishing invariance, we ran the PLS Algorithm and Bootstrap and recorded the Standard Error SE and Beta for each construct, which we used to calculate the pairwise t-statistics and corresponding p value to test for significant differences in beta Clogg et al.

A significant p value indicates a significant Beta difference across the two domains. In this section, we present results that answer our five research questions.

We answer RQ1 by presenting the results of the effectiveness of the five persuasive strategies in the smoking cessation domain. We answer RQ2 by presenting the results of the effectiveness of the five persuasive strategies in the healthy eating domain. We answer RQ3 by presenting a comparison of the overall effectiveness of these strategies across the domains of healthy eating and smoking cessation.

We answer RQ4 by showing the relationships between the five FFM personality factors and the persuasive strategies within each domain. We answer RQ5 by comparing the relationships between the five FFM personality factors and the persuasive strategies across the two domains. First, we examine the effectiveness of the persuasive strategies overall in each of the two domains.

To do this, we computed the means of the persuasiveness for each of the five strategies in their respective domains. Our results showed that all the persuasive strategies were effective, as all the means were above the midpoint of 4. Comparing the effectiveness of the strategies between the two domains, our results reveal that all the strategies were more effective in the healthy eating domain than in the smoking domain.

Below, we present detailed results. As shown in Table 4 and Fig. Comparing the means of the persuasiveness scores for each of the strategies, cooperation followed by personalization emerged as the most preferred persuasive strategy for smoking cessation apps, while normative influence emerged as the least preferred. The boxplot shows the overall persuasiveness y -axis of the 5 persuasive strategies x -axis for the smoking cessation domain on a scale of 1 to 7.

A higher number indicates a higher persuasiveness. The horizontal line indicates a neutral value of 4. As shown in Table 5 and Fig. Comparing the means of the persuasiveness scores for each of the strategies, cooperation followed by personalization emerged as the most preferred persuasive strategy for promoting healthy eating, while normative influence emerged as the least preferred.

The boxplot shows the overall persuasiveness y -axis of the 5 persuasive strategies x -axis for healthy eating domain on a scale of 1 to 7. This means that there are significant differences between the strategies with respect to their persuasiveness overall, without considering domains.

This also means that there are significant differences between domains. There was also a significant interaction between the domain and strategy F 3. This implies that the perceived effectiveness of a persuasive strategy may vary across domains. A Bonferonni-corrected pairwise comparison shows that cooperation emerged as the most preferred strategy in general, significantly different from normative influence, which emerged as the least preferred overall.

The rest of the strategies— personalization, reward , and competition— were in the middle, with personalization leading the list. To understand if there are significant differences in the effectiveness of the strategies across the two domains overall, we performed a pairwise comparison of each of the strategies across the two domains.

This implies that the strategies were perceived to be more effective with respect to their potential to promote healthy behaviours healthy eating in general, compared to discouraging risky or unhealthy behaviours smoking cessation. The structural models determine the relations between the five personality traits from the FFM and the persuasiveness of the strategies see Fig.

We developed structural models for each domain, with the personality traits as the exogenous constructs, see Fig. In the following sections, first, we present the quantitative results from our models and supporting qualitative comments showing the relationship between the persuasive strategies and user personality traits in both healthy eating and smoking cessation domains separately to answer RQ4.

This is followed by a comparison of the effectiveness of the strategies across the two domains for the five personality traits to answer RQ5.

In this section, we discuss and compare the persuasiveness of the strategies for people of different personality factors in the smoking cessation domain. The competition strategy builds on the desire of individuals to compete with each other and prove to themselves and others that they are better. These findings are supported by qualitative comments from the participants that are high in agreeableness to justify their ratings.

I enjoy competition in apps. This comment suggests that people high in agreeableness preferred the strategy because it makes the system fun and increases their enjoyment and user experience. Their primary reason is that they do not like competing in gamified health-related apps and would rather compete in entertainment games. This is evident from the following comments are from participants high in neuroticism.

The cooperation strategy builds on the desire of humans to work together towards achieving goals. One reason why the strategy is preferred is that people do not like disappointing others, hence working with others make them accountable and committed to their health behaviour goal, as evident in the following comments from people who are high in agreeableness, conscientiousness, and extraversion respectively:.

The cooperation strategy does not appeal to neurotic people and is negatively associated with people who are open to experiences, as is shown by comments from people high in neuroticism:. The comments show that these personality factors, especially neurotic people, would not prefer to work with other people. It is evident since neurotic people have more tendency to be shy, anxious, angry, and depressed.

I also know some groups are more useful than others. The reasons for these results can be seen in the comments by people open to experience below:. The two comments suggest that normative influence may not motivate these personalities because they feel the stories are common and there is nothing special about them anymore that will motivate them to quit smoking; therefore, seeing them in the app would have no impact on them.

Its not cold turkey but decreasing cigs, which seems more manageable. These personality traits pointed out that creating a personalized plan and acting on the plan are two different things. They did not see the need for a personalized plan if they are not motivated to act on them, as shown in the following comments by people high in neurotic tendencies and people open to experience respectively:.

Some reasons for the preference for reward is that it gives users a sense of accomplishment, motivate and encourage them, make them exercise some self-control and be determined, as can be seen from the following comments by people high in agreeableness and extraversion, respectively:. I love apps with rewards and a sense of accomplishment. This would encourage me to participate and use the app. A reason for the negative association with reward is that these personalities have no appreciation for badges as rewards in general, they feel badges are meaningless, as shown in these comments by people high in neuroticism:.

I don't want badges that mean nothing to me. Reward needs to be carefully thought out to ensure that they are meaningful to the users else they lose their value or excitement factor. In this section, we discuss and compare the persuasiveness of the strategies for people of different personality traits in the healthy eating domain. Some reasons for the preference for competition by these personality factors is that it challenges and motivates people, makes them work harder and be more determined , as shown in the comments by people high in agreeableness and conscientiousness:.

Some reasons why this strategy is unappealing and negatively associated with this personality is their belief that competition leaderboard is a scam due to the tendency of people to cheat whenever competition is introduced. Again, seeing some really high scores earned by others which may seem unattainable demotivates , as shown in one of the comments by people high in neuroticism.

There's always some jerk who has 10, times more points than everyone else and it is apparent they're cheating. Nothing deflate s an honest person more than seeing unattainable results by the person holding first place. Therefore, it is important that developers of persuasive systems set up mechanisms to prevent cheating in the system. The systems should be able to monitor the activities of users to detect dubious and malicious actions of users to trick the system.

The participants believe that working together with other people would make them more accountable, focused and incentivized as can be seen from the comments by people high in agreeableness and extraversion, respectively:. The bonus points are another great way to create incentives to change. A major reason for the negative association with cooperation by these personalities is that they feel that working with people especially strangers demotivates and is challenging as can be seen by the comments from people high in neurotics and open to experience, respectively:.

Some participants prefer not to work with others, especially strangers, while some believe that the challenges it introduces are just unnecessary, maybe because of the pressure of not disappointing their partners. Similar to the smoking domain, participants feel that the testimonies of other people would highly encourage them to pursue their healthy eating goals, make them feel less alone , and gives them the opportunity to share their success stories , as shown in the comments from people high in agreeableness and conscientiousness:.

Below are some of the comments against the normative influence strategy by these personalities:. I feel like a community share space like this would make me hesitate to post especially if I had strong opinions on healthy versus non-healthy foods. Social media deters me from following food plans. They are worried about the authenticity of the stories , they may just be marketing strategies by companies to make them buy health products or just fake news.

They also believe that forums like this resemble social media and may be detrimental to healthy habits. This is in line with one of the characteristics of neurotic people, they tend to be more self-conscious than other traits.

Also, people are sceptical about social media and sharing their healthy eating stories there, as illustrated by P The main reason for the positive association with this strategy by these personalities is that it convinces them, make them more aware of their behaviours, and offer personalized goal that makes them thrive , as can be seen in the comments from people high in extraversion and conscientiousness:. It looks good. These participants feel that just presenting them with personalized healthy eating goals and suggestions would not be motivating enough for them to adopt the healthy eating behaviour while some participants were sceptical about their privacy and losing control with the tracking , since the app collects their personal information for the personalization purposes, as illustrated in the comments from people high in neuroticism:.

I could always figure out what calories or fats or whatever I should be taking in but it still doesn't do much to help me actually put anything into practice. All things should be our control only. To answer RQ5, Table 8 shows a comparison of the effectiveness of the five persuasive strategies between the two domains for the five personality traits.

The highlighted pairs of coefficients are significantly different for the personality type across the two domains—healthy eating E and smoking cessation S , where negative values represent demotivation by a strategy and positive values represent motivation by a strategy. While personalization is generally effective for agreeable people in both domains, it is significantly more effective for people who are high in agreeableness in the healthy eating domain compared to the smoking cessation domain.

In general, all the strategies except personalization are equally effective at promoting healthy eating and discouraging smoking for people high in agreeableness, see Table 8. There are significant differences in the effectiveness of all strategies across the two domains for conscientious people. Competition , Normative influence , and Reward are significantly effective for promoting healthy eating for people high in the conscientious personality factor but are not significant for promoting smoking cessation for the same personality factor.

On the other hand, Cooperation and Personalization although are positively associated with behaviour change in both healthy eating and smoking cessation domains, they are significantly more effective for promoting healthy eating for people high in conscientious personality traits, as shown in Table 8. Only Normative Influence shows a significant difference between the two domains for people with the extraversion personality trait. Interestingly, normative influence is significantly effective for extraverted people in the smoking cessation domain but not effective in the healthy eating domain.

Competition is not effective for this personality factor in any domain, as shown in Table 8. Competition and Cooperation show significant differences across the two domains for people who are high in emotional stability opposite of Neuroticism. Competition is significantly effective for promoting smoking cessation while it is not significant in the healthy eating domain for this personality type.

On the other hand, Cooperation is significantly effective in the healthy eating domain but not significant in the smoking cessation domain for emotionally stable people, as shown in Table 8. This personality trait shows significant differences in their association with the Competition and Cooperation strategies across the two domains.

Competition although effective for the two domains is significantly more effective in the healthy eating domain than in the smoking cessation domain for people high in closedness to experience. Similarly, Cooperation is effective in the two domains but it is significantly more effective for promoting smoking cessation than in the healthy eating domain, as shown in Table 8. Overall, agreeableness, extraversion, and conscientiousness personality factors emerged as the personality types that are most responsive to the persuasive strategies overall.

Openness and neuroticism emerged as the least responsive, with openness being negatively related to all the strategies while neuroticism is negatively associated with most of the strategies. In general, the strategies are more effective in the healthy eating domain overall than the smoking cessation for different personality types.

According to the Persuasive System Design PSD model Oinas-Kukkonen and Harjumaa , the effectiveness and generalizability of persuasive strategy implementations are dependent on a lot of user and usage context-related factors, including the target domains of behaviour change and user personality traits. So far, research attention has majorly focused on investigating user-related factors that impact the effectiveness of the persuasive strategies and hence inform the tailoring of persuasive gamified systems to various users and user groups.

In line with this, research has investigated the impact of user characteristics such as age groups Oyibo et al. However, little or no research has investigated how and whether usage factors, such as differences in the application domain, impacts the effectiveness of the strategies for different personality types.

Our research is the first to investigate the combined effect of user-dependent factors personality types and usage context-dependent factors different application domains to establish the generalizability of the strategies or not and develop guidelines for tailoring persuasive gamified systems that take both the target user personality and application domains into account.

Overall, our study shows that the effectiveness of persuasive strategies is domain-dependent. This implies that a persuasive strategy implemented identically across multiple domains may likely not have the same persuasive effect on users in each domain. The usage context or domain of persuasion plays an important role in the effectiveness of persuasive systems since every context always possesses some peculiarity that may confound the potential of persuasive strategies in promoting behaviour change.

This further emphasises the importance of tailoring persuasive systems not only to users but also to the context of usage. We also observe that the personality factors of users can greatly contribute to the effectiveness of persuasive strategies. This highlights the important role that personality factors play in determining the effectiveness of persuasive strategies for certain individuals.

For example, McElroy et al. McElroy et al. Furthermore, we have shown that even when persuasive strategies are implemented the same way across two domains, personality factors may still cause significant variations in the effectiveness of the majority of the persuasive strategies employed. This implies that a persuasive system targeted at one domain and designed for a specific user that is high in a personality factor may not be effective for the same user if the system targets another domain.

In the following sections, we discuss how our findings can be applied in developing persuasive gamified systems targeting a specific domain or multiple domains to appeal to the audience of a specific personality trait and a broader audience with various personality traits. Although our results show that significant differences exist with respect to the effectiveness of the strategies across domains for people of various personality factors, it also reveals occurrences where the effectiveness of the strategies generalizes across domains for various personalities.

Here, we discuss opportunities and design implications for employing the strategies to design systems across domains for various personalities. Our results show that people high in agreeableness perceive all the strategies as effective irrespective of the domain of application although at varying degrees.

This is in line with previous research that found that the agreeableness personality factor is the most responsive to the persuasive strategies overall in the area of risky alcohol behaviour change Anagnostopoulou et al.

It also aligns with the characteristics of this personality trait. They tend to be more compliant, modest, and tender-minded, tolerant, considerate of both people and new ideas. Therefore, to design persuasive gamified systems targeting any domain to appeal to people who are high in agreeableness, designers could employ competition, cooperation, personalization, reward, and normative influence , listed in decreasing order of preference to motivate behaviour change.

There are various ways these strategies can be integrated and operationalized in persuasive gamified apps. For example, competition can be implemented as leaderboards that display high scores or status that shows the rank or levels of players.

Reward can be operationalized in a way that players receive virtual items such as points or badges and can level up and gain new abilities Fritz et al. Personalization can be implemented using either system-controlled or user-controlled adaptation approaches. The system-controlled approach automatically adjusts system features to better suit and support users, while the user-controlled approach provides customizable features but relies on the user to adapt the features as they desire to suit them Findlater and McGrenere ; Orji et al.

It can be operationalized in various ways including as personalized goal recommendation Dantzig et al. Similarly, our results also show that cooperation and personalization are perceived as positive by people high in conscientiousness irrespective of the domain.

Cooperation is effective for this personality factor due to their tendency to be orderly and self-disciplined. To effectively work together with people, orderliness is required. Therefore, to design persuasive gamified systems to appeal to people who are high in consciousness, designers could employ cooperation and personalization to promote behaviour change irrespective of the target domain. For extraverted people, our results show that cooperation, personalization and reward are strong motivators of behaviour change across domains.

Therefore, when designing persuasive gamified systems to appeal to people high in extraversion, designers should employ the cooperation, personalization and reward strategy irrespective of the domain. With respect to the most effective strategy for designing persuasive gamified systems to appeal to each personality type across the two domains; Competition is the most effective for designing for agreeableness across the two domains, Cooperation and Reward are equally effective for designing for conscientious people across domains, and Personalization emerged as the most effective strategy for designing for people high in extraversion.

These strategies should be preferred to any other strategy investigated in this paper for designing systems across domains for the distinct personality types. In line with previous research Orji et al. Extraversion, agreeableness, conscientiousness is significantly and positively related with most strategies while openness is negatively associated with all the strategies.

Domains of persuasive technology can broadly be divided into two depending on their behavioural change objectives: 1 Persuasive systems for promoting safe behaviours such as healthy eating; 2 Persuasive systems for discouraging risky behaviours such as smoking cessation. Although designing persuasive gamified systems to cater for a broader audience is the conventional approach because it saves time and resources required to create separate or adaptive systems for a diverse audience, however, there are situations in which tailoring persuasive gamified systems for personalized user experience is appropriate.

In line with this, research has shown that tailoring persuasive gamified systems increases their persuasive appeal and effectiveness Kaptein et al. Tailoring allows designers to design system elements that are specifically effective for a target personality trait in a target domain. Our results highlight opportunities where the tailoring of persuasive strategies to both the personalities and application domain might be appropriate.

In this section, we discuss opportunities and design implications for tailoring to both personalities and domains based on findings. For extraversion, our results reveal that the major difference between promoting healthy eating behaviour and smoking cessation is their preference for the normative Influence strategy.

People high in extraversion have a strong preference for normative influence in smoking cessation. However, normative influence is not significant for this personality in healthy eating.

That means that people high in extraversion are more likely to be motivated to adopt healthy eating behaviour by persuasive gamified applications employing the normative influence , however, they may not be motivated to quit smoking by applications employing the normative influence strategy.

Therefore, to design persuasive gamified applications for promoting healthy eating behaviour targeted at people high in extraversion, designers could employ the normative influence strategy. However, normative influence may not be effective for promoting smoking cessation for this personality, so designers could avoid it. Similarly, our results show that people high in conscientiousness differ significantly across the two domains with respect to their preference for all the five strategies.

Although both Cooperation and Personalization emerged to be effective across the two domains, they are more effective for promoting healthy eating than for smoking cessation for people high in conscientiousness.

However, a major differentiator between the two application domains for people high in conscientiousness is their preference for the Competition , Reward and Normative Influence strategies.

These strategies are significantly associated with conscientiousness in healthy eating and therefore is more likely to be motivated by systems employing these strategies. However, these strategies are not significant for promoting smoking cessation for people high in conscientiousness. Therefore, to design persuasive gamified applications to promote healthy eating behaviour for people high in conscientiousness, designers could employ the Competition , Reward and Normative Influence strategy.

However, these strategies may not be effective for promoting smoking cessation for this personality, designers should probably avoid using them. For people high in agreeableness, our results show that although Personalization showed to be effective in both domains, they are more effective for promoting healthy eating than for smoking cessation. The personalization strategy is one of the most effective strategies for promoting healthy eating and smoking cessation among agreeable people, although it is less effective in smoking cessation.

Therefore, although designers could employ the Personalizatio n strategy when designing persuasive gamified systems across domains, they should be among the top priority in healthy eating domains and should be emphasized. Surprisingly, our results show that people high in openness and neuroticism are unlikely to be motivated to adopt healthy behaviours by employing any of the five strategies investigated in this paper.

This is in line with previous research Orji et al. A possible explanation is that the most commonly used strategies are not appropriate for people high in openness and neuroticism Orji et al.

Hence, persuasive researchers should explore openness and neuroticism-oriented strategies. Therefore, for people high in openness and neuroticism personality type, persuasion may not be an effective approach for motivating behaviour change irrespective of the domain.

There are many ways our results can be used to inform the tailoring of persuasive gamified systems design, we have highlighted a few here as examples. Table 8 details the relations between the strategies and personality traits across healthy eating and smoking cessation domains. It could guide design choices for tailoring persuasive gamified systems considering both the personality type and the application domains.

The reward strategy is one of the most frequently employed strategies in persuasive gamified systems. Our findings reveal that reward is not an effective strategy for people high in conscientiousness in the smoking cessation domain and is likely to demotivate behaviours for people high in openness and neuroticism in both healthy eating and smoking cessation domains. Our qualitative results show that these personalities feel that rewards such as achievement badges and points as used in many persuasive gamified apps has no real-world value.

You can't do anything with badges. They're a waste of time. This is in line with previous research that found that reward was not effective for some user types Orji et al. In fact, the use of rewards especially tangible rewards to motivate behaviour change has been a controversial issue in the literature. Research has pointed out the potential of tangible reward such as money to redirect the intention of any behaviour and refocus the benefit to the real value of the reward Colineau and Paris ; Orji et al.

Therefore, when designing persuasive gamified systems for people high in openness and neuroticism, designers can avoid using the reward strategy entirely or find a way to tie the reward to something meaningful to the user. However, designers should avoid offering money as a reward to create meaning and motivate behaviour change. Recent research has shown that offering money as a form of reward will either not have any effect or be detrimental to behaviour change, decreases intrinsic motivation Cherubini et al.

Our findings show that cooperation demotivates neurotics and people who are open to experience. Based on our qualitative results, a major reason for the negative association with cooperation by these personalities is that they feel that working with people especially strangers demotivates and is challenging as can be seen by the comments below:.

Therefore, we suggest that when designing for persuasive gamified apps targeting people who are open to experience and neurotics, designers should avoid cooperation and if they have to use it, they should provide mechanisms to allow users to choose friends and family they would like to work with.

Previous research shows that some people prefer to work with strangers in their behaviour change journey Orji et al. Our findings extend this previous research by showing that people who are open to experience and neurotics are not part of those who prefer to work with strangers.

On the other hand, personalization is negatively associated with emotionally unstable people neurotic and people who are open to experiences irrespective of the domains. According to our qualitative results, these participants feel that providing just personalized content, goals, and suggestions would not be enough to motivate them to adopt the desired behaviour while some participants were sceptical about their privacy and losing control with the tracking often associated with personalization.

This suggests that the personalization strategy may need to be implemented alongside other complementary strategies that are more likely to engage users and motivate them towards behaviour change. Therefore, designers should employ personalization together with complementary strategies to motivate behaviour change. Research has shown that social support strategies such as competition and cooperation work well with other strategies Burke et al.

To overcome privacy concerns and loss of control due to tracking associated with system-controlled personalization, we suggest that when designing for conscientious and openness individuals, designers should employ the user-controlled approach that provides some personalization affordances but allows the user to use them to personalize systems to suit their preferences.

This gives them control and eliminates or minimizes the need for tracking their personal data. Our results show that competition is not a significant motivator for neurotic and extraverted people while it is negatively associated with people who are open to experience Some reasons why this strategy is unappealing and negatively associated with these personalities is their belief that competition leaderboard is a scam due to tendency of people to cheat whenever competition is introduced.

Again, seeing some really high scores earned by others which may seem unattainable demotivates , as shown in the comment below. This may reduce the urge to cheat to outperform others and promote the desired behaviour Orji et al. Again, designers should ensure fair comparison in persuasive gamified systems employing the competition strategy by not comparing dissimilar people. Pairing and matching people who are very distinct in ability and performance may be detrimental to behaviour change.

It can lead to unbalanced competition, which may make the continuously winning relax downward comparison and the losing partner give up due to the wide performance margin. They can pair people at the same behaviour change stage or implement mechanisms to balance their performance and goals to match their levels.

Our study was based on self-reported data of the participants' perceived persuasiveness of these strategies based on the prototype implementations. Previous work shows personalized application based on self-report was effective in motivating actual behaviour in various domains: eating, eCommerce, snacking, physical activity Kaptein et al.

Both explicit measures self-assessment of strategies and implicit measures actual responses are effective approaches to tailoring persuasive applications Kaptein et al.

However, we acknowledge that the actual persuasiveness of these strategies may differ when implemented in apps and used over long periods. Therefore, we plan to examine the persuasiveness of the recommended strategies deployed in actual persuasive gamified systems targeting multiple domains and used over an extended period of time.

Although our study is based on the popular implementation of each strategy from the literature, there is a possibility that some less popular implementations may be more effective in some domains and for distinct personality types.

Finally, while our results benefitted from a large-scale study of two distinct domains smoking and eating of behaviour change, it may not generalize to other behaviour domains and therefore should be applied with caution in these domains. This paper investigated for possible application domain-dependent variations on the effectiveness of persuasive strategies for people belonging to different personality types, based on a large-scale study of people.

It contributes to the advancement of knowledge in the HCI field by showing that the effectiveness of persuasive strategies varies depending on both the application domain and target user personalities. Our research is the first to investigate the combined effect of user-dependent factors personality types and usage context-dependent factors application domains to establish the generalizability of the strategies or not, and develop guidelines for tailoring persuasive gamified systems that take both the target user personality and application domains into account.

Through our study, we uncovered the limitations of the untailored approach and tailored approaches that consider only the user characteristics but not the target application domains and presented recommendations for designing persuasive gamified systems that appeal to the personalities across domains and for tailoring to appeal to the personalities in a specific domain. Our findings reveal that agreeableness emerged as the personality type that shows the least variability with respect to their response to the persuasive strategies across distinct domains, while conscientiousness showed the most variability.

These must be taken into account to achieve application domain and personality-type-driven tailoring. Our findings could guide designers in making informed decisions on the strategies to employ and those to avoid when designing tailored persuasive and gameful systems. Adolf, J. Article Google Scholar. Aldenaini, N.

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The associations of personality traits with employment sector, amount of clinical patient contact, medical specialty and change of specialty are shown in Table 2.

Specialists who worked in the private sector scored higher in openness and agreeableness compared with specialists working in the public sector. Specialists with clinical patient contact most of their working hours per week scored higher in conscientiousness but lower in openness compared to other specialists on average. Specialists with clinical patient contact approximately half of their working hours also had lower openness but higher neuroticism than other specialists.

Furthermore, specialists who reported no clinical patient contact during their working hours had lower levels of extraversion but higher levels of openness compared with other specialists. No differences in any personality traits were found among specialists having some clinical patient contact, i.

Pediatricians showed higher extraversion whereas psychiatrists showed lower extraversion and conscientiousness but higher openness compared to other specialists on average. Surgeons showed higher conscientiousness but lower agreeableness and neuroticism than other specialists.

Also, specialists from the other sub-specialties of internal medicine e. Ophthalmologists and otorhinolaryngologists as well as general practitioners showed lower openness compared to other specialists.

Specialists in occupational health and general practitioners showed higher agreeableness than other specialists. Specialists who reported having changed their specialty showed higher extraversion and openness compared to specialists who had not changed specialty during the measurement intervals of the current study. Higher openness was associated with working in the private sector, not having clinical patient contact, specializing in psychiatry and having a tendency to change specialty.

Lower openness, in turn, was associated with a high or average amount of clinical patient contact and specializing in general practice as well as in ophthalmology and otorhinolaryngology.

Of the other personality traits, higher conscientiousness was associated with a higher amount of clinical patient contact and specializing in surgery and in other internal medicine specialties whereas lower conscientiousness was associated with specializing in psychiatry and in hospital service specialties. Higher agreeableness was associated with working in the private sector and specializing in general practice as well as occupational health service whereas lower agreeableness was associated with specializing in surgery.

Higher neuroticism was associated with an average amount of clinical patient contact whereas lower neuroticism was associated with specializing in surgery. Women scored higher in extraversion, conscientiousness and neuroticism but lower in openness compared with men.

Specialists with no clinical patient contact showed lower extraversion whereas higher extraversion was associated with specializing in pediatrics and psychiatry and a change of specialty. The association of higher openness with working in the private sector and changing specialties is understandable, as openness facilitates acceptance, flexibility and adequate adjustment to situational changes [ 41 ].

Openness has been linked to academic ability and divergent thinking [ 44 , 45 ] and is seen as becoming more beneficial particularly in clinical education and in the applied settings of medicine [ 18 , 46 ] than in academic achievement during medical education [ 47 , 48 ]. Psychiatrists may benefit in their work from being more open, as this characteristic also reflects general attentiveness to inner feelings, intellectual curiosity and independence of judgment [ 41 ].

Compared with other specialties, the job description of medical researchers, for example, may also allow and make it generally easier to show intellectual curiosity and divergent thinking, thus reflecting higher openness to experience [ 41 , 42 ]. Lower openness was associated with a high or average amount of clinical patient contact and specializing in general practice as well as in ophthalmology and otorhinolaryngology.

The results may refer to physicians being greatly responsible for patients in general. General and family practitioners have been characterized as strict followers of clinical guidelines and principles compared to surgeons, for example [ 33 ].

Family practitioners have been found to be mixed in openness compared with other specialists, and, in any case, score lower on openness compared with psychiatrists and surgeons [ 18 , 21 ].

Also, ophthalmologists and otorhinolaryngologists have been categorized as specialists having a more controlled lifestyle [ 9 ] reflecting lower openness. The job description in general practice as well as in ophthalmology and otorhinolaryngology is based on relatively traditional rules and regular operations [ 9 ].

Therefore, physicians representing these specialties may benefit from their lower openness. As well, stability of choice of specialty has been found to be significantly higher among general practitioners compared to psychiatrists, for example [ 5 ]. Higher conscientiousness was associated with high amounts of clinical patient contact and specializing in surgery and in other internal medicine specialties whereas lower conscientiousness was associated with specializing in psychiatry and in hospital service specialties.

Conscientiousness has been found to be the best predictor of academic success in both preclinical and clinical phases of medical education [ 14 , 18 , 32 , 46 ].

In a recent study among Swedish doctors, psychiatrists scored lower on conscientiousness particularly when compared with surgeons [ 20 ]. Internists including many subspecialties of internal medicine , in turn, have been suggested to score higher on conscientiousness because of their high self-reliance [ 21 ]. In addition, hospital service physicians showed lower conscientiousness compared with surgeons in the above-mentioned Swedish study [ 20 ]. The results are completely new not previously demonstrated.

Neuroticism has been found to be predictive of jobs and working environments where employees work in groups [ 41 ]. Individuals with higher neuroticism have been shown to experience life events more negatively than other individuals [ 51 ] partly because they choose to place themselves in situations that foster negative effects [ 52 ].

However, neuroticism has been shown to be rarely apparent among medical specialists in general [ 21 ]. Distinctive differences in neuroticism have been found only in a small cross-sectional study where surgeons scored at the highest level in neuroticism compared with other specialists [ 19 ].

In a study by Hoffman and colleagues, surgeons scored lower in neuroticism compared with the general population but not when compared with medical students or with other medical specialists [ 27 ].

Our results, however, suggest that the challenging, risk-taking and meticulous nature of surgical specialization may attract and favour physicians who do not have a general tendency to experience negative emotions in response to stressful duties and situations [ 41 ]. Higher agreeableness was associated with working in the private sector and specializing in general practice as well as in occupational health whereas lower agreeableness was associated with specializing in surgery.

Agreeableness has been found to be predictive of clinical competence in medical students [ 55 , 56 ], suggesting that it may facilitate physician-patient relationships [ 18 ]. Previously, general practice including family medicine and occupational health have been classified as person-oriented specialties whose physicians show sympathetic, trusting and cooperative behaviour, reflecting higher Agreeableness [ 21 , 33 ].

Specialists who did not have clinical patient contact showed lower extraversion whereas higher extraversion was associated with specializing in pediatrics and change of specialty. The job description of medical researchers with no clinical patient contact, for example, may allow and make it easier to show withdrawal and deliberate behaviour in general. Higher extraversion, in turn, reflects approaching behaviour and general sociability with a cheerful disposition [ 41 ], which can be seen as favourable characteristics of physicians working with children and encountering new working environments.

Although psychiatrists also scored slightly higher on extraversion compared with other specialists, they may vary within the specialty concerning this trait with respect to trait-related single facets such as being sociable and outgoing [ 21 ]. Doctors choosing psychiatry have been found to be more likely to change their specialty than those choosing general practice [ 5 ].

Choice stability has not, however, been previously related to personality and confidence, or to satisfaction with medicine in general, but instead to the job satisfaction and lifestyle factors associated with the specialty [ 5 ]. Women specialists scored significantly higher in extraversion, conscientiousness and neuroticism but lower in openness compared to men physicians.

Gender differences in agreeableness or gender by specialty interactions, in any personality trait, were not observed.

Women physicians have previously been found to score higher also in agreeableness whereas gender differences with regard to neuroticism have not been shown [ 23 ]. Gender-related individual-level factors such as personality might be a considerable variable to take into account in career counseling and specialty guidance during medical education [ 18 , 57 ] in order to enhance person-job fit [ 16 ] among physicians. The greatest strength of this study is the relatively large and representative population-based sample of actively working licensed Finnish physicians [ 38 , 39 ], an important advantage compared with previous research on the topic.

The findings concerning openness and agreeableness, in particular, might have practical relevance in physician-patient interpersonal relationships. These new findings of the current study may be useful when developing medical career counseling and interventions during and after medical education to help students choose medical careers that best suit their individual personalities.

The present study has limitations as well. The possibility of reverse causality cannot be ruled out. Although personality traits are moderately heritable [ 58 ] and relatively stable over the life course [ 17 , 59 ], major life-events have been found to affect personality development [ 60 , 61 , 62 , 63 ]. Furthermore, we cannot rule out the possibility of residual confounding. Other factors e.

Although carried out with the permission of the FMA [ 40 ], the study was based on voluntary participation. Therefore, the self-selection of physicians participating in the study may explain some of the results.

To assess personality, we used the well-known shortened version of the S-BFI [ 41 ] that has been found to have adequate reliability and convergent validity [ 42 , 64 ] also among medical students [ 46 ]. Despite the obvious advantages of short personality measures found for research purposes [ 64 ], shortened scales might not completely cover all the delicate facets of the FFM. Although only satisfactory in agreeableness, the reliability coefficients of the scales were consistent with previous research conducted with the S-BFI [ 42 , 64 ].

The findings concerning openness and agreeableness, in particular, might have practical relevance in the interpersonal physician-patient relationship. Our results also suggest that gender-related personality might be a considerable individual-level factor to take into account in career counseling and specialty guidance during and after medical education in order to enhance the person-job fit of physicians.

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The influence of gender and personality traits on the career planning of Swiss medical students. Swiss Med Wkly. Doherty EM, Nugent E. Personality factors and medical training: a review of the literature. Tolerance of ambiguity, perfectionism and resilience are associated with personality profiles of medical students oriented to rural practice. Edwards JR. Person-job fit: a conceptual integration, literature review, and methodological critique.

International review of industrial and organizational psychology, vol. Personality development: continuity and change over the life course.

Annu Rev Psychol. Personality assessments and outcomes in medical education and the practice of medicine: AMEE guide no. Personality types and specialist choices in medical students. Association between personality traits and future choice of specialisation among Swedish doctors: a cross-sectional study.

Postgrad Med J. Personality and medical specialty choice: a literature review and integration. Journal of Career Assessment. Personality as a prognostic factor for specialty choice: a prospective study of 4 medical school classes. The Medscape Journal of Medicine. Ability of prospective assessment of personality profiles to predict the practice specialty of medical students.

Proc Baylor Univ Med Cent. Variation in personality traits of medical students between schools of medicine. Trial use of the personal qualities assessment PQA in the entrance examination of a Japanese medical university: similarities to the results in western countries.

Teaching and Learning in Medicine. Career Development International. Personality differences between surgery residents, nonsurgery residents, and medical students. Ferguson E, Lievens F. Future directions in personality, occupational and medical selection: myths, misunderstandings, measurement, and suggestions.

Adv Health Sci Educ. Factors associated with success in medical school and in a medical career: systematic review of the literature. PLoS One. The dark side of conscientiousness: conscientious people experience greater drops in life satisfaction following unemployment.

J Res Pers. A pilot study of the roles of personality, references and personal statements in relation to performance over the five years of a medical degree. Personality and medical specialty choice: technique orientation versus people orientation. J Vocat Behav. Personality patterns of physicians in person-oriented and technique-oriented specialties. ISS :4— Surgeons' personalities: the influence of medical school. Factors in medical school that predict postgraduate mental health problems in need of treatment.

A nationwide and longitudinal study. Stress, burnout and doctors' attitudes to work are determined by personality and learning style: a twelve year longitudinal study of UK medical graduates. BMC Med. Effects of active on-call hours on physicians' turnover intentions and well-being. Scand J Work Environ Health. John OP, Srivastava S.

The big five trait taxonomy: history, measurement, and theoretical perspectives. Handbook of personality: Theory and research.

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Different personalities healthcare with implementing change in employment with humana

Implementing change in healthcare with different personalities	Shen H, Comrey AL. View author publications. Through our study, we uncovered the limitations of the untailored approach and tailored approaches implementing change in healthcare with different personalities consider only the user characteristics but not the target application domains and presented recommendations for designing persuasive gamified systems that appeal to the personalities across domains and for tailoring to appeal to the personalities in a specific domain. Neuroticism has been found to be predictive of jobs and working environments where employees work in groups [ 41 ]. Their findings uncovered that strategies like goal-setting, simulation, self-monitoring, and feedback are more effective for Conscientious people, while check this out people would be easily demotivated by persuasive strategies such as rewards, competition, comparison, and cooperation. However, as shortages in medical staff continue to be reported worldwide [ 12 ], as evidenced by absenteeism, stress and turnover among physicians [ 34 ], it is imperative to ensure the correct fit between physicians and their chosen careers and specialties. Persuasive gamified systems or health are designed as systems with the primary purpose of promoting behaviour or attitude change Bogost click to see more Fogg ; Oinas-Kukkonen and Harjumaa ; Orji et al.
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