Chronic health conditions have necessitated the need for behavioral interventions (such as exercise programs) outside of clinical contexts, increasingly managed through technology such as mobile health (mHealth) services. Gamification has emerged as a promising tool to facilitate greater engagement in these services; however, no studies investigate the links between specific game design elements (GDEs) and psychological or behavioral outcomes within a health context. This domain is motivationally complex and has shown resistance to the satisfaction of social (relatedness) needs, presenting a challenge to the design of gamification products for health promotion. Drawing on self-determination theory, this research demonstrates the strengths of a taxonomy based upon structural features of GDEs (such as social, narrative or reward elements) rather than the design intent definitions of these elements used in previous studies. This taxonomy is then used to assess the relationship between GDEs and psychological needs satisfaction in a survey (N = 236) of gamified exercise/fitness application users. Further qualitative interviews (N = 20) were conducted to clarify survey findings. This research demonstrates the positive association between control and presentation elements and autonomy satisfaction, and control and reward elements and competency satisfaction. However, it also suggests that player type and context may limit the ability for GDEs alone to support relatedness satisfaction in mHealth services. Implications for managers and researchers are discussed, particularly the strengths and weaknesses of using structural taxonomies in gamification assessment.
Keywords: digital health; game elements; game features; game mechanics; gamification; intrinsic motivation; mHealth; needs satisfaction; self-determination theory.
Gamification, which is the use of game design elements (GDEs) such as points, badges and avatars in nongame contexts, has emerged as a promising tool for health promotion. However, while past studies demonstrate the capacity for gamification to deliver positive outcomes in health contexts, there is still limited understanding of what contributes to the success or failure of these health campaigns. This study consists of a quantitative online survey of 236 users of exercise/fitness gamification products, as well as qualitative interviews with an additional 20 users, to investigate the relationship between specific GDEs (such as social elements or control elements) and the satisfaction of users’ psychological needs. This study found that control and presentation elements had a positive relationship with feelings of user agency, while control and reward elements had a positive relationship with feelings of mastery. However, no specific GDEs supported feelings of connection with other users, with the interviews suggesting this may be due to differences in the types of players and the desire for interaction with others outside (rather than inside) the gamification service.
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