Author(s):

  • Lister, Cameron
  • West, Joshua H.
  • Cannon, Ben
  • Sax, Tyler
  • Brodegard, David

Abstract:

Background: Gamification has been a predominant focus of the health app industry in recent years. However, to our knowledge, there has yet to be a review of gamification elements in relation to health behavior constructs, or insight into the true proliferation of gamification in health apps. Objective: The objective of this study was to identify the extent to which gamification is used in health apps, and analyze gamification of health and fitness apps as a potential component of influence on a consumer’s health behavior. Methods: An analysis of health and fitness apps related to physical activity and diet was conducted among apps in the Apple App Store in the winter of 2014. This analysis reviewed a sample of 132 apps for the 10 effective game elements, the 6 core components of health gamification, and 13 core health behavior constructs. A regression analysis was conducted in order to measure the correlation between health behavior constructs, gamification components, and effective game elements. Results: This review of the most popular apps showed widespread use of gamification principles, but low adherence to any professional guidelines or industry standard. Regression analysis showed that game elements were associated with gamification (P<.001). Behavioral theory was associated with gamification (P<.05), but not game elements, and upon further analysis gamification was only associated with composite motivational behavior scores (P<.001), and not capacity or opportunity/trigger. Conclusions: This research, to our knowledge, represents the first comprehensive review of gamification use in health and fitness apps, and the potential to impact health behavior. The results show that use of gamification in health and fitness apps has become immensely popular, as evidenced by the number of apps found in the Apple App Store containing at least some components of gamification. This shows a lack of integrating important elements of behavioral theory from the app industry, which can potentially impact the efficacy of gamification apps to change behavior. Apps represent a very promising, burgeoning market and landscape in which to disseminate health behavior change interventions. Initial results show an abundant use of gamification in health and fitness apps, which necessitates the in-depth study and evaluation of the potential of gamification to change health behaviors.

Documentation:

https://doi.org/10.2196/games.3413

References:
  1. Dennison L, Morrison L, Conway G, Yardley L. Opportunities and challenges for smartphone applications in supporting health behavior change: Qualitative study. J Med Internet Res 2013;15(4):e86 [FREE Full text] [CrossRef] [Medline]
  2. Essany M. Mobile health care apps growing fast in number. 2013   URL: http://mhealthwatch.com/mobile-health-care-apps-growing-fast-in-number-20052/ [accessed 2014-03-14] [WebCite Cache]
  3. Hebden L, Cook A, van der Ploeg HP, Allman-Farinelli M. Development of smartphone applications for nutrition and physical activity behavior change. JMIR Res Protoc 2012;1(2):e9 [FREE Full text] [CrossRef] [Medline]
  4. Waltz E. How I quantified myself. IEEE Spectr 2012 Sep;49(9):42-47. [CrossRef]
  5. Wu W, Dasgupta S, Ramirez EE, Peterson C, Norman GJ. Classification accuracies of physical activities using smartphone motion sensors. J Med Internet Res 2012;14(5):e130 [FREE Full text] [CrossRef] [Medline]
  6. Hampton T. Recent advances in mobile technology benefit global health, research, and care. JAMA 2012 May 16;307(19):2013-2014. [CrossRef] [Medline]
  7. Muñoz RF. Using evidence-based internet interventions to reduce health disparities worldwide. J Med Internet Res 2010;12(5):e60 [FREE Full text] [CrossRef] [Medline]
  8. Kratzke C, Wilson S, Vilchis H. Reaching rural women: Breast cancer prevention information seeking behaviors and interest in Internet, cell phone, and text use. J Community Health 2013 Feb;38(1):54-61. [CrossRef] [Medline]
  9. Fjeldsoe BS, Marshall AL, Miller YD. Behavior change interventions delivered by mobile telephone short-message service. Am J Prev Med 2009 Feb;36(2):165-173. [CrossRef] [Medline]
  10. Fjeldsoe BS, Miller YD, Marshall AL. MobileMums: A randomized controlled trial of an SMS-based physical activity intervention. Ann Behav Med 2010 May;39(2):101-111. [CrossRef] [Medline]
  11. Chomutare T, Fernandez-Luque L, Arsand E, Hartvigsen G. Features of mobile diabetes applications: Review of the literature and analysis of current applications compared against evidence-based guidelines. J Med Internet Res 2011;13(3):e65 [FREE Full text] [CrossRef] [Medline]
  12. Obermayer JL, Riley WT, Asif O, Jean-Mary J. College smoking-cessation using cell phone text messaging. J Am Coll Health 2004;53(2):71-78. [CrossRef] [Medline]
  13. Arthur C. The history of smartphones: Timeline. 2012   URL: http://www.theguardian.com/technology/2012/jan/24/smartphones-timeline [accessed 2014-03-14] [WebCite Cache]
  14. Skillings J. Apple reveals details of 50 billionth app store download. 2013   URL: http:/​/news.​cnet.com/​8301-13579_3-57584793-37/​apple-reveals-details-of-50-billionth-app-store-download/​ [accessed 2014-03-14] [WebCite Cache]
  15. Deterding S, Dixon D, Khaled R, Nacke L. From game design elements to gamefulness: Defining gamification. In: Academic MindTrek Conference: Envisioning Future Media Environments. 2011 Presented at: Proc 15th International Academic MindTrek Conference: Envisioning Future Media Environments. ACM. :9–15; 2011; USA   URL: http://dl.acm.org/citation.cfm?id=2181040
  16. Fankhauser D. Is gamification just a fad?. 2013   URL: http://mashable.com/2013/05/17/gamification-buzzword/ [accessed 2014-03-14] [WebCite Cache]
  17. Ferguson B. Games for wellness—impacting the lives of employees and the profits of employers. Games for Health Journal 2012 Jun;1(3):177-179. [CrossRef]
  18. Ferrara J. Games for persuasion: Argumentation, procedurality, and the lie of gamification. Games and Culture 2013 Aug 27;8(4):289-304. [CrossRef]
  19. Peterson S. Gamification market to reach $2.8 billion in 2016. 2012   URL: http://www.gamesindustry.biz/articles/2012-05-21-gamification-market-to-reach-USD2-8-billion-in-2016 [accessed 2014-03-14] [WebCite Cache]
  20. King D, Greaves F, Exeter C, Darzi A. ‘Gamification’: Influencing health behaviours with games. J R Soc Med 2013 Mar;106(3):76-78. [CrossRef] [Medline]
  21. Ramachandran V. Mashable. 2013. AchieveMint gives you cash for doing healthy activities   URL: http://mashable.com/2013/08/02/achievemint/ [accessed 2014-03-14] [WebCite Cache]
  22. Perez S. Paid apps on the decline: 90% of ios apps are free, up from 80-84% during, says Flurry. 2010. 2013   URL: http:/​/techcrunch.​com/​2013/​07/​18/​paid-apps-on-the-decline-90-of-ios-apps-are-free-up-from-80-84-during-2010-2012-says-flurry/​ [accessed 2014-03-14] [WebCite Cache]
  23. Cowan LT, Van Wagenen SA, Brown BA, Hedin RJ, Seino-Stephan Y, Hall PC, et al. Apps of steel: Are exercise apps providing consumers with realistic expectations?: A content analysis of exercise apps for presence of behavior change theory. Health Educ Behav 2013 Apr;40(2):133-139. [CrossRef] [Medline]
  24. Briones R, Nan X, Madden K, Waks L. When vaccines go viral: An analysis of HPV vaccine coverage on YouTube. Health Commun 2012;27(5):478-485. [CrossRef] [Medline]
  25. Bromberg JE, Augustson EM, Backinger CL. Portrayal of smokeless tobacco in YouTube videos. Nicotine Tob Res 2012 Apr;14(4):455-462 [FREE Full text] [CrossRef] [Medline]
  26. West JH, Hall PC, Arredondo V, Berrett B, Guerra B, Farrell J. Health behavior theories in diet apps. Journal of Consumer Health On the Internet 2013 Jan;17(1):10-24. [CrossRef]
  27. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977 Mar;33(1):159-174. [Medline]
  28. Reeves B, Read JL. Total engagement: Using games and virtual worlds to change the way people work and businesses compete. USA: Harvard Business School Press; 2013.
  29. Doshi A, Patrick K, Sallis JF, Calfas K. Evaluation of physical activity web sites for use of behavior change theories. Ann Behav Med 2003;25(2):105-111. [Medline]
  30. Michie S, van Stralen MM, West R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci 2011;6:42 [FREE Full text] [CrossRef] [Medline]
  31. Glanz K, Rimer BK, Viswanath K. Health behavior and health education: Theory, research, and practice. San Francisco: Jossey-Bass; 2008.
  32. Fogg B. A behavior model for persuasive design. In: Conference on Persuasive Technology. 2009 Presented at: Proc 4th International Conference on Persuasive Technology. ACM; :40; 2009; USA   URL: http://dl.acm.org/citation.cfm?id=1541999
  33. Paredes P, Tewari A, Canny J. Design principles for the conceptualization of games for health behavior change. 2013   URL: http://gamification-research.org/wp-content/uploads/2013/03/Paredes_Tewari_Canny.pdf [accessed 2014-03-14] [WebCite Cache
  34. ]Boulos MN, Yang SP. Exergames for health and fitness: The roles of GPS and geosocial apps. Int J Health Geogr 2013;12:18 [FREE Full text] [CrossRef] [Medline]
  35. Adams MA, Marshall SJ, Dillon L, Caparosa S, Ramirez E, Phillips J, et al. A theory-based framework for evaluating exergames as persuasive technology. 2009 Presented at: Proc 4th International Conference on Persuasive Technology. ACM; 2009; New York, NY   URL: http://dl.acm.org/citation.cfm?id=1542006
  36. Baranowski T, Buday R, Thompson DI, Baranowski J. Playing for real: Video games and stories for health-related behavior change. Am J Prev Med 2008 Jan;34(1):74-82 [FREE Full text] [CrossRef] [Medline]
  37. Gartner. 2013. Methodologies: Gartner hype cycle   URL: http://www.gartner.com/technology/research/methodologies/hype-cycle.jsp [accessed 2014-07-09] [WebCite Cache]
  38. Fogg BJ. Persuasive technology: Using computers to change what we think and do. USA: Morgan Kaufmann; 2003.
  39. Killeen P. The matching law. J Exp Anal Behav 1972;17(3):489-495. [CrossRef]
  40. Reed DD, Kaplan BA. The matching law: A tutorial for practitioners. Behav Anal Pract 2011;4(2):15-24 [FREE Full text] [Medline]