Sustaining the Continued Use of Gamified mHealth Apps (Preprint)
Authors: Mustafa Abdulsalam Salihu , Ali Nor'ashikin , Dhillon Jaspaljeet Singh 
Published: August 2023

BACKGROUND

Mobile health (mHealth) apps are designed to promote healthy habits and behavioral outcomes. However, many users strive to maintain engagement with these apps after installation, often due to lacking motivation. To address this issue, gamification techniques have been incorporated into mHealth apps to sustain user engagement. Gamification integrates game elements into non-gaming environments to motivate individuals and improve user engagement. Despite adopting gamification in mHealth, the existing theoretical models do not fully explain the motivational role of game elements in this context. Also, there is limited empirical research on the complementary effects of intrinsic and extrinsic game elements on sustained engagement with mHealth apps. This ultimately raises doubts about the potential gains and the long-term viability of gamified mHealth apps.

OBJECTIVE

Therefore, this study aims to investigate the factors, including game elements, that drive sustained engagement with gamified mHealth apps for promoting physical activity.

METHODS

The gamification model integrates the self-determination theory (autonomy, competence, and relatedness) with social comparison theory, game elements, and external factors. The gamification constructs include challenges, feedback, leaderboards, and levels. The external variables are facilitating conditions, perceived benefits, fitness app quality, and perceived hedonic gratification. The measurement instrument for the cross-sectional study was developed and tested via a pilot study, and content validity was used to assess the items’ quality. The survey was conducted with 437 fitness app users in Malaysia. Structural equation modeling (SEM) was employed to analyze the data and determine the variables that significantly influenced the continued use of mHealth apps. The significant predictors from SEM were ranked using the Neural Network Model.

RESULTS

A total of 437 mHealth users in Malaysia participated in the study, with a 37% response rate. The findings showed that perceived autonomy (β=0.312; p<0.001), perceived hedonic gratification (β=0.479; p<0.001), feedback (β=0.252; p<0.001), and challenges (β=0.252; p<0.001) have and a significant positive influence on intrinsic motivation. Social comparison (β=1.781; p<0.001) and fitness app quality (β=0.074; p<0.001) had a positive influence on extrinsic motivation. Additionally, intrinsic motivation (β=0.525; p<0.001), extrinsic motivation (β=0.525; p<0.001), and facilitating conditions (β=0.145; p<0.001) significantly influenced continued use. The impact of mHealth experience on the relationships between perceived benefits and extrinsic motivation and that of perceived hedonic gratification and intrinsic motivation were significant. Interestingly, perceived competence (p>0.05) and perceived relatedness (p>0.05) did not influence intrinsic motivation. Also, leaderboards (p>0.05) and levels (p>0.05) had no significant effect on extrinsic motivation. The model accounted for 54% of the total variance of continued use of gamified mHealth.

CONCLUSIONS

This study provides evidence to indicate that intrinsic and extrinsic game elements can complement each other to sustain user engagement with mHealth. The findings expand the existing literature by informing the design and implementation of effective gamified mHealth apps, focusing on users’ autonomy, feedback, benefits, challenges, quality of fitness apps, and hedonic gratification. Moreover, this research provides practitioners and developers with practical guidelines to design more effective gamified mHealth apps to sustain user engagement.

CLINICALTRIAL

NMRR ID-22-00339-ZBN.