# Designing Personalized Persuasive Game Elements for Older Adults in Health Apps
## 5 Discussion
### Discussion of Study Results
Therefore, cash reward strategies can quickly attract the interest of older users in the early stages of use, but intrinsic motivation should be stimulated in long-term use. Social sharing and incentives from close friends or family members may be more likely to motivate older users intrinsically [56]. Design suggestions: In the universal module, social sharing strategies should be designed for older users and their friends and relatives, such as likes, visitor interaction records, and messages from those who care, to meet the social needs of older people through peer support. For the research question RQ2, the ranking of utility value based on conjoint analysis revealed the individualized preferences among of older adults for gamification elements. 1. Analysis by age characteristics. The results of the study (Table 7) show that lower-aged seniors (55-70 years old) preferred feedback mechanisms (46.939%), while higher-aged seniors (70 years old and above) preferred reward mechanisms (52.542%); and, in terms of gamification elements, they preferred status level feedback and cash rewards, respectively. The reason may be that the lower-aged seniors focused more on their personal social image, while the higher-aged seniors focused more on practical benefits. Design suggestions: Various virtual levels should be used to motivate the younger seniors, such as giving identity authentication and increasing the corresponding usage rights. Financial rewards should be used for the older seniors, such as issuing red packet rewards, or using points to exchange with gifts, etc. 2. Analysis by gender characteristics. Table 8 shows that both males and females preferred the winning status mechanism with a relative importance of 58.491% and 45.833%, respectively. However, males preferred the social sharing element and females preferred the leaderboard element. This indicates that female seniors were happy to show their status in a group, while male seniors felt pressured to display their personal status on the leaderboard because they were afraid of failing and would be embarrassed about it. Male older adults prefer to share personal achievements through socializing with friends and gaining appreciation. This indicates that females are susceptible to virtual gamification elements, and this finding is similar to that of other researchers [37], indicating the credibility of the results of this study. Design suggestions: Different winning status mechanisms should be used in the design for males and females to meet the psychological needs of older adults. In addition, designers should design cash rewards for male users and status level feedback for female users. 3. Analysis by educational background. Educational background not only limits the comprehension ability and prevalence of use of health education apps by older users [41], but also affects users' preferences for game elements. The results of the study showed (Table 9) that those in the group with less than secondary educational background were more interested in cash reward, which is a material persuasion element. The group with higher education preferred social sharing on the winning status mechanism, which is a spiritual persuasion element. Design suggestions: Cash rewards or red packet rewards should be used for users with a primary education background, followed by graphic feedback. For users with a secondary education background, a leaderboard element is recommended in addition to designing cash rewards. Multiple social sharing elements should be used for users with higher education background, followed by rewards of random gifts and status rank feedback. 4. Analysis by monthly income. Income affects human needs to some extent. The results of the study (Table 10) indicate that both groups with low income and high income preferred feedback mechanisms with a relative importance of 46.154% and 50.000%, respectively.