# Designing Personalized Persuasive Game Elements for Older Adults in Health Apps
## 5 Discussion  
### Discussion of Study Results  
Compared to the existing literature, this study expanded the number of participants and performed a more disaggregated evaluation of older adult characteristics. Three gamification mechanisms preferred by older adults and the importance of nine gamification elements were analyzed using the Kano model and conjoint analysis. For the research question RQ1, the results showed that the gamification mechanisms (challenge, competition, punishment, and cooperation) were indifferent attributes (I) in the health education application for older adults. The reason for this may be the existence of psychological barriers among older adults who fear that competitive mechanics may damage the image of the individual. The overall preferred gamification mechanisms for older adults were winning status (M), reward (O), and feedback (O). The relative importance of these three gamification mechanisms in the conjoint analysis method was 48.980%, 40.816%, and 10.204%, respectively (Table 6). It was suggested that the winning status attribute was preferred for persuading users. This result suggested that older adults seek a sense of accomplishment \begin{table}
\begin{tabular}{c c c c} \hline \hline
**Characteristic** & **Category** & \multicolumn{1}{c}{\begin{tabular}{c} **Geamification Mechanics** \\ **Recommendation** \\ \end{tabular} } \\ \hline Overall & 103 subjects & Winning Status, Rewards, Feedback \\ \hline Age & \begin{tabular}{c} 55–70 years old \\ \textgreater{}70 years old \\ \end{tabular} & Feedback, Winning Status, Reward \\ \hline Gender & \
\begin{tabular}{c} Male \\ Female \\ \end{tabular} & Winning Status, Reward, Feedback, Reward \\ \hline Educational background &
\begin{tabular}{c} Elementary education \\ Secondary education \\ Higher education \\ \textless{}2000 \\ \textless{}5000 \\ \textgreater{}5000 \\ \end{tabular} & Reward, Feedback, Winning Status \\ \hline \hline \end{tabular}
\end{table} 
Table 11: Recommended gamification mechanics for older adults with different characteristics. \begin{table}
\begin{tabular}{c c c c c} \hline \hline
**Characteristic** & **Category** & **Feedback** & **Rewards** & **Winning Status** \\ \hline Overall & 103 subjects & Identity level & Cash reward & Social sharing \\ \hline Age & \begin{tabular}{c} 55–70 \\ years old \\ \textgreater{}70 \\ years old \\ \end{tabular} & Identity level & Point reward & Social sharing \\ \hline Gender & \begin{tabular}{c} Male \\ Female \\ \end{tabular} & \begin{tabular}{c} Graphic \\ feedback \\ Identity level \\ \end{tabular} & Cash reward & Social sharing \\ \hline \multirow{4}{*}{\begin{tabular}{c} Educational \\ background \\ \end{tabular} } & \begin{tabular}{c} Elementary \\ education \\ Secondary education \\ Higher education \\ \end{tabular} & \begin{tabular}{c} Visual feedback \\ Identity level \\ \end{tabular} & Cash reward & Social sharing \\ \hline \multirow{4}{*}{\begin{tabular}{c} Income (CNY) \\ \end{tabular} } & \
\begin{tabular}{c} Elementary \\ education \\ \end{tabular} &
\begin{tabular}{c} Visual feedback \\ Identity \\ level/Graphic \\ feedback \\ Identity level \\ \end{tabular} & Cash reward & Social sharing \\ \hline \hline \end{tabular}
\end{table} 
Table 12: The optimal combination of gamification elements for different characteristics of older adults. and that gamification elements should satisfy their need for feedback on progress and success [54]. Corresponding to these three mechanisms, the most preferred combinations of gamification elements among older adults were: social sharing, cash rewards, and visual feedback. [PERSON] et al. [33] proved that older adults preferred social sharing with peers. In addition, self-determination theory (SDT) [55] divides motivation into intrinsic and extrinsic motivation. Cash reward is an extrinsic motivation. Sources of cash rewards can be provided with advertising and sponsorship by product companies targeting older users. However, studies have shown that too much of these rewards could be harmful.