# Designing Personalized Persuasive Game Elements for Older Adults in Health Apps
## 4 Results  
### Screening the Gamification Mechanics Preferred by the Elderly  
In this study, common gamification mechanisms and gamification elements were extracted from the DMC pyramid model. The relevant gamification mechanics (challenge, feedback, competition, reward, punishment, cooperation, and winning status) were selected as the elements to be tested. In this paper, we used the Kano model to identify the functional attributes of the gamification mechanics and then select the gamification mechanics preferred by older adults. The two-factor Kano questionnaire was designed as shown in the following example table (Table 1). Older adults aged 55 years or older with experience in using mobile phone apps were selected for this experiment. All participants were informed of the purpose and significance of the study, and consent was obtained from the study participants. A total of 156 valid questionnaires (71 males and 85 females) were recovered. The better-worse coefficients of the gamification mechanisms were calculated using Equations (1) and (2) (see Table 2). The distribution in Figure 3 identifies the Kano attributes of the seven gamification mechanisms. According to the importance of functional attributes (M \(>\) O \(>\) A \(>\) I) [53], the preferred gamification mechanisms of older users were: winning status, feedback, and reward. Among them, winning status was a must-be attribute, and feedback and reward were one-dimensional attributes. \begin{table}
\begin{tabular}{c c c c} \hline \hline \multicolumn{4}{c}{**How Users Feel When This Feature Is Provided**} \\ \hline Very useful & More useful & Does not matter & Impractical & Very impractical \\ \(\bigcirc\) & \(\bigcirc\) & \(\bigcirc\) & \(\bigcirc\) \\ \hline \multicolumn{4}{c}{How users feel when this feature is not available} \\ \hline Very useful & More useful & Does not matter & Impractical & Very impractical \\ \(\bigcirc\) & \(\bigcirc\) & \(\bigcirc\) & \(\bigcirc\) \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Example of Kano two-factor questionnaire. \begin{table}
\begin{tabular}{c c c} \hline \hline
**Gamification Mechanics** & **Better–Worse Coefficient** & **Kano Attributes** \\ \hline Challenge & 0.1428, 0.1290 & Indifferent \\ Feedback & 0.4467, 0.3933 & One-dimensional \\ Competition & 0.1712, 0.1369 & Indifferent \\ Reward & 0.3377, 0.6623 & One-dimensional \\ Punishment & 0.1704, 0.1481 & Indifferent \\ Cooperation & 0.2353, 0.2157 & Indifferent \\ Winning status & 0.3701, 0.1948 & Must-be \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Analysis of Kano questionnaire results. We collected gamification design elements commonly used in existing app applications and categorized them into three gamification mechanisms (winning status, feedback, and reward). In the focus group method, firstly, the purpose of this study was introduced, as well as the basic functions of the health education app and the meaning of the gamification elements. Next, nine older participants were asked to vote on the preferred gamification elements for older adults. Three game mechanisms and nine gamification elements (see Table 3, Figure 4) were finally extracted to build the virtual product.