Potential Adverse Effects Caused by Gamification Elements in mHealth Apps

Authors

DOI:

https://doi.org/10.5753/jbcs.2024.4310

Keywords:

mHealth, Gamification, Adverse effects

Abstract

Health practices using mobile devices (known as mobile health, or mHealth) have increased in recent years. To increase users’ motivation to use it, mHealth researchers and developers have started to use gamification. However, no studies were found on the negative aspects of gamification in health. This work aims to determine the potential adverse effects of gamification in mHealth applications and analyze how different types of gamification elements can cause these effects. To this end, an analysis of 70 gamified mHealth applications extracted from the Google Play Store was performed to identify which gamification elements are commonly applied in mHealth. Then, to identify the negative aspects of gamification in mHealth and how the gamification elements can be related to them, a systematic review of the literature was carried out, where 37 studies were selected. Finally, a study was carried out with users of gamified mHealth applications to analyze in practice what was found in the previous steps. The results of these studies show which gamification elements are the most used in mHealth applications, the potential adverse effects found, and a list of which gamification elements can cause these effects. The results of this study provide insights into the risks associated with gamification in mHealth applications and can make developers, designers and professionals aware of these harmful issues.

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References

Almeida, C., Kalinowski, M., Uchôa, A., and Feijó, B. (2023). Negative effects of gamification in education software: Systematic mapping and practitioner perceptions. Information and Software Technology, 156:107142. DOI: 10.1016/j.infsof.2022.107142.

Andrade, F. R., Mizoguchi, R., and Isotani, S. (2016). The bright and dark sides of gamification. In 13th International Conference on Intelligent Tutoring Systems, pages 176-186. Springer-Verlag. DOI: 10.1007/978-3-319-39583-8_17.

Arora, C. and Razavian, M. (2021). Ethics of gamification in health and fitness-tracking. International Journal of Environmental Research and Public Health, 18(21):11052. DOI: 10.3390/ijerph182111052.

Attig, C. and Franke, T. (2019). I track, therefore i walk-exploring the motivational costs of wearing activity trackers in actual users. International Journal of Human-Computer Studies, 127:211-224. DOI: 10.1016/j.ijhcs.2018.04.007.

Barratt, P. (2017). Healthy competition: A qualitative study investigating persuasive technologies and the gamification of cycling. Health & Place, 46:328-336. DOI: 10.1016/j.healthplace.2016.09.009.

Boendermaker, W. J., Maceiras, S. S., Boffo, M., and Wiers, R. W. (2016). Attentional bias modification with serious game elements: Evaluating the shots game. Journal of Medical Internet Research: Serious Games, 4(2):e6464. DOI: 10.2196/games.6464.

Cheng, V. W. S., Davenport, T., Johnson, D., Vella, K., and Hickie, I. B. (2019). Gamification in apps and technologies for improving mental health and well-being: Systematic review. Journal of Medical Internet Research: Mental Health, 6(6):e13717. DOI: 10.2196/13717.

Cheng, V. W. S., Davenport, T. A., Johnson, D., Vella, K., Mitchell, J., and Hickie, I. B. (2018). An app that incorporates gamification, mini-games, and social connection to improve men's mental health and well-being (mindmax): Participatory design process. Journal of Medical Internet Research: Mental Health, 5(4):e11068. DOI: 10.2196/11068.

Chung, A. E., Griffin, A. C., Selezneva, D., and Gotz, D. (2018). Health and fitness apps for hands-free voice-activated assistants: Content analysis. Journal of Medical Internet Research: mHealth and uHealth, 6(9):e9705. DOI: 10.2196/mhealth.9705.

Deterding, S., Dixon, D., Khaled, R., and Nacke, L. (2011). From game design elements to gamefulness: defining" gamification". In International academic MindTrek conference: Envisioning future media environments, pages 9-15. Association for Computing Machinery. DOI: 10.1145/2181037.2181040.

Dithmer, M., Rasmussen, J. O., Grönvall, E., Spindler, H., Hansen, J., Nielsen, G., Sorensen, S. B., and Dinesen, B. (2016). The heart game: Using gamification as part of a telerehabilitation program for heart patients. Games for Health Journal, 5(1):27-33. DOI: 10.1089/g4h.2015.0001.

El-Hilly, A. A., Iqbal, S. S., Ahmed, M., Sherwani, Y., Muntasir, M., Siddiqui, S., Al-Fagih, Z., Usmani, O., and Eisingerich, A. B. (2016). Game on? smoking cessation through the gamification of mhealth: A longitudinal qualitative study. Journal of Medical Internet Research: Serious Games, 4(2):e5678. DOI: 10.2196/games.5678.

Gal-Oz, A. and Zuckerman, O. (2015). Embracing cheating in gamified fitness applications. In 2015 Annual Symposium on Computer-Human Interaction in Play, pages 535-540. Association for Computing Machinery. DOI: 10.1145/2793107.2810298.

Huotari, K. and Hamari, J. (2012). Defining gamification: a service marketing perspective. In 16th International Academic MindTrek Conference, pages 17-22. Association for Computing Machinery. DOI: 10.1145/2393132.2393137.

Hyrynsalmi, S., Smed, J., and Kimppa, K. (2017). The dark side of gamification: How we should stop worrying and study also the negative impacts of bringing game design elements to everywhere. In GamiFIN, pages 96-104. Available online [link].

Iqbal. App download and usage statistics 2022. Available at: [link], Acesso: 2022-05-23.

Iqbal. App revenue statistics 2022. Disponível em: [link], Acesso: 2022-05-23.

Johnson, D., Deterding, S., Kuhn, K.-A., Staneva, A., Stoyanov, S., and Hides, L. (2016). Gamification for health and wellbeing: A systematic review of the literature. Internet Interventions, 6:89-106. DOI: 10.1016/j.invent.2016.10.002.

Kapp, K. M. (2012). The gamification of learning and instruction: Game-based methods and strategies for training and education. John Wiley & Sons. Book.

Klock, A. C. T., Gasparini, I., and Pimenta, M. S. (2016). 5w2h framework: a guide to design, develop and evaluate the user-centered gamification. In 15th Brazilian Symposium on Human Factors in Computing Systems, pages 1-10. Association for Computing Machinery. DOI: 10.1145/3033701.3033715.

Klock, A. C. T., Gasparini, I., Pimenta, M. S., and Hamari, J. (2020). Tailored gamification: A review of literature. International Journal of Human-Computer Studies, 144:102495. DOI: 10.1016/j.ijhcs.2020.102495.

Lumsden, J., Edwards, E. A., Lawrence, N. S., Coyle, D., Munaf`o, M. R., et al. (2016). Gamification of cognitive assessment and cognitive training: A systematic review of applications and efficacy. Journal of Medical Internet Research: Serious Games, 4(2):e5888. DOI: 10.2196/games.5888.

McDaniel, R. (2016). A taxonomy for digital badge design in medical technologies. In IEEE International Conference on Serious Games and Applications for Health, pages 1-8. IEEE. DOI: 10.1109/SeGAH.2016.7586254.

Orji, R., Nacke, L. E., and Di Marco, C. (2017). Towards personality-driven persuasive health games and gamified systems. In Conference on Human Factors in Computing Systems, pages 1015-1027. DOI: 10.1145/3025453.3025577.

Pereira, P., Duarte, E., Rebelo, F., and Noriega, P. (2014). A review of gamification for health-related contexts. In International Conference of Design, User Experience, and Usability, pages 742-753. DOI: 10.1007/978-3-319-07626-3_70.

Peters, D., Calvo, R. A., and Ryan, R. M. (2018). Designing for motivation, engagement and wellbeing in digital experience. Frontiers in Psychology, 9:797. DOI: 10.3389/fpsyg.2018.00797.

Rapp, A., Hopfgartner, F., Hamari, J., Linehan, C., and Cena, F. (2019). Strengthening gamification studies: Current trends and future opportunities of gamification research. International Journal of Human-Computer Studies, 127:1-6. DOI: 10.1016/j.ijhcs.2018.11.007.

Rocha, I. and Silveira, M. S. (2023). An analysis of gamification elements in mhealth applications. In Proceedings of the XXII Brazilian Symposium on Human Factors in Computing Systems, pages 1-10. Association for Computing Machinery. DOI: 10.1145/3638067.3638126.

Sardi, L., Idri, A., and Fernández-Alemán, J. L. (2017). A systematic review of gamification in e-health. Journal of Biomedical Informatics, 71:31-48. DOI: 10.1016/j.jbi.2017.05.011.

Schmidt-Kraepelin, M., Thiebes, S., Stepanovic, S., Mettler, T., and Sunyaev, A. (2019a). Gamification in health behavior change support systems-a synthesis of unintended side effects. In 14th International Conference on Wirtschaftsinformatik, pages 1032-1046. Available online [link].

Schmidt-Kraepelin, M., Thiebes, S., and Sunyaev, A. (2019b). Investigating the relationship between user ratings and gamification-a review of mhealth apps in the apple app store and google play store. In 52nd Hawaii International Conference on System Sciences, pages 1496-1505. DOI: 10.24251/HICSS.2019.181.

Schmidt-Kraepelin, M., Toussaint, P. A., Thiebes, S., Hamari, J., Sunyaev, A., et al. (2020). Archetypes of gamification: Analysis of mhealth apps. Journal of Medical Internet Research: mHealth and uHealth, 8(10):e19280. DOI: 10.2196/19280.

Seaborn, K. and Fels, D. I. (2015). Gamification in theory and action: A survey. International Journal of Human-Computer Studies, 74:14-31. DOI: 10.1016/j.ijhcs.2014.09.006.

Sweileh, W. M., Al-Jabi, S. W., AbuTaha, A. S., Zyoud, S. H., Anayah, F., and Sawalha, A. F. (2017). Bibliometric analysis of worldwide scientific literature in mobile-health: 2006-2016. Bio Med Central: Medical Informatics and Decision Making, 17(1):1-12. DOI: 10.1186/s12911-017-0476-7.

Tondello, G. F., Mora, A., and Nacke, L. E. (2017). Elements of gameful design emerging from user preferences. In Annual Symposium on Computer-Human Interaction in Play, pages 129-142. Association for Computing Machinery. DOI: 10.1145/3116595.3116627.

van Dooren, M. M., Siriaraya, P., Visch, V., Spijkerman, R., and Bijkerk, L. (2019). Reflections on the design, implementation, and adoption of a gamified ehealth application in youth mental healthcare. Entertainment Computing, 31:100305. DOI: 10.1016/j.entcom.2019.100305.

Warsinsky, S., Schmidt-Kraepelin, M., Thiebes, S., and Sunyaev, A. (2021). Are gamification projects different? an exploratory study on software project risks for gamified health behavior change support systems. In 54th Hawaii International Conference on System Sciences, pages 1305-1315. DOI: 10.24251/HICSS.2021.159.

West, J. H., Hall, P. C., Hanson, C. L., Barnes, M. D., Giraud-Carrier, C., and Barrett, J. (2012). There's an app for that: Content analysis of paid health and fitness apps. Journal of Medical Internet Research, 14(3):e1977. DOI: 10.2196/jmir.1977.

WHO (2011). New horizons for health through mobile technologies. World Health Organization, pages 1-102. Available online [link].

Wohlin, C. (2014). Guidelines for snowballing in systematic literature studies and a replication in software engineering. In 18th International Conference on Evaluation and Assessment in Software Engineering, pages 1-10. Association for Computing Machinery. DOI: 10.1145/2601248.2601268.

Yang, H. and Li, D. (2021). Understanding the dark side of gamification health management: A stress perspective. Information Processing & Management, 58(5):102649. DOI: 10.1016/j.ipm.2021.102649.

Zuckerman, O. and Gal-Oz, A. (2014). Deconstructing gamification: Evaluating the effectiveness of continuous measurement, virtual rewards, and social comparison for promoting physical activity. Personal and Ubiquitous Computing, 18:1705-1719. DOI: 10.1007/s00779-014-0783-2.

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Published

2024-11-20

How to Cite

Rocha, I., & Silveira, M. S. (2024). Potential Adverse Effects Caused by Gamification Elements in mHealth Apps. Journal of the Brazilian Computer Society, 30(1), 608–620. https://doi.org/10.5753/jbcs.2024.4310

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