Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug 12;23(8):e24546.
doi: 10.2196/24546.

The Impact of Gamification-Induced Users' Feelings on the Continued Use of mHealth Apps: A Structural Equation Model With the Self-Determination Theory Approach

Tong Wang  1 , Lingye Fan  2 , Xu Zheng  3 , Wei Wang  1 , Jun Liang  4 , Kai An  3 , Mei Ju  5 , Jianbo Lei  6   7   8
Affiliations

The Impact of Gamification-Induced Users' Feelings on the Continued Use of mHealth Apps: A Structural Equation Model With the Self-Determination Theory Approach

Tong Wang et al. J Med Internet Res. .

Abstract

Background: Continued use of mHealth apps can achieve better effects in health management. Gamification is an important factor in promoting users' intention to continue using mHealth apps. Past research has rarely explored the factors underlying the continued use of mobile health (mHealth) apps and gamification's impact mechanism or path on continued use.

Objective: This study aimed to explore the factors influencing mHealth app users' intention to continue using mHealth apps and the impact mechanism and path of users' feelings induced by gamification on continued mHealth app use.

Methods: First, based on the expectation confirmation model of information system continuance, we built a theoretical model for continued use of mHealth apps based on users' feelings toward gamification. We used self-determination theory to analyze gamification's impact on user perceptions and set the resulting feelings (competence, autonomy, and relatedness) as constructs in the model. Second, we used the survey method to validate the research model, and we used partial least squares to analyze the data.

Results: A total of 2988 responses were collected from mHealth app users, and 307 responses were included in the structural equation model after passing the acceptance criteria. The intrinsic motivation for using mHealth apps is significantly affected by autonomy (β=.312; P<.001), competence (β=.346; P<.001), and relatedness (β=.165; P=.004) induced by gamification. The intrinsic motivation for using mHealth apps has a significant impact on satisfaction (β=.311, P<.001) and continuance intention (β=.142; P=.045); furthermore, satisfaction impacts continuance intention significantly (β=.415; P<.001). Confirmation has a significant impact on perceived usefulness (β=.859; P<.001) and satisfaction (β=.391; P<.001), and perceived usefulness has a significant impact on satisfaction (β=.269; P<.001) and continuance intention (β=.273; P=.001). The mediating effect analysis showed that in the impact path of the intrinsic motivation for using the mHealth apps on continuance intention, satisfaction plays a partial mediating role (β=.129; P<.001), with a variance accounted for of 0.466.

Conclusions: This study explored the impact path of users' feelings induced by gamification on the intention of continued mHealth app use. We confirmed that perceived usefulness, confirmation, and satisfaction in the classical continued use theory for nonmedical information systems positively affect continuance intention. We also found that the path and mechanism of users' feelings regarding autonomy, competence, and relatedness generated during interactions with different gamification elements promote the continued use of mHealth apps.

Keywords: PLS-SEM; continuance intention; continued use; expectation confirmation model of information system continuance (ECM-ISC); gamification; mHealth app; self-determination theory (SDT).

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Research model.
Figure 2
Figure 2
Data inclusion and exclusion process. IP: internet protocol; mHealth: mobile health.
Figure 3
Figure 3
Analysis results of structural model. mHealth: mobile health.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. World health statistics 2020: monitoring health for the SDGs, sustainable development goals. World Health Organization. 2020. [2020-07-08]. https://apps.who.int/iris/bitstream/handle/10665/332070/9789240005105-en....
    1. Loeppke R, Edington DW, Bég Sami. Impact of the prevention plan on employee health risk reduction. Popul Health Manag. 2010 Oct;13(5):275–84. doi: 10.1089/pop.2010.0027. http://europepmc.org/abstract/MED/20879909 - DOI - PMC - PubMed
    1. Study: Wellness Programs Saved $1 to $3 per Dollar Spent. [2020-07-08]. https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/wellness....
    1. Liew MS, Zhang J, See J, Ong YL. Usability Challenges for Health and Wellness Mobile Apps: Mixed-Methods Study Among mHealth Experts and Consumers. JMIR Mhealth Uhealth. 2019 Jan 30;7(1):e12160. doi: 10.2196/12160. http://mhealth.jmir.org/2019/1/e12160/ - DOI - PMC - PubMed
    1. Kao C, Liebovitz DM. Consumer Mobile Health Apps: Current State, Barriers, and Future Directions. PM R. 2017 May;9(5S):S106–S115. doi: 10.1016/j.pmrj.2017.02.018. - DOI - PubMed

Publication types