NOT QUITE PLAYING THE GAME?
MOBILE APPLICATIONS FOR
HEALTHIER LIFESTYLES
Electronic games & Apps
• Increase in popularity
2005 : $10 billion p.a. (Susi, Johannesson, & Backlund, 2007);
2012: $25 ...
Serious gaming
“… purpose in changing knowledge, beliefs,
attitudes and behaviours, solving problems or
building competenc...
Breadth of “Serious Gaming"
Serious Games overall
(Breuer & Bente, 2010)
Health-related serious
games (Susi, et al., 2007)...
• Evidence of success
Rehabilitation (de Wit-Zuurendonk & Oei, 2011)
Disease management (Thompson et al., 2010)
• But not ...
Literature Criticisms
• fragmented, lacking in coherence regarding
theoretical underpinnings (Boyle, Connolly, & Hainey, 2...
Purpose
1. reviewing the range of theoretical
frameworks claimed to be in use in the
serious games sector
2. contrasting t...
Theory Overview Author
Theory of Planned Behaviour Proposes that attitudes, perceived behavioural
control and social norms...
• merely listing features rather than presenting coherent
predictive models (Boyle, et al., 2011)
Common also to wider beh...
Design Principles
• Like the theoretical frameworks, design
principles are equally fragmented
Persuasive Strategy Descript...
Methodologogy
1. five apps developed by the National Health
Service (NHS) in the UK
2. five top-selling, commercially avai...
AppName
BMITracker
Smokefree
Moodometer
DrinksTracker
Fungenerator
5KRunner
Myplate
iFitness
Caloriecount
DrinkInMyHand
St...
Livestrong vs NHS (Reduction)
iFitness vs NHS Drinks (Self-
Monitoring)
iFitness vs NHS Drinks (Self-
Monitoring)
Suggestion
Surveilance
Future directions
• identify health behaviour app providers and
investigate what theory or combinations of
theories used i...
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Mobile Applications for Healthier Lifestyles: Not quite playing the game?

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Paper presented at the 2013 World Marketing Congress (Melbourne), focusing on the use of mobile “app”-based interventions as tools to influence health-related behaviour. We use established design criteria to review a range of current apps developed by one public body, the UK NHS and commercial developers of health-related apps and compare these to commercial apps promoting unhealthy food items. We suggest that there are serious weaknesses evident in the apps provided by public bodies and that this sector could learn from an analysis of the development strategies used in the commercial sector. The full paper is available in the proceedings.

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Transcript of "Mobile Applications for Healthier Lifestyles: Not quite playing the game?"

  1. 1. NOT QUITE PLAYING THE GAME? MOBILE APPLICATIONS FOR HEALTHIER LIFESTYLES
  2. 2. Electronic games & Apps • Increase in popularity 2005 : $10 billion p.a. (Susi, Johannesson, & Backlund, 2007); 2012: $25 billion p.a. (Entertainment Software Association, 2012). • Limited effectiveness of traditional channels, => “apps” becoming increasingly important as a new channel • phones are nearly always with their users (Andrew, Borriello, & Fogarty, 2007) • bridge between online and offline worlds (Lathia, 2012).
  3. 3. Serious gaming “… purpose in changing knowledge, beliefs, attitudes and behaviours, solving problems or building competencies” (de Wit-Zuurendonk & Oei, 2011; Göbel, Hardy, Wendel, Mehm, & Steinmetz, 2010; Hummel et al., 2011) “persuasive games” (Khaled, Barr, Noble, Fischer, & Biddle, 2007) “gamification” (Groh, 2012)
  4. 4. Breadth of “Serious Gaming" Serious Games overall (Breuer & Bente, 2010) Health-related serious games (Susi, et al., 2007) Military Exergames (physical activity and exercise) Governmental Health education Educational Biofeedback Corporate Therapy Healthcare Political Religious Art
  5. 5. • Evidence of success Rehabilitation (de Wit-Zuurendonk & Oei, 2011) Disease management (Thompson et al., 2010) • But not automatic simply presenting material in a game-like setting is insufficient (Breuer & Bente, 2010) enthusiasm for wanes in a short time period (Baranowski, Baranowski, O'Connor, Lu, & Thompson, 2012)
  6. 6. Literature Criticisms • fragmented, lacking in coherence regarding theoretical underpinnings (Boyle, Connolly, & Hainey, 2011) • small sample sizes, short time periods and inconsistent success measures (Baranowski, et al., 2008; Biddiss & Irwin, 2010; Woodruff, Hasbrouck, & Augustin, 2008) • conclusions being presented that “cannot be considered valid evidence to support or refute efficacy” (Kato, 2012 : 74).
  7. 7. Purpose 1. reviewing the range of theoretical frameworks claimed to be in use in the serious games sector 2. contrasting the design principles used by serious (health-related) and commercial games delivered via mobile apps.
  8. 8. Theory Overview Author Theory of Planned Behaviour Proposes that attitudes, perceived behavioural control and social norms are important predictors of behavioural intentions (Boyle, et al., 2011; Kharrazi, Faiola, & Defazio, 2009; Lu, Baranowski, Thompson, & Buday, 2012) Self- determination Theory Explains motives for playing games, including needs for competence and autonomy, together with the reduction of differences between the ideal self and actual self. The theory also acknowledges the impact of social environments on behaviour. (Deci & Ryan, 2008; Lu, et al., 2012; Lynch, La Guardia, & Ryan, 2009; Przybylski, Weinstein, Murayama, Lynch, & Ryan, 2012) Uses and gratification theory Explains technology use in everyday life. (Kamal, Fels, Blackstock, & Ho, 2011) Flow theory Immersion in tasks, together with channeling and energising emotions and learning results in enjoyment and fulfillment. In the serious games context, the need for clear goals, direct feedback, self-efficacy and control are acknowledged. (Pavlas, Heyne, Bedwell, Lazzara, & Salas, 2010) Multiple Identity Theory Players identify with games at affective, cognitive and behavioural levels, resulting in positive alternations to attitudes and thus behaviours. (Christenson et al., 2012; Williams & Williams, 2011) Health Belief Model Attempts to explain and predict behaviours by focusing on attitudes and beliefs, assuming a rational weighing up of perceived risk against likelihood of alternative outcomes from behaviour change. Accepts that knowledge alone is insufficient to change behaviours. (Brox, et al., 2011; Peng & Schoech, 2008) Transtheoretical Model Explains behaviour change as a progression of stages from lack of knowledge about a behaviour and its impact, through to sustained behaviour change. (Lin, Mamykina, Lindtner, Delajoux, & Strub, 2006; Ross & Tomlinson, 2011; Shegog, 2010) (Brox, et al., 2011 Social Cognitive Theory Describes the reciprocal and interacting influences of personal, environmental and behavioural factors and includes learning from past and current behaviours and from observing the behaviour of others. (Annetta & Bronack, 2011; Lu, et al., 2012)
  9. 9. • merely listing features rather than presenting coherent predictive models (Boyle, et al., 2011) Common also to wider behaviour change literature (Michie & Prestwich, 2010) • We were unable to locate – any discussion of how the cited theories were used – nor a systematic comparative analysis different theories across a range of behavioural tasks and population segments. • Further… – several assume a direct link between attitudes and behavioural intentions > ignoring attitude-behaviour gap (Sniehotta, Scholz, & Schwarzer, 2005). – focuses on games in isolation (Osorio, Moffat, & Sykes, 2012).
  10. 10. Design Principles • Like the theoretical frameworks, design principles are equally fragmented Persuasive Strategy Description Reduction Making a complex task simpler Tunnelling Guided persuasion; giving control over to an expert Tailoring Customization; providing more relevant information to individuals Suggestion Intervene at the right time with a compelling suggestion Self-monitoring Automatically tracking desired behaviour Surveillance Observing one’s behaviour publicly Conditioning Reinforcing target behaviour based on Andrew, Borriello, Fogarty, 2007
  11. 11. Methodologogy 1. five apps developed by the National Health Service (NHS) in the UK 2. five top-selling, commercially available apps for similar health behaviour outcomes, 3. five commercial apps not related to health outcomes: three apps for unhealthy food items (one each from alcohol, soft-drinks and fast-food category respectively) top two free games (all categories, UK iTunes store).
  12. 12. AppName BMITracker Smokefree Moodometer DrinksTracker Fungenerator 5KRunner Myplate iFitness Caloriecount DrinkInMyHand Stella9Step FantaKingofthePark McDonald'sMorning FamilyFortune TheSimpsons Category NHS NHS NHS NHS NHS Commercial Commercial Commercial Commercial Commercial Alcohol SoftDrink FastFood Game Game Reduction × × × × × ✓ ✓ ✓ ✓ ✓ ✓ × × ✓ ✓ Tunnelling ✓ ✓ × ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ × ✓ × × Tailoring ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ Suggestion × ✓ × × ✓ ✓ ✓ × ✓ × ✓ ✓ ✓ ✓ ✓ Self- monitoring ✓ × ✓ ✓ × ✓ ✓ ✓ ✓ ✓ × ✓ ✓ ✓ ✓ Surveillance × × × × × ✓ ✓ × ✓ ✓ ✓ ✓ × ✓ ✓ Conditioning × × × × × ✓ ✓ × ✓ ✓ ✓ ✓ ✓ ✓ ✓ No of Strategies 3 3 2 3 3 7 7 4 7 6 6 5 5 6 6
  13. 13. Livestrong vs NHS (Reduction)
  14. 14. iFitness vs NHS Drinks (Self- Monitoring)
  15. 15. iFitness vs NHS Drinks (Self- Monitoring)
  16. 16. Suggestion
  17. 17. Surveilance
  18. 18. Future directions • identify health behaviour app providers and investigate what theory or combinations of theories used in planning the apps • investigate whether, and in what way, age, gender and cultural factors impact on the way games are perceived • evaluate apps as ‘stand-alone’ devices versus part of multi-component interventions: This will require transdisciplinary approaches to the development of appropriate evaluation systems

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