Playing alone: can game design elements satisfy user needs in gamified mHealth services?

Chronic health conditions have necessitated the need for behavioral interventions (such as exercise programs) outside of clinical contexts, increasingly managed through technology such as mobile health (mHealth) services. Gamification has emerged as a promising tool to facilitate greater engagement in these services; however, no studies investigate the links between specific game design elements (GDEs) and psychological or behavioral outcomes within a health context. This domain is motivationally complex and has shown resistance to the satisfaction of social (relatedness) needs, presenting a challenge to the design of gamification products for health promotion. Drawing on self-determination theory, this research demonstrates the strengths of a taxonomy based upon structural features of GDEs (such as social, narrative or reward elements) rather than the design intent definitions of these elements used in previous studies. This taxonomy is then used to assess the relationship between GDEs and psychological needs satisfaction in a survey (N = 236) of gamified exercise/fitness application users. Further qualitative interviews (N = 20) were conducted to clarify survey findings. This research demonstrates the positive association between control and presentation elements and autonomy satisfaction, and control and reward elements and competency satisfaction. However, it also suggests that player type and context may limit the ability for GDEs alone to support relatedness satisfaction in mHealth services. Implications for managers and researchers are discussed, particularly the strengths and weaknesses of using structural taxonomies in gamification assessment.