The gamification of risk: how health apps foster self-confidence and why this is not enough

Distal and proximal factors of wearable users' quantified-self dependence: A cognitive-behavioral model

Objective

While using self-tracking devices for physical health has become ubiquitous, the potential for quantified-self (QS) dependence as a detrimental outcome for mental health is under-explored. This study examined the mechanism of wearable users' QS dependence by investigating both the distal and proximal factors based on a cognitive-behavioral model.

Methods

A total of 535 wearable users aged 18-35 years were surveyed in this study. The surveys included control variable questions related to age, gender, monthly income, BMI, and wearable use experience. Key variable measures included distal factor (habitual use of wearables), proximal factors (perceived external regulation, recognition, and perceived irreplaceability), and perceived QS dependence. Structural equation modeling (SEM) was used to test research hypotheses.

Results

The results revealed that habitual use of wearables as a distal factor alone was negatively associated with perceived QS dependence. However, it positively influenced perceived external regulation, recognition, and perceived irreplaceability, which in turn significantly contributed to perceived QS dependence, suggesting the suppression effect of the proximal factors.

Conclusions

The relationships between habitual use of wearables and QS dependence are complex. Although habitual use may seem apparently harmless, it can indirectly foster maladaptive cognitions, thereby promoting dependence. These findings underscore the potential threats of maladaptive cognitions that may arise from leveraging technology to promote physical health, thus offering guidance to technology designers for interventions.

Incorporating new ways of doing by learning from everyday experiences and interactions using a multifactorial mHealth app

Background

Digital health innovations can support the prevention and management of risk factors for cardiovascular diseases, such as stroke. However, little is known about people's everyday experiences of digitally augmented stroke-prevention programmes combining onsite group sessions including peers and healthcare professionals with interaction and support from a multifactorial mHealth app.

Objective

The aim of this study was to explore how people with stroke risk experienced interaction with a multifactorial mHealth app as support in the make my day stroke-prevention programme.

Methods

Repeated interviews and observations with 12 adults with moderate to high stroke risk were analysed using a constant comparative method informed by constructive grounded theory.

Results

Incorporating new ways of doing into everyday life involves a process through which participants learn from both being and doing in different environments (e.g., digital, physical and social). Digital self-monitoring combined with seemingly trivial everyday experiences played central roles in the process of increasing awareness of health and stroke risks, and providing tools to support increased self-reflection on everyday behaviours. Adoption of positive health behaviours in everyday life was supported or hindered by how easy to use and personally relevant the mHealth app was perceived to be.

Conclusions

An experience-based group programme together with a personally relevant multifactorial mHealth app can be supportive in stroke prevention to increase general health literacy and stroke risk literacy, and promote the incorporation of new ways of doing in everyday life. Routines of doing digital self-monitoring and health-promoting activities were however strongly influenced by different environments in which choices are presented. It is therefore important to explore how both self-monitoring and health-promoting activities can be incorporated into everyday routines for different individuals. Research should also explore how personally relevant mHealth can be developed and integrated into prevention practices in primary healthcare.

The materialities and embodiments of mundane software: exploring how apps come to matter in everyday life

Purpose

In this article, the authors aim to explore mobile apps as both mundane and extraordinary digital media artefacts, designed and promoted to improve or solve problems in people's lives. Drawing on their “App Stories” project, the authors elaborate on how the efficiencies and affordances credited to technologies emerge and are performed through the specific embodied practices that constitute human–app relationships.

Design/methodology/approach

The project involved short written accounts in an online survey from 200 Australian adults about apps. Analysis was conducted from a sociomaterial perspective, surfacing the emotional and embodied responses to and engagements with the apps; the relational connections described between people and their apps or with other people or objects; and what the apps enabled or motivated people to do.

Findings

Findings point to three salient concerns about apps: (1) the need for efficiency; (2) the importance and complexity of human relationships and maintaining these connections; and (3) the complex relationships people have with their bodies. These concerns are expressed through themes that reflect how everyday efficiencies are produced through human–app entanglements; apps as relational agents; apps' ability to know and understand users; and future app imaginaries.

Originality/value

This project explores the affective and embodied dimensions of app use and thinks through the tensions between the extraordinary and mundane dimensions of contemporary techno-social landscapes, reflecting on how apps “matter” in everyday life. Our analysis surfaces the active role of the body and bodily performances in the production of app efficiencies and underlines the ways mobile apps are always situated in relation to other media and materialities.

Use of Machine Learning to Mine User-Generated Content From Mobile Health Apps for Weight Loss to Assess Factors Correlated With User Satisfaction

IMPORTANCE

The effectiveness of mobile health (mHealth) apps for reducing obesity is not ideal in daily life. Therefore, it would be useful to explore factors associated with user satisfaction with weight loss apps. Currently, research on these factors from the perspective of user-generated content is lacking.

OBJECTIVE

To mine the themes and topics frequently discussed in user-generated content in mHealth apps for weight loss, explore correlations of the topics with user satisfaction and dissatisfaction, and assess whether these correlations were asymmetric.

DESIGN, SETTING, AND PARTICIPANTS

In this population-based cross-sectional study, unsupervised machine learning was used to identify themes and topics in online discussions generated between January 1, 2019, and May 20, 2021, by Chinese users of mHealth apps for weight loss.

MAIN OUTCOMES AND MEASURES

Based on the 2-factor theory, a tobit regression model was used to explore the correlation of various app discussion topics with user satisfaction and dissatisfaction. Differences of the coefficients in models of positive rating deviation (PD) and negative rating deviation (ND), defined as the difference between the users' rating of the app and the app's comprehensive rating in the app stores, were analyzed by the Wald test.

RESULTS

In total, 191 619 reviews and ratings from unique usernames were collected for 2139 weight loss apps; 86 423 reviews (45.1%) from 339 apps (15.8%) were included in the study. Most users (65 249 [75.5%]) were satisfied with the mHealth app. Eighteen topics were identified and summarized into 9 themes. Nine topics had significant positive correlations with the PD of user satisfaction, and 6 had significant negative correlations. The factor with the strongest positive correlation with the PD was celebrity effect (β = 0.307; 95% CI, 0.290-0.323), and the factor with the weakest correlation was economic cost (β = -0.426; 95% CI, -0.447 to -0.406). Nine topics had significant positive correlations with the ND of user satisfaction, whereas 7 topics had significant negative correlations. The factor with the strongest positive correlation with the ND was fitness effect (β = 1.369; 95% CI, 1.283-1.455), and the factor with the strongest negative correlation was economic cost (β = -2.813; 95% CI, -2.875 to -2.751). There were significant differences in the PD and ND of user satisfaction. Nine motivation factors (ie, value-added attributes) and 7 hygiene factors (ie, user-expected attributes) for mHealth apps were identified.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, 16 factors had asymmetric correlations with user satisfaction and dissatisfaction with weight loss apps; 7 were related to basic expected attributes of the apps and 9 to value-added attributes. By distinguishing between expected and value-added factors, the use of weight loss apps may be improved.

A Protocol Study to Establish Psychological Outcomes From the Use of Wearables for Health and Fitness Monitoring

Background: The last few decades people have increasingly started to use technological tools for health and activity monitoring, such as tracking apps and wearables. The main assumption is that these tools are effective in reinforcing self-empowerment because they support better-informed lifestyle decision-making. However, experimental research assessing the effectiveness of the technological tools on such psychological outcomes is limited.

Methods and Design: Three studies will be conducted. First, we will perform a systematic review to examine the experimental evidence on the effects of self-tracking apps on psychological outcome measurements. Second, we will conduct a longitudinal field experiment with a between subject design. Participants (N = 150) begin a 50-day exercise program, either with or without the aid of the self-tracking app Strava. Among those who use Strava, we vary between those who use all features and those who use a limited set of features. Participants complete questionnaires at baseline, at 10, 25, and 50 days, and provide details on what information has been tracked via the platform. Third, a subset of participants is interviewed to acquire additional qualitative data. The study will provide a rich set of data, enabling triangulation, and contextualization of the findings.

Discussion: People increasingly engage in self-tracking whereby they use technological tools for health and activity monitoring, although the effects are still unknown. Considering the mixed results of the existing evidence, it is difficult to draw firm conclusions, showing more research is needed to develop a comprehensive understanding.

Trial registration: Netherlands Trial registration: NL9402, received on 20 April 2021; https://www.trialregister.nl/trial/9402.

Ethics of Gamification in Health and Fitness-Tracking

The use of game-like elements is become increasingly popular in the context of fitness and health apps. While such “gamified” apps hold great potential in motivating people to improve their health, they also come with a “darker side”. Recent work suggests that these gamified health apps raise a number of ethical challenges that, if left unaddressed, are not only morally problematic but also have adverse effects on user health and engagement with the apps. However, studies highlighting the ethical challenges of gamification have also met with criticism, indicating that they fall short of providing guidance to practitioners. In avoiding this mistake, this paper seeks to advance the goal of facilitating a practice-relevant guide for designers of gamified health apps to address ethical issues raised by use of such apps. More specifically, the paper seeks to achieve two major aims: (a) to propose a revised practice-relevant theoretical framework that outlines the responsibilities of the designers of gamified health apps, and (b) to provide a landscape of the various ethical issues related to gamified health apps based on a systematic literature review of the empirical literature investigating adverse effects of such apps.

The Influence of Gamification and Information Technology Identity on Postadoption Behaviors of Health and Fitness App Users: Empirical Study in the United States

BACKGROUND

The use of health and fitness apps has been on the rise to monitor personal fitness and health parameters. However, recent research discovered that many users discontinue using these apps after only a few months. Gamification has been suggested as a technique to increase users' interactions with apps. Nevertheless, it is still not clear how gamification mechanisms encourage continued use and inspire user self-management.

OBJECTIVE

The main objective of this study was to articulate how gamification mechanisms in studies of designing and using health and fitness apps can contribute to the realization of information technology (IT) identity and positive behavioral outcomes. The broader goal was to shed light on how gamification mechanisms will translate into positive use behaviors in the context of mobile health apps.

METHODS

Data were collected from 364 users of health and fitness apps through an online survey to empirically examine the proposed model.

RESULTS

Based on identity theories, this study suggests the fully mediating role of IT identity to describe how gamification elements can lead to continued intention to use health and fitness apps, and increase users' tendency for information sharing through the apps. The findings indicate that perceived gamification can increase users' IT identity. In turn, a higher IT identity would encourage users to continue using the apps and share more personal health information with others through the apps.

CONCLUSIONS

The results of this study can have practical implications for app designers to use gamification elements to increase users' dependency, relatedness, and emotional energy associated with health apps. Moreover, the findings can have theoretical contributions for researchers to help better articulate the process in which gamification can be translated into positive use behaviors.

Influencing Factors of Acceptance and Use Behavior of Mobile Health Application Users: Systematic Review

Purpose/Significance: Mobile health applications provide a convenient way for users to obtain health information and services. Studying the factors that influence users’ acceptance and use of mobile health applications (apps or Apps) will help to improve users’ actual usage behavior. Method/Process: Based on the literature review method and using the Web of Science core database as the data source, this paper summarizes the relevant research results regarding the influencing factors of the acceptance and use behavior of mobile health application users and makes a systematic review of the influencing factors from the perspectives of the individual, society, and application (app or App) design. Result/Conclusion: In terms of the individual dimension, the users’ behavior is influenced by demographic characteristics and motivations. Social attributes, source credibility, and legal issues all affect user behavior in the social dimension. In the application design dimension, functionality, perceived ease of use and usefulness, security, and cost are the main factors. At the end of the paper, suggestions are given to improve the users’ acceptability of mobile health applications and improve their use behavior.

'The Internet Both Reassures and Terrifies': exploring the more-than-human worlds of health information using the story completion method

Lay people are now encouraged to be active in seeking health and medical information and acting on it to engage in self-care and preventive health practices. Over the past three decades, digital media offering ready access to health information resources have rapidly expanded. In this article, I discuss findings from my study that sought to investigate health information practices by bringing together the social research method of story completion with more-than-human theory and postqualitative inquiry. Narratives of health, illness and embodiment are powerful ways to portray people's experiences and identify the shared cultural norms and discourses that give meaning and context to these experiences. The research method of story completion is a novel approach to eliciting narratives that involve participants' responses to hypothetical situations. Participants were asked to use an online questionnaire format to complete three stories involving characters faced with a different health problem. This approach sought to identify the human and non-human enabling resources with which the characters engaged as they tried to address and resolve their problem, with a particular interest in how both digital technologies and non-digital resources were used. This analysis highlighted the affective and relational dimensions of humans' enactments of health, illness and embodiment. The stories surfaced the relations of sense-making, embodiment and care and how they are distributed between humans and non-humans. Agential capacities were closed off by elements such as too much information online creating confusion or anxiety, self-consciousness about the appearance of one's body, feelings of embarrassment and shame, or not wanting to appear to be too weak or vulnerable. Capacities for change, wellness and recovery were opened by finding helpful information, making connections with others and finding therapeutic spaces and places.

"A good little tool to get to know yourself a bit better": a qualitative study on users' experiences of app-supported menstrual tracking in Europe

Background

Menstrual apps facilitate observation and analysis of menstrual cycles and associated factors through the collection and interpretation of data entered by users. As a subgroup of health-related apps, menstrual apps form part of one of the most dynamic and rapidly growing developments in biomedicine and health care. However, despite their popularity, qualitative research on how people engaging in period-tracking use and experience these apps remains scarce.

Methods

Between June 2016 and March 2017, we conducted 26 qualitative interviews with menstrual app users living in Austria and Spain. The participants were asked about their practices and experiences regarding app-supported menstrual tracking. The interviews were audio recorded, transcribed verbatim, and coded using the software NVivo.

Results

An inductive content analysis was performed and eight characteristics of app-supported menstrual tracking were identified: 1) tracking menstrual cycle dates and regularities, 2) preparing for upcoming periods, 3) getting to know menstrual cycles and bodies, 4) verifying menstrual experiences and sensations, 5) informing healthcare professionals, 6) tracking health, 7) contraception and seeking pregnancy, and 8) changes in tracking. Our study finds that period-tracking via apps has the potential to be an empowering practice as it helps users to be more aware of their menstrual cycles and health and to gain new knowledge. However, we also show that menstrual tracking can have negative consequences as it leads to distress in some cases, to privacy issues, and the work it requires can result in cessation. Finally, we present practical implications for healthcare providers and app developers.

Conclusions

This qualitative study gives insight into users’ practices and experiences of app-supported menstrual tracking. The results provide information for researchers, health care providers and app designers about the implications of app-supported period-tracking and describe opportunities for patient-doctor interactions as well as for further development of menstrual apps.

Ambivalence in digital health: Co-designing an mHealth platform for HIV care

In reaction to polarised views on the benefits or drawbacks of digital health, the notion of 'ambivalence' has recently been proposed as a means to grasp the nuances and complexities at play when digital technologies are embedded within practices of care. This article responds to this proposal by demonstrating how ambivalence can work as a reflexive approach to evaluate the potential implications of digital health. We first outline current theoretical advances in sociology and organisation science and define ambivalence as a relational and multidimensional concept that can increase reflexivity within innovation processes. We then introduce our empirical case and highlight how we engaged with the HIV community to facilitate a co-design space where 97 patients (across five European clinical sites: Antwerp, Barcelona, Brighton, Lisbon, Zagreb) were encouraged to lay out their approaches, imaginations and anticipations towards a prospective mHealth platform for HIV care. Our analysis shows how patients navigated ambivalence within three dimensions of digital health: quantification, connectivity and instantaneity. We provide examples of how potential tensions arising through remote access to quantified data, new connections with care providers or instant health alerts were distinctly approached alongside embodied conditions (e.g. undetectable viral load) and embedded socio-material environments (such as stigma or unemployment). We conclude that ambivalence can counterbalance fatalistic and optimistic accounts of technology and can support social scientists in taking-up their critical role within the configuration of digital health interventions.

The Datafication of Health

Over the past decade, data-intensive logics and practices have come to affect domains of contemporary life ranging from marketing and policy making to entertainment and education; at every turn, there is evidence of “datafication” or the conversion of qualitative aspects of life into quantified data. The datafication of health unfolds on a number of different scales and registers, including data-driven medical research and public health infrastructures, clinical health care, and self-care practices. For the purposes of this review, we focus mainly on the latter two domains, examining how scholars in anthropology, sociology, science and technology studies, and media and communication studies have begun to explore the datafication of clinical and self-care practices. We identify the dominant themes and questions, methodological approaches, and analytical resources of this emerging literature, parsing these under three headings: datafied power, living with data, and data–human mediations. We conclude by urging scholars to pay closer attention to how datafication is unfolding on the “other side” of various digital divides (e.g., financial, technological, geographic), to experiment with applied forms of research and data activism, and to probe links to areas of datafication that are not explicitly related to health.