<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Archiving and Interchange DTD v1.0 20120330//EN" "JATS-archivearticle1.dtd">
<article xmlns:xlink="http://www.w3.org/1999/xlink">
  <front>
    <journal-meta />
    <article-meta>
      <title-group>
        <article-title>Dynamic Text Messaging in a Persuasive Gaming Environment to Promote Participation in Self-Tracking of Health Status</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Yong-Xiang Chen</string-name>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Hsin-Wen Liang</string-name>
          <xref ref-type="aff" rid="aff1">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Pin-Hsin Lin</string-name>
          <xref ref-type="aff" rid="aff1">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Jui-Chun Hsia</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Chia-Hao Chang</string-name>
          <xref ref-type="aff" rid="aff1">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Chen-Yu Wang</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Yi-Ping Hung</string-name>
          <email>hung@csie.ntu.edu.tw</email>
        </contrib>
        <aff id="aff0">
          <label>0</label>
          <institution>Department of Computer Science and Information Engineering, National Taiwan University</institution>
          ,
          <addr-line>Taipei</addr-line>
          ,
          <country country="TW">Taiwan</country>
        </aff>
        <aff id="aff1">
          <label>1</label>
          <institution>Graduate Institute of Network and Multimedia, National Taiwan University</institution>
          ,
          <addr-line>Taipei</addr-line>
          ,
          <country country="TW">Taiwan</country>
        </aff>
        <aff id="aff2">
          <label>2</label>
          <institution>IoX Center, National Taiwan University</institution>
          ,
          <addr-line>Taipei</addr-line>
          ,
          <country country="TW">Taiwan</country>
        </aff>
      </contrib-group>
      <fpage>28</fpage>
      <lpage>37</lpage>
      <abstract>
        <p>Numerous researchers have described the importance of self-tracking one's daily life in the pursuit of a goal. However, many people are unable to maintain such a regimen. In this study, we sought to resolve this problem by making the process of self-tracking more fun and attractive. We investigate the effectiveness of three encouragement systems on influencing individuals to participate in an e-Diary system used to record health status. The three systems were: “self-tracking promoting message (SPM) only,” “self-tracking promoting message (SPM) + individual game,” and “game promoting message (GPM) + social game.” Our results revealed 328% improvement in participation performance (compared with baseline) associated with messages aimed at promoting participation in the social game. Qualitative analysis of the interviews helped to explain these results. We proposed the integration approach of dynamic text messages and social gaming to modify behavior. We believe that assigning one individual to send game promoting messages every day was key to the persuasive power of the social game, and then this persuasive power will contribute to target behavior.</p>
      </abstract>
      <kwd-group>
        <kwd>Dynamic Text Message</kwd>
        <kwd>Social Game</kwd>
        <kwd>Self-tracking</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>-</title>
      <p>
        Numerous researchers have described the importance of self-tracking one’s daily
habits in the pursuit of a goal. For example, Helsel. et al. reported that self-tracking
behavior makes the process of losing weight more efficient [
        <xref ref-type="bibr" rid="ref1">1</xref>
        ]. However, many
people are unable to maintain such a regimen, particularly when using a paper diary. In
contrast, e-diary systems have gained considerable popularity for use in recording
food intake, medication, and physical activities. Despite advances in sensing
technology, some types of subjective data must be input manually, such as sleep satisfaction
and one’s mood or goals. Many people are unable to maintain the discipline required
for self-tracking activities [
        <xref ref-type="bibr" rid="ref2">2</xref>
        ]. In this study, we sought to resolve this problem by
making the process of monitoring more fun.
      </p>
      <p>
        Previous researchers have suggested the use of persuasive tools, such as text
messages, to make self-tracking more enjoyable [
        <xref ref-type="bibr" rid="ref3">3</xref>
        ]. In this study, we adopted dynamic text
messaging as a means of reminding participants to input self-tracking data. We also
assigned one individual (the leader) to send text messages manually every day, and
each individual responded with messages that were visible to the entire group. Ross et
al. described the benefits of yoga in improving one’s health [
        <xref ref-type="bibr" rid="ref4">4</xref>
        ]. In this study, we
applied the proposed system to encourage participants to engage in self-tracking.
2
      </p>
    </sec>
    <sec id="sec-2">
      <title>Method</title>
      <p>The purpose of this study was to investigate the effectiveness of three encouragement
systems on influencing individuals to participate in an e-Diary system used to record
health status. The three systems were as follows: “self-tracking promoting message
(SPM) only,” “self-tracking promoting message (SPM) + individual game,” and
“game promoting message (GPM) + social game.” Self-tracking data was stored in
the participant’s smart phone prior to processing and synchronization on a system
server. The obtained data was used in quantitative as well as qualitative analysis.
2.1</p>
      <sec id="sec-2-1">
        <title>Win-Win a Diary</title>
        <p>We developed an e-diary app named Win-Win a Diary (WWaD), which prompts the
user to answer questions pertaining to their health status. After the questions are
answered, the app uploads data related to participation performance to a server via the
internet. WWaD can also be configured to send a notification to remind users to fill in
WWaD twice a day. The questions used in the experiment are listed in Table 1. The
answers include the recording of input times (e.g. 9:30 pm) and multiple choices
answers (e.g. my mood is “very good” now). Participants were required to spend only
35 minutes filling in WWaD each day.
2.2</p>
      </sec>
      <sec id="sec-2-2">
        <title>Win-Win a Game</title>
        <p>We developed a mobile game called Win-Win a Game (WWaG), which is based on
raising a virtual pet. The game can be played in either individual or a social version.
WWaG divides the growth of the virtual bird into three stages: egg, chick, and adult.
In the individual version, participants feed the bird by navigating through a virtual
world in which the location of rice (bird food) is indicated on a map. Figure 1 presents
a screenshot of WWaG. Participants try to derive the optimal path through the game
in order to improve their scores. Virtual gardening tools, which are obtained by
completing the self-tracking questions, are used to redistribute rice on the game world in
order to increase yield. The number of gardening tools that a participant obtains
corresponds to their participation in filling out the questions. The chicks hatch from the
eggs to become adult birds (nine varieties) when participants reach a score threshold.
Figure 2 presents a screenshot showing a list of the adult birds, referred to as the bird
index (birdex). Participants are able to raise two adult birds each week as long as they
complete the self-tracking system every day.</p>
        <p>The social version of the game includes elements of intra-team cooperation and
teamto-team competition in the form of a leader board, virtual treasure, and team
chatroom. We listed the score and ranking of participants on the leader board and posted
the average score of the entire team at the top of the leader board. Participants can
also obtain information pertaining to the location of treasure as long as they complete
their self-tracking requirements each day. The treasure is automatically assigned by
the system to a nearby area in the game world of their teammates. The chatroom is
used to notify teammates of the treasure location, thereby developing cooperation,
with one team member passing on the location of the treasure and the other one
digging it up. Figure 3 presents the structure of the individual game and social versions
of the game.
Previous researchers have investigated the influence of dynamic text messages that
present different content everyday with the aim of conveying eight types of message:
messages that reduce barriers, pros and cons lists, public testimonies, rewards and</p>
        <p>
          Message Type
Remind participants that a new week is
starting
Motivation
encouragement, moti-vational messages, personal testimonies, information, and time
man-agement tips [
          <xref ref-type="bibr" rid="ref3">3</xref>
          ].
        </p>
        <p>In this study, we invited four club staff members to act as leaders in manually sending
text messages to the participants (in accordance with guidelines set out by
researchers) once an evening. One type of message was meant to promote self-tracking,
whereas the others were meant to promote game play. Sample messages are listed in
Tables 2 and 3.
Every race begins with the first step! Run and
fill in your WWaD now!
Yoga helps to stabilize your mood. Try to pay
attention to and record the emotions before
and after each practice.</p>
        <p>Six members have filled in WWaD.
Congratulations! Keep it up!
Complete your WWaD requirements
immediately when you see the message so that you
won’t forget.</p>
        <p>The aim of meditation is to become
"mindful." Meditating with your eyes closed calms
you more effectively.</p>
        <p>Observe your mood changes on WWaD and
ask your partners if they aware of their own
changes.
2.4</p>
      </sec>
      <sec id="sec-2-3">
        <title>Subjects and procedures</title>
        <p>Participants who did not have the habit of practicing yoga regularly and self-tracking
themselves were recruited from the Kundalini Yoga Club of National Taiwan
University (NTU). After describing the experiment to members, new recruits signed a
content form. The 25 participants were divided into four groups de-pending on baseline
test results over a period of two weeks, as follows: social game (two groups – 6
participants on the red team and 6 partic-ipants on the white team), individual game (one
group – 7 participants), and no-game (one group – 6 participants). The experiment
was conducted in three stages. In the first stage (baseline stage), participants installed
the e-diary WWaD app (developed in our lab) on their smartphones and used it
without WWaG for two weeks (also without receiving dynamic text messages). In the
second stage, we assigned participants to use the WWaD in conjunction with one
version of WWaG for four weeks. In the last stage, we interviewed the partici-pants
using predefined semi-structured questions (30 minutes) to de-rive their experience
using WWaD and WWaG. A total of 20 partici-pants completed the experiment, for
which they were compensated $25.</p>
        <p>Group(participants)</p>
        <p>SPM only
(initial:6;dropped:2)
SPM + Individual game
( initial:7;dropped:2)</p>
        <p>GPM + Social game
( initial:6+6;dropped:0+1)
All of the experiment data were collected using a server. We also recorded the
interviews with the participants. The transcripts were later analyzed by three research team
members, wherein interview data was separated into message-related and
gamerelated data before summarizing the findings.
3</p>
      </sec>
    </sec>
    <sec id="sec-3">
      <title>Results</title>
      <p>We collected a total of 20*28*7 = 3920 data points pertaining to self-tracking status.
And the filling rate is calculated as “weekly filling rate = weekly total filling
questions / weekly total questions”. In the following, we present quantitative as well as
qualitative results.
3.1</p>
      <sec id="sec-3-1">
        <title>Quantitative results</title>
        <p>
          Our results determined a 328% improvement in participation performance (compared
with everyone’ filling rate in baseline stage of social game group) associated with
messages aimed at promoting participation in the social game.
We observed a 22% improvement among players participating in the individual game
who were sent messages to encourage participation in self-tracking. We did not
observe any improvement among individuals receiving only messages aimed at
promoting participation in the self-tracking app. In fact, we actually observed a 99% decrease
in the participation of these individuals by the end of the study period. Table 5
presents the results of participation performance in the various groups, which differ from
the results in [
          <xref ref-type="bibr" rid="ref5">5</xref>
          ], in which researchers reported no improvement when a social game
was included. Qualitative analysis of the interviews helped to explain these results.
Despite a small sample size, our quantitative results revealed that the social game and
game promoting messages improved the performance of participants with regard to
maintaining the habit of using WWaD .
        </p>
        <p>In the third stage, we conducted a 30-minute interview with each participant to collect
their views regarding the use of the proposed system. The responses of participants
support the above results.
3.2</p>
      </sec>
      <sec id="sec-3-2">
        <title>Qualitative results</title>
        <p>Qualitative data was analysed in order to reveal the reasons for the quantitative results
we obtained.</p>
      </sec>
      <sec id="sec-3-3">
        <title>SPM only.</title>
        <p>Participants in this group received only messages encouraging participants to fill in
self-tracking data. In the interviews, the participants reacted favourably to all
messages, which they described as attractive and unobtrusive, due to their brevity.
Participants also reported a sense of expectation concerning the dynamic text messages
because the messages send a positive content. Nonetheless, it appears that the messages
did not maintain their persuasive effect for long time. For example, P12 mentioned
that although she really liked the messages, she still tended to forget to use the app.</p>
      </sec>
      <sec id="sec-3-4">
        <title>SPM + individual game.</title>
        <p>Participants in this group used WWaD as well as the solitaire game version of
WWaG. Again, they received only messages aimed at promoting participation in
filling self-tracking data. P9 found the individual version of the game somewhat dull due
to the fact that was unable to share her achievements with others on WWaG.
Nonetheless, she said that she was still willing to play WWaG in the future because she likes
the virtual birds and is curious about those that she did not collect during the
experiment. P4 found the game rules easy to follow but would prefer to see the birds he
collected in the game itself instead of having to use Birdex. P19 reported enjoying
WWaG.</p>
      </sec>
      <sec id="sec-3-5">
        <title>GPM + social game .</title>
        <p>Most of the participants in this group reported that messages aimed at prompting
game play were immediately effective. Furthermore, the rules of the social version of
WWaG also prompted them to participate in the use of WWaD. P16 reported feeling
like a member of a team when she received messages. P7 described feeling motivated
when she received messages. It also appears that the games enhanced their sense of
responsibility with regard to cooperating with teammates in the competition. P1
reported that she had spent too much time playing games in the past, such that she was
not particularly interested in the game at first. Nonetheless, that she did not want to be
the weak link and hoped to make a contribution to her team. Ultimately, she found
that playing WWaG did not take up too much of her time. P8 reported playing
seriously only because she wanted to win the competition. P10 claimed that he would
report the location of virtual treasures immediately because he hoped his teammates
would be able to score in time.
4</p>
      </sec>
    </sec>
    <sec id="sec-4">
      <title>Discussion</title>
      <p>Our results revealed that sending self-tracking promoting messages alone was
ineffective; however, this result may have been due to the small sample size. Nonetheless,
the game-playing groups presented notable improvements in participation
performance, indicating the persuasion potential of this type of game. The progress made by
players in the game could be the topic of messages aimed at motivating players. For
example, “Today, we are getting close to team BB. Let’s work together to pass them
tomorrow!” We determined that dynamic text messages aimed at game promotion
were particularly effective in promoting cooperation and competition and that these
effects were mutually beneficial. Figure 4 illustrates how dynamic text messages and
games could be designed and integrated to maximize their persuasive capability.
These experiments were conducted in collaboration with Kundalini Yoga Club of
NTU, which meant that the participants already met at a weekly yoga class and were
therefore familiar with each other. In the interviews, participants in the social game
groups claimed that their familiarity with the other participants induced in them a
sense of responsibility for the group. As a result, even the participants who were
disinterested in the game itself were more likely to participate in the game and maintain
their self-tracking system. In contrast, the familiarity with other participants was of no
benefit to individuals in the non-game group and the individual game group. From
this we can infer that face-to-face encounters increase familiarity among members;
however, familiarity is not necessarily sufficient to influence individuals in
performing the target behavior.</p>
      <p>
        The social game was shown to leverage a sense of responsibility, which proved highly
effective in altering the behavior of participants. This suggests that social games could
be particularly effective in situations where the subjects have an opportunity to meet.
Mutsuddi et al. reported that dynamic text messages improved the performance of
participants in their experiment [
        <xref ref-type="bibr" rid="ref3">3</xref>
        ]. However, in our experiment we believe that
assigning one individual to send game-related messages every day was key to the
persuasive power of the game. Overall, messages directly prompting participation in the
WWaD did not bring large improvement, whereas those associated with gameplay
proved highly effective.
This paper outlines a novel approach to persuading individuals to maintain a regimen
of recording their progress in practicing yoga by combining dynamic text messages
within the context of a social game. Participants from an actual yoga club were asked
to follow an exercise regimen and keep track of their results. Despite a small sample
size, our results suggest that this approach is quite effective. We organized an
intergroup game with a leader tasked with sending game promoting messages to persuade
participants to engage in the game. Future researchers could increase the sample size
and extend the duration of the experiment. To overcome the difficulties involved in
assigning group leaders to send messages every day, a system module could also be
developed to enable the automatic forwarding of messages from a central database.
      </p>
    </sec>
    <sec id="sec-5">
      <title>Acknowledgments</title>
      <p>This research was supported in part by the Ministry of Science and Technology of
Taiwan (MOST 103-2218-E-002-025-MY3 and MOST-103-2811-E-002-040).</p>
    </sec>
  </body>
  <back>
    <ref-list>
      <ref id="ref1">
        <mixed-citation>
          1.
          <string-name>
            <surname>Helsel</surname>
            ,
            <given-names>D.L.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Jakicic</surname>
            ,
            <given-names>J.M.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Otto</surname>
            ,
            <given-names>A.D.</given-names>
          </string-name>
          :
          <article-title>Comparison of Techniques for Self-Monitoring Eating and Exercise Behaviours on Weight Loss in a Correspondence-Based Intervention</article-title>
          .
          <source>Journal of the American Dietetic Association</source>
          <volume>107</volume>
          (
          <issue>10</issue>
          ),
          <fpage>1807</fpage>
          -
          <lpage>1810</lpage>
          (
          <year>2007</year>
          ).
        </mixed-citation>
      </ref>
      <ref id="ref2">
        <mixed-citation>
          2.
          <string-name>
            <surname>Li</surname>
            ,
            <given-names>I.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Dey</surname>
            ,
            <given-names>A.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Forlizzi</surname>
            ,
            <given-names>J.:</given-names>
          </string-name>
          <article-title>A Stage-Based Model of Personal Informatics Systems</article-title>
          .
          <source>In: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems. ACM</source>
          , pp.
          <fpage>557</fpage>
          -
          <lpage>566</lpage>
          (
          <year>2010</year>
          ).
        </mixed-citation>
      </ref>
      <ref id="ref3">
        <mixed-citation>
          3.
          <string-name>
            <surname>Mutsuddi</surname>
            ,
            <given-names>A.U.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Connelly</surname>
            ,
            <given-names>K.</given-names>
          </string-name>
          :
          <article-title>Text Messages for Encouraging Physical Activity</article-title>
          .
          <source>In: Proceedings of the 6th international conference on pervasive computing technologies for healthcare (Pervasive Health</source>
          <year>2012</year>
          ) pp.
          <fpage>33</fpage>
          -
          <lpage>40</lpage>
          . IEEE,
          <string-name>
            <surname>United States</surname>
          </string-name>
          (
          <year>2012</year>
          ).
        </mixed-citation>
      </ref>
      <ref id="ref4">
        <mixed-citation>
          4.
          <string-name>
            <surname>Ross</surname>
            ,
            <given-names>A.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Thomas</surname>
            ,
            <given-names>S.</given-names>
          </string-name>
          ,:
          <article-title>The Health Benefits of Yoga and Exercise: A Review of Comparison Studies</article-title>
          .
          <source>The journal of alternative and complementary medicine 16(1)</source>
          ,
          <fpage>3</fpage>
          -
          <lpage>12</lpage>
          (
          <year>2010</year>
          ).
        </mixed-citation>
      </ref>
      <ref id="ref5">
        <mixed-citation>
          5.
          <string-name>
            <surname>Lin</surname>
            ,
            <given-names>J.J.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Mamykina</surname>
            ,
            <given-names>L.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Lindtner</surname>
            ,
            <given-names>S.</given-names>
          </string-name>
          ,
          <string-name>
            <surname>Delajoux</surname>
            ,
            <given-names>G.</given-names>
          </string-name>
          ,
          <article-title>: Fish'n'Steps: Encouraging Physical Activity with an Interactive Computer Game</article-title>
          .
          <source>In: Proceedings of the 8th international conference on Ubiquitous Computing</source>
          , pp.
          <fpage>261</fpage>
          -
          <lpage>278</lpage>
          . Springer, Berlin (
          <year>2006</year>
          ).
        </mixed-citation>
      </ref>
    </ref-list>
  </back>
</article>