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  <front>
    <journal-meta />
    <article-meta>
      <title-group>
        <article-title>A Theory-Driven System Model to Promote Physical Activity in the Working Environment with a Persuasive and Gamified Application</article-title>
      </title-group>
      <contrib-group>
        <aff id="aff0">
          <label>0</label>
          <institution>Md Sanaul Haque Timo Jämsä Maarit Kangas Research Unit of Medical Research Unit of Medical Research Unit of Medical Imaging, Physics and Technology Imaging, Physics and Technology Imaging, Physics and Technology University of Oulu University of Oulu University of Oulu Oulu, Finland Medical Research Center Oulu Medical Research Center Oulu</institution>
        </aff>
      </contrib-group>
      <pub-date>
        <year>2017</year>
      </pub-date>
      <abstract>
        <p />
      </abstract>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>-</title>
      <p>Physical activity (PA) is important to prevent
and lessen the risks of various diseases as well
as progress in physical and mental health.
Employees expend a lot of time at their
workplace such as office environment.</p>
      <p>Working efficiency may be harmfully affected
if the worker is physically inactive. The
purpose of this study was to design a system
model to guide employees at their workplace
on their PA promotion. We propose a system
model integrating the psychological theory
known as Self-determination Theory (SDT)
which indicates that people can be motivated
extrinsically through the fulfilment of three
psychological needs: autonomy, competence,
and relatedness. To do this, game elements
such as points, badges and leaderboard were
applied into the system model. We utilized the
system model to design a gamified persuasive
application. We developed a prototype of PA
promotion app using the User-Centered Design
(UCD) process. We conducted UCD iteration
and pilot-tested the prototype of an app with
end users. They used the prototype of an app to
perform some activities e.g. walking after
breakfast and lunch hour. We found that it
brings a positive impact on the employees in
promoting their PA in their workplace. The
Copyright © by the paper’s authors. Copying permitted only for private
and academic purposes.
result of the study will be used to build an
actual persuasive application with gamification
techniques.</p>
    </sec>
    <sec id="sec-2">
      <title>1 Introduction</title>
      <p>
        Recently, persuasive applications, targeted at changing
behaviors, have become well-known and popular in
health domain [
        <xref ref-type="bibr" rid="ref1">1</xref>
        ]. Persuasion is one of the most
effective tools to support change behaviour [
        <xref ref-type="bibr" rid="ref2">2</xref>
        ].
Persuasive Technology has been proposed as an actual
method to encourage behaviour change and it has a
potential for improving health-related quality of life [
        <xref ref-type="bibr" rid="ref3">3</xref>
        ].
Thus, by using PA promotion application it might be
possible to increase work productivity and to improve
weight management. To design persuasive applications,
researchers use game design elements in non-game
contexts as an effective technique to encourage
employees to achieve their goals. Gamification is an
effective catalyst to persuade individuals submissive to
roles [
        <xref ref-type="bibr" rid="ref4 ref5">4-5</xref>
        ]. Furthermore, persuasive technology and
gamification research share common ground with
respect to the psychological factors [
        <xref ref-type="bibr" rid="ref6">6</xref>
        ].
      </p>
      <p>
        In recent times, persuasive applications have been
designed for psychological influence. E.g. goals and
feedback was applied in a mobile phone app to promote
PA among young adults [
        <xref ref-type="bibr" rid="ref7">7</xref>
        ]. Rewards, feedback and
goal setting have been used in a smartphone application
to increase PA among the patients [
        <xref ref-type="bibr" rid="ref8">8</xref>
        ]. Health Month [
        <xref ref-type="bibr" rid="ref9">9</xref>
        ]
is an application in which game elements (points and
badges etc.) have been used to inspire users to select
rubrics for health-related behavior for one month. Users
can win or lose points based on those rubrics and receive
inspiration via a social platform. However, research has
shown diminutive evidence about gamified systems e.g.
persuasive application for PA promotion in the working
environment. Gethealthapp [
        <xref ref-type="bibr" rid="ref10">10</xref>
        ] is an intuitive mobile
application for employees and an online dashboard for
employers allowing effective tracking and management
of their wellness programs. Employees use the
application to check their daily health tasks, such as
move, munch, and mind. The move is like PA, munch is
to eat well and mind is to keep one’s mind calm like
napping. The mobile application uses gamified methods
such as it gives the employees to gain rewards as points
and leaderboard of friends and colleagues. Recent
research revealed methodological limitations in
gamified systems – “proper psychometric
measurements, absence of motivational affordance,
psychological and behavioural outcomes” [
        <xref ref-type="bibr" rid="ref11">11</xref>
        ]. Our
project deliberates theoretical constructs using the game
mechanism, UCD process and implementing our
application. The main purpose of this study is to answer
the key research question:
      </p>
      <p>Can we incorporate a psychological concept in
designing a gamified system model for employees’ PA
promotion in the working environment?</p>
      <p>
        To answer the research question, the previously
established SDT was selected because it brings the
capability to support individual’s behaviour to offer
reinforcement by the three psychological needs known
as autonomy, competence, and relatedness. We present
a system model by using these psychological needs
inclined by autonomy support to encourage the
employees in their PA promotion in their working
environment. Previous research has indicated that
applications which are developed focused on the users’
models are more likely to have effectiveness than those
applications which are not focused on users’ models
[
        <xref ref-type="bibr" rid="ref12">12</xref>
        ]. Therefore, we applied our proposed system model
to design a gamified persuasive application using the
UCD process. Our system model is grounded on the
Ryan’s SDT theory model of physical activity
behavioural change [
        <xref ref-type="bibr" rid="ref13">13</xref>
        ].
      </p>
    </sec>
    <sec id="sec-3">
      <title>2 Literature Review</title>
      <sec id="sec-3-1">
        <title>2.1 Motivation</title>
        <p>
          Two motivational approaches are accepted by the
human which is intrinsic and extrinsic motivation [
          <xref ref-type="bibr" rid="ref14">14</xref>
          ].
According to SDT, there are three types of
psychological needs that are competence, autonomy and
relatedness which can intrinsically motivate people [
          <xref ref-type="bibr" rid="ref14">14</xref>
          ]
in their PA promotion. Competence is the sense of being
able to finish an activity, e.g. after the breakfast and
lunch period at the office, walking for 10 minutes.
Autonomy refers to the feelings of having the choice to
view one’s social environment and enabling selections
corresponding to complete an activity, e.g. the ability to
go for a 10-minute walking with colleagues or alone.
Relatedness is the ability to connect with others, e.g. to
stay connected with other colleagues using a PA
application. Employees are motivated intrinsically when
they sense happy while doing activities whereas more
extrinsically motivated employees perform the activity
because they want to achieve to some degree from
completing the activity, for example, earning
badges/points after walking for 10 minutes after the
breakfast/lunch period. The employees who are not
interested in doing any activities are regarded as
amotivated.
        </p>
      </sec>
      <sec id="sec-3-2">
        <title>2.2 Game Design Elements</title>
        <p>
          Gamification is defined as the use of game design
elements in non-gaming environments [
          <xref ref-type="bibr" rid="ref4">4</xref>
          ]. Gamification
refers to motivating users by making their experience
more playful and fun [
          <xref ref-type="bibr" rid="ref15">15</xref>
          ]. According to the theory of
motivation [
          <xref ref-type="bibr" rid="ref16">16</xref>
          ], human behaviour is principally
motivated by extrinsic factors for example incentive or
reward [
          <xref ref-type="bibr" rid="ref16 ref17">16-17</xref>
          ]. The reward is offered to “an individual
as a result of the accomplishment of a specific task or
the achievement of a target behaviour” [
          <xref ref-type="bibr" rid="ref18">18</xref>
          ]. Within the
domain of persuasive technology research, reward acts
as the construct to measure how fit the reward as a
persuasive approach can persuade individuals to
perform a target behaviour. The reward can be
implemented as virtual points and badges etc. [
          <xref ref-type="bibr" rid="ref18">18</xref>
          ].
        </p>
        <p>
          Moreover, competition is a persuasive approach that
delivers from the Theory of Competition [
          <xref ref-type="bibr" rid="ref19">19</xref>
          ].
Competition refers to “the act of seeking or endeavoring
to gain what another is endeavoring to gain at the same
time” [
          <xref ref-type="bibr" rid="ref20">20</xref>
          ]. Within the domain of persuasive technology
research, competition acts as the construct to measure
how fit the competition as a persuasive approach can
persuade individuals to perform a target behaviour. In
the persuasive applications, Competition can be
implemented as a leaderboard on which users’
performance is demonstrated [
          <xref ref-type="bibr" rid="ref21">21</xref>
          ]. Competition allows
users to know their position, view and compares their
performance of a target behavior by means of the
performance of others [
          <xref ref-type="bibr" rid="ref22">22</xref>
          ].
        </p>
      </sec>
    </sec>
    <sec id="sec-4">
      <title>3. Designing System Model</title>
      <sec id="sec-4-1">
        <title>3.1 Game Elements</title>
        <p>
          Out of the game elements found in the literature, we
selected some possible game elements. In general,
empirical research has found that the implementation of
reward i.e. points and badges and leaderboards is a
practical means to encourage users’ behaviour in
nongame contexts [
          <xref ref-type="bibr" rid="ref23">23</xref>
          ]. Specifically, within the PA
research, the game elements reward i.e. points and
badges [
          <xref ref-type="bibr" rid="ref24 ref25 ref26 ref27 ref28 ref29 ref30">24-30</xref>
          ], and leaderboard [
          <xref ref-type="bibr" rid="ref24 ref25 ref26 ref28 ref29">24-26,28-29</xref>
          ] can
persuade people to accomplish a specific activity such
as PA promotion i.e. exercise/walking in the working
environment.
        </p>
      </sec>
      <sec id="sec-4-2">
        <title>3.2 System Model</title>
        <p>
          The approach used here was a combination of the
theoretical concept of SDT, regular game elements
(points, badges and leaderboard), and positive and
motivating outcomes (exercise and weight control). We
utilized the existing Ryan’s SDT theory model of health
behavioral change [
          <xref ref-type="bibr" rid="ref13">13</xref>
          ] to scaffolding the proposed
system model. Ryan’s SDT theory model indicates that
the satisfaction of autonomy, competence and
relatedness brings positive outcomes for mental health
(higher quality of life, less anxiety, depression and
somatization) and physical health (workout/exercise,
weight loss, glycemic control, non-smoking medication
use, healthier diet and dental hygiene). This study,
however, highlighted the physical health elements
particularly exercise/walking and weight control (Fig.
1). SDT has been selected as it runs principally as an
analysis for psychological level, seeks for the sources
and reasons of the individual level of motivation, their
thoughts, reactions and emotions. Thus, SDT theory
indicated the purpose of motivation to improving
motivational progress and wellbeing [
          <xref ref-type="bibr" rid="ref31">31</xref>
          ]. SDT
facilitates a gateway to understand the outlines of
PArelated behaviour consequences e.g. walking/exercise,
the three basic psychological needs and
autonomysupportive elements that support the purpose of PA. This
effort of SDT helps to conceptualize a system model, for
example, our system model for employees to do PA. As
an example, we assume a mobile application to which
SDT is applied and employees update their daily
activities (10 minutes of walking after breakfast/lunch)
period. On the application, if the employee selects to go
for walking alone which implies their expression of the
psychological need autonomy. If the employee chooses
to go for walking with others/colleagues, it indicates
their expression of the psychological need relatedness.
Active peering with others (e.g. display- a leaderboard
on the application to perceive others’ accomplishments)
implies their expression of the psychological need
competence.
        </p>
        <p>We selected extrinsic motivation to use the game
elements (e.g. rewards - scoring points and earning
badges to monitor the progress of everyday walking
after breakfast/lunch period). We integrated the entire
sequence of using SDT, autonomy support –
psychological needs – self-determination motivation,
using these game elements to build an application. For
PA promotion such as exercise or weight control,
employees monitor their daily achievement when
walking after breakfast/lunch period. An example of a
milestone is that an employee starts to walk for 20
minutes daily. They divide this task into two parts, i.e.
10 minutes walking after the breakfast period and
another 10 minutes walking after the lunch period, and
they get rewards (scoring points and earning badges) in
return. Similarly, other milestones can be monitored for
example positioning 1st, 2nd or 3rd on the leaderboard
based on total earned points. Their physical activities
can be measured by an application daily to track their
walking, and how they prefer to walk (walking with
colleagues or walking alone etc.). Data-driven
approaches can be used to measure user’s fulfillment of
autonomy, competence and relatedness. To do this, an
application followed by the system model is expected to
record the everyday data of the users’ activities and a
comparative analysis of several weeks can be
conducted. The application may count how active users
are by calculating their earned rewards and their time
spent in using the application etc.</p>
      </sec>
      <sec id="sec-4-3">
        <title>3.3 User-Centered Design (UCD) Process</title>
        <p>
          UCD is an iterative application design process that
focuses on how the users use the application [
          <xref ref-type="bibr" rid="ref32">32</xref>
          ]. It
consists of five steps: Empathize, Define, Ideate,
Prototype, and Test. Empathize is described as the sense
of understanding when answering a problem. Define
indicates making the sense of information collected
from the Empathize step and concludes with a problem
statement i.e. a point-of-view (POV). Ideate focuses on
creating ideas for designing prototypes that fit users’
recommendations and needs. Examples of ideation are
body storming, mind mapping and sketching. Prototype
denotes to an initial stage of an application release. This
prototype can be a hard copy/paper object or an
interactive display in smart devices) to support in
creating the final design. Testing confirms that the
prototype and result are polished, reconnoitering the
needs of the users and clarifying the POV. Multiple
ideas were considered to build a prototype by using
several game elements. Ideation occurred in this time
leading to prototyping to generate the final design. The
prototype was then tested by few participants.
Eight employees living in the Finland were interviewed
face-to-face. Participants were from three nationalities.
The purpose of the interview was to perceive
employees’ views in relation to their willingness of PA
promotion in their office environment. The employees
were asked to describe their views and experience of
overcoming physical inactivity at the office such as how
do they conduct PA when sitting for long-time and
thoughts about anything that might motivate them and
any technology-mediated tools that might support them
to do PA. Six employees (75%) reported the lack of PA
in the working environment. Seven employees (88%)
strongly recommended for a technological tool to which
they can do PA particularly walking and weight control,
and connect with others such as the tool can have the
option to choose walking alone or walking with others.
They wanted to see their daily progress in a leaderboard.
They showed their interest to experience something that
can make them competitive, for example, lower points
holder will appear on the leaderboard with fatty face
They showed interest to use the game elements: (scoring
points and earning badges -1st, 2nd and 3rd). However,
some recommended exchanging the points in real time
voucher/gift, for example, a tea/coffee voucher. The
above observation has informed us to move to the
Define step to come up with an actionable problem
statement.
Based on the results of the interviews the following
problem statement has been concluded:
        </p>
        <p>Employees sense a lack of being physically active in
their working environment. A technological tool using
game elements can help them overwhelming the state of
their physical inactivity and can help them to motivate
in walking and tracking everyday walking history.</p>
        <p>The above POV has drawn attention on how we
might build an application with the aid of game elements
to which users can experience more fun in their PA
promotion.</p>
      </sec>
      <sec id="sec-4-4">
        <title>3.3.3 Ideation</title>
        <p>The POV from the Define step has led us to design the
prototype of the PA application. The idea of designing
the prototype was to observe users’ response and how
they responded using game elements in accordance with
the SDT sequence. The prototype was designed by
adding PBL game elements (points, badges and
leaderboards).</p>
      </sec>
      <sec id="sec-4-5">
        <title>3.3.4 Prototype</title>
        <p>The objective of building the prototype was to verify
whether users can run a gamified persuasive application,
and how do they react in using the application that
incorporates SDT using game elements. A low fidelity
paper prototype (Fig. 2) was built which lets the user to
input his/her initial details to log-in (name, age and
weight etc.). After logging into the application, the user
had the option to go for physical activity with others or
alone (Fig. 2). Once a user selects an option to walk,
time starts to count for 10 minutes, and the user receives
1 point for every 5 minutes. After the walking session,
users can track their tier activities on the leaderboard.
3.3.5 Test
Ten Employees had been invited via email/telephone.
Out of those, 5 employees confirmed their availability to
take part in the study.</p>
        <p>The prototype was not interactive i.e. participants
used printed paper to access the paper prototype. Each
participant had been allocated for 15 minutes to test the
prototype. The aim was to observe the usability issues
of the prototype, and how users valued to use the SDT
sequence using game elements. Employees were
informed briefly how to use the prototype, e.g. they had
been guided to pretend using the prototype similarly as
they were using it in real time. The participants were
asked to report whether the prototype motivated them to
promote their PA in the working environment. Our
intention in this study was to find the qualitative
information data of how participants use the prototype
and response to the game elements in the prototype. We
collected participants’ response that was compelled
by qualitative data. The data showed their progress in
completing the tasks facilitated by the prototype.</p>
      </sec>
    </sec>
    <sec id="sec-5">
      <title>4 Results and Limitations</title>
      <p>
        Based on the first iteration of the UCD process on a
persuasive and gamified application for promoting PA
at working environment, we have concluded the
following results. Four participants felt that choosing the
options to go for a walk with others or alone gave them
the freedom of choice. Three participants expressed
interest for a reminder that can be set before using the
application. People naturally sense idle to do anything
enthusiastically but may be tricked by external triggers
such as diabetic patients improved their self-efficacy to
control glycemic through text messaging [
        <xref ref-type="bibr" rid="ref33">33</xref>
        ]. Overall,
most participants positively reported in using the paper
prototype i.e. it motivated them to go for PA.
Participants showed their interest in earning the points
and badges (Gold, Silver and Bronze). Participants were
interested to view the leaderboard except for one
participant who was confused about the ranking list.
This prototype should be updated to build an actual PA
promotion app with a built-in reminder, e.g.
alarm/vibration, and a detailed feature with the game
elements. The findings of the study suggest us that
adopting SDT using game elements to design a system
model followed by the Ryan’s SDT theory model of
health behavioral change is a successful approach to
motivate employees in their PA promotion.
      </p>
      <p>Moreover, through the study, the limitations have
been uncovered. The concrete motivational outcome
may differ when implemented in an actual PA
promotion app. Therefore, we plan to examine the effect
of the system model implemented in an actual gamified
persuasive application. Also, our study has not tested in
long-term use since users ran the prototype of an app for
only 15 minutes and pretended to use the application.
Users pretended to use the actual application when using
the paper prototype of an app to walk for a 10-minute
and thus, using the actual PA promotion app may bring
different effect to walking consequences such as weight
control and work productivity etc.</p>
    </sec>
    <sec id="sec-6">
      <title>5 Conclusion and Future Work</title>
      <p>Our study presents the system model to motivate the
employees for physical activity promotion in the
working environment that was implemented in a paper
prototype of an app. This study contributes to the
Human-Computer Interaction (HCI) community to
deepen understanding of how psychological theory can
be integrated to design a system model as well as using
game design elements within the system model. The
secondary objective of the paper was to develop a
prototype of a PA promotion app based on our proposed
system model. We tested the system model through a
pilot followed by the UCD iteration. Results have shown
that employees within their office environment, felt that
using a PA promotion app could increase their
PArelated behaviours such as walking after breakfast and
lunch hour. The pilot study was small-scale and due to
the paper prototype-based study and participants cannot
really draw generalizable conclusions. The limitations
of the study addressed us to examine the application
empirically. Our results can guide us to develop an
actual PA promotion app by adding extra features e.g.
reminders and tracking record built in the app. This
study also opens the gateway for further examination.
Further research should concentrate on building the
actual application, evaluate in comparison with existing
applications i.e. experimental and control condition, and
work out exactly where the game elements play a
significant role by tracking users’ daily activity from the
data-server connected with the PA promotion app.
Further research should also focus on users actually
using the PA promotion app, its usability issues and a
long-term study to examine the real effect of the PA
promotion app.</p>
    </sec>
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