Motivating Engagement with a Wellbeing App Using Video Games and Gamification Kellie Vella Daniel Johnson Nikki Peever Queensland University of Queensland University of Queensland University of Technology (QUT) Technology (QUT) Technology (QUT) Brisbane, Australia Brisbane, Australia Brisbane, Australia kellie.vella@qut.edu.au dm.johnson@qut.edu.au n.peever@hdr.qut.edu.au Vanessa Wan Sze Cheng Tracey Davenport Jo Mitchell The University of Sydney The University of Sydney The Mind Room Sydney, Australia Sydney, Australia Melbourne, Australia wche7541@uni.sydney.edu.au tracey.davenport@sydney.edu.au jo@themindroom.com.au ABSTRACT great familiarity of the Australian population with MindMax is a mobile wellbeing application produced by videogame play (67% of the population plays [3]) is the Australian Football League Players’ Association (AFL currently being used to engage current users within the app, Players), with the aim of improving the wellbeing of young and is intended to also engage current and potential users Australians. The project engages a strategy of wellbeing external to the app, such as with live streamed videogame science delivered via mobile technology while harnessing competitions and real-world events in game play venues. the popularity and appeal of both sports and videogames. Though the app itself provides traditional casual gameplay, Relatedly, the project makes use of a range of gamification the integration of the game with other elements of the app techniques, such as points (in this case ‘footies’, or also drives engagement with the wellbeing content as well Australian footballs) and leaderboards to encourage users to as interactions with other users. This paper reports upon the access and return to the wellbeing content. However, it design of the application and project, as well as providing facilitates a more meaningful engagement with these an initial evaluation of the impact of its use of games and mechanics by personalising the ways in which users engage gamification. with the app, such as through: avatar customisation; a social feed in which users can post, comment and like each other’s Author Keywords contributions; and space for users to reflect upon how the Videogames; video games; gamification; mHealth; wellbeing content can be applied within their own lives wellbeing; engagement [17]. Additionally, users are given ‘footies’ every time they ACM Classification Keywords complete a wellbeing module, or engage with the social K.8.0 Personal Computing: General: Games; J4 Social and feed (posting or commenting), that can then be used in the Behavioural Sciences: Psychology; H.5.m. Information app’s collection of casual games (i.e., each ‘footie’ can be interfaces and presentation (e.g., HCI): Miscellaneous used to take a shot at goal in a football kicking game). This means that games and gamification are utilised at multiple INTRODUCTION levels: within the overall engagement strategy; to tie MindMax is a free-to-use mobile health (mHealth) together elements of the application; and to directly provide wellbeing app designed and developed by the Australian casual gameplay, which comes with its own associated Football League Players Association (AFLPA), and funded benefits [19]. by the Movember foundation, in order to engage young people with wellbeing educational resources. These The development process has also involved the input of resources have been based upon the principles of cognitive potential users during the early design stages. As the project behavioural therapy, mindfulness, and strengths and values moves forward, it remains responsive by making use of an recognition in order to increase users’ resilience and agile methodology, in which user feedback continues to psychological wellbeing. The MindMax engagement inform future updates. Updates include both the release of strategy aims to harness the high interest in videogames and new wellbeing content as well as additional functionality AFL to engage users with this content. In particular, the and the refinement of existing functionality. In this way, the project seeks to maintain user interest over time, with Positive Gaming: Workshop on Gamification and Games for Wellbeing the proviso that productive disengagement, in which users’ A CHI PLAY ’17 Workshop needs are met and the app becomes no longer needful, is October 15, 2017, The Netherlands also a desirable outcome [22]. © 2017 Copyright held by the authors/owners. This paper describes both the design process and Avoiding a one-size-fits-all approach to design also engagement strategy in greater detail, as well as its ongoing suggests customizing the gamification experience to diverse evaluation, initial findings, and next steps. Initial user motivations. An early exploration of gamification user experiences suggest that the casual gameplay is bringing preferences resulted in a six-sided framework, with people back to the application, as well as engaging them correlations to different design elements (e.g. the Socialiser with other components. The potential for greater delivery of positively correlates with guilds or teams, while the meaningful gamification within further iterations is Achiever prefers levels and quests) [24]. As such, the discussed. different features MindMax presents may engage differing motivations or even populations. Tracking preferences for GAMES, GAMIFICATION AND MOTIVATION Balancing the relationship between intrinsic motivation, or different features may retrospectively support this typology choosing to take part in an activity because it is enjoyable or provide further insight into these categories. to do so, and extrinsic motivation, or the requirement to be Finally, the facilitation of player-generated content has been rewarded for taking part in an activity, is at the heart of identified as a way by which users might develop a more both games and gamification design processes. mHealth meaningful relationship to content [17]. One way this can and electronic health (eHealth) applications faced with the be achieved is through the user setting the goals or challenge of motivating healthy behaviours have borrowed benchmarks that must be reached [9]. However, there is from gamification practices to motivate engagement with evidence that goal-setting within an online community is content, and behavioural change [13]. Gamification entails more effective when users interact with other goal-setters, the use of video game mechanics or components within through the receiving of feedback, or collaboration with non-game settings in order to make the activity more others [4]. It seems likely that positive, including creative, enjoyable and to motivate greater engagement [11]. For interactions may foster a sense of relatedness between example, Zombies, Run! is a mobile exergame using individuals and with a community. Relatedness, or the need narrative elements and events (e.g. missions, zombies to feel connected with others is key to the processes of chasing you) and to motivate running [7]. In contrast, Oiva, internalization, and also has a direct relationship to another mobile application, uses virtual rewards and wellbeing [20]. As such, building a feeling of community progress indicators to motivate engagement with content within and around MindMax may well be pivotal to framed by acceptance and commitment therapy [1]. While increasing wellbeing across the targeted population. gamification has been found to be especially impactful on DESIGN AND ENGAGEMENT STRATEGIES physical health interventions, mixed findings have been Participatory design was utilised in order to create a found for cognitive outcomes [13]. credible and engaging mHealth intervention. Workshops Recent research also suggests that the use of elements such took place in the Australian capital cities of Melbourne, as points, levels and leaderboards act as extrinsic Brisbane and Sydney between September 5-6, 2016. They motivators, which while potentially increasing the quantity captured the thoughts of AFL players and fans; videogame of effort that individuals put into a task, do not impact on players; and mental health and wellbeing consumers and the quality [15]. This is supported by research finding that professionals, including clinicians and academics. General intrinsic motivation is associated with greater quality of feedback was given regarding the need for a free, performance [5]. Taken together this suggests that both lightweight (low bandwidth) app that provided passive data intrinsic and extrinsic motivation need to be considered if tracking. However, more specific feedback indicated the authentic driven engagement is a desired outcome. need to provide rewards for continued engagement, and the challenge of integrating a game into the app. Rather One solution is concerned with creating ‘meaningful participants believed that gaming could more easily be a gamification’, or providing users with the means to reward in and of itself, with access to games or game events internalise the need to perform the actions required of them used to motivate engagement with the app. [17]. Internalisation is a process by which an external regulation is transformed to one that is linked to a sense of With this in mind the development team decided upon self, through the satisfaction of psychological needs [20]. It which features would be released initially, with additional has been suggested that internalization is made possible by functionality and content to be released and evaluated in acknowledging that the user and artefact are situated with a subsequent stages. User acceptance testing (UAT) was larger social sphere and that creating a match between them applied to a Beta version of the app, while the post-Launch requires understanding how this context shapes the version (MM.1) incorporated the learnings of the UAT. interaction [10]. As such, a granular investigation of users’ MM.1 was subject to extensive marketing by the AFLPA, experience of MindMax – including investigation of the Movember, and partners, resulting in its uptake by 661 personal characteristics of these users and how they use the members of the public within the first week of the official app - is necessary to better understand how to make launch. improvements across the design cycle. MM.1 offers wellbeing modules focused on Fit Minds, Values and Thoughts (held under a tab labelled ‘Train’). Fit Minds proceeds with a survey used to gauge users’ current accidentally) causes them to increase in size, so players wellbeing and prompt self-reflection. Additionally, it must wait for them to pass to avoid making the unhelpful- contains a call to action called the MaxFive. This produces thought asteroids expand to fill the whole screen. Further a player card in which users nominate to complete five mini-games are intended for modules yet to be released. goals that action five ways of improving wellbeing: The connecting device between the different elements of Connect, Move, Tune In, Learn, and Give (see Figure 1 the app - the modules (Train), the social feed (Share) and below). In turn, each users’ MaxFive can be shared on to the games (Play) is the use of ‘footies’. These are points the social feed, under a tab labelled ‘Share’. Additional tabs given for completing modules (however many times they give users the option to customise their avatar (‘Me’), and wish), or posting or commenting on posts in the social feed, play any available casual games (‘Play’). Both the Values which can then be used for additional lives in the casual (an exploration of users’ values and how to implement game on offer. The first game on offer was Cr***y Bird, in them) and Thoughts (how to identify ‘wonky’ thoughts and which a small bird needs to navigate a series of obstacles, place them in perspective) modules also contain content using tapping on the screen to keep it aloft. Feedback from that can be shared (‘shareables’). participants suggests that the game was extremely difficult. The use of playful devices to illustrate key concepts are The follow-up game, an Australian football-based game embedded in each of the modules. For example, the Values based upon paper-toss game mechanics, allows players to module makes use of audio files to demonstrate that flick a footy through goal posts while negotiating changes ‘wonky thoughts’ don’t hold as much power when spoken in wind direction and strength. The beta version of this in funny voices. This module also makes use of users’ game game has to date, just been released (29 August, 2017), play knowledge and a mini-game to illustrate a concept. with the final version to be included in the MM.2 update. The player is first introduced to the metaphor of third- The MM.2 update is due to be released on 11 September, person view in videogame play as providing the player with 2017, and will address the feedback produced by the a more objective position from which they can identify and Interview and App Usage study, and the Co-Researcher deal with problems. They are then asked to identify goals Workshops (described in later sections of this report). As they would like to focus on (e.g. go on an adventure with MindMax is the interface for a broader engagement family). The next tab then illustrates these ideas using a strategy, further iterations will deliver functionality that mini-game. Users’ goals are written on asteroids, which presents the user with the chance to participate in events float across the screen. The player is asked to tap an and compete for virtual and real-world rewards. For asteroid when they are in colour. Crucially, tapping obstacle example, further updates (MM.3 and up), are anticipated to asteroids containing unhelpful thoughts (intentionally or integrate the ‘footies’ into team-based competitions in which players compete to win tickets to AFL matches or the chance to play online with professional videogame players. Additionally, events will be advertised in the app that will occur both at physical locations (e.g. console gaming challenges and attendance by high-profile ambassadors), and online (e.g. streaming live game-play with expert gamers). In turn, while high-profile AFL players have already been enlisted to use and endorse MindMax as Ambassadors, the next stage will engage high profile gamer Ambassadors. It follows that the constant evolution of the app and attendant strategies demands an evaluation that is flexible and responsive. EVALUATION A multi-pronged evaluation of the application began in June, 2017. The use of an agile methodology in the design means that the evaluation sits either along the continuum of the project (from June to December 2017), or captures a slice of the design process. For example, user acceptance testing was conducted on the Beta in December, 2016 and March, 2017, prior to the official release on the 21 June, 2017. Upon the official launch of MM.1, two studies began: a longitudinal series of interviews with recruited and organic users (complemented with app usage data), and a naturalistic trial using surveys administered at multiple time-points. These two studies will both continue for the Figure 1 'MaxFive': five ways to wellbeing length of the project. Bridging the design stages of MM.1 and MM.2 only, a cohort of co-researchers was assembled The interviews covered a range of subjects, from users’ to study how to build community in and around MindMax. definition of wellbeing and discussion of their current At the time of writing only the UAT has been completed wellbeing; their interest in the AFL, games, and other and all other studies are ongoing. The following describes mHealth apps; and their experience of using Mindmax. At these studies in greater detail and presents initial findings. the time of writing fifteen participants have been engaged in this study: nine recruited and six organic users, aged 18 User Acceptance Testing to 49 years (M = 34 years), comprised of ten males and five During the Beta release a number of quick updates were females. Reimbursements were minimised in order to not made to accommodate feedback from the user acceptance unduly influence the choice to use MindMax. In parallel, all testing. Testing with nine participants (aged 19 to 37 years, M = 26.44 years, 5 female), confirmed that the decision to participants are tracked in terms of their frequency of use, allocate points for posting content was engaging. However, what elements of the app they chose to use, their use of the concerns were raised as to the possibility that users may not social feed, and time spent playing the game. Any insights engage meaningfully with the app or wellbeing content, but that might impact on the further development of the app instead be focussed upon gaining points. While sharing the were fed back to the project’s management team. app with AFL celebrities was appreciated, concerns were Initial interviews with recruited users demonstrated that the raised as to how users’ might protect their own privacy game (Cr***y Bird) acted to bring them back to app, when (specifically, via the shareables). These points were shared they felt they had exhausted all other options for back iteratively with the management and development engagement. For example: teams. I’ve played Cr***y Bird … I’m pretty bad at it but I think Naturalistic Trial it’s a good mind challenge. I mean, it got me wanting to A naturalistic trial is currently evaluating the impacts of beat my last score and stuff like that. (P4) MindMax, using validated wellbeing and usability measures. Participants are asked to engage with the app In addition, these participants expressed an appreciation of normally and respond to a survey on a regular basis at five being able to set personal goals using the MaxFive time-points (Day 1, Day 30, Day 60, Day 90, and last day shareable, however would have appreciated additional of trial, maximum 180 days). Each person’s Day 1 is the functionality that helped them achieve these goals. For first day they start using MindMax. Trial participants are example: remunerated for their time. The measures include: I’d probably like to be able to refer back to what I’ve demographics, interest and involvement in both AFL and completed really quickly, so as a goal setting thing I can video game communities; Flourishing scale [12]; Connor- just go back to the information I’ve entered really quick and Davidson Resilience scale [6]; The Warwick-Edinburgh see, ... what I’ve entered. Keeps you motivated or keeps Mental Well-being Scale [23]; adapted General Help- you on track. (P6) seeking Questionnaire [25]; Basic Need Satisfaction in General - Relatedness subscale [8]; adapted Assessment of Interviews with organic users reveal a complex relationship Self-Group Overlap [21]; adapted Perceived Cohesion [2]; between users’ backgrounds, expectation and actual use of and the System Usability Scale [18]. At the time of writing, the app. Initial findings suggest that while AFL fandom is Day 30 has been reached by approximately 18 participants. the primary force motivating initial uptake, continued use is Data analysis is planned once Day 30 reaches a minimum dependent on a range of factors (including whether of one hundred participants. MindMax met their initial expectations, desire for self- betterment, and level of comfort with social media), Interview and App Usage Study combined with current functionality. This study focusses on the initial and ongoing user experience of MindMax. Specifically, it asks how Co-researcher Workshops MindMax features and content; activities and events; and These workshops make use of the insider knowledge of users’ personal interests, lifestyle and motivations, all young people interested in either AFL, videogames, contribute to the user experience. Additionally, it seeks to wellbeing or technology. The program was designed to better understand if MindMax is influencing users’ attitudes build their competencies as researchers, as well as glean a towards and subjective appraisal of their wellbeing. By fresh approach to understanding the app. Specifically, the utilising both recruited and organic users it seeks to gain a workshops were aimed at better understanding how to build thorough and ecologically valid assessment of the user community both in and around MindMax, and how to study experience. Recruited users are asked to try out all the this. Eleven co-researchers aged between 17 to 31 years (M features of the app and to take part in three once-per-week = 20.9 years; ten males and one female), were asked to interviews. Organic users are users of the app who are attend regular weekly workshops as well as participate in asked to take part in weekly interviews during the course of online discussion. One participant only took part in the their application usage. online component as he was physically distant from the workshop site. As with the previously reported study, any Interviews took place both face-to-face, as well as via Skype and phone for geographically distant participants. feedback that might be used to improve the app was passed physical health interventions is directed towards improving on to the project’s management team. motivation to engage with the intervention and complete tasks [14]. However, health behaviours are influenced not At the time of writing, several suggestions have been made only by an individual’s motivation, but also their ability to regarding how the app might encourage people to learn complete the behaviour (capability), as well as triggers to about other users, find friends, utilize the ‘MaxFive’ perform the behaviour (opportunity) [16]. A possible shareable for cooperative and competitive ends, and take solution could therefore be approaching future updates from part in community challenges. For example, the app could the standpoint of facilitating social accountability and benefit from additional functionality that allows people to collaboration, as other research suggests [4]. In turn, the ‘buddy up’ with others who have similar MaxFive goals, in future integration of competitive features is anticipated to order to encourage each other to complete them. be well received from users drawn from the AFL and game One concern expressed in both this and the previously play communities. mentioned study is that the presence of shareables on the CONCLUSION Share feed are acting to confuse users as to the authenticity This initial evaluation of the MindMax mHealth application of the posts. As such, one of the challenges identified by the provides insight into the challenges and potential of using co-researchers is how to encourage authentic posting. A games and gamification to meaningfully engaging users field experiment has been proposed in which three posts - with wellbeing content delivered via mobile technology. each of which attempts to test different social psychological The use of user created goal-setting and embedded casual theories - will be added to the Share feed with the aim of game play is acting to engage people with the app and gauging which one generates the most interaction and wellbeing content. However, initial qualitative findings activity in the feed. At the time of writing, this study is suggest that greater social integration will create more underway. meaningful engagement. Future updates will act as testing DISCUSSION grounds for the learnings of each stage of the evaluation. The MindMax initiative presents a unique opportunity to ACKNOWLEDGEMENTS both evaluate the impacts of a mobile wellbeing application We would like to thank our participants for their time, and shape its course. 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