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  <front>
    <journal-meta>
      <journal-title-group>
        <journal-title>Workshop
October</journal-title>
      </journal-title-group>
    </journal-meta>
    <article-meta>
      <title-group>
        <article-title>Using technology to boost employee wellbeing? How gamification can help or hinder results</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Ekaterina Pogrebtsova</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Gustavo F. Tondello</string-name>
          <email>gustavo@tondello.com</email>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Hardy Premsukh</string-name>
          <email>hpremsukh@flourishiq.com</email>
          <xref ref-type="aff" rid="aff1">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Lennart E. Nacke</string-name>
          <email>lennart.nacke@acm.org</email>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <aff id="aff0">
          <label>0</label>
          <institution>Department of Psychology, University of Guelph</institution>
          ,
          <addr-line>ON</addr-line>
          ,
          <country country="CA">Canada</country>
        </aff>
        <aff id="aff1">
          <label>1</label>
          <institution>FlourishiQ Inc.</institution>
          ,
          <addr-line>Waterloo, ON</addr-line>
          ,
          <country country="CA">Canada</country>
        </aff>
        <aff id="aff2">
          <label>2</label>
          <institution>HCI Games Group, University of Waterloo</institution>
          ,
          <addr-line>ON</addr-line>
          ,
          <country country="CA">Canada</country>
        </aff>
      </contrib-group>
      <pub-date>
        <year>2017</year>
      </pub-date>
      <volume>15</volume>
      <issue>2017</issue>
      <abstract>
        <p>Research can help improve the lives of employees by revealing ways in which technology can be leveraged to progress innovative, time and cost-effective ways to promote their wellbeing. However, even with the trends of building “positive organizations” and promoting employees' wellbeing using the latest technologies in today's best companies worldwide, there has been a lack of rigorous research to provide solid evidence for these decisions. In this review, we present a call for future research to integrate and test technologically facilitated positive psychology interventions with gamification elements to better understand how to minimize harm and promote user benefits. We review the current online positive psychology intervention research, which we argue provides a critical guide for the development of future wellbeing technology. We also explore how gamification shows promise for promoting the benefits of positive psychology interventions (e.g., user enjoyment, autonomous motivation), as well as areas where gamification can pose a threat to wellbeing. There may be a fine line between harmful and helpful wellbeing solutions in our connected and technologically driven world of work; research now needs to uncover where to draw that line.</p>
      </abstract>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>-</title>
      <p>
        INTRODUCTION
In the modern working world, employees face the burden of
“telepressures,” or the endless stream of emails, adapting to
ever-changing technologies, and constant pressure to be
available online [5]. However, if wisely applied, technology
can instead be leveraged to facilitate employees’ wellbeing.
This can be accomplished by using technology to apply a
range of feasible, evidence-based wellbeing interventions
from the burgeoning field of positive psychology [
        <xref ref-type="bibr" rid="ref51">39</xref>
        ].
      </p>
      <p>
        Positive psychology is the study of optimal human potential
and wellbeing, or what is called flourishing in life [
        <xref ref-type="bibr" rid="ref51">39</xref>
        ].
Many techniques from positive psychology—from showing
gratitude to practicing mindfulness meditations—are quick,
easy to learn, and can be self-practiced by employees [
        <xref ref-type="bibr" rid="ref54">42</xref>
        ].
Combining positive psychology with technology is
advantageous for health promotion because it can further help
with cost-effectiveness, accessibility, motivation, and
customization for users as compared to in-person programs.
Organizations worldwide have been investing increasing
amounts of time and money into the latest wellbeing
technologies to promote their employees’ wellbeing and
performance [
        <xref ref-type="bibr" rid="ref41">9,29</xref>
        ]. For example, in 2015 alone, 580,000
companies in the United States implemented wellness
programs involving wearable health and wellbeing trackers for
employees [
        <xref ref-type="bibr" rid="ref32">20</xref>
        ]. Moreover, it is expected that organizations
will implement 13 million Workplace Self-tracking
Technologies (WSTT) between 2014–2019 [2]. However, there
is currently an absence of rigorous research to ground this
hype around WSTT in promoting positive employee and
organizational outcomes [
        <xref ref-type="bibr" rid="ref42">30</xref>
        ]. This trend towards wellbeing
technology in organizations now requires evidence-based
guidance more than ever before. Despite evidence from
randomized controlled trials that online positive psychology
interventions can be effective over and above controls, such
as with online mindfulness programs [
        <xref ref-type="bibr" rid="ref21 ref35">10,23</xref>
        ] and online
positive reflection journals and exercises [
        <xref ref-type="bibr" rid="ref22">8,11</xref>
        ], much more
research is needed to explore how and why different types
of technologies and software elements can help or hinder
users’ long-term benefits [
        <xref ref-type="bibr" rid="ref29">17</xref>
        ].
      </p>
      <p>
        One promising avenue for discovering and understanding
improved ways to deliver positive psychology interventions
via technology is with the addition of gamification: the use
of game design elements in non-game contexts [
        <xref ref-type="bibr" rid="ref26">14</xref>
        ].
Adding gameful elements to digital applications can help to
increase users’ motivation and engagement with the system
[
        <xref ref-type="bibr" rid="ref31 ref50">19,38</xref>
        ], but research in this area is still preliminary. There
is promise that gameful applications may help motivate
users to adopt positive behaviour change that could benefit
their health and wellbeing [
        <xref ref-type="bibr" rid="ref37">25</xref>
        ]. Conversely, research also
suggests that certain aspects of gamification, in particular
extrinsic rewards, may inadvertently thwart motivation and
sustained improvements for positive behaviour change
[
        <xref ref-type="bibr" rid="ref1">1,9</xref>
        ]. In this review, we present a call for future research to
integrate and test technologically facilitated positive
psychology interventions with gamification elements to better
understand how to minimize harm and promote user
benefits. We begin by reviewing the current online positive
psychology intervention research to date, deducing key
elements to help guide future technologies to promote
employee wellbeing. Further, we critique the preliminary research
on gameful wellbeing technology. We end with
implications for future research and use of gameful wellbeing
technology in organizations.
      </p>
      <p>
        ONLINE POSITIVE PSYCHOLOGY INTERVENTIONS FOR
EMPLOYEE WELLBEING PROMOTION
Positive psychology interventions aim to teach positive
psychology activities, known as the “simple, intentional,
and regular practices meant to mimic the myriad healthy
thoughts and behaviors associated with naturally happy
people.” [28, p. 57]. Because these activities are simple,
cost-effective, and easy to learn, there has been an increase
in positive psychology interventions implemented with
employees via technology, mainly in the form of websites and
mobile applications. These programs are broadly referred to
as Online Positive Psychology Interventions (OPPIs; [7]),
and show benefits over and above control conditions, with
some interventions finding effects comparable to traditional
in-person wellbeing and stress-management programs [
        <xref ref-type="bibr" rid="ref43">31</xref>
        ].
Overall, a large amount of randomized controlled trials
have shown that OPPIs and related wellbeing promotion
online interventions are beneficial and produce small to
moderate effect sized improvements in wellbeing (for
metaanalyses, see van Genugten et al. [
        <xref ref-type="bibr" rid="ref30">18</xref>
        ] and Sin and
Lyubomirsky [
        <xref ref-type="bibr" rid="ref54">42</xref>
        ]). Many OPPIs have been tested with employees
across various organizations and sectors, showing wide
promise for application outside of the lab.
      </p>
      <p>
        In a recent example of a brief OPPI with employees, Clauss
et al. [
        <xref ref-type="bibr" rid="ref22">11</xref>
        ] randomly assigned 90 caregivers to a
5–10minute positive reflection intervention practiced on an iPad
for only 10 days, or a control exercise. The intervention was
simple; participants were guided to select a positive and
meaningful work-related event that took place that day,
establish deep breathing and a mindful state, and reflect on
the meaningful and positive details of the event. The iPad
sent a reminder to employees to practice the exercise every
day during a break. Results showed reductions in emotional
exhaustion and fatigue in the intervention group, and
increased hope and optimism in employees who indicated
they needed more recovery from work the most at baseline.
Similar effects have been found with a multitude of brief
online mindfulness training programs with employees. For
example, Hülsheger et al. [
        <xref ref-type="bibr" rid="ref35">23</xref>
        ] found that compared to a
waitlist control, education and healthcare employees who
participated in a brief 2-week online mindfulness
intervention showed significantly less emotional exhaustion and
increased job satisfaction.
      </p>
      <p>
        Not surprisingly, longer OPPIs tend to show more
substantial results and involve training in a range of wellbeing
skills via modules, videos, and guided exercises. In one
8week intervention, training was provided to employees on a
number of core positive psychology topics taught one week
at a time: self-awareness, positive emotions,
selfcompassion, strengths, autonomy, meaning, positive
relationships, and savouring positive moments [
        <xref ref-type="bibr" rid="ref36">24</xref>
        ]. Each week,
participants received a 9–10-minute introductory video on a
topic, as well as a 10-minute daily guided meditation and a
2-minute daily experiential activity (e.g., expressing
gratitude or bringing loving kindness to daily interactions).
Results showed that intervention participants showed
significant increases in wellbeing indicators (e.g.,
selfcompassion, engagement, mindfulness, and positive
relationships) and decreases in ill-being (e.g., stress and
depression) over time compared to the waitlist control, and these
effects held true one month later. Overall, it appears that
grounding technology in positive psychology principles is a
practical and evidence-based way to promote wellbeing in
organizations.
      </p>
      <p>
        BEST PRACTICES LEARNED FROM ONLINE POSITIVE
PSYCHOLOGY INTERVENTIONS AND BEYOND
Given the substantial meta-analytic evidence in support of
OPPIs and related online wellbeing programs [
        <xref ref-type="bibr" rid="ref30 ref54">18,42</xref>
        ], the
question now becomes, which elements of OPPIs work best
and why? Exemplary interventions and meta-analyses help
uncover this question to show that certain core elements can
improve the effectiveness of OPPIs: longer programs,
frequent and varied practice, enjoyment and
personintervention-fit, user-friendliness, and virtual support.
Longer interventions, frequent practice, and variety
In general, longer interventions and more frequent practice
of OPPIs promote greater effectiveness. One study found
that although a 2-week gratitude “count your blessings”
intervention practiced daily led to increases in positive
affect, a longer 10-week version practiced on a weekly basis
led to psychological wellbeing improvements as well as
lowered physical health complaints [
        <xref ref-type="bibr" rid="ref27">15</xref>
        ]. In another
intervention with over 3,000 participants using the “Live
Happy” mobile application providing a number of grounded
positive psychology exercises, the frequency of application
usage was significantly related to increased mood over time
[
        <xref ref-type="bibr" rid="ref45">33</xref>
        ].
      </p>
      <p>
        Of course, it should be noted that increasing the sheer
frequency of exercise practice can be futile or may even harm
user engagement. Another intervention randomly assigned
participants to savour (i.e., think about positive aspects) of
one through 10 events from the day, generating 10
conditions of varying savouring frequency. Unexpectedly, higher
frequency of events savoured did not have any effect on
decreasing negative affect [3]. This is why intervention
variety, in addition to practice length and frequency, has
been deemed necessary for OPPIs to be effective [
        <xref ref-type="bibr" rid="ref40">28</xref>
        ].
Exemplifying the importance of activity variety, the “Live
Happy” mobile application intervention results also found
that the number of different types of activities that
participants engaged in was related to increased mood and
happiness scores. This is in line with research from the broader
health promotion literature showing the important of
variety. For example, using a variety of physical activities [
        <xref ref-type="bibr" rid="ref56">44</xref>
        ]
and positive thinking strategies in daily life [
        <xref ref-type="bibr" rid="ref46">34</xref>
        ] is
associated with greater wellbeing and health.
      </p>
      <p>
        However, it should also be cautioned that other OPPI
research has shown that increased options and variety may
actually overwhelm participants. Schueller and Parks [
        <xref ref-type="bibr" rid="ref49">37</xref>
        ]
witnessed this counter-effect when exploring
empiricallysupported positive psychology exercises (e.g., gratitude,
strengths, savouring) randomly assigned in toolkits of two,
four, or six exercises, or a control. Results showed no
difference between the 6-exercise condition and control, with
only the 2–4-exercise conditions showing improvements.
Overall, although further research is required to explore
some of the mixed findings, most of the studies suggest that
a moderate amount of exercise versatility can help reduce
habituation and promote intervention benefits, in addition to
longer-term and frequent practice.
      </p>
      <p>
        Enjoyment and person-intervention fit
Another key insight from OPPI research is the importance
of exercise enjoyment and person-activity fit [
        <xref ref-type="bibr" rid="ref40">28</xref>
        ]. In one
study, Schueller [
        <xref ref-type="bibr" rid="ref48">36</xref>
        ] found that users’ higher preference for
various positive activities, as indicated by enjoyment,
perceived benefits, and perceived ease of exercise completion,
were related to greater use of these activities and
subsequent improvements. Similar results were found in a study
of a mindfulness smartphone application—Headspace
OnThe-Go’s “Take 10” program—in which participants
practiced 10 minutes of guided mindfulness exercises for 10
days and learned about the science behind mindfulness
[
        <xref ref-type="bibr" rid="ref34">22</xref>
        ]. Results showed that the “Take 10” program led to
increases in positive affect and decreases in depressive
symptomology in the intervention but not in a placebo
condition using a list-making mobile application. Importantly,
ratings of task enjoyment were positively correlated with
the increases in positive affect in the intervention but not in
the placebo group.
      </p>
      <p>
        Given the importance of enjoyment, how can technology
appeal to users best when there are so many different
positive psychology exercises to choose from? One solution is
to personalize an intervention to each user to promote
person-activity fit. Schueller [
        <xref ref-type="bibr" rid="ref48">36</xref>
        ] randomly assigned
participants to one of three empirically-supported positive
psychology exercises administered online (i.e.,
activeconstructive responding, gratitude visit, and counting your
blessings) and asked them to rate whether they liked the
exercise. In the second phase of the study, participants were
randomly assigned to either a “matched” or an “unmatched”
activity group. The matched activity group received a
second exercise that was most likely to suit their preferences,
based on their feedback on the first exercise, whereas the
unmatched group received a randomly assigned second
exercise. Results showed that matched participants reported
significantly greater enjoyment and perceived benefits with
their “personalized” exercise compared to the unmatched
group. Moreover, matched participants showed a trend of
greater changes in subjective wellbeing over the course of
the week-long intervention (i.e., lower negative affect,
higher positive affect and life satisfaction) than the
unmatched group with a medium-sized effect. Interestingly,
there were no differences in time spent practicing between
the two groups, suggesting that differences in wellbeing
were attributable specifically to the exercise enjoyment
factor. Therefore, over and above exercise practice, it
appears that user enjoyment is fundamental for users to reap
the most benefits from their wellbeing technologies.
User-friendliness and virtual support
Beyond creating enjoyable interventions that fit each user,
developers of wellbeing technology should also remember
to make content easy, clear, and informative to ensure that
the most benefits are reaped. Although an absence of OPPIs
to date have examined the incremental benefits of
userfriendly software and virtual social support, implications
can be drawn from the multitude of interventions conducted
in the online health behaviour and clinical psychology
literature. One meta-analysis of 52 internet-based interventions
aimed at improving health behaviours found that
interventions that were rated as more “efficient,” meaning that they
required less time to understand and were easier to use,
were more likely to produce behaviour change and benefits
than interventions that were rated as less efficient [
        <xref ref-type="bibr" rid="ref30">18</xref>
        ].
Another randomized controlled intervention for hepatitis
prevention examined how various website elements influence
outcomes. Results found that users visited more webpages,
spent more time on, and scored higher on a hepatitis
knowledge questionnaire after one week of using a
“tunneled” website with a pre-set flow of modules and
information as opposed to a “freedom-of-choice” version in
which participants freely explored all of the same
information but on their own [
        <xref ref-type="bibr" rid="ref24">12</xref>
        ]. These findings solidify the
importance of putting substantial effort into user-friendly
and simple design of wellbeing technology. This is essential
to help users learn materials easily on their own, given that
most online wellbeing interventions do not involve any
inperson training.
      </p>
      <p>
        Aside from making clear and concise materials to ensure
user-friendliness, an innovative way to help users learn is
by providing options for virtual social support. A
metaanalysis of online mindfulness interventions found overall
larger effect sizes in improvements in interventions
providing users with access to therapist guidance via telephone,
online chat, or email as compared to unguided interventions
[
        <xref ref-type="bibr" rid="ref55">43</xref>
        ].
      </p>
      <p>Moreover, research suggests that automated support and
reminders may be just as effective for health behaviour
change as support from a romantic partner. In a 10-day
randomized controlled intervention, participants received
information on physical health recommendations (i.e., to
engage in 30 minutes of physical activity per day in at least
10-minute intervals) along with either an automated daily
text message reminder to engage in the activity, or the same
daily reminder text message but received from their
romantic partners in a more personalized way [6]. Both messages
involved goal awareness, self-monitoring, and encouraged
self-regulation. Results found that in both conditions
participants achieved their recommended amount of physical
activity on 32% of the days as measured by a wearable
activity tracker, as compared to only 21% of the days in a
control condition with the same health information but no
text message reminders. Importantly, no significant
differences in physical activity were found between the
automated text messages and the personalized text from a romantic
partner. Implications show that automated reminders may
not actually be as much of a nuisance to participant as they
may appear; in fact, they are a feasible and cost-effective
strategy to help individuals engage in goal-oriented health
behaviours.</p>
      <p>
        APPLYING GAMIFICATION TO POSITIVE PSYCHOLOGY
PROGRAMS: HELPFUL OR HARMFUL?
Given what is known from the OPPI research to date—that
longer and more engaged practice, variety, enjoyment,
userfriendliness and virtual support are beneficial for
improvements—researchers can now examine ways to further
promote these helpful elements in new technologies. One
innovative way forward is with the application of
gamification to OPPIs. Theory on gamification and emerging
interventions suggest that adding playful or gameful1 elements
such as fun rewards, stories, and interactive games has
potential to increase intervention effectiveness [4,9].
However, most health-related gameful applications only focus on
physical health, nutrition, or disease management [
        <xref ref-type="bibr" rid="ref37">25</xref>
        ].
Another limitation is that unlike the OPPI literature, there are
fewer randomized controlled trials testing specific
gamification elements, making implications for practice less clear
with many questions left unanswered. Nevertheless, several
notable wellbeing applications and technologies using
gamification elements have been tested in recent years showing
positive user feedback, high engagement, and some
preliminary wellbeing benefits [
        <xref ref-type="bibr" rid="ref37">25</xref>
        ].
      </p>
      <p>
        Promoting user enjoyment with games, stories, and
virtual worlds
One of the most fruitful uses for gamification in wellbeing
technology is to increase user engagement and enjoyment
with stories, games, and other playful and gameful
elements. Several such interventions have been tested. For
example, Baranowski et al. [4] found 27 studies involving
video games aimed at promoting a variety of health
behaviours, such as diet, exercise, and medication adherence.
Although large idiosyncrasies between the studies
prevented a meta-analysis, Baranowski et al. [4] did conclude that
the majority of studies showed pre-post increases in various
health-related outcomes, including change in health
behav1 In the context of gamification research, playful elements
refer to unstructured, free-form activities, such as
narratives, comic visuals, or animations, whereas gameful
elements refer to activities structured around goals and rules,
such as challenges, points, levels, and leaderboards. [
        <xref ref-type="bibr" rid="ref26">14</xref>
        ]
iours, knowledge, and psychological wellbeing variables.
The two most common elements across the video games
were the use of a health-behaviour storyline and
healthbehaviour goal-setting. However, given the single-group
studies in this review, the added benefit of such game
elements compared to controls or other game elements was not
clear.
      </p>
      <p>
        Other studies show that users give positive feedback for
wellbeing interventions incorporating gameful elements
such as fun and engaging storylines, metaphors, and
visuals. One digital gameful application—“This Is Your Life!”
[
        <xref ref-type="bibr" rid="ref38">26</xref>
        ]—was aimed at teaching positive psychology exercises
to primary school teachers. The users’ path towards optimal
wellbeing was presented through a metaphor of an
interactive “flourishing journey” on a map with topics presented as
different locations. Initial feedback data demonstrated that
users found the application and the metaphor motivating for
promoting their wellbeing.
      </p>
      <p>
        Some gameful technologies take the playful element even
further and develop interventions involving a physical toy.
In an innovative example, Roo et al. [
        <xref ref-type="bibr" rid="ref47">35</xref>
        ] designed a
mixedreality sandbox to train mindfulness meditation. The system
featured a sandbox with real sand that users could play with
to express their feelings. Gathering information from the
movements users created in the sandbox and their breathing
patterns as tracked by physiological sensors, the system
created a virtual world simulation with water, vegetation,
and wildlife all seen through a virtual reality headset. The
weather and water levels in this virtual world fluctuated in
sync with the users’ breathing. This generated a form of
biofeedback to help users enter a deep and meditative
breathing pattern. Although results are preliminary, an
evaluation with 12 participants showed that most users
enjoyed the experience and felt that it could help them
meditate and reach a calm and mindful state. In a similar playful
light, Ludden and Meekhof [
        <xref ref-type="bibr" rid="ref39">27</xref>
        ] designed the “Break
Trigger”: a small lighting device for employees to use on their
desks as a fun, playful reminder to take regular breaks. The
Break Trigger would slowly fade to dark at the end of every
hour to encourage users to get up and out of their desks for
a short respite every hour. Results showed that users of the
Break Trigger scored higher on positive affect and
motivation and lower on negative affect and frustration after
taking a break. Overall, despite small sample sizes and mostly
feedback-based findings, it appears that various playful and
gameful technologies and programs can help bring users
more enjoyment.
      </p>
      <p>
        How motivating is “winning” at wellbeing?
Although there is much promise that incorporating more
play, games, and stories into wellbeing interventions can be
helpful and engaging for users, another element worth
noting is the very purpose of many games: to win. Winning at
games used for leisure is often seen as harmless and fun,
but does this hold true when a game aims to improve
wellbeing? This question seeps into a major topic of debate in
the positive psychology and health behaviour change
literature on motivation: how do we motivate users to gain
sustainable benefits? The grounding theory behind much of
this research is Deci and Ryan’s [
        <xref ref-type="bibr" rid="ref25">13</xref>
        ] Self-Determination
Theory, which suggests that humans are more likely to
engage in, persist at, and develop positive physical and
psychological health behaviours when they experience more
autonomous and less controlled motivation. According to
Deci and Ryan [13, p. 14], “Autonomous motivation
involves behaving with a full sense of volition and choice,
whereas controlled motivation involves behaving with the
experience of pressure and demand towards specific
outcomes that comes from forces perceived to be external to
the self.” Research from positive psychology shows that
users’ degree of autonomous motivation to engage in their
assigned exercises leads to more frequent exercise practice
and subsequently greater improvements in wellbeing
outcomes [
        <xref ref-type="bibr" rid="ref53">41</xref>
        ]. The question for research now becomes, how
can we apply gameful design to wellbeing interventions to
promote more autonomous, and less controlled motivation?
Various elements of gameful design promote “winning,”
such as badges and trophies for achievements, increasing
levels, and competitions against other players. A case can
be made for or against these approaches in promoting
autonomous, controlled, or both forms of motivation for
wellbeing. On the one hand, these gameful elements can
promote users’ psychosocial needs deemed essential for
promoting autonomous motivation, according to
SelfDetermination Theory [
        <xref ref-type="bibr" rid="ref25">13</xref>
        ]: (1) relatedness with other users
(e.g., competing in a game for fun with a group of friends),
(2) competency (e.g., seeing one’s skill development
progress), and (3) autonomy (e.g., choosing which awards and
levels to strive towards). However, these very same
psychosocial needs and subsequent autonomous motivation can
just as easily be thwarted with extrinsic gameful rewards,
such as those that breed continuous comparison with others,
discouraging difficultly, unwanted pressure, a “gimmicky”
feel, or too much focus on the benefits of the health
behaviour instead of the actual process.
      </p>
      <p>
        Unfortunately, there is an absence of rigorous research to
date examining how various forms of “winning” and
rewards in gameful technologies can help or hinder
autonomous motivation and subsequent benefits. Given that
technology with gameful rewards may seem like a standard
practice in the world of workplace technology (e.g., Fitbit2,
MUSE3, and Headspace4 provide points, levels, prizes, etc.
for users’ health improvements), it is surprising that so little
research has actually examined the specific effects of these
elements. Studies that have examined this area present a
cautionary tale. For example, Ahtinen et al. [
        <xref ref-type="bibr" rid="ref1">1</xref>
        ] tested a
mental wellness mobile application, grounded in acceptance
and commitment therapy [
        <xref ref-type="bibr" rid="ref33">21</xref>
        ] and guided mindfulness
ex2 https://www.fitbit.com
3 http://www.choosemuse.com
4 https://www.headspace.com
ercises, which showed improvements in users’ stress and
life satisfaction after one month. However, when
participants were asked their opinion on the possibility of future
iterations of the application including gamification elements
such points, achievements, and rewards, feedback was not
supportive. Overall, participants felt these features would
not fit well with the context of the application and would be
detrimental to their autonomous motivation for
selfimprovement due to focus on external rewards. In another
study, Orji et al. [
        <xref ref-type="bibr" rid="ref44">32</xref>
        ] investigated participants’ preferences
for different persuasive strategies frequently used in games
and gameful applications for health behaviour change.
While strategies such as competition and social comparison
were deemed motivational for some participants, others
reported that they would actually feel demotivated by these
elements, mentioning that they would feel stressed,
discouraged, and less self-confident in case of a lower
performance in comparison with their friends.
      </p>
      <p>
        Outside of gamification research, studies in health
behaviour change further caution against too much focus on
external rewards and outcomes, which may thwart
autonomous user motivation. Fishbach and Choi [
        <xref ref-type="bibr" rid="ref28">16</xref>
        ] examined
how health behaviour change may be promoted with
experiential goal pursuit, defined as focusing on the activities of
the goal itself, as opposed to instrumental goal pursuit, in
which the focus is on the outcome of the goal. Grounded in
Self-Determination Theory [
        <xref ref-type="bibr" rid="ref25">13</xref>
        ], the researchers posited
that experiential goal pursuit would channel more
autonomous motivation, whereas instrumental goal pursuit would
channel more controlled motivation. They conducted four
experiments to show that across a wide range of wellbeing
behaviours such as physical exercise, dental care, and
practicing yoga, having participants think about instrumental
goals (e.g., to lose weight, to boost health) as compared to
experiential goal pursuit (e.g., I will first stretch, then run
on the treadmill) led to more negative experiences and
lower intentions to continue the health behaviour in the future.
Thus, while much more research with long-term outcomes,
randomized conditions, and wellbeing technology is
required, caution against too much of a “winning” focus is
warranted.
      </p>
      <p>
        IMPLICATIONS FOR GAMEFUL POSITIVE
PSYCHOLOGY DESIGN AND FUTURE RESEARCH.
It is time for technology to be leveraged to improve the
lives of employees. Research has recently begun to show
that innovative, time and cost effective online positive
psychology programs and gameful technologies can reduce
stress and promote employees’ well-being. In this paper, we
summarized key insights from the online positive
psychology intervention literature to help guide future wellbeing
technologies: longer program length, frequent practice,
activity variety, enjoyment and person-intervention fit, user
friendliness, and virtual support. We also reviewed the
literature on gamification in wellbeing technology to see how
gamification can promote the beneficial elements of
positive psychology interventions. From the research to date, it
appears that new technologies with various gameful
elements (e.g., stories, interactive games, virtual reality
experiences) show promise in increasing user enjoyment,
engagement, and wellbeing. Some exemplary studies have
even integrated gameful technology with positive
psychology exercises such as practicing mindfulness and savouring
positive moments (e.g., [
        <xref ref-type="bibr" rid="ref38 ref47">26,35</xref>
        ]), showing positive user
feedback. However, lack of placebo-controlled
experimentation curtails us from claiming that gameful versions of
wellbeing programs and technologies are necessarily better
or worth the investment in organizations.
      </p>
      <p>
        Thus, many questions are still left unanswered. Rigorously
evaluating gameful technology’s added benefit over and
above current programs, potential burdens, and areas for
improvement is needed more than ever in our tech-driven
world of work. Despite progress to show that gameful
technologies can be effective, researchers now need to test the
incremental benefits of various gamification elements in
randomized controlled trials aimed at promoting
psychological wellbeing. There has been an increase in the online
positive psychology intervention research showing that
various elements such as user choice and customized
exercises can provide incremental benefits over and above
standard online interventions without these elements [
        <xref ref-type="bibr" rid="ref48">7,36</xref>
        ].
The same level of methodological rigor would now be
helpful to guide future gameful technology development by
better understanding which elements should be applied,
when, and with whom.
      </p>
      <p>
        Of course, there may be good reason for the lack of
randomized controlled trials in the wellbeing technology
literature; researchers face many challenges in conducting
rigorous, long-term and large-scale interventions using new
technology, such as limited access to prototypes of the
latest technology and the fact that technology may change
before the study even concludes [
        <xref ref-type="bibr" rid="ref41">29</xref>
        ]. However, while it is
understandable why the efficacy of each new mobile
application or technological breakthrough cannot be feasibly
tested with an experiment, there should be ample
opportunity to conduct randomized controlled trials to test core
gamification elements and guiding theories that stay constant
even as technologies change. Thus, we encourage future
researchers to rigorously test specific gamification
principles (e.g., rewards, points, social networks) with
randomized trials to confirm whether they are truly beneficial over
and above standard versions without these elements.
One area in particular that requires more rigorous
randomized trials is that of gameful rewards and the idea of
“winning” at improving one’s wellbeing. This includes testing
various elements such as badges, levels, and points, and
whether or not adding a social comparison element to these
rewards is helpful or harmful for promoting users’
autonomous motivation, engagement, and benefits. Previous
randomized controlled trials in OPPIs and other wellbeing
technology studies showcase the added benefits of creating
a social environment, such as in the form of virtual support
[
        <xref ref-type="bibr" rid="ref55">43</xref>
        ] and text message reminders [6]. However, it is still
unknown the extent to which sharing one’s rewards and
rankings with other users, and making social comparisons
across rankings in a virtual world promotes or hinders
wellbeing across various conditions and different types of users.
Moreover, because Self-Determination Theory [
        <xref ref-type="bibr" rid="ref25">13</xref>
        ] is a
guiding theory behind the design of many technologically
facilitated health behaviour and positive psychology
interventions [9], the extent to which gameful technologies can
foster autonomous versus controlled motivation is a critical
question for future research. Future research should explore
if different types of virtual reward environments, such as
providing options and customization for rewards, or a more
social “team” winning environment, can help mitigate
against controlled motivation and promote users’ sense of
autonomous motivation. In addition to answering these
questions with empirical evidence (such as measuring
autonomous motivation across different gameful conditions),
richer qualitative accounts of users’ intervention
experiences using interviews and focus groups can help tap into the
more complex and nuanced ways that wellbeing technology
influences motivation, enjoyment, and benefits seen in real
life.
      </p>
      <p>
        Finally, how effective are technologies and gameful
interventions in promoting wellbeing long-term? Findings from
online positive psychology literature show that users
continue to see benefits up to six months after interventions end
[
        <xref ref-type="bibr" rid="ref52">40</xref>
        ]. However, long-term study of most wellbeing
technologies, particularly gameful technologies, is lacking. To
prevent the wellbeing technology trend from being cast as just
a “quick fix,” future interventions are encouraged to
analyze cost-effectiveness and long-term sustainability in
addition to pre-post effect sizes and immediate user feedback
[9]. In all, we encourage researchers to pursue these
important questions on more nuanced and contextual aspects
of wellbeing technologies and how they affect employees’
lives. There may be a fine line between harmful and helpful
wellbeing solutions in our connected and technologically
driven world of work. If we do not discover where to draw
that line soon, the wellbeing technology craze may just as
quickly fade from our workplaces.
      </p>
      <p>ACKNOWLEDGMENTS
Author Pogrebtsova’s research is supported by the SSHRC
Joseph-Armand Bombardier CGS Doctoral Scholarship
(767-2016-1727). Author Tondello’s research is supported
by the CNPq, Brazil. This research was also partially
funded by SSHRC (895-2011-1014, IMMERSe), NSERC
(RGPIN-418622-2012), CFI (35819), and Mitacs with
FlourishiQ Inc. (IT07255).</p>
      <p>Allied Business Research. 2013. Corporate Wellness is
a 13 Million Unit Wearable Wireless Device
Opportunity. ABI Research. Retrieved September 29,
2017 from https://www.abiresearch.com/press/
corporate-wellness-is-a-13-million-unit-wearable-w/</p>
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