Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 24, 2020
Date Accepted: Jul 13, 2021
Date Submitted to PubMed: Aug 13, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
The Impact of Gamification on the Continued Use of the mHealth App: A Structural Equation Model from the Self-Determination Theory Perspective
ABSTRACT
Background:
Continued use of mHealth Apps can achieve better effects in health management. Gamification is an important factor in promoting users’ intention to continue using mHealth Apps. Past research has rarely explored the factors underlying continued use of mHealth Apps and gamification’s impact mechanism or path on continued use.
Objective:
This study aimed to explore the factors influencing mHealth App users’ intention to continue using mHealth Apps, as well as the impact mechanism and path of gamification on continued use intention of mHealth Apps.
Methods:
First, based on the Expectation Confirmation Model of Information System Continuance (ECM-ISC), we built a theoretical model for continued use of mHealth Apps with gamification. We used self-determination theory (SDT) to analyze gamification’s impact on user perceptions and set the resulting feelings (competence, autonomy, relatedness and reward intention) as constructs into the model. Second, we used the survey method to validate the research model and partial least squares to analyze the data.
Results:
A total of 2988 responses were collected from mHealth App users, and 356 responses were included in the structural equation model after passing the acceptance criteria. The autonomy (beta=.347, P<.001), competence (beta=.185, P=.046) and relatedness (beta=.262, P=.001) generated by gamification significantly affect motivation for using mHealth Apps. The motivation for using mHealth Apps has a significant impact on satisfaction (beta=.312, P<.001) and continuance intention (beta=.137, P=.021); furthermore, satisfaction impacts continuance intention significantly (beta=.391, P<.001). Confirmation has a significant impact on perceived usefulness (beta=.865, P<.001) and satisfaction (beta=.405, P=.021), and perceived usefulness has a significant impact on satisfaction (beta=.205, P<.001) and continuance intention (beta=.307, P<.001). The mediating effect analysis showed that in the impact path of motivation for using the mHealth App on continuance intention, satisfaction plays a partial mediating role (beta=.122, P<.001, VAF=0.471).
Conclusions:
This study constructed a theoretical model about gamification’s impact on continued use of mHealth Apps for the first time. We not only confirmed that perceived usefulness, confirmation and satisfaction in the classical continued use theory for nonmedical information systems have a positive effect on continuance intention but also found the path and mechanism of gamification in promoting continued use of mHealth Apps by stimulating users’ autonomy, competence and relatedness.
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