Accepted for/Published in: JMIR Serious Games
Date Submitted: Jun 9, 2025
Date Accepted: Feb 14, 2026
User Experiences of Behavioural and Psychological Change Techniques in a Walking-Based Mobile Exergame: A Cross-Sectional Qualitative Study
ABSTRACT
Background:
Exergaming, the integration of physical activity with game-based elements, offers a promising approach to promote physical activity in individuals with chronic conditions. Despite its potential, limited evidence exists on how specific game elements influence behavioural and psychological outcomes in this population.
Objective:
To explore the behavioural and psychological change techniques experienced by individuals with chronic conditions using a walking-based mobile exergame, called Heart Farming.
Methods:
A qualitative deductive design was used, using data from semi-structured interviews with 14 participants aged 67–92 years who used the Heart Farming exergame for three months. Participants were recruited from two ongoing studies in individuals with chronic conditions. Data were analysed using deductive content analysis guided by a gamification framework.
Results:
Participants reported an increased motivation to walk, facilitated by game elements such as goals, rewards, feedback, and planning. Exergaming was integrated into daily routines and perceived as enjoyable, especially due to its farming theme and visual design. Behavioural change techniques such as goal setting, feedback, and social support were commonly experienced, whereas focus on past success -as described in the gamification framework- was not used as a technique by the exergame. Psychological techniques including self-monitoring and stress management were mentioned. A feeling of discomfort due to playing in public was reported, and participants varied in terms of the levels of digital literacy. Social interaction features were not adequately used, even though some participants created informal support groups to exergame.
Conclusions:
Exergaming incorporates a variety of behavioural and psychological change techniques which were experienced by the participants with various ways. Individuals’ previous knowledge of exergaming, interests, and illness progression were mentioned as factors that can influence their experiences of exergaming. Further research is needed to refine behaviour change techniques and assess condition-specific adaptations to maximize engagement and health outcomes. Clinical Trial: The study is registered on clinicaltrials.gov under the registration number NCT05641662: https://clinicaltrials.gov/study/NCT05641662
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