JMIR Publications

ABSTRACT

Background:

Managing blood pressure (BP) in prehypertensive individuals is crucial to prevent the incidence of hypertension. While physical activity has proven effective in BP management, physical inactivity remains prevalent. Gamification has shown promise in addressing physical inactivity; however, its effectiveness is limited due to the suboptimal intervention design.

Objective:

This study aimed to develop a comprehensive understanding of prehypertensive individuals' needs, design preferences, and motivational drivers for gamified exercise applications by integrating the Octalysis Gamification Framework with Self-Determination Theory (SDT) through a participatory qualitative methodology.

Methods:

The qualitative study employing semi-structured interviews was conducted from June to July 2025 through across mainland China. Participants were recruited through online platforms using purposive sampling to select individuals with prehypertension [systolic BP (SBP) 120-139 mmHg and/or diastolic BP (DBP) 80-89 mmHg]. Interview guides were systematically structured around SDT constructs and the Octalysis framework's eight core gamification drives to explore participants' needs, design preferences, and motivational drivers for gamified exercise applications. An inductive/deductive hybrid thematic analysis was utilized to identify key themes.

Results:

A total of 14 eligible prehypertensive individuals participated in the study. Their needs and preferences for exercise apps, including exercise guidance, data monitoring and feedback, werable device portability, were summarized. Eight core gamification motivational drives, like epic meaning and social influence, according to the Octalysis framework, were explored with interviewees, including their attitudes and creative design considerations. Moreover, the study examined how the satisfaction of basic psychological needs (eg., sense of volition, technical challenges, and social connections) influences the transformation of motivation.

Conclusions:

This theory-informed investigation reveals that successful gamified exercise applications for prehypertensive individuals must transcend traditional game mechanics to address deeper psychological needs. Applications should prioritize personalized exercise programming, robust health monitoring capabilities, and psychologically-grounded gamification elements that foster intrinsic motivation. By integrating the Octalysis framework with SDT principles and user-centered insights, this study provides evidence-based design guidelines for developing engaging and effective gamified exercise applications specifically tailored to support sustained physical activity adoption and BP management in prehypertensive populations.