The Impact of Gamification-Induced Users' Feelings on the Continued Use of mHealth Apps: A Structural Equation Model With the Self-Determination Theory Approach

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 the continued use of mobile health (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 and the impact mechanism and path of users’ feelings induced by gamification on continued mHealth app use. Methods First, based on the expectation confirmation model of information system continuance, we built a theoretical model for continued use of mHealth apps based on users’ feelings toward gamification. We used self-determination theory to analyze gamification’s impact on user perceptions and set the resulting feelings (competence, autonomy, and relatedness) as constructs in the model. Second, we used the survey method to validate the research model, and we used partial least squares to analyze the data. Results A total of 2988 responses were collected from mHealth app users, and 307 responses were included in the structural equation model after passing the acceptance criteria. The intrinsic motivation for using mHealth apps is significantly affected by autonomy (β=.312; P<.001), competence (β=.346; P<.001), and relatedness (β=.165; P=.004) induced by gamification. The intrinsic motivation for using mHealth apps has a significant impact on satisfaction (β=.311, P<.001) and continuance intention (β=.142; P=.045); furthermore, satisfaction impacts continuance intention significantly (β=.415; P<.001). Confirmation has a significant impact on perceived usefulness (β=.859; P<.001) and satisfaction (β=.391; P<.001), and perceived usefulness has a significant impact on satisfaction (β=.269; P<.001) and continuance intention (β=.273; P=.001). The mediating effect analysis showed that in the impact path of the intrinsic motivation for using the mHealth apps on continuance intention, satisfaction plays a partial mediating role (β=.129; P<.001), with a variance accounted for of 0.466. Conclusions This study explored the impact path of users’ feelings induced by gamification on the intention of continued mHealth app use. We confirmed that perceived usefulness, confirmation, and satisfaction in the classical continued use theory for nonmedical information systems positively affect continuance intention. We also found that the path and mechanism of users' feelings regarding autonomy, competence, and relatedness generated during interactions with different gamification elements promote the continued use of mHealth apps.

Identifying major impact factors affecting the continuance intention of mHealth: a systematic review and multi-subgroup meta-analysis

“…Continuance intention is the user’s willingness and tendency to continue using mHealth. 15 This variable was measured by a self-reported questionnaire, usually on a 5 or 7 point Likert scale, such as “I intend to continue using the mHealth App I used rather than discontinue its use”. (3) The type of study was quantitative.…”

“…Continuance intention is an important driving force for long-term use, which is defined as user’s willingness and tendency to continue using the mHealth. 15 Therefore, relevant studies on the factors and mechanisms of continuance intention of mHealth services have gradually been increased. Studies on the various types of mHealth services, such as preventive health care or chronic disease management apps, 16 , 17 wearable devices, 18 and telemedicine, have been conducted.…”

eHealth and mHealth Development in Spain: Promise or Reality?

“…However, more differences appeared in sociodemographic profiles. The literature on accessibility [ 28 , 29 ] has highlighted the mobile phone as the main element for contributing to the achievement of healthcare equality, due to its portability, price, and use and connection cost. The use of mHealth will probably continue to grow and develop in step with new connectivity technologies that facilitate it.…”

“…The use of mHealth will probably continue to grow and develop in step with new connectivity technologies that facilitate it. In fact, the expansion of mHealth could even help “socialize” mobile technology [ 28 , 29 ]. For both chronic and occasional users, mobile phones may help activate patients to seek information and take greater care of their health, giving rise to what is known as the ePatient [ 33 ].…”

“…The literature review revealed that research has centered mainly around studying—but very little on achieving—data usability, accessibility, and quality [ 28 , 29 ]. Significant interoperability issues derived from the incompatibility of gathered data are believed to persist [ 30 ]; the worldwide web is still considered insecure and lacking in investment [ 31 ]; institutional barriers have been detected [ 32 ]; and the lack of first-language information on the internet is accompanied by information reliability issues [ 33 ].…”