Exploring the use of a gamified intervention for encouraging physical activity in adolescents: a qualitative longitudinal study in Northern Ireland

Rekesh Corepal, Paul Best, Roisin O'Neill, Mark A Tully, Mark Edwards, Russell Jago, Sarah J Miller, Frank Kee, Ruth F Hunter, Rekesh Corepal, Paul Best, Roisin O'Neill, Mark A Tully, Mark Edwards, Russell Jago, Sarah J Miller, Frank Kee, Ruth F Hunter

Abstract

Objective: To explore the temporal changes of adolescents' views and experiences of participating in a gamified intervention to encourage physical activity behaviour and associated processes of behaviour change.

Design: A qualitative longitudinal design was adopted whereby focus groups were conducted with the same participants in each intervention school (n=3) at four time-points (baseline, end of each of two intervention phases and 1-year follow-up). The framework method was used to thematically analyse the data.

Setting: Secondary schools (n=3), Belfast (Northern Ireland).

Participants: A subsample (n=19 at four time-points) of individuals aged 12-14 years who participated in the StepSmart Challenge, a gamified intervention involving a pedometer competition and material rewards to encourage physical activity behaviour change.

Results: Three core themes were identified: (1) competition; (2) incentives and (3) influence of friends. Participants indicated that a pedometer competition may help initiate physical activity but suggested that there were a number of barriers such as participants finding it 'boring', and feeling as though they had a remote chance of 'winning'. 'Incentives' were viewed favourably, although there were participants who found not winning a prize 'annoying'. Friends were a motivator to be more physically active, particularly for girls who felt encouraged to walk more when with a friend.

Conclusions: The intervention in general and specific gamified elements were generally viewed positively and deemed acceptable. Results suggest that gamification may have an important role to play in encouraging adolescents to engage in physical activity and in creating interventions that are fun and enjoyable. The longitudinal approach added additional depth to the analysis as themes were refined and tested with participants over time. The findings also suggest that gamified Behaviour Change Techniques align well with core concepts of Self-determination Theory and that various game elements may require tailoring for specific populations, for example, different genders.

Trial registration number: NCT02455986; Pre-results.

Keywords: preventive medicine; public health; qualitative research.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Diagrammatic representation of the temporal thematic pathways that developed during focus group interviews. PA, physical activity.

References

    1. Tremblay MS, Barnes JD, González SA, et al. . Global matrix 2.0: report card grades on the physical activity of children and youth comparing 38 Countries. J Phys Act Health 2016;13(Suppl 2):S343–66. 10.1123/jpah.2016-0594
    1. Telama R. Tracking of physical activity from childhood to adulthood: a review. Obes Facts 2009;2:187–95. 10.1159/000222244
    1. Telama R, Yang X, Leskinen E, et al. . Tracking of physical activity from early childhood through youth into adulthood. Med Sci Sports Exerc 2014;46:955–62. 10.1249/MSS.0000000000000181
    1. Metcalf B, Henley W, Wilkin T. Effectiveness of intervention on physical activity of children: systematic review and meta-analysis of controlled trials with objectively measured outcomes (EarlyBird 54). BMJ 2012;345:e5888 10.1136/bmj.e5888
    1. Soares NM, Leão AS, Santos JR, et al. . Systematic review shows only few reliable studies of physical activity intervention in adolescents. ScientificWorldJournal 2014;2014:1–8. 10.1155/2014/206478
    1. Gillis L, Tomkinson G, Olds T, et al. . Research priorities for child and adolescent physical activity and sedentary behaviours: an international perspective using a twin-panel Delphi procedure. Int J Behav Nutr Phys Act 2013;10:112 10.1186/1479-5868-10-112
    1. McCartney M. Margaret McCartney: game on for Pokémon Go. BMJ 2016;354:i4306.
    1. Wong FY. Erratum to: influence of Pokémon Go on physical activity levels of university players: a cross-sectional study. Int J Health Geogr 2017;16:17 10.1186/s12942-017-0089-5
    1. Lister C, West JH, Cannon B, et al. . Just a fad? Gamification in health and fitness apps. JMIR Serious Games 2014;2:e9 10.2196/games.3413
    1. Hunter RF, de Silva D, Reynolds V, et al. . International inter-school competition to encourage children to walk to school: a mixed methods feasibility study. BMC Res Notes 2015;8:19 10.1186/s13104-014-0959-x
    1. Coombes E, Jones A. Gamification of active travel to school: a pilot evaluation of the beat the street physical activity intervention. Health Place 2016;39:62–9. 10.1016/j.healthplace.2016.03.001
    1. Michie S, Richardson M, Johnston M, et al. . The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med 2013;46:81–95. 10.1007/s12160-013-9486-6
    1. Sardi L, Idri A, Fernández-Alemán JL. A systematic review of gamification in e-Health. J Biomed Inform 2017;71:31–48. 10.1016/j.jbi.2017.05.011
    1. Cugelman B. Gamification: what it is and why it matters to digital health behavior change developers. JMIR Serious Games 2013;1:e3 10.2196/games.3139
    1. Best P, Tully MA, Corepal R, et al. . Time to ’re-think' physical activity promotion for young people? Results from a repeated cross-sectional study. BMC Public Health 2017;17:208 10.1186/s12889-017-4136-8
    1. Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol 2000;55:68–78. 10.1037/0003-066X.55.1.68
    1. Ryan RM, Williams GC, Patrick H, et al. . Self-determination theory and physical activity: the dynamics of motivation in development and wellness. Hellenic Journal of Psychology 2009;6:107–24.
    1. Ryan RM, Patrick H, Deci EL, et al. . Facilitating health behaviour change and its maintenance: Interventions based on self-determination theory. European Health Psychologist 2008;10:2–5.
    1. Silva MN, Marques MM, Teixeira PJ. Testing theory in practice: the example of self-determination theory-based interventions. Eur Health Psychol 2014;16:171–80.
    1. Sebire SJ, Kesten JM, Edwards MJ, et al. . Using self-determination theory to promote adolescent girls' physical activity: exploring the theoretical fidelity of the bristol girls dance project. Psychol Sport Exerc 2016;24:100–10. 10.1016/j.psychsport.2016.01.009
    1. Saldana J. Longitudinal qualitative research: analysing change through time. California: AltaMira Press, 2003.
    1. Corden A, Millar J. Qualitative longitudinal research for social policy – introduction to themed section. Social Policy and Society 2007;6:529–32. 10.1017/S1474746407003867
    1. Calman L, Brunton L, Molassiotis A. Developing longitudinal qualitative designs: lessons learned and recommendations for health services research. BMC Med Res Methodol 2013;13:14 10.1186/1471-2288-13-14
    1. Jago R, Bailey R. Ethics and paediatric exercise science: issues and making a submission to a local ethics and research committee. J Sports Sci 2001;19:527–35. 10.1080/026404101750238980
    1. Harper M, Cole P. Member checking: can benefits be gained similar to group therapy? The Qualitative Report 2012;17:510–7.
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3:77–101. 10.1191/1478088706qp063oa
    1. Albanese RvF, David D. Rational behavior in groups: the free-riding tendency. Academy of Management Review 1985;10:244–55.
    1. Barte JCM, Wendel-Vos GCW. A systematic review of financial incentives for physical activity: the effects on physical activity and related outcomes. Behav Med 2017;43:79–90. 10.1080/08964289.2015.1074880
    1. Suchert V, Isensee B, Sargent J, et al. . Prospective effects of pedometer use and class competitions on physical activity in youth: A cluster-randomized controlled trial. Prev Med 2015;81:399–404. 10.1016/j.ypmed.2015.10.002
    1. Hardman CA, Horne PJ, Fergus Lowe C. Effects of rewards, peer-modelling and pedometer targets on children’s physical activity: a school-based intervention study. Psychol Health 2011;26:3–21. 10.1080/08870440903318119
    1. Horne PJ, Hardman CA, Lowe CF, et al. . Increasing children’s physical activity: a peer modelling, rewards and pedometer-based intervention. Eur J Clin Nutr 2009;63:191–8. 10.1038/sj.ejcn.1602915
    1. Finkelstein EA, Tan YT, Malhotra R, et al. . A cluster randomized controlled trial of an incentive-based outdoor physical activity program. J Pediatr 2013;163:167–72. 10.1016/j.jpeds.2013.01.009
    1. Cahill K, Hartmann-Boyce J, Perera R. Incentives for smoking cessation. Cochrane Database Syst Rev 2015;5:CD004307 10.1002/14651858.CD004307.pub5
    1. Burns RJ, Donovan AS, Ackermann RT, et al. . A theoretically grounded systematic review of material incentives for weight loss: implications for interventions. Ann Behav Med 2012;44:375–88. 10.1007/s12160-012-9403-4
    1. Frey BS, Jegen R. Motivation crowding theory. Journal of Economic Surveys 2001;15:589–611. 10.1111/1467-6419.00150
    1. Mantzari E, Vogt F, Shemilt I, et al. . Personal financial incentives for changing habitual health-related behaviors: A systematic review and meta-analysis. Prev Med 2015;75:75–85. 10.1016/j.ypmed.2015.03.001
    1. Mitchell MS, Goodman JM, Alter DA, et al. . Financial incentives for exercise adherence in adults: systematic review and meta-analysis. Am J Prev Med 2013;45:658–67. 10.1016/j.amepre.2013.06.017
    1. Strohacker K, Galarraga O, Williams DM. The impact of incentives on exercise behavior: a systematic review of randomized controlled trials. Ann Behav Med 2014;48:92–9. 10.1007/s12160-013-9577-4
    1. Knowles AM, Niven A, Fawkner S. A qualitative examination of factors related to the decrease in physical activity behavior in adolescent girls during the transition from primary to secondary school. J Phys Act Health 2011;8:1084–91. 10.1123/jpah.8.8.1084
    1. Ames C. Achievement attributions and self-instructions under competitive and individualistic goal structures. J Educ Psychol 1984;76:478–87. 10.1037/0022-0663.76.3.478
    1. Lam SF, Yim PS, Law JS, et al. . The effects of competition on achievement motivation in Chinese classrooms. Br J Educ Psychol 2004;74(Pt 2):281–96. 10.1348/000709904773839888
    1. Grant D, Green WB. Grades as incentives. Empir Econ 2013;44:1563–92. 10.1007/s00181-012-0578-0
    1. Giles EL, Robalino S, McColl E, et al. . The effectiveness of financial incentives for health behaviour change: systematic review and meta-analysis. PLoS One 2014;9:e90347 10.1371/journal.pone.0090347
    1. Hunter RF, Tully MA, Davis M, et al. . Physical activity loyalty cards for behavior change: a quasi-experimental study. Am J Prev Med 2013;45:56–63. 10.1016/j.amepre.2013.02.022
    1. Seghers J, Vissers N, Rutten C, et al. . Intrinsic goals for leisure-time physical activity predict children’s daily step counts through autonomous motivation. Psychol Sport Exerc 2014;15:247–54. 10.1016/j.psychsport.2014.01.003
    1. Sebire SJ, Jago R, Fox KR, et al. . Testing a self-determination theory model of children’s physical activity motivation: a cross-sectional study. Int J Behav Nutr Phys Act 2013;10:111 10.1186/1479-5868-10-111
    1. Maculada ST. Gender differences in task and ego goal orientation and motivation in sport participation. Philippine Journal of Psychology 2007;40.
    1. Cantador I, Conde JM. Effects of competition in education: A case study in an e-learning environment Proceedings of the IADIS International Conference E-learning, 2010.
    1. Maiden B, Perry B. Dealing with free‐riders in assessed group work: results from a study at a UK university. Assessment & Evaluation in Higher Education 2011;36:451–64. 10.1080/02602930903429302
    1. Garbers Y, Konradt U. The effect of financial incentives on performance: a quantitative review of individual and team-based financial incentives. J Occup Organ Psychol 2014;87:102–37. 10.1111/joop.12039
    1. Gunnthorsdottir A, Rapoport A. Embedding social dilemmas in intergroup competition reduces free-riding. Organ Behav Hum Decis Process 2006;101:184–99. 10.1016/j.obhdp.2005.08.005
    1. Kugler T, Rapoport A, Pazy A. Public good provision in inter‐team conflicts: effects of asymmetry and profit‐sharing rule. Journal of Behavioral Decision Making 2010;23:421–38.
    1. Howe LA. On competing against oneself, Or ‘I need to get a different voice in my head’. Sport Ethics Philos 2008;2:353–66. 10.1080/17511320802475762
    1. Van den Berghe L, Vansteenkiste M, Cardon G, et al. . Research on self-determination in physical education: key findings and proposals for future research. Phys Educ Sport Pedagogy 2014;19:97–121. 10.1080/17408989.2012.732563
    1. Teixeira PJ, Carraça EV, Markland D, et al. . Exercise, physical activity, and self-determination theory: a systematic review. Int J Behav Nutr Phys Act 2012;9:78 10.1186/1479-5868-9-78
    1. Gardner B, Lally P. Does intrinsic motivation strengthen physical activity habit? Modeling relationships between self-determination, past behaviour, and habit strength. J Behav Med 2013;36:488–97. 10.1007/s10865-012-9442-0
    1. Fitzgerald A, Fitzgerald N, Aherne C. Do peers matter? A review of peer and/or friends' influence on physical activity among American adolescents. J Adolesc 2012;35:941–58. 10.1016/j.adolescence.2012.01.002
    1. Maturo CC, Cunningham SA. Influence of friends on children’s physical activity: a review. Am J Public Health 2013;103:e23–e38. 10.2105/AJPH.2013.301366
    1. Sawka KJ, McCormack GR, Nettel-Aguirre A, et al. . Friendship networks and physical activity and sedentary behavior among youth: a systematized review. Int J Behav Nutr Phys Act 2013;10:130 10.1186/1479-5868-10-130
    1. Lewis J. Analysing qualitative longitudinal research in evaluations. Social Policy and Society 2007;6:545–56. 10.1017/S1474746407003880
    1. MacPhail A, Gorely T, Kirk D, et al. . Children’s experiences of fun and enjoyment during a season of sport education. Res Q Exerc Sport 2008;79:344–55. 10.1080/02701367.2008.10599498

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅