Health Behavior Theory in Physical Activity Game Apps: A Content Analysis

Abstract

BackgroundPhysical activity games developed for a mobile phone platform are becoming increasingly popular, yet little is known about their content or inclusion of health behavior theory (HBT).ObjectiveThe objective of our study was to quantify elements of HBT in physical activity games developed for mobile phones and to assess the relationship between theoretical constructs and various app features.MethodsWe conducted an analysis of exercise and physical activity game apps in the Apple App Store in the fall of 2014. A total of 52 apps were identified and rated for inclusion of health behavior theoretical constructs using an established theory-based rubric. Each app was coded for 100 theoretical items, containing 5 questions for 20 different constructs. Possible total theory scores ranged from 0 to 100. Descriptive statistics and Spearman correlations were used to describe the HBT score and association with selected app features, respectively.ResultsThe average HBT score in the sample was 14.98 out of 100. One outlier, SuperBetter, scored higher than the other apps with a score of 76. Goal setting, self-monitoring, and self-reward were the most-reported constructs found in the sample. There was no association between either app price and theory score (P=.5074), or number of gamification elements and theory score (P=.5010). However, Superbetter, with the highest HBT score, was also the most expensive app.ConclusionsThere are few content analyses of serious games for health, but a comparison between these findings and previous content analyses of non-game health apps indicates that physical activity mobile phone games demonstrate higher levels of behavior theory. The most common theoretical constructs found in this sample are known to be efficacious elements in physical activity interventions. It is unclear, however, whether app designers consciously design physical activity mobile phone games with specific constructs in mind; it may be that games lend themselves well to inclusion of theory and any constructs found in significant levels are coincidental. Health games developed for mobile phones could be potentially used in health interventions, but collaboration between app designers and behavioral specialists is crucial. Additionally, further research is needed to better characterize mobile phone health games and the relative importance of educational elements versus gamification elements in long-term behavior change.

The promise of an augmented reality game—Pokémon GO

“…Recent advances in technology facilitate the promoting of physical activity (1)(2)(3)(4)(5)(6)(7)(8). This is important due to the health effect of physical activity and the reach and disseminability of technology based programs/interventions.…”

“…So the public health impact potential is substantial. It is recommended that researchers apply theoretical constructs of health behavior theory (HBT) for behavior change to promote physical activity (6,7). For example, SuperBetter includes tailored educational elements based on HBT, such as individualized assistance and feedback on each player's achievement/improvement.…”

Gamification of Older Adults’ Physical Activity: An Eight-Week Study

“…Motivation to engage in PA is influenced by their own personalities, attitudes towards technology and social interaction [37]. Currently, we lack guidelines for designing and tailoring PA programs for older adults from a motivation-and-goals systems view compared to rewards-based systems [25,31,48].…”

3MD for Chronic Conditions, a Model for Motivational mHealth Design: Embedded Case Study (Preprint)

“…The use of instant feedback and positive reinforcement from learning theories are common use in mHealth applications [29,47]; Health Belief Model (HBM) has been used in mHealth interventions for self-management and health promotion [52][53][54]; the Transtheoretical Model (TTM) has been used in mobile solutions for smoke cessation and other addictive behaviors [55][56][57][58]; physical activity and fitness interventions use the Theory of Planned Behavior (TPB) [29,50,59], as well as self-regulation theories [29,[60][61][62][63]. The basis for Social Cognitive Theories (SCT) can be found in many interventions using health apps for disease management [64][65][66] and goal setting is very often used in mHealth apps [60,67].…”

“…The basis for Social Cognitive Theories (SCT) can be found in many interventions using health apps for disease management [64][65][66] and goal setting is very often used in mHealth apps [60,67]. It has been noted that each BCM carries its limitations and problems [68][69][70].…”