GAME ON? THE GAMIFICATION OF MHEALTH APPS IN THE CONTEXT OF SMOKING CESSATION. Sarim Siddiqui, Abdulrahman El-Hilly, Zaid Al-Fagih, Mohammed Muntasir, Yusuf Sherwani, Maroof Ahmed & Sheeraz Iqbal

68% of smokers want to quit Only 3% are successful (Stopping Smoking: The benefits and aids to quitting, 2014) Sarim Siddiqui, Abdulrahman El-Hilly, Zaid Al-Fagih, Mohammed Muntasir, Yusuf Sherwani, Maroof Ahmed & Sheeraz Iqbal

Effective Smoking Cessation Pharmacological Intervention Behavioural Support NHS reaches 1 in 10 smokers wanting to quit

Mobile Health Poor User Engagement Gamification Sarim Siddiqui, Abdulrahman El-Hilly, Zaid Al-Fagih, Mohammed Muntasir, Yusuf Sherwani, Maroof Ahmed & Sheeraz Iqbal Solution Using basic game components to make tasks more manageable and enjoyable Behavioural Support

(Hamari, 2014) Sarim Siddiqui, Abdulrahman El-Hilly, Zaid Al-Fagih, Mohammed Muntasir, Yusuf Sherwani, Maroof Ahmed & Sheeraz Iqbal Game Elements Motivational Affordances Desired Psychological Outcomes Behavioural Outcomes Education Business ? Health Behaviour

How gamification leads to a change in health behaviour with respect to smoking cessation AIM Sarim Siddiqui, Abdulrahman El-Hilly, Zaid Al-Fagih, Mohammed Muntasir, Yusuf Sherwani, Maroof Ahmed & Sheeraz Iqbal

Methods Sarim Siddiqui, Abdulrahman El-Hilly, Zaid Al-Fagih, Mohammed Muntasir, Yusuf Sherwani, Maroof Ahmed & Sheeraz Iqbal Qualitative Longitudinal Study [5W] 9 – Gamified Cohort7 – Non- Gamified Cohort  4 semi-structured interviews per participant  Behaviour and emotions tracked

Triangulation Sarim Siddiqui, Abdulrahman El-Hilly, Zaid Al-Fagih, Mohammed Muntasir, Yusuf Sherwani, Maroof Ahmed & Sheeraz Iqbal Systematic Literature Review Expert Interviews Secondary Data  Semi-structured interviews  4 experts in gamification and smoking cessation  Data from gamified app  Data from over 200,000 users

Triangulation Sarim Siddiqui, Abdulrahman El-Hilly, Zaid Al-Fagih, Mohammed Muntasir, Yusuf Sherwani, Maroof Ahmed & Sheeraz Iqbal Secondary Data Expert Interviews Systematic Literature Review Qualitative Longitudinal Study Triangulation of Data Sources

Results Sarim Siddiqui, Abdulrahman El-Hilly, Zaid Al-Fagih, Mohammed Muntasir, Yusuf Sherwani, Maroof Ahmed & Sheeraz Iqbal Longitudinal Interviews App Engagement External Influences Game Engagement

Drivers for all mHealth apps ① Attitude Change ② Goal Setting ③ Association Results Drivers Specific to gamified apps ① Perceived Behavioural Control ② Intrinsic Motivation Sarim Siddiqui, Abdulrahman El-Hilly, Zaid Al-Fagih, Mohammed Muntasir, Yusuf Sherwani, Maroof Ahmed & Sheeraz Iqbal Longitudinal Interviews Expert Interviews Literature Review Secondary Data

Purpose User Alignment Functional Utility Critical Factors Framework Sarim Siddiqui, Abdulrahman El-Hilly, Zaid Al-Fagih, Mohammed Muntasir, Yusuf Sherwani, Maroof Ahmed & Sheeraz Iqbal +ve Drivers 1.Personalisation 2.Meaningful Framing 3.Fun 4.Challenge-ability balance 5.Unpredictability 6.User-centred design 7.Community Influencers Change in Health Behaviour Change in Health Behaviour Game Engagement External Social Influence External Social Influence -ve Driver Perceived Behavioural Control Perceived Behavioural Control Intrinsic Motivation Intrinsic Motivation

-ve Driver External Social Influence External Social Influence Purpose User Alignment Functional Utility Critical Factors +ve Drivers Framework Sarim Siddiqui, Abdulrahman El-Hilly, Zaid Al-Fagih, Mohammed Muntasir, Yusuf Sherwani, Maroof Ahmed & Sheeraz Iqbal Intrinsic Motivation Intrinsic Motivation Perceived Behavioural Control Perceived Behavioural Control Control Beliefs Self-efficacy Game Engagement Change in Health Behaviour Change in Health Behaviour

Purpose User Alignment Functional Utility Critical Factors +ve Drivers Framework Sarim Siddiqui, Abdulrahman El-Hilly, Zaid Al-Fagih, Mohammed Muntasir, Yusuf Sherwani, Maroof Ahmed & Sheeraz Iqbal Perceived Behavioural Control Perceived Behavioural Control Intrinsic Motivation Intrinsic Motivation Change in Health Behaviour Change in Health Behaviour Game Engagement Doing something that is inherently enjoyable

Purpose User Alignment Functional Utility Critical Factors Framework Sarim Siddiqui, Abdulrahman El-Hilly, Zaid Al-Fagih, Mohammed Muntasir, Yusuf Sherwani, Maroof Ahmed & Sheeraz Iqbal +ve Drivers 1.Personalisation 2.Meaningful Framing 3.Fun 4.Challenge-ability balance 5.Unpredictability 6.User-centred design 7.Community Influencers Change in Health Behaviour Change in Health Behaviour Game Engagement External Social Influence External Social Influence -ve Driver Perceived Behavioural Control Perceived Behavioural Control Intrinsic Motivation Intrinsic Motivation

Purpose User Alignment Functional Utility Critical Factors Framework Sarim Siddiqui, Abdulrahman El-Hilly, Zaid Al-Fagih, Mohammed Muntasir, Yusuf Sherwani, Maroof Ahmed & Sheeraz Iqbal Change in Health Behaviour Change in Health Behaviour Game Engagement +ve Drivers Perceived Behavioural Control Perceived Behavioural Control Intrinsic Motivation Intrinsic Motivation 1.Personalisation 2.Meaningful Framing 3.Fun 4.Challenge-ability balance 5.Unpredictability 6.User-centred design 7.Community Influencers

Purpose User Alignment Functional Utility Critical Factors Framework Sarim Siddiqui, Abdulrahman El-Hilly, Zaid Al-Fagih, Mohammed Muntasir, Yusuf Sherwani, Maroof Ahmed & Sheeraz Iqbal +ve Drivers 1.Personalisation 2.Meaningful Framing 3.Fun 4.Challenge-ability balance 5.Unpredictability 6.User-centred design 7.Community Influencers Change in Health Behaviour Change in Health Behaviour Game Engagement External Social Influence External Social Influence -ve Driver Perceived Behavioural Control Perceived Behavioural Control Intrinsic Motivation Intrinsic Motivation

Sarim Siddiqui, Abdulrahman El-Hilly, Zaid Al-Fagih, Mohammed Muntasir, Yusuf Sherwani, Maroof Ahmed & Sheeraz Iqbal 6.5M smokers want to quit 65% try and fail 3% successfully quit 32% don’t want to quit

NICE Guidelines Sarim Siddiqui, Abdulrahman El-Hilly, Zaid Al-Fagih, Mohammed Muntasir, Yusuf Sherwani, Maroof Ahmed & Sheeraz Iqbal Effective Smoking Cessation Pharmacological Intervention Behavioural Support Cognitive Behavioural Therapy  Expensive  Inconvenient  Practitioner dependent Behavioural Support

Loading 100% 33 Y/O Female: “I didn’t care much at the beginning but once I was on level 9 I did not want to go down so tired my best to stay at the same level...I didn’t think much about gaining levels but I really did not want to lose levels” Thematic Analysis App Engagement Behaviour Change Game Engagement External Influence Functional Utility Emotional Utility Awareness Commitment Social Influence Triggers of Relapse Sub-ThemesOver-arching ThemesCodes from Transcripts Coding Pool Coding Pool

Loading 100% 33 Y/O Female: “I didn’t care much at the beginning but once I was on level 9 I did not want to go down so tired my best to stay at the same level...I didn’t think much about gaining levels but I really did not want to lose levels” Modifiers for App Engagement Modifiers Initial Motivation Ease of Use Aesthetics Extant Knowledge

Loading 100% 33 Y/O Female: “I didn’t care much at the beginning but once I was on level 9 I did not want to go down so tired my best to stay at the same level...I didn’t think much about gaining levels but I really did not want to lose levels” Modifiers for Game Engagement Modifiers Personalisation Unpredictability Contextual Meaning Challenge-Ability Balance Need-fulfilling Design Fun Community

Loading 100% 33 Y/O Female: “I didn’t care much at the beginning but once I was on level 9 I did not want to go down so tired my best to stay at the same level...I didn’t think much about gaining levels but I really did not want to lose levels” Game and Play

Loading 100% Green Gamification Attitude Change Goal Setting Association Perceived Behavioural Control Perceived Behavioural Control Intrinsic Motivation Intrinsic Motivation Barrier Green Gamificatio n Green Gamificatio n mHealthGamification

Number of Smoking Related Deaths [EU] (European Commission, 2015) Sarim Siddiqui, Abdulrahman El-Hilly, Zaid Al-Fagih, Mohammed Muntasir, Yusuf Sherwani, Maroof Ahmed & Sheeraz Iqbal

Purpose User Alignment Functional Utility Critical Factors Framework Sarim Siddiqui, Abdulrahman El-Hilly, Zaid Al-Fagih, Mohammed Muntasir, Yusuf Sherwani, Maroof Ahmed & Sheeraz Iqbal Change in Health Behaviour Change in Health Behaviour Game Engagement +ve Drivers Perceived Behavioural Control Perceived Behavioural Control Intrinsic Motivation Intrinsic Motivation 1.Personalisation 2.Meaningful Framing 3.Fun 4.Challenge-ability balance 5.Unpredictability 6.User-centred design 7.Community Influencers Game Elements Game Engagement Behaviour Change Challenges and rewards which are self-relevant Linking the challenge of changing health behaviour to an overall self-relevant goal A dynamic balance must exist between the perceived ability and perceived challenge Unexpected rewards Ensuring that the user’s needs and goals are constantly met The experience must be innately enjoyable Drivers 1.Personalisation 2.Meaningful Framing 3.Challenge-Ability Balance 4.Unpredictability 5.User-centric design 6.Community 7.Fun Create a community of like-minded individuals, posting accolades will boost reputation Influencers