Abstract

Mental health is defined as a condition of a person’s well-being in coping with the stress of life. Mobile apps that used gamification has been proven effective as a mental health intervention in the form of therapeutic tool for counseling and mental therapy. Entertainment content of video games has been shown to improve mood, enhances motivation, and reduce stress/emotional relief. Though the benefits of gamification as an intervention tool for assisting people during life difficulties were widely researched, yet less research focused on what are the significant gamification elements in a game design that can influence one mental health state. In fact, research on mental health and gamification in Malaysia is relatively new and limited. This research aims to identify the significant gamification design elements which influence the user in overcoming their mental health problems through game playing and game interaction. The scope of this research involved a focus group consists of five (5) users with anxiety issues and with more than two years’ experience in playing entertainment games to elevate their anxiety problems. The research methodology was conducted using qualitative approaches via narrative inquiry (in-depth interview) to understand the user’s experiences and interaction with the entertainment game app. The results were consolidated using a thematic analysis approach. From the research findings, four (4) design themes emerged, there are 1) storytelling 2) challenge 3) engagement, and 4) point and reward. Based on the participant’s feedback the design element of engagement was discovered as the most significant to enhance passion and emotional involvement in participation and completion of levels/challenge in game interaction. In conclusion, the research has identified four (4) gamification design elements that drive possible emotional changes of the participants during their interaction with the game app. As the research was exploratory in nature with a limited number of respondents; for future work, we proposed a mixed-method approach to understand each design element and its relationship through prototype building and theoretical model validation.

Keyword

Gamification, Mental health, Design elements, Thematic analysis.

Cite this article

Ibrahim EN, Jamali N, Suhaimi AI

Refference

[1][1]Hosman CM, Jané Llopis E, Saxena S. Prevention of mental disorders: effective interventions and policy options. Geneva : World Health Organization. 2004.

[2][2]https://www.who.int/maternal_child_adolescent/documents/adolescents-health/en/. Accessed 26 September 2020.

[3][3]http://iku.moh.gov.my/images/IKU/Document/REPORT/NHMS2017/NHMS2017Infographic.pdf. Accessed 26 September 2020.

[4][4]Garett R, Lord LR, Young SD. Associations between social media and cyberbullying: a review of the literature. Mhealth. 2016; 2(12):1-7.

[5][5]https://www.thestar.com.my/news/nation/2019/05/17/cops-teen-who-committed-suicide-after-instagram-poll-suffered-from-depression/. Accessed 26 September 2020.

[6][6]https://www.moh.gov.my/moh/resources/Penerbitan/Penerbitan%20Utama/Annual%20Report%20MoH%202017.pdf. Accessed 26 September 2020.

[7][7]Ab razak A. Cultural construction of psychiatric illness in Malaysia. The Malaysian Journal of Medical Sciences. 2017; 24(2):1-5.

[8][8]Razali SM, Najib MA. Help-seeking pathways among Malay psychiatric patients. International Journal of Social Psychiatry. 2000; 46(4):281-9.

[9][9]Bin Hassan MF, Hassan NM, Kassim ES, Hamzah MI. Issues and challenges of mental health in Malaysia. International Journal of Academic Research in Business and Social Sciences. 2018; 8(12), 1685–96.

[10][10]Alqithami S, Alzahrani M, Alzahrani A, Mostafa A. Modeling an augmented reality game environment to enhance behavior of ADHD patients. In international conference on brain informatics 2019 (pp. 179-88). Springer, Cham.

[11][11]Iacovides I, Mekler ED. The role of gaming during difficult life experiences. In proceedings of the CHI conference on human factors in computing systems 2019 (pp. 1-12).

[12][12]Naslund JA, Aschbrenner KA, Araya R, Marsch LA, Unützer J, Patel V, et al. Digital technology for treating and preventing mental disorders in low-income and middle-income countries: a narrative review of the literature. The Lancet Psychiatry. 2017; 4(6):486-500.

[13][13]Lau HM, Smit JH, Fleming TM, Riper H. Serious games for mental health: are they accessible, feasible, and effective? a systematic review and meta-analysis. Frontiers in Psychiatry. 2017; 7:1-13.

[14][14]Király O, Urbán R, Griffiths MD, Ágoston C, Nagygyörgy K, Kökönyei G, et al. The mediating effect of gaming motivation between psychiatric symptoms and problematic online gaming: an online survey. Journal of Medical Internet Research. 2015; 17(4):1-15.

[15][15]Von Der Heiden JM, Braun B, Müller KW, Egloff B. The association between video gaming and psychological functioning. Frontiers in Psychology. 2019; 10: 1-11.

[16][16]Ebert DD, Cuijpers P, Muñoz RF, Baumeister H. Prevention of mental health disorders using internet-and mobile-based interventions: a narrative review and recommendations for future research. Frontiers in Psychiatry. 2017; 8:1-16.

[17][17]Fairburn CG, Patel V. The impact of digital technology on psychological treatments and their dissemination. Behaviour Research and Therapy. 2017; 88:19-25.

[18][18]Fleming TM, Bavin L, Stasiak K, Hermansson-Webb E, Merry SN, Cheek C, et al. Serious games and gamification for mental health: current status and promising directions. Frontiers in Psychiatry. 2017; 7: 1-7.

[19][19]Deterding S. The lens of intrinsic skill atoms: a method for gameful design. Human–Computer Interaction. 2015; 30(3-4):294-335.

[20][20]Jones C, Scholes L, Johnson D, Katsikitis M, Carras MC. Gaming well: links between videogames and flourishing mental health. Frontiers in Psychology. 2014; 5: 1-8.

[21][21]Liverpool S, Mota CP, Sales CM, Čuš A, Carletto S, Hancheva C, et al. Engaging children and young people in digital mental health interventions: systematic review of modes of delivery, facilitators, and barriers. Journal of Medical Internet Research. 2020; 22(6): 1-16.

[22][22]Mandryk RL, Birk MV, Lobel A, Van Rooij M, Granic I, Vanden Abeele V. Games for the assessment and treatment of mental health. In extended abstracts publication of the annual symposium on computer-human interaction in play 2017 (pp. 673-8).

[23][23]Mohr DC, Weingardt KR, Reddy M, Schueller SM. Three problems with current digital mental health research and three things we can do about them. Psychiatric Services. 2017; 68(5):427-9.

[24][24]Bowman ND, Tamborini R. Task demand and mood repair: the intervention potential of computer games. New Media & Society. 2012; 14(8):1339-57.

[25][25]James EL, Bonsall MB, Hoppitt L, Tunbridge EM, Geddes JR, Milton AL, et al. Computer game play reduces intrusive memories of experimental trauma via reconsolidation-update mechanisms. Psychological Science. 2015; 26(8):1201-15.

[26][26]Holmes EA, James EL, Kilford EJ, Deeprose C. Key steps in developing a cognitive vaccine against traumatic flashbacks: visuospatial tetris versus verbal pub quiz. PloS One. 2010; 5(11):1-9.

[27][27]Aventin A, Houston S, Macdonald G. Utilising a computer game as a therapeutic intervention for youth in residential care: some preliminary findings on use and acceptability. Children and Youth Services Review. 2014; 47(3):362-9.

[28][28]Palinkas LA. Qualitative and mixed methods in mental health services and implementation research. Journal of Clinical Child & Adolescent Psychology. 2014; 43(6):851-61.

[29][29]Badu E, O’Brien AP, Mitchell R. An integrative review on methodological considerations in mental health research–design, sampling, data collection procedure and quality assurance. Archives of Public Health. 2019: 77: 1-15.

[30][30]https://www.mentalhealth.org.uk/sites/default/files/fundamental-facts-about-mental-health-2016.pdf. Accesses 11 August 2020.

[31][31]Mosalanejad L, Abdollahifard S, Abdian T. Psychiatry gamification from blended learning models and efficacy of this program on students. Journal of Education and Health Promotion. 2020; 9:(68).

[32][32]Litvin S, Saunders R, Maier MA, Lüttke S. Gamification as an approach to improve resilience and reduce attrition in mobile mental health interventions: a randomized controlled trial. PloS one. 2020; 15(9):1-23.

[33][33]Stenros J. The game definition game: a review. Games and Culture. 2017; 12(6):499-520.

[34][34]Leaning M. A study of the use of games and gamification to enhance student engagement, experience and achievement on a theory-based course of an undergraduate media degree. Journal of Media Practice. 2015; 16(2):155-70.

[35][35]Eden S, Eshet-Alkalai Y. The effect of digital games and game strategies on young adolescents aggression. Journal of Educational Computing Research. 2014; 50(4):449-66.

[36][36]Caserman P, Hoffmann K, Müller P, Schaub M, Straßburg K, Wiemeyer J, et al. Quality criteria for serious games: serious part, game part, and balance. JMIR Serious Games. 2020; 8(3):1-14.

[37][37]Wiemeyer J. Towards a generic framework for serious games. In international symposium on computer science in sport 2019 (pp. 193-200). Springer, Cham.

[38][38]Dörner R, Göbel S, Effelsberg W, Wiemeyer J. Serious games. Springer International Publishing. 2016.

[39][39]Bond M, Beale R. What makes a good game? using reviews to inform design. People and computers XXIII celebrating people and technology. 2009 (pp. 418-22).

[40][40]Morschheuser B, Hassan L, Werder K, Hamari J. How to design gamification? a method for engineering gamified software. Information and Software Technology. 2018; 95:219-37.

[41][41]Desurvire H, Wiberg C. Game usability heuristics (PLAY) for evaluating and designing better games: the next iteration. In international conference on online communities and social computing 2009 (pp. 557-66). Springer, Berlin, Heidelberg.

[42][42]Rajanen M, Rajanen D. Usability benefits in gamification. In GamiFIN 2017 (pp. 87-95).

[43][43]Liu D, Santhanam R, Webster J. Toward meaningful engagement: a framework for design and research of gamified information systems. MIS Quarterly. 2017;41(4):1011-34.

[44][44]Floryan M, Chow PI, Schueller SM, Ritterband LM. The model of gamification principles for digital health interventions: evaluation of validity and potential utility. Journal of Medical Internet Research. 2020; 22(6):1-10

[45][45]https://mindfulnessinschools.org/wp-content/uploads/2013/09/video-games-and-wellbeing.pdf. Accessed 26 September 2020.

[46][46]Vajawat B, Varshney P, Banerjee D. Digital gaming interventions in psychiatry: evidence, applications and challenges. Psychiatry Research. 2020.

[47][47]Huang B, Hew KF. Implementing a theory-driven gamification model in higher education flipped courses: effects on out-of-class activity completion and quality of artifacts. Computers & Education. 2018; 125:254-72.

[48][48]Cheng VW, Davenport T, Johnson D, Vella K, Hickie IB. Gamification in apps and technologies for improving mental health and well-being: systematic review. JMIR Mental Health. 2019; 6(6):e13717.

[49][49]Skopljakovic E. Gaming as a social construct: towards a framework for player socialization in massive multiplayer online videogames. University of Porto Open Repository. 2019.

[50][50]Jennett C, Cox AL, Cairns P, Dhoparee S, Epps A, Tijs T, et al. Measuring and defining the experience of immersion in games. International Journal of Human-Computer Studies. 2008; 66(9):641-61.

[51][51]Taquet P, Romo L, Cottencin O, Ortiz D, Hautekeete M. Video game addiction: cognitive, emotional, and behavioral determinants for CBT treatment. Journal of Behavioral and Cognitive Therapy. 2017; 27(3):118-28.

[52][52]Grund CK. How games and game elements facilitate learning and motivation: a literature review. Informatik 2015:1279-93.

[53][53]Kapp KM. The gamification of learning and instruction: game-based methods and strategies for training and education. John Wiley & Sons; 2012.

[54][54]Dale S. Gamification: making work fun, or making fun of work? Business Information Review. 2014; 31(2):82-90.

[55][55]Alsawaier RS. The effect of gamification on motivation and engagement. The International Journal of Information and Learning Technology. 2018; 35(1): 56-79.

[56][56]Abdul Jabbar AI, Felicia P. Gameplay engagement and learning in game-based learning: a systematic review. Review of Educational Research. 2015; 85(4):740-79.

[57][57]Boateng GO, Neilands TB, Frongillo EA, Melgar-Quiñonez HR, Young SL. Best practices for developing and validating scales for health, social, and behavioral research: a primer. Frontiers in Public Health. 2018; 6:149.

[58][58]Kroenke K, Spitzer RL, Williams JB. The PHQ‐9: validity of a brief depression severity measure. Journal of General Internal Medicine. 2001; 16:606-13.

[59][59]Tolks D, Sailer M, Dadaczynski K, Lampert C, Huberty J, Paulus P, et al. ONYA—The wellbeing game: how to use gamification to promote wellbeing. Information. 2019; 10(2):58.

[60][60]Lee JH, Clarke RI, Rossi S. A qualitative investigation of users’ discovery, access, and organization of video games as information objects. Journal of Information Science. 2016; 42(6):833-50.

[61][61]Nowell LS, Norris JM, White DE, Moules NJ. Thematic analysis: striving to meet the trustworthiness criteria. International Journal of Qualitative Methods. 2017; 16(1):1-13.

[62][62]Braun V, Clarke V. APA handbook of research methods in psychology, Research designs: quantitative, qualitative, neuropsychological, and biological. American Psychological Association; 2012.

[63][63]Giakalaras MM. Gamification and storytelling. University of the Aegean. 2016.

[64][64]Moreau KA, Eady K, Sikora L, Horsley T. Digital storytelling in health professions education: a systematic review. BMC Medical Education. 2018; 18:1-9.

[65][65]De Vecchi N, Kenny A, Dickson-Swift V, Kidd S. Exploring the process of digital storytelling in mental health research: a process evaluation of consumer and clinician experiences. International Journal of Qualitative Methods. 2017; 16(1):1-13.

[66][66]Chan KY, Tan SL, Hew KF, Koh BG, Lim LS, Yong JC. Knowledge for games, games for knowledge: designing a digital roll-and-move board game for a law of torts class. Research and Practice in Technology Enhanced Learning. 2017; 12:1-20.

[67][67]Shi YR, Shih JL. Game factors and game-based learning design model. International Journal of Computer Games Technology. 2015:1-11.

[68][68]Schmidt-Kraepelin M, Toussaint PA, Thiebes S, Hamari J, Sunyaev A. Archetypes of gamification: analysis of mHealth apps. JMIR Mhealth and Uhealth. 2020; 8(10):1-15.

[69][69]Lenhart A, Duggan M, Perrin A, Stepler R, Rainie H, Parker K. Teens, social media & technology overview. Pew Research Center. 2015.

[70][70]Rusczek J. Experiences of playing massively multiplayer online role-playing games: a phenomenological exploration.2015.

[71][71]Imran H. Evaluation of awarding badges on student’s engagement in gamified e-learning systems. Smart Learning Environments. 2019; 6:1-12.

[72][72]Birk M, Mandryk RL. Control your game-self: effects of controller type on enjoyment, motivation, and personality in game. In proceedings of the SIGCHI conference on human factors in computing systems 2013 (pp. 685-94).

[73][73]Ahn SJ, Johnsen K, Ball C. Points-based reward systems in gamification impact children’s physical activity strategies and psychological needs. Health Education & Behavior. 2019; 46(3):417-25.