Hualong Yang and Dan Li, the authors of the paper „Understanding the dark side of gamification health management: A stress perspective“, investigate the behaviour and stress responses to participants in a person-environment fit, using the Chinese health management app „WеcChat Sports“. The findings of the paper are that, while utilization of gamification in healthcare contexts, does provide positive results, they are either not universal or they are not long-lasting. There are also privacy concern risks involved.
Concerning the non-universal appeal, a challenges and rewards system appears to be daunting to a certain group of people, in some cases those in need of the health support, are the ones who are revolted away from the whole system, whereas those who continue on using it for longer, are the goal-oriented, striving after achievement types, for whom the app is not designed.
„For example, with a health management app, some gamification characteristics may lead many users with health management needs to stop using the app, with only users who want to win game achievements and rewards continuing to us the app. This means that the role of the app cannot be fully played, which eventually leads to some users’ failure in health management.
Thus, gamification design may be a double-edged sword, and designers must consider the negative consequences as well as positive consequences of gamification design.“
The authors cite gamification-, or tech- rather, exhaustion as another reason for why participants would tire of the gamified health system. Constatly keeping up with rules and striving after achievements can be exhausting, especially in a technology-dominated world. The last thing you would want to do after a hard day at work on the computer and scrolling social media would be to spend more time at a device using social media elements for your health.
„An increasing number of users are abandoning gamification health management programs or becoming less involved in them. One possible reason is that gamification health management causes stress for users, which then exhausts them. Previous studies have noted that stress can lead to technological exhaustion (Cao et al., 2018b; Maier, Laumer, Weinert & Weitzel, 2015), which is an aversive, unconscious psychological response to stress that reflects the level of tiredness users feel when using technology (Lee, Son & Kim, 2016; Xiao & Mou, 2019). In gamification health management, technological exhaustion refers to users’ weariness and aversion to the gamification design, which leads to a decrease in users’ health management performance and perhaps makes them stop using their health management app. The integration of the game design and social media functions in health management apps may also lead to potential stressors (e.g., social overload and privacy invasion), which can lead to users’ technological exhaustion.“
The gamified aspect also provides a stress-factor, as the motivation for partaking in the rules of the game is to keep yourself under a constant state of suspense.
„That is, although applying gamification design and social media functions may enhance interaction and competition between users, the social media element of the app can make the gamification design become a strain for users, tiring users and leading to gamification exhaustion. In addition, the gamification design can increase the frequency of interaction and information sharing between users. This mutual circulation of information and data among users may lead to feelings of personal privacy invasion and social overload, which leads to the gamification design becoming a source of stress for users.“
There is also the element of privacy issues: in order to integrate a competitive aspect to the health app, one has to integrate a social leaderboard, which then inevitably has to share private user data regarding their activity history and current and past health status.
„In the field of health management, sharing of health-related information and data is an important privacy issue and the achievement mechanism of a gamification health management app may reveal information about the user’s health and personal behavior. The social media functions may also reveal the user’s health information in the app, thus possibly leading to invasion of the user’s privacy and personal life. Moreover, the competition and interaction mechanisms of gamification design strengthen the information flow and mutual attention between users. Friends and family members in the same social network pay special attention to the health of users, which will increase the frequency of communication on health issues. This may lead to the stressor of social overload of users. Thus, the social media element of gamification may increase the stressors that can be associated with gamification design, among which social overload and privacy invasion are the most likely negative effects in gamification health management.“
