This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on http://formative.jmir.org, as well as this copyright and license information must be included.
Employees in an office setting are more likely to remain physically inactive. Physical inactivity has become one of the major barriers to overcoming the risk factors for anxiety, depression, coronary heart disease, certain cancers, and type 2 diabetes. Currently, there is a gap in mobile health (mHealth) apps to promote physical activity (PA) for workers in the workplace. Studies on behavior change theories have concluded that health apps generally lack the use of theoretical constructs.
The objective of this study was to study the feasibility of a persuasive app aimed at encouraging PA among employees and to understand the motivational aspects behind the implementation of mHealth apps among office workers.
A 4-week study using a mixed methods (quantitative and qualitative) design was conducted with office-based employees in cities in 4 countries: Oulu, Finland; Carlow, Ireland; London, United Kingdom; and Dhaka, Bangladesh. Of the 220 invited participants (experimental group, n=115; control group, n=105), 84 participated (experimental group, n=56; control group, n=28), consisting of working-age volunteers working in an office setting. Participants used 2 different interventions: The experimental group used an mHealth app for PA motivation, and the control group used a paper diary. The purpose was to motivate employees to engage in healthier behavior regarding the promotion of PA in the workplace. A user-centered design process was followed to design, develop, and evaluate the mHealth app, incorporating self-determination theory (SDT) and using game elements. The paper diary had no specific theory-driven approach, design technique, nor game elements.
Compliance with app usage remained relatively low, with 27 participants (experimental group, n=20; control group, n=7) completing the study. The results support the original hypothesis that the mHealth app would help increase PA (ie, promoting daily walking in the workplace) in comparison to a paper diary (
The SDT-based mHealth application motivated employees to increase their PA in the workplace. However, compliance with app usage remained low. Future research should further develop the app based on user feedback and test it in a larger sample.
Lack of physical activity (PA) affects normal physiological processes in the human body, which may destabilize the body's energy balance, cause muscle atrophy, and diminish exercise capability [
Technology-enhanced solutions are a promising approach to motivating people and promoting PA. Mobile health (mHealth), using smartphones for health-oriented applications, has emerged as a vital tool for health-oriented behavioral change interventions [
Persuasive health apps have been proposed as a technique to foster behavioral change [
According to the self-determination theory (SDT), people can be intrinsically and extrinsically motivated to perform an action [
Gamification is the use of game elements in non-gaming contexts [
As a potential solution to increase PA in the workplace, this study designed and developed a persuasive mHealth app called iGO that incorporates SDT. SDT was selected for its acknowledgment in PA research [
What is the feasibility that the persuasive iGO app will motivate employees to increase their daily walking in the workplace?
What is the employees’ view of the persuasive iGO app regarding the needs of autonomy, competence, and relatedness for promoting daily walking?
To answer the research questions, we evaluated the iGO mHealth app during a 4-week study with a mixed methods (quantitative and qualitative) design. We hypothesized that iGO would motivate employees to increase their daily walking and increase their autonomy (confidence level and ability to choose regular walking to reach their goal), competence, and relatedness.
An experimental study was conducted with a group of office-based employees for 4 weeks. Participants were randomly assigned to 1 of 2 groups. The experimental group used the iGO mHealth app, and the control group used a paper diary on weekdays for 4 consecutive weeks.
iGO was iteratively developed in previous studies, and the app design has been presented elsewhere [
Our proposed gamified system model was used to design and develop a low-fidelity prototype (paper prototype) of iGO applying the UCD process, consisting of 5 steps: empathize, define, ideate, prototype, and test. The details have been published elsewhere [
The overall concept of the iGO app is shown in
Overall concept of the mobile health app iGO, developed using the user-centered design process.
The flow within the iGO mHealth app is shown in
The iGO app (
The accelerometer sensor in the smartphone tracks the footsteps of the users, targeting 1000 steps in 10 minutes, based on the recommendation of 3000 steps in 30 minutes [
An 8-week usability evaluation of the final iGO mHealth app was conducted earlier, utilizing the unified theory of acceptance and technology model. The details have been published elsewhere [
Flow within the iGO mobile health app.
A user’s walk and step count after the lunch recess are tracked, and the data are gathered in the web server.
The 4-week experimental study was conducted at 4 sites in 4 countries: the city of Oulu, Northern Finland (population, ~199,000); Carlow, South Leinster, Ireland (population, ~26,000); the megacity of London, United Kingdom (population, ~8,136,000); and the megacity of Dhaka, Bangladesh (population, ~1,984,000). The 4 countries were selected due to practical reasons owing to existing collaborations. To recruit the participants, we selected 10 multinational information and communications technology companies (2 in the United Kingdom, 2 in Ireland, 3 in Finland, and 3 in Bangladesh), 1 research institute from each country (University of Oulu, Finland; Queen Mary University of London, United Kingdom; Institute of Technology, Carlow, Ireland; and Bangladesh University of Professionals, Bangladesh), and people in startup companies (Finland, United Kingdom, Ireland, Bangladesh). The list of the companies was collected, and we personally communicated with university researchers and professors. People working in the information technology sector were invited to participate, owing to the relationship between information technology skills and technology acceptance. We contacted each site by email and asked for an invitation email to be forwarded to their employees. The first author of the study contacted the people at the startup companies directly. A total of 220 people was invited. The people were randomized to the experimental (n=115) and control (n=105) groups before sending the invitations (
Flow chart of the study participants.
The flow chart of the study participants is shown in
In the experimental group, 115 people were asked to participate in the 4-week trial using the iGO app. Of these participants, 56 completed the consent procedure (mean age 39 years, range 24-49 years), and 20 participants completed the study (12 men and 8 women; mean weight 72.2 kg; mean BMI 24.8 kg/m²). The reasons given for dropping out of the trial (n=36) were a lack of time, holidays, laziness, or personal issues (16/36, 44%); unwillingness to use the mHealth app because they disliked its appearance or were already using an mHealth app (6/36, 17%); did not feel a need for this type of service or were already taking care of themselves (3/36, 8%); and other reasons (7/36, 20%). A further 11% (4/36) did not give a reason for declining.
The control group (n=105) was asked to participate in the 4-week trial using a paper diary. Of these 105 people, 28 completed the consent procedure (mean age, 39 years; range 26-49 years), and 7 participants completed the study (5 men and 2 women; mean weight 71.4 kg; mean BMI 24.5 kg/m²). The reasons given for dropping out (n=21) were a lack of time, holidays, laziness, or personal issues (6/21, 28%); unwillingness to use the paper diary because they disliked it, since it was only paper, with no alarm (7/21, 35%); did not feel a need for this type of service or they were already taking care of themselves (3/21, 13%); and other reasons (6/21, 26%).
Baseline characteristics of the participants.
Variable | Invited, N=220 | Consented, n=84 | Completed, n=27 | ||||
Ea, n=115 | Cb, n=105 | E, n=56 | C, n=28 | E, n=20 | C, n=7 | ||
|
|
|
|
|
|
|
|
|
Female | 44 (38.3) | 42 (40.0) | 23 (41.0) | 12 (42.9) | 10 (50.0) | 4 (57.1) |
|
Male | 71 (61.7) | 63 (60.0) | 33 (59.0) | 16 (57.1) | 10 (50.0) | 3 (42.9) |
|
|
|
|
|
|
|
|
|
University | 62 (53.9) | 50 (47.6) | —c | — | — | — |
|
ITd industry | 36 (31.3) | 41 (39.0) | — | — | — | — |
|
Startup company | 17 (14.8) | 14 (13.4) | — | — | — | — |
|
|
|
|
|
|
|
|
|
United Kingdom | 32 (27.8) | 30 (28.5) | 18 (32.1) | 9 (32.1) | 6 (30.0) | 2 (28.6) |
|
Ireland | 22 (19.1) | 19 (18.1) | 12 (21.4) | 5 (17.9) | 6 (30.0) | 1 (14.3) |
|
Finland | 26 (22.6) | 24 (22.9) | 15 (26.8) | 8 (28.6) | 5 (25.0) | 3 (42.9) |
|
Bangladesh | 35 (30.4) | 32 (30.5) | 11 (19.6) | 6 (21.4) | 3 (25.0) | 1 (14.3) |
aE: experimental group.
bC: control group.
cData were not available.
dIT: information technology.
Baseline characteristics of the participants by country.
Variable | Invited, N=220 | Consented, n=84 | Completed, n=27 | ||||||
Ea, n=115 | Cb, n=105 | E, n=56 | C, n=28 | E, n=20 | C, n=7 | ||||
|
|
|
|
|
|
|
|||
|
Female | 11 (34.4) | 13 (43.3) | 7 (38.9) | 3 (33.3) | 2 (33.3) | 1 (50.0) | ||
|
Male | 21 (65.6) | 17 (56.7) | 11 (61.1) | 6 (66.7) | 4 (66.7) | 1 (50.0) | ||
|
|
|
|
|
|
|
|||
|
Female | 10 (45.5) | 7 (36.8) | 5 (41.7) | 1 (20.0) | 3 (50.0) | 0 (0) | ||
|
Male | 12 (54.5) | 12 (63.2) | 7 (58.3) | 4 (80.0) | 3 (50.0) | 1 (100) | ||
|
|
|
|
|
|
|
|||
|
Female | 11 (42.3) | 9 (37.5) | 6 (40.0) | 4 (50.0) | 3 (60.0) | 2 (66.7) | ||
|
Male | 15 (57.7) | 15 (62.5) | 9 (60.0) | 4 (50.0) | 2 (40.0) | 1 (33.3) | ||
|
|
|
|
|
|
|
|||
|
Female | 12 (34.3) | 13 (40.6) | 5 (45.5) | 4 (66.7) | 2 (66.7) | 1 (100) | ||
|
Male | 23 (65.7) | 19 (59.4) | 6 (54.5) | 2 (33.3) | 1 (33.3) | 0 (0) |
aE: experimental group.
bC: control group.
The paper diary had a simple chart to record walking after breakfast and lunch. The diary did not incorporate SDT needs and PBL elements. Users entered their data manually. Participants were instructed to complete their walking record on the paper diary during their breakfast and lunch breaks every weekday for 4 weeks. An alarm/vibration as a reminder was not included with the paper diary (
Based on the users’ feedback in the previous study [
Semistructured 20-minute interviews [
The iGO app was first installed on the participant’s smart device. Samsung (Seoul, South Korea) Android phones were lent to any participants who did not have a compatible phone. Participants were instructed to use the mHealth app or paper diary for 4 weeks. Participants in the experimental group were asked to use the mHealth app daily for at least 10 minutes after breakfast and 10 minutes after lunch, while walking during their break time. The participants customized the breakfast and lunch times to their preferred times. Based on the set time, the phone initiated a vibration/alarm as a reminder for participants to start walking. After walking for 10 minutes, the participants were notified by the iGO app that they completed their goal. The participants filled in the quantitative questionnaires at the end of the study.
The statistical tool SPSS 25.0 (IBM Corp, Armonk, NY) was used to analyze the quantitative data. Differences between the experimental group and control group were compared using
An overview of the quantitative questionnaire results is shown in
User ratings of whether the iGO app (experimental group) or paper diary (control group) increased physical activity, autonomy, competence, and relatedness, rated using a 7-point Likert scale.
Condition | Experimental group (n=20), mean | Control group (n=7), mean | |
Increasing physical activity | 6.15 | 4.30 | .033 |
Autonomy | 5.05 | 3.30 | .004 |
Competence | 4.86 | 2.00 | .014 |
Relatedness | 3.15 | 3.43 | .535 |
The score for increasing physical activity was significantly higher for participants in the experimental group than for those in the control group (
Participants in the experimental group were significantly more likely to consider that the mHealth app increased their feeling of competence to view themselves in a social environment (ie, on the leaderboard), compared with the control group (
Participants inputted their weight when installing the iGO app on the smartphone and transferred this information to the postexperimental questionnaires. A trend for weight loss was found when using iGO, with borderline statistical significance (pre-intervention mean weight, 72.2 kg vs post-intervention mean weight, 71.4 kg,
Based on the interview, most experimental group participants (14/20, 70%) were motivated, set their daily goal of 10-minute walking after breakfast and lunch, and tracked their daily walking when using the iGO app, which indicated autonomy.
I sort of liked the way how it influenced me to go for a walk and became my daily routine, liked it.
I felt like using the app has changed my habit of sitting idle in the office after breakfast/lunch.
Participants (13/20, 65%) felt competent when using the iGO app to view themselves in a social environment to walk daily.
[It] assisted me to interact with the phone and to walk with others
[It] became a habit, but I wanted to see more in the apps like more connection [among] people who are using it!
They felt competent using the mHealth app, which indicates fulfillment of the psychological need of competence.
Only few participants (5/20, 25%) were motivated to participate in PA (eg, walking with others) when using iGO. One participant felt connected with their colleagues and noted: “[I] walked with colleagues and friends and made me mix with others while walking; a social platform.” Perhaps iGO allowed the participant to walk daily with colleagues from the same office and track their progress from the data server. In this way, they might feel connected with colleagues. However, one participant stated: “I cannot feel any betterment to walk with others.” The sense of being connected to others using the gamified prototype is not valid in this case. Therefore, we cannot agree that the last psychological need, relatedness, was fulfilled.
One participant ranked in the leaderboard reported: “I liked the way … it influenced me to go … walking and [it] became my daily routine, liked it.”
However, the social, fun part of the game elements was not apparent among the participants who reported:
Maybe add a way to create events to [attend].
Should add more socializing features.
Maybe more social fun activities options.
Participants wanted to see different points for the 2 walking conditions. One participant mentioned, “Some difference in the points for walking alone and walking with others.”
The log data showed that some regular users did not upload their name and photo so they were visible on the leaderboard, even though users preferred a leaderboard that included their details when prototyping the iGO app. Within the control group, most participants suggested that some sort of reminder should be added in the paper diary.
I wish there were a kind of alarm type feature or image that [could] draw … attention towards the paper.
[A] paper diary can be easily ignored in the busy schedule, so it should be more attractive.
Of the participants who completed the study using the iGO app, 8 (8/20, 40%) participants used a provisioned Samsung phone, whereas the remaining participants used their own smartphones. The log data showed that those who used their own phone had more points and ranked higher on the leaderboard. Moreover, the data from the participants who completed the study in Ireland showed that those who ranked highly on the leaderboard (4/6, 66%) were colleagues from the same offices and building.
This study presents the feasibility of an mHealth app designed for promoting walking in the workplace during breaks. Based on the examination, the iGO app helped to overcome physical inactivity by increasing walking. The data supported compliance with 2 of the basic psychological needs, namely autonomy and competence, but not for the needs of relatedness. However, compliance in using the app remained low.
Satisfaction with the SDT basic needs for autonomy, competence, and relatedness is essential for establishing intrinsically motivated and sustained PA behavior [
Discontinuation is a central problem in technology-enhanced intervention studies [
Studies have shown that interventions targeting PA promotion can be designed to focus on setting-specific issues that are open to change within demographic settings differentiated by gender, age, social disadvantage, and geographic location [
On the other hand, weather conditions may affect outdoor PA, as demonstrated for older adults [
We did not examine the users’ recommendations, age, and gender based on the specific geographic location but averaged all users’ preferences from the 4 different countries when designing the app. The SDT needs of relatedness were absent in this study (ie, the participants did not connect with others while walking). Previous research has suggested that being connected to more people may help with PA promotion [
Cognitive, emotional, and social benefits are credited to gamification [
Using mobile reminders is a conventional approach in health research [
Compliance with the paper diary was comparatively low, compared with that of the mHealth app. Participants forgot to complete the paper diary, it was less attractive, there was no alarm system, and it was difficult to record walking time on paper.
Walking can be beneficial for weight loss [
This study has some limitations. First, the final sample size was relatively small. Larger-scale studies are needed to confirm the findings. Many consented participants, who typically were young programmers or developers, discontinued the 4-week study. A next-generation solution should be designed based on the feedback received, in order to increase compliance. Second, participants were randomized before they received their invitations. This may have influenced the difference in the number of participants between the groups.
Another limitation of the study is that the weight was self-reported and collected only at the beginning and end of the study. However, this study targeted an increase in PA, not weight loss, which may reduce the possibility for bias.
The iGO app was still a prototype with somewhat limited graphical design and user interface. Some participants may have failed to connect with others due to the contemporary design of the mHealth app. PA measured by a smartphone can underestimate the number of steps, as people may leave their phone on their office desks. Fewer measured minutes of walking may result in fewer points and therefore an inaccurate leaderboard, which could demotivate participants to follow ranks and points on the leaderboard. Furthermore, the accelerometer sensor was not installed in some smartphones, and users were not able to track their steps. Hence, the actual walking data may be different from the data in the web server. The measured increase in PA was obtained from questionnaire data. We used the accelerometer-based step count to calculate the rewards. However, we did not use the objective PA data for other purposes in this study.
More features and options could be added, such as socializing functions and social, fun activities allowing users to interact with others [
In the research for this paper, we conducted a feasibility study on the mHealth persuasive app for promoting PA in the workplace. This mHealth app was developed by incorporating the SDT theory and applying game design elements. The design of the app followed the UCD process. A 4-week study was conducted with a group of office workers. The mHealth app supported users to increase their PA at the workplace, when compared with a paper diary. The iGO app fulfilled the SDT basic needs of autonomy and competence, but not relatedness (ie, it did not support participants in feeling connected with others). This study demonstrates how even a simple mHealth app can help employees increase their PA. The design of the app appeared to be a successful approach that is viable for future persuasive apps. Future research should aim to develop the app further based on users’ feedback and test it on a larger scale, enabling the critical components within the mHealth intervention to be studied.
User interfaces of the iGO app.
Consent form.
Paper diary.
Questionnaire.
CONSORT-EHEALTH Checklist V1.6.
mobile health
physical activity
points, badges, and leaderboards
self-determination theory
user-centered design
This study was partly funded by the Horizon 2020 Framework Programme of the European Union COST Action ENJECT (TD 1405) and the University of Oulu Scholarship Foundation. We are indebted to Dr. Shabbir Syed-Abdul (Taipei Medical University), Muhtadi Akif, and Miral Sarwar (Multiplexer Lab) for their cooperation and support. We thank Mehnaz Alam for helping us with data collection, Shahriar Hasan, and all participants for their contribution to the study.
None declared.
This randomized study was not registered. The editor granted an exception from ICMJE rules mandating prospective registration of randomized trials because the risk of bias appears low and the study was considered formative. However, readers are advised to carefully assess the validity of any potential explicit or implicit claims related to primary outcomes or effectiveness, as retrospective registration does not prevent authors from changing their outcome measures retrospectively.