Digital health interventions using mobile technologies such as mHealth apps and wearables have the potential to promote healthy behavior change in individuals at a scale larger than traditional interventions. However, the lack of user retention with these interventions still limits their long-term effectiveness in health outcomes. Gamification increases user engagement, however, gamification does not increase the entertainment value of the content, which is often perceived as unengaging by users. In contrast, popular entertainment focused mobile games do foster retention due to their engaging content, and often augmented through the use of persuasive dark patterns. Although dark patterns are ethically questionable techniques for driving engagement, there is potential for ethically enabled dark patterns to increase engagement in health interventions. In this feasibility study, we present the Health Intervention Minigame Framework that enables the embedding of entertainment games into digital health interventions. We demonstrate a proof of concept prototype that supports three entertainment games with ethically enabled dark patterns. Although the framework is a first step towards the implementation of ethically-enabled dark patterns in entertainment games, it is still unclear whether the potential increased engagement with real-world health activities of such implementations outweighs their psychological cost.

Publicly displaying personal tracking data can promote healthier lifestyles, with most existing research focusing on digital visualizations. However, public physicalizations have been shown to attract more attention and foster greater engagement. Despite this, few studies in this area have utilized personal physical activity data as input or explored its impact on motivating data generators’ physical activity. To address this gap, we designed PlanetWalker, a system that visualizes users’ walking steps on their phone and shows the visualization publicly through a digital display, as well as medium- and large-scale public physicalizations as probes. The probes were deployed following the Wizard of Oz method in sequence during a six-week in-the-wild study. Through evaluations with users generating data and passersby, our findings show how public physicalizations can improve motivation, facilitate social interaction, and increase engagement. We conclude by discussing the design directions for supporting the public presentation of personal data through public physicalization to motivate physical activity and provide design trade-offs and suggestions on the physicality and scale of the medium.

Mobile health (mHealth) tools are regularly used in a wide range of mental health domains to assess and monitor patients, potentially increasing patient engagement. Recent studies demonstrated that tailored approaches provide better results than generic approaches. However, the effectiveness of tailoring has not yet been investigated empirically for patients with severe mental illnesses (SMIs). It also remains unclear how personalized goals, which are critical from a treatment point of view, impact engagement. Therefore, we designed a novel mHealth tool to increase SMI patient engagement with their personal goals which we evaluated empirically. We designed a two-period, two-arm within-subject crossover study in which 4 participants were exposed to personalized and non-personalized behavioral goals. Contrary to expectations, personalized behavioral goals did not have a significant impact on engagement levels. When considering our participant feedback and also in the context of flow theory, we rationalized that our goal personalization strategy was too static for SMI patients. Therefore, in our future work, we will investigate dynamic strategies that adapt goal difficulty over time.