What motivates participants: a qualitative analysis of gamification and financial incentives to increase physical...

Physical activity reduces the risk of major cardiovascular events, but many people who are most at-risk do not get enough exercise. In the BE ACTIVE randomized controlled trial, - a study in which text messages were used to communicate with participants- game playing (gamification), financial incentives, and the combination of gamification plus financial incentives increased physical activity from baseline more than control over a 12-month intervention period. Participants randomized to gamification plus financial incentives maintained a significantly greater increase than control over the 6-month post-intervention follow-up. To understand the impact of the interventions on motivation and performance we conducted semi-structured interviews with a subset of participants.

Using extreme case sampling, interviewees were selected from participants who were randomized to an intervention arm and were identified as either high or low performers based on their change from baseline to the end of the trial in mean daily step count. During semi-structured telephone interviews, participants were asked their thoughts and feelings about the trial, motivations for participation, and about specific aspects of the intervention. Interviews were conducted within 6 months after the participant completed participation in the trial. Thematic analysis was conducted inductively and deductively, and identified themes were mapped onto the COM-B Framework to understand the interaction between different themes.

We achieved saturation after conducting interviews with 55 participants (30 high performers and 25 low performers); 19 in the gamification arm, 19 in the financial incentives arm, and 17 in the gamification plus financial incentives arm. Based on qualitative interviews, the importance of individual accountability via goal setting and feedback appears to be a primary factor in behavior change in this trial; however, the combination of accountability with the opportunity of access to the intervention had additional impact on the results.

Gamification and financial incentives both increased physical activity in the BE ACTIVE study, but results may be improved by tailoring interventions based on participants' personal traits and level of social support to optimize motivation. (328 words) TRIAL REGISTRATION: NCT03911141 Registration date: 04/09/2019.