Using gamification to support positive health behaviour change: A kaupapa Māori approach

Abstract

As our lives become increasingly technology-dependent, healthcare practitioners and researchers recognise the opportunities to deliver effective digital healthcare initiatives to improve patient outcomes. Gamification is one such technological approach to consider. While some important work has been done in gamification, to date, there have been few gamified healthy lifestyle intervention studies undertaken within an Indigenous or minority population. Therefore, this research extends the current knowledge of gamification with a focus on an Indigenous population. Māori are the Indigenous People of New Zealand, and as in many other colonised countries, Māori are over-represented in obesity statistics; a factor which contributes to significant health inequities, such as a higher incidence of chronic illness among Māori people. Gamification may be an effective means of supporting positive lifestyle choices (e.g., increased physical activity) to reduce the prevalence of chronic illness. This research takes a Kaupapa Māori approach to address the research question: How can gamification support positive health behaviour change? Kaupapa Māori is a philosophical Māori-centric approach that ensures tino rangatiratanga (the right to self-determination). The research approach follows Māori tikanga (customary practices) and recognises the importance of Te Reo Māori (Māori language) and Te Ao Māori (a Māori worldview). This research followed a design science research (DSR) process and consisted of two phases: Phase One was a prototype design phase, and Phase Two evaluated the prototype. Phase One involved a series of co-design hui (focus groups) to explore the social context and health aspirations of Māori and to ideate potential solutions. Phase One found that normative beliefs strongly influence effective gamification design preference for Māori and that culturally-tailored design is effective for Māori; a notion that contradicts previous Western-oriented gamification implementations. Phase Two consisted of a cross-sectional survey and regression analysis to evaluate the prototype designed during Phase One. Major findings from Phase Two show that three critical factors predict whether Māori users would use the gamified intervention: Perceived Ease-of-Use; Māori-Centric Design; and the use of Whakataetae (competitive) persuasive design strategies. This research contributes to gamification literature by identifying the gamification elements that most significantly impact behavioural intention toward gamified health applications for Māori; knowledge that may be transferable to other Indigenous populations. The importance of implementing a competitive strategy contradicts previous literature on collectivist cultures and guides the development of future gamified interventions. This research also contributes to theoretical and practical knowledge by demonstrating that effective persuasive strategies are not universal; Māori-centric design is a self-determined approach that keeps the needs of the target audience central to the design of a solution. This research provides theory-driven practical guidelines for design processes and design decisions that are driven by the needs and aspirations of Māori.