Design Requirements for Gamified Exercise Apps for Adults With Prehypertension Based on the Octalysis Framework and Self-Determination Theory: Qualitative Interview Study.

Abstract

Background: Managing blood pressure (BP) in prehypertensive individuals is crucial to prevent the incidence of hypertension. While physical activity has proven effective in BP management, physical inactivity remains prevalent. Gamification has shown promise in addressing physical inactivity; however, its effectiveness is limited due to the suboptimal intervention design.

Objective: This study aimed to develop a comprehensive understanding of prehypertensive individuals' needs, design preferences, and motivational drives for gamified exercise apps by integrating the Octalysis Gamification Framework with Self-Determination Theory (SDT) through a participatory qualitative methodology.

Methods: The study adopted a cross-sectional qualitative interview study design and used semistructured interviews conducted from June to July 2025 across mainland China. Participants were recruited through online platforms using purposive sampling to select adults with prehypertension (systolic BP 120-139 mm Hg and/or diastolic BP 80-89 mm Hg). Interview guides were systematically structured around SDT constructs and the Octalysis Framework's 8 core gamification drives to explore participants' needs, design preferences, and motivational drives for gamified exercise apps. An inductive or deductive hybrid thematic analysis was used to identify key themes.

Results: A total of 14 eligible prehypertensive individuals participated in the study. Their needs and preferences for exercise apps, including exercise guidance, data monitoring and feedback, and wearable device portability, were summarized. Eight core gamification motivational drives, such as epic meaning and social influence, according to the Octalysis Framework, were explored with interviewees, including their attitudes and creative design considerations. Moreover, the study examined how the satisfaction of basic psychological needs (eg, sense of volition, technical challenges, and social connections) influences the transformation of motivation.

Conclusions: This theory-informed qualitative study is among the first to explore the needs and preferences of individuals with prehypertension for gamified exercise apps by integrating the Octalysis Gamification Framework with SDT. The findings suggest that successful gamified exercise apps for prehypertensive individuals may benefit from going beyond traditional game mechanics to address deeper psychological needs. Participants emphasized the importance of personalized exercise programming, robust health monitoring capabilities, and human-centered gamification designs that support autonomy, competence, and relatedness. Satisfaction of these basic psychological needs is critical for transforming extrinsic motivations, such as weight management and health values, into intrinsic enjoyment of exercise. By integrating a theoretical basis with user-centered perspectives, this study provides context-specific design implications for future development of gamified exercise apps tailored to prehypertensive individuals in similar digital health contexts.