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Building personal wellness communities: meaningful play in the everyday life of a network society

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BUILDING PERSONAL WELLNESS COMMUNITIES: MEANINGFUL PLAY
IN THE EVERYDAY LIFE OF A NETWORK SOCIETY

by

Hua Wang

_____________________________________________________________________

A Dissertation Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(COMMUNICATION)

December 2010

Copyright 2010 Hua Wang
ii

DEDICATION
I dedicate this dissertation to my father, who is my ultimate supporter, and to the
scholars and practitioners who are devoted to making this world a better place every day.
iii

ACKNOWLEDGMENTS
First and foremost, I would like to thank my dissertation committee: Drs.
Margaret McLaughlin, Thomas Valente, Michael Cody, and Dmitri Williams. I could not
ask for a better group of experts. Peggy, you have so much faith in me. Your
encouragement and recognition of my personal growth as a scholar mean a great deal to
me. I share your values of new technology in health communication and social services.
I thank you for being the most open-minded academic advisor and dissertation committee
chair. It has allowed me the freedom to explore, experiment, and find my scholarly
identity. I also thank you for the advice and support you have provided me in all its
possible forms especially at the time of need. They have brought me countless
opportunities and helped me accomplish one milestone after another. Tom, you are
brilliant. Thank you for opening my eyes to the world of social networks and health
promotion, and the exciting possibilities for the kind of work I would like to continue to
pursue. It was very kind of you to have me on the Wellness Partners grant project. This
has been a tremendous learning experience for me and I truly appreciate it. Cody, you
are one of the nicest professors I have ever met! Thanks so much for inviting me to be
part of the many professional and social events you have organized, for introducing me to
other scholars, for having me as a guest speaker in your classes, and for taking the time to
comment on my research papers even if I am not your advisee. Dmitri, you are sharp,
charming, and diligent. You have set the bars high for many budding scholars including
me. I admire you and have learned a lot from our conversations and from just observing
iv

you in the classroom as well as at professional events. Thanks for sharing your
experience and thoughts with me.
In addition, this dissertation has benefited from my dialogues with Drs. Peter
Monge, Sandra Ball-Rokeach, Manuel Castells, Janet Fulk, Lynn Miller, and Douglas
Thomas of USC Annenberg School, Ralph Schroeder of Oxford Internet Institute, James
Fowler of University of California in San Diego, David Kenny of University of
Connecticut, and Harold Green of RAND Corporation at various research seminars,
workshops, and project meetings. Thanks also to the Director of Annenberg School of
Communication Larry Gross and the Director of Annenberg Ph.D. program Tom
Goodnight for your generous funding support of my work.
This dissertation would not have been possible without the outstanding Wellness
Partners interdisciplinary research team and the pioneering grant from the Robert Wood
Johnson Foundation. Particularly, I want to thank Marientina Gotsis of USC School of
Cinematic Arts, Interactive Media Division, for working together with me shoulder to
shoulder day in and day out in the last two years, and for the fearless spirits and tireless
efforts that we still share after numerous ups and downs. Marientina, you rock! It has
also been a great pleasure to work with Drs. Maryalice Jordan-Marsh of USC School of
Social Work and Donna Spruijt-Metz of USC Keck School of Medicine. Thank you both
for sharing your wisdom of expertise. I thank the amazing Wellness Partners data
collection team, especially Liset Dondiego, Marrall Bagerdjian, and Ritu Kavishwar.
Thanks so much for your hard work. We finally made it ;-) My thanks also go to Meng
Zhang and Lani Shotlow Rincon for assisting me with data mining in the last few weeks
v

which made it possible for me to finish in time. In addition, I thank all the research
participants for their time and input in this study.
I appreciate my Annenberg colleagues and friends. I am lucky to have the best
cohort and colleagues with shared interests in the Ph.D. program. Thank you all for the
stimulating discussions, heartfelt pep talks, and fun social gatherings we have had over
the past five years.
I especially want to thank Cindy Shen, Joyee Chatterjee, Hayoen Song, Yujung
Nam, Jingfang Liu, Shuya Pan, Joe Phua, Robby Ratan, Deborah Hannan, Shawna Kelly,
and Ting Shi for being my friends through thick and thin, and Lu Tang, Ying Li, Fan
Dong, Jingbo Meng, Nan Zhao, Jinghui Hou, Zheng An, and Li Lu for your
heartwarming friendships as well. I wish to acknowledge and thank Drew Margolin, Jae
Eun Chung, Lauren Frank, Matthew Weber, Amanda Beacom, Arul Chib, Sasha
Costanza-Chock, Lauren Movius, Travers Scott, and Nina O’Brian for your constructive
comments at different stages of this dissertation.
I am also indebted to many friends close to home as well as half way across the
world: my Benzene sisters Jing Wang, Yan Li, Xuerong Zhang, Nannan Guo, and Mei
Yu; my PKU buddies Zhaodan Huang, Zhilong Qian, Peng Wang, and Zhijing Huo; my
CDF pals Andromeda Salvador and Matt Zhou; my OII comrades Bárbara Neves, Bertil
Hatt, Monica Bulger, Henry Li, and Mingfeng Lin; my friends in San Diego Patricia and
Dwight Cole, Thomas Weismann, George Barrack, the late William Shelton, Cathy
Cirina, and Beth Bailey; and my friends in Los Angeles Zhili Fu, Jun Tian, Manqin He,
Xiaoqun Wang, Peter Shen, Xiaoyan Huang, and Dr. Jing Chen. Plus, a special thank
vi

you to Cindy Shen, Jingfang Liu, Joyee Chatterjee, Stacey Spiegel, and Steve Pro for the
support and equal distraction that helped to balance my world during the final process.
I am grateful to Dr. Ray Heisey of Kent State University for directing me to the
field of communication exactly a decade ago and to Dr. Peter Andersen of San Diego
State University for your kind understanding and guidance in my early years of graduate
studies and your continued support ever since. These life-changing events have opened
up many doors and led me to meet some of the most influential people in my life. Mere
words cannot express the deepest appreciation I have for my mentors, co-authors, and
dear friends Drs. Ute Ritterfeld of Technical University of Dortmund in Germany, Arvind
Singhal of University of Texas in El Paso, and Barry Wellman of University of Toronto
in Canada. Each and every one of you has had a tremendous impact on my intellectual as
well as personal development trajectories. Thank you for the inspirations you have
brought to my journey as a young scholar and much beyond.
Most importantly, I owe my ultimate gratitude to my family: Naihong Wang,
Xiuyun Zhang, Hui Wang, Xiaona Yin, and Larry Ni, for your love sets the foundation
for the past, present, and future of my being in this world. Thank you and I love you!

vii

TABLE OF CONTENTS

Dedication ii
Acknowledgments iii
List of Tables x
List of Figures xi
Abstract xii
Chapter 1: Introduction – Networked Play for Health 1
1.1 Play: Digital, Causal, and Online 3
1.2 The Proliferation of SNS and Social Games 5
1.3 Play in a Network Society 8
1.4 Play Beyond Entertainment 11

Chapter 2: Literature Review – Games, Networks, and Health 16
2.1 Media Enjoyment and Digital Games 16
2.1.1 Media Enjoyment 16
2.1.2 Technological Affordance 16
2.1.3 Design Heuristics 18
2.1.4 Player Experience 18
2.1.5 Theorizing Game Enjoyment 20
2.2 Digital Games for Health Promotion 23
2.2.1 Health in Serious Games 23
2.2.2 Games for Health 25
2.2.3 Enjoyment as a Mediator 34
2.3 Co-Play as Networked Play Context 35
2.3.1 Co-Play with Family 36
2.3.2 Co-Play with Friends 37
2.3.3 Co-Play as Community Building 37
2.4 Personal Community and Health 38
2.5 Innovative Intervention for Physical Activity 39
2.5.1 Physical Inactivity as a Public Health Crisis 39
2.5.2 Exercise Psychology and Behavior 42
2.5.3 Interventions to Promote Physical Activity 46
2.6 Research Questions and Hypotheses 48
2.6.1 Research Questions and Hypotheses Regarding Play and Health 49
2.6.2 Research Questions and Hypotheses Regarding 49
Network and Health

viii

Chapter 3: Research Design and Mixed Methods 50
3.1 Research Design 50
3.2 Intervention 51
3.2.1 Web Interface of Activity Diary 51
3.2.2 Web Interface of Social Game 58
3.3 Participant Recruitment 62
3.4 Random Assignment 63
3.5 Data Collection 64
3.5.1 Online Surveys 65
3.5.2 Server Data 69
3.5.3 Interviews 70
3.6 Data Analysis 71
3.6.1 Quantitative Analysis 71
3.6.2 Qualitative Analysis 72

Chapter 4: Results of Quantitative and Qualitative Analysis 73
4.1 Results of Quantitative Analysis 73
4.1.1 Sample Characteristics 73
4.1.2 Manipulation Check 74
4.1.3 Descriptive Statistics 74
4.1.4 Hypotheses Testing 83
4.2 Results of Qualitative Analysis 86
4.2.1 Interview Participants 86
4.2.2 User Profiles and Web Activities 87
4.2.3 The Hierarchy of Media Enjoyment 92
4.2.4 Characteristics of Play Partners 95
4.2.5 The Value of Meaningful Play 97

Chapter 5: Discussion and Conclusion 101
5.1 Summary of Major Findings 101
5.1.1 The Fun Aspect 101
5.1.2 The Network Aspect 103
5.1.3 The Health Aspect 105
5.2 Contributions and Implications 107
5.3 Limitations and Future Directions 109

References 112

Appendices
Appendix A: Wellness Partners Recruitment Email 138
Appendix B: Wellness Partners Recruitment Flyer 139
Appendix C: Frequently Asked Questions Web Page 140
Appendix D: Consent for Contact Form 147
Appendix E: Telephone Screening Survey for Primary Participants 149
ix

Appendix F: Wellness Partners Referral Form 152
Appendix G: Wellness Partners Telephone Screening Survey for 155
Adult Alters
Appendix H: Telephone Screening Survey for Youth Alters 157
Appendix I: Wellness Partners User Instructions 159
Appendix J: Wellness Partners Online Surveys Master Copy 164
Appendix K: Network Visualization and Group Web Activities 199
Appendix L: Recruitment Email for Interview Participants 240
Appendix M: Information Sheet for Interview Participants 241
Appendix N: Wellness Partners Participant Interview Guide 244
Appendix O: Wellness Partners User Profile 247
Appendix P: Wellness Partners Designer/Developer Interview 255
Appendix Q: Selected Sample Quotes from Fun Factor Content Categories 268

x

LIST OF TABLES

Table 1: An Example of Random Assignment of Study Groups in a Block of 10 64

Table 2: Media Enjoyment Factor Loadings 76

Table 3: Descriptive Statistics for Media Enjoyment 77

Table 4: Descriptive Statistics for Social Gaming Features 78

Table 5: Wellness Partners Daily Login Summary 80

Table 6: Descriptive Statistics for Web Activities 80

Table 7: Descriptive Statistics for Exercise Self-Efficacy 81

Table 8: Descriptive Statistics for Perceived Social Support 82

Table 9: Descriptive Statistics for Exercise Habits 82

Table 10: Descriptive Statistics for Perceived Wellness 83

Table 11: Results of Independent t-tests on Media Enjoyment 84
and User Participation

Table 12: Results of Independent t-tests on Health-Related Outcomes 85

Table 13: Frequency Distribution of Fun and Frustrating Factors by 95
Enjoy Threshold Model

Table 14: Descriptive Statistics for Alters Nominated and Enrolled 96

xi

LIST OF FIGURES

Figure 1: Proportions of Serious Games by Content Categories 24

Figure 2: Screenshot of Wellness Partners Web Interface in the 53
Control Condition

Figure 3: Screenshot of Wellness Partners Web Interface for Posting Updates 53

Figure 4: Screenshot of Wellness Partners Web Interface for Reporting Activities 54

Figure 5: Screenshot of Wellness Partners Web Interface for Posting 54
New Activities

Figure 6: Screenshot of Wellness Partners Web Interface for Adding Friends 55

Figure 7: Screenshot of Wellness Partners Web Interface of Thank 55
You for Posting

Figure 8: Screenshot of Wellness Partners Web Interface for Reporting Setbacks 56

Figure 9: Screenshot of Wellness Partners Web Interface for Reporting 56
New Setbacks
Figure 10: Screenshot of Wellness Partners Web Interface for Sending Messages 57

Figure 11: Screenshot of Wellness Partners Web Interface for Activity History 57

Figure 12: Screenshot of Wellness Partners Web Interface for Naming Robot 59

Figure 13: Screenshot of Wellness Partners Web Interface in the 59
Experiment Condition

Figure 14: Images of Wellness Partners Locations for the Robot 60

Figure 15: Examples of Wellness Partners Virtual Collectibles 60

Figure 16: A Mashup of Wellness Partners Robot Activity Animation Snapshots 61

Figure 17: Types of Wellness Partners Web Activities 87

xii

ABSTRACT

This dissertation explored the possibilities and challenges of using a social game
in conjunction with selected members of personal communities to promote physical
activity. Digital entertainment media enjoyment and the role of close social ties as
partners for health promotion were investigated through the evaluation of an intervention
called Wellness Partners. Mixed methods of an experiment of pretest-posttest control
group design and qualitative analysis of server log files as well as in-depth interviews
were used. The study found that the average user managed to log in almost every other
day, some with more enthusiasm than others. Quantitative analysis suggested that their
enjoyment and participation did not differ significantly between the experimental and
control conditions both at the individual and group level. On average, 3.47 partners were
nominated and 1.60 were able to enroll in the study, with over two fifths from immediate
family and the rest from close friends and colleagues of shared interests. Members of
larger study groups participated significantly more although they didn’t necessarily enjoy
it better. No statistically significant health effects were found in the quantitative analysis
regarding exercise self-efficacy, perceived social support, exercise habits, and perceived
wellness. However, qualitative analysis indicated that participants used the website
differently and three major web activities were tracking, socializing, and gaming. Their
comments about the most and least enjoyable experiences supported a three-level
enjoyment hierarchy model. The results suggested that overall participants encountered a
lot of technical difficulty, yet still they appreciated the social and gaming features and
demanded more. The intervention made some qualitative differences in participants’
xiii

perceptions and behavior related to physical activity and holds great potential if the play
activities are tied to specific health goals and content.
1

CHAPTER 1: INTRODUCTION – NETWORKED PLAY FOR HEALTH
Digital games include games played by one or more people on arcade units,
console systems, handheld devices, personal computers, and the Internet, and can be used
as an umbrella term for video games, computer games, online games, as well as mobile
games (Castronova, 2007; Vorderer & Ritterfeld, 2009). In 50 years, digital games have
gone through phases to first become a medium, then through public debates and industry
development a legitimate entertainment and social media platform, and now one of the
largest and most profitable media industries with its products being integrated into
contemporary everyday life (Juul, 2010; Vorderer, Bryant, Pieper, & Weber, 2006;
Williams, 2006a). From Halo3 and World of Warcraft to Wii sports and Guitar Hero,
digital games not only have a wide range but also reach people from all walks of life
(Juul, 2010; Vorderer & Bryant, 2006).
In recent years, the advancement of Internet connections and gaming technologies
has given rise to a phenomenon called networked play (Castronova, 2007; Juul, 2010;
Pearce & Artemesia, 2009; Williams, 2006a). Networked play is powerful for several
reasons. First, an underlying premise is that games are fun. Game designers and
developers strive to create an entertaining and engaging place where people would
willingly spend time and even real money to play (e.g., Castronova, 2007; Juul, 2010;
Klimmt, 2009; Sellers, 2006; Spiegel & Hoinkes, 2009). Understanding what gaming
mechanisms and features can boost the fun appeal and retain users is not just imperative
for commercial games, but even more so for games with serious goals and content (Wang,
Shen, & Ritterfeld, 2009). Second, the play activities are fundamentally different once
2

they are networked through the Internet. The technological infrastructure of multiplayer
online games naturally interweaves the networks of computers and players, enabling
interesting social dynamics on a much larger scale than single player games (e.g.,
Castronova, 2007; Chan & Vorderer, 2006; Williams, 2006b). So who people choose to
play with and how they play together matter a great deal. Third, these games are often
transformed into a persistent social space and affect both the worlds online and off
(Castronova, 2007; Steinkuehler & Williams, 2006; Williams, Yee, & Caplan, 2008).
For instance, World of Warcraft, as currently the world’s most popular massively
multiplayer online role-playing game (MMORPG), hosts over 12 million active
subscribers, many of whom are dedicated members of this online community where
technology and play intersect, identities are challenged, and new cultures emerge (Nardi,
2010). Second Life pioneers a model of virtual worlds that not only affords the users an
extravagant exodus to a world of perpetual fantasy but also creates a fun economy; even
the United States Internal Revenue Service has taken a look at their profitable business
model of the virtual currency Linden Dollars that are convertible to real money (Au, 2008;
Castronova, 2007). Such impacts can be quite profound with regard to the well-being of
the individual members and the society as a whole.
Prior research has focused on networked play in massively multiplayer online
games and virtual worlds, particularly related to gender, age, time, place, play
motivations, and social consequences such as the feeling of isolation or accumulation of
social capital (e.g., Chan & Vorderer, 2006; Williams, Consalvo, Caplan & Yee, 2009;
Williams, Martins, Consalvo & Ivory, 2009; Yee, 2006, 2007, 2008). This dissertation
3

explores the notion of networked play in the context of digital games integrated in social
network sites (SNS) – a relatively new genre called social games, and examines the
potential and challenges of leveraging the intertwining social and technological networks
particularly for health promotion through casual play in everyday practice. There are
three key aspects to this dissertation: (1) the fun aspect – evaluating enjoyment of SNS
web interface and integrated digital gaming elements; (2) the network aspect – exploring
the advantages of close ties as play partners in personal networks; and (3) the health
aspect – testing if social games and members of personal communities can help make a
difference in health-related attitudes and behavior.
1.1 Play: Digital, Casual, and Online
As Castells (2010) points out, “If the media are largely entertainment-based, then
this new form of entertainment, rooted entirely in the Internet and software programming,
is now a major component of the media system” (p. xxix). Digital games are an
important entertainment medium and networked play is an increasingly popular if not yet
dominant form of social practice. Compared to traditional games, digital games can
provide easier access to more people with larger amount of information compressed and
transmitted within shorter period of time (Lowood, 2006; Vorderer, 2000). With the
development and diffusion of new information and communication technologies, digital
game play is becoming prevalent. The Entertainment Software Association reports that
65% of American households played games; the average age of a game player is 35, with
a quarter of all game players under 18, about half (49%) between the age of 18 and 50,
and over a quarter (26%) at the age of 50 or older (Entertainment Software Association,
4

2008). For teens between the age of 12 and 17, fully 97% play games and they mainly
spend time socializing in the gaming worlds (Ito, Horst, Bittanti, boyd, Herr-Stephenson,
Lange, et al., 2008; Lenhart, Kahne, Middaugh, Macgill, Evans, & Vitak, 2008). Adults
are also frequent players: Among those who play digital games, more than one in five
(21%) play every day or almost every day and when older adults do play games, they
tend to play even more frequently than some younger age groups (Lenhart et al., 2008).
Digital game play is further normalized by trendy causal games such as Bejeweled
and Wii sports. Juul (2010) calls this “a casual revolution” as these games require little
prior gaming knowledge or skills, much less time commitment, and offer more flexibility
to fit in all occasions, thus lower the threshold of digital game play to returning hardcore
gamers as well as brand new players, expanding the audience scope outside of the young
male stereotype. For example, surveys of downloadable casual games indicate that their
players are largely female and older. A 2006 survey found 71% of downloadable casual
game players to be women with the majority being over 35 years old; and a more recent
survey found that 93% of respondents were female with an average respondent age of 41
(Juul, 2010). Meanwhile, even though the games themselves do not demand a
considerable amount of play time, many casual game players seem to be avid: 35% play
several times a day for at least one hour and 14% play several times a day for more than
three hours (Juul, 2010).
A recent report on Internet use in 13 countries and regions suggests that the
Internet is not just an information superhighway but rather an entertainment
superhighway, and playing games is one of the most popular activities online (Center for
5

the Digital Future, 2009). In the United States, adult Internet users spend an average of
two hours per week playing games online (Center for the Digital Future, 2010). The
Entertainment Software Association (2008) reports that the most often played online
games are puzzle/board/game show/trivia/card (47%), action/sports/
strategy/role-play (16%), downloadable games (14%), and persistent multiplayer games
(11%), suggesting that casual games are the digital games played most frequently online.
China has about 120 million Internet users who play games online and an average player
spends more than 7 hours per week; more Internet users play games online (59%) than
use the Internet to check email (56%); and for 9% of Chinese Internet users, playing
games is the first thing they do when they get online (CNNIC, 2008).
1.2 The Proliferation of SNS and Social Games
Social network sites (SNS) are “web-based services that allow individuals to (1)
construct a public or semi-public profile within a bounded system, (2) articulate a list of
other users with whom they share a connection, and (3) view and traverse their list of
connections and those made by others within the system” (boyd & Ellison, 2007). SNS
have been burgeoning and flourishing around the globe since their inception in 1997.
The social media giant Facebook currently hosts more than 400 million active users
worldwide; over 60 million status updates are posted each day and 5 billion pieces of
digital content such as photos, news stories, blog posts are shared each week (Facebook,
2010). The microblogging service provider Twitter has grown exponentially, with a
staggering 1,382% increase in unique visitors in the United States just between February
6

2008 and February 2009 (Nelson Online, 2009) and 50 million tweets a day (or 600
tweets per second) in 2010 (Shaer, 2010).
SNS are not merely a technological infrastructure for information sharing among
acquaintances; they offer opportunities for personal interactions that are otherwise
impossible. Many sites incorporate digital gaming applications as the social glue to
retain and engage their users (Tangos, 2008). Social games are casual multiplayer games
with structured activities and contextual rules for players to interact with their friends on
SNS (O’Neil, 2008). Social games have gained tremendous popularity among SNS users.
For example, Buying Houses on Kaixin001.com, one of the most popular social games on
Chinese SNS, attracts over 15 million players spending an average of over five hours
playing every day (Guo, 2009). Another game, Happy Farm, has brought its developer a
monthly income of more than 4 million RMB through advertising and value-added
services (Guo, 2009). In fact, some of these social games became so popular that they
were adopted and incorporated into SNS in other countries. Facebook imported Happy
Farm in April 2009 and it brought in 30 to 40 percent of monthly revenue for the
company within the very first two months (Guo, 2009). So far the game has gained more
than 2.8 million monthly active players (Facebook, 2010).
A survey conducted in January 2010 among nearly 5,000 Internet users in the
United States and the United Kingdom has suggested that close to a quarter (24%) of
Internet users play social games at least once a week; 41% of social game players are
full-time employees, followed by 13% retirees and 11% homemakers; like other casual
games, players of social games are also more likely to be women (55%) and older
7

(average aged 41); 95% of social game players play multiple times a week and log into
Facebook or another SNS specifically to play social games about half of the time; 38%
play one to five hours per week and 28% play six or more hours per week (ISG, 2010).
In May 2010, social game players surpassed 92 million in China, although their players
are more likely to be male (64%) and younger (67% are between 18 and 30 years old); 31%
are employees at corporations and institutions and 27% are students; 97% play social
games that are asynchronous; 22% play multiple times a day and 32% play almost every
day; 30% report playing less than 30 minutes each time they login, 43% report playing 30
minutes to two hours each time they login, and 17% report playing more than two hours
each time they login (CNNIC, 2010).
Social games hold distinct characteristics from other game genres (c.f., Bartle,
1996; Lucas & Sherry, 2004; Molen & Jongbloed, 2007; Sun, Zhong, & Zhang, 2006;
Williams et al., 2008; Yee, 2006, 2008). Situated in an SNS environment, social game
players are largely constituted of people who already know each other or even share close
connections (boy & Ellison, 2007). Thus, social games afford a unique venue for
socialization with real life social ties in a playful manner. This may be different from
MMOs whose players are mainly virtual friends (Yee, 2006) and have never met out of
their online gaming context (Nardi & Harris, 2006). Social games may also be different
from many role playing games as the players will likely represent their real identities so
their friends can recognize and communicate with them as who they actually are but just
to add more fun to it. Furthermore, with game play embedded in the networks of social
relationships and mediated communication, social games indeed function as interesting
8

ecological systems that foster interactions in order for people to play well. Such playful
activities will in turn enhance their player experience, boost their morale for continued
participation, and develop a sense of belonging to the community. Therefore, the first
focus of this dissertation is to find out if social games make SNS more appealing to their
users and what specific factors contribute to or hinder a compelling user experience.
1.3 Play in a Network Society
The rise of networked play has not only coupled with the dominance of
entertainment media such as digital games, but also with the larger societal structural
change. In the latter part of the 20
th
century, the world underwent some major structural
changes from a traditional mass society centered around encompassing, densely knit, and
geographically bounded local groups to a system of more diverse, sparse, permeable,
specialized, and dynamic communication networks – a network society (Castells,
1996/2000/2010; van Dijk, 1991/2006; Wellman, 2001). From the network perspective,
individuals, groups, organizations, and nation-states can be viewed as actors within a
larger ecological system and understood by examining their connections, structural
compositions, and changes over time (e.g., Monge & Contractor, 2003). Although this
societal shift cannot be accounted for only by technological advancement (Wellman,
2001), the invention, diffusion, and penetration of new information and communication
technologies such as mobile phones, personal computers, and more recently social
networking platforms have undoubtedly made a profound impact on the ways in which
we organize and communicate our social connections (e.g., Boase & Wellman, 2006;
Huberman, Romero, & Wu, 2009; Thelwall, 2008). A network society is distinctively
9

characterized by the intertwining media and social networks, creating a multidimensional
“real virtuality integrated with other forms of interaction in an increasingly hybridized
everyday life” (Castells, 2010, p. xxix). Particularly, our daily routines most often
involve what we do with and through these communication technologies and the
activities are centered around us as individuals, a tendency called networked
individualism (Wellman, 2001, 2004) or network individualization (van Dijk, 2006,
2008a, 2008b).
It is not that people never had any personal networks of social relationships; it is
just that the infrastructure, design, and use of these new information and communication
technologies have made their personal networks more palpably visible (boyd & Ellison,
2007; Chua, Madej, & Wellman, 2009). For example, SNS require users to articulate
their personal networks and make them accessible to selected others; their social
networking features and services enable users to share personal information and maintain
social relationships, particularly with pre-existing connections (boyd & Ellison, 2007).
While one can easily get hundreds of people to show up as “friends” on their profiles,
how many of these “friends” are real friends and carry significant meanings in their
interactions nonetheless remain questionable (e.g., Gilbert & Karahalios, 2009; Tong,
Van Der Heide, Langwell, & Walther, 2008). However, we do know that people can
only manage a certain number of ties within their social circles without compromising the
quality of their relationships. Roberts, Dunbar, Pollet, and Kuppens (2009) have recently
confirmed that there is a distinct upper bound on the size of personal networks and a
negative association between network size and emotional closeness. Prior research on the
10

role of technology in social interactions also suggests that although new media platforms
and applications afford tremendous opportunities for new relationships to flourish, they
are also used in good part to supplement communication with existing ties (e.g., Boase,
Horrigan, Wellman, & Rainie, 2006; Quan-Haase & Wellman, 2002; Shklovski, Kraut, &
Cummings, 2008). After all, what matters the most is the collectives of significant others
to us – our personal communities (Chua et al., 2009; Spencer & Pahl, 2006).
The distinction between personal networks and personal communities is that
personal networks normally consist of an individual’s entire set of relationships with
others (from blood ties to mere acquaintances, from friends of pleasure to professional
collaborators, from childhood neighbors to college classmates) while personal
communities are made of only those who are important to an individual and ties are
established via persistent and meaningful interactions (Chua et al., 2009, Hogan, 2009a).
It is this circle of close ties with whom people share their ups and downs – the ones on
their mind when they are happy and the ones they would turn to in the time of need
(Boase et al., 2006). Different communication technologies have different social
accessibilities (Hogan, 2009b). People establish differentiated practices in using these
technologies for relational communication. That is, they end up keeping in touch with
people who are most accessible on certain media platforms rather than the strongest ties
(Hogan, 2009b). Even though members of one’s personal community may be desired
communication partners and have substantial influence on an individual, they can be
easily left out of the communication loop if they do not use the medium. Therefore, the
second focus of this dissertation is on social game players’ personal communities,
11

especially the attributes of their partners and the potential of their influence on health-
related attitudes and behavior through networked play.
1.4 Play Beyond Entertainment
When a new technology is first introduced, it often stirs up public debates as to
whether it will have a positive or a negative impact on society (e.g., Marvin, 1988; Nisbet,
1962; Putnam, 2000; Stein, 1960; Wirth, 1938). The typical process comes in three
waves: It starts with the fear of the new technology’s taking people away from
established meaningful activities, then causing harm to their health, and in the end
shaking up their values, attitudes, and behavior (Wartella & Reeves, 1983, 1985). Like
trains, cars, telephones, radios, and televisions (Berger, 1979; Cowan, 1999; Fischer,
1982; Marvin, 1988; Marx, 1964; Wellman & Leighton, 1979), the Internet and digital
games have gone through the same process (Fischer, 2009; McPherson, Smith-Lovin &
Brashears, 2006; Williams, 2006a). The popular press framed these new technologies as
a threat to social cohesion and well-being (Fountain, 2006; Harmon, 1998; Mallaby, 2006;
Vedantam, 2006; Williams, 2003).
Digital play activities are viewed as “frivolous at best and harmful at worst”
(Prensky, 2003, p. 2). A dominant paradigm is the general aggression model (GAM) by
Anderson and Bushman (2001, 2002). The GAM is an integration based on previous
theoretical models such as social learning theory (Bandura, 1977), cognitive-
neoassociationist model (Berkowitz, 1993), social information-processing model (Dodge
& Crick, 1990), affective aggression model (Geen, 1990), script theory (Huesmann,
1986), and excitation transfer model (Zillmann, 1971). The GAM posits a cyclical
12

process wherein the effects of individual and situational variables on aggression are
mediated by cognition, affect, and arousal (Anderson & Bushman, 2001, 2002; Carnagey
& Anderson, 2003). For a number of years, scholars focused on the negative
consequences of digital game play such as aggression and violence (e.g., Anderson, 2004;
Anderson & Bushman, 2001; Dill & Dill, 1998; Gentile, Lynch, Linder, & Walsh, 2004;
Sherry, 2001). Their findings are mixed and the effect size is rather small (Lee & Peng,
2006; Weber, Ritterfeld, & Kostygina, 2006).
As games continue to mature in terms of genres and design and more people grow
up with games, digital game play is becoming mainstream (Juul, 2010). A Pew survey
reports that 62% of parents of gamers say games have no effect on their children one way
or the other; 19% say games have a positive influence, 13% say games have a negative
influence, and 5% say games have some positive and some negative influence depending
on the game (Lenhart et al., 2008). In fact, almost since the beginning, game designers
and developers have been collaborating with experts in other fields to produce games that
help foster learning and promote health (Lee & Peng, 2006; Lieberman, 2009). However,
only in the past few years, with the advent of gaming technologies, more visibly
successful applications, the increase of evidence on game effectiveness, and accumulated
knowledge about game design principles and strategies, projects on games with serious
goals and content are now attracting more public attention, valuable funding resources,
and enthusiastic research efforts (Lee & Peng, 2006; Lieberman, 2009; Ritterfeld, Cody,
& Vorderer, 2009). This emerging field is commonly referred to as serious games and
13

represents the scholarship and practices of using digital game platforms and technologies
for purposes beyond pure entertainment (Ritterfled et al. 2009; Sawyer, 2009).
Now that we have moved beyond the false dichotomy of good or evil about the
Internet and digital games, the question becomes how exactly we can take advantage of
digital networked game play for public good. Scholars and practitioners have developed
powerful models to use entertainment media for health promotion and positive social
change. The field of entertainment-education is one excellent example. Traditionally,
entertainment-education has been understood as “the process of purposely designing and
implementing a media message both to entertain and educate, in order to increase
audience members’ knowledge about an educational issue, create favorable attitudes, and
change overt behavior” (Singhal, Cody, Rogers, & Sabido, 2004, p. 5; Singhal & Rogers,
1999, p. 9). In the course of the past 30 years, entertainment-education has grown rapidly
around the world. Several hundred interventions have taken place mainly as radio or
television entertainment programs in developing countries but also in increasingly diverse
formats as well as geographic areas (Singhal & Rogers, 2004). Taking into account the
recent developments in the field – especially the popularity of digital entertainment media,
Wang and Singhal (2009) recently proposed a reformulation of the previous definition:
“Entertainment-education is a theory-based communication strategy for purposefully
embedding educational and social issues in the creation, production, processing, and
dissemination process of an entertainment program, in order to achieve desired individual,
community, institutional, and societal changes among the intended media user
populations” (pp. 270-271). Scholars and practitioners are just starting to explore the
14

potential and challenges of using web interfaces and interactive entertainment media for
health promotion (e.g, de Fossard, & Lande, 2008; Rogers, 2004). Therefore, the third
focus of this dissertation is to test if networked play in social games can help change
health-related attitudes and behavior.
To sum up, this dissertation argues that networked play is becoming an important
manifestation of the real virtuality in a hybridized contemporary everyday life. The three
propositions under study are: (1) digital games are fun and engaging; (2) whom people
play games with and how they play together are critical, and close ties could be
meaningful play partners; and (3) networked play can be used for purposes beyond pure
entertainment and hold potential for health promotion. Chapter 1 introduces the notion of
networked play and provides an overview about the prevalence of digital games, the
proliferation of social network sites and social games, the societal structural shift to
individualized personal networks and communities, and the potential of networked play
for health promotion. Chapter 2 draws from the literature of digital games, personal
networks, and health interventions to provide specific research inquires about networked
play for health. Theoretical models and empirical findings are reviewed with regard to
media enjoyment and digital games, digital games for health promotion, co-play as social
context of digital game play, personal communities and health, physical activity as a
public health crisis, exercise psychology and behavior, and interventions for physical
activity. A series of research questions and hypotheses are proposed. Chapter 3 details
the research design and mixed methods, the health intervention used in this study,
participant recruitment and assignment, data collection, and data analysis procedures.
15

Chapter 4 reports the results of quantitative analysis of online surveys and server log data
as well as the results of qualitative analysis of interview transcripts. Chapter 5
synthesizes the major findings of the study, discusses its theoretical, methodological, and
practical implications, acknowledges its limitations, and points out future research
directions.
16

CHAPTER 2: LITERATURE REVIEW – GAMES,
NETWORKS, AND HEALTH
2.1: Media Enjoyment and Digital Games
1
2.1.1 Media Enjoyment

Enjoyment refers to the positive responses of individual users toward
communication technologies and media content (e.g., Bryant, Roskos-Ewoldsen, &
Cantor, 2003; Gee, 2005; Vorderer, Klimmt, & Ritterfeld, 2004). Entertainment (such as
networked play in digital gaming) is a major source of enjoyment in contemporary
societies (Bryant & Vorderer, 2006; Bryant & Zillmann, 2002; Vorderer & Bryant, 2006;
Zillmann & Vorderer, 2000). Enjoyment of entertainment media can come from sensory
pleasures, acquisition of cognitive competence, and emotions evoked within a person as
well through social interactions (Bosshart & Macconi, 1998; Vorderer, 2001; Vorderer et
al, 2004; c.f., Vorderer, Wulff, & Friedrichsen, 1996; Zillmann & Bryant, 1994).
Enjoyment is at the heart of digital gaming and scholars and practitioners have
approached it from different perspectives in game design, media psychology, social
psychology, economics, and communication (e.g., Castronova, 2007; Desurvire, Jegers,
& Wiberg, 2008; Juul, 2010; Klimmt, 2003; Wang et al., 2009).
2.1.2 Technological Affordances
Technological affordances are the possibilities enabled by the properties and
features of information and communication technologies (Norman, 1988). Lessig (1999)
advocates that code is law, arguing that what people can do with a certain media program

1
Some parts of this section are published or based on Wang, Shen, & Ritterfeld (2009).
17

is largely dictated by the software programming. In many game studies, the fun aspect is
often assumed; how games work and what makes them work are taken for granted in the
evaluation of their media effects (c.f., Ritterfeld, Shen, Wang, Nocera, & Wong, 2009).
Klimmt (2009) explicates five characteristics of digital games: multimodality,
interactivity, narrative, social use, and specific frame of play situation. Multimodality can
enhance the digital game play experience through multiple sensory channels (Ritterfeld et
al., 2009). Huge financial investments in digital games are focused on improving
aesthetic and realistic visual representations, sound effects and speech recognition, and
more recently haptic devices such as the innovative Nintendo Wii controller (Klimmt,
2009; Juul, 2010). Interactivity allows for communication between an individual player
and the digital gaming system as well as other players through turn-taking, feedback
loops, and choices (Grodal, 2000; Lee, Park, & Jin, 2006; Klimmt & Vorderer, 2007;
Rittfeld et al., 2009). Thus, digital games can be more engaging than books and
televisions by providing the player opportunities to interact with the gaming world,
change the trajectories of game play, and obtain a sense of control and empowerment
(Klimmt & Hartmann, 2006; Klimmt, Hartmann, & Frey, 2007; Klimmt & Vorderer,
2007). Narrative can provide game players a coherent framework and engage them using
compelling story arcs and virtual characters with various personalities (Fullerton, Swain,
& Hoffman, 2004; Lee et al., 2006). The social use of digital games can afford
unprecedented scalability from a single player to millions of players and satisfy their
innate human desires for socialization (Chan & Vorderer, 2006; Williams, 2006a; Yee,
2007). The specific frame of play situations (or experiential game play) can put the
18

players at the center of game play, immerse them in the course of actions, and allow them
to experiment with choices and consequences (Klimmt, 2009; Wang & Singhal, 2009).
2.1.3 Design Heuristics
Game designers use heuristics to guide their design and evaluate game playability
(e.g., Clanton, 1998; Desurvire, Caplan, & Toth, 2004; Federoff, 2002; Fullerton et al.,
2004). These heuristics typically include game interface such as the look and feel and
navigation; game mechanics such as the core game activities; game story such as story
lines and characters; and game play such as goals, pace, and immersion (Desurvire et al.,
2004). Along the same lines, Juul (2010) offers five casual game design principles: (1)
players should be introduced to the casual game using a frame of emotionally positive
fiction using screen shots or web logos; (2) casual games should have high usability such
that is easy for players without much prior gaming knowledge or skills to figure out how
to use them; (3) unlike hardcore games, casual games should require minimal time
investment and be flexible with interruptibility; (4) players need to face appropriate level
of challenges and difficulty; and (5) casual games can attract players with their juiciness
through frequent positive feedback.
2.1.4 Player Experience
Although game designers and developers strive to make their games fun, what
they think matters the most doesn’t always match the actual game players’ preferences
and experiences (e.g., Choi, Kim, & Kim, 1999). Therefore, researchers have also
studied digital game enjoyment from players’ perspectives, such as intrinsic motivation,
uses and gratifications, and perceived alternative reality (e.g., Malone & Lepper, 1987;
19

Sherry, Lucas, Greenberg, & Lachlan, 2006; Sweester & Wyeth, 2005; Vorderer, 2001;
Yee, 2007). For example, earlier research on children and educational games suggested
that challenge, fantasy, curiosity, control, and choice are primary intrinsic motivations for
digital game play (Cordova & Lepper, 1996; Lepper & Malone, 1987; Malone, 1981a;
1981b; Malone & Lepper, 1987). Yee (2005, 2007) found that achievement, socializing,
and immersion are key motivations of playing online games. The empirical work by
Ryan, Rigby, and Przybylski (2006) offered support for the three variables in self-
determination theory (i.e., autonomy, competence, and relatedness) as significant
predictors of digital game enjoyment. Sherry et al. (2006) adopted the uses and
gratifications framework and identified six factors: competition, challenge, social
interaction, diversion, fantasy, and arousal.
Moreover, Vorderer (2001) proposed to (re)frame digital gaming as a form of
play in coping with reality – "an intrinsically motivated action, accompanied by a change
in perceived reality that is repeatedly used and highly attractive" (p. 256). For example,
based on flow theory by Csikszentmihalyi (1997), game researchers recommended a
game-flow model of eight elements (i.e., concentration, challenge, skills, control, clear
goals, feedback, immersion, and social interaction) for evaluating player enjoyment in
digital games (Sweetser & Wyeth, 2005). Other scholars have focused on the notion of
presence, which is a psychological state in which virtual objects are experienced as actual
objects, or the perceptual illusion of nonmediation (e.g, Lee, 2004; Lombard & Ditton,
1997). In the ISG 2010 report mentioned earlier, the top three reasons for playing social
games are fun and excitement (53%), stress relief (45%), and competitive spirit (43%);
20

and beyond the social interactions, people also like the competitive nature of social game
play, the interactive game play, and the opportunity to win prizes (ISG, 2010). It seems
that the fun factors for social games are consistent with all the factors reviewed in game
enjoyment literature.
2.1.5 Theorizing Game Enjoyment
Klimmt (2003) proposed a conceptual model of game enjoyment and argued that
during game play the enjoyability of a game may be determined by different factors at
three levels: At the first and basic level, the play process can be viewed as a series of
quick and direct feedback loops between the player and the gaming system resulted from
unique technological affordances of digital games (e.g., interactivity) that enable players
an experience of effectance. At the intermediate level, the play process is viewed as a
sequence of interconnected episodes triggered by the player’s intrinsic motivations (e.g.,
curiosity) that unfold with a sense of suspense-relief and increased self-esteem. At the
last and most complex level, the play process is viewed as a whole, characterized by the
player’s active role in engaging with the narrative and their experience of perceived
alternative reality in the gaming world (e.g., presence). Klimmt’s model focuses on the
psychological processes during digital game play and the human computer interaction.
In a recent study, Wang et al. (2009) conducted a comprehensive literature review
and a content analysis of 60 professional game reviews. We identified 27 fun factors,
coded reviewer comments into three valence groups (positive, negative, and neutral),
calculated their frequencies, and compared the categories most frequently used in general
and for games of the highest and the lowest fun scores. These 27 fun factors were then
21

classified into five groups and proposed as the Big Five of digital game enjoyment –
namely, technological capacity, game design, aesthetic presentation, entertainment game
play experience, and narrativity. Technological capacity includes factors about the
technical aspect of an application such as usability issues. Game design includes factors
about the general design of an application such as game mechanics. Aesthetic
presentation includes factors about the presentation of an application such as look and
feel. Entertainment game play experience includes factors about player’s entertainment
experience of an application such as excitement. Narrativity includes factors about
narrative elements in an application such as characters. The results of content coding in
terms of valence suggested that some factors related to narrativity and game design
tended to appear in positive comments more often while other factors particularly related
to technological capacity were more likely to appear in negative comments. Further
comparisons on the content coding of most fun and least fun games indicated that some
factors related to entertainment game play, experience and narrativity, were perceived to
have either made games particularly entertaining or frustrating. Relative ranking s of
these fun factor categories implied that there are certain thresholds that a game has to
pass in order to be playable or entertaining, and yet an additional set of factors is needed
for a game to be considerably compelling and engaging.
Wang et al. (2009) arranged these patterns into a three-level model with a
playability threshold, an enjoyment threshold, and a group of super fun-boosting factors.
The playability threshold is based on common complaints related to technological
capacity and basic game elements (such as usability, control, challenge, and visual
22

presentation). These are things that are expected to be in place for a game to be playable,
and serve as the prerequisites for game enjoyment. If they are not there, it is easy to
generate a feeling of disappointment, frustration, and irritation. It is fairly understandable
that not many people would be interested in playing a game that looks ugly, takes forever
to load, has numerous glitches, and becomes easily repetitive. The enjoyment threshold
constitutes common factors mentioned in both positive and negative ways and reflected
in fun factors related to aesthetic presentation and game design (such as quality visual
and audio presentation, complexity and diversity, mechanics, freedom, levels, balanced
degree of challenge, and gratification). For example, the game should have decent
graphic and sound effects; the player is given a variety of options to explore the game
world at different levels, make decisions, and take actions; or their decisions and actions
are reasonably connected to the consequences that follow, enabling the player to create a
trajectory of personal experience through the game play. These things satisfy our innate
human desires for discovery and problem-solving and create genuine feelings of pleasure
(Gee, 2005; 2007). Finally, the super fun-boosting factors can make games extremely
entertaining. These are the outstanding factors derived from the top games in our sample.
These super fun-boosting factors are often related to extraordinary game design elements
(such as complexity and diversity, novelty, mechanics, and gratification), superior quality
of aesthetic presentation (such as highly sophisticated, stylish, and immersive visual and
audio environments), and particularly the role of narrative in games (such as storylines,
characters, and humor) and player’s social interaction during and after the game play
experience.
23

Although this three-level threshold model of enjoyment was developed based on
prior research and our own analysis of entertainment and commercial games, an
evaluation of the enjoyability of seven serious games supported this three-level
enjoyment hierarchy (Shen, Wang, & Ritterfeld, 2009). However, as discussed earlier,
social games are gaming applications integrated in SNS and are different from hardcore
games usually studied by game scholars. Whether this enjoyment hierarchy applies to
social games remains unknown. Therefore, this dissertation attempts to explore the most
fun and frustrating aspects of the user experience in social games. Ultimately, the
questions are: How do people play? What makes their user experience compelling? What
ruins it? Can the gaming elements embedded in SNS make a user’s experience more
enjoyable and engaging? Thus, the following research hypothesis and research questions
are proposed:
H1: Participants in a health intervention integrated in the form of a social game
will enjoy their experience better and participate more on the website than
an intervention without the game.

RQ1: How would people use a health intervention in the form of a social game?

RQ2: What makes a user’s experience most enjoyable or frustrating?

2.2: Digital Games for Health Promotion
2.2.1 Health in Serious Games
Ratan and Ritterfeld (2009) identified 612 serious games released between 1997
and 2007, and attempted to classify them based on primary educational content, primary
learning principles, target age group, and platform. Results of their study suggest that
dominant categories of games are for academic content targeting (extra)curricular
24

guidelines, skill practices, elementary and preschool age and below, and primarily
computer-based (Ratan & Ritterfeld, 2009). In their sample, digital games for health
promotion only constituted 8% of all serious games as opposed to 63% for academic
content or edutainment (see Figure 1, reproduced from Figure 2.1 on Ritterfeld, Cody, &
Vorderer, 2009, p. 14).
Figure 1. Proportions of Serious Games by Content Categories

However, no more detailed information was provided in Ratan & Ritterfeld (2009)
about these health games. The raw dataset (N = 46) was then requested and obtained
from the authors for further analysis. Results suggest that in terms of primary learning
principles, 30% of the health games are designed for players to gain knowledge through
discovery or exploration, 26% by practicing certain skills, 24% by cognitive problem
solving, and 20% by social problem solving. In terms of target age groups, 65% of health
games include college student, adults, and senior citizens in their target groups, 63%
include middle school and high school age groups, 24% include elementary school age
group, and none of the health games include preschoolers in their target age groups. In
25

terms of game genre, 54% of the health games are adventure games, 22% are strategy
games, 17% are role-playing games, 4% are puzzle games, and 2% are action games. All
of the health games in this sample are computer-based games.
2.2.2 Games for Health
Digital games have been developed for health education and behavioral change
since mid-1990s (Lieberman, 2009). Over the years, game applications for health
promotion have expanded from CD-based to be online, downloadable, and causal. To
supplement the data analysis based on the 46 health games included in the Ratan &
Rittereld (2009) sample, this section provides a brief review of how digital games have
been used for health purposes in terms of primary functions, content, and target
population groups along with some empirical evidence of game effectiveness for health
promotion.
Primary Functions of Games for Health
Health games have been developed for an array of objectives. For instance,
games – and especially simulations – have been used for professional training such as for
surgeons to practice skills (see examples on GamesforHealth.org). Others say the simple
pleasure of play embedded in gaming experiences help satisfy innate human needs and
maintain emotional and psychological well-being (Schiesel, 2007; Yam, 2007). Even
data from some recreational games may be useful to assessment and early detection of
symptoms of cognitive impairment (Jordan-Marsh & Chung, in press). However, a good
majority of health games are developed to aid individuals with certain medical conditions
or who are at high risk for particular health hazards.
26

Distraction. Pain management is a common use of digital games in hospital
settings. To date, numerous studies have documented the effective strategy of using
games to distract patients from the sensation of pains, particularly children and young
adults (e.g., Das, Grimmer, Sparnon, McRae, & Thomas, 2005; Griffiths, 2003; 2005;
Hoffman, Doctor, Patterson, Carrougher, & Furness, 2000; Patel, 2005; Watters, Oore,
Shepherd, Abouzied, Cox, Kellar, et al., 2006). Griffiths (2005) described the challenge
with a 8-year-old neurodermatitis patient who had a habit of picking at his upper lip
which persisted despite all previous treatment and it was only until a handheld video
game given to him that the dangerous picking behavior was able to be stopped which
allowed the affected area to heal in two weeks. Clinical trials have also demonstrated the
effectiveness of handheld video games that modulate pain of pediatric and adolescent
patients from burns (e.g., Das et al., 2005; Hoffman et al., 2000; Patel, 2005) and
alleviate the discomfort of cancer treatment (e.g., Kolko & Rickard-Figueroa, 1985;
Pegelow, 1992; Redd, Jacobsen, Die Trill, McEvoy, & Holland, 1987; Vasterling,
Jenkins, Tope, & Burish, 1993). Therefore, games function as a practical solution and a
channel of cognitive distraction in the above mentioned health contexts.
Therapy/Rehabilitation. Games have also been used as a therapeutic tool.
Nintendo Wii games are revolutionary in many aspects, one of which has to do with the
intuitive game features. They are being exploited by many therapists to engage patients
in otherwise repetitive and tedious practices (Jordan-Marsh & Chung, in press). Other
popular games such as Guitar Hero have been used for rehabilitation after hand surgery
(Jordan-Marsh & Chung, in press). Griffiths (2005) listed several other game-related
27

programs for physiotherapy (e.g., movement recovery, muscular dystrophy) and
occupational therapy (e.g., repetitive strain injuries). In addition, a research group at
University of Southern California led by McLaughlin has been exploring the potential
and value of 3-dimensional games for stroke rehabilitation (e.g., Jung, Yeh, McLaughlin,
Rizzo, & Winstein, 2009; McLaughlin, 2005).
Motivation & monitoring. Serious games research outside of the realm of health
has demonstrated the strong motivational appeal of digital games among learners with a
low level of knowledge and interest (e.g., Ritterfeld et al., 2009). This function certainly
applies to health games, such as those that promote physical activities and exercise
(Warburton, Bredin, Horita, Zbogar, Scott, Esch, et al., 2007). Empirical research has
typically validated the use of games for boosting patient self-efficacy (e.g., Lieberman,
2001, 2006b), which can be used as a proxy for motivation (Bandura, 2004a).
Furthermore, one of the factors that make games entertaining is replayability (Wang et al.,
2009), which attracts people to come back and keep playing a game – potentially
enhancing its positive effects in the long run. This is particularly useful for health
promotion because many medical treatments require long-term adherence (Watters et al.,
2006). This function goes hand in hand with monitoring when individual data can be
recorded, tracked, and evaluated unobtrusively. For example, Glucoboy is not only a
game, but also a blood glucose measurement device at the same time (Jordan-Marsh &
Chung, in press).
Learning. Games afford an entertaining way to learn about health-related issues.
Research since the 1990s has documented ample evidence that patients can increase their
28

knowledge about particular diseases and medical conditions through digital game play
(e.g., Lieberman, 1997, 2001, 2006b; 2009; Watters et al., 2006). For example, children
who played the video game Bronkie: The Bronchiasaurus learned significantly more
about asthma than those who watched the same content on videotape (Lieberman, 2001).
More recently, results of a multi-site, randomized controlled clinical trial suggested that
young people living with cancer who played a first-person shooter, role-playing serious
game, Re-Mission, achieved a much greater level of cancer-related knowledge gain than
those who played a commercial, entertainment game (Cole, Kato, Marin-Bowling, Dahl,
& Pollock, 2006; Kato, Cole, Bradlyn, & Pollock, 2008).
Coaching. Watters and colleagues (2006) suggested that coaching is a critical
function to extend the use of digital games in health care and promotion. Experiential
play is one of the most powerful features of serious games (e.g., Klimmt, 2009; Wang &
Singhal, 2009). By putting oneself into the position of a virtual character, people can
explore, experiment, and experience multiple identities and possible consequences that
are otherwise impossible – practicing skills without jeopardizing one’s stake in real life
(Klimmt, 2009; Peng, 2008). Brown and colleagues (1997) found that an interactive
adventure game improved self-management skills of diabetic children and adolescents
significantly during a 6-month controlled trial, contributing to a subsequent decrease of
77% in diabetes-related emergency and urgent care visits. Likewise, Lieberman (2001)
demonstrated the effectiveness of a health video game in asthma self-care skills among
pediatric patients.
29

Persuasion. Games can be instrumental in terms of knowledge gain and skill
practice; they can change people’s attitude, perceptions, behavioral intention, and
practice patterns as well (e.g., Jordan-Marsh & Chung, in press; Wang & Singhal, 2009).
As we are facing numerous public health challenges in the new millennium, games could
be a useful medium, along with other media platforms, in campaigns for health
promotion and social change (Wang & Singhal, 2009). Multi-level games and
simulations are being designed and developed to help understand epidemics that are
devastating people around the world (e.g., Bauman & Hartjes, 2008; Kafai, in process).
Moreover, lifestyle diseases are threatening public health (Peng, 2009). RightWay Café
is a role-playing game to promote healthy eating among college students (Peng, 2009).
Results of a recent random controlled experiment indicated that using the game as a
health intervention was effective for attitudinal change: participants in the game
condition had significantly higher level of perceived benefits and intention to commit to
healthy eating habits than those in the control group; and sustained attitudinal change was
found among game players a month later (Peng, 2009).
Primary Content of Games for Health
Digital games have been used to address various health-related issues such as
chronic diseases, lifestyle problems, cognitive deficits, and sexual and reproductive
health.
Chronic diseases. A good number of health games are developed for patients to
learn about their chronic medical conditions and gain useful coping skills. Several
research groups have used computer- or Internet-based programs as well as more
30

sophisticated video games to promote asthma self-management (e.g., Bartholomew,
Shegog, Parcel, Gold, Fernandez, Czyzewski, et al., 2000; Huss, Winkelstein, Nanda,
Naumann, Sloan, & Huss, 2003; Krishna, Francisco, Balas, Konig, Graff, & Madsen,
2003; Lieberman, 1997, 2001; McPherson, Glazebrook, Forster, James, & Smyth, 2006).
While a considerable number of studies have demonstrated a substantial increase in
knowledge, skill, self-efficacy, and decrease in occurrences of hospitalization or
emergency department visits (Bartholomew et al., 2000; Krishna et al., 2003; Lieberman,
1997, 2001), some found no changes or limited change (Huss et al., 2003; McPherson et
al., 2006). In a very similar fashion, games have also been often used to control diabetic
conditions (Brown et al., 1997; Horan, Yarborough, Besigel, & Carlson, 1990;
Lieberman, 2001) and cope with cancer treatment (Cole et al., 2006; Kato et al., 2008;
Lieberman, 2009).
Lifestyle problems. In addition to infectious and chronic diseases, the general
public and health professionals are becoming more concerned about lifestyle-related
diseases such as obesity. Games are developed to promote healthy dietary habits and
combat the epidemic of obesity and inactivity among children, college students, and
marginalized high-risk ethnic groups (e.g., Baranowski, Baranowski, Cullen, Marsh,
Islam, & Zakeri, 2003; Peng, 2008, 2009; Thompson, Baranowski, Cullen, & Baranowski,
2007; Turnin, Tauber, Couvaras, Jouret, Bolzonella, Bourgeois et al., 2001). For
example, in RightWay Café, players could exercise different food choices, check nutrition
facts, consult experts in a simulated gaming environment; the customized messages,
personalized adventure of weight management and nutrition education, and dialogues
31

with non-player characters all helped produce desired positive outcomes (Peng, 2009).
Another related area is games to promote physical activities, sometimes called exergames
(Lieberman, 2006a). If Dance Dance Revolution started the first wave of exergames,
then Nintendo Wii series of fitness games is definitely creating a great deal of talk around
exergames right now. Parents are usually worried about their children spending too much
time playing games because of the prevalence of violent content and the sedentary nature
of this play activity (e.g., Lieberman, 2009). But exergames represent a new kind of
gaming experience where a certain degree of body movement is combined with other
game elements and they have thus far received quite positive feedback (Lieberman,
2006a). Research interest in exergames has rapidly grown in the past few years (e.g.,
Graves, Stratton, Ridgers, & Cable, 2007; Mellecker & McManus, 2008; Sall & Grinter,
2007). Moreover, some scholars have looked into games for change in physical activity
among people with disabilities (e.g., Fitzgerald, Cooper, Thorman, Cooper, Guo, &
Boniger, 2004; O'Connor, Cooper, Fitzgerald, Dvorznak, Boninger, Van Sickle, 2000;
Widman, McDonald, & Abresch, 2006). Game applications have also been used to
address other lifestyle problems such as stress management (Jin, 2007).
Cognitive capacity. Part of the enjoyment of digital game play comes from
overcoming challenges presented at various levels (Sherry et al., 2006; Wang et al., 2009).
“Brain games” such as chess and word puzzles are not only being translated from
traditional board games into the digital world, but new and innovative games are also
being created to enhance cognitive processing capacity among the young, the old, and the
simply curious (e.g., Jordan-Marsh & Chung, in press). Websites like Games for the
32

Brain (http://www.gamesforthebrain.com) provide a variety of game challenges for all
who are interested. Tailored digital games have been found especially useful for
sustaining or improving neural plasticity of senior citizens (Aison, David, Milner, &
Targum, 2002).
Sexual and reproductive health. Digital games also provide a safe and private
channel for education on sensitive issues, such as safe sex and HIV/AIDS (e.g., Chib,
2008; Farrar, Snyder, Barta, & Lin, 2007; Miller, Christensen, Godoy, Appleby, Corsbie-
Massay, & Read, 2009; Song, 2008; Thomas, Cahill, & Santilli, 1997). Games for safer
sex and negotiation are being developed for urban young adults by a research group at the
University of Connecticut (Farrar et al., 2007) and for gay men by a research group at the
University of Southern California (Miller et al., 2009). Game interventions have also
been used in the context of developing countries for HIV/AIDS education through a
computer-based multimedia platform (Chib, 2008) as well as mobile technologies (Song,
2008).
Primary Intended Population Groups
As previously mentioned, digital game initiatives have covered young adults (e.g.,
college students) and people living in developing countries, but a significant amount of
health game projects focus on children and adolescents with medical conditions and
increasingly older adults.
Children and adolescents with medical conditions. Although many earlier
successful health games for pediatric and young patients were products of ClickHealth,
HopeLab has emerged as a recent key player in this field with the enthusiasm of its
33

founders and staff, financial investment in game design and development, and massive
research undertakings. Re-Mission is a digital game and community for young persons
living with cancer; players can take the role of a nanobot and learn about different kinds
of cancer and treatment as well as coping strategies through challenging missions
(Lieberman, 2009). Data reported on its website from early 2008 suggested a total of
over 110,000 copies of the game had been distributed in 78 countries in less than two
years (HopeLab, 2008). Results of their recent publications indicate that over time
participants in the game condition demonstrated a significantly higher level of knowledge
related to cancer treatment, greater self-efficacy in communicating about cancer and
managing side effects, and adherence to a prescribed treatment plan, but no effects on
perceived stress, health locus of control, or overall quality of life have been observed
(Cole et al., 2006; Kato et al., 2008; Lieberman, 2009).
Older adults. Digital games are no longer limited to younger generations. As
many societies like America and European countries are facing a fast aging population,
some have suggested using games to promote healthy living and psychological well-
being of older adults (e.g., IJsselsteijn, Nap, de Kort, & Poels, 2007; Jordan-Marsh &
Chung, in press; Schueren, 1986; vanden Abeele & van Rompaey, 2006). If properly
adapted, digital games can be helpful for the elderly to maintain cognitive acuity,
participate in social activities, and fulfill personal recreational needs (Aison et al., 2002;
IJsselsteijn et al., 2007; Jordan-Marsh & Chung, in press; vanden Abeele & van Rompaey,
2006; Wang & Singhal, 2009). ElderGames, funded by the European Union, is an
initiative that employs digital gaming technologies to help improve the health condition
34

and social lives of older people living in Europe. The project incorporates gaming
environments into real-life technology and senior recreational centers, and aims at
serving as a preventive and therapeutic tool for early health diagnosis, facilitating social
interactions through intercultural encounters, and ultimately improving the quality of life
for elderly adults (Gamberini, Alcaniz, Barresi, Fabregat, Ibanez, & Prontu, 2006).
Game customization guidelines have been developed based on prior research as well as
specific aging challenges in the participating European countries (Gamberini et al., 2006).
The review of the games for health literature suggest that digital games hold great
potential for health promotion and can be effective to a certain degree in some cases.
However, whether or not the subtle gaming elements and applications integrated in SNS
have enough persuasive power to change health-related attitudes and behavior remain
unknown. And this dissertation attempts to test if a health intervention in the form of a
social game will have significant health effects on its users. Therefore, the following
hypothesis is proposed:
H2: Participants in a health intervention integrated in the form of a social game
will have better health-related effects than without the game.
2.2.3 Enjoy as a Mediator
Entertainment media can have direct effects on people’s perceptions, emotions,
and behavior (Bryant & Vorderer, 2006; Shrum, 2004; Zillman & Vorderer, 2000).
However, in the case of entertainment-education programs, the educational effects are
largely mediated by various media enjoyment mechanisms such as parasocial interaction,
transportation, identification, and absorption (e.g., Busselle & Bilandzic, 2008; Cohen,
2001, 2006; Giles, 2002; Green, 2004; Green, Brock, & Kaufman, 2004; Slater & Rouner,
35

2002). By the same token, Ritterfeld and Weber (2006) argue that there are different
ways to take advantage of the entertainment value of video games to facilitate learning
and they propose three paradigms in which media enjoyment or entertainment functions
as motivation, reinforcement, or part of a blended immersive environment respectively.
Applying the same logic to health games, the assumption under investigation in this
dissertation is that media enjoyment could potentially mediate health-related intervention
effects. Therefore, the following hypothesis is proposed:
H3: Enjoyment will mediate the health-related effects of a web-based health
intervention.
2.3: Co-Play as Networked Play Context
According to a survey by Pew Internet and American Life Project, more than
three quarters (76%) of teens play digital games with others at least some of the time; 65%
play with other people who are in the same room; and 27% play with people they connect
with through the Internet (Lenhart et al., 2008). Although 90% of parents always or
sometimes supervise their children’s game play activities, only a little over 30% of
parents actually play with their children (Entertainment Software Association, 2008). A
recent survey suggests that 62% of social gamers play with their real life friends and 43%
play with relatives. Previous studies have an emphasis on digital game player profiles in
terms of key sociodemographic characteristics such as gender and age.
However, despite the prevalence of socialization in digital games, the social
context of networked play has long been understudied (Ritterfeld & Weber, 2006;
Williams, 2006b). Who people play with and how they play together can have a critical
impact on their game play experiences. There are at least three forms of co-play that
36

should be considered: play in family contexts, play through friendship networks, and
community building around game play.
2.3.1 Co-Play with Family
Digital games have brought new dynamics in family communication as well as
between different generations. As mentioned earlier, parents now are more tolerant and
acceptable of digital game play and 30% of American parents play games with their
children at home (Lenhart et al., 2008). Among those parents, 72% think it is fun for the
entire family, 71% do it because they are asked to, 66% take it as a good opportunity to
socialize with their kids, and 50% use it to monitor game content (Entertainment
Software Association, 2008). However, the situation with grandparents projects a very
different picture – the discrepancy of new media literacy is creating a digital divide and
generation gap within families (Tapscott, 1998). Others are more optimistic as this
inequality of knowledge and skills may offer new opportunities for the older generation
to enter the social realm of their (grand)children if they know how to maneuver through
the communication processes to become a “ratified” participant rather than a “bystander”
(Aarsand, 2007). As cited in Gamberini et al. (2006), some games such as Age Invader
allow the elderly to play with their grandchildren in a physical space while parents can
tap in through the web. This type of social activity and interaction can provide ample
psychological and social benefits especially for older people (Jordan-Marsh & Chung, in
press; vanden Abeele & van Rompaey, 2006). Earlier health game research has briefly
touched on family communication around game play as a quantitative outcome variable
(Brown et al., 1997), but no further information was given if people would voluntarily
37

invite parents or grandparents as their play partners and if so how they might play
together.
2.3.2 Co-Play with Friends
The network of digital game play overlaps with the network of friendships. As
reviewed earlier, the Pew Internet & American Life Project and the MacArthur
Foundation report that 97% teens between the age of 12 and 17 play digital games. In the
same report, they also detail that 65% of these teens play with other people in the same
physical location, 27% play with others via the Internet, and 47% play with people they
know in real life (Lenhart et al., 2008). Another report of the Digital Youth Project
funded by MacArthur Foundation also find that games mainly function as a social space
for friends to “hang out” and for some to find new friends with shared interests (Ito et al.,
2008). This project led by Ito focuses on youth and learning in new media environments
primarily using ethnographic approach which can be expanded to other user populations
and issues with a health focus.
2.3.3 Co-Play as Community Building
Co-play even with people with similar attributes or shared interests could help
create a sense of community. Despite a plethora of research on communities online and
off, health game-based community building and management seems to be non-existent.
Re-Mission claims to be a game and community of young people living with cancer (see
http://www.re-mission.net). Its website does indicate that game designers and developers
tried to collaborate with their prospect game players when creating the game, and they do
have message boards, blogs, and spaces for sharing artwork and poetry among registered
38

users. Yet none of its research findings address issues at the community level; only
results at the individual level have been reported. Although many websites are meant to
create and facilitate the building of online communities for wellness and fitness, there
have not been any examples using digital game play to engage members in one’s existing
social networks to build personal wellness communities.
2.4 Personal Community and Health
People’s social networks and the resources they could access and benefit from
these social networks have positive effects on their physical, mental, and social health
(Heaney & Israel, 2008; Valente, 2010). In a comprehensive review about the
relationship between social networks and health, Heaney and Israel (2008) conclude that
despite some inconsistency in the empirical findings and the fact that the results of
individual studies can be open to different interpretations, the general trends and patterns
found in the literature across a wide range of research papers provide strong evidence for
the causal effects of social networks on health attitudes and behavior (also see, House,
1981). As discussed earlier, personal communities consist of close ties of family and
friends. Health communication research suggests that long-standing, intimate social
relationships have unique support capabilities and may provide all sorts of assistance:
Family members most often provide long-term and emotional support while friends tend
to offer more temporary and instrumental aid (Gottlieb & Wagner, 1991; Feeney &
Collins, 2003; McLeroy, Gottlieb, & Heaney, 2001). Health promotional programs have
attempted to take advantage of the unique qualities of social networks (Valente, 2010)
and enhance close social ties and facilitate the provision, receipt, and exchange of social
39

support within existing networks to change participants’ health-related attitudes and
behaviors (Heaney & Israel, 2008). However, there have not been many studies using
digital games and networked play to engage personal community members to achieve
desirable health outcomes. When people are presented opportunities to involve their
significant others in their health life, whom would they choose to play, why they chose
them, and how they might play together to produce meaningful results remain unknown
and thus are some of the questions this dissertation tries to explore. Therefore, the
following research hypotheses and questions are proposed:
H4: The larger the size of participants’ personal wellness community, the more
they will enjoy the intervention experience and participate on the
intervention website.

RQ3: What are the characteristics of partners that participants would like to
invite in a health intervention in the form of a social game? Why?

RQ4: How can members of one’s personal community work together to promote
health through meaningful networked play activities?
2.5 Innovative Intervention for Physical Activity
2.5.1 Physical Inactivity as a Public Health Crisis
It is well accepted among the general public as well as the scholarly community
that regular participation in physical activity can substantially improve people’s physical
and psychological well-being (Biddle & Mutrie, 2008; Carron, Hausenblas, & Mack,
2007; Dishman & Buckworth, 2007). For example, exercise can help healthy adults stay
in shape and develop skills for children (Duda & Tappe, 1989; Gill & Williams, 2008);
expend energy and accomplish weight loss for people with obesity (Wilfley & Brownell,
1994); improve women’s experiences of menstruation, pregnancy, and menopause (Choi
40

& Salmon, 1995; Daley, MacArthur, Stokes-Lampard, McManus, Wilson, & Mutrie,
2007; Israel, Sutton, & O’Brian, 1985; Prior & Vigna, 1987; Rankin, Hillan, & Mutrie,
2000); and delay functional loss and maintain independence for the elderly (Fillingim &
Blumenthal, 1993; Shephard, 1994). Exercising regularly can also help reduce anxiety,
alleviate depression, improve stress indices, and positively change personality traits such
as neuroticism (Carron et al., 2007; Gill & Williams, 2008).
However, it is estimated across various epidemiological studies that between 30%
and 60% of the global adult population are sedentary; at least 60% fail to achieve the
minimum recommendation of 30 minutes of moderate intensity physical activity on a
daily basis; 25% do not exercise at all; people complain that they do not have time for
physical activity, but they spend a significant amount of time watching television, playing
video games, and surfing the Internet (Biddle & Mutrie, 2008; Godin, Desharnais, Valois,
Lepage, Jobin, and Bradet, et al., 1994; Lox, Martin, & Petruzzello, 2006; McAuley,
Peña, & Jerome, 2001; National Center for Health statistics, 1980; Stephens, Jacobs, &
White, 1985; World Health Organization, 2004). These findings may vary depending on
the research focus, definition, and methodology of specific studies, but taken together
they have provided clear evidence that the level of physical activity is far from the WHO
recommended standards worldwide (World Health Organization, 2004) and not many
people living in contemporary societies are physically active enough to receive health
benefits (Biddle & Mutrie, 2008). Indeed, “[w]e are living our lives now in totally
different ways from what we have done as humans for more than 99 percent of our
existence” (Biddle & Mutrie, 2008, p. 8).
41

Moreover, such problematic lifestyles are said to have rendered an array of
reverberations in the realm of public health, some of which are even labeled as
hypokinetic diseases – health problems caused by or associated with physical inactivity
(Kraus & Raab, 1961). Examples of hypokinetic diseases include coronary heart disease,
type 2 diabetes, osteoporosis, obesity, hypertension, and some cancers (Biddle & Mutrie,
2008; Gill & Williams, 2008). Researchers have also found that sedentary living habits
can double the risks of morbidity and all-cause mortality (Blair, Kohl, Paffenbarger,
Clark, Cooper, & Gibbons, 1989; Lee & Skerrett, 2001; Powell & Blair, 1994). Physical
inactivity is more than a personal health issue, it is a major public health concern at the
community, national, and global levels as well (Biddle & Mutrie, 2008; Gill & Williams,
2008; King, 1994; Lox et al., 2006; McElroy, 2002). The lack of physical activity is
more prevalent than smoking, hyptertension, and hypercholesterolemia, and is as risky as
these conditions if not more (Biddle & Mutrie, 2008; Powell, Thompson, Caspersen, &
Kendrick, 1987), especially among females, older adults, the poor, less educated, and
ethnic minority groups (Trost, Owen, Bauman, Sallis, & Brown, 2002). It has become a
high priority issue for international organizations, government agencies, and private
foundations in recent years. Some well-known initiatives include the global strategy on
diet, physical activity and health by the World Health Organization, Healthy People 2000
and Healthy People 2010 by the Department of Human Health Services and Center for
Disease Control and Prevention in the United States, and the Active Living research
program funded by the Robert Wood Johnson Foundation (Biddle & Mutrie, 2008; Gill &
42

Williams, 2008; Kahn, Ramsey, Brownson, Heath, Howze, Powell, Stone et al., 2002;
Kraft, Sallis, Moudon, & Linton, 2006 ).
2.5.2 Exercise Psychology and Behavior
Given the well-established relationship between physical activity and people’s
health and well-being, much of the research in this area in the last three decades has
focused on different motivational mechanisms for exercise adoption and adherence
(Biddle & Mutrie, 2008; Carron et al., 2007; Dishman & Buckworth, 2007). Biddle and
Mutrie (2008) summarize five theoretical approaches in exercise psychology and
behavior: (a) belief and attitude centered theories such as the health belief model (Becker,
1974; Becker, Haefner, Kasl, Kirscht, Maiman, & Rosenstock, 1977), the theory of
reasoned action (Fishbein & Ajzen, 1975), the theory of planned behavior (Ajzen, 1991;
Ajzen & Fishbein, 1980), and the protection motivation theory (Rogers, 1983); (b)
competence-based theories such as the self-efficacy theory (Bandura, 1977, 1986); (c)
control-based theories such as the self-determination theory (Deci & Ryan, 1985, 1991)
and locus of control (Rotter, 1966); (d) stage-based theories such as the transtheoretical
model (Prochaska, DiClemente, & Norcross, 1992); and (e) hybrid models such as the
health action process approach (Schwarzer, 1992, 2001). Depending on the study
contexts, some theoretical constructs have found more useful than others.
Self-Efficacy. Within this motivational paradigm, self-efficacy appears to be one
of the most significant and powerful determinants and outcomes of physical activity
(Ewart, Taylor, Reese, & DeBusk, 1983; Feltz, 1992; McAuley & Blissmer, 2000;
McAuley et al., 2001). Bandura (1986) defines self-efficacy as "people's judgments of
43

their capabilities to organize and execute courses of action required to attain designated
types of performances” (p. 391). Therefore, people’s sense of confidence and
competence is contingent upon specific situations and what matters most is their self-
perceptions of capabilities in these specific situations rather than the actual skills they
possess (Bandura, 1986). Individuals are viewed as behavioral change agents through
their motivation and action (Bandua, 1997, 2001, 2004a, 2004b). Efficacy expectations
come from prior performance accomplishment, social modeling, verbal and social
persuasion, and physiological arousal; they may vary in terms of magnitude, strength, and
generality; and they are primary determinants of choice of activity, level of effort, and
degree of persistence (Bandura, 1986, 1997).
Maddux (1995) makes an important distinction between task self-efficacy and
self-regulatory or coping efficacy. Task self-efficacy involves assessment of individual
capabilities of performing a specific physical activity while self-regulatory or coping
efficacy involves assessment of challenges and impediments to successful completion of
the performance (Maddux, 1995). Taking into consideration concern about time as a
common barrier to exercise, Rodgers, Wilson, Hall, Fraser, and Murray (2008) extend
Maddux’s categorization in the context of self-efficacy for physical activity to include
task efficacy (e.g., performing a required body movement), coping efficacy (e.g., going to
the gym despite lack of energy), and scheduling efficacy (e.g., arranging one’s schedule
to include exercise in the daily routine).
In exercise psychology, earlier studies by Ewart and colleagues with patient
groups found more efficacious individuals exert more effort and recover from
44

rehabilitation to normal activities much faster (Ewart et al., 1983). Studies with non-
patient groups have shown self-efficacy to be a significant predictor of exercise change
over time (Sallis, Haskell, Fortmann, Vranizan, Taylor, & Solomon, 1986; Sallis, Hovell,
Hofstetter, & Barrington, 1992) and exercise adherence over dropout (Rodgers &
Brawley, 1993). In their extensive and influential work, McAuley and colleagues
demonstrated the close yet complex relationship between self-efficacy and physical
activity: Self-efficacy is a critical determinant of physical activity in terms of adoption,
maintenance, and persistence; self-efficacy can be increased as a result of both acute and
chronic physical activity; health interventions may manipulate self-efficacy to test effects
on social cognitions, affect, and behavior; and the role of self-efficacy becomes
particularly potent in challenging contexts such as in the early stages of exercise adoption,
long-term maintenance of activity, and among population groups who are sedentary,
older, living with or recovering from a medical condition (McAuley, 1992a, 1992b;
McAuley & Blissmer, 2000; McAuley & Courneya, 1993; McAuley, Lox, & Duncan,
1993; McAuley & Mihalko, 1998; McAuley et al., 2001).
Social Support. People’s perceptions, attitudes, and behaviors are largely affected
by others around them (Baron & Byrne, 1991) and physical activity is no exception.
Only in recent years have scholars and practitioners started to embrace an ecological
perspective and pay more attention to the external factors of exercise psychology and
behavior such as government policies, physical environments, and social influence
(Biddle & Mutrie, 2008; Kahn et al., 2002; Kraft et al., 2006; Trost et al., 2002). In the
exercise literature, sources of social influence include family, friends, physicians,
45

exercise instructors or leaders, individual co-exercisers, and social and task cohesive
exercise groups (Anderssen & Wold, 1992; Atkins, Kaplan, Timms, Reinsch, & Lofback,
1984; Carron et al., 2007; Clifford, Tan, & Gorsuch, 1991; Miller, Johnson, Garrett,
Wickoff, & McMahon, 1982; Spink & Carron, 1994). A particularly relevant construct is
the social support from such sources. Social support is defined as resources provided to
individuals from their interactions with others and it can be tangible and informational, as
well as emotional (Biddle & Mutrie, 2008; Gill & Williams, 2008; Rosenfeld & Richman,
1997; Shumaker & Brownell, 1984).
Studies have found that parents’ and siblings’ level of physical activity, direct
parental help, and social support from parents and significant others are positively
associated with the physical activity of children and young adults (Biddle, Whitehead,
O’Donovan, & Nevill, 2005; Sallis, Prochaska, & Talyor, 2000). In their systematic
review, Trost et al. (2002) provided evidence that social support from spouse/family and
friends/peers consistently plays an important role in exercise participation among adults.
Scholars have also studied social influence and motivational climate from the perspective
of goal-setting and reward mechanisms: Some focus on a mastery-based climate fostered
by individual effort and improvement while others emphasize a performance-based
climate that is competitive by way of social comparison (Gill & Williams, 2008).
Empirical research suggests that motivational climates, especially those initiated by
parents and peers, are positively associated with attitudes toward physical activity and
exercise enjoyment (Digelidis, Papaioannou, Laparidis, & Christodoulisdis, 2003; Vazou,
Ntoumanis, Duda, 2006; Waldron & Krane, 2005).
46

More recently, a meta-analysis conducted by Carron et al. (2007) evaluated the
impact of social influence on exercise behavior (adherence and compliance), cognitions
(intentions and efficacy), and affect (satisfaction and attitude). They found that across
the various sources, social influence generally has a small to moderate positive effect; but
social support from family and important others have a moderate to large effect on
exercise involvement (Carron et al., 2007). They also recommended further exploration
of the relationships between social influence factors and self-efficacy for physical as well
as other frameworks beyond individualistic social psychological approaches such as
theories of social networks (Carron et al., 2007). Bartholomew et al. (2001) suggested
that “personal networks are particularly useful for the study of social support” (p. 100).
2.5.3 Interventions to Promote Physical Activity
Health interventions have been designed, implemented, and evaluated at the
individual, group, community, organizational, and policy levels for exercise adoption,
adherence, and compliance (Biddle & Mutrie, 2008; Kahn et al., 2002; King, 1994).
Such an intervention can take place in various forms such as professional counseling at a
health clinic, a modified physical education curriculum at school, a supervised exercise
program, or a social support group (Biddle & Mutrie, 2008; Heaney & Israel, 2008; Kahn
et al., 2002; Wright, 2009). In the past two decades, interventions to promote physical
activity have shifted from unidimensional approaches that target small and homogenous
population groups to larger-scale, theory-driven, community-based programs for people
with diverse backgrounds in gender, age, race, ethnicity, education, socio-economic as
well as health status (Biddle & Mutrie, 2008; Dishman & Buckwork, 2007).
47

Owen and Dwyer (1988) recommend that interventions to promote physical
activity in the community should emphasize the role of environmental settings as well as
social support for the intervention to operate at different levels simultaneously and to
offer participants a variety of options in an intrinsically interesting manner. Similarly,
Sallis and Owen (2002) stressed the importance of a social ecological perspective to the
design and evaluation of health interventions to understand the influence across multiple
levels on physical activity behavior.
In their systematic review on the effectiveness of interventions to increase
physical activity, Kahn and colleagues (2002) found strong empirical evidence for
“building, strengthening, and maintaining social networks that provide supportive
relationships for behavior change” (p. 84). Although these interventions typically
involved volunteers in the local community, churches, and universities as well as the
workplace to establish an exercise interest group where members could offer
companionship and social support to help each other in achieving their personal goals
through self-monitoring, discussion, and phone calls, they found potential in using social
support from family to increase physical activity as well.
Dishman and Buckworth (2007) conducted a meta-analysis on findings of 445
effects from 127 studies based on 131,156 people between 1965 and 1995. Their analysis
“provides some support for consensus opinions that modifying traditional guidelines for
exercise programming to accommodate moderately intense physical activities of varied
type in a community using mediated, as well as face-to-face, approaches will increase
participation among segments of the sedentary population. The maintenance of successful
48

physical activity after the conclusion of an intervention has been less encouraging
implying a need for sustained or repeated implementation of interventions” (p. 352).
Overall, the review of exercise psychology and behavior suggests that despite the
merits of traditional interventions, more innovative programs are needed to integrate
individuals and their support partners to take effect on multiple levels. Even more
important is the challenge of engaging and retaining participants over time. More than 15
years ago, when commenting on the role of technology in health interventions, Dirkin
(1994) foresaw the potential of community building through computer networks and
mediated human interactions, and the value of interactive digital entertainment media
such as video games. Now with the development of the Internet and gaming technologies,
using networked play in social games to build personal wellness communities with
selected significant others seems to be a promising form of health intervention to
overcome the challenges of user engagement and participation through fun gaming
mechanisms and produce positive attitudinal and behavioral change at both the individual
and network level in the long run.
2.6 Research Questions and Hypotheses
Based on the literature review of digital game enjoyment, personal networks and
communities, and their relationships with health interventions and outcomes, the
hypotheses and research questions that this dissertation aims to examine are summarized
below.

49

2.6.1 Research questions and hypotheses regarding play and health
H1: Participants in a health intervention integrated in the form of a social game
will enjoy their experience better and participate more on the website than
an intervention without the game.

H2: Participants in a health intervention integrated in the form of a social game
will have better health-related effects (i.e., self-efficacy, perceived social
support, behavioral change, and perceived wellness) than without the
game.

H3: Enjoyment will mediate the health-related effects of a web-based health
intervention.

RQ1: How would people use a health intervention in the form of a social game?

RQ2: What makes a user’s experience most enjoyable or frustrating?

2.6.2 Research questions and hypotheses regarding network and health

H4: The larger the size of participants’ personal wellness community, the more
they will enjoy the intervention experience and participate on the
intervention website.

RQ3: What are the characteristics of partners that participants would like to
invite in a health intervention in the form of a social game? Why?

RQ4: How can members of one’s personal community work together to promote
health through meaningful networked play activities?

50

CHAPTER 3: RESEARCH DESIGN AND MIXED METHODS
3.1 Research Design
Mixed methods were used in this dissertation for data collection and analysis.
This approach recognizes the strengths and weaknesses of different research
methodologies and combines quantitative and qualitative methods to complement each
other (e.g., Axinn & Pearce, 2006; Bergman, 2008; Creswell & Plano, 2007; Tashakkori
& Teddlie, 2003). Thus, the results from using different methodological approaches can
be triangulated to provide more comprehensive and in-depth understanding of the
phenomenon under study (Greene, Caraceli, & Graham, 1989; Tashakkori & Teddlie,
2003). Given the nature of the research inquiries, appropriate quantitative and qualitative
methods can be selected, arranged in temporal sequences, and assigned even or uneven
weights (Creswell & Plano, 2007).
In order to answer the proposed research questions and test hypotheses, the data
of this study were collected through a larger research grant project funded by the Robert
Wood Johnson Foundation’s Pioneer Profile program for health games. To find out
whether social games can make a difference in users’ entertainment media enjoyment,
program participation, and health-related intervention effects, an experiment with a
pretest-posttest control group design was implemented. Since daily Internet access was a
requirement for all participants, online surveys were used to collect data before and after
the intervention. For the larger grant project, participants completed a baseline survey
before they started using one version of the intervention, filled out a follow-up survey
after five weeks, and were then switched to the other version of the intervention for
51

another five weeks, and filled out the second follow-up survey. The intervention was
web-based, so participants’ use of the program could be tracked online and recorded in
the server database. For the purpose of this dissertation, only the baseline survey, the
first follow-up survey, and server log files from the first five weeks were used for data
analysis. Since there were no prior interventions that used a social game to promote
health and many questions remain exploratory, in-depth interviews were chosen to help
correct measurement errors in the quantitative part of the study, contextualize
participant’s survey answers, and obtain personal insights about user perceptions and
experiences.
3.2 Intervention
A web-based health program called Wellness Partners was created to combine
digital gaming and social networking for promoting physical activity. The application
was designed and developed by the Interactive Media Division at the School of
Cinematic Arts, University of Southern California (hereafter USC). This program
functioned through a web interface similar to Facebook and Twitter where people can log
in and update personal information but mostly regarding physical activities. Participants
were asked to invite at least one family member or friend to enroll in the program as their
wellness partners. Two versions of the web interface were used, one for the control
group and the other for the experimental group.
3.2.1 Web Interface of Activity Diary
In the control condition, the interface functioned as an activity diary (see Figure 2). The
following features were included: (1) Posting updates of physical activities or setbacks.
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When participants clicked on the link to “post update,” a window would pop up for them
to select and report either an activity or a setback (see Figure 3). If they chose to report
an activity, they would be prompted to report a new activity or choose from their own list
(see Figure 4). They were then asked to fill out a form about the activity type, duration,
and intensity with an option to keep it private (see Figure 5). Participants could also add
their wellness partners if any of their network members attended the same activity (see
Figure 6). Then a thank you message appeared after they were finished sending the
update (see Figure 7). Similarly, if they chose to report a setback, they were prompted to
report a new setback or choose from their own list (Figure 8). Then they were asked to
type in the setback such as a phrase “I was tired” (see Figure 9). They would receive a
short thank you message when finished. (2) Sending private messages to partners. When
participants clicked on the link to “send a message,” a window would pop up for them to
choose the person from their wellness partners enrolled in the study and type in a text
message within 140 characters (see Figure 10). When participants clicked on the link to
“messages,” they would be able read the private messages they received from their
partners in the study. (3) Recording updates. When participants clicked on the link to
“activity summary,” they would be able to see a complete history of all public updates
posted by the participants as well as their partners (see Figure 11). (4) Displaying a tag
cloud. On the bottom of the screen, there was a section showing the tags of all the
physical activities reported by the participants and their partners. The more frequently an
activity was reported, the larger the font in the tag cloud. Each tag had a hyperlink that
could be used as a shortcut for reporting the same activities (see Figure 2).
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Figure 2. Screenshot of Wellness Partners Web Interface in the Control Condition

Figure 3. Screenshot of Wellness Partners Web Interface for Posting Updates

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Figure 4. Screenshot of Wellness Partners Web Interface for Reporting Activities

Figure 5. Screenshot of Wellness Partners Web Interface for Posting New Activities

55

Figure 6. Screenshot of Wellness Partners Web Interface for Adding Friends

Figure 7. Screenshot of Wellness Partners Web Interface of Thank You for Posting

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Figure 8. Screenshot of Wellness Partners Web Interface for Reporting Setbacks

Figure 9. Screenshot of Wellness Partners Web Interface for Reporting New Setbacks

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Figure 10. Screenshot of Wellness Partners Web Interface for Sending Messages

Figure 11. Screenshot of Wellness Partners Web Interface for Activity History

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3.2.2 Web Interface of Social Game
In the experimental condition, all the features of an activity diary remained the
same and additional gaming elements were incorporated into the web interface. The
following additional features were included: (1) Naming a virtual character. There was a
virtual character that looked like a robot in the game version. At the first login,
participants could name their own robot (see Figure 12). (2) Displaying points as reward
for updates (see Figure 13). Participants were rewarded with points for posting updates
about their physical activities and setbacks. More points were assigned to activities of
higher intensity, and longer duration. Bonus points were awarded for each of the other
network members who participated. One point was awarded to all the setbacks.
Participants were given credit for the first two activities and the first setback they
reported within a day. The point system generally encouraged continuity (i.e., reporting
every day) and sociability (i.e., working out with family and friends). (3) Choosing
locations. They could also select from 11 locations where their robots would be situated
(see Figure 14). An example of location is a Zen garden. (4) Collecting virtual items as
reward. Participants could redeem their points for collectibles associated with the robot’s
location and create their own collections (see Figure15). For instance, the collectibles
associated with Zen garden included a tea kettle, a rock, a rake, and a poem. (5) Playing
robot activities. Participants could use their points to make the robot play an animated
activity associated with the location (see Figure 16).
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Figure 12. Screenshot of Wellness Partners Web Interface for Naming Robot

Figure 13. Screenshot of Wellness Partners Web Interface in the Experiment Condition

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Figure 14. Images of Wellness Partners Locations for the Robot

Figure 15. Examples of Wellness Partners Virtual Collectibles

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Figure 16. A Mashup of Wellness Partners Robot Activity Animation Snapshots

There were 69 activities and some examples of these animations were surfing by the
beach, flying a kite at the playground, releasing a butterfly in the sunflower field, and
writing a poem in the Zen garden. Some animations would result in a collectible
depending on the location and the type of activities the robot performed. For example,
going surfing would result a surf board in the collection. Once played, all animations
were stored as “memories” and could be replayed at any time. (6) The robot’s activities
were also included in the “activity summary” which now became a complete history of
all public updates by network members as well as their robots. (7) Exchanging virtual
gifts. Participants could also pick items from their collectibles and send them to other
network members as gifts.
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3.3 Participant Recruitment
Participants in this study were recruited through several methods. A research
announcement was included in the monthly email blast (see Appendix A) from the USC
Center for Work and Family Life to their registered staff members in mid October, 2009.
A total of 12,000 mailers were printed and delivered to staff office mailboxes on campus
in early November, 2009 (see Appendix B). In addition, flyers were distributed on
campus throughout the fall semester in 2009. Potential participants were directed to the
study website (http://interactive.usc.edu/wellnesspartners/faq/index.html) where they
could learn more about the study from the Frequently Asked Question web page (see
Appendix C). They were instructed to fill out the Consent for Contact Form (see
Appendix D) to grant permission for the research team to contact them.
The primary participants (or “egos” in social network parlance) in this study had
to meet the following criteria: (1) USC staff or graduate student workers; (2) fluent in
English; (3) had daily access to the Internet; (4) owned a cell phone; (5) not currently
enrolled in another formal study about weight loss or healthy lifestyle; (6) had never
enrolled in Wellness Partners before; (7) between the ages of 25 and 44; (8) had a social
circle of at least four people for support; and (9) would be willing to enroll at least one
member from a close social circle (family, domestic partner, friends) to participate in the
study together. Potential primary participants were screened by telephone (see Appendix
E). Qualified primary participants were instructed to nominate their family and friends to
join the study with them by providing their full names in an online Referral Form (see
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Appendix F) and by directing their potential partners to fill out the Consent for Contact
Form as well.
The secondary participants (partners or network “alters”) had to be invited by a
qualified primary participant and also had to meet the following criteria: (1) fluent in
English; (2) had daily access to the Internet; (3) never enrolled in Wellness Partners
before; and (4) between the ages of 12 and 85. Potential partners were then screened
over the telephone (see Appendix G for adult alters and H for youth alters). Once at least
one partner passed the screening, the qualified primary participant as well as his/her
qualified alter(s) formed an egocentric network and would use the intervention together
as a study group. Since this recruitment and screening process was lengthy and
painstaking, it was not possible to start all the qualified study groups at the same time and
a rolling recruitment procedure was implemented till the study achieved a reasonable
sample size (N = 84).
3.4 Random Assignment
Random assignment is key to a true experiment (Kuehl, 1999). Given that this
study adopted a rolling recruitment procedure and participants were grouped by their
personal networks, the study groups were used as the unit of random assignment and a
special randomization strategy was used for condition assignment. First, a rule was set
up to use odd numbers to represent the experimental condition (A) and even numbers to
represent the control condition (B). Then, instead randomly picking numbers from a fixed
range defined by the sample size, groups were randomly pre-assigned in blocks of 10. A
random number between 1 and 10 was generated. If the result was an odd number, then
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the group was assigned to condition A. If the result was an even number, then the group
was assigned to condition B. The frequency of odd and even numbers were tracked until
one condition reached five groups within the block, then the rest of the groups would be
assigned to the other condition regardless of the results of the random number generator.
Therefore, each block consisted of 10 study groups with half randomly assigned to
condition A and the other half randomly assigned to condition B. The same steps were
repeated when the total number of study groups exceeded 10, 20, 30, and so on. Table 1
demonstrates this random assignment procedure.
Table 1. An Example of Random Assignment of Study Groups in a Block of 10
Ego Network Random Number Generated Condition Assigned
#1 7 A
#2 10 B
#3 3 A
#4 8 B
#5 4 B
#6 2 B
#7 1 A
#8 10 B
#9 A
#10 A
3.5 Data Collection
In an email, each participant was given user instructions about Wellness Partners
appropriate for their assigned condition (see Appendix I). They were encouraged but not
required to use the program every day and they all used it as a study group for about five
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weeks. The primary participants could invite additional partners at any time during the
study. Data were collected from the participants through three methods: online surveys,
server log files, and interviews.
3.5.1 Online Surveys
All participants were asked to complete an online survey at the beginning and the
end of the study. The survey questionnaires included questions about participants’
exercise habits, social networks, perceived wellness, prior digital gaming and SNS
experience, and their evaluation of the Wellness Partners program (see Appendix J for
IRB approved information sheets and a master copy of the questionnaires). All the
primary participants and their first five partners received $10 of compensation for each of
the online surveys completed. The survey data were collected between October 27, 2009
and April 27, 2010.
Measurement of Media Enjoyment
In order to test the research hypotheses regarding users’ entertainment experience,
a set of statements were developed to assess the various aspects of the intervention. They
were grounded in previous research on evaluation of web interface and digital gaming
elements (e.g., Aladwani & Palvia, 2002; Desurvire et al., 2008). For the evaluation of
the web interface in the control condition, participants were asked to rate (1 = strongly
disagree, 7 = strongly agree) the following 15 statements: “I like the look and feel,” “It
was difficult to navigate around,” “I did not experience many technical problems,” “It
was confusing to fill out information for my physical activity updates,” “It was easy to
send activity updates through my cell phone,” “It did not take too much time to send
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updates every day,” “I enjoyed sharing information about my physical activities with
family and friends,” “It was not important to me to have features with respect to privacy,”
“I like reading my partners’ updates,” “It motivated me to be more active when it comes
to exercise, “It prompted me to think more about healthy lifestyles,” and “I would like to
sign up with my family and friends if this program were made available in the public
domain.”
In addition, seven statements were developed to evaluate enjoyment of the digital
gaming elements added to the more interactive version of the intervention: “It did not
give me a sense of accomplishment when I was rewarded points for the physical activities
I reported,” “The display of total points presented me a feeling of competition with my
partners in the program,” “I liked the variety of locations that I could choose from,” “The
collectables were cute,” “Giving the virtual character a personalized nickname was not
necessary,” “I liked the look and feel of the virtual character,” and “I enjoyed watching
the animated activities of the virtual character.”
Moreover, nine statements modified from the parasocial presence scales
(http://www.presence-research.org/AppendixA.html) were used to evaluate the parasocial
communication between players and their virtual characters. The scale consisted of the
following nine statements to assess intimacy: “The virtual character created a sense of
closeness with me,” “The virtual character was very impersonal in its dealings with me,”
and “I found the virtual character to be almost like a friend in real life”; positivity: The
virtual character is … “likeable,” “unfriendly,” and “fun;” and involvement: The virtual
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character “holds my attention,” “excites my curiosity,” and “motivates me to do more
exercise.”
Prior Gaming and SNS Experience
A number of questions derived or modified from the Pew gaming and civic
engagement survey (Lenhart et al., 2008) and ESA game industry survey (2008) were
included in this study to evaluate participants’ prior gaming experience. They were asked
if they had ever played any digital games. If so, follow up questions were asked about
the kind of games they played and how they played in terms of game platforms (on a
computer; on a game console such as PlayStation, Xbox, Wii, and GameCube; on a cell
phone or handheld organizer; and on a portable gaming device such as DS, PSP, and
GameBoy), game genres (puzzle, strategy, sports, action, adventure, fighting, first-person
shooter, racing, role playing, simulation, and other), and game play context (how often
they played alone, played with people they knew in real life, played with people they first
met online, played with people in the same room, and played through the Internet).
Additional questions asked the participants how many social networking tools they used
regularly, what they were, and how often they used them.
Exercise Self-Efficacy
Exercise self-efficacy was measured by a multidimensional scale developed by
Rodgers et al. (2008). Respondents were asked to rate their confidence level (0= not at
all confident, 100 = completely confident): How confident are you that you
can …“complete exercise using proper technique,” “follow directions to complete
exercise,” and “perform all of the required movements” to assess task efficacy; “exercise
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when you feel discomfort,” “exercise when you lack energy,” and “exercise when you
don’t feel well” to assess coping efficacy; “include exercise in your daily routine,”
“consistently exercise three times per week,” and “arrange schedule to include regular
exercise” to assess scheduling efficacy.
Perceived social support
A modified version of Pender’s exercise social support scale (http://www.nursing.
umich.edu/faculty/penderinstruments/researchinstruments.html) was used to measure
perceived social support for physical activity. Participants were asked “In the past 4
weeks, how often have your family and friends done the following things with you? Play
sports with me; exercise with me; encourage me to exercise; praise me for exercising; and
criticize me for exercising.” They were given the options of “never,” “less than once a
year,” “once a year,” “less than once a month,” “once a month,” “less than once a week,”
“once a week,” and “more than once a week.” Questions about perceived general social
support were modified from the social support inventory by Brown, Brady, Lent, Wolfert,
and Hall (1987). Participants were also asked “In the past five weeks, how much of these
kinds of help or support have you received?” and to rate (1= none, 7 = very much) the
following seven statements: “Assurance that you are loved,” “Know others whom you
could talk to when you are down and blue,” “Help to see optimism in the future,” “Help
to set realistic goals,” “Information to change negative feelings,” “Assistance when act in
self-defeating ways,” “Financial assistance for emergencies,” and “A model or an
example to follow.”

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Exercise Habits
Exercise habits were measured through a scale developed by Godin and Shephard
(1985) by asking participants “Considering a 7-day period (a week), how many times, on
average, do you do the following kinds of exercise for more than 15 minutes during your
free time?” ; the exercise types are mild, moderate, and strenuous physical activities. A
weekly physical activity score of arbitrary units could be calculated for each participant
using the formula provided with the original scale.
Perceived Wellness
Perceived wellness was accessed using the SF-12v2 questionnaire. Participants
were asked “During the past 4 weeks, how much of the time have you had any of the
following problems with your work or other regular daily activities as a result of your
physical health or emotional problems (as in a separate question)?” They could answer
“Accomplished less than you would like” and “Were limited in the kind of work or other
activities” on a 5-point scale (1= none of the time, 5 = all of the time). A physical health
component score (PCS) and a mental health component score (MCS) could be calculated
separately for each participant.
3.5.2 Server Data
All participants’ use of the Wellness Partners web interface was tracked and
logged on the server database. Records of web activities were extracted from the server
database and processed to represent the online interactions of the 39 groups during the
study. The server data were collected between December 7, 2009 and April 30, 2010.
The log files included 3,904 records of user login information, 3,571 postings of
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individual physical activities, 397 postings of setbacks, 546 postings of group physical
activities, 127 records of memories replayed, 568 records of collectibles, and 518 private
messages with text and/or virtual gifts. These online activities were tallied for each of the
100 participants and summed up to reflect their individual participation in the program.
Individual counts were also added up to reflect the mediated-interactions within each
group (see Appendix K for a detailed visualization of network dynamics along with the
records of group web activities).
3.5.3 Interviews
Semi-structured, in-depth interviews were conducted with the participants as well
as the designer/developer of Wellness Partners between March 31, 2010 and May 11,
2010. A total of 20 participants were interviewed upon their completion of the study.
They were selected based on their individual attributes such as their role in the study as
an ego or alter, gender, age, user behavior on the intervention website as well as the
structure of their personal networks such as a dyad, triad, or a group of larger size. They
were recruited through an email invitation (see Appendix L) along with the IRB approved
information sheet (see Appendix M). The user interviews were semi-structured using
questions outlined in the IRB approved interview guide (see Appendix P). On average,
the interviews took 37 minutes. They were either conducted in person or via telephone.
All interviews were digitally recorded and transcribed for analysis (see Appendix O).
Questions included but were not limited to: Why did you decide to participate in this
study? How did you choose your wellness partner(s)? What did you like the most and
the least about the website? How did you feel about the switch from one condition to the
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other? What were the most interesting and most frustrating aspects to your experience?
Did you talk about health, exercise, or this study with your partners and other family and
friends? How can we improve the program to better serve a user like you? An additional
$25 of compensation was offered to the interview participants.
To complement the participants’ experiences and perspectives, an in-depth
interview was also conducted with the designer and developer of the Wellness Partners
program (see Appendix P). The interview ran for 55 minutes and questions covered the
initial inspirations, goals and intended outcomes, key design principles, development
processes, as well as major features and limitations.
3.6 Data Analysis
3.6.1 Quantitative Analysis
Quantitative data were analyzed using SPSS 17.0. For descriptive statistical
analysis, frequency distributions were used for categorical variables and the minimum,
maximum, and mean values were obtained for continuous variables. Reliability tests
were carried out for each of the continuous variables measured using multiple items and
Cronbach’s alpha was calculated. An index variable was then created as the average of
all the values on the reliable items. Exploratory factor analysis was conducted for multi-
dimensional measures on enjoyment and exercise self-efficacy.
For inferential statistical analysis, Chi-square tests, Pearson correlations, and
independent samples t-tests were carried out. Results with a p-value lower than .05 were
considered statistically significant.

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3.6.2 Qualitative Analysis
According to Seidman (2006), interview data can be analyzed in two ways:
profiling and thematic analysis. He suggests that in-depth interviews can tell compelling
everyday life stories and profiles are a powerful way of understanding and sharing
interview data through vignettes of each participant’s experience reconstructed by the
interviewer (Seidman, 2006). Therefore, all the interview transcripts were marked and
labeled with passages of interest to craft a series of user profiles. Pseudonyms were used
to protect participants’ real identities but key elements of demographic and network
information were preserved to help contextualize their idiosyncratic characteristics.
Atlas-ti 4.1, a qualitative data analysis software, was used for the thematic and
content analysis of interview transcripts. All the transcripts were transformed into one
single plain text recognizable by the program and assigned as the “primary document’ for
analysis. The text was read multiple times to identify themes and sub-themes.
Participants’ comments were marked as “quotations” and labeled with “codes” as the
main steps for classification. For reference purposes, “memos” were also written for
some quotations as notes during the coding process. Frequency of the codes was tallied.
The “visual mapping” tool was used to assist synthesizing the results.
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CHAPTER 4: RESULTS OF QUANTITATIVE
AND QUALITATIVE ANALYSIS
4.1 Results of Quantitative Analysis
4.1.1 Sample Characteristics
A total of 100 participants (39 egos and 61 alters) completed the pretest survey
questionnaire (hereafter baseline). Of these 100 participants, 84 also completed the
posttest survey questionnaire (hereafter follow-up) and logged into the Wellness Partners
website at least once during the study. Therefore, the final sample included 84
participants: 42 in the control condition and 42 in the experimental condition, and 35
egos and 49 alters. They participated in the study in 38 study groups: In the experimental
condition, there were 19 groups consisting of 42 participants. They included 13 groups of
two, four groups of three, one group of four, and one group of six. In the control
condition, there were 19 study groups consisting of 42 participants. They included 13
groups of two, three groups of three, two groups of four, and one group of six.
Among all the 84 participants, ages 16 to 56 with an average of 33.77 years, 32.1%
were male and 67.9% were female; 2.5% had less than high school education, 2.5% were
high school graduates or equivalent, 11.1% had some college education, and 84.0% were
college graduates or above; 43.9% were White or Caucasians, 24.4% were Hispanics or
Latino, 23.1% were Asians or Pacific Islanders, 2.4% were Black or African American,
and 4.9% were of other racial or ethnic origins; 35.8% were single, 43.2% were married,
12.3% were living with a partner, 7.4% were divorced or separated, and 1.2% were
windowed. The 35 primary participants were affiliated with 29 USC departments and 18
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job categories. The time they had been working at USC varied from one year to 21 years
with an average of 5.89 years.
4.1.2 Manipulation Check
The social game version of the intervention included features such as points as
reward, the robot virtual character, redeeming points for collectibles, gifting, playing
robot-animated activities, and replaying memories. Among these features, participants’
collectibles, gifting behavior, and replay of memories were tracked and recorded in the
server log files. The server data suggested that of the 42 participants in the experiment
condition, 36 took advantage of these gaming features. Although there was no direct
evidence to suggest that the other 6 participants tried out any of the gaming features, the
point reward system and the presentation of the robot virtual character on the web
interface for the experiment condition was obvious, and they all rated the statements
about these other gaming features in the follow-up survey.
4.1.3 Descriptive Statistics
Prior Gaming and SNS Experience
Among all the 84 participants, 13.1% never played digital games, 17.9% used to
play, 39.3% still played but infrequently, and 29.8% played frequently. Of the 73
participants who had played digital games, 90.4% played on a computer; 87.7% played
on a game console such as PlayStation, Xbox, Wii, and GameCube; 78.1% played on a
cell phone or handheld organizer; and 47.9% played on a portable gaming device such as
DS, PSP, and GameBoy. The game genres participants played ranged from 1 to 10, with
most people reporting playing one to three different genres (in descending order- puzzle:
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64.4%, strategy: 41.1%, sports: 34.2%, action: 31.5%, adventure: 24.7%, racing: 23.3%,
fighting: 20.5%, simulation: 17.8%, role playing: 16.4%, first-person shooter: 13.7%, and
other: 6.8%). When asked how often they played alone, 17.8% said always, 50.7% said
often or sometimes, and 31.5% said rarely or never. When asked how often they played
with people they knew in real life, 11.1% said always, 56.9% said often or sometimes,
and 31.9% said rarely or never. When asked how often they played with people they first
met online, 0% said always, 11.3% said often or sometimes, and 88.7% said rarely or
never. When asked how often they played with people in the same room, 8.3% said
always, 54.2% said often or sometimes, and 37.5% said rarely or never. When asked
how often they played through the Internet, 1.4% said always, 22.2% said often or
sometimes, and 76.4% said rarely or never. Additional questions asked the participants
how many social networking tools they used regularly, what they were, and how often
they used them. The number of social networking tools ranged from 0 to 9 (M = 1.65,
SD = 1.25); 50.0% used Facebook at least daily while 13.1% never used it; 6.0% used
Twitter at least daily while 78.6% never used it; 1.2% used MySpace at least daily while
82.1% never used it; and 1.2% used LinkedIn at least daily while 89.3% never used it.
Media Enjoyment
The follow-up survey included a series of statements for participants to evaluate
various aspects of the Wellness Partners web interface. Of all these statements, 15
statements were rated on a 7-point scale by participants both in the control condition and
the experimental condition. Using the method of Principal Components, an exploratory
factor analysis initially extracted four factors out these 15 items with the eigenvalue of
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each factor above 1, but the Scree Plot indicated a three-factor solution. Then the number
of factors was set to be three and using the method of Maximum Likelihood for
extraction and Varimax for rotation, results of the factor analysis suggested that the final
three factors together accounted for 49.2% of the variance, with the first factor
accounting for 19.3%, the second factor accounting for 16.0%, and the third factor
accounting for 13.9% of the variance. Table 2 shows the factor loadings. Only the
loading of item 9 was low on all factors and the results of the reliability test also
suggested that Cronbach’s alpha could be substantially improved when item 9 was
removed. Therefore, the final scale of media enjoyment consisted of 14 items, with five
items loaded on factor 1, five items loaded on factor 2, and four items loaded on factor 3.
Table 2. Media Enjoyment Factor Loadings
Item Factor 1 Factor 2 Factor 3
1. It is difficult to navigate around. (reversed) .691
2. Web pages load fast. .665
3. It has valid hyperlinks. .471
4. It is easy to access. .788
5. I have not experienced many technical problems. .547
6. It has a nice look and feel. .608
7. It looks organized. .485
8. It is confusing to fill out information about my physical
activity updates. (reversed)
.746
9. It is convenient to send activity updates through my cell
phone.
[.295]
10. It does not take too much time to send updates every day. .580
11. I enjoy sharing information about my physical activities
with my family and friends.
.606
12. I like reading my partners’ updates. .552
13. It motivates me when it comes to exercise. .725
14. It prompts me to think more about healthy lifestyles. .801
15. I would like to sign up with my family and friends if this
program were made available in the public domain.
.593
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Table 3 shows the values of Cronbach’s alpha, mean, and standard deviation of
the final scale and sub-scales. These results suggest that overall participants’ enjoyment
of the Wellness Partners program was just slightly above average.
Table 3. Descriptive Statistics for Media Enjoyment
Scale/Subscales α M SD
Enjoyment (14 items) .87 4.70 1.10
Factor 1 (5 items) .82 4.57 1.39
Factor 2 (5 items) .78 5.03 1.31
Factor 3 (4 items) .79 4.43 1.43
A closer look at the results of the factor analysis also indicated that the items
loaded on the three factors roughly corresponded with the three levels of enjoyment
threshold model proposed by Wang et al. (2009) and discussed in Chapter 2. The items
for factor 2 corresponded with the aspect of technical capacity and the playability
threshold; the items for factor 3 corresponded with the aspect of basic game design and
the enjoyability threshold; and the items for factor 1 corresponded with some of the super
fun boosting elements. An index variable was then created as the average value of all the
items for the media enjoyment scale and subscales at the individual level. A group media
enjoyment score was also computed by averaging all members’ individual scores of the
enjoyment scale (Min = 2.79, Max = 6.86, M = 4.70, SD = .91).
Additionally, using the same 7-point scale, the 42 participants in the experimental
condition rated seven statements specifically about the social gaming features embedded
in the Wellness Partners web interface. Table 4 reports the minimum, maximum, mean,
and standard deviation values on those items. The descriptive statistics suggest that the
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average ratings of the gaming features in Wellness Partners were around average. The
look and feel of the virtual character was rated the lowest and using points as reward was
rated the highest.
Table 4. Descriptive Statistics for Social Gaming Features
Item Min Max M SD
16. It gives me a sense of
accomplishment when I am rewarded
points for the physical activities I
report.
1 7 5.21 1.70
17. The display of total points presents
me a feeling of competition with my
partners in the program.
1 7 3.81 1.98
18. I like the variety of locations I can
choose from.
1 7 4.19 1.82
19. The collectables are cute. 1 7 4.55 1.82
20. I like the fact that I can give the
virtual character a personalized
nickname.
1 7 4.40 2.01
21. I like the look and feel of the
virtual character.
1 7 3.43 1.68
22. I enjoy watching the animated
activities of the virtual character.
1 7 4.19 2.11
Moreover, a parasocial presence scale of nine statements was used to evaluate the
parasocial communication between players and their virtual characters in the
experimental condition. The results of an exploratory factor analysis suggested a
unidimensional scale that consisted of only the following six statements: “The virtual
character created a sense of closeness with me,” “The virtual character is likeable,” “The
virtual character is fun;” “The virtual character holds my attention,” “The virtual
character excites my curiosity,” and “The virtual character motivates me to do more
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exercise;” ( α = .93). An index variable was created based on the average rating score of
the above six statements to reflect participants’ evaluation of their interactions with the
virtual character (M = 3.21, SD = 1.65). This suggests that the rating of the parasocial
communication aspect of game play was slightly below average for participants in the
experimental condition and the use of the virtual character in the Wellness Partners was
not very successful.
User Participation
Participants’ use of the Wellness Partners web interface was tracked and recorded
in the server log files. Table 5 summarizes the minimum, maximum, and average
number of days participants were in their assigned study conditions, days they logged in
to the Wellness Partners website, their total number of logins, their number of logins
throughout the day and the days of the week. There were three participants who only
logged in once. It is not clear whether it was because of technical difficulties or lack of
interest. On the other hand, there was one participant who logged in every day and two
participants who logged in almost every day. A ratio was calculated for every participant
using the number of days logged into the Wellness Partners website divided by the
number of days the participant was in the assigned condition. The ratio varied from 2.2%
to 100.0%, with an average of 45.3%, meaning that an average user logged into the
intervention website almost every other day. Participants appeared to log in more
frequently during late morning (9am~12noon) and in the evening (6pm~12midnight) than
other time of the day. On average, participants logged in 3.44 times per day during the
week and 1.90 times per day during the weekend.
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Table 5. Wellness Partners Daily Login Summary
Min Max M
Days in the condition 8 60 39.7
Days logged in 1 40 17.7
Total # of logins 1 69 21.1
12am~6am 0 6 0.6
6am~9am 0 17 2.7
9am~12noon 0 32 5.0
12noon~3pm 0 14 2.7
3pm~6pm 0 11 2.2
6pm~9pm 0 16 3.6
9pm~12midnight 0 25 4.1
Week days (Mon-Fri) 0 55 17.2
Weekend (Sat+Sun) 0 21 3.8
The number of logins was used as a proxy of individual participation on the
Wellness Partners website. Group participation was then computed as the sum of all
members’ individual participation. Table 6 presents the minimum, maximum, mean, and
standard deviation values of individual and group participation counts.
Table 6. Descriptive Statistics for Web Activities
Min Max M SD
Individual Participation 1 69 21.02 12.54
Group Participation 2 122 45.32 29.35

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Exercise self-efficacy
Exercise self-efficacy was measured by a multidimensional scale developed by
Rodgers et al. (2008). A total of nice statements were rated from 1 to 100 about task
efficacy, coping efficacy and scheduling efficacy. Although the results of an exploratory
factor analysis yielded two factors with eigenvalues over 1, the Scree Plot suggested a 9-
item unidimensional factor. Table 7 presents the Cronbach’s alpha, mean, and standard
deviation values for the 9-item exercise self-efficacy scale at both baseline and follow-up.
Table 7. Descriptive Statistics for Exercise Self-Efficacy
α M SD
Baseline .92 70.79 19.60
Follow-up .92 68.15 18.96
Perceived social support
A modified version of Pender’s exercise social support 8-point scale was used to
measure perceived social support for physical activity in this study. The results of
exploratory factor analysis and reliability test suggested a unidimensional 4-item scale,
including the family and friends “Play sports with me,” “Exercise with me,” “Encourage
me to exercise,” and “Praise me for exercising.” Perceived general social support was
measure using a modified version of the 7-point social support inventory by Brown et al.
(1987). The results of exploratory factor analysis and reliability test suggested a
unidimensional 6-item scale with the following statements: “Assurance that you are
loved,” “Know others whom you could talk to when you are down and blue,” “Help to
see optimism in the future,” “Help to set realistic goals,” “Information to change negative
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feelings,” “Assistance when act in self-defeating ways.” Table 8 presents the Cronbach’s
alpha, mean, and standard deviation values for the two perceived social support scales at
both baseline and follow-up.
Table 8. Descriptive Statistics for Perceived Social Support
Exercise Social Support General Social Support
α M SD α M SD
Baseline .66 4.56 1.58 .92 5.75 1.17
Follow-up .68 4.85 1.64 .91 5.92 1.03
Exercise habits
Exercise habits were measured through a scale developed by Godin and Shephard
(1985). A weekly physical activity score of arbitrary units was calculated for each
participant using the formula provided with the original scale. The higher the scores
were, the better exercise behavioral habits they indicated. Table 9 presents the minimum,
maximum, mean, and standard deviation values of the weekly physical activity scores of
arbitrary units.
Table 9. Descriptive Statistics for Exercise Habits
Min Max M SD
Baseline 0 82 23.76 21.30
Follow-up 0 108 28.26 19.61
Perceived wellness
Perceived wellness was accessed using the SF-12v2 questionnaire. A physical
health component score (PCS) and a mental health component score (MCS) were
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calculated separately for each participant. Table 10 presents the minimum, maximum,
mean, and standard deviation values of PCS and MCS at both baseline and follow-up.
Table 10. Descriptive Statistics for Perceived Wellness
Min Max M SD
Physical Component Score (PCS)
Baseline 34.59 65.05 53.22 6.70
Follow-up 25.66 69.18 52.22 7.60
Mental Component Score (MCS)
Baseline 7.83 63.38 44.27 10.62
Follow-up 5.69 62.39 44.15 11.62
4.1.4 Hypotheses Testing
Participants’ prior gaming experience was measured as a categorical variable and
results of Pearson Chi-Square test suggested that there was no statistically significant
difference between the two conditions at baseline [Chi-square = 8.03, df = 3, p = .05].
Participants’ prior SNS experience was measured as a continuous variable and the results
of an independent samples t-test suggested that there were no statistically significant
difference between the two conditions at baseline [t(82) = -1.68, p = .10].
H1 hypothesized that the social game version of the Wellness Partners program
would be more fun and engaging than the activity diary version. A series of independent
samples t-tests were carried out to see if there was any difference in media enjoyment or
user participation both at the individual level and the group level. None of the results
was statistically significant except that post-hoc examination of specific types of
participation suggested that participants in the experimental condition posted
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significantly fewer updates but sent significantly more messages than those in the control
condition (see Table 11). Therefore, H1 was not supported.
Table 11. Results of Independent t-tests on Media Enjoyment and User Participation
M
ctrl
M
exp
t df p
At the Individual Level
Enjoyment 4.69 4.70 -.05 82 .96
Factor 1 4.72 4.43 .96 82 .34
Factor 2 5.02 5.04 -.07 82 .95
Factor 3 4.24 4.63 -1.22 82 .23
Participation 22.24 19.81 .89 82 .38
Posting 30.02 22.31 2.05 82 .04*
Messaging 1.31 3.45 -2.67 82 .01*
At the Group Level
Enjoyment 4.55 4.81 -.88 34 .39
Participation 48.29 42.63 .56 34 .58
Note: * p < .05
The health-related outcomes were all measured as continuous variables at the
individual level in this study. Results of independent samples t-tests suggested that
between the two conditions there were no statistically significant differences in exercise
self-efficacy [t(82) = -.01, p = .99], perceived social support [exercise social support: t(82)
= 1.07, p = .29; general social support: t(82) = -.09, p = .93], exercise habits [t(82) = .82,
p = .42], or perceived wellness [PCS: t(82) = 1.88, p = .06; MCS: t(82) = -.16, p = .88] at
baseline.
H2 hypothesized that participants who used the social game version would have
better health-related outcomes than those who used the activity diary version of the
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intervention. A series of independent samples t-tests were carried out to see if there was
any difference in exercise self-efficacy, perceived social support, exercise habits, or
perceived wellness at follow-up. And none of the results were statistically significant
(see Table 12). Therefore, H2 was not supported.
Table 12. Results of Independent t-tests for Health-Related Outcomes
M
ctrl
M
exp
t df p
Exercise self-efficacy 69.85 66.44 .82 82 .41
Exercise social support 5.13 4.57 1.59 82 .12
General social support 5.90 5.94 -.16 82 .87
Exercise habits 26.98 29.55 -.60 82 .55
Perceived wellness (PCS) 52.55 51.90 .39 81 .70
Perceived wellness (MCS) 44.91 43.41 .59 81 .56
H3 hypothesized that media enjoyment and participation would mediate the
intervention effects on health-related outcomes. Since the results of H1 and H2 were not
statistically significant, H3 could not be tested in this study.
H4 hypothesized that the larger group size, the more group members would enjoy
and participate in the program. The scores of media enjoyment and user participation
were both aggregated from the scores at the individual level. The type of measurement
for media enjoyment was interval and the type of measurement for user participation was
ratio. A series of Pearson Product Moment correlation analyses were carried out. At the
individual level, the relationship between group size and media enjoyment was not
statistically significant [r = .05, p = .69] but the relationship between group size and user
participation was statistically significant [r = .02, p = .87]. At the group level, the
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relationship between group size and media enjoyment was not statistically significant
[r = .04, p = .83] but the relationship between group size and user participation was
statistically significant [r = .71, p < .001]. This means that the larger the study group size,
the more members of the study group participated but the people in larger groups did not
necessarily enjoyed the program better than those in smaller groups. Therefore, H4 was
partially supported.
4.2 Results of Qualitative Analysis
4.2.1 Interview Participants
The interview participants included 10 egos and 10 alters; 9 males and 11 females
(including two pregnant women). Two were in a group of two but their partners dropped
out, three were in a group of two with their partners participating, four were in a group of
three, four were in a group of four, three were in a group of four that later increased to
five during the second 5-week period, and four were in a group of six. The interview
participants’ age ranged from 23 to 54 with an average age of 33.25. All of them had at
least college education except one participant who completed high school. In terms of
racial and ethnic background, ten of them were White/Caucasian, five were Asian or
Pacific Islander, four were Hispanic/Latino, and one was Black/African American. In
terms of marital status, eight of them were single, 10 were married, one was living with a
partner, and one was divorced. In terms of geographic location, 16 of them were local
residents and four were living outside of southern California.

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4.2.2 User Profiles and Web Activities
Following the profiling procedure in Seidman (2006), a user profile was created
based on the interview transcript for each of the 20 participants, highlighting their
individual experiences with Wellness Partners, their reasons to participate in the study,
their exercise habits, the things they liked about the program the most and the least,
features they would like to see implemented, their communication about exercise and the
program with others, and other important opinions they expressed about the intervention
(see Appendix O). RQ1 asked how people would use a health intervention in the form of
a social game. Thematic analysis of server log files and interview transcripts yielded
different types of activities that participants engaged in on the Wellness Partners website
(see Figure 17).
Figure 17. Types of Wellness Partners Web Activities

Wellness Partners
Web Activities
Tracking
• Virtual motivator
• Web-based diary
• Online monitor
Socializing
• Social support
• Friendly competition
• Emotional bonding
Gaming
• Entertainment
• Information sharing
• Social networking
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Tracking
The first type of activity on the Wellness Partners website is tracking. The default
function of this intervention was a activity diary of physical activities that would help
participants establish healthy habits of exercising and logging their activities and setbacks
every day. Participant 0110018 experienced a lot of technical difficulties with the
Wellness Partners program and only successfully posted updates eight out of the 14 days
she logged in. Yet still, she found the program to be of some value. She said,
The one thing that I think it did help do was it helped me exercise because I have
to report this. I don’t want to report a setback. I want to report that I did
something. So that was useful and I found it as a motivator.

Participant 0260080 used to be an active runner and had been habitually tracking
his physical activities in a paper journal for over 10 years. He said: “
When I write in my journal, I usually write once a week and I detail how many
miles I ran and how many days I went running because that’s an important goal to
me…I look through my journal sometimes often when I don’t exercise regularly
for a few months. I go back and see, whoa, that was really like four months I
didn’t go running. So it’s a reflective experience and this website was a way for
me to do it online.

For people already highly motivated and physically active, the expectations were
even higher. Both participant 0040011 and participant 0170049 were interested in health
and exercise science. They expressed that they had hoped that the Wellness Partners
program would allow more detailed personal input of data such as heart rates, blood
pressure, and resting pulse and receive instant feedback for them to monitor the changes
related to their physical activities over time.

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Socializing
The second type of activity on the Wellness Partners website is socializing. This
intervention was built to allow participants to share their physical activities with members
of their personal communities. Such a platform can afford the possibility and opportunity
for social support and conversations about healthy lifestyles and exercise habits. For
example, participant 0310071 and 0310089 are friends, both obese, and paired up to join
the study. In their text messages, the partner said, “Good job on the elliptical today!
What's your plan for tomorrow? I want to do some weight training.” And then another
day, she sent a message, “Thinking wonderful thoughts for you before your surgery.
Can’t wait to see you in 2 weeks.” The primary participant responded, “Thanks for the
messages. Call you when I get home.” And a few days later, she commented “This
taking it easy thing is ruining my progress. And shop/walk beats sitting around watching
TV.”
In another case, participant 0140032 and 0140025 are two friends in their early
40s. The alter lives in another state so they used the program to exchange text messages
as a form of small talk. When one asked, “Tuesdays are my BIG day at the gym. Can
you see my activities now?” The other replied, “I can see your messages now!! =) You
are ROCKIN’ at the gym on Tuesdays – you go girl!” and later she commented
“Apparently, walking the dog is your most popular activity!! ;)” The response came back,
“Walking the dog is definitely my biggest fitness activity, but not my favorite.” She also
talked about other events, “Yard work was yesterday – but I forgot to post…” “My kick
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box instructor is on her honeymoon, so we had a boot camp instructor today,” and “Do
you like my shopping workout???? I added that to make you laugh :)”
Socializing on the Wellness Partner website could translate into a sense of peer
pressure too. Participant 010003 admitted that:
What motivated me more was knowing that my friends would see…the real
motivator for me was that I had to post what type of exercise I was doing and I
didn’t want it to be the same thing every day…so maybe I’ll try to mix it up. I
would do different types of exercise and maybe a longer duration just because I
knew that they would then see it as well.

For others, the program afforded an opportunity to share feelings and emotions
through exercise related activities. Group 4 is a couple who are both very active. The
husband said:
With my wife I don’t actually do that much exercise in the last couple of months
as we used to (due to her pregnancy) but we still talk about it a lot. Even in the
past, we would be exercising at the same time but doing totally different things as
we are in very different athletic spheres. So in terms of immediate social
networking and support, it’s like I do things with her vicariously even though we
are not actually exercising at the same time …or even just by getting a leaf from
her. I knew I got the leaf because she exercised and she told me that she did it
yesterday. It’s kind of cool to see that she did something, she got points, she got a
leaf, and she sent it to me.

These playful activities in the experimental condition also added another channel of
communication for intimacy. One of the animated activities by the virtual character was
to write a poem in the Zen garden, which would result in a gift – the poem. So while the
husband was traveling, he sent his wife this gift, “Roses are red. Violates are blue. I’m in
SF. But it’s lame without you.”

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Gaming
The third type of activity on the Wellness Partners website is gaming. This was
enabled by the digital gaming elements embedded in the experimental condition. For
example, there was a reward system through accumulating points. The game play in this
context took place in two forms: solitary play and social play. In the case of participant
0070023, she used to play a lot of MMORPG such as World of Warcraft and was still
actively playing social games on Facebook such as Farmville, Mafia Wars, and Happy
Aquarium. She is overweight and admitted that she always made excuses not to exercise
even though she was very concerned about her weight and well-being at times. But while
participating in this study, she started walking to meetings on the USC campus and she
commented, “I told myself, ‘Oh, well if I keep putting that I walk to campus, they will
give me more points.” … so I was like, ‘Well, now the weather is a little bit better I can
walk and take advantage of it and get points.”
Gifting was another gaming element on the Wellness Partner website. It is
playful and also a manifestation of altruism. Participant 0340094 said it well:
It was great to be able to send gifts to my sisters. Personally, it was nice to
accumulate points but the most favorite part of accumulating the points was
spending them….So you’d go surfing and send a surf board to somebody because
it’s just a great gift you want to give someone and it may in fact motivate them to
do something on their own…send a gift back to you or maybe send a gift to
somebody else in the group and that I really, really enjoyed.

In one of the messages she sent to her sister along with a gift, she wrote “It may not look
like much but I had to get sweaty to get it to you!”
People also used the Wellness Partners program for social networking. Group 15
consisted of six male participants in their 20s. The primary participant 0150044 Ken said:
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[w]hat got me interested (in this study) was just a chance to network with my
friends that I had talked to and see what it is all about… I got five out of five –
that’s pretty good…I would send my friend an item I collected in the game, like a
feather as an invitation gift to say, hey, you finally signed on, here is a feather.
Just to keep them engaged.

One of his partners Harry mentioned, “Ken said, hey, everybody is already in the
program, are you playing the game?”
4.2.3 The Hierarchy of Media Enjoyment
RQ2 asked what makes a user’s experience compelling. In the interviews,
participants were asked to discuss the most enjoyable and most frustrating aspects of their
experience in the Wellness Partners program. They were also asked to provide
suggestions to improve the program and list features and functions they would like to
have. The results of the thematic and content analysis are presented in Table 13. There
were a total of 101 comments about the frustrations, 52 comments about the enjoyment,
and 62 comments about wishful features (see Appendix Q for selected sample quotes
from each of the listed content categories). The content categories were organized based
on the three-level enjoyment threshold model discussed in Chapter 2.
The complaints were largely about the technical functionality and basic design of
the program, whereas both the existing and wishful fun factors tended to cluster in the
categories beyond the enjoyability threshold. For example, participants said that they had
a hard time establishing the habit of logging into the Wellness Partners program every
day if they didn’t have an easy access, or when they did they had problems logging in and
experienced many technical issues such as reported activities not being recorded on the
site. Some also expressed the frustration that it took too many screen steps to do one
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thing and the web interface was too simple and bland. There were not too many things
they could do with the system or the virtual character.
On the other hand, some participants appreciated that reporting activities and
connecting with their family and friends through the program didn’t take too much time.
They found the point scoring system motivating and the virtual character lovely. More
importantly, they enjoyed sharing their activities and learning about what their family and
friends were doing. For couples with different athletic spheres, they felt that the program
provided them a way to vicariously exercise together and sharing the joy of their
accomplishment. For other groups, being able to track individual and partners’ activities
created a friendly yet competitive environment for motivation through social comparisons.
Some also liked the mediated interactions they were able to have with their partners
whom they didn’t see often and some were living far away.
Although most participants thought the Wellness Partner program had good
potential and their overall experience was positive, they also pointed out many features
and functionalities that they had expected or hoped to enjoy. For instance, they thought
the level of intensity was subjective and they would have liked to have the option to input
more detailed personal data such as weight, heart rate, blood pressure, etc. and track over
time with some visualization. Related to that, participants also stressed the importance
and value of setting personal goals and obtaining either scientific/educational or
social/motivational feedback. Suggestions to improve the user experience also included
the ability to customize the site, personalize the robot, enhance robot interactions, and
connect virtual rewards with real life rewards such as a free pass to the gym.
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Moreover, the fun factors listed in the three-level threshold model did not
particularly distinguish the different types of fun interactions that passed the enjoyability
threshold. The analysis of the interview transcripts seemed to have suggested that it
might be helpful to make the distinction between the player-system interaction which is
non-social, the parasocial interaction between the player and the virtual character, and the
social interaction between players. All of these three types of interaction could
significantly improve user experience, but the enjoyment mechanisms may be different
socially and psychologically.
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Table 13. Frequency Distribution of Fun Factors by Enjoy Hierarchy Model
Frustration
(101 comments)
Fun
(52 comments)
Desirable
(62 comments)
Technical
Capacity
Access (4)
Login (7)
Loading (6)
Bug (24)
Time (2)
Playability Threshold
Basic
Design
Presentation (10)
Navigation (10)
Mechanics (21)
Style (2) Clear definitions &
objective criteria (4)
Levels (4)
Customization (5)
Enjoyability Threshold
Real
Enjoyment
(1) Non-
social
Points reward (12) Points reward (9) Goal-setting (8)
Tracking w/ visuals (7)
Feedback (14)
Reward system (5)
(2) Parasocial
Virtual character (7) Virtual character (9) Robot personalization
(5)
Robot interaction (2)
(3) Social Sharing updates (2)
Reading updates (10)
Vicarious experience (2)
Friendly competition (6)
Social interaction (10)
Photo sharing (3)
Friendly competition (5)
Social interaction (5)
4.2.4 Characteristics of Play Partners
RQ3 asked about the characteristics of the partners that people would invite to
participate in a health intervention like Wellness Partners. The number of alters
nominated by the primary participants and the number of alters they actually enrolled in
the study were tallied (see Table 14). On average, the egos nominated 3.49 partners and
actually enrolled 1.60 alters.
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Table 14. Descriptive Statistics for Alters Nominated and Enrolled
Min Max M SD
Alters Nominated 1 11 3.49 2.73
Alters Enrolled 1 5 1.60 1.06
The 49 alters in this study ranged in age from 16 to 56 with an average of 34.59
years; 32.7% were male and 67.3% were female; 4.3% had less than high school
education, 2.2% were high school graduates or equivalent, 17.4% had some college
education, and 76.1% were college graduates or above; 44.7% were White or Caucasians,
25.5% were Hispanics or Latina, 25.5% were Asians or Pacific Islanders, 2.1% were
Black or African American, and 2.1% were of other racial or ethnic origins; 37.0% were
single, 41.3% were married, 13.0% were living with a partner, 6.5% were divorced or
separated, and 2.2% were windowed.
Also, of all the alters, 44.9% were family members (4.1% were parents, 16.3%
were spouses, 4.1% were domestic partners, 2.0% were children, and 18.4% were
siblings and relatives) and 28.6% were friends, 4.1% were school mates, and 22.4% were
co-workers; 31.8% lived within half a mile of the egos while 68.2% not; and 54.5% had
ever exercised with the egos while 45.5% not.
In the interviews, primary participants were asked why they chose these people as
their wellness partners, and both primary and secondary participants were asked who else
they would like invite to participate in the program together. There were eight comments
made about having family members as alters in the Wellness Partners program. The
reasons included: (1) The egos enjoy exercising with family who live together such as
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their spouses and domestic partners and could have consistent workout schedules with
them; (2) The alters are physically active; and (3) The ego and their alters care about each
other’s health and feel comfortable sharing information and supporting each other
through the program when they live far away such as siblings living in different states.
There were seven comments made about having friends and colleagues as alters in the
Wellness Partners program. The reasons included: (1) The egos and the alters have
similar schedules and can be in the vicinity to coordinate activities together; (2) The
alters are open-minded and have the interest and time to participate; and (3) The egos and
alters share similar health concerns such as weight and would like to try out a new way to
resolve the problem.
When asked about inviting others to join a program like Wellness Partners, six
participants said it would be more interesting if there were simply more people in their
social circles enrolled and being active in the program. Eight comments were made
about inviting family members who might live in the same household but the ego doesn’t
have much opportunity to communicate with or family members who live far away and
the program could make it easier to know what they are doing. Fifteen comments were
made about inviting friends who exercise together, have shared interests in physical
activity and health or friends who are living or working far away.
4.2.5 The Value of Meaningful Play
RQ4 asked if networked play could help promote health through playful activities
such as a social game with selected significant others. The qualitative content analysis of
interview transcripts suggest that simply being in the Wellness Partners program
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motivated many participants to think about increasing their physical activity and reflect
on their own exercise habits as they were encouraged to log in and report on a daily basis.
For example, participant 0340102 said that:
Being part of the program did get me up to four days a week. And I think that was
helpful because that was part of my issue of trying to increase the number of days
that I exercise and how vigorous the activity is. It has been a challenge for me.
So, I think it was helpful in that way because I’ve become more aware that I
wasn’t going to have something to log in.

However, the qualitative differences that this intervention really made still came
from the networked play with selected significant others. First, it was motivating to
know that people whom they care about were part of the network and might be reading
their updates. For example, participant 0010002 said:
I want to look like that I was a good exerciser at times. I mean I was aware that
other people will be looking at it, so I kind of want to make it look like it was
good. Not that I was inflaming my values which is a lot, but I was doing what I
said I did.

Similarly, participant 0260080 commented:
To me it was more about sharing with the other people in my group that I
remembered to exercise. I remembered to do something and here is what I did.
Here’s what I accomplished. It is just sort of sharing the news …To me there’s
something rewarding about saying, “I ran three miles.” Whether they care or not,
you told them and it feels good to say, “Look what I did.”

Later in the interview, he also gave an instance:
we were able to do things together and post it on the Wellness Partners as a group
activity between my brother and I, which I really, really enjoy doing because I get
to show my younger sister Ashley that I'm doing things with Bob and she’s not
here, so come and visit us.

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Second, participants learned about what others were doing, which in some cases
triggered them to think about their own lifestyle and exercise habits. As participant
0150048 said:
[w]ith some of the people when I was reading their updates it was interesting
because I didn’t know that they did certain things before. We never really talked
about what we posted on there but I'm sure we all read each other’s updates. But
in general…it was kind of a learning experience for me because everybody was
doing stuff that I have no idea that they did before.

Participant 0320094 commented:
My sister is diabetic and I want to support her. It was good without having to ask
her, I saw I had posted an update 12 hours before and they posted an update 19
hours before and I could at least get a sense of what they were doing.

In addition, participant 0150044 commented,
I think what also triggered my intention to exercise was seeing my friends
exercise on the website….when I saw other people on my social network are
exercising or even walking, doing the simplest things, I was like, ‘hey maybe I
should it too.’… I have one friend from northern Cal. I don’t get to talk to him
too frequently but just seeing him making an effort to exercise I was like maybe I
should too!

Third, being in the same study group and able to share information about personal
activities also generated friendly competitions. The intervention seemed to have initiated
or enhanced the communication among participants about physical activity and wellness,
and in rare cases encouraged them to take actions together. Participant 0320102 said,
“[b]eing able to see your points accumulate or seeing that my sisters were accumulating
points too, that was a way to be motivated.” Her sister participant 0340094 also admitted
that:
there is some sense of satisfaction to log in and have the status checked. Like the
fact that my bar of walking is much larger than my siblings is awesome! And the
fact that they know it is also awesome!
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Later in the interview, she also brought up that “It’s funny because as a result of being
involved with the study, we have talked amongst ourselves and Cameron and I now use
an iPhone app which is very similar to the Wellness Partners program.” In a different
study group, participant 0260080 said:
I think the purpose of the website for us was to make each other aware of what we
are doing and … at the beginning we had said, “Hey, I'm exercising more than
you!”…Also, if there was a setback, then immediately I knew that there was a
reason they didn’t exercise and so that I can call them and talk to them about the
setback.

In another example, participant 0150044 said:
The website did encourage us to talk a little bit more about our physical lifestyle.
I mean it’s not like a usual topic between us. I guess the website shifted us in the
loop about it. We talked about it and joked about the website too. …Just recently,
we went to some kind of food fair. So it was a bad kind of food fair because it's a
cheese food fair but we walked to the fair together. We did a lot of walking at the
fair …there was at least you know two, three hours worth of walking of light
intensity or something…It just kind of got us talking about it, thinking about it.

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CHAPTER 5: DISCUSSION AND CONCLUSION
This dissertation studied networked play in the context of social games for health
promotion through the evaluation of an innovative intervention called Wellness Partners.
Specific research questions and hypotheses were proposed regarding users’ enjoyment
and participation in the program, characteristics of their partners in the study, and the
potential as well as challenges of using digital game play and personal networks to
promote a healthy lifestyle in terms of physical activity in everyday practice. Mixed
methods were used for data collection, including an experiment of pretest-posttest via
online surveys with a control group, server log files of user activities on the intervention
website, and semi-structured in-depth interviews. Research hypotheses were tested using
quantitative, statistical analyses and research questions were investigated using
qualitative, thematic and content analyses.
5.1 Summary of Major Findings
5.1.1 The Fun Aspect
On average, participants logged into the program almost every other day. They
did so throughout different times of the day and week, but more frequently around lunch
time, in the evening, and during the week days. Their evaluation of the enjoyment of the
program was slightly above average, with a mean value of 4.70 on a 7-point scale. The
unique gaming feature that they appreciated the most was the point reward system for
reporting activities. The rating of their communication with the virtual character was
slightly below average, with a mean value of 3.21 on a 7-point scale.
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H1 hypothesized that compared with those in the control condition, participants in
the experimental condition would enjoy it more and participate more. The results
suggested that overall there were no statistically significant differences in media
enjoyment or user participation between the two conditions at the individual and group
level. Post-hoc analysis found that people used the program differently. Although
participants could use both features in either version of the intervention web interface,
those in the experiment condition posted significantly fewer updates but sent significantly
more messages than those in the control condition, indicating that when the intervention
web interface incorporated social gaming elements, people tended to communicate in a
more interactive way. Although theoretically speaking, the social game version of the
intervention should be more interactive and engaging than the activity diary version, this
finding needs to be systematically investigated in the future.
RQ1 and RQ2 asked how people would use a health intervention in the form of a
social game for health promotion and what factors could facilitate or hinder their
enjoyment of the program. The results of qualitative analysis yielded different user
profiles and use patterns. There were three overlapping categories with their own
ramifications: tracking (as a virtual motivator, web-based diary, and online monitor),
socializing (for social support, friendly competition, and emotional bonding), and gaming
(for entertainment, sharing, and social networking). Interview participants’ comments
about their most fun and frustrating experiences in the program were coded and
synthesized based on the three-level enjoyment threshold model by Wang et al. (2009).
The results suggested that participants were mostly frustrated by the technical difficulty
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they experienced during the study and found the usability of the intervention limited.
However, they still enjoyed the embedded gaming features to a certain degree and greatly
appreciated the innovative ways on the website to communicate with their family and
friends about an important health and lifestyle issue. Their list of desirable features
highlighted user demand of options, control, customization, goal-setting, and feedback
and these are consistent with the literature on the advantages of digital entertainment
media (e.g., Sundar, 2008; Sundar, Marathe, Kang, & Bellur, 2010). This analysis of fun
factors also provided empirical evidence of the enjoyment hierarchy by Wang et al. (2009)
about technical capacity as a prerequisite and threshold for playability, and basic design
as the core for the threshold of enjoyability. Furthermore, the fun factor analysis in this
study suggested that the super fun boosting factors can be categorized into three groups
that might work with different mechanisms: non-social (human-computer interaction,
such as using points as reward), parasocial (communication between game players and
virtual characters, such as the fitness robot), and social (mediated interactions between
players, such as messaging and gifting).
5.1.2 The Network Aspect
This dissertation argued that members of one’s personal communities, the close
and meaningful ties in their personal networks, hold potential for intervention
engagement and asked what kind of role these selected significant others could play in
the study. Primary participants were required to enroll at least one of their family and
friends and participate in the Wellness Partners program together as a study group.
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H4 hypothesized that the larger the group size, the better enjoyment and more
participation in the program. This hypothesis was partially supported. As the group size
increased, participants’ web activities on the intervention website also significantly
increased. However, their enjoyment did not turn out to be a function of group size. As
discussed in the section above, perhaps group members enjoyed the program in different
ways individually, and overall the study group size was small with the largest being six
members; thus it was not too surprising that the group size didn’t correlate with
enjoyment.
RQ3 asked who people would like to choose as their partners for an intervention
like Wellness Partners and why. On average, the primary participants invited 3.49
partners and managed to enroll 1.60 in the study. Their alters could be as young as 12
and as old as 85, but the people they actually enrolled were between the ages of 16 and
56 with an average age of 34.59, and most groups did not have substantial age difference
among members. Close to half of the alters were immediate family such as spouses,
domestic partners, and siblings; more than one fifth were categorized as friends and
another one fifth were colleagues at work or school. The reasons why they were chosen
as partners were mainly because of their geographic proximity and ease of scheduling
coordination such as spouses who exercise together, or due to geographic separation or
scheduling conflict that the program was seen to be useful to share personal updates and
facilitate relational communication related to health concerns. When interview
participants were asked who else they might want to invite for such a program, they
nominated family and friends who they do not often meet in person, who are interested in
105

exercise and wellness, who have similar health concerns, and who they might be able to
coordinate activities through the website.
5.1.3 The Health Aspect
Ultimately, this study aimed at exploring the potential and challenges of using
networked play in the form of a social game for health promotion. The intervention
under study was particularly designed and developed to feature the entertainment of
digital game play as well as selected member of personal communities to induce positive
changes in attitudes and behavior related to physical activity. The intended outcomes
included exercise self-efficacy, perceived social support (both exercise social support and
general social support), exercise habits, and perceived wellness (both physical and mental
health).
H2 hypothesized that the experiment version of the intervention web interface
would lead to better health outcomes than the one in the control version. And H3
hypothesized that enjoyment should mediate the health effects of the intervention. The
results of the study did not find any statistically significant differences in any of the
health outcomes between the two conditions and therefore it was not possible to test the
mediation effect in this case.
RQ4 asked what kind of influence networked play could have on health, if at all.
Although there was no quantitative evidence to support the effectiveness of this pilot
application, the participant interviews did yield some qualitative differences that the
program made among the users, especially given the semi-public nature of the postings
and medicated communication about physical activity on the intervention website.
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Cialdini (1984) discusses the “weapons of influence,” one of which is called commitment
and consistency. Results of this study added to the existing evidence that once people are
committed to a task, they are likely to make an effort to be consistent with their behavior.
In this case, participants made their commitment by agreeing to log their physical
activities on the Wellness Partners website. Therefore, some participants still found it
helpful despite the technical difficulty and the inactivity of their study partners. What
was also commonly mentioned in the interviews was that being part of this study made
participants become more reflective on their exercise habits, related life goals and
everyday practices.
In addition, the semi-public nature of postings and medicated communication
among selected members of personal communities provided another layer of motivation.
In social presence theory, Short, Williams, and Christie (1976) posit that there is a
continuum of social presence across different media in terms of degrees of awareness of
the existence of other actors in a communication interaction. Such awareness will
subsequently influence people’s attitudes and behavior. When participants were
networked with family members and friends they cared about, they felt motivated simply
by knowing that others would be able to read their updates. They also learned about what
others were doing, which were often something they did not know before. And in some
cases, they were encouraged by their partners’ effort to live a healthy lifestyle and started
contemplating making a change with their own.
In social comparison theory, Frestinger (1954) explains that individuals evaluate
their own attitudes and behavior by comparing themselves with others. Being in a group
107

of selected significant others created a safe space for participants in this study to share
physical activities, compete against each other in a friendly and enjoyable manner, and
take actions together when circumstances render. Moreover, interview participants also
commented on the importance of linking the digital game play features and activities with
real life changes in order to make the play activities meaningful.
5.2 Contributions and Implications
This dissertation is a pilot study, looking at networked play in the form of a social
game for health promotion. More specifically, this dissertation explored the potential and
challenges of using causal play of a digital game incorporated in a social network site
with selected members of personal communities to promote physical activity.
First, this study focused on participants’ media enjoyment of the intervention
program. An underlying assumption of any effect that a gaming application may have is
that digital games are fun and engaging. Understanding what factors lead to enjoyment
or frustration is imperative for games research in general and health games research in
particular. A three-level enjoyment threshold model by Wang et al. (2009) was reviewed
and used to guide assessment. The results of this study not only supported the proposed
enjoyment hierarchy but also suggested more sophistication to help refine the model with
three sub-categories for substantially improving the fun appeal.
This study also suggested that these fun mechanisms could work as a double-
bladed sword. If the application could barely pass the playability threshold and the users
encounter technical difficulty, it will work against any serious goals and good intentions.
However, if the application has elements that work well for the users to participate with
108

easy access, low time demand, and friendly and interactive features, it could create a
persistent and social space that potentially lead to longer-term effects at individual and
group levels.
Second, this dissertation used mixed methods of a field experiment of pretest-
posttest and a control group design as well as semi-structured in-depth interviews.
Measurement scales were developed to evaluate the various features of the intervention
web interfaces. Both the quantitative analysis of online surveys and the qualitative
analysis of server log files as well as interview transcripts provided a richer, more
comprehensive and insightful evaluation of this real-time intervention Wellness Partners.
Traditional entertainment-education programs rely on mass media channels such
as television and radio soap operas to address important health issues (Singhal et al., 2004;
Singhal & Rogers, 1999). However, digital entertainment media are being integrated into
people’s everyday life and this dissertation conducted empirical research to purposefully
evaluate the merits and barriers of using digital entertainment media for health promotion.
Moreover, social network analysis and studies on online communities often focus on
sociometric networks rather than personal networks. When close ties were examined in
the health context, it was mostly about interpersonal communication in the patient-
caregiver settings and about social support in general. Yet, much of the daily activities
are now mediated social interactions between an individual and their significant others.
This dissertation attempted to converge the prevalent practice of digital game play with
selected members of personal networks to build personal wellness communities through
causal and meaningful play activities. Although the results of this study didn’t provide
109

much significant quantitative evidence, the thematic and content analysis of in-depth
interviews did suggest the qualitative differences that the intervention made despite its
limited technical capacity and design features. The lessons from this pilot study can be
informative for other similar health interventions and research projects.
5.3 Limitations and Future Directions
The design, development, and evaluation of this intervention faced many
challenges and obstacles. Many novel features that the team brainstormed during the
design phase could not be implemented in the actual application due to the budgetary and
time constraints of the research grant. For example, the mobile connection was an
important feature in the design, but having the participants to link their Twitter account
and send updates became impossible when the actual intervention went into the field. It
was originally planned as a one-year project, but the in the end the intervention design
and development took a year by itself and the project timeline had to be delayed and
extended. The multidisciplinary nature of the project required expertise and commitment
from designers, programmers, study coordinators, and research investigators of various
areas. Such a collaborative process was often filled with layers of complexity. And the
research design had to go parallel with the game design, which was much less ideal for
the effectiveness of the evaluation effort. Future endeavors could put these aspects into
consideration in the budget and planning when applying for research grants.
In particular, what specific digital gaming elements or a combination to include in
an intervention should be based on more theoretically grounded rationales and each
element should be tested independently from others in order to collect causal evidence on
110

the enjoyment and health effects. For example, Ritterfeld, Shen, et al. (2009) emphasized
that in the evaluation of digital gaming applications, the various properties of digital
games such as multimodality and interactivity are often assumed and the acclaimed
outcomes can only be associated with the game as a whole, but it is unclear which feature
is causing which outcome. In this study, a number of digital gaming features were
included in the Wellness Partners program, such as the point reward system, a virtual
character, collectibles, gifts, animations, etc. Future research should consider creating
multiple versions of the intervention and separate them out in different experimental
conditions. Also, using an activity diary as the control condition might not be able to
create substantial contrast compared to social game versus a traditional exercise and
wellness program such as Weight Watchers. Moreover, as the qualitative results
suggested, five weeks might not have been long enough for big changes to take place
even though the intervention started to change the perceptions and attitudes among some
participants at the end of five weeks. Therefore, future studies should consider a field
experiment of longer duration with more conditions to compare effects.
In addition, as the study results suggested, there were different types of mediated
interactions between the users and the intervention website. The measurement items
could have captured these non-social, parasocial, and social interactions better. Future
research could develop a more generic enjoyment scale for evaluating web-based
interventions and gaming applications based on the theoretical model and the content
categories discussed in this dissertation.
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Lastly, given the research design of this study, individual participants are
naturally nested in ego networks, creating social interactions and dynamics at multiple
levels. This dissertation tested research hypotheses and questions at the individual and
group/network level. Future analysis should look into the communication processes and
effects at the dyadic level and adopt more advance statistical procedures such as
multilevel modeling.

112
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138

APPENDIX A:
WELLNESS PARTNERS RECRUITMENT EMAIL

Wellness Partners is a collaborative research project about exercise
habits and perceived wellness designed by the USC School of Cinematic
Arts, Keck School of Medicine, and School of Social Work.
You are invited to help us test a newly developed intervention by
participating in very brief activities via the Internet and/or mobile phone
over the period of 10 weeks. We will also be taking in-person physical
measurements (height and weight) and asking you to answer questions
online.
As a token of our appreciation, you may receive up to $45 for participating
in the study.
Your participation is voluntary and any information collected during the
study will be kept confidential.
Support for this study is provided by a grant from the
Robert Wood Johnson Foundation.
If you have additional questions please read the
Frequently Asked Questions
(http://interactive.usc.edu/wellnesspartners/faq)
If you are interested, please email:
WPSTUDY-L@USC.EDU
Phone: 310-933-6648
Copyright © 2009 by the University of Southern California.
All Rights Reserved.

139
APPENDIX B:
WELLNESS PARTNERS RECRUITMENT FLYER

Wellness Partners is a collaborative research project about exercise habits and
perceived wellness designed by the USC School of Cinematic Arts, Keck School of
Medicine, and School of Social Work.
You are invited to help us test a newly developed intervention by participating in very
brief activities via the Internet and/or mobile phone over the period of 10 weeks. We
will also be taking in‐person physical measurements (height and weight) and asking you
to answer questions online.
As a token of our appreciation, you may receive up to $45 for participating in
the study.
Your participation is voluntary and any information collected during the study will be
kept confidential.
Support for this study is provided by a grant from the Robert Wood Johnson
Foundation.
If you have additional questions please read the Frequently Asked Questions at
http://interactive.usc.edu/wellnesspartners/faq
If you are interested, please email:
WPSTUDY‐L@USC.EDU
Phone: 310‐933‐6648
Copyright © 2009 by the University of Southern California. All Rights Reserved.
UPIRB#: UP‐08‐00378 Date of Preparation: September 21, 2009

This study is coordinated through a partnership with USC's Center for Work & Family Life.
www.usc.edu/worklife

140
APPENDIX C:
FREQUENTLY ASKED QUESTIONS WEB PAGE
Last Updated 5/11/2010 11:00PM PST
Who is conducting this study?
This study is a collaboration between Marientina Gotsis, MFA (School of Cinematic
Arts), Thomas Valente, PhD (Keck School of Medicine), Maryalice Jordan-Marsh, PhD,
RN (School of Social Work), and Donna Spruijt-Metz, PhD, MFA (Keck School of
Medicine), and the Center for Work and Family Life at the University of Southern
California. Support for this study is provided by grant #U-64448 from the Robert Wood
Johnson Foundation.
What is the purpose of the study?
Wellness Partners is a collaborative research project about exercise habits and perceived
wellness focusing on middle adults and their social networks. You are invited to help us
test a newly developed intervention by participating in very brief activities via the
Internet and/or mobile phone over the period of 10 weeks. We will also be taking in-
person physical measurements (height and weight) and asking you to answer questions
online.
Is this a weight loss or fitness study? Do I need to want to lose weight or be very
active already? What if I am injured or have a health problem?
The Wellness Partners pilot program is not currently including or excluding volunteers
based on their exercise habits, health status or perceived wellness. It is a new study
program that may or may not result in an increase in physical activity and/or wellness.
The participation criteria is listed below.
When will the study close?
We will keep the study open until we have reached the maximum numbers of participants
required or May 23rd, whichever comes first.
Can I participate if I will be on vacation for holiday break?
If you and at least one of your partners will have internet access you can participate.
Otherwise, we can schedule you to begin after your return from vacation.

141
Appendix C, Continued
How do I qualify for the study?
You can participate in this study if you meet the primary or secondary criteria below. If
you qualify as a primary participant, you must invite at least one person who meets the
secondary criteria in order to enroll in the study. If you qualify as a secondary participant,
you must join a partner who qualifies as a primary participant. Primary participants can
invite as many partners as they want to join their study group so long as those partners
meet the secondary participation criteria.
We inform primary participants that since their partners' study activities are conducted
online, their partners don't have to live with the Los Angeles metro area. If you are
interested, please fill out a Consent for Contact Form and we will contact you to answer
more questions. The screening process takes place over the phone and takes a couple of
minutes.
Primary inclusion criteria:
• You must be a USC employee*
• You must be between the ages of 25-44
• You must be fluent in English
• You must own a cell phone ( you are not required to use it)
• You must have daily access to the internet
Secondary inclusion criteria:
• You must be between the ages of 12-85
• You must be fluent in English
• You must have daily access to the internet
* staff, postdoc or benefits-eligible student (for example: research assistant but not work-
study student)
When do I begin the study?
If you're the primary participant in a study group, the study begins as soon as you have a
qualified partner. If you're joining someone who is already enrolled, you will join them as
soon as you fill out the first survey. If you're joining someone and you're not the second
partner, your study participation may be shorter than 10 weeks depending on when the
primary participant began the study.

142
Appendix C, Continued
Why do I need a partner?
We are evaluating the role of social networks in perceived wellness and exercise habits,
therefore we require people to sign up with at least one person they feel is part of their
social support network.
I don't qualify to be a primary participant due to my age range. Why are you
excluding people in my age range?
This study is currently in pilot phase which means it is limited in scope and funding,
therefore we have to restrict some criteria to increase the chances that our findings
strongly apply to a subset of the population. In other words, we have to use a smaller
group of people with similar characteristics to start before we can expand the study to
include more people. If you do not qualify for this phase but wish to be contacted in the
future, you may let us know during the screening.
Will I be compensated?
We can compensate the first six members of each study group (the primary participant
and their first 5 partners). During screening you will be informed whether you are eligible
for compensation and you can determine whether you wish to proceed with study.
If you are eligible, as a token of our appreciation, you may receive a total of $45 :
• $10 for completing each of three surveys and physical measurements*, and
• $15 upon study completion toward any cell phone text messaging costs incurred
* Surveys can be completed online and will be required of both primary and secondary
participants. For physical measurements, only the first (primary) participant of each study
group who qualifies and consents to the study is expected to meet the study staff first at
the Center for Work and Family Life (CWFL) at UPC/University Village once before
week 1 and two more times (during week 5, after week 10 of the study) to allow us to
measure their weight, height, BMI and body fat on a high-end precision scale. The
second and third time we can come to you with the portable scale (no height will be
obtained), or you can come to our office at SCA 224 or an appointment can be made
again at CWFL.
Measurement data will be shown to each primary participant during their appointment
(we're not withholding that information). Please see the next two questions for more
details.

143
Appendix C, Continued
What do I have to do in the study?
If you volunteer to participate in this study, we would ask you and your study partners to
do the following things:
• You will be expected, but not required, to use the online application for about 1-5
minutes each day by using a web browser or your cell phone.
• You will be asked to answer three online surveys with questions at the beginning,
middle and end of the study.
• If you are the first person (the primary participant)in your social network who has
contacted the study and you are not joining someone else who has already
enrolled as their partner, you would also be expected to allow the study
coordinators to measure your height and weight in a private setting* at the
beginning, middle and end of the study.
* A private room at the USC Center for Work and Family Life (CWFL) at UPC's
University Village. Free parking is available at this location. You are required to come to
the first appointment at the CWFL but for the second and third measurement we can
come to your office or you can meet us at SCA 224 by appointment.
Where do primary participants have to come for the height and weight
measurements and how will this be arranged?
For the first appointment ONLY:
The study coordinators will arrange a time and date for you to come to the address below.
The process shouldn't take longer than 10 minutes. It is best if you haven't eaten before
coming in.
Free parking is available at the University Village lot without validation. No walk-ins can
be accepted.

USC Center for Work and Family Life
University Park Campus
University Village
UVI E206
3375 South Hoover Street, Suite E206
Los Angeles, CA 90007-7794
We understand that some participants may be located at HSC or other USC locations but
at this time we can only offer UPC appointments for the first appointment due to the pilot
144
Appendix C, Continued
nature of the study. We have advertised the study to the entire USC staff community to
maximize the opportunity for inclusion but we understand that some volunteers will be
unable to participate because coming to UPC is difficult.
For the second and third appointment ONLY:
You will have three options for convenience:
• The study coordinators will arrange a time and date for you to come to CWFL
(UPC University Village).
• The study coordinators will arrange a time and date for you to come to your office
(flexible location).
• The study coordinators will arrange a time and date for you to come to SCA 224
(UPC).
What types of activities will I be doing online?
The program has two parts:
• PART A: 5-week period of using a social networking site (similar to Facebook)
for self-reporting physical activity. This version includes playful interactive
animation features.
• PART B: 5-week period of using a similar social networking site (similar to
Facebook) for self-reporting physical activity. This version doesn’t include
playful interactive animation features.
Every participant has to complete both parts of the program. You will start the program
with either Part A or B by chance and after the 5th week will be switched to the other part.
Is this some sort of social networking venture with people I won't know?
Only you and your partner will be able to see your activities. You can't see what other
groups in the study are posting. We're liming activities to only between the partners you
have allowed in your network and you won't know who else is in the study or what they
are doing. They won't know who you are or what you're doing either.

145
Appendix C, Continued
What are the technical requirements for my computer or cell phone to use the
Wellness Partners online application?
The online application works best with Firefox 3.5 and higher, and Internet Explorer 7
and higher on a PC or Mac. PART A of the study requires Flash Player 9 or higher to be
Appendix C, Continued
installed on your browser and will unlikely work properly on a cell phone web browser.
PART B of the study has been tested on the iPhone and Opera mobile browsers. Since
this study is a pilot, we look forward to reports and suggestions on a better mobile
experience in the future using our software. Several Flash-enabled mobile handsets are
expected in the market in 2010.
How do I refer other people to the study?
If you want other people to join your study group, you must
1. Fil out the Referral Form
2. Ask the people you want to invite to fill out a Consent for Contact Form or ask
them to email us at WPSTUDY-L@USC.EDU
Your invitees don't have to live in Los Angeles or be USC employees and only need to
meet the secondary inclusion criteria.
Secondary inclusion criteria:
• You must be between the ages of 12-85
• You must be fluent in English
• You must have daily access to the internet
When you fill out the referral form, you are letting us know that the people you listed
may be contacting us and that if they qualify, we may add them to you study group. We
can't contact people unless they contact us first. We can't begin the process of adding
someone to your study group unless you invite them.
Your referral doesn't guarantee your invitee's participation. Your invitees must (a) be
screened to determine whether they meet the participation criteria (b) must review the
consent forms and (c) must complete an online survey before they can join you.

146
Appendix C, Continued
If you are inviting minors between the ages of 12-17, their parents or legal guardians
would have to fill out the Consent for Contact Form or contact us by emailing
WPSTUDY-L@USC.EDU.
Do I need to have a computer to participate?
You don't have to own a computer, but you need to have daily access to the internet for at
least 5 minutes.
Do I need to have a cell phone to participate?
You must own a cell phone, but you are not required to use it for the study.
What types of questions are on the survey?

We will ask you simple demographic data (e.g., age, gender, job title), questions about
your eating and exercise habits (e.g., how often you exercise), your perceived wellness
(e.g., rate your heath), your social network and social support system (e.g., with whom
you talk for important matters) and your favorite social media and entertainment
applications (e.g., Facebook, games). In the second and third survey we will also ask your
input on our prototype social networking site and its features.

147
APPENDIX D:
CONSENT FOR CONTACT FORM
Consent for Contact Form
"I am interested in knowing more about Wellness Partners, and would like the Wellness
Partners team to give me a call to explain the study."

* Required

Your Last Name: *

Your Middle Name:

Your First Name: *

Your work phone number:

Your home phone number:

Your cell phone number:

Your email address: *

Preferred contact: *
• Work phone
• Home phone
• Cell phone

148
Appendix D, Continued

In order to determine whether you qualify for the study we have to ask you some
questions over the phone. Please let us know which times are best for you in the next
week to have us contact you for a few minutes.

Are you joining someone who is already part of the study? *
• Yes
• No
• Not sure

If you were referred by someone, please enter their last name below:

Submit

Powered by Google Docs

149
APPENDIX E:

TELEPHONE SCREENING SURVEY FOR PRIMARY PARTICIPANTS

Wellness Partners Telephone Screening Survey for Egos

INT. Hello, my name is _______________. I'm calling from the University of Southern
California. [PAUSE] Do you have a minute now to answer a few short questions? I
will try to determine if you qualify for the study and if you do, I will give you more
information and instructions on how to proceed. [IF NOT AVAILABLE NOW,
ASK FOR BEST TIME TO CALL BACK]

USC. Are you currently employed by USC as staff (or a graduate student worker)?

1 - YES
2 - NO [TERMINATE]

LAN. Is English your native language?

1 - YES [GO TO NET]
2 - NO

LANa. On a scale of 1 to 10, where 1 means not very fluent, and 10 means very fluent,
how would you rate your English proficiency?

_______________ [IF LOWER THAN 7, TERMINATE]

NET. Do you have daily access to the Internet?

1 - YES
2 - NO [TERMINATE]

CEL. Do you own a cell phone?

1 - YES
2 - NO [TERMINATE]

PAT. Are you currently participating in any other formal studies toward weight loss or
healthy lifestyle?

1 - YES [TERMINATE]
2 - NO

150
Appendix E, Continued

FWP. Have you ever enrolled to a study called Wellness Partners before?

1 - YES [TERMINATE]
2 - NO

AGE. Please stop me when I mention the category that contains your age...You don't
have to tell me how old you are.
1 - 18 to 24 [TERMINATE]
2 - 25 to 34
3 - 35 to 44
4 - 45 to 54 [TERMINATE]
5 - 55 to 64 [TERMINATE]
6 - 65 or over [TERMINATE]
9 - REFUSED/PREFER NOT TO ANSWER [TERMINATE]

SUP. How many people do you have in your social circles that you could rely on for
social support?

_______________ [IF LOWER THAN 4, TERMINATE]

PNR. Would you be willing to enroll at least one of the people you rely on such as
family members, spouse, domestic partners, or friends to participate in the
Wellness Partners study with you in the next 10 weeks?

1 - YES
2 - NO [TERMINATE]

TERM.I am sorry but we are looking for people with certain characteristics for the
purpose of this particular research project. Thank you for your interest. Have a
nice day!

IC. [That sounds great!] It appears that you are qualified for our study.

The next step is that we will email you the link to the Referral Form where you
can provide names of the people you would like to invite to participate in the
study with you. Once at least one of them has completed the Consent to Contact
Form just as you did, we will start the study if they qualify. Your partners can be
as young as 12 and as old as 85 and they don't need to be USC staff or live in Los
Angeles.

151
Appendix E, Continued

Are you aware that as the first person in your study group you are required to
come to University Park Campus for three physical measurements but your
partners don't have to? [give more details if asked]

FINALLY:
[If you have any questions, please feel free to email us at WPSTUDY-L@usc.edu
or call us at 310-933-6648.] We will get in touch again via email. Thanks so much
for your time and participation! Have a nice day/Have a good evening!

I am sorry but we are looking for people with certain characteristics for the
purpose of this particular research project. We probably cannot use your help at
this time. Thank you so much for your interest. Have a nice day!/Have a good
evening!

[IF they qualify as alters, explain that they can join a friend who could qualify for
the study and email the info to them again]

ENTER THE POTENTIAL PARTICIPANT'S INFO:

FULL NAME:

PARTICIPANT'S SEX:

1 - MALE 2 - FEMALE

NUMBER REACHED AT:
WORK PHONE
HOME PHONE
CELL PHONE

DATE/TIME OF SCREENING INTERVIEW COMPLETED:

152
APPENDIX F:

WELLNESS PARTNERS REFERRAL FORM

I would like to invite people from my social network to join my study group. I would like
to confirm that the people listed below may be contacting the study list or phone number.
I understand that my referrals and their contact do not guarantee their participation and
they must still go through the screening and consent process.

My name is:
Last name:

Middle name (optional):

First name:

The first person I would like to invite is:
Last name:

Middle name (optional):

First name:

Would you like to invite additional people?
Yes
No [GO TO THE END OF THE SURVEY]

Second Invitation

The second person I would like to invite is:
Last name:

Middle name (optional):

First name:

Would you like to invite additional people?
Yes
No [GO TO THE END OF THE SURVEY]

153
Appendix F, Continued
Third Invitation

The third person I would like to invite is:
Last name:

Middle name (optional):

First name:

Would you like to invite additional people?
Yes
No [GO TO THE END OF THE SURVEY]

Fourth Invitation

The fourth person I would like to invite is:
Last name:

Middle name (optional):

First name:

Would you like to invite additional people?
Yes
No [GO TO THE END OF THE SURVEY]

Fifth Invitation

The fifth person I would like to invite is:
Last name:

Middle name (optional):

First name:

End of Survey – Thank You:

Thank you for inviting people in your social network to participate in the Wellness
Partners study with you! You may come back to the Wellness Partners website at anytime
during the study and make additional referrals.

154
Appendix F, Continued

End of Survey – Thank You (nominations exceeding 5 alters):

Thank you for inviting people in your social network to participate in the Wellness
Partners study with you! This form allows for up to 5 referrals at a time. You may come
back to the Wellness Partners website at anytime during the study and make additional
referrals.

155

APPENDIX G:

WELLNESS PARTNERS TELEPHONE SCREENING SURVEY
FOR ADULT ALTERS

INT. Hello! My name is ____________. I am calling to follow up on your participation
in the Wellness Partners study. [PAUSE] Do you have a minute now to answer a
few short questions? [IF NOT AVAILABLE, ASK FOR BEST TIME TO CALL
BACK]

LAN. Is English your native language?

1 - YES [GO TO NET]
2 - NO

LANa. On a scale of 1 to 10, where 1 means not very fluent, and 10 means very fluent,
how would you rate your English proficiency?

_______________ [IF LOWER THAN 7, TERMINATE]

NET. Do you have daily access to the Internet?

1 - YES
2 - NO [TERMINATE]

FWP. Have you ever enrolled to a study called Wellness Partners before?

1 - YES [TERMINATE]
2 - NO

AGE. Please tell me when I mention the category that contains your age...
1 - 18 to 24
2 - 25 to 34
3 - 35 to 44
4 - 45 to 54
5 - 55 to 64
6 - 65 or over
7 - REFUSED/PREFER NOT TO ANSWER [TERMINATE]

156

Appendix G, Continued

TERM.I am sorry but we are looking for people with certain characteristics for the
purpose of this particular research project. Thank you for your interest. Have a
nice day!

IC. Great! It appears that you are qualified for our study. You are the _____ person in
__________’s study group. Only members 1-6 are eligible for compensation. Do you
still want to proceed with learning more about the study?

1 - YES
2 - NO [BYE]

Thank you so much! So for the next step, we will email you detailed directions for
your participation in this study. [If you have any questions, please feel free to email
us at WPSTUDY-L@usc.edu or call us at 310-933-6648.] Thank you again! Have a
good day/evening!

BYE. We appreciate your time and interest. Thank you.

ENTER THE POTENTIAL ADULT ALTER'S INFO:
FULL NAME OF ALTER:

FULL NAME OF INDEX:

POTENTIAL ADULT ALTER'S SEX:
Male
Female

NUMBER REACHED AT:
WORK PHONE
HOME PHONE
CELL PHONE

DATE OF SCREENING INTERVIEW COMPLETED:

157
APPENDIX H:

WELLNESS PARTNERS TELEPHONE SCREENING SURVEY
FOR YOUTH ALTERS

INT. Hello! My name is ____________. I am calling to follow up on your participation
in the Wellness Partners study. [PAUSE] Do you have a minute now to answer a
few short questions? [IF NOT AVAILABLE, ASK FOR BEST TIME TO CALL
BACK]

LAN. Is English your native language?

1 - YES [GO TO NET]
2 - NO

LANa. On a scale of 1 to 10, where 1 means not very fluent, and 10 means very fluent,
how would you rate your English proficiency?

_______________ [IF LOWER THAN 7, TERMINATE]

NET. Do you have daily access to the Internet?

1 - YES
2 - NO [TERMINATE]

FWP. Have you ever enrolled to a study called Wellness Partners before?

1 - YES [TERMINATE]
2 - NO

AGE. Please tell me when I mention the category that contains your child’s age...
1 - 0 to 5 [TERMINATE]
2 - 5 to 11 [TERMINATE]
3 - 12 to 17
4 - REFUSED/PREFER NOT TO ANSWER [TERMINATE]

TERM.I am sorry but we are looking for people with certain characteristics for the
purpose of this particular research project. Thank you for your interest. Have a
nice day!

158
Appendix H, Continued

IC. Great! It appears that you are qualified for our study. You are the _____ person in
__________’s study group. Only members 1-6 are eligible for compensation. Do you
still want to proceed with learning more about the study?

1 - YES
2 - NO [BYE]

Thank you so much! Then for the next step, we will email you the link to a parental
consent form. After you sign off the form, we will send your child detailed directions
regarding the study. [If you have any questions, please feel free to email us at
WPSTUDY-L@usc.edu or call us at 310-933-6648.] Thank you again. Have a good
day/evening!

BYE. We appreciate your time and interest. Thank you.

ENTER THE POTENTIAL ADULT ALTER'S INFO:
FULL NAME OF ALTER:

FULL NAME OF INDEX:

POTENTIAL ADULT ALTER'S SEX:
Male
Female

NUMBER REACHED AT:
WORK PHONE
HOME PHONE
CELL PHONE

DATE OF SCREENING INTERVIEW COMPLETED:

159
APPENDIX I:
WELLNESS PARTNERS USER INSTRUCTIONS
WP Study Part A - Instructions
Welcome to Wellness Partners online! You have been randomly assigned to start with
Part A of the study.
Overview
In this part of the study, you will be using an online social network site (similar to
Facebook) to share your physical activity information with the family and friends whom
you invite to join the program with you. We ask that you try login and spend a few
minutes on the Wellness Partners site every day. The study team will provide a daily
email with website usage tips and a survey link for providing feedback on its features.
This version of the site includes features for you to Post an Update and Send a Message.
It also displays your total points and allows you to interact with a virtual animated
character. There is an optional feature to receive reminders from the Wellness Partners
site via Twitter (email or text messaging) if you haven’t posted any updates within a 24
hour period.
First Login:
1. Logon to http://wp.usc.edu/login with user username and password
password
2. In the first screen, you will be asked to enter your Twitter username
(optional), a nickname to use in this program, a new password and a
name for your virtual character. You can change all these later from the
Preferences section.
What can I do on the website?
• Post an Update: Each day, you can report completed physical activities (e.g.,
walking, running, doing chores) or setbacks (e.g., I was tired, I was busy). When
reporting a particular physical activity, you can specify duration (15-90 minutes),
intensity (light, medium, heavy) and mark it private (optional).
• Earn Points: You earn points for reporting completed physical activities and
setbacks. You can earn more points for reporting a physical activity you
completed with your invited study partner(s) and/or for posting updates on a
regular basis.
• Send Messages: You can send direct messages to any of your study partner(s).

160
Appendix I, Continued
• Review Daily Summary & Complete Activity History: Every post you make will
be displayed in the Daily Summary and the Complete Activity History. The Daily
Summary resets on a daily basis. The Completed Activity History shows a
detailed summary of posts from the beginning of the study. Your posts will be
shared with your invited study partner(s) unless you mark them as private.
• Review Partner Status: Based on your selection under Preferences you can
display to your study partner(s) when was the last time you logged on and how
many points you have (Full Details), you can withhold your points (Hide Points)
or you can hide all status information (Invisible).
• Popular Activities: Every new type of activity you and your study partner(s) log
will be displayed in this area. Popular activities are displayed in a larger font than
less popular activities. Popular activities can also be used as shortcuts for doing a
quickpost.
What can I do with my points?
Your virtual character has a choice of free Locations they can visit with different
Activities that can be redeemed for points. Once you pay for an activity using your
points, you earn a Memory that you can replay unlimited times by clicking on it. Some
Activities result in collectible items that get added to Your Collection. Collectibles can be
gifted to your study partners by clicking on them.
Optional Twitter Feature
Twitter (http://www.twitter.com/) is a very popular social networking site. If you enable
Twitter with Wellness Partners you will receive a daily email reminder via Twitter to
post an update.
How do I enable Twitter with Wellness Partners?
o Make a new twitter account or use your existing account. You can enter
your Twitter account information at first login or at any time by clicking
on Preferences.
o In Twitter, search and follow “wp_bot”. It will follow you back soon!
How do I enable Twitter Mobile Updates with Wellness Partners?
o Please review this document to setup your phone with Twitter if you
haven’t done this already:
http://twitter.zendesk.com/forums/59008/entries/14014

161
Appendix I, Continued
o In Twitter, click on “following”, find “wp_bot” and click on the settings
icon to enable updates to be sent on your mobile phone via text
messaging.
Getting to know Twitter
For help on Twitter, please read the following online document:
http://twitter.zendesk.com/forums/10711/entries/13920
Text Messaging Costs
Twitter is free, but text messaging on your cell phone may cost you a few cents
per message depending on your cell phone plan. We will compensate you a flat
fee of $15 if you complete the entire study to cover any text messaging costs
regardless of whether you use the feature or not.
Wellness Partners Website Help/Feedback
If you are having trouble with the website or would like to give us positive or negative
feedback about the software, please fill out the form below:
https://usc.qualtrics.com/SE?SID=SV_4TNTBBrishbdPjm&SVID=Prod

WP Study Part B – Instructions
Welcome to Wellness Partners online! You have been randomly assigned to start with
Part B of the study.
Overview
In this part of the study, you will be using an online social network site (similar to
Facebook) to share your physical activity information with the family and friends whom
you invite to join the program with you. We ask that you try login and spend a few
minutes on the Wellness Partners site every day. The study team will provide a daily
email with website usage tips and a survey link for providing feedback on its features.
This version of the site includes features for you to Post an Update and Send a Message.
There is an optional feature to receive reminders from the Wellness Partners site via
Twitter (email or text messaging) if you haven’t posted any updates within a 24-hour
period.

162

Appendix I, Continued
First Login:
1. Logon to http://wp.usc.edu/login with user username and password
password.
2. Change your password by clicking on the Preferences link after your log
on.
What can I do on the website?
• Post an Update: Each day, you can report completed physical activities (e.g.,
walking, running, doing chores) or setbacks (e.g., I was tired, I was busy). When
reporting a particular physical activity, you can specify duration (15-90 minutes),
intensity (light, medium, heavy) and mark it private (optional).
• Send Messages: You can send direct messages to any of your study partner(s).
• Review Daily Summary & Complete Activity History: Every post you make will
be displayed in the Daily Summary and the Complete Activity History. The Daily
Summary resets on a daily basis. The Completed Activity History shows a
detailed summary of posts from the beginning of the study. Your posts will be
shared with your invited study partner(s) unless you mark them as private.
• Review Partner Status: Based on your selection under Preferences you can
display to your study partner(s) when was the last time you logged on and how
many points you have (Full Details), you can withhold your points (Hide Points)
or you can hide all status information (Invisible).
• Popular Activities: Every new type of activity you and your study partner(s) log
will be displayed in this area. Popular activities are displayed in a larger font than
less popular activities. Popular activities can also be used as shortcuts for doing a
quickpost.
Optional Twitter Feature
Twitter (http://www.twitter.com/) is a very popular social networking site. If you enable
Twitter with Wellness Partners you will receive a daily email reminder via Twitter to
post an update.

163
Appendix I, Continued

How do I enable Twitter with Wellness Partners?
o Make a new twitter account or use your existing account. You can enter
your Twitter account information at first login or at any time by clicking
on Preferences.
o In Twitter, search and follow “wp_bot”. It will follow you back soon!
How do I enable Twitter Mobile Updates with Wellness Partners?
o Please review this document to setup your phone with Twitter if you
haven’t done this already:
http://twitter.zendesk.com/forums/59008/entries/14014
o In Twitter, click on “following”, find “wp_bot” and click on the settings
icon to enable updates to be sent on your mobile phone via text
messaging.

Getting to know Twitter
For help on Twitter, please read the following online document:
http://twitter.zendesk.com/forums/10711/entries/13920
Text Messaging Costs
Twitter is free, but text messaging on your cell phone may cost you a few cents
per message depending on your cell phone plan. We will compensate you a flat
fee of $15 if you complete the entire study to cover any text messaging costs
regardless of whether you use the feature or not.
Wellness Partners Website Help/Feedback
If you are having trouble with the website, or would like to give us positive or negative
feedback about the software, please fill out the form below:
https://usc.qualtrics.com/SE?SID=SV_4TNTBBrishbdPjm&SVID=Prod

164
APPENDIX J:

WELLNESS PARTNERS ONLINE SURVEYS MASTER COPY

Wellness Partners Survey Questionnaire
(Master copy – Feb 13, 2010)

Introduction

Hello,

Thank you for your interest in participating in our study on health and wellness. This
study is approved by the Institutional Review Board at the University of Southern
California.

The survey takes on average about 5-10 minutes. There are no right or wrong answers to
the survey. All your responses will be kept strictly confidential and only accessible to the
research team. Your input and contribution are highly valuable to us!

The Wellness Partners Research Team

Informed Consent screening1
Are you at the age of 18 or older?
Yes
No  GO TO IC-Minor
Informed Consent screening2
Who are you consenting to participate in the Wellness Partners study?
Myself  GO TO IC-Adult
My child  GO TO IC-Parent
IC-Minor

165
Appendix J, Continued

INFORMATION SHEET FOR NON-MEDICAL RESEARCH

YOUTH PARTICIPANT

Completion and return of this web survey questionnaire will constitute consent to
participate in this research project.

You are invited to participate in a research study conducted by Marientina Gotsis, MFA,
Thomas Valente, PhD, Maryalice Jordan-Marsh, PhD, RN, and Donna Spruijt-Metz,
PhD, MFA, from the University of Southern California. Your participation is voluntary.
You should read the information below and ask questions about anything you do not
understand before deciding whether or not to participate. Please take as much time as you
need to read the consent form. You may also decide to discuss it with your family or
friends. Your parents permission has been obtained; however, the decision whether to
participate is yours. You do not have to participate, even if your parents say you can. If
you decide to participate, you will be asked to sign this form by entering your initials at
the end. You can print this page for your records.

PURPOSE OF THE STUDY
Wellness Partners is a collaborative research project about health and wellness. We need
you to help us test a newly developed intervention by participating in very brief activities
via the Internet and/or mobile phone over the period of up to 10 weeks. We anticipate a
minimum of 160 participants in this study.

PROCEDURES
The study is a 10-week program for which you must enroll along with at least one adult
family member or friend.

The program has two parts:
• PART A: 5-week period of using a social networking site (similar to Facebook)
for self-reporting physical activity. This version includes playful interactive
animation features.
• PART B: 5-week period of using a similar social networking site (similar to
Facebook) for self-reporting physical activity. This version doesn’t include
playful interactive animation features.

All participants have to complete both parts of the program. You will start the program
with either Part A or B by chance and after the 5
th
week will be switched to the other part.

166
Appendix J, Continued

If you volunteer to participate in this study, we would ask you to do the following things:
 You will be expected, but not required, to use the online application for about 1-5
minutes each day by using a web browser or your cell phone.
 You will be asked to answer three online surveys with questions at the beginning,
middle and end of the study.

POTENTIAL RISKS AND DISCOMFORTS
Researchers do not anticipate that you will experience any risks or discomforts during
this study that would exceed those of your everyday life. The physical measurements will
be taken at a private setting by a trained study coordinator who will not ask you any
further questions. You may experience slight embarrassment when we measure your
height or weight. You do not have to answer any questions that make you feel
uncomfortable in the online surveys. We will provide technical assistance in using the
Wellness Partners online application to minimize any potential difficulty you may
experience.

POTENTIAL BENEFITS TO SUBJECTS AND/OR TO SOCIETY
You may or may not receive any health benefits from taking part in this study. However,
your participation may help us better understand exercise habits and perceived wellness.
PAYMENT/COMPENSATION FOR PARTICIPATION
You are not required to incur any costs for participating in the study. You may incur
some costs if you choose to use your cell phone to send text messages to the Wellness
Partners software application.
We can compensate the first six members of your study group. During screening your
parent was informed whether you are eligible for compensation.
If you are eligible, as a token of our appreciation, you will receive a total of $45:
 $10 for completing each of three surveys, and
 $15 upon study completion toward any cell phone text messaging costs incurred.

Since you are younger than 18 years, you will receive a $30 retail gift certificate and the
$15 toward cell phone text messaging will be issued to your parent or guardian.

POTENTIAL CONFLICTS OF INTEREST
The University of Southern California may use your data to develop products that can be
sold. If they make money from these products, you will not receive any money. The
investigators of this research have some financial interest as they may share intellectual
property rights and patents with the University.

167
Appendix J, Continued

CONFIDENTIALITY
Any information that is in connection with this study and that is identified with you will
remain confidential and will be disclosed only with your permission or as required by
law. Only members of the research team will have access to the data associated with this
study. Your parents will not have access to your responses. The data will be stored in the
investigator’s office in a locked file cabinet or password protected computer.

We may share the information collected with our sponsor (Robert Wood Johnson
Foundation), we may publish the information from this study in journals or present it at
meetings. If we do, we will not use your name. The data may also be used for educational
purposes (shown to students in classes or training sessions).

The data will be stored for a minimum of three years after the study has been completed
and for a maximum of six years and then will be destroyed. When the results of the
research are published or discussed in conferences, no information will be included that
would reveal your identity.

PARTICIPATION AND WITHDRAWAL
Your participation is voluntary. Your refusal to participate will involve no penalty or loss
of benefits to which you are otherwise entitled. You may withdraw your consent at any
time and discontinue participation without penalty. You are not waiving any legal claims,
rights or remedies because of your participation in this research study. The investigator
may withdraw you from this research if circumstances arise which warrant doing so. For
example, the investigator may have to withdraw you to make changes to the study, or
they may terminate the study due to technical problems.

RIGHTS OF RESEARCH SUBJECTS
If you have any questions about your rights as a study subject or you would like to speak
with someone independent of the research team to have questions answered about the
research, or in the event the research staff can not be reached, please contact the
University Park IRB, Office of the Vice Provost for Research Advancement, Stonier
Hall, Room 224a, Los Angeles, CA 90089-1146, (213) 821-5272 or upirb@usc.edu

IDENTIFICATION OF INVESTIGATORS
If you have any questions or concerns about this study, please feel free to contact
Marientina Gotsis at 310-933-6648 or mgotsis@cinema.usc.edu, or Thomas Valente at
626-457-6678 or tvalente@usc.edu.

By entering my initials below, I agree that I have read this Youth Participant Form
carefully and would like to participate in this study.

Initial here to consent: __________

168
Appendix J, Continued

If initials are entered, GO TOQ1

IC-Adult

INFORMATION SHEET FOR NON-MEDICAL RESEARCH
ADULT PARTICIPANT
Completion and return of this web survey questionnaire will constitute consent to
participate in this research project.

You are invited to participate in a research study conducted by Marientina Gotsis, MFA,
Thomas Valente, PhD, Maryalice Jordan-Marsh, PhD, RN, and Donna Spruijt-Metz,
PhD, MFA, from the University of Southern California. Your participation is voluntary.
You must be aged 18 or older. You should read the information below, and ask questions
about anything you do not understand before deciding whether or not to participate.
Please take as much time as you need to read the consent form. You may also decide to
discuss it with your family or friends. If you decide to participate, you will be asked to
sign this form by entering your initials at the end. You can print this page for your
records.

PURPOSE OF THE STUDY
Wellness Partners is a collaborative research project about health and wellness. We need
you to help us test a newly developed intervention by participating in very brief activities
via the Internet and/or mobile phone over the period of 10 weeks. We anticipate a
minimum of 160 participants in this study.

PROCEDURES
The study is a 10-week program for which you must enroll with at least one more person
(friend, family member, or spouse).

The program has two parts:
• PART A: 5-week period of using a social networking site (similar to Facebook)
for self-reporting physical activity. This version includes playful interactive
animation features.
• PART B: 5-week period of using a similar social networking site (similar to
Facebook) for self-reporting physical activity. This version doesn’t include
playful interactive animation features.

169
Appendix J, Continued

All participants have to complete both parts of the program. You will start the program
with either Part A or B by chance and after the 5
th
week will be switched to the other part.

All participants will be asked to complete both parts of the program, for a total of 10
weeks of participation. You will start the program with either Part A or B by chance.

If you volunteer to participate in this study, we would ask you to do the following things:
 You will be expected, but not required, to use the online application for about 1-5
minutes each day by using a web browser or your cell phone.
 You will be asked to answer three online surveys with questions at the beginning,
middle and end of the study.
 If you are the first person in your social network who has contacted the study and
you are not joining someone else who has already enrolled, you would also be
expected to allow the study coordinators to measure your height and weight in a
private setting at the beginning, middle and end of the study.

POTENTIAL RISKS AND DISCOMFORTS
Researchers do not anticipate that you will experience any risks or discomforts during
this study that would exceed those of your everyday life. The physical measurements will
be taken at a private setting by a trained study coordinator who will not ask you any
further questions. You may experience slight embarrassment when we measure your
height or weight. You do not have to answer any questions that make you feel
uncomfortable on the online surveys. We will provide technical assistance in using the
Wellness Partners online application to minimize any potential difficulty you may
experience.

POTENTIAL BENEFITS TO SUBJECTS AND/OR TO SOCIETY
You may or may not receive any health benefits from taking part in this study. However,
your participation may help us better understand exercise habits and perceived wellness.

PAYMENT/COMPENSATION FOR PARTICIPATION
You are not required to incur any costs for participating in the study. You may incur
some costs if you choose to use your cell phone to send text messages to the Wellness
Partners software application.
We can compensate the first six members of your study group. During screening you
were informed whether you are eligible for compensation.
If you are eligible, as a token of our appreciation, you will receive a total of $45:
 $10 for completing each of three surveys and physical measurements, and
 $15 upon study completion toward any cell phone text messaging costs incurred

170
Appendix J, Continued

POTENTIAL CONFLICTS OF INTEREST
The University of Southern California may use your data to develop products that can be
sold. If they make money from these products, you will not receive any money. The
investigators of this research have some financial interest as they may share intellectual
property rights and patents with the University.

CONFIDENTIALITY
Any information that is in connection with this study and that is identified with you will
remain confidential and will be disclosed only with your permission or as required by
law. Only members of the research team will have access to the data associated with this
study. The data will be stored in the investigator’s office in a locked file
cabinet/password protected computer.

We may share the information collected with our sponsor (Robert Wood Johnson
Foundation), we may publish the information from this study in journals or present it at
meetings. If we do, we will not use your name. The data may also be used for educational
purposes (shown to students in classes or training sessions).

The data will be stored for a minimum of three years after the study has been completed
and for a maximum of six years and then will be destroyed. When the results of the
research are published or discussed in conferences, no information will be included that
would reveal your identity.

PARTICIPATION AND WITHDRAWAL
Your participation is voluntary. Your refusal to participate will involve no penalty or loss
of benefits to which you are otherwise entitled. You may withdraw your consent at any
time and discontinue participation without penalty. You are not waiving any legal claims,
rights or remedies because of your participation in this research study. The investigator
may withdraw you from this research if circumstances arise which warrant doing so. For
example, the investigator may have to withdraw you to make changes to the study, or
they may terminate the study due to technical problems.

RIGHTS OF RESEARCH SUBJECTS
If you have any questions about your rights as a study subject or you would like to speak
with someone independent of the research team to have questions answered about the
research, or in the event the research staff can not be reached, please contact the
University Park IRB, Office of the Vice Provost for Research Advancement, Stonier
Hall, Room 224a, Los Angeles, CA 90089-1146, (213) 821-5272 or upirb@usc.edu

IDENTIFICATION OF INVESTIGATORS
If you have any questions or concerns about this study, please feel free to contact
Marientina Gotsis at 310-933-6648 or mgotsis@cinema.usc.edu, or Thomas Valente at
626-457-6678 or tvalente@usc.edu.
171
Appendix J, Continued

By entering my initials below, I confirm that I am aged 18 or older and I have read
this Adult Participant Form carefully and agree to participate in this study.

Initial here to consent: __________
If initials are entered, GO TO Q1.
IC-Parent
INFORMATION SHEET FOR NON-MEDICAL RESEARCH

PARENTAL CONSENT FORM
Completion and return of this web survey questionnaire will constitute consent for
your child to participate in this research project.

Your child is invited to participate in a research study conducted by Marientina Gotsis,
MFA, Thomas Valente, PhD, Maryalice Jordan-Marsh, PhD, RN, and Donna Spruijt-
Metz, PhD, MFA, from the University of Southern California. Your child’s participation
is voluntary. You should read the information below, and ask questions about anything
you do not understand before deciding whether or not to allow your child to participate.
Please take as much time as you need to read the consent form. If you agree to allow your
child to participate and your child decides to participate, you will be asked to sign this
form by entering your initials at the end; your child will be asked to initial a separate
document, which we call an assent form. You can print the documents for your records.

PURPOSE OF THE STUDY
Wellness Partners is a collaborative research project about health and wellness. We need
your child to help us test a newly developed intervention by participating in very brief
activities via the Internet and/or mobile phone over the period of up to 10 weeks. We
expect a minimum of 160 participants in this study.

PROCEDURES
The study is a 10-week program for which your child is invited to enroll with an adult
family member or friend.

The program has two parts:
• PART A: 5-week period of using a social networking site (similar to Facebook)
for self-reporting physical activity. This version includes playful interactive
animation features.

172
Appendix J, Continued

• PART B: 5-week period of using a similar social networking site (similar to
Facebook) for self-reporting physical activity. This version doesn’t include
playful interactive animation features.

All participants have to complete both parts of the program. Your child will start the
program with either Part A or B by chance and after the 5
th
week will be switched to the
other part.

If your child volunteers to participate in this study, we would ask him/her to do the
following things:
 Your child will be expected, but not required, to use the online application for
about 1-5 minutes each day by using a web browser or your cell phone.
 Your child will be asked to answer three online surveys with questions at the
beginning, middle and end of the study.

POTENTIAL RISKS AND DISCOMFORTS
Your child does not have to answer any questions that will make him/her feel
uncomfortable. We will provide technical assistance in using the Wellness Partners
online activity diary and game to minimize any potential difficult your child may
experience in using the application. If you would like access to the questions asked of
your child, please contact the researcher for copies.

POTENTIAL BENEFITS TO SUBJECTS AND/OR TO SOCIETY
Your child may or may not receive any health benefits from taking part in this study.
However, your child’s participation may help us learn more about how to develop
interventions for physical activity using social networks.

PAYMENT/COMPENSATION FOR PARTICIPATION
Your child is not expected to incur any costs to participate in the study. You may incur
some costs if your child chooses to use your cell phone to communicate with the
Wellness Partners website.
We can compensate the first six members of you child’s study group. During screening
you were informed whether your child is eligible for compensation.
If your child is eligible, as a token of our appreciation, your child will receive a $30 retail
gift certificate. You as the parent or guardian will receive $15 toward any cell phone text
messaging costs.

173
Appendix J, Continued

POTENTIAL CONFLICTS OF INTEREST
The University of Southern California may use your data to develop products that can be
sold. If they make money from these products, you will not receive any money. The
investigators of this research have some financial interest as they may share intellectual
property rights and patents with the University.

CONFIDENTIALITY
Any information that is in connection with this study and that is identified with you or
your child will remain confidential and will be disclosed only with your permission or as
required by law. You will not have access to your child’s responses. Only members of the
research team will have access to the data associated with this study. The data will be
stored in the investigator’s office in a locked file cabinet/password protected computer.

We may share the information collected with our sponsor (Robert Wood Johnson
Foundation), we may publish the information from this study in journals or present it at
meetings. If we do, we will not use your child’s name. The data may also be used for
educational purposes (shown to students in classes or training sessions).

The data will be stored for a minimum of three years after the study has been completed
and for a maximum of six years and then will be destroyed. When the results of the
research are published or discussed in conferences, no information will be included that
would reveal your child’s identity.

PARTICIPATION AND WITHDRAWAL
You child’s participation is voluntary. Your or your child’s refusal to participate will
involve no penalty or loss of benefits to which you are otherwise entitled. You may
withdraw your consent at any time and discontinue participation without penalty. You are
not waiving any legal claims, rights or remedies because of your participation in this
research study. The investigator may withdraw your child from this research if
circumstances arise which warrant doing so. For example, the investigator may have to
withdraw your child to make changes to the study, or they may terminate the study due to
technical problems.

RIGHTS OF RESEARCH SUBJECTS
If you have any questions about your rights as a study subject or you would like to speak
with someone independent of the research team to have questions answered about the
research, or in the event the research staff can not be reached, please contact the
University Park IRB, Office of the Vice Provost for Research Advancement, Stonier
Hall, Room 224a, Los Angeles, CA 90089-1146, (213) 821-5272 or upirb@usc.edu

174
Appendix J, Continued

IDENTIFICATION OF INVESTIGATORS
If you have any questions or concerns about the research, please feel free to contact
Marientina Gotsis at 310-933-6648 with any questions or concerns about your
participation in this study. If you feel you have been hurt by taking part in this study,
please contact Marientina Gotsis at 310-933-6648.

By entering my initials below, I agree that I have read this Parental Consent Form
carefully and agree to allow my child to participate in this study. I understand my
child will be given a separate document to review.

Initial here to consent: __________
My child’s name: _____________

If initials are entered, GO TO the (WP General Thank You) END OF SURVEY page.

Q1. Please indicate your first and last name:

First Name:

Last Name:

Q2. You were born in:

Q3. Your sex:

Male Female

175
Appendix J, Continued

Q3a. What is the highest level of schooling that you have completed?
Less than high school
High school graduate / vocational school / trade school
Some college
4-year college graduate or above
Prefer not to answer

Q3b. What is your racial or ethnic background?
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Other, specify:
Prefer not to answer

Q3c. What is your marital status?
Single
Married
Living with partner
Divorced /separated
Widowed
Prefer not to answer

176
Appendix J, Continued

Q4. Which USC department are you affiliated with?

Q5. Which category does your job at USC belong to?

Q6. What is USC internal job title?
My job title:

Q7. When did you join USC?
Please indicate the specific year (e.g., 1998):

Q8. How did you hear about this study?
From a family member
From a friend or colleague
Internet blast (email) from USC Work & Family Life
Advertisement in USC publication (Chronicle, DailyTrojan, etc.)
Sign or poster
Other (please specify):

Q9. Who invited you to participate in the Wellness Partners study?
Full name of the person:

Q10. How tall are you?
Feet:

Inches:

177
Appendix J, Continued

Q11. How much do you weigh?
In lbs:

Q12. On average, how many hours of sleep do you get at night?
Hours per night:

Q13. On average, how many servings of fruits and vegetables do you consume in one
day?
0-1 servings
2-3 servings
4-5 servings
5 servings or more

Q14. On average, how often do you exercise? (If you don't exercise at all, please enter 0)
Days per week:

Minutes per day:

If “days per week” is equal to 0, GO TO Q20

________________________________________________________________________

Q15. Do you usually exercise alone, with someone else, or both?
Alone
With someone else
Both
There are different types of physical activities:
Mild exercise with minimal effort such as yoga, archery, fishing from river band,
bowling, horseshoes, golf, snow-mobiling, easy walking
178
Appendix J, Continued
Moderate exercise which is not exhausting such as fast walking, baseball, tennis, easy
bicycling, volleyball, badminton, easy swimming, alpine skiing, pop or folk dancing
Strenuous exercise with heart beats rapidly such as running, jogging, hockey, football,
soccer, squash, basketball, cross country skiing, judo, roller skating, vigorous swimming,
vigorous long distance bicycling
Q16. Considering a 7-day period (a week), how many times, on average, do you do the
following kinds of exercise for more than 15 minutes during your free time?

Number of times
Mild exercise:

Moderate exercise:

Strenuous exercise:

Q17. Considering a 7-day period (a week), during your leisure time, how often do you
engage in any regular activity long enough to work up a sweat (heart beats rapidly)?

Never/Rarely Sometimes Often

Q18. Considering just the past week (last 7 days), how many times, on average, did you
do the following kinds of exercise for more than 15 minutes during your free time?

Number of times in the past
week

Mild exercise:

Moderate exercise:

Strenuous exercise:

179
Appendix J, Continued
Q19. Considering just the past week (last 7 days), how many minutes each time, on
average, did you do the following kinds of exercise for more than 15 minutes during your
free time?

Average minutes each time in
the past week

Mild exercise:

Moderate exercise:

Strenuous exercise:

Q20. How many people in your social circles that you can turn to
discuss important matters?
Number of such people:

Q21. Please provide the names of up to 5 people you talk to about important matters (For the
purpose of the study, please use both their first and last names):

Name 1:

Name 2:

Name 3:

Name 4:

Name 5:

180
Appendix J, Continued

Q22. How is this person connected to you?

» Name 1:

» Name 2:

» Name 3:

» Name 4:

» Name 5:

Q23. Is this person male or female?

Male Female
» Name 1:

» Name 2:

» Name 3:

» Name 4:

» Name 5:

Q24. What is the approximate age of this person?

» Name 1:

» Name 2:

» Name 3:

» Name 4:

» Name 5:

181
Appendix J, Continued

Q25. Does this person live within half a mile of your home?

No Yes
» Name 1:

» Name 2:

» Name 3:

» Name 4:

» Name 5:

Q26. How long have you known this person? (Please answer in years - If less than one
year, enter 1):

» Name 1:

» Name 2:

» Name 3:

» Name 4:

» Name 5:

Q27. Will this person enroll in this study with you?

No Yes
» Name 1:

» Name 2:

» Name 3:

» Name 4:

» Name 5:

182
Appendix J, Continued

Q28. How often have you exercised together with this person?

Never
Less
than
once a
Month
Once a
Month
2-3
Times a
Month
Once a
Week
2-3
Times a
Week
Daily
» Name 1:

» Name 2:

» Name 3:

» Name 4:

» Name 5:

Q29. What kind of activities do you usually do with this person, if at all?

» Name 1:

» Name 2:

» Name 3:

» Name 4:

» Name 5:

183
Appendix J, Continued

Q30. How confident are you that you can ...

0 = Not at all
confident

100= Completely
confident

0 10 20 30 40 50 60 70 80 90 100

complete exercise using proper technique?

follow directions to complete exercise?

perform all the required movements?

exercise when you feel discomfort?

exercise when you lack energy?

exercise when you don’t feel well?

include exercise in your daily routine?

consistently exercise three times per week?

arrange your schedule to include regular exercise?

184
Appendix J, Continued

Q31. There are a variety of reasons why people engage in physical activity. Please
indicate how true each of these reasons is for why you engage in physical activity.

Not at all true Somewhat true Very true
Because I simply
enjoy being
physically active.

Because being
physically active is
important and
beneficial for my
health and lifestyle.

Because I would feel
bad about myself if I
didn't do it.

Because it is fun and
interesting.

Because others like
me better when I am
in shape.

Because I'd be afraid
of falling too far out
of shape.

Because it helps my
image.

Because it is
personally important
to me to work out.

Because I feel
pressured to work
out.

Because I have a
strong value for
being active and
healthy.

Because I want
others to see me as
physically fit.

185
Appendix J, Continued

Q32. In the past 4 weeks, how often have your family and friends done the following
things with you?

Never
Less
than
once a
year
Once a
year
Less
than
once a
month
Once a
month
Less
than
once a
week
Once a
week
More
than
once a
week
Encourage me to
exercise

Praise me for
exercising

Criticize me for
exercising

Exercise with me

Play sports with me

Q33. How much of the following kinds of help or support do you think you have?

None
1
2 3 4 5 6
Very
much
7
Assurance that you are loved

Financial assistance for emergencies

Help to set realistic goals

Assistance when you act in self-defeating ways

Know others whom you could talk to when you
are down and blue

Information to change negative feelings

Help to see optimism in the future

186
Appendix J, Continued
Digital games include video games, computer games, online games, and mobile games.
Q34. Have you ever played digital games?
No  GO TO Q39 Yes

Q35. Which of the following game platforms have you used? [CHECK ALL THAT
APPLY]
A game console (e.g, PlayStation, Xbox, Wii, GameCube)
A portable gaming device (e.g., DS, PSP, GameBoy)
A desktop or laptop computer
A cell phone or handheld organizer
None of the above

Q36. How often do you play digital games now?
Don’t play anymore
Every now and then
At least once or twice a month
At least once or twice a week
At least once or twice a day

Q37. If you play digital games, what kind do you play? [CHECK ALL THE APPLY]

Action

Adventure

First-Person Shooter

Fighting

Puzzle

Racing

Role-Playing

Simulation

Sports

Strategy

Other (please specify):

187
Appendix J, Continued

Q38. There are different ways to play digital games. Please indicate how often you play
games the following ways:

Never Rarely Sometimes Often Always
Play alone, by myself.

Play with people I know in
real life.

Play with people I first met
online.

Play with people in the
same room.

Play with people through
the Internet.

Q39. How many online social networking tools (such as Facebook and Twitter) do you
use, if at all?
Number of social networking tools used:

If entered zero, GO to Q45 in Baseline, Q42 in Posttest-Diary Only, or Q43 in Posttest-
Game

Q40. What are the online social networking tools that you have been using regularly?
1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

188
Appendix J, Continued

41. On average, how often do you use these online social networking tools?

Less
than
once a
month
Once a
month
2-3
times a
month
Once a
week
2-3
times a
week
Once a
day
More
than
once a
day
» 1.

» 2.

» 3.

» 4.

» 5.

» 6.

» 7.

» 8.

» 9.

» 10.

189
Appendix J, Continued
Q42. How much do you agree or disagree with the following statements about Wellness
Partners activity diary? [1 = strongly disagree and 7 = strongly agree]

1 2 3 4 5 6 7
It is difficult to navigate
around.

Web pages load fast.

It has valid hyperlinks.

It is easy to access.

I have not experienced many
technical problems.

It has a nice look and feel.

It looks organized.

It is confusing to fill out
information for my physical
activity updates.

It is convenient to send activity
updates through my cell phone.

It does not take too much time
to send updates every day.

I enjoy sharing information
about my physical activities
with family and friends.

I like reading my partners'
updates.

It motivates me to be more
active when it comes to
exercise.

It prompts me to think more
about healthy lifestyles.

I would like to sign up with my
family and friends if this
program were made available
in the public domain.

190
Appendix J, Continued
Q43. How much do you agree or disagree with the following statements about Wellness
Partners activity diary? [1 = strongly disagree and 7 = strongly agree]

1 2 3 4 5 6 7
It is difficult to navigate
around.

Web pages load fast.

It has valid hyperlinks.

It is easy to access.

I have not experienced many
technical problems.

It has a nice look and feel.

It looks organized.

It is confusing to fill out
information for my physical
activity updates.

It is convenient to send activity
updates through my cell phone.

It does not take too much time
to send updates every day.

I enjoy sharing information
about my physical activities
with family and friends.

I like reading my partners'
updates.

It motivates me to be more
active when it comes to
exercise.

It prompts me to think more
about healthy lifestyles.

I would like to sign up with my
family and friends if this
program were made available
in the public domain.

191
Appendix J, Continued

It gives me a sense of accomplishment when I am
rewarded points for the physical activities I report.

The display of total points presents me a feeling of
competition with my partners in the program.

I like the variety of locations I can choose from.

The collectables are cute.

I like the fact that I can give the virtual character a
personalized nickname.

I like the look and feel of the virtual character.

I enjoy watching the animated activities of the virtual
character.

________________________________________________________________________
Q44. How much do you agree or disagree with the following statements about the
communication between you and the virtual character? [1 = strongly disagree and 7
= strongly agree]

1 2 3 4 5 6 7
The virtual character
created a sense of
closeness with me.

The virtual character
was very impersonal
in its dealings with
me.

I found the virtual
character to be almost
like a friend in real
life.

The virtual character
is likeable.

The virtual character
is unfriendly.

The virtual character
is fun.

The virtual character
holds my attention.

192
Appendix J, Continued

The virtual character excites my curiosity.

The virtual character motivates me to do more exercise.

________________________________________________________________________
Q45. During the past week (last 7 days), on average, how many hours per day did you
engage in the following activities? (If none, please enter 0)

Average hours per day
Play digital games

Surf social network sites

Work at the computer

Watch TV

Drive to and from work

Read for pleasure

Q46. Please indicate how much do you agree or disagree with each of the following
statements:

Strongly Disagree Disagree Neutral Agree
Strongly
Agree
A healthy lifestyle is
important to me.

I am knowledgeable about
healthy lifestyle choices.

I often eat foods that are
not good for me.

Digital games are fun.

I like playing games on the
computer.

I use the Internet daily.

I use my cell phone a lot.

193
Appendix J, Continued

Q47. In general, would you say your health is:
Excellent Very good Good Fair Poor

Q48. The following questions are about activities you might do during a typical day.
Does your health now limit you in these activities? If so, how much?

Yes, limited a lot Yes, limited a little No, not limited at all
Moderate activities, such as
moving a table, pushing a
vacuum cleaner, bowling, or
playing golf

Climbing several flights of
stairs

Q49. During the past 4 weeks, how much of the time have you had any of the following
result of your physical health?

All of the
time
Most of the
time
Some of the
time
A little of
the time
None of the
time
Accomplished less
than you would like

Were limited in the
kind of work or other
activities

194
Appendix J, Continued

Q50. During the past 4 weeks, how much of the time have you had any of the following
result of any emotional problems (such as feeling depressed or anxious)?

All of the
time
Most of the
time
Some of the
time
A little of
the time
None of the
time
Accomplished less than
you would like

Did work or other
activities less carefully
than usual

Q51. During the past 4 weeks, how much did pain interfere with your normal work
(including both work outside the home and housework)?

Not at all A little bit Moderately Quite a bit Extremely

Q52. These questions are about how you feel and how things have been with you during
the past 4 weeks. For each question, please give the one answer that comes closest to the
way you have been feeling. How much of the time during the past 4 weeks…

All of the
time
Most of the
time
Some of the
time
A little of
the time
None of the
time
have you felt calm
and peaceful?

did you have a lot of
energy?

have you felt
downhearted and
depressed?

195
Appendix J, Continued

Q53. During the past 4 weeks, how much of the time has your physical health or
emotional problems interfered with your social activities (like visiting friends, relatives,
etc.)?

All of the time Most of the time
Some of the
time
A little of the time
None of the
time

Q54. Please feel free to share your comments and/or concerns about this study:

GO to the (WP General Thank You) END OF SURVEY page.

196
Appendix J, Continued

Questions included in “Baseline – Egos”:
IC-Minor, IC-Adult, IC-Parent, Q1-8, Q10-41, Q45-54

Questions included in “Baseline – Alters”:
IC-Minor, IC-Adult, IC-Parent, Q1-3, Q8-41, Q45-54

Questions included in “Posttest – Diary Only”:
Q1-2, Q12-33, Q39-42, Q45-54

Questions included in “Posttest – Game”:
Q1-2, Q12-33, Q39-41, Q43-54

Questions used “forced response”:
IC-Minor, IC-Adult, IC-Parent, Q1-6, Q10-11, Q14-34, Q39, Q42-44, Q47-53

Questions used “randomization” of the order of items:
Q30-33, Q42-44

Notes:
1. Each underline indicates a page break in Qualtrics but the yellow highlighted
headings won’t appear in the surveys
2. Q16 and Q17 replicated Godin and Shephard (1985) measures
3. Q30 replicated Rogers et al (2008) multidimensional measure of self-efficacy for
physical activity
4. Q32 are modified measures of perceived social support for physical activity based
on Pender’s exercise social support scale (http://www.nursing.umich.edu/faculty/
penderinstruments/researchinstruments.html)
5. Q33 are modified measures of perceived social support in general based on
Brown, Brady, Lent, Wolfert, and Hall (1987).

197
Appendix J, Continued

6. Q44 are modified para-social presence scales from Kumar and Benbasat (2002)
http://www.presence-research.org/AppendixA.html

7. Q47-Q53 are identical to SF-12v2 standard questionnaire including the
directionality of options

Baseline
Egos
Baseline
Alters
Posttest
Diary Only
Pottest
Game
Informed
Consent
√ √
Q1-2 √ √ √ √
Q3 √ √
Q3a-c √ √ √ √
Q4-7 √
Q8 √ √
Demographic
and basic info
Q9 √
Health basics Q10-13 √ √ √ √
Exercise habits Q14-19 √ √ √ √
Social network Q20-29 √ √ √ √
Self-efficacy Q30 √ √ √ √
Exercise
motivation
Q31 √ √ √ √
Social support Q32-33 √ √ √ √
Prior gaming
experience
Q34-38 √ √
SNS use Q39-41 √ √ √ √
Q42 √ Diary
evaluation
Q43 √

198
Appendix J, Continued

Game
evaluation
Q44 √
Lifestyle Q45-46 √ √ √ √
Health/SF12v2 Q47-53 √ √ √ √
Comments Q54 √ √ √ √

199
APPENDIX K:
NETWORK VISUALIZATION AND GROUP WEB ACTIVITIES

200

Appendix K, Continued Network #1

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
Group
Act
Messages
Memories
Collectibles
Gifting

0010001

Ego
29
29
25
4
1
6
0
14
3

0010002

Alter
28
13
6
2
1
2
0
11
0

0010003

Alter
23
22
29
9
0
1
1
10
3

Note:
Participant
0010001
became
pregnant
during
the
study.

201

Appendix K, Continued Network #2

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0020006

Ego
32
16
10
1
0
0
N/A
N/A
N/A

0020004

Alter
29
1
0
0
0
0
N/A
N/A
N/A

202

Appendix K, Continued Network #3

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0030014

Ego
25
37
23
11
13
4
3
22
2

0030012

Alter
26
24
15
9
13
6
2
15
3

203

Appendix K, Continued Network #4

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0040011

Ego
33
28
41
2
1
0
N/A
N/A
N/A

0040013

Alter
32
30
25
6
1
0
N/A
N/A
N/A

Note:
Participant
0040013
was
in
her
late
pregnancy
during
the
study.

204

Appendix K, Continued Network #5

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0050009

Ego
31
18
16
3
6
9
0
15
2

0050010

Alter
32
39
23
4
6
2
0
10
0

205

Appendix K, Continued Network #6

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0060021

Ego
27
26
32
2
0
0
N/A
N/A
N/A

0060022

Alter
32
8
9
3
0
0
N/A
N/A
N/A

206

Appendix K, Continued Network #7

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0070023

Ego
32
27
4
18
3
2
10
5
1

0070020

Alter
33
0
0
0
0
0
0
0
0

207

Appendix K, Continued Network #8

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0080029

Ego
36
19
24
1
3
0
N/A
N/A
N/A

0080039

Alter
40
5
12
0
3
0
N/A
N/A
N/A

208

Appendix K, Continued Network #9

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0090015

Ego
35
25
15
0
3
5
1
9
2

0090033

Alter
31
9
7
0
3
1
0
1
0

0090019

Alter
34
22
15
2
0
2
0
5
0

Note:
Participant
0090019
became
pregnant
during
the
study.

209

Appendix K, Continued Network #10

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0100036

Ego
44
39
11
3
0
9
12
15
7

0100026

Alter
27
3
3
0
0
3
0
1
2

0100059

Alter
28
10
6
0
0
1
1
5
3

210

Appendix K, Continued Network #11

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0110018

Ego
30
15
6
1
0
0
N/A
N/A
N/A

0110016

Alter
55
0
0
0
0
0
N/A
N/A
N/A

211

Appendix K, Continued Network #12

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0120037

Ego

36

17
9
2
0
3
1
3
0

0120042

Alter

16

8
6
1
0
0
0
3
0

0120046

Alter

36

6
8
1
0
1
0
1
0

212

Appendix K, Continued Network #13

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0130038

Ego
28
30
19
9
5
0
0
3
0

0130051

Alter
30
22
18
5
5
0
0
2
0

213

Appendix K, Continued Network #14

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0140032

Ego
41
28
27
1
0
4
N/A
N/A
N/A

0140025

Alter
41
46
86
4
0
10
N/A
N/A
N/A

214

Appendix K, Continued Network #15

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0150044

Ego
26
34
22
19
18
13
0
16
7

0150048

Alter
24
25
18
2
18
4
2
12
3

0150053

Alter
24
16
13
0
5
6
4
7
2

0150063

Alter

26
13
11
0
9
2
4
10
2

0150070

Alter

24
8
12
0
10
1
0
10
1

0150082

Alter

26
7
11
0
3
0
0
0
0

215

Appendix K, Continued Network #16

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0160040

Ego
25
15
20
1
0
0
0
0
0

0160041

Alter
25
10
17
1
0
0
0
1
0

216

Appendix K, Continued Network #17

ID
T1
T2
Role
Age
Logins
Activities
Setbacks

Group

Act

Messages
Memories
Collectibles
Gifting

0170049

Ego
39
41
39
5
28
0
N/A
N/A
N/A

0170047

Alter
29
15
35
0
28
0
N/A
N/A
N/A

217

Appendix K, Continued Network #18

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0180057

Ego
41
2
1
0
0
1
0
1
1

0180027

Alter
57
29
22
0
1
15
0
9
4

0180065

Alter
33
2
4
0
1
4
0
2
2

218

Appendix K, Continued Network #19

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0190056

Ego
36
34
28
5
1
3
N/A
N/A
N/A

0190060

Alter
50
26
20
4
1
3
N/A
N/A
N/A

0190064

Alter
38
1
1
0
0
0
N/A
N/A
N/A

0190091

Alter

54
28
23
8
0
0
N/A
N/A
N/A

219

Appendix K, Continued Network #20

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0200050

Ego
37
39
37
10
9
0
N/A
N/A
N/A

0200045

Alter
32
22
18
10
9
0
N/A
N/A
N/A

220

Appendix K, Continued Network #21

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0210052

Ego
41
27
37
1
2
4
0
22
1

0210068

Alter
22
28
27
3
2
4
1
32
2

221

Appendix K, Continued Network #22

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages

Memorie
s

Collect-‐
ibles

Gifting

0220
067

Ego
29
61
49
6
13
1
N/A
N/A
N/A

0220
066

Alter
27
23
29
3
5
0
N/A
N/A
N/A

0220
109

Alter
53
5
1
0
1
0
N/A
N/A
N/A

0220
112

Alter

47
19
15
0
0
0
N/A
N/A
N/A

222

Appendix K, Continued Network #22
Table
Continued

02201
15

Alter

50
23
24
2
7
0
N/A
N/A
N/A

02201
14

Alter

37
14
1
0
0
0
N/A
N/A
N/A

223

Appendix K, Continued Network #23

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0230073

Ego
25
18
23
0
2
0
0
1
0

0230072

Alter
27
21
22
2
2
1
0
0
0

224

Appendix K, Continued Network #24

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0240043

Ego
33
14
17
4
4
2
0
0
0

0240028

Alter
39
19
10
1
4
0
0
0
0

225

Appendix K, Continued Network #25

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0250076

Ego
26
1
0
0
0
1
0
0
0

0250077

Alter
21
0
0
0
0
0
0
0
0

226

Appendix K, Continued Network #26

ID
T1
T2
Role
Age
Logins
Activities
Setbacks

Group

Act

Messages
Memories
Collectibles
Gifting

0260080

Ego
27
24
26
0
6
1
N/A
N/A
N/A

0260075

Alter
25
22
19
1
8
2
N/A
N/A
N/A

0260079

Alter
27
23
13
2
6
0
N/A
N/A
N/A

0260100

Alter

22
18
9
10
4
0
N/A
N/A
N/A

Note:
Participant
0260079
was
in
her
late
pregnancy
during
the
study.

227

Appendix K, Continued Network #27

ID
T1
T2
Role
Age
Logins
Activities
Setbacks

Group

Act

Messages
Memories
Collectibles
Gifting

0270078

Ego
33
3
0
0
0
0
0
0
0

0270074

Alter
27
21
28
0
0
0
0
20
0

228

Appendix K, Continued Network #28

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0280055

Ego
28
18
18
2
1
1
0
10
0

0280054

Alter
28
33
42
2
1
1
3
18
0

229

Appendix K, Continued Network #29

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0290058

Ego
44
22
27
1
11
4
N/A
N/A
N/A

0290069

Alter
42
44
38
1
6
3
N/A
N/A
N/A

0290117

Alter
46
5
2
0
11
0
N/A
N/A
N/A

230

Appendix K, Continued Network #30

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0300086

Ego
33
26
28
5
34
2
N/A
N/A
N/A

0300096

Alter
33
18
18
0
34
1
N/A
N/A
N/A

231

Appendix K, Continued Network #31

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0310071

Ego
37
25
13
10
0
4
N/A
N/A
N/A

0310089

Alter
31
19
8
8
0
3
N/A
N/A
N/A

232

Appendix K, Continued Network #32

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0320098

Ego
36
69
30
5
1
1
17
17
1

0320088

Alter
35
15
18
0
1
0
0
20
0

233

Appendix K, Continued Network #33

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0330101

Ego
25
23
35
1
0
1
N/A
N/A
N/A

0330099

Alter
28
1
0
0
0
0
N/A
N/A
N/A

0330095

Alter
29
0
0
0
0
1
N/A
N/A
N/A

234

Appendix K, Continued Network #34

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0340102

Ego
38
29
17
5
0
11
0
3
2

0340094

Alter
34
28
21
5
0
7
0
13
5

0340118

Alter
44
28
27
1
0
14
4
12
4

0340092

Alter

46
11
6
1
0
23
0
4
5

235

Appendix K, Continued Network #35

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0350104

Ego
27
18
10
3
1
2
N/A
N/A
N/A

0350105

Alter
55
25
9
7
5
1
N/A
N/A
N/A

0350111

Alter
56
13
11
1
4
0
N/A
N/A
N/A

236

Appendix K, Continued Network #36

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0360103

Ego
30
7
7
1
1
0
N/A
N/A
N/A

0360106

Alter
32
1
0
0
1
0
N/A
N/A
N/A

237

Appendix K, Continued Network #37

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0370097

Ego
31
1
0
0
0
0
0
0
0

0370085

Alter
31
9
10
1
0
2
0
4
0

238

Appendix K, Continued Network #38

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0380062

Ego
43
1
0
0
0
0
0
0
0

0380037

Alter
45
8
14
2
0
2
0
4
0

239

Appendix K, Continued Network #39

ID
T1
T2
Role
Age
Logins
Activities
Setbacks
GroupAct
Messages
Memories
Collectibles
Gifting

0390110

Ego
36
10
8
1
1
1
0
0
0

0390107

Alter
56
10
15
3
1
0
0
0
0

240
APPENDIX L:
RECRUITMENT EMAIL FOR INTERVIEW PARTICIPANTS

Email Recruitment of Interviewees

Dear {insert Wellness Partners participant name},

Thank you for your participation in the Wellness Partners study! Only up to 15 primary
participants and up to 15 secondary participants are invited for an interview to share their
personal experience and thoughts about the Wellness Partners program. And you are one
of them!

You have been selected based on your individual attributes such as your role in the study
as a primary or secondary participant, gender, age, user behavior on the intervention
website as well as the structure and size of your study group.

You will receive an additional $25 for participating in a 45-60 minutes interview either in
person or via telephone. All the details about the interview are included in the attached
information sheet. Please read carefully.

If you choose to accept this interview offer, simply reply to this email and indicate as
such and I will follow up to arrange the time and location.

Thank you very much!

Cordially,
Helen Hua Wang
The Wellness Partners Research Team

241
APPENDIX M:
INFORMATION SHEET FOR INTERVIEW PARTICIPANTS
INFORMATION SHEET FOR NON-MEDICAL RESEARCH
Interview Informed Consent for Adults
You are invited to participate in an interview conducted by the Ph.D. Student Investigator
Helen Hua Wang on the Wellness Partners Research Team at the University of Southern
California. As a participant currently enrolled in our study, you have granted consent for
using the study intervention website for 10 weeks and completing three online surveys
(as well as three physical measurements if you are a primary participant in your group).

This document describes the importance, procedure, and compensation regarding only the
interview part of the project that was not included in your previous informed consent
form. Your participation is entirely voluntary and confidential.

PURPOSE OF THE INTERVIEW
As you know, Wellness Partners is a collaborative research project about exercise habits
and perceived wellness. We appreciate your participation in the past 10 weeks. This
interview will help us contextualize and supplement the answers you provided in our
online surveys, your use of the intervention website, as well as the data from your
physical measurements if you are a primary participant in your study group.

PROCEDURES
The interview will take place either at a meeting room on the USC University Park
Campus or via telephone. You may or may not be interviewed along with some of your
wellness partners in the study group depending on their availability. The interview will
last 45-60 minutes. Your answers will be recorded using a digital voice recorder.

POTENTIAL RISKS AND DISCOMFORTS
If both you and your wellness partner(s) are present at the interview, you may hear from
your study partner(s) unexpected comments about their personal experience and/or
thoughts specifically related to this study or physical activity and individual well-being in
general. However, given that all your wellness partners are family or friends in real life
and that you have been using the intervention website together as a group for the past 10
weeks, the researchers do not anticipate that you will experience any risks or discomforts
during this interview that would exceed those of your everyday life.

242
Appendix M, Continued

POTENTIAL BENEFITS TO SUBJECTS AND/OR TO SOCIETY
You may use this opportunity to clarify your concerns with the experience you have had
with this study, assist the researchers to correct any possible errors during data collection
and provide more accurate interpretations and generalization of the study results.

PAYMENT/COMPENSATION FOR PARTICIPATION
As a token of our appreciation, you will receive $25. This is in addition to the total of up
to $45 that you are compensated for participating in the other parts of the study.

CONFIDENTIALITY
Any information that is in connection with this interview and that is identified with you
will remain confidential and will be disclosed only with your permission or as required
by law. Only members of the research team will have access to the data associated with
this interview. The original interview files and transcriptions will be stored on the project
computers with password protection during the study, and for a minimum of three years
and a maximum of six years after the study has been completed and then they will be
destroyed.

The information collected from this interview may be shared with our sponsor Robert
Wood Johnson Foundation, presented at professional conferences, published in academic
journals, or used for educational purposes such as shown to students in classes or training
sessions. If we do, we will not use your real name.

PARTICIPATION AND WITHDRAWAL
You can choose whether or not to participate in this interview. If you do volunteer to
participate in the interview, you may withdraw your consent at any time and refuse to
answer any questions you do not feel comfortable with.

RIGHTS OF RESEARCH SUBJECTS
If you have any questions about your rights as a study subject or you would like to speak
with someone independent of the research team to have questions answered about the
research, or in the event the research staff can not be reached, please contact the
University Park IRB, Office of the Vice Provost for Research Advancement, Stonier
Hall, Room 224a, Los Angeles, CA 90089-1146, (213) 821-5272 or upirb@usc.edu

IDENTIFICATION OF INVESTIGATOR
If you have any questions or concerns about this study, please feel free to contact
Helen Hua Wang at 626-315-7362 or wanghua@usc.edu.

243
Appendix M, Continued

I confirm that I am at least 18 years old and I have read this Adult Participant
Form carefully and agree to participate in this interview.

Participant’s Name (Print): ________________________________

Participant’s Signature: ___________________________________

Today’s date: ___________________________________________

244
APPENDIX N:
WELLNESS PARTNERS PARTICIPANT INTERVIEW GUIDE
Interview Guide with Wellness Partners Participants
Hello, {insert participant first name}. Thank you for taking the time to talk with me today.
As you know, Wellness Partners is a collaborative research project between the USC
Schools of Cinematic Arts (Interactive Media Division), Preventive Medicine, and Social
Work. I am a Ph.D. student investigator and have been working with the team since the
beginning, which has been almost two years now. I am interested in studying
communication technologies and health promotion, particularly the potential and
challenges of using digital interactive entertainment media to promote healthy lifestyles,
which is physical activity in the context of this study.
[For in-person interviews, give the participant a few minutes to read over the information
sheet again and sign before recording. For phone interviews, confirm that the signed info
sheet has been (e)mailed back before asking questions.]
Q1. (For egos) How did you learn about this study? Why did you decide to participate in
the first place? Did you have any specific expectations once you learned that it was
about wellness and exercise?

(For alters) I understand you were invited to enroll in the study by {insert ego’s first
name}, is that correct? How did you learn about this study from him/her? What did
he/she tell you? Besides being invited by a family member/friend, was there any
other reason why you decided to participate in this study? Did you have any
specific expectations once you learned that it was about wellness and exercise?
So after a lengthy screening procedure, you completed an online survey before you
started using one version of the Wellness Partners website, and a second online survey
roughly at the end of the fifth week. Then you were given instructions to switch to a
different version of the website and were asked to fill out the last survey questionnaire
not too long ago.
Our records indicate that your study group started using a more/less interactive version of
the Wellness Partners website with the virtual character from {insert date} to {insert date}

245
Appendix N, Continued
and a less/more interactive version of the website from {insert date} to {insert date}.
[Review login patterns if there was any interesting observations here].
I have two sections of questions I would like to ask you. Some are about your answers in
the three online surveys. [I went over them and if I see interesting changes over time or
consistent patterns, I would go over the details and ask if there were any reasons such as
life events that contributed to the changes/patterns just so I can better understand what is
going on behind the numbers]. Others questions have to do with your experience as a user
of the Wellness Partners program.
Q2. Now that you have used the Wellness Partners program for almost 10 weeks,
overall what do you think of it?
Q3. (For egos) Why did you decide to invite this person/these people to participate in
the study with you?

(For alters) If you were someone who could invite others to join the program, who
(else) would you invite?
Q4. What are your primary sources of information about health in general and exercise
in particular?
Does physical activity/exercise ever come up in your everyday conversations with
your family and friends? (How and how often?)
Did you communicate this topic with your Wellness Partner through the website?
And/or outside the context of this study?
Did you ever talk about the Wellness Partners study/website with your group
members? With other family and friends?
As you know, there are a number of things you could do on the Wellness Partners
website. You can report an individual physical activity or a setback, a group activity,
send a private message with your group members, and view the complete history of your
and your partners’ updates. In the more interactive version of the website, you can give a
name to the robot, accumulate points for the activities and setbacks you report, play the
animated activities by the robot, collect virtual items, or give them away as gifts.
Q5. Describe to me when you logged in for the first time, what was it like for you?

246
Appendix N, Continued
Q6. How did you feel about the switch (from one version to the other)? Which one did
you like better and why?
Q7. So looking back, what were some of the most interesting aspects to your experience?
Q8. What were the most frustrating aspects to your experience? [Check any entries in
the bug report about technical problems encountered]
Q9. [Given participant’s gaming experience] Did you perceive the more interactive
version of the Wellness Partners website as a game? Why or why not?
Q10. How did you like the robot/virtual character?
Q11. [Given participant’s use of social media] what do you think of Wellness Partners if
we were given the opportunity to modify and improve it? Would you like it to be a
standalone program or an application embedded on a popular social networking site
such as Facebook? Why?
Q12. [If the participant uses Twitter or tried to access the intervention site through their
cell phone] Did you try to use the Twitter function to link your Wellness Partners
account with your Twitter account? How would you like it if it worked for you?
Q13. What have you benefited from being part of the Wellness Partners program, if at all?
Q14. What could we do to improve the Wellness Partners program to best serve a user
like you?
Q15. If the Wellness Partners program was made available in the public domain, would
you be interested in using it with your family and friends? Why and why not?
These are all the questions I have for you unless you have additional comments you
would like to include. Thank you so much for sharing your thoughts and experience with
me today. [For in-person interviews, hand over the debit card to the participant. For
phone interviews, confirm the mailing address for sending the debit card.] Have a nice
day/evening/weekend!

247
APPENDIX O:
WELLNESS PARTNERS USER PROFILE

User profile #1
(0010001, female, ego, 29, college graduate, married, White, local, in a group of 3)
• Reasons to participate: Interested in research, active exerciser, monetary incentive
• Exercise habits: I exercise a lot (e.g., running); have friends at the gym but not
enrolled in the study; get ready for exercise with husband every morning but don’t
usually do it together
• Likes: Liked robot, point reward, see friends doing and talk about it, receive gifts
• Communication: Tried to figure out the game together and joked about it
• Dislikes: Exercise criteria are subjective (e.g., intensity)
• Desirable features: Be able to see personal trajectories

User profile #2
(0010002, male, alter, 28, college graduate, married, White, local, in a group of 3)
• Reasons to participate: tracking exercise habits, be held responsible to others
through reports
• Exercise habits: Push-ups and running in the morning, swimming in the afternoon
• Likes: Fun to collect points and spend them with the robot
• Challenges: Difficult to get in habit of using it; not into social networking or
games; privacy concerns;
• User experience: No competition, mainly about play and impression management
as “a good exerciser”
• Dislikes: Lack of clear definition of labels such as group activities (running at the
same time but not together), and objectivity of evaluation criteria such as intensity;
not being able to customize robot’s name after first login
• Potential: Would be interested in family and friends who do exercises as he does
and can be more competitive and motivating

User profile #3
(0010003, female, alter, 23, college graduate, married, White, local, in a group of 3)
• Reasons to participate: like research and to help others, potentially motivating to
exercise and track progress
• Exercise habits: Normally do the same exercises at the gym, but tried to include a
variety and longer duration for impression management on the website
• Social influence: Knowing that friends can see what I do is most motivating; it
could be even more so if there were more friends
• Likes: Getting points, collecting items, and sending gifts
• Desirable features: Would be nice to know the scoring system – how many points
for what activities, etc. and to be able to report more than two activities within 24
hours and still get points

248
Appendix O, Continued

• Game: Not into games; didn’t see Wellness Partners as a game, it was more of a
program about exercise

User profile #4
(0040011, male, ego, 33, college graduate, married, White, local, in a group of 2)
• Reasons to participate: Interested in exercise science, tracking personal progress
• Exercise habits: Strenuous exercises (rowing and running) in the evening when
kids are in bed; runs triathlon and plays basketball
• Likes: Enjoyed sharing info with wife as vicariously exercising together and send
gift along with messages
• Dislikes: Not able to report more than two activities and still get point as reward,
report activities from previous days, have rest days not as setbacks; restriction on
the length of robot’s name; loading time and glitches with animations
• Desirable features: keep track of more detailed personal data such as heart rate;
able to customize the color schemes; ways to bank big points; own multiple of the
same collectibles; increase the interactivity between robots
• Challenges: Not big fan of games or social media – waste of time; could be more
involved is immediate social circle participate

User profile #5
(0040013, female, alter, 33, college graduate, married, White, local, pregnant, in a group
of 2)
• Reasons to participate: Invited by husband; no big commitment
• Exercise habits: YMCA classes (sometimes with friends), running
• User experience: Mostly used it for tracking, inputting exercise info was easy and
not time-consuming; felt it was more of a game with myself
• Likes: Robot; points reward; sending messages and gifts
• Dislike: Glitches, technical issues
• Potential: Might have been more fun to have played with more friends who are
also into exercise

User profile #6
(0070023, female, 32, college graduate, married, Pacific Islander, local, in a group of 2)
• Reasons to participate: to help out with the study; monetary incentive; to do it
together with husband and he needs it more than I do, but the program didn’t hold
his interest
• Exercise habits: Do not normally exercise, but now tries to take talks when going
to meetings at work (due to participation in the program and the summer weather);
has a toddler who runs around to play...and sometimes the family walk together;
but tends to stop once seen some improvements; no time or energy to exercise and
have all kinds of excuses

249
Appendix O, Continued

• Dislikes: The game was not fun compared to other virtual worlds or social games;
there is not much I can do with the robot, and if I don’t exercise much and always
report setbacks, I cannot do much without many points
• Likes: Getting points reward, collecting items, exploring locations
• Desirable features: Customization of the robot; levels and reward within levels;
goal setting; tip of the day attached to the website instead of sent in emails;
teamwork to motivate players, invite friends to play together
• Potential: an ex-hardcore player of World of Warcraft now an avid social game
player on Facebook; would be more convenient to play and invite friends if the
game is on Facebook

User profile #7
(0110018, female, 30, college graduate, married, Black, local, in a group of 2)
• Reasons to participate: Was working on getting healthier at the time of
recruitment
• Exercise habits: Did not exercise at baseline, then due to health concerns started
taking a Pilates class twice a week during the intervention, and tried to keep it up
with three times a week (such as walking) when the class ended; also run around
with the three little children at home and outdoors
• Dislikes: Experienced a lot of technical issues such as reported activities not
showing up on the screen or incomplete history
• Likes: The fact the I have to report physical activities was a motivator as I didn’t
want to report it as a setback, I wanted to report that I did something
• Desirable features: Helpful exercise tips; motivational messages; set personal
goals and monitor progress; record more detailed data such as a food log

User profile #8
(0120037, female, ego, 36, high school graduate, Hispanic/Latino, divorced, local, in a
group of 3)
• Reasons to participate: Personal health and interested in learning about exercising
the right way
• Exercise habits: Was not exercising before starting the program, now exercise
four days a week about 45 minutes each time
• User experience: Keep track of personal and partners’ workouts, not interested in
games or play
• Likes: Sending messages; nice to know what others are doing
• Dislikes: Have to spend points to make the robot do things; repetitive, lack of
variety
• Challenges: Always on a tight schedule and don’t have time to play online
• Desirable features: Motivational visual cues such as a smiley face; healthy
lifestyle tips

250
Appendix O, Continued

User profile #9
(0150044, male, ego, 26, college graduate, single, Asian, local, in a group of 6)
• Reasons to participate: The topic is similar to my current work; curious about
experience as a participant in research; a chance to network with friends;
monetary incentive
• Exercise habits: Do not exercise regularly; has tried to jog once a week for 30
minutes when not busy; started exercising after seeing activities reported by
friends on the website; as a tradeoff for exercise, I try to cook with more veggies
for myself now
• User experience: Overall positive, just to plug in daily activities; had a few
technical problems; took some effort to enroll friends; interested in using points to
get collectibles, not animations
• Communication: Exercise was not a usual topic, but being part of the study
changes the loop. It triggers the conversations when I and my friends joke about
the robot
• Game: I play a lot of games and definitely see this program with gaming elements;
but mostly it was a way for me to keep a journal of my activities (mainly setbacks)
• Likes: Networking and play with friends; discuss the program and exercise/health;
reading funny comments on the website
• Dislikes: Too simplistic without many features; problems with loading; reported
activities not recorded; the tag cloud was cluttered
• Desirable features: Able to upload a live picture; to keep track of activities and
see progress on a regular basis; to personalize the robot

User profile #10
(0150048, male, alter, 24, college graduate, single, local, in a group of 6)
• Reasons to participate: Help out with friend; monetary incentive
• Exercise habits: Sometimes exercise alone, sometimes play basketball with
coworkers
• User experience: Had trouble remembering to log in; Reported when remembered
to login, and sometimes logged in just to see others’ updates; Learned about
friend’s exercise habits
• Likes: earning points to make the robot to doings and collect items
• Dislikes: Not able to access from iPhone; too many screens to go through to send
updates; not able to report past activities from a different day; no additional points
for more than two activities reported in a day; one of the memories couldn’t
replay properly
• Desirable features: Easy notifications of activities on the website such as a red
check or flashing exclamation point; personalize the color theme of the website;
have different robots to choose from and customize

251
Appendix O, Continued

User profile #11
(0150053, male, alter, 24, college graduate, single, Asian, long distance)
• Reasons to participate: Help out with friend; monetary incentive
• User experience: Reported to get points and collect items, gave a couple away;
it’s just a joke
• Likes: a personal message from a friend saying something funny to motivate him
login
• Desirable features: Able to see friend’s points to make it competitive; use
incentives like a free 30-day pass to a gym to motivate people actually do it
outside of the program

User profile #12
(0150082, male, alter, 26, college graduate, single, Asian, local, in a group of 6)
• Reasons to participate: Monetary incentive
• User experience: Problems with logging in; navigation and the robot on the
website were confusing; learned more about friend’s exercise habits and happy
for them
• Desirable features: Upload and share pictures of the reported events; play with
friends to achieve goals together

User profile #13
(0170049, male, ego, 39, college graduate, single, White, local, in a group of 2)
• Reasons to participate: Interested in health, fitness, and metrics associated with
measuring fitness; curious about how the program monitors fitness and the
feedback it can provide
• Exercise habits: athletic, plays soccer, basketball, table tennis, running, hiking, etc.
• User experience: Thought the idea of collaborating with friends and colleagues in
fitness and recording activities was good, but the technology was disappointing
and web interface was poorly designed
• Dislikes: Lots of bugs and couldn’t do some of the simple tasks, the web interface
was poor in terms of functionality and aesthetics; not interested in games and
would appreciate a clean and profession interface to input personal data, keep
track, and get feedback
• Desirable features: Able to input more detailed info such as blood pressure and
resting pulse, visualize the trajectories over time, and provide scientific feedback;
would be nice to know how the numbers are calculated; quantify personal
objectives and track progress; tie the robot activities to user’s exercises in real life
to make it more meaningful and not just frivolous play

252
Appendix O, Continued

User profile #14
(0190056, male, 36, college graduate, married, White, local, in a group of 4)
• Reasons to participate: Interested in wellness and weight loss; easy for me logging
as I sit at computer all day anyway; was previously in a weigh watcher group at
work and another group with close social circle, thought this program would be a
good fit to do it on the computer
• Exercise habits: running in the evening after putting kids in bed
• User experience: Experienced some technical issues such as not being able to
change password, and user names not showing up in comment; Liked the
simplistic version with straight reporting and sharing with friends; thought the
game version was confusing in terms of the rules and navigation
• Likes: The simplicity – report activities, see them show up on the screen, and send
private message if I wanted – simple, straightforward, not time-consuming
• Desirable features: weekly weighing option, plotting the changes, not weight in
absolute numbers; integrate the program on Facebook for easy access and info
sharing

User profile #15
(0190060, female, alter, 50, college graduate, married, White, local, in a group of 4)
• Reasons to participate: Invited by a friend; interested in wellness and weight loss
• Exercise habits: Walks with sister twice a week, and exercise another way for the
third day
• Dislikes: In the beginning, the user names would not show up for reported
activities of different group members
• Desirable features: Larger font for older users
• Challenges: Do not text on cell phone or use Facebook other than monitoring
children; have a stable and close social circle mostly see in person; not easy to
change habits although I admit being part of this program did motivate me to
exercise and eat healthy

User profile #16
(0190091, female, alter, 54, college graduate, married, White, local, in a group of 4)
• Reasons to participate: Be motivated to lose weight; out of primary target group,
joined as a partner of a coworker/friend
• User experience: Simply wanted to track personal activities; did not care about the
game and not sure how and why to get points or spend points
• Likes: Found the daily email reminder helpful to motivate me think about
exercising because I have got to log in.
• Dislikes: Had problem logging in; the system wouldn’t always record the
activities

253
Appendix O, Continued

User profile #17
(0260080, male, ego, 27, college graduate, married, White, local, in a group of 4)
• Reasons to participate: Interested in wellness; to interact with family in a new
way; keep track and accountable to both myself and my family for my exercise
habits
• Exercise habits: Used to be an athlete in college; now do not exercise regularly,
but keep a journal to keep track of running time, distance, etc.; would play sports
or do things together when family get together such as hiking, talking, playing
badminton, running, swimming
• Communication: Exercise used to be a topic of conversation when I went running
and my family member did something, but now it is less often; we tried to
message through the website a couple times and then just used it to share
information about our activities
• Likes: The very idea of keeping an exercise journal online and show others that I
am active
• Dislikes: The shortcut of posting activities didn’t work; sometimes my wife
would keep logged in and I posted activities under her name a few times
• Desirable features: Other than intensity and duration, it would be nice to include
an option to record distance as running is a frequent activity for me; automatic
email updates with summaries of reported activities on the program without
necessarily logging every day but hyperlinks directly connected to the original
web page if I might be interested in checking out more details, this would help
keep track of other’s activities and work together towards shared goals;
motivational messages to encourage me log in more frequently; some charts
should be nice

User profile #18
(0340102, female, ego, 38, college graduate, single, Hispanic/Latino, local, in a group of
5)
• Reasons to participate: I exercise regularly and was looking to see if using the
program to monitor my activities could help me exercise more
• Likes: Track personal activities; tag clouds to see the most popular activities; see
my sister’s activities and joke about it
• Dislikes: The black and white of activity versus setback, I could just have a day I
didn’t exercise but I don’t necessarily consider it a setback; able to record past
activities on the days I forgot to login; the animations were lame and pointless
• Desirable features: A calendar view to see each day who logged in and what they
reported which also allows me to report past events; visualization is better than
tallying numbers; use the robot to help set personal goals and send motivating
messages in terms of progress

254
Appendix O, Continued

User profile #19
(0340094, female, alter, 34, college graduate, living with a partner, Hispanic/Latino,
long-distance, in a group of 5)
• Reasons to participate: Discussed this with sisters on Skype and thought it would
be nice to do it together
• Dislikes: I am used to the aesthetics in video games and social media, so I felt the
game interface was rudimentary; although I didn’t find the robot depressing, I
didn’t associate with it and feel too compelled to do anything with it; same
activities reported on the same day didn’t count as much
• Like: Knowing what my sisters are doing and provide support; accumulate points
so I can send gifts; friendly competition and easy to see the results through the tag
clouds
• Desirable features: improve the graphics and have a better artistically drawn robot;
the robot should not always be doing thing alone, it would be nice to see your
robot interacting with other’s robots to make it more social; use the collectibles as
the robot’s accessories; goal setting; levels

User profile #20
(0340118, female, alter, 44, college graduate, single, Hispanic/Latino, long distance, in a
group of 5)
• Reasons to participate: My sister wanted to join the program and motivate herself
to exercise more. She thought it would be good for us and invited me and other
sisters.
• Likes: See what my sisters are doing and to report and track my own activities
• Dislikes: The simplistic functions of the robot; there are many extra and
unnecessary steps for reporting an activity such as the “done adding friends” and
“okay” screens; some reports would not show up and I don’t see all my sisters’
updates; only the first two entries you can get points for; not be able to report past
activities
• Desirable features: The robot would provide instant feedback upon reported
activities; to customize and accessorize the robot such as a pedometer, a pair of
gyms shoes, or a yoga mat as onscreen reward; a virtual personal training; have
the tips up front to know about the shortcuts instead of learning about it from the
email tip of the day later; send mass email messages; weekly summaries of all
users in a table; at the end of the day input more data like pedometer info such as
number of steps; goal setting and tracking progress; setting up competitions and
prize for each month, year, etc. ; motivational reminders to exercise; be able to
move around and resize the boxes of different sections to change the layout;
organize the tag clouds in alphabetical order

255
APPENDIX P:
WELLNESS PARTNERS DESIGNER/DEVELOPER INTERVIEW

Interview with the Wellness Partners Designer Marientina Gotsis

I'm going to interview you more as a designer and developer of this
intervention today. Most of the questions are more specific about this
intervention the Wellness Partners program itself and some of them are
more general about your thinking in terms of using digital games for health
promotion. So let me start with the first question, I guess more about your
personal experience. What inspired you to become interested in games for
health?

I guess the first time that I was really interested in trying to do something was when
I was volunteering for a forum online for Thalassemia. It was an international forum
for a condition known as the Thalassemia which is a hereditary blood disorder. And
then I was working with a local foundation and I also has spoken to some clinicians
here at the Children’s Hospital who take care of a lot of kids that have Thalassemia.
And I was looking into solutions that could help with the highest priority problem for
kids with Thalassemia which was treatment compliance. And part of the treatment
requires that you do it everyday, on a daily basis, and so I was brainstorming with
some other students and trying to think about what kind of games we could do that
could make the reporting and compliance for a daily health-related activity fun, and
also something that becomes a family affair because ultimately for certain disorders,
especially this one, the critical period was adolescence. And before that, your
parents take care of you, but as you become more dependent, kids kind of stop
doing what they’re supposed to be doing and they don't see the results of their
noncompliance until they have heart or liver damage.

So we were trying to find ideas and designing interventions for something that was
daily, that would increase people’s compliance, something like a diary activity
potentially. And we submitted a grant to Microsoft initially and that didn’t get
funded, they were looking for some more engineering–oriented solutions and then
the Robert Wood Johnson call came out and I had been monitoring them for about a
year looking into programs and they don’t fund specific conditions, they fund kind of
bigger ideas. And so we thought, “Okay if we can crack a basic problem that affects
everybody such as exercise, perhaps then we can move on to customize for a more
specialized condition.” So that’s how this was born.

And so then what are the major phases and processes that you and your
team had to go through to develop this program?

So we went through a pre-design phase in order to submit the grant application
because they wanted a brief game design document. So we had some brainstorming
sessions. First with Maryalice Jordan-Marsh, we white boarded it to try to figure out
what the main components of it should be. And then we worked with Diana Hughes
who was the first game designer we worked with, who was a senior programmer who
graduated to work on a preliminary game design document and we submitted that to

256
Appendix P, Continued

the sponsor (Robert Wood Johnson Foundation). After the project was, thankfully,
approved and funded, we went to an actual design process. So we went a little bit in
parallel in the beginning in terms of trying to think about what platform it would live
on and also what kind of design ultimately what form it would take. And when we
first conceptualized it, we thought it would be an iPhone application but it turned out
to be too expensive to do it for the iPhone and manage the participants and also the
development was kind of difficult for the graphics that you wanted to do, and then
we also thought we would problems actually finding this population with all of them
would have iPhones and it just became a little messy. So we step back a little bit and
we decided that our platform should be the web and not hardware specific which is a
really big challenge. It turns out that that was a good decision because as I'm
seeing now with a lot of people who are trying similar things, they are trying to make
web the platform. And also for the graphics we chose flash to be the platform and
that seems to be more and more supported, and in fact the only platform it doesn't
support is the iPhone, but we've got to have to eventually, even though it had a big
part in the market.

So design-wise, we started very, very low—at low end. So we actually tried to
prototype the interaction, so it kind of scrapped a lot of what was in the initial design
document, and we did a prototype over email. So we rehearsed the interactions
through an email and a cell phone, so I hired another designer at the time Jamie
Antonisse and went through a series of iterations, trying to figure out what it would
feel like to use this. So, it was completely fixed so there was a person on the other
side and he would text message me and I would text message back and it would
make change on the fly, maybe they should sound like this, and the voice should be
like that. And then we did it over email and we quickly found that we were designing
too much of a game because the research management system was becoming really
complex. And when we opened it up, we tested it more with Maryalice who’s less
technically savvy and at the time she knew very little about games. And so we found
that there’s just too many things about it, so it was always—we always kept
expanding and contracting, expanding and contracting and this happens all the time.

So the struggle is that, designer is over design and ultimately I knew that we
couldn’t develop all the features and make robust enough to open it up for
assessment. So we always kept chopping, chopping back. So when we got a good
paper design that we were interested in, then I actually contracted a developer and
started designing the back end of it. And then slowly, we got to the front end and
then the graphic interface and it kind of went like that.

And a lot of the features that we developed weren’t robust enough to actually deploy
in the study version. So Twitter-specific issues and also some game-depth specific
features like levels, unlockables that would basically, we would have hidden things
that if you received an item from a person, it would actually unlock features. A lot of
the stuff wasn’t actually deployed, we designed it but we have too many technical
difficulties and don't have development money.

And the other thing that I regret not implementing enough was things that would
increase the relationship between the player and the character. So we had all that

257
Appendix P, Continued

worked out but we had to chop a lot of the features that would really increase the
connection between the character and the player because it was just complex,
making dialogue come up at the right time after the right activity, it requires a lot of
testing and there was just not enough time to do that.

So we have lots and lots of game design still to be implemented and I regret not
implementing a lot of the Twitter reporting features because they initially worked,
but then as we made a lot of changes, they stopped working, and there wasn't
enough time to go back and actually fix those. So right now the only thing that you
get from Twitter is a daily notification, but you can actually report through Twitter
which was something we really wanted. But it was kind of interesting that—from the
reports that I see so far, the diffusion of Twitter is kind of low so ultimately that
would have been an investment that would not be worth it for this kind of grant.
Maybe it would have been great, but at least we kind of have—we have most of the
code working, so down the line we could actually go back and implement it.

What are some of the key principles, design principles that you applied
particularly in this application?

I would say the most important thing was sort of iterative design. So design it, try
to develop it, test it, scale back, I mean it’s just this sort of cycle. In terms of more
specific principles, we wanted a very simple sort of collecting game, so very simple
reward system. And we were interested in both quantifiable rewards so you get
points for what you do, but also things that you can get from other people, so we’re
interested in looking at altruism game mechanics. So you might get things from
other players, right? So you might get gifts from people and collect things that way.
And those are still things but you get them through other people. And so we didn’t
know if people would be interested in collecting points or if they would be interested
in collecting gifts or if they would be interested in collecting memories. I mean we
just didn’t know. So in terms of design, we just gave a little bit for everybody to see
if there’s any trends toward what people are interested in.

I guess in terms of principles, I would say—since this was designed to test
intergenerational possibilities, we tried to make sure the design wasn’t too gendered
and too specific to particular age group. So when we designed the look and feel of
the animations and activities and all that, we tried as much as possible to have
things that both men and women would be interested in and of different age groups.
So I did employ different age groups and different genders of designers to kind of
keep that variety and we took in various requests for things, so we’re not quite sure
if that was successful but maybe we’ll find out.

Also, the big design principle was that the game should be something that you can
play for very little amount per day. So as little as two minutes a day, just log on to
self report so we were interested in episodic play, so something that you can do
every day but come back, you know, the next day, come back the next day. I didn’t
want people to just sit on it for hours, so a very shallow game play.

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Appendix P, Continued

So how does the program work in its final version, I mean now in the study
version, and what are the major features?

So right now you can log on every day and report physical activity or setback and
you can report how many minutes, how difficult it was and whether you did it with a
friend or not. And you can report a setback. And the other thing you can do is as
you get points for either activities or setbacks, you can redeem them for activities.
So your character comes with eleven free locations, backgrounds basically, and you
get points that you can redeem for activities that your character can do in those
locations. And there’s 65 or 66, I forgot, animations and we calculated how many we
needed based on sort of people who would be very fit and potentially be reporting
physical activity every single day versus people who might be only reporting
setbacks as we made a calculation based on that and the length that they would be
enrolled in the study. So every activity results in a memory that each player has,
they can't exchange with other people and they can play indefinite amount of times.
And then some of the activities result in collectibles that can be gifted to each other,
infinite amount of times. And there are basic social networking features, you can
send messages to each other, you can look at each other’s status, and there’s a tag
cloud so you can see and aggregate group reported activities so that you can quick
post by clicking on them. So if you don’t want to go the regular routes to let’s say
report walking, you can look at the tag cloud and click walking and make a quick
post. The people who are more social networking savvy might use that. The other
people might use it just from the regular route. And the other thing is, there’s an
activity history very much like Facebook and you get to see what you're doing but
also what your friends are doing and what each other’s characters are doing.

So what do you think that made Wellness Partners different from programs
of similar kind?

Well, I don’t really know what there is out there that is a similar kind. And there’s
Facebook, but there’s nothing for self-reporting daily activity, I mean, the closest I
can think of is you know weight watchers but that’s a point subtraction system where
you kind of have a number of points to spend that correlates to food items. So
initially, we were thinking about—somehow like that, but that didn’t really work for
what we were interested in.

So the closest would be, I'm not quite sure, we thought about Virtual Pets, because
this application would work much better actually on a cell phone in terms of keeping
track of your character. And in some ways we thought that, if your character has
enough points you can actually spend a lot of things to kind of keep him or her
happy and occupied.

How did you actually want this character to function, in terms of, I guess,
engagement and how that’s related to the actual behavior to establish
habits in their perceived wellness?

So we want, first, the character to provide sort of feedback on reporting. Then
reminders which would happen to better integration with email and text messaging

259
Appendix P, Continued

system ultimately that would preserve sort of voice of a virtual character and not
automated reminders. And the other thing would be potentially to have more
personality in terms of prompting you to kind of explore locations.

So one of the things that we didn’t want it to be, although initially that’s what we
thought we would do, is have it to be a real coach and kind of tell you, suggest you
do this, do that. So we really wanted to have its own personality and wants and
needs. And even all the activities that we programmed, they’re all wellness activities
and some of them involved physical activities, some involved more sort of meditation
and relaxation but we didn’t want to have something like a lot of sports games out
there that have an avatar that you work out with. Like it’s not like Wii games, Wii
sports or EA Sports Active. We don’t want the character to let’s say, if you reported
walking, for you to get walking activities for your character or for you to—if you’re on
the treadmill, for your character to be on the treadmill, so we didn’t want this sort of
mirroring kind of character. We wanted to have its own personality and own kinds of
things that it does.

And if we actually have money to spend in the project, one of the things that we
really knew that people would want and couldn’t afford is the ability to choose
different characters and different types of—I would say personalities which might
result in different groups of activities and backgrounds and locations. So that might
help people create a better connection with their character where now it’s very
generic.

Or even—I guess to be able to personalize it even more, right? Because
now you can only give it a name and that’s only at the first log in, you can
now change it later…

You can change it later, yeah. Not everybody figured out how to do that but you can
change it later.

And then there’s also the number of characters as a limitation….

I didn’t discover that until much later, yeah. That was a limitation that shouldn’t
have been there. So I think we didn’t have a limitation initially and then I think it
was limited because it was doing a character wrap that looks bad and somebody’s
idea to fix it was to actually limit the characters.

So actually what you could have deployed in terms of the virtual character
in this final study version is to have a kind of personalized name and then
have the character do a series of animations, the activities. That was pretty
much it. No feedbacks, no tips, no coaching…Not much interactions,
basically.

Yeah, I mean the interactions that we programmed that didn’t go in were actually—
there was more that was available that we couldn’t program in terms of—after you
report it. There were supposed to be more interactions that were actually not
deployed.

260
Appendix P, Continued

Then so given what you have been able to implement, how would you like
the users to best take advantage of these features, available features for
their health benefits? I mean if, as a designer would you have an ideal
situation on how would you like the user to use your program or you are
just kind of open…

My hope for this since we kind of opened it to all users and all comers, all
participants both fit and sort of less fit, was that I wanted to see if you could
somehow increase interaction between people regardless of their level of fitness, just
increase the social discussion. So for me, just in very selfish, I know that in
coordinating physical activities within intimate relationships, managing conflict is
kind of a difficult thing to do especially between some couples. Maybe coordinate,
just talk about it even, you know, like that maybe we should we need to change our
lifestyle or something like that. So I initially thought that it could increase the
conversation between some people who are basically not active. And that the
program could somehow make that visible for us to observe and see if that would
happen. And I also thought that maybe some people would inspire other people
within the group if there were some people that really fit and they could sign up with
people who weren’t just fit, that they could somehow be inspired because I feel that
for a lot of people, it’s really not fun to exercise, especially if you can’t exercise
together which might provide some level of social attraction. Maybe this would give
people an excuse to do something even if it’s a silly excuse. And it would maybe
could provide distraction for the conversation instead of saying, “Oh my god the guilt
because I haven’t worked out,” its more like “Let's go out and get some points to do
something for our character because we just want to see what happens just out of
curiosity, right?

Well I mean, now given the features available, you could say because I
guess the instruction we are giving to the participants is we don’t require
but we encourage you to log in everyday. So I guess for them, from my
interviews, the understanding is that they should try to log something
everyday even though they might not be doing anything. So even just the
mechanism how that works might have changed their mind or their
behavior in some way…

Just thinking about it, yeah. I mean I know that some people were, you know—they
told me that their level of fitness was nonexistent basically. They’ve just tried it all.
And one thing that I knew from sort of personal experience is that, it’s good to at
least keep track of why you’re not exercising because maybe that can help you fix
something or make the change in your life to add that. So if you have a diary, and
every single day you are reporting a setback, “I have a headache, I have a
headache, I have a headache, I have a headache,” you know like, “I feel sick, I feel
sick, I feel sick, I feel sick,” or “I'm busy, I'm busy, I'm busy,” you know to see that
compounded over the course of five weeks, if you have to look at your activity report
and you kind of look at it in one big group, it’s like, “Oh my God” for like 30 days I
have reported nothing but setbacks.

261
Appendix P, Continued

So they become more aware of what’s going on with them—A reflective
action.

Exactly, and I knew that that probably decreases the self efficacy in some people but
people need time to make changes in their lives that can fit other kinds of changes.
So I knew that five weeks is really not a lot of time. It’s enough time to maybe start
thinking about it. I'm thinking about change but if you’re in a busy family and
maybe there are some health problems involved, figuring out what are the changes
you need to make in order to fit more exercise in your life, you know it just takes a
long time to do that.

And I was hoping that somehow I could plant the seed in people’s heads through
different ways either through selling motivation or through awareness by looking at
the daily activity or through increasing discussion with the people there in the same
group, there’s multiple ways and I'm sure it’s different for each person. And I just
thought of a lot of selfish reasons of why I would be interested in doing this for
myself and I think that every person would have different reasons for doing it or not
doing it, or enjoying it or not enjoying it.

So it sounds like most of the part you're thinking is how to use the people,
the active people, what they’re doing and how they talk about exercise to
motivate the unfit or less fit people, so have you thought about how this
program could actually be useful to those who are already very motivated
and active?

Well I think for the people who are already motivated, there’s probably two ways—
first, if you had enough game depths that they could just get a lot of out of the game
itself, in terms of more fun features, more personalization so they could feel
achievement toward like what they have accomplished for their character so that
they are—whatever they’re doing translates to things that they could do with their
character. So maybe special things that only they can get, for the high achievers,
I'm not quite sure of what would exactly motivate them.

And converting out of the world behavior into reward mechanisms in games is pretty
great territory right now, so I don’t really know that you can do anything else other
than that for the moment, I mean even thinking about a lot of the sensor-based
games, they’re not designed for you to report out of game activity into the game and
receive some kind of compensation for it. So this is like the first application to my
knowledge that actually does that, that just does some kind of conversion from real
world behavior into the game world.

I know that there’s applications like we can say smoking cessation, and other things
like that, that give you like there’s voucher systems for some programs that you get
compensated for reporting out of world—they’re not exactly games, they’re sort of
generic programs. But I'm not quite sure what you can get for the very high-
achieving people. I think that a lot of the communities for people who are already
very fit are geared toward socializing, specifically. So there are communities built,
let’s say around the runners, right? And people who train regularly that helped

262
Appendix P, Continued

people to just keep track of very social stuff. So it’s not necessarily motivating per
se to increase things but maybe to kind of create different challenges.

So for runners, like you might have things that helped the people to schedule stuff,
find other people with similar interests, maybe a little bit of a challenge in terms of
choosing different tracks and things like that, it’s not so much for keeping with the
program, but more as a mitigator of boredom. And that's kind of different than what
we’re all trying to do with this application. So I was hoping that if I had high
achievers in this application, that maybe—let’s say, motivate low achievers in the
application.

If you could have a list of goals or objectives of this project and then if you
have to prioritize, what will be your top three goals?

Okay, from a designer’s perspective, the goal always is for it to be fun. That's
always the top priority and it doesn’t always happen unless you test something to
death, you know. And then the kind of fun would vary like for some people it may
be fun and for others it may not be. Even to see it as a game. So I guess the first
step would be to just design something that's fun, right? And the second goal for a
game is to design something that somebody can play long term without being time
suck. And the third is for it to give you something more than fun you know, improve
your life somewhat. Open-ended for now, I mean it's an exploratory application.

For the study, I guess yeah—the first one was to kind of increase the conversation. I
mean for me, creating opportunities for conversation about a health topic within
friends and family networks was a top priority. I don’t know if it necessarily was for
everybody else in the group but it was a top priority for me. It’s an excuse to have a
conversation. And to problem-solve potentially.

So, were you expecting them to actually use the functionality of the
program to talk about it or maybe they’ll talk outside of the study?

Either way, so I wanted to see if they could talk about it outside of the study and
whether they would talk about it within the study. So I knew that it wouldn’t be the
same across. But I wanted to create that opportunity. It’s an excuse, it’s like
coming home in an advertisement about something, but this is—like I felt that this
would be really benign to start to start a conversation. And yes, it’s less serious
than let’s say coming home to talk about HIV, okay or STDs of even smoking which
is very serious.

But at this point, I think in America, physical activity, I mean, it’s become a topic
that makes a lot of people be very self-conscious. If you get somebody that weighs
300 pounds, they think about physical activity very differently than somebody who
weighs 120 pounds, okay. There's taboo subject between people. So finding safe
opportunities to kind of talk about it, in a fun way I thought. If people could enroll
and study and see if they can find other people to enroll with, maybe that would kind
of start the conversation, you know.

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Appendix P, Continued

So the second thing for the study, I guess was to expose people to kind of new
applications, even if this was a small and very basic. Yeah, this kind of format for a
lot of people who are necessarily not using these types of things. Even though it
seems that most people in the study are Facebook users, you know, I wanted to see
if they would be open to using this type of applications for different things,

Do you mean as maybe a Facebook app or a standalone program?

Either way. So if they are using a Facebook app, and that means that they’re
comfortable using that format on their computer and a subset of them are
comfortable using Facebook on their cell phone. So you know, again, Facebook is a
web platform. So if you can use it on the computer, it’s probably easy for you to use
on your cell phone too.

Third one for the study, I guess, would be to just really figure out, what does it take
to make this kind of application—to gather the preliminary data to understand what
do we need to know in order to really design these types of applications. So in many
ways, this game, I call it a pre-game because we really don’t know what kind of
game we need to have for this to really work.

So you mean, it was there to accumulate knowledge about what works and
what doesn’t work?

Exactly. In this format, you know—not just technology but also the study format
because an intervention is usually not just a product, it’s the whole study design. If
you just release this application on the internet on its own, I mean, it would never
work the way it is right now. In many ways, right, the actual game and application
was designed to be parallel, complementary to the actual study design, like all those
things had to be done together. We didn’t just design one thing and then designed
everything around it, like we actually knew the study design approximately well
before what we knew what the game was going to be.

A lot of times, you know, you don’t have that luxury. You might have gotten some
third party thing that you’re trying to design the study around or it might be that—
two things have been designed completely disconnected of each other and there are
just issues with assessment because you just don’t know what’s going on.

So lessons about interdisciplinary collaboration?

Yeah, start from scratch, from the beginning in parallel. And even in our study, we
weren’t able to do that enough because there wasn’t enough money to get people’s
attention nonstop from beginning to end and hold regular meetings. So I think
everybody learned a little bit about each other’s discipline. But if this was larger
project, then you could really force people to come and sit in the same room and
make a lot of decisions together and understand what it takes to do this.

264
Appendix P, Continued

So now looking back, what you see has really worked very well and what do
you see is just probably some major limitations or some of your
observations?

Design-wise, what has worked and what doesn’t, okay. I think that I would have
spent more time probably developing narrative-based communication between the
game and the player and less time on sort of programming and assets. So I would
have—because we knew that felt right. You know, a lot of times people ask, “Well,
how can you know if it works?” Well, when a game feels right, it just feels right.
And there was something in the early testing that we lost in the development
process. So if I could have gone back, I would have scaled some of the development
and some of the design like the asset creation and all that further and spend more
time in actual preservation of daily communications between the player and the
character.

Well then, my impression is—one of the themes or the focuses is on the
social interactions. So the social part is not just—because if it's just the
virtual character and the player, that’s not that social. It's probably through
the virtual character that you wanted to facilitate some interaction between
the real players, if that’s what it meant or kind of both—?

Yeah, I mean it's both. You wanted to first work as a single player application and in
case the other person is just unavailable and you wanted to also increase interaction
between two people. So for example, to have that kind of automation that, let's say,
it has your character remind you that your partner hasn’t logged on for two or three
days, “Hey, maybe you should send him a message,” like those kind of social
facilitator notice that we don’t just have right now because those require a lot more
programming.

The kinds of things are like, “Oh, so you log on after three days of haven't logged
on.” Well instead of getting nothing, your character is just waiting, I would have
wanted to see, “Hey, we haven’t seen you in two or three days. Do you have
anything to report?” So just more opportunities for communication between the
player, the character, and between even characters, just sort of sending messages to
each other, like more automation that increases the illusion of social functionality
and para-social functionality—we had it a lot in the beginning. But implementing
that, it actually requires a lot of programming and there were two many different
skills involved that we lost throughout the process.

The other problem with small projects is that students had to cycle and announce
every three months so you lose expertise and you kind of sacrifice certain features
for other features. So that’s something that I know would have worked that we
couldn't implement.

Successes—I mean I think I like how half of it has turned out in terms of the
application, in terms of—like I like the fact that you can't—you’re basically have to
just post an update. And whether that is a positive one or a negative one, it doesn’t
matter. It's like just posting updates, just do it, you know like that kind of thing.

265
Appendix P, Continued

I’d like that work flow that we worked out. I don’t know if it translated to something
people understood. There’s a glitch within that that I know was not worked out in
terms of understanding how to add people, I think that didn’t always work. But I like
that we didn’t separate post-physical activity versus post setback versus group
activity, and so there was some simplified user interface things that worked out, that
I think with more testing, the final work flow would have been pretty good.

I like the character and it's sort of world that let it lives in and just showing it to a lot
of people, I seem to get a lot of positive feedback. So I don’t know how that
translates, scaled up to big results. I guess we’ll see that, but I was happy with that.

Well, if you had more time and money, would you want to spend I guess—or
would you want to make the game world even more sophisticated?

Yeah, I think I would give it more depths and again having personality. So just
having the mobility so that different kinds of characters could live in different kinds
of worlds and do different things and again, some of the features that we wanted is
sort of like the secret places that you can unlock only by certain gifts. I think it
would have been interesting for people, I think that level of curiosity would have
excited a certain type of audience.

But how would you keep that in balance in terms of—because you said you
want it to be something simple, not too time consuming but at the same
time you want to keep the users engaged in a long run.

Well that simple thing which seems very simple wouldn’t have added that much
more play. It just meant that if you got to give from somebody that was magical, it
could unlock a secret location with the bunch more activity that you can redeem and
only you would have those and somebody else wouldn’t have that. So that increases
sort of the coolness factor for you, and also the altruism kind of points, right? You’ve
got something really magical that really helped you.

And it would have added much more play. It was just sort of—be a single thing that
unlocked more things for you. So I think it would increase motivation. …But just to
add that, we have add it probably two months of getting that installed and tested, in
combination with narrative stuff. So if we had more narrative interaction and we
added that, it would require a lot more testing to kind of capture every possible
scenario and prevents issues.

Well, so if you are given another opportunity, would you still choose to start
from scratch? And given the challenges and difficulties and all the ups and
downs…

Yeah, we probably would start from scratch because we would take what you would
have and create a spec from it, of exactly how you want things to be versus how
they are because you have the example to kind of work from. And sometimes, in a
prototype, a lot of the initial code that is created is just garbage by the time you’re

266
Appendix P, Continued

done with it. So it's like your sandbox and you keep working on the sandbox and by
the end of it, you don’t want to go back to that. You just—because what we have is
actually very, very simple, but the code behind it is like there's a lot of bloat that it's
just not necessarily used or even needed anymore. So if you have the prototype, you
go from there and see, “Okay, this is how I wanted to work. Now, I’ll do it for real.”

So basically, through this project, you’re trying to test out some format and
mechanism, sort of like almost—like establishing a model of creating and
evaluating this kind of intervention….

Yeah. So like when we knew that in having more sort of the appearance of a
conversation between the user and the player, we kind of got that but it was just so
buggy based on the existing architecture of the code that we had to kill it, whereas
now if we had to redo it from scratch, we knew what we want. We have it and sort
of written out in terms of how we wanted to work and whoever would write it would
have to write the architecture to support that without it being flaky.

And then one last question would be, I guess, just one step back and to see
this—I guess, using digital and interactive media platform for health’s
promotion, what do you think of this format so far, given your experience?

I mean as a designer I think, it's like open territory like its fun to kind of think about
all these things. As a developer, I always think about it as a nightmare to implement
because you just don’t really know, like you always end up in a situation where you
have sort of the pre-version of it. And then by the end, you have all these regrets
about all kinds of things that you know you want but you just don’t have time to
implement because you have the researcher on top of you who wants the thing
ready so they can assess it. So as a researcher, I think I’m frustrated that I never
have enough time to include—to see all the things from the design included and test
it, so that can be assessed. There's a lot of things that as a researcher I really
wanted, I really wanted to have in there because I knew they would have worked
and I know that them not being there, it just really affects the results, you know, I
just know it. So it's always like a balancing act. There are always so many things
you can actually include.

What I mean using this, it's almost like a social networking website with
some gaming elements embedded. So it's playful and it's digital,
presumable an easier access to people I guess for most of the population
groups we’re talking about. So I mean, using this kind of intervention
versus the traditional kind of mass media campaigns or PSA’s and all those
other kind of approaches, where do you see this as, you know, where it's
going and how it can really better serve some population sort of people with
conditions…

I think that it will definitely serve some populations. It's hard to tell where Facebook
is going because it seems to be pervasive. ...But at the same time you can’t—as a
researcher, I feel like it's hard to trust those platforms because if you work on a two

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Appendix P, Continued

to five year grant cycle, it's just—you're always going to have to control your own
platform.

So had I known the Twitter was going to be the thing of the day for at least a couple
of years, this whole thing would have worked on Twitter. But when we are designing
this, there was no Twitter, no Twitter API, otherwise we would have designed it and
use all of the features, all of the back end and messaging of Twitter and just lauder
everything through Twitter. And it would have been a very different intervention but
I would have always lived on the edge in terms of wondering who’s going to buy
Twitter next and what features they’re going to change and Facebook changes what
it looks like every three months and they kind of move stuff around. So for small
projects and for human subjects research, it's kind of scary to rely on mass media
stuff that you can't control. So in some ways, you kind of reduce ecological validity
in exchange for control of your application. So you would get different results if you
installed this and developed it for Facebook as an application and just kind of release
that out there and still enroll people to the studies. It would have been a completely
different piece and you have to keep track of Facebook and what it's doing, and I
think that it's exciting and also scary at the same time because technology is
changing. And I think that for researchers, their job is to figure out, first of all, what
are the questions they’re trying to answer and which technology they want to assess
and what application they want to design and that’s truly how we design the study.
We have, till this day, we did not really changed what our research questions and
hypotheses are, you know, like we still have the same questions.

To me that was important, to just sort of work with that and try to figure out ways to
answer that because we could have answered those questions with different media.
It didn’t have to be this, right? So it's not like we designed this game first and then
thought about, “Okay what can you learn from it,” right, “How can you use this
intervention?”

Well there has to be something very generic to this kind of format, so at
least to some degree, it's sustainable, if you are working with new
technology that’s ever changing.

Well, it's not different than playing a card game. It’s not—no different in playing a
card game between a few people on a table. It's like having that level of
conversation in my opinion. It's very casual, its people you know, but some are
friends, some are closer, some are further way and you’re just engaged in activity
and you're just exchanging some assets and having conversation. And some of it is
routine and some of it—some people maybe doing it for the first time. So it's that
level of playfulness and social interaction.

268
APPENDIX Q:
SELECTED SAMPLE QUOTES FROM FUN
FACTOR CONTENT CATEGORIES

Selected Sample Quotes of Interview Content Analysis

Frustration - Access

“One of the things that I didn’t like about it was that I wasn’t able to access it from my
iPhone because in general at work I spend the entire day in front of the computer, the last
thing I want to do when I get home is to spend more time in front of a computer. So it
was a little bit frustrating at first because I tried posting updates through my phone but I
can tell it wasn’t doing it right.”
“Going online is a hassle for me to do these types of (social networking) things…. I was
trying hard to remember but it was ways out of my mind…. Most of the time, I’d update
when my wife says ‘You haven’t been on.’”

Frustration - Login

“I would just get frustrated at first. The website wasn’t letting me log in”

“I couldn’t change my password”

Frustration – Loading

“another really big frustration for me was how long it took to load…this is the last thing I
would do at the end of the day on my way to bed as I’m turning off the computer. And so
I mean the last thing I want to do is to wait for a couple of minutes sometimes it would
take to load.”

“I liked the animations but they only worked about 80% of the time. Sometimes they just
didn’t work. I figured that it had to do with why it was taking so long to load maybe.
Sometimes I got a snapshot and it skipped straight to the end and occasionally it would
do the wrong thing”

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Appendix Q, Continued

Frustration – Bugs

“It had several glitches. At time when I would input exercise that I did and it said
‘You’ve already inputted for the day three times.’ I was like ‘Oh, no, I didn’t!’ Or other
days when it would say that I had said that I didn’t do exercise but thanks for letter me
know. I said, ‘No, I didn’t do that either.’ So I mean there were some technical issues.”

“You know what, it was ongoing and I think that was some of my frustration and at one
point I just stopped doing it. Because a lot of times, I would enter entries and it wasn’t
recording. I’ll press enter, it will say, ‘Okay, you’ve submitted.’ And then when it goes to
the screen, it shows nothing.”

“What happened to me was after I log something in, it will be there, but when I log back
in, it will say nothing reported.”

“There were many bugs. The dropdown menus weren’t working. The ability to change
username and password wasn’t working. In many cases, I wasn’t able to report an activity
because it didn’t appear in the thing. I couldn’t select from the list of previous activities
or enter new activities, and setback reporting was particularly problematic.”

“We couldn’t tell who was who…making a comment. It was like a dot.”

Frustration - Presentation

“The human computer interface was quite disappointing…It was kitty website…the
graphics look horrible.”

“I’m used to seeing very well done art on video and online games – actually my partner
and I joked about it when we looked at the interactive site when I first logged on because
it’s very rudimentary and it’s not meant to do a lot of exciting things like a video
game. …So stylistically for me, it was a turn off just because it was so simplistic, and you
want it to be fun.”

“The view for the activity history, I didn’t think that was laid out very helpful.

“I thought the box in the bottom where we record some of the most frequent user
activities was a little bit cluttered. It didn’t really attract me to see it.”

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Appendix Q, Continued

Frustration - Navigation

“For me, the website causes too much headache and I’m not a very patient guy. When it
comes to things that I can’t really figure out in the first one to three minutes, then
sometimes I just say oh forget it, I’m going to move on to something else.”

“Another thing that I thought wasn’t particularly well designed was the way to report
activities or setbacks. Not that I wasn’t able to figure it out, but I feel like you have to
click too many different screens to report something.”

“So I would just put down I walked 30 minutes and then it would say add friends.
Obviously, sometimes I don’t see my friends during the week so then it would give me a
confirmation, is this everybody that you want to add…so navigating it was a little bit
tricky.”

“If there was a problem, I wouldn’t have known….because it didn’t give me any errors so
I don’t know what it should have looked like and I can’t really compare it with something
else.”

“It was quite obvious that the exercises that were reported most were getting bigger fonts.
So that was making it another kind of log, and you can just click on them (as a shortcut)
instead of going to the post and update…I didn’t notice until later…”

“It took me a while to realize you could name your robot. I didn’t realize that was what
the history was showing. Some of the listings were activities of what my sisters had done
and others were the activities of what their robots had done. If the names changed, I
wouldn’t know what the robot was called. My sister was in Chicago, clearly named her
robot Oprah. So when it said ‘Oprah went sunset’ I thought ‘oh, these must have been
other people that are in the program.”

Frustration - Mechanics

“It was just a little too simplistic sometimes. There weren’t too many features.”

“You can make it more fun and not too repetitive. It would be nice for a variety with
some kind of changes, not necessarily the same thing all the time.”

“It was an update of either activity or setback that seems just a little black and white
thinking. So I didn’t care for that too much.”

“Not being able to record my data from the day before. I mean that was a pretty
significant handicap.”

271
Appendix Q, Continued

“For me, I would have lied to be able to post updates after the fact, because I didn’t know
if I would get on the computer on the same day.”

“Another thing I found frustrating was that if I didn’t exercise in a day, that was supposed
to be a setback which I didn’t consider that was a setback because there were days that I
planned on not exercising. There were either recovery days or I just planned on not
having time for it.”
“It was the 24 hours thing. So if I reported exercise that I did the previous day at
10:00am, and then if I tried to record the next day what I had done the previous day at
9:00am, it still acted like it was within the same day.”

“The timing thing - that was really a big handicap. Rowing is very high intensity, you
know – if I do 10 minutes of rowing, maybe 15 minutes of hard run and then two other
things, I would have three or four activities. The very first time I tried that, I discover
that I only get point for two of them which was honestly very de-motivating because at
that point I was like, well why I’d bother to report this if I’m not going to get any points
for it?”

Frustration – Points Reward

“Actually the tea kettle got me excited. I was like ‘oh, this is a kettle.’ But that’s only the
illusion of those things. It wasn’t as entertaining as some of the other games and you
couldn’t do anything unless you had points.”

“I never got points for reporting setbacks. I think after my first setback that I got points
for, I only got points if I actually had an activity.”

“One of the things that bothered me about the award scheme was the points. It seems to
be arbitrary. I would get 30 points for 20 minutes of hard running but 8 points or
whatever for 10 minutes of hard rowing. I’m sure there’s a system I just don’t know what
the system was.”
“I actually thought it would have been interesting to see how many points you would get
for a certain thing you do.”

“I didn’t necessarily understand where these points are coming from and what they are
based on. I didn’t understand the rules that were assigned with it. So I sort of lost in it and
didn’t see the value of watching impend for gold or whatever it was.”

“The least that I like was when I had to use my points if I wanted to do something with
the robot and just like that they are gone, my points.”

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Appendix Q, Continued

“So that whole accumulation of points in making your robot do something, I think, is
going to have limited appeal to people that are into online gaming because it’s simply so
clunky. They can use the points for online shopping through – you know, there’s got to
be better ways of reaching all that in points and actually investing some value on those
points for the user rather than (on the robot). I think there are a few people having the
interest in accumulating points for a robot to make them do one or 10 different activities
and different colored backgrounds. That’s not going to make people exercise more.”

“I think they were really lame. I’m so sorry. I just thought, you know, you save up these
points and just watch this animation for less than five seconds. It was just maybe silly for
me evening doing it.”

Frustration - Virtual character

“I’d say I’d really hate to see anything with that robot thing. If I wanted to see activities
(my sisters posted), I would have put in at least the option to deselect those robot things
because I don’t care if the robot went to the garden but it would be motivated from each
other’s report then I would only want to see them.”

“Like my sister pointed out that the character seems a little depressed and it’s just kind of
a little ghost face. I didn’t find the character depressing. That being said, I didn’t
associate with it, I didn’t really feel too compelled to do anything with the character per
se. Even when the character was animated like if you want it to do a barbeque or
whatever, that watching the character do the activity was kind of sad. Yeah, it wasn’t
very joyful like they run in a picnic, but in a sense they were alone, there was nobody
doing the activity with them. It was the elements around it, not that they look particularly
depressed doing it, but the activity didn’t seem fu. No balloons. That part was
frustrating.”

“I was frustrated with the name of the robot. I ended up leaving it as ‘my robot’ when I
was given a chance to personalize it. But when I saw that I was only allowed like six
characters, I was like ‘Well, okay.’ The limitation on the space was like a very big

disappointment for me which is really silly…the name that I came up with I think was
sever characters…that was why I just kind of through with my arms.”

“It was kind of boring compared to the other games. I mean the robot was whatever, you
couldn’t customize it. I didn’t do anything. All I could do was to change the background.
I wasn’t really interactive.”

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Appendix Q, Continued

Fun - Time

“Inputting your exercise or your setbacks was easy to do and it didn’t take much time, so
that was nice.”

Fun - Design

“I like that it was sort of simple in terms of the number of landscapes, because it was very
manageable conceptually for me.”

“I actually liked that it was simplistic. It was just straight news back and forth like a
Twitter kind of thing and less of a game.”

Fun - Sharing updates

“For me, I was already sharing the information and getting that was my reward, I didn’t
need the points and the little tokens to accumulate that. It wasn’t a game to me that way.
It was more of just the sharing and feeling good about sharing your success.”

“I enjoyed showing people that I’m active. I think when I’m active it encourages them to
be so, and I think that’s very important. The biggest advantage over just writing in my
(paper) journal was the reinforcement going on.”

Fun - Reading updates

“I thought it was interesting to read what other people were writing what they were
reporting to Wellness Partners. I think it is interesting because it was also a group of
people that you know.”
“I guess with some of the people when I was reading their updates, it was interesting
because I didn’t know that they did certain things before. We never really talked about
what we posted on there but I’m sure we all read each other’s (updates). But in general, it
was kind of a learning experience for me I guess because everybody was doing stuff that
I have no idea that they did before.”

“I just thought it was kind of funny…some of the comments.”

Fun - Vicarious experience

“Athletically we are in very different spheres and this was a way for us to share that more
than just you know we are exercising at the same time doing totally different things
which is what we do in the past. So this was like sort of vicariously we do the same thing
together.”

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Appendix Q, Continued

Fun - Points reward

“I thought the concept was really great and I actually find myself thinking about
exercising in terms of how many points I might get.”

“You feel validated if you get a lot of points when you exercise. You did a hard exercise
and you know it and then you get a score for it. It felt good. To reward was nice.”

“I don’t think it was necessarily connected with the robot itself but just getting points and
collecting items as some sort of recognition or reward for exercising was nice.”

“The most fun or most interesting part would have been the robot animations and that
whole interaction. I guess that was one part of the interaction between the idea of
collecting the points and using those points to do an animation.”

Fun - Virtual character

“Probably the most fun aspect I thought was the robots and earning points to make the
robots do different things.”

“I thought the animations were cute and they were fun.”

“The robot was cute. I named him Fitbot or something. And I thought it had a bit of a
personality because it would view different things and different environments.”

“The virtual character was cute. When you open up the program, it also makes you smile.
The look is quite lovely and I liked the backgrounds too.”

Fun - Friendly competition

“I liked that I was able to see what they were doing. It was like ‘oh, I didn’t work out.
She did.”
“I think it kind of makes us a little bit competitive, especially at first….Competition is a
big part of it for our family. Also, I think we really positively reinforce each other when
we exercise. So if I go running, I can expect to have positive reinforcement from my wife
and my siblings…competition and positive feedback, positive reinforcement all around.”

“I liked being able to kind of see my sisters log on. I don’t know why but there’s
something about the numbers that made it easy. ….I like the idea that you are winning
points. I used to joke to my sister that her walking is outshining my yoga classes. And I
was like, ‘oh, I have to keep the training so I make it just the biggest spot (in the tag
cloud) as walking. So I guess that’s a bit of my competitive side coming out.”

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Appendix Q, Continued

“There is some sense of satisfaction to log in and have the status checked. Like the fact
that my bar of walking is much larger than my siblings’ is awesome. And the fact that
they know it is also awesome!”

Fun - Social interaction

“Personally, it was nice to accumulate points but the most favorite part of accumulating
the points was spending them. So you would go out and you’d buy, you’d have a
barbeque and then you’d send something to a friend or go surfing and send surf board to
somebody, it’s just a great gift that you want to give someone and you know that it may
in fact motivate them to do something on their own.”

“The settings were fun. I really enjoyed being able to send that stuff to my wife…and to
send messages I got from her which is really enjoyable. I actually really appreciated that
once I’d send them, they were gone from my collection of things…You gave it away.
Then it made you think what I was doing and I don’t have it anymore.”

“I didn’t mind. I mean because it’s something—like I said, you know my friend has
joked about it so then when the items got passed around, just seeing who got what then..it
was kind of funny. It was like for example, you got like a feather, it’s like an invitation
gift to my friend, “You finally signed on. Here’s a feather.” Just kind of keep my friends
engaged in the game. I had to do something on my own part.”

“Probably just a chance to connect my friends—I mean not all my friends knew each
other so it was a good chance to kind of get them talking. I mean the funny thing is
during the same week (as the fair), I had my birthday and then, Harry and Derrick didn’t
know Ben. Because they were sort of already in that program, the Wellness Partners
game, they had something to talk about to sort of get them going. We made a couple of
jokes about that.”

Wishful - Clear definitions & objective criteria

“Sometimes I didn’t know like this is silly like when the exercise intensity like if that was
just -- you know, totally subjective like the easy, moderate, hard¡- sometimes you can
have a really easy run. And sometimes you can have a hard run. So sometimes I think
maybe I gave myself too much. Or it was almost an incentive to cheat like I know I can
get more points if I put heavy.”

“I'm not sure how you’re counting the numbers behind the scenes, but if you’re able to
bring some of that information forward for the user, someone like me would be much
more likely to use this on a regular basis because I have interest on that sort of feedback.”

276
Appendix Q, Continued

Wishful - Levels

“I mean I'm not that bad you know where it’s like I have to buy this stuff, so what I mean
it’s just the achievements and stuff on there you know. Do I have the blue ribbon and red
ribbon? So I guess maybe something like that where it was like achievements You
accumulate points to go to different places and do different activities in these different
places. But what I’m saying is like a different subset, like the achievements would be
something like you able to have. You’ve collected five collectables is an achievement or
you’ve now or you’ve visited five different places is an achievement. It’s separate from
gaining up points to be able to do all these little things. More goal-oriented because I log
in and I’m like, which area would I want to go to? I don’t know. You know I mean I have
no idea of they were like leveled or tiered or it was just kind completely wrap them like
I’ve just happened to like to go to the beach or I want to go to my backyard.”
“I can't imagine after a while I might have got bored with those options, so I don¡¯t know
if there were plans to expand or whatever but I can see how that would have been also
continuing to motivate in that sense.”

Wishful - Customize presentation

“It would be interesting to be able to change the color scheme of the application to
because there was like beige which you know it's very soft and very -- you know
soothing to the eye but very generic as well. It would have been interesting to be able to
say I want my screen to be bright green or I want my screen to be pink rather than you
know like the beige backdrop.”

“I didn’t really like the colors theme of the website, it was just kind of bland and boring -
maybe it's kind of like with Gmail, if you could make it your own theme, it could be
interesting. Maybe if there are different robots that you can choose from or create your
own avatar and the robot, maybe, and then have yourself do plenty of stuff.”

“I am 50 years old. Maybe the font could be larger for somebody my age - You know, I
always had to make it larger on my screen.”

Wishful - Goal-setting

“Also, if it is something like within an achievement, your own personal achievements or
maybe even a set up of schedule routine for myself and monitor how well I do against it,
like I told myself, I want to do one walking activity a week right then I would be like, I
just figured I can do it. I like to check more things that this is done, this is done, this is
done, this is done, you know. So I guess when I log in, there’s nothing it’s almost like
when you just tell someone to study on your own, you know.”

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Appendix Q, Continued

“I don’t know how realistic that is, but even to be able to put in goals, like say in 10
months, I want to be here, this is where I want to be. And then maybe every month or so
or two months, it revisits your goal, this is your goal into where you are now. So you
could see progress or no progress¡- if you see that you are flat, but then you see, go back
up, you can see a pattern. Then it can help fix whatever that problem may be, and maybe
I just need more water, and maybe I need to stop eating so much sugar and things like
that. Or even like a food log where you just put in, this is what I ate. The ways you can go
with it and it can track, like you can see, well, when I did this, this and this and I did this
amount of exercise, I lost this amount of weight. Or when I did this, this and this, and I
didn’t do any exercise, I gained this or I stayed the same, but it’s just tracking progress
and I think that would be something that would be interesting to me.”

I guess part of it would be if you had concrete goals, let's say I was able to state that I
knew that I'm pretty active on those three days a week but my goal is to add at least one
to two days of cardio an hour each time, which was my goal and so that it says specific
goal that you’re aiming for rather than just logging in a day of activity because I would
have exercised in the same way to get more points depending on how many minutes you
exercised. It can even be just as simple as I want to be able to log 500 minutes of exercise
a week. I don’t know if we’re just like big five year olds but would be nice to see it in a
set of a hundred points then having a visual whether it’s a little character moving closer
to a finish line or you are given a number you have accomplished 30% of your goal, I
think that would be helpful.

Wishful - Tracking w/ visuals

I think that would help keep up with the progress. I use these other programs, when I was
more frequently exercising, I had this program where I would record the number of
minutes I walked and also the distance that I walked as well. It’s a self-reported
application that you could just download on a computer. So it’s just kind of keeps track
of your progress - something to refer back to on your progress of how much you’re
exercising. So it kind of goes the whole map. It probably does exactly but I just think it
keeps track of like the difference of how you’re improving on a daily basis. It had a
couple more of mathematical equations I think, built into the applications, so that was
helpful.

For me, it was just another acknowledgment for the activity site, it was all about weight.
But it might be interesting to add in a weekly weigh in option I guess you don’t have to
see the weight number but you could have an option like up or down so many pounds
each week or, because that was the interesting thing here at work that people did.
Everybody weighed but we always knew like oh you went down two pounds, good for
you or you went up - so there is one person who is in charge of weighing and they would
have a spreadsheet that they would keep for themselves. The only public information that
went out was everyone out throughout there would be a how many pounds total have you
278
Appendix Q, Continued

gained or lost. Who’s in first place like that thing. Whereas at Heather’s house we’re all
close and we don’t care if we know how much each of us weighed. You could show line
graphs of what your weight was and where you are now or it’s you that wouldn’t work.
We did it almost every week for probably nine to ten months since last March and then it
sort of been sporadic since then and we¡¯re trying to get back to at least meeting up once
a month -It was good. Then like I said my wife and I were the only really successful ones.
Heather did okay but she sort of did the roller coaster up and down. My sister never really
lost much at all.

I haven’t thought of that particularly but that would be very nice because if you have
different charts that you could look at or even just minute totals, the basic version, it just
has the minute totals for everyday or every week or a month or something, that would be
a good result to see. I definitely read it because when you’re clicking on the view recent
activity and you just you can see the events for the last few days but you don’t see the
long-term picture and it’s correct. It’s not a very good visualization.

Because it’s just the way my mind works, I would prefer to have a calendar view if we
were really in a network and using peer support to motivate each other. If there was a
calendar view in our icon for example would pop up on each day through whichever day
that we logged, I guess then it could feel more like you’re exercising with that person
even though you didn’t say that I exercised that day too, and that could also allow the
flexibility for me going back in the days that I forgot to log an exercise, and to be honest
there would be no need for me to have a points tally because I'm a more visual person
and even if other people are on that calendar with me being able to visually see how
frequently and also ensuring that it was spaced-out and not like, oh I did three days in a
row and then I don’t do anything for five days and I do things for four things in a row so
that I think it would serve myself two functions inspiring me to say, oh look how much
I’ve done and also make sure that I'm pretty steady in that.

Wishful - Feedback

More detailed - “What it would have made that more useful for me is if it could have
been like points, as well as, I mean like with my heart rate monitor, like I’m seeing
maximum heart rate and calories and I know a lot of that is sort of dependent on the
mechanism, but to able to track okay. So I got 30 points that’s great, but it also means
this sort of evaluation, I did these many calories and this many—you know whatever.
That would have been very interesting to me, as supposed to a point system that I felt like
I had no control over. And then even if I weren’t getting points for like my third and
fourth activities, I can still see, oh but I still did all of these, I have still (get the
information that I am) doing these many calories or whatever.”

279
Appendix Q, Continued

From my point of view, I’m interested in more scientific feedback. So you would type in
these measurements, so three points throughout the program. I’ll be interested in also
monitoring blood pressure or resting pulse, those sorts of things. So, if you could get that
stuff in there and get a button to bring out the graph or something, so you could look at
the way your blood pressure or resting pulse change, giving idea of how much a day that
variation is associated with the increase of activity or with stress because you’re also
monitoring other lifestyle track as well.

And then there are websites out there, like MapMyRun and I don’t know if you know that
one. So you can just click on a map and it will automatically store your routes, store your
time and automatically calculate the distance you’ve run and even gradient and that sort
of stuff. So if I went for a 10 kilometer run on the weekend, the most information I can
enter on the site was low, medium, hard exercise. There is no way of quantifying the
objective. If I was involved in this for a year, I want to track progress and make sure I
was getting fitter and make sure that my exercise was achieving the goals I wanted. So if
I saw that by going for a 15 kilometer run instead of a 10 kilometer run on Sunday, then
my blood pressure drop for the following week. I’d be delighted to sign up and I’d be
using three times a day. But I felt that there simply wasn’t enough tangible information or
enough of a sort of quantified record of what I’ve done. Yeah, I found it a bit
disappointing.

There is only a way to post minutes and during an exercise. And sometimes you don’t
necessarily do something for a certain amount of minutes or you don’t keep track of how
long you're doing it. So I like to go running by distance a lot and I would enjoy a feature
that would allow me to post like running 11 miles or went running three miles or
something like that. So running for 70 minutes, yeah that’s nice but if you say 11 miles
then that’s a lot.

Motivational - Also, if you could input your information such as weight and it pops up a
flashing message to say you lost X pounds and all your friends could see that - that could
be exciting and motivating.

Well, what would make it interesting also I see is that¡ªlike if it can give you players or
like a guy or maybe just like a face for the day, something positive, something that¡¯s
different and it’s positive and you see it there. It changes, like positive faces I see that
would help. It’s motivation and it’s kind of nice, you know like a pop-up that has a
positive (face) saying or phrase, things like that, or also advice on how to stay healthy the
carrot is for this or the apple is for that, you know, something that was just it’s learning
about healthy food. It’s kind of like the website is communicating with you. That’s
important I think emailing automatic updates maybe a feature that I might take advantage
of. Almost everybody’s emails get flooded every day with all sorts of e-mails. So I’m not
sure that I would take advantage with feature like that, but I think I might. Because if I'm

280
Appendix Q, Continued

not in this study, I'm not going to feel like I need to log in everyday to check. However, if
I have a group of 11 people and every morning I have an email that says the summary of
these 11 people activities, then “Oh, hey, I should be active too.” Particularly there was a
friend that I have that lives in Anchorage, Alaska that I did not enroll in the study
although I should have because he and I are trying to we want to run race, a marathon
next year. So I would say that I would enjoy using the website for the purpose that when
he went running, it would email if that was a feature and vice versa so that we could kind
of work together towards a goal but still live in two different places.

I rarely posted a setback. If I didn’t exercise, I just didn’t log on. There were a few times
when I still logged on just to see what other people are doing. But if instead, I was getting
a daily reminder that said not just make sure to log on but look at your friends are doing.
Your friends are running laps around you and you haven’t logged on in three days. I think
that one other. I’m reading some large volume of books right now and I'm on a reading
schedule and there was this website that actually keeps track of how often you log in and
emails you and says, “We haven’t seen you in two weeks, where are you” or you could
compile it to one email that says, “Look what your friends are doing and you haven’t
logged in for three weeks.”

Yes. That will probably be a concise way to say that. I don’t Facebook and other similar
applications have emailing feature where they email you automatically, goes back to the
original page. If it were in Facebook, I would perhaps appreciate daily from that
application but I can’t think of any other suggestions.

Tip of the day - There was actually something I mentioned as a suggestion to everyone
who’s working on the site and they said with the whole like tip of the day. And I was like,
“You know how long it is to put on differently to go to view the tip of the day but it’s not
attached to the website.” You know how I normally like yeah, it could be something on
the site of the web site or you know just motivational tips - Or there could be a popup
from the robot to say, “Hey, you have an exercise in a week, if you exercise a day, I’ll
give you ten points.”

I think helpful tips for someone who is trying to exercise or some motivational messages
(would be helpful). I could say if I put in I had a setback, I was tired or something and
there would be some messages to say “it’s okay,” you know, just like put like personal
motivation. Or if it was like, “Okay, I didn’t do this, or I thought I lost this kind of weight
and I had missed it.” It’s like, okay, well, better diet, like diet tips, like you should eat this
or more water or whatever the case may be. I am just throwing stuff out there but I think
that would be more useful for me, more motivating for me, even to be able to something
like that to see a change.

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Appendix Q, Continued

Wishful - Reward system

“It surprises me how quickly my points accumulated. I was unsure what to do about that,
I felt like well I’ve got 96 points, I think I’ll just blow them on these three scenes and
map out those three themes. it almost felt like you would be interesting to be able to do
something like to bank my points or something, like to have a reason, to have these many
points because I mean I’m going to be exercising and when I had a couple of weeks that I
just don’t have time to spend a lot of time with the robot, they just they get accrue
quickly. And it was a little bit overwhelming to have that many points and not really sure
what to do with them. So maybe¡ªmaybe some really big ticket items would have taken
care about that or maybe the chance to use those points to like buy a new robot to open
up a new level or something, I don’t know.”

It would have been interesting I think to me to be able to do some things more than once
because you throw a Frisbee in the park, but you can never throw a Frisbee again, which I
don’t know that you would want to, but like I remember collecting a rock, I spend like 3
points on the rocket, and I was like, cool, I have a rock. Well, it might be nice to have
liked a couple of rocks, so it’s totally like a silly thing. But if I send one to my wife, I
don’t have a rock anymore, I can’t get another rock.

You could also get corporate sponsors to provide coupons of healthy food, free gym
membership as incentive or reward.

One drawback for me is actually having a membership into the gym. Maybe, you guys
got funding and it’s actually a big program and then you study it on the people, maybe
give them a free 30-day pass to a gym where they can actually be like, “If you want to
work out, go work out. It’s not hard. Go do it!”

Wishful - Robot personalization
“I think it would be interesting to be able to personalize the robot in more ways to sort of
avatar-like. To make it you know different colors or different styles”

Maybe because you are not able to customize the avatar to kind of make it more yours. I
think Sam mentioned it would be nice to be able to customize the avatar. People like to
identify their characters so we won’t all have the same gray robot.

Or like if you get a gift from your partner, the sunglasses and then you should be able to
put it on your character or something like that?

282
Appendix Q, Continued

Wishful - Robot interaction

I think one other thing I comment on earlier with the fact that the character is always
alone like it's odd to me. It’s like you’re in a community form and say you want your
character you know if you could see other people currently surf you could see your robot
interacting with another k you can see them giving a gift. So, if it was a little bit more
social or included other people than just you alone on the beach or something. And then
the actual graphics themselves, they’re not very colorful¡- the color pallet is pretty bland
from what I remember. And it just wasn’t really exciting¡-. It’s very common in video
games if you wanted to get your character a dress or a pearl or accessories or sun glasses
or barbecue like you can actually do anything to your robot.

Wishful - Photo sharing

Yeah, okay. Pictures and maybe more linking it to the activity, instead of just saying, “Oh
I set back, Clipper game,” you can say like you know, picture of the guys going to play
Clipper game …

Well, what’s good about Facebook is they have the pictures. So if you can load pictures
and see oh, along with the program then you¡¯d be like you can tie what you did also to
the pictures and then that would be a more vivid thing.

Wishful - Friendly competition

Yeah, it was more kind of a game with the points. But it’s not competitive because you
cannot see how many points your friends have. So then that's one part I think the program
could improve if you could see the points that your friends have.

Well, if your friends are involved. Yeah, like if somebody else was on the other side and
then you’re playing with each other and try to achieve a goal like I said and you once you
complete the goal, you know, you’re like, “yeah! We did this!” You give each other high
fives - So it’s more like online gaming. So that’s what makes it fun.

Yeah, well that’s a big part of it and that’s like being able to kind of post and what your
character has accomplished like a lot of video games if you play online, they’ll say you
can at least go over a character packed games that they play and you can see how many
achievements that they’ve opened. So it’s that same kind of thing like obstacle that your
character has been or that you sell out how many if you said you’re going to exercise five
times, did you achieve that goal and did you mark something for it. Like that sense of

283
Appendix Q, Continued

reaching a goal and then you know selfishly letting other people know that you’ve
reached that goal in a very competitive way.

Wishful - Social interaction

“If there is a forum on the website for groups to discuss issues you know say for moms
to get together and plan a walk in the park or something..”

“You could also make it easier to invite friends- you know if I want somebody that join
me on Farmville, it’s a simple click, send them an invite or request. If they deny it, they
deny and if not, if they join, they join. You know so if was something as simple as that, I
have like 500 of my friends on my Facebook. So it’s just like click send and to take invite,
I probably just do it, you know if it was something that I wanted to do.”

“I didn’t think that it was necessarily easy to see if you had received messages from other
people. I didn’t think that there is any sort of notification or text maybe like a popup or
some sort of red check or flashing exclamation point, things like that.”

“Yeah, they would have been better and I thought if I could tell people like a setback or
you know, a triumph, it would have been nicer to tell it to everybody even if only one
person responded. I just felt like it would feel more like a group, especially since we
don’t live in the same state, all of us.”

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Asset Metadata

Creator Wang, Hua (author)

Core Title Building personal wellness communities: meaningful play in the everyday life of a network society

School Annenberg School for Communication

Degree Doctor of Philosophy

Degree Program Communication

Publication Date 08/13/2010

Defense Date 05/27/2010

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag game,health,networked play,OAI-PMH Harvest,personal community,physical activity,social network

Place Name California (states)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor McLaughlin, Margaret L. (committee chair), Cody, Michael J. (committee member), Valente, Thomas W. (committee member), Williams, Dmitri (committee member)

Creator Email lesemao@gmail.com,wanghua@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-m3397

Unique identifier UC1487239

Identifier etd-Wang-4036 (filename),usctheses-m40 (legacy collection record id),usctheses-c127-394884 (legacy record id),usctheses-m3397 (legacy record id)

Legacy Identifier etd-Wang-4036.pdf

Dmrecord 394884

Document Type Dissertation

Rights Wang, Hua

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Repository Name Libraries, University of Southern California

Repository Location Los Angeles, California

Repository Email cisadmin@lib.usc.edu