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Gamification + HCI + CMC: effects of persuasive video games on consumers’ mental and physical health
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GAMIFICATION + HCI + CMC:
EFFECTS OF PERSUASIVE VIDEO GAMES ON CONSUMERS’ MENTAL AND
PHYSICAL HEALTH
by
Yunwen 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 2022
Copyright 2022 Yunwen Wang
ii
DEDICATION
To the memory of my grandmother
iii
ACKNOWLEDGEMENTS
Among the many wonderful beings to which I am grateful, I would like to first thank my
dissertation committee: Drs. Margaret (Peggy) McLaughlin, Lynn Carol Miller, Gale Lucas, and
Jonathan Gratch; as well as Dr. Robin Stevens who, although not on my committee, has been a
close mentor of mine in the past three years. The guidance and support from all of you during my
doctoral program at USC meant a lot to me. Each of you provided me with a unique perspective
on how amazing teaching and research could be.
Peggy, thank you for always having so much faith in me. You inspire me not only as a
pioneering researcher in computer-mediated communication, an advisor who encourages
students to generate novel and cutting-edge research, but also a role model who is devoted to
making the world a better place through both research and civic participation. Thank you for
having me as your last student before your retirement. In my country of origin, we assign utmost
emotional values and missions to the last student of a master in their career, with the expectation
that this student will pass down their legacy. I do not know how my future will unfold yet – I
know you will be pleased to see me contributing to the world in any form regardless – but I will
continue to set a high bar in terms of my research.
Lynn, thank you for being tremendously generous with your time and support. It is a true
commitment of you to make constant efforts in making sure I feel supported and make good
progress. You joined my journey as a co-advisor, which doubled the mentorship that I am
privileged to have. I learnt from you the importance of holding the highest precision in research
design and statistical analysis. I also benefited a lot from your career advising, which was a key
factor that kept me on the right track.
iv
Drs. Lucas and Gratch, every time I think back I feel very lucky to have enrolled in INF
549 in the second year of my PhD study. Through that course, I got to know Dr. Lucas, whose
research in Human-Computer Interaction (HCI) and Affective Computing was so refreshing and
intriguing to me as someone whose previous training had been all in Communication. I also
learnt so much from the Directed Research course in HCI with Dr. Lucas, through which we
surveyed a variety of topics including rapport/ therapeutic alliance, embodied agents and
anthropomorphism, personality and perception of agents, trust in automation, and many more.
The course prepared me for my first ever research publication about TikTok and presence/
immersion, on which Dr. Gratch also provided valuable feedback. Thank you both for having me
as a Directed Research Intern in your lab in the summer of 2019, during which I had the
opportunities to directly work and interact with your other PhD students, participate in your lab
meetings, be immersed in a highly interdisciplinary research setting, and be inspired to plan my
own research program by integrating a computational approach and HCI theories.
Robin, thank you for joining me on this journey in my third year. I am so grateful that I
am able to work with you for the USC Health Equity and Media Collab. I enjoy having you as a
mentor and supervisor in both teaching and research, and you are my role model in terms of
finding a purpose in the research we do.
I would also like to acknowledge the guidance of my mentors and professors during
previous academic programs, as they pointed me in the direction of a research career. They
especially include but are not limited to my Master’s thesis committee at Purdue University: Drs.
William Bart Collins, Maria Venetis, and Marifran Mattson, and my undergraduate mentor at the
University of Macau: Dr. Xiaoqin Li. They were all so resourceful throughout my academic
v
adventure. Both institutions were extremely supportive and resourceful, as well, in every
possible aspect, thanks to the phenomenal staff teams.
To my PhD cohort, friends, colleagues, and research collaborators at USC Annenberg
and other research institutions, Steffie Kim, Caitlin Dobson, Paulina Lanz, Tyler Quick, Sierra
Bray, Olivia Gonzalez, Natalie Jonckheere, Calvin Liu, Paul Sparks, Hye Min Kim, Yao Sun, Do
Own Donna Kim, Yusi Aveva Xu, Jessica Hatrick, Becky Pham, Essence Wilson, Ashley
Phelps, Mingxuan Liu, Yuanfeixue Nan, Grace Wang, Jack Tang, Junyi Lv, April Yue, Larry
Zhiming Xu, Jiaxi Wu, and many others, thank you for this shared journey and your support.
Lastly, thank you to my family and friends for their unconditional love, trust, and great
encouragement from different parts of the world. Thank you for being my constant reason to
finish.
vi
TABLE OF CONTENTS
DEDICATION ................................................................................................................................ ii
ACKNOWLEDGEMENTS ........................................................................................................... iii
LIST OF TABLES ......................................................................................................................... ix
LIST OF FIGURES ........................................................................................................................ x
ABSTRACT ................................................................................................................................... xi
CHAPTER 1: INTRODUCTION ................................................................................................... 1
Research Motivation ............................................................................................................. 1
Gamification, HCI, and CMC: Towards Persuasive Worlds ........................................ 1
Humans, Cyborgs, and Technologies as Social Actors ................................................ 3
Technology-enabled Healthy Lifestyle for the Post-pandemic Future ......................... 6
Organization of the Current Research ................................................................................ 11
CHAPTER 2: GAMIFICATION FOR HEALTH ........................................................................ 14
Concepts Explicated ........................................................................................................... 14
Gamification ............................................................................................................... 14
Persuasive Technology, Social Simulation Game, and Exergame ............................. 15
Theoretical Rationale for Gamification for Health ............................................................ 18
Affordances of Persuasive Video Games ........................................................................... 20
Social Simulation Game Affordances ................................................................................ 21
Exergame Affordances ....................................................................................................... 22
Virtual Agents and Haptic Devices ............................................................................. 22
Realism ....................................................................................................................... 25
Presence and Immersion ............................................................................................. 26
Agency/Control ........................................................................................................... 28
Narratives .................................................................................................................... 29
Sensors and Haptic Devices ........................................................................................ 29
Requests and Rewards ................................................................................................ 30
vii
User Experience (UX) and UX Evaluation ........................................................................ 31
Usability and Functionality ......................................................................................... 31
UX Evaluation Methods ............................................................................................. 32
CHAPTER 3: SOCIAL SIMULATION GAME UX EVALUATION (STUDY 1) .................... 36
Background ........................................................................................................................ 36
Animal Crossing: New Horizons ....................................................................................... 38
Literature Review ............................................................................................................... 39
Methods .............................................................................................................................. 43
Data ............................................................................................................................. 43
Procedure and Data Analysis ...................................................................................... 44
Results ................................................................................................................................ 46
Topic Modeling ........................................................................................................... 46
Sentiment Analysis and Emotion Classification ......................................................... 50
Reddit Post Classification ........................................................................................... 54
Negative Sentiment and Emotions Associated with the Game ................................... 57
Study One Discussion and Conclusion .............................................................................. 58
Study One Limitations and Future Research ...................................................................... 60
CHAPTER 4: EVALUATION OF A HOME-BASED EXERGAME, RING FIT ADVENTURE
(STUDY 2) .................................................................................................................................... 62
Habitual Physical (In-)Activity .......................................................................................... 62
Health Interventions for Physical Activity ......................................................................... 64
Gamification in Fitness Applications and Exergames ....................................................... 65
Health Risks Involved in Trusting Technology ................................................................. 71
Reddit and Subreddit .......................................................................................................... 73
Methods .............................................................................................................................. 76
Data and Data Collection ............................................................................................ 76
Sentiment and Emotion Analysis ................................................................................ 76
Image Clustering ......................................................................................................... 76
Qualitative Analysis .................................................................................................... 77
Results ................................................................................................................................ 78
Descriptive Statistics on Posting Activity ................................................................... 78
Sentiment and Emotion Analysis ................................................................................ 79
viii
Exergame Affordances and Social Interactions in Image Clusters ............................. 80
Sports Injuries, Physical Health Risks, and Accessibility .......................................... 86
Exergame Effects on Weight Management ................................................................ 93
Exergame Effects on Mental Health, Sleep, and Substance Use ................................ 97
Study Two Discussion ...................................................................................................... 101
CHAPTER 5: GENERAL DISCUSSIONS AND CONCLUSIONS ......................................... 107
Implications ...................................................................................................................... 107
Limitations and Future Research ...................................................................................... 111
Conclusions ...................................................................................................................... 112
REFERENCES ........................................................................................................................... 114
APPENDICES ............................................................................................................................ 132
Appendix A: Coding Scheme for the UX Classification of Reddit Posts ........................ 132
Appendix B: Table A1. Themes and Example Tweets of the 20 LDA Topics ................ 133
ix
LIST OF TABLES
Table 2.1. Motion sensing games by release year……………………………………………………18
Table 4.1. Keywords used for filtering the data to obtain subsets for qualitative analysis…………78
Table 4.2. Sports injuries, pain, and physical effects of the exergame, Ring Fit Adventure………………87
Table 4.3. Posts from r/RingFitAdventure reporting the exergame’s effect on weight loss…………..95
x
LIST OF FIGURES
Figure 2.1. Fitness buddy, Ring (left); fitness instructor, Tipp (right), in Ring Fit Adventure……………23
Figure 2.2. Antagonist ECAs, Dragaux (left), and mini bosses (middle and right)…..………………….23
Figure 2.3. The ring, leg strap, joy-cons (left); the player’s self-avatar and the ring as an ECA (right)……24
Figure 2.4. Custom self-avatar appearance…………………………………………………………28
Figure 3.1. Coherence score (red) and log of perplexity (blue) by the number of topics, step = 1………46
Figure 3.2. Word cloud of ACNH-related tweets……………………………………………………50
Figure 3.3. Counts of sentiment by date, red = negative, blue = neutral, purple = positive………………51
Figure 3.4. Mean sentiment scores of daily tweets by date, red = negative, blue = neutral, purple =
positive .…………………………………………………………………………………………..51
Figure 3.5. NRCLex sentiment and emotion word counts in the ACNH Twitter dataset………………52
Figure 3.6. NRCLex sentiment and emotion word counts in the ACNH Reddit dataset…………………53
Figure 3.7. A family aquarium tour in Animal Crossing………………………………………………55
Figure 3.8. An Animal-Crossing memorial……………….…………………………………………56
Figure 3.9. The meme Our Saving Grace……………………………………………………………57
Figure 4.1. Word “physical activity” trend from Google Books Ngram Viewer………………………63
Figure 4.2. Image clustering pipeline………………………………………………………………77
Figure 4.3. Post frequency by date on r/RingFitAdventure (Oct 18, 2019 – Oct 18, 2022) ………………79
Figure 4.4. NRCLex sentiment and emotion counts in the Ring Fit Adventure Reddit dataset…………80
Figure 4.5. Cluster 1 image examples…….……………………………………………………………….81
Figure 4.6. Cluster 2 image examples….………………………………………………………………….81
Figure 4.7. Cluster 3 image examples…….……………………………………………………………….82
Figure 4.8. Cluster 4 image examples…….……………………………………………………………….83
Figure 4.9. Cluster 5 image examples……….…………………………………………………………….84
Figure 4.10. Cluster 6 image examples…...……………………………………………………………….85
xi
ABSTRACT
Increasingly, media technologies that employ avatars and embodied conversational
agents are becoming intimately involved in human lives, as users communicate within and with
such technologies. Persuasive video games are one example, or test case, of how this type of
technology will be accepted and used. Due to the potential effects of these games on consumers’
well-being, a first step is to ensure that consumers’ concerns and responses to such games are
understood – so that they can be addressed. Therefore, this dissertation project empirically
assesses the user experience (UX), affective responses, and perceived health outcomes associated
with two recent commercial off-the-shelf video games, i.e. Animal Crossing: New Horizons
(ACNH) and Ring Fit Adventure, which were released during the COVID-19 pandemic when the
general public’s physical, mental, and social well-being were severely challenged. Study 1
combines computational Natural Language Processing (NLP) techniques and qualitative
thematic analysis to evaluate the perceived effects of a social simulation game (i.e., ACNH) on
players’ social interaction and coping of pandemic-related loss and stress during pandemic
lockdowns. Study 2 analyzes online discussions of Ring Fit Adventure in a gamer community
and specifies health behavioral outcomes from user-generated content. The two studies provide
methodological implications for UX evaluation using computational mixed methods, practical
implications for persuasive game design, and theoretical implications for bridging health
communication, persuasive technology, human-computer interaction, and computer-mediated
communication. From an equity perspective, this dissertation project concludes by discussing
how the digital divide and technoableism may structurally marginalize certain groups, if we use
digital gaming to address isolation, mental and physical health in the post-pandemic future.
1
CHAPTER 1: INTRODUCTION
Research Motivation
Gamification, HCI, and CMC: Towards Persuasive Worlds
Despite considerable hype regarding an emerging metaverse (i.e., a single, universal
immersive virtual world), populated by engaged avatars (human driven agents) and virtual
humans (driven by algorithms), set to be worth up to $5 trillion by 2030 (McKinsey, 2022),
Meta’s first multi-billion dollar attempt to create a Metaverse is suggested by its company
documents to be failing, with relatively few users visiting regularly and continuing to spend time
there (Horwitz et al., 2022). As game design professor, Celia Pearce, notes, this effort is “off-
putting” to both game and non-game audiences and “really missed the mark in terms of creating
something [engaging] for the right audience” (Mello-Klein, 2022). Still, Pearce argues that the
idea at the heart of the metaverse – digital portals into a universally networked community that
affords opportunities to connect and create special worlds, including those in which they can be
creative – is compelling. As marketing experts would agree (Mello-Klein, 2022), persuading
audiences to engage in these worlds depends upon understanding the motives and goals of
audiences (what do consumers want to achieve and want to avoid) and ensuring that the
technological affordances available can and do help them achieve those goals. Such worlds
themselves – persuasive worlds – that could help change individuals, in desired ways, offline as
well as online, for example by enhancing their mental and/or physical health, could be
exceptionally compelling.
But what academic fields are poised to conduct the social science research that can help
create such compelling and persuasive worlds? Currently, although there is not a specific field in
2
communication – or any other social science – focused on this goal, there are three fields (i.e.,
games studies, human-computer interaction (HCI), and computer-mediated communication
(CMC)) where disciplinary boundaries are blurring and from which such an emergent field of
study in that world (e.g., including on persuasive video games) is likely. Historically, game
studies, HCI, and CMC were relatively distinct fields, but these boundaries are blurring. HCI is a
multidisciplinary field aimed at studying interactions (e.g., browsing a website, navigating a
mobile app) between humans (i.e., users) and computers (e.g., desktop computers, mobile
devices) (Rouse, 1981; Wang, 2020). This domain may also include a non-human user-interface
agent, for example, that provides personalized assistance to the user (Schiaffino & Amandi,
2004). Social science and information science researchers in this domain (Beneteau et al., 2019;
Pallavicini et al., 2019), for example, conduct usability studies assessing the user’s experience
(UX) including the extent to which, given the technology and its interface users perceive that
they have achieved their goals (i.e., effectiveness), competence needed to use affordances to
achieve goals (i.e., efficiency), and user’s satisfaction (e.g., in using the system including their
affective reactions). CMC refers to the area of study in communication focused primarily on
communication between humans separated in time (asynchronous) and/or not (synchronous) and
separated in space using technologies such as email, social media, or videoconferencing
(Romiszowski & Mason, 2004): It is a key area in the field of communication including in the
division of communication and technology of the International Communication Association
(ICA) and publishes the leading journal in Communication, Journal of Computer-Mediated
Communication. Games studies is a division in the ICA that includes studies of human
communication in video/digital games, advanced media (e.g., Virtual Reality (VR)), and
simulations, overlaps with HCI, and includes interests in the social science uses and effects of
3
games and users’ motivations, as well as affective and cognitive experiences. Increasingly,
media technologies that employ human-driven avatars and embodied conversational agents
(typically non-human, driven by artificial intelligence) are becoming intimately involved in
human lives, as users communicate within and with such technologies. Today, there are some
emerging commercial games that come closer to what is possible in tomorrow’s persuasive video
games (e.g., humans interacting via avatars with other human-driven avatars and agents). Yet,
there is little research to date that attempts to understand the UX in and about these worlds in
achieving users’ desired goals. That is the goal of the current work, which is also inspired by a
history of research in communication that supports the view that cyborgs and technologies, as
well as humans, can be construed as social actors.
Humans, Cyborgs, and Technologies as Social Actors
The idea that technologies are extensions of the human body originated half a century ago
when Marshall McLuhan discussed the relationship between humans and tools (or media) in the
book Understanding Media: The Extensions of Man (McLuhan, 1964). McLuhan’s view that “all
technologies are extensions of our physical and nervous system to increase power and speed” (p.
91) positions technologies as a form of augmentation and acceleration of humanity. In its
essence, the view did not predict how indispensable and essential certain information
technologies can become to humans in current society (with electronic mail systems and
smartphones as two examples). It also did not foresee how at times like the COVID-19
pandemic, social media and interactive video games would be heavily used by many people – if
not all – as coping mechanisms (Nilsson et al., 2022) in the face of the global lockdown’s
unprecedented challenges to their physical, mental, and social well-being. For example, during
the enforcement period of initial stay-at-home orders, the United States (U.S.) witnessed a 75%
4
increase in online gaming according to Verizon, a telecommunications company, and the
increase was sharply defined by the pandemic (Hollywood Reporter, 2020).
The “technological extension and amputation” theory of McLuhan (1964) focuses on
how technologies extend human body and mind, but it also posits that mankind would lose
certain abilities (i.e., amputation) due to technological extension, such as the loss of archery
skills following the development of gunpowder and firearms. In contrast, Frank Biocca (1997)
proposed an alternative view of “technological adaptation” and argued that humans have become
more and more like cyborgs through interacting with readily available technologies and
integrating them into our self-identity. According to Donna Haraway (1991), “a cyborg is a
cybernetic organism, a hybrid of machine and organism, a creature of social reality as well as a
creature of fiction.” (p. 3) When we project ourselves into an immersive virtual environment, we
allow the machine to equip us with a virtual presence, either embodied or disembodied, and we
extend our physical intuitions to the virtual environment to reason about the logic of the
projection, engage in social interaction in a mediated context, and gauge the limits and
capabilities of ourselves within or through this new form of media. Relatedly, Amber Case
argued (2010) that whenever we look at a computer screen or use our smartphone to accomplish
a task, we are cyborgs. While I do not endorse an oversimplified view of equating humans’
technology use to the notion of cyborgs, Case offers an interpretation of the increasing and
immense involvement of digital media technology as we fulfill our everyday tasks. The effect of
such a trend on users, and its implications for traditional human communication, humanity, and
humans’ multifaceted well-beings, thus become important inquiries.
Kevin Kelly (2009) claim that humans have the moral obligation to increase the power
and presence of technology in the world, while according to Kelly, many opponents of
5
technology consider technology to be contrary to nature (by exploiting natural resources and
destroying ecological habitats), to human (by eroding the human character), to God (by enabling
wars and mass killing), and to technology itself (by being self-destructive if one day getting out
of control). Therefore, as I will argue later, the moral obligation of humans, with regard to
technology, would be to constantly evaluate the power and presence of technology and to
empower humans with technology. To do so requires the mankind to structurally examine media
effects and critically reflect on media design, evaluating if users’ motivations and needs are
successfully understood and achieved. Of particular significance to media effects research, the
various risks and negative consequences associated with emerging technologies ought to be
closely monitored, as they may cause unintended adverse effects on consumers along with their
well-intended benefits. Namely, users shall not take novel technology adoption for granted and
assume its effect is always “good” or “bad”. With rapid advances in virtual agents, robotics, and
artificial intelligence, that these technologies have the potential to empower humans brings about
new obligations for researchers and designers such as to understand the human-machine
relationship and to keep the interaction as beneficial, ethical, and responsible as possible.
McLuhan (1995) also argued that “the medium is the message.” He used the example of
television viewing to explain this argument, saying that it is not the content of the television that
is important, but the participatory nature of the television viewing experience. While television
viewing itself has extensively evolved, this saying resonates with today’s researchers whose
theories about the human-technology relationship leverage the important concept of agency
(Lucas et al., 2018; Nowak & Biocca, 2003; Qin et al., 2009). That is, media do not only convey
messages, but meaningfully interact with consumers to generate independent effects. Media
consumers also do not passively receive messages from media but participate in the experience
6
and interact with the media to jointly create meanings and shape outcomes. If a medium is
perceived to have agency, namely the extent to which people think media are social actors, or
have social attributes that resemble a real human, people will respond to the medium accordingly
(Lucas et al., 2018; Nowak & Biocca, 2003). By viewing media technologies as social actors, we
allow our research to focus on nonconventional mediated social interactions and how users meet
social needs through media technology use. As noted earlier, the mediated social interaction is
not only through computer-mediated communication (CMC) but human-computer interaction
(HCI), or the increasingly blurring field of these two forms of information exchange.
With interactive video games as an example, the agency that players perceive from the
game play may have multiple sources, including the agency of players themselves or of other
players in the virtual game world, the agency of non-player characters (NPC) who can socially
interact with players, and the various game mechanisms that enable mediated social interaction.
These sources of agency, ultimately, can bring agency to the game itself and enable it to create
new social meanings for the players. That is, depending on the specific game elements that
players perceive to be meaningful, interactive video games may be considered as social actors
(Fogg, 2002). Following this train of thought, this dissertation project is specifically aimed at
examining the social affordances and effects of two select video games of somewhat different
nature; the term social affordance can be defined as the games’ properties that permit social
actions and social activities, especially in an atypical time of pandemic with prolonged physical
constraints.
Technology-enabled Healthy Lifestyle for the Post-pandemic Future
As technologies become more substantially immersed in human life, another trend has
emerged: a more active healthy lifestyle, with extensive social interaction and physical activity,
7
appears to have declined, with a more sedentary lifestyle on the rise (CDC, 1996; CDC, 2016).
The COVID-19 pandemic that started at the end of 2019 and the beginning of 2020 has made
this situation even more salient. As of early November 2022, COVID-19 had claimed 6.58
million lives and infected 630.83 million based on confirmed cases (WHO, 2022). Since the
beginning of 2020, lockdowns and quarantines have been enforced or recommended in different
parts of the world, as a public health measure to prevent the spread of the virus. Following such
large-scale interventions, research evidence shows that pandemic-related social, psychological,
behavioral, and environmental changes have negatively impacted people’s mental and physical
health. These negative consequences include increased emotional distress, insomnia, depression,
generalized anxiety disorder (GAD), post-traumatic stress (Brooks et al., 2020; Marroquín et al.,
2020), and widespread weight gain in some populations (Zachary et al., 2020).
Targeting the issue of a sedentary lifestyle, many persuasive technologies have been
introduced and tested (see a review: Wang et al., 2018). Persuasive technology refers to those
designed for changing users’ attitude and behavior (Fogg, 2002), such as social simulation games
that aim to increase social activity, and exergames that aim to increase physical activity.
Reflecting on the commercial off-the-shelf video games released amidst the pandemic, two
games stand out as tackling these health challenges. First, Animal Crossing: New Horizons is a
social simulation game that has an intended effect of increasing social activity, but as Chapter 3
will elaborate, it can also have an unintended effect on players’ mental health – mostly positive,
but occasionally it induces players’ anxiety. Second, Ring Fit Adventure, as Chapter 5 will
elaborate, is an exergame that incorporates multiple types of virtual agents and rich social
features to motivate continuous and habitual physical activity. However, it was not surprising to
also find that this exergame impacts players’ mental health as well, as physical activity in general
8
promotes mental well-being. These two games were chosen for their popularity and continuity.
Unlike exploratory or experimental games of the kind designed by research labs and maintained
for a limited duration, commercial off-the-shelf games with millions of sales would allow for
evaluation of game elements and effects on a much larger scale of consumers in natural
gameplay settings over a longer term.
As noted in Chapter 4, evaluation of the effectiveness of gamification for health has
mostly focused on absolute outcomes, overlooking the role of the user experience (UX) in
interactive media use. Therefore, one of this dissertation’s foci will be evaluating the UX of
these two games. Through reviewing previous UX evaluation methods of persuasive health
technologies, this dissertation identifies a gap in current evaluation methods, which is that they
heavily rely on lab testing and online surveys. Lab-based UX tests provide researchers an
opportunity to directly engage with the end users, but also tend to situate users in an environment
unfamiliar to them and potentially induce unnatural behavioral responses. Such tests also focus
on evaluating short-term effects of technologies in one sitting. Online surveys, in comparison,
allow researchers to reach larger samples than lab tests of UX. However, surveys tend to
represent a knowledge structure of the survey designers rather than the survey respondents,
enforcing the responses to follow a predetermined range of questions that may under-represent
what most concerns the consumers. Therefore, this dissertation takes a different UX evaluation
approach, a mixed-method computational approach that explores the combination of human
strategies and computational techniques. This approach allows the researcher to examine user-
generated content (UGC, i.e., images, text, audio, and other forms of content posted by users on
online platforms such as social media sites) at different scales, leaning on the knowledge
structure of consumers as opposed to researchers. One potential limitation of this approach,
9
admittedly, is that it may only include a limited range of voices from certain social media
platforms. Future extension of this project will seek to apply a purposeful sampling pipeline that
can enable us to reach structurally marginalized populations, which my research collaborators
and I have been exploring in the past two years. While not being a focus of this present work,
this type of purposeful sampling pipeline may be achieved by involving the target community,
and by leveraging Natural Language Processing (NLP) techniques to analyze and model the
language features of UGC from the target community on social media (Weissenbacher et al.,
2022). Through UX evaluation, this dissertation seeks to summarize a broad range of social
behaviors and social activities that are afforded by these two exemplar games as well as their
social media gamer communities during the pandemic.
The COVID-19 pandemic, as mentioned above, presents a new condition for home-based
video games to assist social and physical activity when alternative venues are of limited or no
access. As my previous work found (Wang, 2020), consumers are likely impacted by persuasive
TikTok videos to adopt smart-home technologies that assist them in accomplishing tasks at
home. A similar electronic word-of-mouth (e-WoM) mechanism may exist on other social media
platforms with respect to the acceptance of other trendy interactive media technologies. Using
social media UGC to understand UX of technologies that have potential health implications,
therefore, may inform us on how to foster a sustainable and resilient post-pandemic future that
embraces a technology-enabled healthy lifestyle.
In the realm of dementia care, for example, tracking devices and home surveillance
technologies (e.g., wrist bands, smart watches, GPS enabled mobile devices, sensors carried or
worn by users, surveillance cameras) help monitor the activities of people with dementia,
mitigate caregiver burden (Sugihara et al., 2009), and support an aging-in-place paradigm that
10
satisfies older adults’ need to maintain normalcy and continuity (Von Kutzleben et al., 2012).
With my colleagues, we have studied factors associated with the acceptance of these assistive
health technologies for dementia caregiving, which are faced with many barriers as well as
facilitators (Sun et al. 2021; Xu et al., 2020). For example, we found that participation in online
caregiver support groups predicted the use of surveillance technology for dementia care (Xu et
al., 2020) with one possible explanation being the e-WoM persuasion mechanism mentioned
above. Yet, given privacy and agency related concerns, one of the controversial issues
surrounding the acceptance of such persuasive health technologies is the extent to which we
allow them to be intimately involved in our everyday lives, especially in a household setting, and
if we perceive the risks involved in adopting them are not outweighed by their benefits.
This is particularly the case in light of the development in intelligent virtual agents and
robots for healthcare (Lucas et al., 2014; Okamura et al., 2010), as the extent to which users rely
on the machine is determined by trust in automation (Hoff & Bashir, 2015). In the type of social
simulation games and exergames that function primarily around virtual agents (including virtual
humans, or humanoid virtual animals), the level of agency we see and the level of trust we have
in these virtual agents can both influence how much “discretional power” (Baier, 1986, p.237)
we allow them to have over something close to us, and in these two cases it is our mental, social,
and physical health. If we entrust a social simulation game or an exergame, we allow them to
exert some level of “free will” on our behalf. For a social simulation game, it is with whom we
socially interact, how the social interaction is constructed, the personalities of the virtual social
agents we interact with, and who may have an effect on our social and mental well-being through
their social interaction with us. For an exergame, the level of “free will” it can have on users
include how the workout session is organized (i.e., duration, movement combinations, intensity
11
level definitions), how we move our bodies, and if we get injured rather than more fit after
following the machine’s fitness instructions. Thus, the acceptance and actual use of health-
oriented game software have to be closely examined – from the perspectives of users, the
technology, and the environment (i.e., home) where the human-technology dyad is situated.
To meet one’s social needs during pandemic related physical distancing, do people
perceive simulated social interaction with avatars and virtual agents to meaningfully fulfill their
social needs? To motivate oneself to be physically active, are exergames with virtual fitness
trainers capable of supporting users to achieve desired health outcomes? Lastly, what kinds of
social interactions are present in these virtual game environments, when the users are physically
located at home? This dissertation seeks to answer these questions.
Organization of the Current Research
This dissertation consists of five chapters on gamification for health, drawing on
computer-mediated communication (CMC) and human-computer interaction (HCI) phenomena
to evaluate the effects of gamified social interaction on consumers’ mental, social, and physical
well-being. Two games designed for a household setting were considered exemplary in a special
time of the COVID-19 pandemic when face-to-face social interaction was constrained; and the
two games were assessed for their effects on consumers. The two games are, as introduced
above, a social simulation game, Animal Crossing: New Horizons, and an exergame, Ring Fit
Adventure.
The first and current chapter introduces the motivation and organization of this research.
Chapter 2 introduces the key concepts in this literature about gamification for health, the
theoretical basis of gamified persuasive health technologies, and UX and UX evaluation methods
which are central to this investigation.
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Chapter 3 reports a study on the select social simulation game, gaining insights and
triangulating findings from Twitter and Reddit data. Reflecting on the gap in previous UX
evaluation methods, this chapter explores the use of computational mixed methods for evaluating
UX, including consumers’ affective response to the game over a seven-month period and the
variety of UX behaviors within the game (by interacting with other players’ virtual avatars, or
with the NPC of virtual animal agents) and in online gamer communities (by interacting with
other players’ social media presences).
Chapter 4 reports a study about the select exergame that involved a series of
computational mixed-method analyses of longitudinal data over three years, including sentiment
and emotion analysis, k-means image clustering, and qualitative analysis. The study evaluates the
effects of the exergame on consumers’ physical and mental health, covering such aspects as
weight management, sport injuries associated with the exergame, mental health and sleep, and
accessibility considerations.
Chapter 5 presents a general discussion of the findings of the two studies, including their
theoretical implications for communication research given the future blurring of HCI and CMC,
practical implications for persuasive health technology design and evaluation, methodological
implications for using UGC and a computational mixed method approach in UX evaluation.
Chapter 5 also discusses the limitations of the studies reported in this dissertation project,
concluding with major findings and presenting several future research directions.
In summary, contributions of this work to the current knowledge include the following:
• This work studies user-game interaction, as well as its perceived effect on user well-
being, throughout four phases: before adoption and usage, during interaction, while
engaged in a specific task, and especially in assessing the relatively longer-term use.
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To this end, UGC data related to the issues of interest were sampled and analyzed
using multiple methods, covering both textual and image data.
• This work shows the agency of interactive video games in user-game interaction, i.e.
their ability to be in action and exert power on users. Users of these games report
well-being in mostly positive but occasionally negative ways. Their agency likely
comes from the embodied conversational agents in the games, the narrative game
plot, and sensors and haptic devices that support real-world and game-world
synchronization.
• Findings of this work demonstrate how social media discussion forums and in-game
communities argument/amplify each other’s effect on video game consumers.
• This work specifies an array of game elements that have enabled the two video
games to support consumers’ situational needs, including social interactions, mental
health, and fitness. Multiple types of UX behaviors are reported in this work.
• Showing that players are motivated by a zest for novelty to adopt new video games,
this work suggests that from an equity perspective, if we use digital gaming to
address isolation, mental and physical health in the post-pandemic future, we need to
address digital divide and technoableism that may further structurally marginalize
certain groups.
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CHAPTER 2: GAMIFICATION FOR HEALTH
This dissertation project explores the potentials of gamification for health. Using two
persuasive video games for case studies, the project includes such objectives as identifying the
range of user experience (UX) in health-oriented persuasive video games, understanding the role
of social media platforms in amplifying the game’s positive effects, and lastly providing
theoretical, methodological, and practical implications for a post-pandemic future where we
could optimize digital health interventions and support intrinsically motivated self-regulation of
health with the assistance of emerging technologies in a household environment. The chapter
provides the definitions of key concepts related to this literature, reviews the theoretical bases of
gamification’s hypothetical efficacy, and lastly introduces the concept of UX and gaps in UX
evaluation methods.
Concepts Explicated
Gamification
A game is an activity “enjoyed for its own sake… as instinctive as breathing”
(Ackerman, 2011, p. 11). “Play”, relatedly, is “a voluntary act” that “offers pleasure in its own
right (and by its own rules)” (Flanagan, 2009, p. 5). Rooted in the concepts of games and play,
gamification is the process of applying game-like features to the design of products, systems,
services, organizations, and activities in traditionally non-game contexts (Huotari & Hamari,
2017). The concept of gamification started to enjoy prominence around 2011 (Xi & Hamari,
2018). Gamification features use various mechanisms to engage users during their interaction
with the technology. For example, narrative can help users define the conventions of a game
world and align expectations with the logic of the game world, hence increasing a sense of
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immersion (McMahan, 2003). In-game storytelling or narrative also supports users in perceiving
meaningful choices and relations (Bormann & Greitemeyer, 2015). Features such as teammates
(Sailer et al., 2017), leaderboards (Hanus & Fox, 2015; Mekler et al., 2017; Sailer et al., 2017),
weekly challenges and group competition (van Roy & Zaman, 2018), may motivate users by
fulfilling their social and relational needs.
Persuasive Technology, Social Simulation Game, and Exergame
Persuasive technologies are designed with an intended outcome, such as changing users’
attitudes or behaviors, and the outcome occurs from a persuasion process enabled by the
technology (Berdichevsky & Neuenschwander, 1999). As examples of persuasive technologies, a
social simulation game is aimed to increase mediated social interactions, while an exergame is
aimed to promote exercise or physical activity in place. Different design elements can offer
technologies different social roles, through which they persuade (Fogg, 2002).
Social simulation video games are a type of life simulation video game that focus on
delivering virtual social interactions between multiple parties. They are often agent-based.
Representative social simulation games include The Sims and Animal Crossing. In these social
simulation games, not only can the player’s self-avatar be modeled as to appearance, emotion
and personality, but the non-player characters (NPCs) can have simulated emotions and social
relations programmed to enhance the human interactant’s perception of the agents’ believability
and perceived realism (Ochs et al., 2009).
Such social interactions can take place in two forms. First, if the social simulation game
allows for networked gameplay, different real-human players can interact with each other’s
avatars in the virtual game world to create a form of computer-mediated communication (CMC).
Second, regardless of whether networked gameplay is possible in a social simulation game,
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players can usually interact with NPCs, which offers human-computer interaction (HCI) or more
specifically human-agent interaction. According to a previous ethnographic case study of Animal
Crossing: Wild World, an earlier version of Animal Crossing: New Horizons, players were found
to be able to participate in creative activities within the game and gain a sense of control through
this process, with the help of the interactive elements in the game (Kim, 2014). Socializing with
virtual animal villagers on the player’s island, for example, is one of the main social interaction
mechanisms in Animal Crossing. Unlike “hardcore” action video games, social simulation games
such as Animal Crossing are viewed as more casual and more open to players’ own goals (Kim,
2014). The latest version of the game, Animal Crossing: New Horizons, has supported players’
mental and social well-being during the COVID-19 pandemic, providing escapism and relief
from pandemic-related stress (Pearce et al., 2021).
In addition to persuasive video games targeting mental and social well-being, exergames
directly address physical activity and fitness. The term “exergame” is a compound noun
consisting of “exercise” and “game.” Exergames are interactive or active video games that
enable the users to perform physical activity, which distinguishes them from conventional video
games with primarily leisure purposes. In previous research, exergames have been studied in the
context of physical activity promotion focusing on motivation and adherence (Peng et al., 2013),
rehabilitation (Smeddinck et al., 2015), balance training (Schröder et al., 2019), and depression
intervention (Li et al., 2016), among populations such as children and youth (Biddiss & Irwin,
2010; Gao et al., 2015), older adults (Cacciata et al., 2019; Stojan & Voelcker-Rehage, 2019),
and persons with chronic health conditions (Butler et al., 2019) or disabilities/physical
impairments (Knights et al., 2016; Mat Rosly et al., 2017). Outcomes such as cognition (Stojan
& Voelcker-Rehage, 2019), depression symptoms (Li et al., 2016), and cardiovascular fitness
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(Knights et al., 2016) were found to be improved after exergaming. Originating from their
competitive or cooperative nature, sports tend to contain a social component and contributes to
the engagement with the exergame. Furthermore, the gamification nature of exergames is also
believed to be why they can be effective in promoting physical activity (Peng et al., 2013).
“FruitSalad,” one example exergame involving older adults, was documented in Brauner
et al.’s research (2013). In this game, participants ranging in age from 20 to 86 years (M = 48.3,
SD = 21.6) were able to move their bodies to control an avatar for virtually making a salad. The
avatar could pick apples from a tree and carrots from the soil in a virtual game world. As
participants’ body movement and gestures in the physical world were captured by a Microsoft
Kinect sensor, the computer system would project the user simultaneously to the virtual game
world. The gamification feature of avatar is applied in conjunction with smart interactive textiles
(Brauner et al., 2013). Its synchronization between the real-human player and their avatar is
enabled by sensors.
In addition to exergames produced by researchers, there also have been commercial off-
the-shelf exergames, of which Nintendo Co., Ltd. (i.e., a Japanese multinational video game
company headquartered in Kyoto, Japan) is a major producer. (See Table 2.1 for a summative list
of motion sensing exergames by release year.) Wii Sports and Wii Fit (initially released in
November 2006 and December 2007 respectively) are among the best known commercial
exergaming video games with high adoption at the time. Both games run on the Wii home video
game console, featuring a variety of yoga, strength training, aerobics, and balance mini-games
for use with the Wii Balance Board peripheral. Nintendo Switch Sports, released later than Ring
Fit Adventure, are improved versions of Wii Sports and Wii Fit, and it runs on the Nintendo’s
Switch game console – but all three of the games primarily support leisure sports. Ring Fit
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Adventure, in comparison, entails more intense full-body fitness training beyond leisure sports. It
is an interactive video exergame that runs on Nintendo’s Switch game console as well. The game
was officially launched on October 18, 2019 (see official pages of Ring Fit Adventure at
https://www.nintendo.co.jp/ring/adv/ and https://ringfitadventure.nintendo.com/).
Table 2.1. Motion sensing exergames by release year
Game Title Year
Nintendo Switch Sports 2022
Just Dance 2021 2020
Jump Rope Challenge 2020
Ring Fit Adventure 2019
Zumba Burn It Up! 2019
Yoga Master 2019
Fitness Boxing 2018
Just Dance 2019 2018
Mario Tennis Aces 2018
Arms 2017
1-2-Switch 2017
Just Dance (Wii) 2009
Punch-Out (Wii) 2009
Wii Sports Resort 2009
Wii Fit Plus 2009
Wii Fit 2007
Wii Sports 2006
Theoretical Rationale for Gamification for Health
Gamification for health is theoretically grounded, with theoretical bases encompassing
cognitive, affective, and social dimensions. Cognitively, the flow theory posits that flow, the
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complete absorption of oneself in a state, a moment, or an environment, would yield positive
affective states from intrinsically motivated activity regardless of external rewards such as
money or fame (Csikszentmihalyi, 1975/2000). An activity that promises to produce flow must
first appeal enough to yield an initial investment of consumer attention, and meeting that bar, the
activity should then also be viewed as enjoyable (Csikszentmihalyi, 2020). While the flow theory
was not set out to explain social simulation video games or exergames, among other emerging
persuasive technologies, a flow experience can often be observed during video gaming. This is
because, essentially, the design of these video games follows the conventional notion of game,
which has a set of goals, rules, and logics. As Csikszentmihalyi (2020) noted, flow is more likely
to occur when the goals of the game and the expected user behavior are clear. With regard to
persuasive video games for health behavioral change, the purposes of the games and what the
player is expected to do and achieve are usually clearly communicated.
The first cognitive basis of gamification is therefore extended engagement due to flow,
which is driven by intrinsic motivation conceptualized in self-determination theory (Ryan &
Deci, 2000). The goal-setting theory (Locke, 1968; Locke & Latham, 2002) also taps into the
relationship between goals and motivation. The satisfaction resulting from goal accomplishment
is considered to be an enabler of further commitment (Locke & Latham, 2002), i.e., engagement
over time. In the specific contexts of social simulation video games and exergames, it appears
that they are both relatively more straightforward than heavy-duty video action games, and easier
to offer players with instant social or physiological feedback. Thus, by gamifying social
simulation or exercise, players would presumably be more engaged with the target health
behavior both motivationally and cognitively.
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Secondly, gamification also has theoretical bases in affective and social dimensions.
Gamification has been extensively studied in the field of educational technologies. A meta-
analysis of 19 studies found that gamification predicts positive affective outcomes of participants
in formal educational settings (Ritzhaupt et al., 2021). Furthermore, another meta-analysis of 16
studies specified that the effect of gamification on behavioral learning outcomes is moderated by
the presence of a fictional game world or story and social interaction (Sailer & Homner, 2020).
Since social interaction provides players with a relational frame of reference, it can influence the
effectiveness of feedback in gamification systems (Hattie & Timperley, 2007). When social
interaction involves primarily competition and some collaboration, it is presumed to be able to
benefit motivational learning outcomes as well (Sailer & Homner, 2020). In the health
communication field, gamification has been combined with narratives to bring about health
behavior changes and enhance health-related knowledge, self-efficacy, and enjoyment in
participants (Zhou et al., 2020). As understanding contextual factors associated with gamification
is critical to successful gamification in health behavioral interventions (Alahäivälä & Oinas-
Kukkonen, 2016), to understand what specific game elements other than narrative support
computer-mediated persuasion and human-computer persuasion (Fogg, 1998) requires close
examinations of specific games.
Affordances of Persuasive Video Games
Affordances are “possibilities for action” (Evans et al., 2016, p. 36) and “the quality of an
object or an environment which allows humans to perform some specific actions” (Gibson, 1982,
as cited in Yao et al., 2013, p. 2512). In previous literature, affordances are prone to be
conceptually equated to functionality (e.g., Yao et al., 2013). However, apart from a functional
aspect, there is also importantly a relational aspect of communication technology that frames but
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does not determine the possibilities with the action of an agent (e.g. a human) in response to an
object (e.g., a persuasive video game) (Hutchby, 2001). Donald Norman (1999) specifically
noted that there exist “real affordances” and “perceived affordances” and they are not the same.
The user may perceive a game to afford an action, regardless of whether or not a technology
indeed affords the action. Influenced by Norman, affordance as a concept has been adopted by
the design community and considered to pertain to design elements (Norman, 1999). This
dissertation mainly focuses on analyzing users’ perceived affordances and perceived effects of
video games, through which we may be able to illuminate the role of specific design elements in
the process. In the realm of video games, affordances can be understood as the quality and
properties of a video game which enables the users to perform certain actions, to achieve certain
goals, or to realize certain effectiveness through interacting with the video game. To understand
and evaluate technologies’ affordances, user experience (UX) evaluation is a process that follows
design and implementation, and it compares them to users’ needs.
The concept of affordance and the evaluation of UX both underpin the understanding
process of persuasive video games’ effects on consumers, including the effects of social
simulation games and exergames on consumers’ physical, mental, and social well-being. In the
two following sections, I will discuss the affordances of social simulation games and exergames.
After the sections, I will review literature on UX and UX evaluation.
Social Simulation Game Affordances
Animal Crossing is a social simulation video game series by Nintendo. Animal Crossing:
New Horizons (ACNH) is its latest version running on a hand-holdable game console called
Switch. The date and time in the game is by default synced to the real world to have realistic
variations in day- and night-time scenes and four seasons. The player, assuming the role of a
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human character, starts the game by starting a new life on a deserted island with 10 non-player
characters (NPC) who are personified conversational animal villagers with unique names. In
total, there are 402 animal villagers in ACNH. A maximum of 10 animal villagers in random
combinations can live on one island. Animal villagers may come and go, relocating from or to
other islands. Players, along with their NPC animal villagers, carry out a variety of indoor and
outdoor activities including socializing, island construction, home decoration, Do-it-Yourself
(DIY) crafting, fishing, gardening, and collecting items such as fossils and rare followers.
Exergame Affordances
Despite recent evaluative research on Ring Fit Adventure suggesting its positive effects
on consumers (Sato et al., 2021; Takei et al., 2022), how gamification features or combinations
of gamification features in this exergame are driving its effects remains insufficiently studied. As
mentioned above, affordance refers to the properties of an object or an activity that enables
actions; for technologies, their affordances connect the game and players and allow players to
take actions to satisfy their needs (Zhang, 2008). The following passages will elaborate on a
selection of feature affordances seen in exergames, i.e., virtual agents, narrative, rewards, and
haptics. They jointly influence the UX associated with exergames, conceptualized as
agency/control, physical presence, social presence, immersion, and entertainment in this study.
Virtual Agents and Haptic Devices
Gamified health and fitness applications sometimes incorporate virtual agents. Embodied
Conversational Agents (ECA) are “computer generated anthropomorphic interface agents that
employ humanlike behavior within a dyadic conversation with a human user” (Krämer et al.,
2018, p. 113). An ECA can interact with humans using social cues, e.g., speech, gestures, and
gaze (Bickmore & Cassell, 2005). The interactivity is characterized by the features such as
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feedback provision and turn-taking, receiving input data and output reactions. The system
mimics human communication. Humans may unconsciously think and behave socially to
computers even though they know these are computers (Krämer et al., 2018).
Ring Fit Adventure has several types of ECAs in the game, including (1) a fitness
instructor/trainer, Tipp (i.e., a virtual human who lacks facial features such as eyes and a mouth
to present as androgynous), (2) the player’s fitness buddy, Ring (i.e., the in-game
anthropomorphic version of the physical ring that a player holds in hands while playing the game
in the real world), (3) Dragaux (i.e., the main antagonist of the game, a fictional dragon and
fitness guru who aims to take over the game world) who also manages a variety of mini bosses or
monsters (i.e., Kennelbell, Belldog, Pitbell, Sufferfish, Stomper, Scuttleknell, Scuttlebell,
Absploder, Mallusk, Naughtylus, Protean Shaker, Slinkbug, Robbin, Matta Ray, Matta Slay,
Hoplin, Stepper, Puffersquish, Megaphauna), (4) the four masters, Allegra, Armando, Abdonis,
and Guru Andma (expert in workouts involving legs, arms, abs, and yoga respectively), and (5)
the players’ virtual self-representation character, or self-avatar (see Figure 2.1 and Figure 2.2).
Figure 2.1. Fitness buddy, Ring (left); fitness instructor, Tipp (right), in Ring Fit Adventure
Figure 2.2. Antagonist ECAs, Dragaux (left), and mini bosses (middle and right)
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A player needs to collaborate with the fitness buddy and instructor by completing
combinations of workouts to beat Dragaux and the mini bosses. These ECAs take turns to “talk”;
most speeches and non-verbal behaviors are scripted. However, as mentioned above, the fitness
instructor agent sometimes offers contextualized albeit scripted feedback according to the
player’s real-time movement. For example, when the sensor system figures that a player’s
position may be incorrect during deep squats, the fitness instructor will point it out and orally
repeat the instructions on the posture. Previous research shows that variability in an agent’s
speech behaviors over time positively impacts long-term engagement (Bickmore et al., 2010).
The “Ring,” of the shape and size of a steering wheel, is an electronic device that senses
and reacts to the player’s movement in the real world, and projects it to the virtual game world.
As each Nintendo Switch contains two detachable controllers, or “joy-cons”, one piece of joy-
con can be attached to the ring as an additional sensor that tracks the user’s arm movement and
heart rate; the other piece of joy-con can be tied to a leg strap for the player to wear to track leg
movement. The ring itself is a haptic device capable of sensing the level of forces when stretched
or squeezed. Jointly, the three sensor parts provide a proxy of the user’s full-body movement. In
the virtual world of the game, Ring is an anthropomorphic ECA with a human face and a body of
the “ring” at a size scalable to that of the user’s virtual character, referred to as the “Ring Fit
trainee.” Please see Figure 2.3 for the visualization of the game’s haptic devices.
Figure 2.3. The ring, leg strap, joy-cons (left); the player’s self-avatar and the ring as an ECA (right)
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Traditional interventions for physical activity have used online support forums, bulletin
boards, phone calls, and in-person support, among other strategies, to provide participants socio-
emotional support in order to persuade them to adopt healthy behavioral change (e.g., Glasgow
et al., 2003; Harvey-Berino et al., 2002). Similarly, some virtual agents are designed to be
relational agents that foster long-term engagement with the user with the hope of enhancing the
system’s persuasiveness as well. As previous research demonstrates, relational agents are
particularly helpful in the healthcare domain, promoting medical adherence and physical
activities (Bickmore et al., 2010). Through exergames, players can receive socio-emotional
support from workout buddies who appear in the forms of virtual agents.
Humans’ social interaction with artificial entities can resemble some features of the
interaction between real humans, fulfilling humans’ social needs. As a prior study found,
interaction with virtual humans may reduce the need for social contact among people who have a
high need to belong, but only when the virtual agent is capable of responding socially using both
verbal and nonverbal social cues (Krämer, Lucas, Schmitt, & Gratch, 2018). The realism and
conversational contingency of a virtual agent, therefore, contribute to the extent to which players
perceive the virtual agents in the exergame as competent social actors.
Realism
Realism includes form realism and behavioral realism. Form realism is about how much
the appearance of an agent resembles that of a given entity; behavioral realism is the level of
similarity of a virtual representation’s behaviors compared to the behaviors of a given entity
(Bailenson et al., 2006). Behavioral realism can be verbal and nonverbal. Human-like
appearance, facial animation, and natural language processing (Burgoon et al., 2016) all help
increase the behavioral realism of an embodied virtual agent or an avatar.
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Research to date has inferred human perception of agents through measuring “perceived
realism” (e.g. Daher et al., 2017; Raij, 2009). The real-time nature of the interactive haptic
devices mentioned above may contribute to conversational contingency of ECAs in exergames,
i.e., the extent to which a response is dependent upon the context and the prompted question that
precedes the response, which thereafter can contribute to players’ perceived realism and
relational connectedness of the virtual agents. As an important dimension of communication
interactivity (Lew et al., 2018), conversational contingency may influence the user experience
associated with Ring Fit Adventure and eventually influence the player’s total game play time, or
active time.
Presence and Immersion
The sense of realism is inseparable from two other essential concepts: presence and
immersion. Presence impacts how individuals feel, think, and behave in social interaction
(Allport, 1985). Presence can include the presence of others and one’s own presence, and it
compromises physical and social presence (Blascovich et al., 2002). Relatedly, co-presence
(Goffman, 1959) describes the sense of being together with others in a physical or virtual
environment with shared temporal, spatial, or conceptual references. Physical presence, social
presence, and co-presence may elevate immersion. In particular, social presence and immersion
interact with and elevate each other to enhance UX in a virtual environment (Oh et al., 2018).
Immersion is the sense of being enveloped by, absorbed by, or engrossed in an experience
or interacting with an artificial world (Witmer & Singer, 1998). Among the variety of factors
contributing to the sense of immersion, narratives are a powerful form of content delivery
because as mentioned above they help users define the conventions of a world and align
expectations with the logic of the world (McMahan, 2003). However, video games do not always
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need narratives to create engagement (or deep play) with users. For example, in 3-dimensional
(3D) games, although both first-person perspective and isometric (i.e., god’s-eye view)
perspective have their advantages, a first-person perspective may increase the sense of
immersion (McMahan, 2003).
Meanwhile, Witmer and Singer (1998) stated that isolation from the physical
environment increases immersion. Based on my observations as well as my previous research,
this may be true sometimes, but it is not always the case. Another major objective of the current
project, therefore, is to illustrate through empirical evidence that isolation from the physical
environment is not required for creating high levels of immersion. Through exergames like Ring
Fit Adventure, players remain physically located at a place that feels familiar and comfortable,
but they are simultaneously also transported to the virtual game world. The physical presence of
exergame players in the virtual world and their social presence through interacting with other
social actors in the virtual world both influence their game UX and thus influence subsequent
behavioral outcomes. If the projection of social experience is of high fidelity, and if the
synchronization in player cognition and movement between the real-world and virtual world is
enabled by sufficient agency/control (which will be explained in the following section), then
isolation from the physical environment would not be required to increase immersion. In fact,
one of my central arguments in this dissertation is that the evolving human-technology
relationship should not separate humans further away from nature and the physical world. Virtual
reality or metaverse may not be an ideal paradigm for humans to move toward; instead,
augmented reality that aims to strengthen our ties to nature and the physical world, supporting us
to better perform real-world tasks, may be a better approach. I will elaborate on this point later.
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Agency/Control
The players’ ability to manage gameplay through control mechanisms and influence the
storyline is considered agency or control (Qin et al., 2009). In Ring Fit Adventure, players can
customize the appearance of their self-avatar with regard to gender, skin color, and eye color (see
Figure 2.4). They can also choose the gender of their fitness buddy, Ring, who as mentioned
above is both the embodied device that a player holds in their hands and an anthropomorphic
ECA projected to the game world. The customization and user choices underpin the construct of
agency or control. Conceptually, perceived agency is the extent to which people think some
social actor is a real human and respond to her accordingly (Lucas et al., 2018; Nowak & Biocca,
2003). Perceived agency can be manipulated through telling the participants the virtual human is
controlled by a computer (thus, is an agent) or by a human (thus, is an avatar) (Nowak & Biocca,
2003). Perceived agency does not equate to but may be influenced by actual agency.
Figure 2.4. Custom self-avatar appearance
The extent to which players see their in-game self-avatars as realistic representations of
themselves and as able to carry out their decisions constitutes the notion of identification.
Identification has been referred to as the psychological ownership of a character (Moon et al.,
2013) or an extension of players themselves, specifically avatar identification (Christy & Fox,
2016). In the context of exergames, agency/control and identification may add to form realism,
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behavioral realism, and conversational contingency to influence how players perceive and
interact with the self-avatar, fitness buddy, instructor, and opponent ECAs.
Narratives
Gamification features have various mechanisms of engaging users during their interaction
with the game, such as using narratives. Humans are narrative beings who read and evaluate
texts with the standards of narratives: narrative probability, coherence, fidelity, and realness
(Fisher, 1985). As introduced above in the discussion of immersion, narrative can help users
define the conventions of a game world and align expectations with the logic of the game world,
hence increasing a sense of immersion (McMahan, 2003). In-game storytelling or narrative
supports users in perceiving meaningful choices and relations (Bormann & Greitemeyer, 2015),
through representative characteristics of narrative such as character, plot, setting, and events (Qin
et al., 2009). With the help of an inviting narrative, or back story, or game plot, the ECAs that
are also relational agents can offer the user a sense of social presence, physical presence, and
entertainment.
Sensors and Haptic Devices
Sensors and haptic devices, through a feedback system (e.g. force feedback, McLaughlin
et al., 2001; Richard et al., 2006), create a form of synchrony between the user and her avatar, or
her virtual representation. The aforementioned “FruitSalad” exergame, for example, used the
Microsoft Kinect sensor to capture and project users’ movement to the virtual game world
(Brauner et al., 2013). The gamification feature of avatar is applied in conjunction with smart
interactive textiles (Brauner et al., 2017) or what are called sensors and haptic devices.
This type of interactive feedback system creates an interface that helps to enhance the
user’s physical presence. Specifically, immediate tactile cues (Richard et al., 2006) contribute to
30
the authenticity and believability of the synchrony between the user and her virtual
representation in the artificial reality. The system is useful for many 3D games: they are
constructed in worlds where game characters can move beyond linearly, but these games would
usually be reduced to appear as 2-dimensional in a physical world, e.g., on a TV or computer
screen. The tactics of sensors and haptic devices can help to support the multi-dimensionality of
the game design.
Requests and Rewards
When players like a game, they tend to play it more. But, reciprocation is a more
powerful persuasive tactic than liking. As social beings, individuals tend to feel obligated to
repay gifts and favors in kind, especially when there is a request or an expected behavior
explicitly communicated to them; this is the principle of reciprocation persuasion (Cialdini,
2006). In an exergame context, the request and repayment is that players engage in more
physical activity, and in a continuous way.
Previous studies that report on physical activity interventions have used a variety of
rewards to motivate players to exercise. As mentioned above, the rewards included teammates
(Sailer et al., 2017), leaderboards (Hanus & Fox, 2015; Mekler et al., 2017; Sailer et al., 2017),
weekly challenges and group competition (van Roy & Zaman, 2018). Rewards and competition
fulfill players’ social and relational needs and may be persuasive through enhancing engagement
and entertainment (van Roy & Zaman, 2018). Similar to the link between gamification and social
features discussed earlier (Wang & Collins, 2021), in exergames reward-based behavioral
requests and reciprocation persuasion are on relational and social terms. In Ring Fit Adventure,
each of its three game modes (i.e., adventure, quick play, and custom workouts) integrates
reciprocation persuasion. The more active time invested and the more accurate the workout
31
postures are, the higher level a player will achieve. Leveling up unlocks new workout types, new
digital smoothie recipes, and new mini games, building up the player’s in-game
accomplishments. Another objective of this study is thus to evaluate players’ responses to Ring
Fit Adventure around the game’s reward and level system.
User Experience (UX) and UX Evaluation
Usability and Functionality
From an engineering perspective, functionality and usability are two of the numerous
factors
1
that are pertinent to the success of interactive software application (Mayhew, 1999). As
Deborah Mayhew (1999) observed, the attention of designers, developers, and consumers in
1999 was predominantly on functionality, i.e., the ability of a software system to provide the
necessary features for supporting the users in fulfilling the prescribed tasks (Goodwin, 1987).
Usability, by comparison, addresses the quality of the human interface. It was insufficiently
studied as of 1999 but has been widely studied since.
Regarding the relationship between functionality and usability, opinions are divided. On
the one hand, Deborah Mayhew (1999) considers it as a tradeoff to have more powerful
functionality or a simpler, clearer interface. On the other hand, Nancy Goodwin (1987) argued
that good usability fulfills – rather than limits – functionality. Both opinions hold true in their
respective contexts. When the complexity of functionality exceeds an appropriate level, it can
adversely influence the quality of the system’s human interface, making it less user-friendly. For
instance, a study of Arnhold et al. (2014) found that the number of app functions was negatively
associated with expert-reported usability for the app. Meanwhile, if a designer is too obsessed
1
Other factors include performance, cost, reliability, and maintenance (Mayhew, 1999).
32
with making the human interface simple and easy, it may pose challenges to achieving the
desired functionality (Mayhew, 1999). However, Goodwin’s point also appears legitimate in that
a user-friendly human-computer interface may help users learn how to navigate the app better
and faster to perform the tasks better, faster, and in a way that is intended. The colliding views
on the usability-functionality dyad exactly indicate the possibility and necessity to not separate
usability from functionality when we evaluate computer systems including persuasive video
games.
Affordance and evaluation are two terms related to usability and functionality. As
mentioned above, affordances are “possibilities for action” (Evans et al., 2016, p. 36) and “the
quality of an object or an environment which allows humans to perform some specific actions”
(Gibson, 1982, as cited in Yao et al., 2013, p. 2512). UX can be defined as “a person’s
perceptions and responses that result from the use and/or anticipated use of a product, system or
service” (ISO 9241-110:210, clause 2.15). Conducting UX evaluation can assess technology
affordances, and the extent to which the implementation of the technology is able to produce the
effectiveness as the designer sought, which is a fundamental purpose of persuasive technologies.
In summary, UX evaluation assesses the affordances, and the functionality, usability, likeability,
and receptibility of a product, system or service.
UX Evaluation Methods
When Jakob Nielsen (1994)’s canonical book Usability Engineering first came out, the
industry was yet to produce products or services that were as complex as their counterparts
decades later. Hence, the evaluation methods Nielsen proposed appeared to focus largely on the
early-time usability attributes such as learnability, efficiency of use, few errors, and subjective
pleasantness (Nielsen, 1994). Regarding efficiency of use, for example, the measurement method
33
was typically to bring users to the lab (or observe users in a natural environment) and give them
tasks to perform without much assistance from the experimenter. This measurement method was
mostly concerned with functionality, despite being labeled as usability. The past two decades
have witnessed rapid changes in the human-computer interaction field. Subjective pleasantness,
enjoyment, or entertainment, for instance, has obtained increased interest both among system
designers and researchers (Kätsyri et al., 2012).
In addition to observation and quantifiable measures, the “Think Aloud” method is also
used in UX evaluation (Nielsen,1994). “Think Aloud” is when the participant is continuously
verbalizing their real-time thoughts while using the system. The merit of this method is that it
lets researchers understand what specifically the users are doing at certain moments and why
they are doing it that way. The process offers more insights about the causal mechanism and
avoids users’ later rationalizations. However, this method has three drawbacks. First, users’ own
theories may be overly weighted and thus interfere with researchers’ judgment. Second, response
biases such as acquiescence bias can occur because users are aware that they are verbalizing
thoughts. Third, thinking aloud can slow down users’ performance or influence users’
performance in some unknown ways.
Several variations of the Thinking Aloud method include “Constructive Interaction (or
Co-discovery Learning)”, “Retrospective Testing”, and “Coaching Method” (Nielsen, 1994).
Constructive Interaction is seen in Whitlock et al.’s (2011) study where they have older adults (N
= 56) play a video game system (i.e., Boom Blox, a video puzzle game running on Nintendo
Wii) both individually and in pairs. The second variation method, Retrospective Testing, is when
users review video recordings of their own interaction with the system and give extensive
comments. This method lacks immediacy and introduces confounds from users’ later
34
rationalization compared to the Constructive Interaction method. However, Retrospective
Testing enables researchers to ask follow-up questions about participants’ comments as much as
needed without interfering with the test session. Thus, in addition to incorporating the
Constructive Interaction strategy, Whitlock et al. (2011) also video recorded test sessions.
However, it was the researchers – rather than participants – who retrospectively watched and
analyzed the video recordings. Despite that, participants in the study were able to share their
opinions about the game’s usability through a questionnaire with close- and open-ended
questions. Lastly, the third variation of the Thinking Aloud method, Coaching Method, is when
the experimenter has high involvement in guiding the user during the test session. This method is
suitable for UX testing when the objective is to construct or improve a user manual or a training
protocol.
In summary, there are mainly two categories of UX evaluation methods. One bases itself
on objective, quantitative measures; the other focuses on users’ subjective, qualitative feedback.
In a recent review (Maramba et al., 2019) of UX evaluation methods, most of the 131 studies
used quantitative methods (87.8 %, n = 115), followed by qualitative methods (53.4%, n = 70),
and heuristic testing (13.7 %, n = 18). Over half of the studies used more than one method: eight
studies (6.1%) used all three methods; 57 (43.5%) are both quantitative and qualitative; and 14
(10.7%) used both quantitative and heuristic testing. No research leveraging computational
mixed methods was reported in Maramba et al.’s (2019) review.
Besides the two-category typology for evaluation methods, another review (Roto et al.,
2020; http://www.allaboutux.org/) proposed several typologies to organize 86 UX evaluation
methods. One typology is per method type: field studies (n = 54), lab studies (n = 66), online
studies (n = 33), and questionnaire/scales (n = 20), where n is the number of methods. A second
35
typology is per development phase: scenarios/sketches/concepts (n = 24), early prototypes (n =
22), functional prototypes (n = 69), and products on the market (n = 75). Rationale for the second
typology is based on the life cycle of a computer system. The third typology addresses the
different phases of the human-computer interaction: before usage (n = 25), snapshots during
interaction (n = 37), an experience of a task or activity (n = 64), and long-term UX (n = 29). The
fourth and last typology is per evaluator or information provider: UX experts (n = 10), one user
at a time (n = 75), groups of users (n = 8), and pairs of users (n = 6). There exist overlaps
between categories for some of these UX method typologies. Some methods can belong to more
than one category.
Given these UX evaluation method typologies, this project explores the feasibility and
validity of a computational mixed method approach to studying video game UX. According to
Vermeeren (2010), a UX evaluation method should be judged by five criteria: (1) scientific
quality (the reliability and validity of tool and process, including psychometrics), (2) scoping
(comprehensiveness in covering facets of UX), (3) practicability (feasibility regarding equipment
and expertise, usability of the method/tool), (4) utility (for stakeholders), and (5) specificity (with
respect to domains and users). On Nintendo’s ACNH and Ring Fit Adventure, my dissertation
project seeks to study user-game interaction throughout four phases: before adoption and usage,
during interaction, while carrying out a specific task, and especially the relatively longer-term
use.
36
CHAPTER 3: SOCIAL SIMULATION GAME UX EVALUATION
(STUDY 1)
Background
For most of 2020, physical interactions were restricted due to the COVID-19 pandemic.
With social distancing policies expanding worldwide starting in January 2020, many people
moved to virtual worlds such as video games for entertainment and social engagement (King et
al., 2020; López-Cabarcos et al., 2020). In the United States (U.S.), for example, pandemic
lockdowns started in some states on March 15, 2020 and expanded to most states of the country
by early April to prevent the spread of COVID-19, given its highly contagious viral nature
(CDC, n.d.). One unintended yet almost inevitable consequence of this public health
intervention, however, was that the public became abruptly deprived of outdoor time and social
interaction, which was found to have subsequently challenged their social well-being and mental
health (Marroquín et al., 2020; Viana & de Lira, 2020). Over the course of one month from
February to March in 2020, within-subject research found that stay-at-home order status and
personal distancing were independently associated with increased symptoms of depression and
generalized anxiety disorder (GAD) (Marroquín et al., 2020). In situations of prolonged “true”
quarantine following COVID-19 diagnosis, previous research also found emotional distress,
depression, GAD, insomnia, and post-traumatic stress to be some of the mental health correlates
(Brooks et al., 2020).
The COVID-19 pandemic stretched from late 2019 (and early 2020) to at least December
2022 (when this document was finalized), posing chronic stress to many communities: but, the
immediate effect, I argue, during the first COVID-19 surge constituted an acute stress, which is
37
difficult to cope with in a timely way when one is unexpectedly placed in a stressful situation for
which one is unprepared. Such acute stress came as the result of the sudden withdrawal from
social contact and social activities as mentioned above (Brooks et al., 2020; Marroquín et al.,
2020), and additionally the various information uncertainty experienced associated with the
pandemic (Lin et al., 2020). In response, there was an increase in social media use (Nilsson et al.,
2022) and online gaming (King et al., 2020; López-Cabarcos et al., 2020), with online social
gaming at the intersection.
Notably, the World Health Organization (WHO) collaborated with the video game
industry (including companies such as Activision Blizzard, Kabam, Snap Games, Amazon
Appstore, Maysalward, Twitch, Big Fish Games, Playtika, Unity, Dirtybit, Pocket Gems,
Wooga, Glu Mobile, Riot Games, YouTube Gaming, Jam City, SciPlay, and Zynga) on the
latter’s initiative of a hashtag-driven social media campaign, #PlayApartTogether
(https://twitter.com/play_a_together). The campaign was intended to encourage people to follow
the WHO health guidelines while promoting social gaming for stress reduction during the
subsequent prolonged physical isolation and decreased face-to-face social interaction.
Yet, research evidence on increased online social gaming during the pandemic offers
conflicting recommendations: one side acknowledges the protective effect of online social
gaming (López-Cabarcos et al., 2020), and the other side considers it as “problematic gaming,” a
view which holds a long-standing position in the game addiction literature (King et al., 2020). As
previous research suggests, gaming is not necessarily problematic, since it may facilitate online
socializing and reduce loneliness (Carras et al., 2017). Beyond hunches, however, little empirical
evidence existed at the time when this study was conducted to demonstrate how players see
online social gaming.
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This is especially the case for understanding users’ perceptions of play in social
simulation games during the acute stress phase of the global lockdowns: Did they perceive that
gameplay, at least in a specific social simulation game, was having an impact on their social
interactions (that were constrained during the pandemic)? Did they perceive that gameplay
helped them cope with pandemic-related loss and stress? What were players’ emotional
responses? Relatively unknown is this: What are the types of computer-mediated communication
(CMC) and human-computer interaction (HCI) affordances of social simulation games that
might enable players to fulfill their social and mental health needs? How do social media
platforms compare regarding patterns of participant responses to a given game? This study,
hence, seeks to answer these questions within the context of a representative social simulation
game that became uniquely popular amidst the first surge of the pandemic. Building upon
previous research, this study analyzes user-generated social media content from two online
gamer communities to understand and evaluate the user experience (UX) and affective response
associated with this game.
Animal Crossing: New Horizons
As mentioned in Chapter 2, Animal Crossing: New Horizons (ACNH) is a social
simulation video game running on a hand-holdable game device called Switch. There are three
reasons why this game was chosen for investigation: (1) phenomenal popularity (i.e., potential
sample size and scalability), (2) ease of play (i.e., affording a potentially more diverse audience
without specialized gaming skills) and (3) release date (ACNH was released on March 20, 2020,
when the global lockdowns began to take effect in an increasing number of countries and cities).
Globally, the game had five-million digital sales within the first month of release in the midst of
the pandemic, and over 38 million copies as of March 2022, among which 31 million copies
39
occurred in 2020 (Nintendo, 2020). Unlike other game titles that are predominantly popular
among consumers who identify as “gamers,” ACNH is a non-gamer friendly game that does not
require sophisticated gameplay strategies or skills, and it does not involve intense navigation and
action controls like action games. Its ease of play, on top of pandemic-related factors,
presumably contributed to ACNH’s market success and enabled this study to cover an unusually
inclusive sample of the population who do not typically identify themselves as gamers but
participate in social game play during a special time. The entertainment experiences of ACNH
exhibits not only hedonic but also prosocial values: recent research found a positive relation
between the time spending on ACNH, intrinsic need satisfaction (i.e., perceived autonomy and
perceived relatedness), and well-being, suggesting the potential of playing ACNH as a coping
mechanism to curb negative emotions during the quarantine period (Johannes et al., 2021).
Reflecting on the media-induced recovery and vitality potential of playing ACNH, this
study takes a bottom-up approach to understand how players appraise the unique affordances of
ACNH during the pandemic. Theoretically, this study extends self-determination theory (Deci &
Ryan, 2008) and the model of situated motivational affordances of game elements (Deterding,
2011) by examining affordances of the social simulation game that help compensate for the
negative emotions induced by social isolation. Practically, this study sheds light on the unique
emotion management potential of entertainment gaming experiences in coping with an
unprecedented collective trauma.
Literature Review
Situated Motivational Affordances of Game Elements
In the past decades, research on human-computer interaction has expanded the focus
from usability to user experience, incorporating aspects such as emotion, motivation, and need
40
satisfaction (Przybylski et al., 2010). Self-determination theory (Deci & Ryan, 2008) has been
widely adopted in this regard as it connects gaming experiences to basic psychological need
satisfaction and well-being (Tyack & Mekler, 2020). According to self-determination theory,
video games have the potential to enhance intrinsic motivation and well-being if the play
experience satisfies the intrinsic needs of players (Przybylski et al., 2010). Building upon self-
determination theory and the theoretical perspective of motivational affordances (Zhang, 2008),
Deterding (2011) proposed the model of situated motivational affordances of game elements. As
mentioned in Chapter 2, affordance means the actionable properties that connects an object and
an actor (Zhang, 2008). Affordances help users to take actions to satisfy their needs. Games with
motivational affordances comprise properties that support users’ motivational needs; if the
affordances are perceived to be existent and effective, users are more likely to enjoy and engage
with the game. For example, ACNH affords features that enhance user autonomy such as
allowing players to build a virtual island based on their will and taste. The situated motivational
affordances of game elements model incorporates the consideration of social situations where the
appraisal of player-game interaction has to account for environmental and situational inputs
(Deterding, 2011). This model links the well-established concept of affordances with need
satisfaction elaborated in self-determination theory, and it incorporates situational factors to
explain the motivational pull of video games. Given that the voluntariness of play is somewhat
thwarted during the pandemic, the situated motivational affordances of game elements model
provides a theoretical framework to examine how the affordances of ACNH may support
players’ play experience and need satisfaction amidst of a collective trauma.
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Social Simulation Games and Their Affordances
Research to date has been trying to identify the affordances of social simulation games
and the dynamics of player-game interaction. Social simulation games are a type of life
simulation game that allow players to explore social interactions with or between artificial lives,
and the social interactions affect the outcome of the situations (Wright, 2004). These games often
provide individualized performances and social flexibility, encouraging players to express
themselves within certain limitations and rules of the games. With respect to ACNH, Etchells
(2020) pointed out “getaway”, “autonomy”, “competence” and “relatedness” as the key elements
that could have potentially contributed to the success of ACNH. Similarly, Zhu’s (2020) case
study examined the psychology behind ACNH play during the COVID pandemic. Zhu (2020)
expressed concerns about people’s psychological well-being during quarantine and argued that
video games like ACNH provided the “escape”, “comfort” and “social connection” people
needed in times of social isolation.
From a human communication perspective, games like ACNH seem to facilitate both
CMC and HCI. In Animal Crossing’s virtual game world, the former form of communication
involves players visiting other players’ islands and spending time together in the game; the latter
form of communication witnesses how players interact with the virtual agents, who are
personified animals and NPCs in the game. However, it remains unclear what types of in-game
behaviors constitute the social simulation, and what specific game features players mostly
engage with and value. Insights and gaps in prior research led to the questions if players did feel
relieved from hardships and loneliness through the ACNH gameplay, and if so, in which ways
such digital escapism may function to fulfill players’ unmet social and relational needs.
Furthermore, as psychosocial well-being may moderate the relationship between escapism and
42
online gaming (Kardefelt-Winther, 2014), online gaming can be both a coping strategy and a risk
factor to player well-being depending on the design of the game as well as the player’s pre-play
psychosocial well-being and motivation. Thus, updated research is required to investigate
players’ sentiments and discussions in the context of ACNH, leveraging the abundant social
media data to (in)validate the play of video games as a coping mechanism for stress and
loneliness.
Game UX
Related to the above discussions on game affordances, UX is a discipline of design and
development, centered around the psychology of the end-user and their behaviors, thinking
processes and capabilities. As mentioned in Chapter 2, UX evaluation has been primarily and
conventionally conducted in lab settings, through surveys (Williams et al., 2015), thinking aloud
method (Nielsen, 1994), and focus groups (Schnall et al., 2016). These methods enable feedback
from game players for accessibility and usability improvements. For social simulation games
with low operation requirements that aim to leverage everyone like ACNH, social media content,
for its volume and accessibility, provides a novel opportunity to understand UX among players
who do not necessarily have a long history of playing video games.
As early as a decade ago had research by Kujala et al. (2011) pointed out that UX studies
focused mainly on “the initial adoption of new product designs,” whereas the relationship
between players and the product can evolve over time; to truly understand UX or the effect of
products on customers (e.g., health effects) requires collecting and analyzing longitudinal UX
data. Nevertheless, the past decade has not seen many research efforts that attempt to fill this
gap. In light of the importance of a multi-method approach for UX evaluation (Vermeeren et al.,
2010), the present study aims to contribute to current UX research by testing the validity of a
43
human-assisted computational approach. The methods and results of this study provide
methodological, theoretical, and practical implications for UX researchers and game makers. The
following research questions are proposed. Specifically, social interaction pertains to social and
mental well-being, and coping with pandemic-related loss and stress may improve mental health.
RQ1. What are the players’ perceived effects of Animal Crossing: New Horizons
gameplay during the first surge of the COVID-19 pandemic (January 1, 2020 to July 31, 2020)
on (a) social interaction, which had been constrained due to the pandemic social distancing
practices, and (b) coping with pandemic-related loss and stress?
RQ2. What are players’ affective responses to Animal Crossing: New Horizons?
RQ3. What types of user experience does Animal Crossing: New Horizons afford?
RQ4. What role do social media platforms play in amplifying these effects of ACNH?
Methods
Data
This study consisted of a two-step investigation of social media discussions of ACNH on
both Twitter and Reddit. The Twitter dataset entails general postings about ACNH in parallel to
the mentions of Coronavirus-related content, offering a description of ACNH player experience
pertinent to the first surge of the COVID pandemic (RQ1). While the discourse on Twitter is
generally related to the game, Reddit contains a gamer community where the discussion forums
are more specific and informative. A Reddit dataset, hence, can complement the tweets in
answering RQ1 and RQ3. Both datasets help answer RQ2. To answer RQ4, Twitter and Reddit
were analyzed both independently and in comparison.
Twitter. After using a Python script to filter a published, the largest-to-date, Coronavirus
dataset (Chen et al., 2020) spanning from January 1, 2020 to July 31, 2020, the final sample
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contained tweets (n = 25,435) that had at least one of the keywords, “animal crossing,”
“animalcrossing” and “acnh” (non-case sensitive), and the metadata of these tweets.
Reddit. Using the Reddit API and a web-scraping procedure in Python, posts published
during the same time frame as the Twitter data (January 1 to July 31, 2020) were collected from
three subreddits “r/animalcrossing,” “r/animalcrossingnewhor,” and “r/ac_newhorizons,”
including posts (n = 2,125) and their metadata.
Procedure and Data Analysis
The study protocol received a waiver of review from the Institutional Review Board of
the University of Southern California and was determined not to be human subject research.
Topic Modeling. For answering RQ1, this study firstly performed Latent Dirichlet
Allocation (LDA) topic modeling (Blei et al., 2003) on the Twitter data to identify the array of
coherent topics that reveal associations between the play of ACNH and the pandemic life. Before
training topic models, the text of tweets was preprocessed by removing HTML links, mentions,
hashtags, special characters, and stop words. All tweets were then stemmed, lemmatized, and
tokenized. A bag-of-words was stored after filtering out extreme words appearing in less than 15
documents or more than 50% of documents. The LdaMulticore package was then used to train
topic models.
Sentiment and Emotion Classification. To answer RQ2, sentiment analysis of both
datasets revealed players’ affective reactions in/to the game. The compound score, ranging from
0-Most Negative to 1-Most Positive, from the sentiment analyzer VADER (Valence Aware
Dictionary and sEntiment Reasoner) was used (Hutto & Gilbert, 2014). The compound score
combines the negative, positive, and neutral ratings on each document. A tweet with a compound
score larger than zero is categorized as positive; negative if it is smaller than zero; or neutral if it
45
equals zero. Mapping sentiment by the tweets’ publication dates, players’ affective trend over
seven months was investigated.
In addition, both datasets went through a classification procedure to detect eight discrete
emotions (anger, anticipation, disgust, fear, joy, sadness, surprise, and trust) and two sentiments
in absolute unit counts (positive and negative) in each post, based on the NRC Word-Emotion
Association Lexicon (using the Python package, NRCLex) (Mohammad & Turney, 2013).
Among the several types of results that NRCLex returned, this study used each post’s raw word
counts of each sentiment or emotion in subsequent analyses.
To partially answer RQ4, the two social media platforms are compared on select
emotions using the independent-samples Mann-Whitney U test, which is the nonparametric
alternative to the independent-samples t test, suitable for social media data that are often inflated
with values of zeros (which can lead the data distribution to be non-normal).
Reddit Post Classification on UX Behaviors. Two human coders including the author
of this dissertation followed an iterative process to create classes and develop a coding scheme
(Hsieh & Shannon, 2018) for ACNH player UX behavior classification. The coding scheme was
considered saturated when no new classification structure emerged (see Appendix A for the eight
UX categories). Inter-coder reliability was good: percent agreement (Hunt, 1986) was 82.20% on
a random subset (n = 118, i.e., 5.52% of the sample) of the Reddit posts.
Several Python packages, including nlp and sklearn, were used in an exploratory manner
to attempt an automated machine classification of Reddit posts according to the human-
developed categories using a human-annotated training set. However, the machine classifier’s
accuracy was low, at 0.208 on a test set (n = 165). This unsuccessful machine classification
process only takes texts as the input. However, based on retrospective examination, ACNH-
46
related Reddit posts are mostly short in texts and often only contain a title and an image.
Accurate classification of the posts would require the machine learning procedure to reference
not only textual data but also image data (e.g., pictures, videos). Namely, machine classification
that leverages multi-modal data would be ideal for future research.
Therefore, in this study human content analysis was applied to this dataset following
computational topic modeling, which involves a manual classification procedure with the pre-
determined UX topology (see Appendix A). The classification results answered RQ3, revealing
various types of player experience within and outside of ACNH.
Results
Topic Modeling
Using Latent Dirichlet Allocation (LDA) topic modeling, the author trained 38 models on
the 25,435 tweets, with the number of topics ranging from 2 to 39. To select a model with an
appropriate number of topics, the author calculated the coherence value and log value of
perplexity of each candidate LDA topic model (see Figure 3.1).
Figure 3.1. Coherence score (red) and log of perplexity (blue) by the number of topics, step = 1
47
A higher coherence value indicates a better quality of topics judging the level of semantic
coherence in topical concepts (Mimno et al., 2011). A lower perplexity (positively correlated to
the log of perplexity) indicates a better predictive power (Blei et al., 2001) when classifying an
unseen document to the most suited topic. Considering both evaluation measurements, the 20-
topic model yielded a relatively high coherence value at 0.448 and a relatively low log value of
perplexity at -8.105. This topic model also made the most sense to human understanding and
interpretation, which is an essential part of the decision-making process. Appendix B lists the
topic labels and example tweets of each topic.
Topic modeling results show how ACNH gameplay impacted players’ everyday life
during the first surge of the COVID pandemic (January 2020 to July 2020) (RQ1). Topic #13,
for example, covers an array of personal narratives about how following social distancing rules,
people get together in the virtual game world of ACNH to attend social activities such as
romantic dates and protests. Topic #9 entails accounts of in-game events as well, distinguishing
itself from Topic #13 for mentioning the organization of more special ceremonies or celebrations
(e.g. graduation, holidays) on the virtual islands. Both ways allow the player to virtually interact
with other players and share love and support during the pandemic. Relatedly, Topic #1 focuses
on live streaming of events, and Topic #4 is various references to Animal Crossing - not only
events. Topic #4 is slightly different from other topics in this theme as it often draws on images
or videos. Typical posts of this theme are as follows. All example tweets quoted in this work
were slightly edited without changing meanings to make them less searchable online for
protecting post authors’ identities.
“My partner and I can’t see each other because of social distancing. So, we went
on an animal crossing date ♥.” (Topic #13 example tweet)
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“A lovely story of Animal Crossing being used during the COVID pandemic...
[screenshot of graduation ceremony]” (Topic #9 example tweet)
“I’m hosting a National Day celebration in two days on my island called *. Who
wants to come and do prizes shopping?” (Topic #9 example tweet)
“Celebrating my birthday in lockdown and Nina throwing me a party, so
wholesome #ACNH #NintendoSwitch [video]” (Topic #4 example tweet)
The finding of the above topic theme suggests that the social simulation game ACNH
enables CMC within the virtual game world, enhanced by embodied virtual representations of
players and socially meaningful in-game features (e.g., simulated island scenes, personalized
outfits). In this way, not only physical presence but also social presence are afforded by the
game. Social and emotional support underpin the mediated human interaction through the game.
Topic #10 tweets additionally commented on this kind of mediated communication: popular
ACNH brought people together during lockdown. RQ1a about ACNH gameplay’s effect on
player’s (digital) social interaction during pandemic social distancing practices was answered.
Outside of the game, Topic #12 is Animal-Crossing fan art advocating charity causes to
help people affected by COVID. A representative tweet of this topic is constituted of a call-to-
action text, a URL, and an image in which the tweet author showcases their pixel art inspired by
ACNH. It is one of the several ways in which ACNH gamer communities send emotional or
tangible support to each other or non-gamers in the midst of the COVID pandemic. Topics that
fall into this theme include Topic #14 (retweeting to get free giveaways of ACNH tools and
artifacts), Topic #15 (giveaways for spreading positivity as all are dealing with coronavirus), and
Topic #19 (follow for a follow back and/or ACNH giveaways). However, unlike Topic #12,
these latter three topics may additionally involve advertising/commercial motives. RQ1b about
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ACNH gameplay’s effect on coping pandemic-related loss and stress is somewhat answered but
needs further examination.
“As we are all dealing with the #coronavirus, I’d like to spread some positivity!
I’m giving 1 lucky follower a Nintendo Switch with #AnimalCrossing. must
retweet, follow me @* and turn my notification on! good luck to everyone!
#StayAtHomeAndStaySafe” (Topic #15 example tweet)
Topic #3 sees people expressing resentment of the pandemic-impacted life, in contrast to
the upside of having ACNH during the pandemic. See two example tweets below. Although
sentiment and emotion analysis in the following section will more rigorously describe the
affective responses of the players to the game, tweets from topic #3 indicate general positivity
toward the game despite of COVID-19. Similarly, Topic #5 tweets included jokes such as that
Nintendo should release ACNH early to force people to stay inside and contain the coronavirus:
people on Twitter who attended to ACNH back when the pandemic started did seem to believe
that playing this game was going to be an attractive and helpful means of coping with impacts of
COVID. RQ1b is further answered.
“The latest Animal Crossing is released just as the global coronavirus pandemic
made real life a lot less palatable than fake life…” (Topic #3 example tweet)
“I saw more people discussing animal crossing than coronavirus in my timeline
since the game was released. This makes me extremely happy and joyful.”
(Topic #3 example tweet)
Another cluster of topics (#6, #7, #0, #8) shed light on more detailed ACNH UX. Twitter
users posted about COVID in relation to ACNH; or conversely, posting about ACNH in relation
to the COVID, further answering RQ1 about the associations between the two agenda. Posts in
this theme share fun moments from playing ACNH while staying at home during the quarantine.
“Lolll this is me writing a letter to my future self in animal crossing. I asked if I
survived the pandemic... I really had high hope!” (Topic #6 example tweet)
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“Thanks to lockdown, a little island tour - 90 hours in.” (Topic #7 example tweet)
“What are butterflies and foxes doing during this stay at home period?
Personally, I’ve been playing ACNH at home and learning a new instrument.”
(Topic #0 example tweet)
“Once again, my freestyle on playing Animal Crossing because no one can leave
the house over the KK Slider ‘Cruisin’ beat. http://*” (Topic #8 example tweet)
Besides the above four themes of tweets emerging from the 20 topics, a word cloud
(Figure 3.2) is generated to show the 50 most frequent words from all tweets in this study. As
mentioned, the bag of words filtered out extreme words appearing in less than 15 documents and
more than 50% of documents. The remaining popular words, including “people,” “lockdown,”
“social,” “giveaway,” “cheer,” “support,” “island,” and “world”, jointly delineate a support
network within and beyond the game interface of ACNH and its social media gamer community
in parallel to the difficult global pandemic.
Figure 3.2. Word cloud of ACNH-related tweets
Sentiment Analysis and Emotion Classification
Among all tweets in this study were 6,044 (23.76%) negative, 3,864 (15.19%) neutral,
and 15,527 (61.05%) positive tweets (Figure 3.3 shows daily tweet counts by dates). A peak of
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neutral tweets occurred on March 12, 2020, citing news articles about the upcoming release of
ACNH. Positive tweets peaked on March 31, 2020, implying people’s initial reactions to the
game was positive after its release on March 20, 2020.
Figure 3.3. Counts of sentiment by date, red = negative, blue = neutral, purple = positive
Taking all tweets posted on a particular day as an entity, the mean scores of daily tweets’
positive, negative, and neutral sentiments were calculated (see Figure 3.4). The range of positive
and negative scores during January and April was greater than that during May and July of 2020.
It appears that post authors expressed more drastically varying and intense reactions toward
COVID-19 and ACNH when quarantine started. As the quarantine was prolonged, emotions in
the tweets became less intense starting May 2020.
Figure 3.4. Mean sentiment scores of daily tweets by date, red = negative, blue = neutral, purple = positive
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For the Reddit data, the compound sentiment score for each post was also calculated.
Reddit posts were mostly positive (41.42%, n = 886) or neutral (45.02%, n = 963) as well,
having a small portion of negative posts (13.56%, n = 290) – fewer than Twitter (23.76%).
Judging data ranges, Reddit users expressed slightly more varying levels of negative sentiments
(-0.01 to -0.85) than that of positive sentiments (0.22 to 0.92). Namely, joy is more
homogeneous whereas sadness/anger/disgust are more heterogeneous. The sources of negative
sentiment in ACNH subreddits will be specified when classification results are presented.
The sentiment scores above provided a percentage breakdown of affective distributions in
the two datasets, with posts falling into each valence of sentiment. Furthermore, the results of
sentiment and emotion classification using the Word-Emotion Association Lexicon provided a
description of the dataset based on the absolute volumes of positive/negative sentiment and eight
discrete emotions. Results showed that the Twitter ACNH dataset had approximately 1.925 times
of positive sentiment words (n = 19760) than negative sentiment words (n = 10268), and
predominantly positive emotions: 1) anticipation (n = 11429), 2) joy (n = 11127), 3) fear (n =
8954), 4) surprise (n = 8410), 5) trust (n = 8369), 6) sadness (n = 5035), 7) anger (n = 3285), and
8) disgust (n = 2988), ranked by the counts of emotion-indicating words in a descending order.
See Figure 3.5 histogram for a visual representation for the Twitter data.
Figure 3.5. NRCLex sentiment and emotion word counts in the ACNH Twitter dataset
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As for the Reddit dataset, there were approximately 2.7 times as many positive sentiment
words (n = 1173) as negative sentiment words (n = 434), at a much larger ratio compared to that
of the Twitter dataset. Emotions among post authors in the r/RingFitAdventure subreddit were
also predominantly positive: 1) joy (n = 733), 2) trust (n = 699), 3) anticipation (n = 687), 4)
surprise (n = 322), 5) sadness (n = 241), 6) fear (n = 234), 7) disgust (n = 188), and 8) anger (n =
176), ranked by the counts of emotion-indicating words in a descending order. See Figure 3.6 for
a histogram of emotion and sentiment counts in the ACNH related Reddit data.
Figure 3.6. NRCLex sentiment and emotion word counts in the ACNH Reddit dataset
In comparison, there appeared to be trends that the emotion of “trust” was more prevalent
on Reddit than on Twitter on the same topic, and the emotion of “fear” was more prevalent on
Twitter than on Reddit. To determine if such differences in trends were statistically significant,
two independent-samples Mann-Whitney U tests were conducted as mentioned in the Methods
section.
Results of the first Mann-Whitney U test showed that despite the fact that “trust” was
ranked higher as an emotion in the Reddit dataset than it was in the Twitter dataset – compared
to other emotions, the chance of a post expressing “trust” was not statistically different across the
Twitter (Mean Rank = 13777.11, n = 25435) and Reddit (Mean Rank = 13821.13, n = 2125)
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platforms, U = 27111025.50, z = .32, p = .75. It was consistent across both platforms that more
posts express “trust” than “sadness,” “anger,” and “disgust” on the topics of ACNH and COVID-
19.
However, results of the second Mann-Whitney U test showed that on this topic, Twitter
discussions were indeed more likely to be tinged with “fear” (Mean Rank = 14003.47, n =
25435, ranked ascendingly) than Reddit discussions (Mean Rank = 11111.72, n = 2125, ranked
ascendingly), U = 21353521.00, z = -20.30, p < .001. Since the above sentiment and emotion
analysis were not aspect-based, namely not specifying a target of the sentiment or emotion, a
later subsection will draw on qualitative analysis to provide situation-specific negative sentiment
and emotions associated with the game in more depth.
Reddit Post Classification
As the Methods section mentioned, with the help of another human coder, the author of
this dissertation took an iterative approach to develop a typology of player experience enabled by
ACNH, drawing on the Reddit data. Appendix A is the typology entailing eight main categories
and 34 sub-categories. The human classification process found that the Reddit posts published
publicly on ACNH-related subreddits shared various hilarious, proud, and heartwarming
contents. They exemplified mediated communication between players in ACNH and ACNH’s
online gamer communities, and they provided insights into the array of human-agent
communication between players and the animal villagers in the game.
A majority of the posts are photo- and video-screenshots from the game. One Reddit user
posted a screenshot where she wanted to move Punchy’s (an animal villager, supposedly a cat)
house at midnight and Punchy showed up at the island’s management office in his pajamas, with
the Reddit post’s caption being “…sorry Punchy.” Besides hilarious posts were heartwarming
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scenes. Examples include social interactions between players mediated by the game. One Reddit
user posted, “My mother came for a visit on my island. She lives in another country. We were on
a call and walking around the island and I was showing her everything,” attaching a screenshot
of them as embodied virtual characters visiting the post author’s Animal-Crossing aquarium of
high visual fidelity (see Figure 3.7).
Figure 3.7. A family aquarium tour in Animal Crossing
Like what was observed in the Twitter data, Reddit posts also showcased formal social
events mediated by ACNH, including weddings, memorials, and graduations. One engaged
couple had to cancel their pre-scheduled offline wedding because of the pandemic. Nevertheless,
their best friends organized a surprise ACNH wedding for them instead. Another Reddit user
shared an ACNH game scene with a grave that she made for her brother after his death.
Surrounding her brother’s grave were many flowers, left by other known or unknown ACNH
players who visited her island with her Dodo Code (a Dodo Code allows other players to visit
one’s island). See Figure 3.8. Although comments were not the focus of our study, when coding
the web-based Reddit posts, there were such comments to this memorial post as: “I saw your
earlier post, and this one. Both made me cry... All the love to you, I’m so sorry for your loss”,
and “Glad that people in this community can support each other in times of difficulty. Wish you
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all the best.” As such, players communicated and extended emotional support in and outside of
the game both verbally and tangibly (through in-game props and artifacts) to fellow players who
were going through negative emotions such as regrets, losses, and grief related to and amidst the
pandemic.
Figure 3.8. An Animal-Crossing memorial
In-game props, along with numerous garments in different styles, enable players to
arrange in-game characters (i.e., self-avatars, avatars of other players, virtual animal agents) and
decoration items to express a meaning that corresponds to the real world. In particular, players
often DIY crafts, fabrics, and paintings in the game, and they may share their designer codes
with other players. These DIY items, in addition to the default props, allow players to design
their islands’ landscape as well as their houses’ interiors, which bring about another large
category of Reddit posts (“showcasing/showing off island designs”). Apart from the
aforementioned wedding and memorial, in-game characters sometimes pose after famous scenes,
e.g. the painting The Last Supper, the fictional character Joker, and the movie character from Ace
Ventura: Pet Detective.
Not only do players participate in in-game meaning making, some of them also create fan
art outside of the game, including fine painting, animation, humorous comics and memes, among
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other off-line creative activities inspired by the game. One player posted about their mother’s
making a birthday cake after the look of the player’s favorite animal villager: “I only told my
mom ONCE about Ketchup and she made this for my birthday,” attaching a photo of the cake
with candles (Ketchup is a humanoid duck villager fused with a tomato-looking skin color and
hair style). In the case of this cake, the game provides an opportunity to strengthen the real-life
relational ties between the player and their family. In the meantime, a meme captioned “Our
Saving Grace” (Figure 3.9) has amassed 27.3 thousand upvotes and 172 comments in a year
since it was posted on March 25, 2020, signaling to some extent the special meaning of the game
to a large number of its players in a difficult year.
Figure 3.9. The meme Our Saving Grace
Negative Sentiment and Emotions Associated with the Game
So far the results have suggested overwhelmingly positive player experience, especially
in compensating for the social interaction missed during the pandemic, and in seeking and
offering care and support with the help of the game. Nevertheless, as the sentiment analysis
earlier suggested, there was a small – yet noteworthy portion – of negative sentiment detected in
ACNH-related tweets and Reddit posts.
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Several important sources of such negative sentiments were identified. First, many posts
mentioned COVID and some related issues in a negative light. Second, some posts pointed out
the ways in which the game’s UX design was unsatisfying and could be improved. Last, most
alarmingly: the game can induce anxiety. Several posts expressed feeling social pressure from
comparing their own islands to others’. As mentioned above, a player has considerable freedom
to customize and personalize the look of their island with respect to the landscape and the
house’s interior, and many players would record the game console’s screen and “show off”
photos and videos of their islands online. Empirically, self-reported feelings of anxiety were
observed among early-stage players as they were worried about falling behind in the game
compared to other more creative players. They were eager for their island to receive a “five-star”
rating from the island’s management office, partially because a “five-star” island could grant
access to bonus game features, e.g. a golden watering pot and rare flowers, but also because they
wanted to have an “ideal” island, one that is as nice as those they saw being shared by other
players in online gamer communities.
Study One Discussion and Conclusion
This study leveraged public social media UGC data to evaluate the UX and effects of a
phenomenal social simulation game (Animal Crossing: New Horizon, or ACNH) during the first
surge of the COVID pandemic, January 2020 to July 2020. With an aim to contribute to literature
on longitudinal UX evaluation, this study designed a mix-method pipeline combining
computational and human strategies (i.e., topic modeling, sentiment and emotion analysis,
qualitative content analysis). In particular, topic modeling has been widely used to understand
new events or phenomena about which the public had little prior knowledge, especially given
textual data (e.g., Ordun et al., 2020).
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The cross-platform empirical evidence answered the research question if playing ACNH
was indeed associated with players’ life experience during the chosen time period in many
aspects. Social media users shared through rich textual and image data the various ways in which
they used the game to cope with pandemic-related loneliness, loss, anxiety, stress, and grief –
although it has to be noted that the game sometimes also induced anxiety in some players due to
the peer pressure effect from social comparison. Future research is needed to disentangle the
mixed effects of a social simulation game like this one on players’ anxiety level. One possible
approach for future research could be studying individual differences in player-game interaction
and in the effects of the game on anxiety related outcomes, informed by personality theories.
Such mixed effects were rare, as in most data a positive game effect was observed. The
publicly shared user narratives on gameplay demonstrated that the game had successfully
afforded social simulation. Through game-mediated communication between players as well as
between the player and the NPC virtual animal villagers, players join in-game activities (e.g.,
virtual weddings, romantic dates, protests, funerals) that carry and express their unsettled
emotions. ACNH helped compensate for the social interaction missed due to the COVID-19
pandemic, in the midst of global lockdowns, social distancing, and isolation. The game brought
people closer in the virtual game world to overcome geographical boundaries and restrictions of
the real-world. Social simulation video games, like the one this study focused on, may have the
potential to enhance players’ mental well-being during difficult times.
The bottom-up approach to examining UX of a social video game during the pandemic
also identified the unique game elements that are capable of enabling situated motivational
affordances. Theoretically, this study applied and tested the model of situated motivational
affordances of game elements in a natural setting through unobtrusive observation. The
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situational factor was indeed crucial to account for when examining the motivational affordances
of game elements and function to effectively explain some negative sentiment toward the game.
Practically, results of this study shed light on the potential restorative power of social simulation
games’ elements on player experience and well-being; and they provided insights for a human-
centered game design.
In the meantime, both social media platforms investigated in this study witnessed
predominantly positive sentiment toward ACNH. Reddit, as presumed, is where gamers gather to
form communities called the subreddit. It was observed that redditors share their animal-crossing
designs where they create scenes to mimic cultural icons from the real world. What was also
observed was animal-crossing related hilarious memes, heartwarming moments, and fan art that
were intended to share or gain care, support, and laughter. Meanwhile, players shared thoughts
on unsatisfying UX, suggesting improvements in the game feature design. This study offered a
bottom-up structure of the wide array of player behaviors associated with ACNH. Future
research on social simulation games, or video games in general, may draw on this study’s UX
classification structure (Appendix A) for replication, validation, and extension.
Study One Limitations and Future Research
This study is not immune to limitations. First, the Reddit dataset had a small sample size
of 2,139 and included only the popular (“hot”) posts in the seven months. A larger, more
representative Reddit dataset, like the Twitter dataset, would have yielded a more accurate and
comprehensive typology of various UX behaviors related to ACNH. Also, this study only
examined the substance of posts. Future research would benefit from additionally studying post
comments, which could provide invaluable insights regarding the context of discussions,
emotion contagion, and the interactive CMC dynamics in subreddits. Second, the machine
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classifier this study attempted had a low accuracy score, which pushed this study to eventually
adopt human content analysis instead. A classifier that takes multi-modal data (not only texts, but
also images) as the input could ideally be more accurate in classifying image-heavy social media
datasets. Third, platform-wise, social media discussions from only Twitter and Reddit were
featured and analyzed in this study. Future research may test if findings of this study are
replicable on other platforms, especially other gamer forums. As social networking sites have
somewhat different feature affordances, it may be expected that the findings from other
platforms to be informative in different ways.
Last but not the least, the commercial nature of these video games and humans’ persistent
zest for novelty confined games like ACNH to fully unleash their potentials of benefiting
consumer well-being in the longer term. At the time of this study, which was a year after the
game’s release date, the game was also experiencing a fall in its vigor of discussion. What ought
to be stressed at the end of this study is that the problematic and excessive use of video games,
although not the main findings of this study, should be examined more critically in future
research and be minimized, so that video games with situational social affordances can exert an
optimal impact on players.
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CHAPTER 4: EVALUATION OF A HOME-BASED EXERGAME,
RING FIT ADVENTURE (STUDY 2)
Habitual Physical (In-)Activity
Regular physical activity reduces health risks and improves life quality. In the general
population, lack of regular physical activity is associated with a higher risk of cardiovascular
diseases (Manson et al., 2002; Powell et al., 1987), certain cancers (e.g., colon cancer, Hoffman-
Goetz, 1998), and mental disorders (e.g., depression, anxiety, and schizophrenia, Saxena et al.,
2005). In contrast, regular physical activity helps prevent or manage the top-five most prevalent
chronic conditions – as of 2014 – among adults in the U.S. (Buttorff et al., 2017). They were: (1)
hypertension (Diaz & Shimbo, 2013), (2) lipid disorders (e.g., high cholesterol, Cook et al.,
1986), (3) mood disorders (e.g., depression, bipolar disorder, Dunn et al., 2001; Wright et al.,
2009), (4) diabetes mellitus (Toledo et al., 2007), and (5) anxiety disorders (e.g., anxiety, panic
disorders, stress, Anderson & Shivakumar, 2013). Given that multiple chronic conditions are
prevalent among 42% of U.S. adults and 81% of adults aged 65 years and above (Buttorff et al.,
2017), it is imperative to encourage regular physical activity to improve public health, which
includes not only physical but also mental health.
Meanwhile, people living with special needs or in their later years would particularly
benefit from regular physical activity because it helps preserve physical features such as muscle
strength, balance, and mobility (Bartlo & Kleim, 2011; Frändin et al., 2016). Preservation of
physical functions can alleviate behavioral difficulties and prevent fall-related adverse health
complications. Initiating physical activity in early adulthood and integrating it into a habitual
pattern prior to older adulthood is therefore crucial to health throughout the human lifespan.
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Consistent with abundant evidence for the benefits of physical activity, the phrase
“physical activity” itself has also gained growing attention. According to Google Book Ngram
Viewer (http://books.google.com/ngrams) (Michel et al., 2011), in books published from 1900 to
2008, the frequency rate of the phrase “physical activity” had an 18-fold increase. Since the
algorithm has normalized the number of total published books in each year, the frequency rates
of a certain phrase indicate its popularity and the salience of the agenda associated with the
phrase. On a public rather than an individual level, this trend implies soaring public discussions
about “physical activity” since the 1960s, especially since the 1990s (see Figure 4.1; there are
three curves because the search was case-sensitive).
Figure 4.1. Word “physical activity” trend from Google Books Ngram Viewer
Physical activity is key to preventing adverse health outcomes, and there has been a
growing public interest in physical activity over the past century. However, mobilizing habitual
physical activity as a national initiative is still unattainable. From 1996 to 2017, according to the
U.S. Department of Health and Human Services, the percentage of U.S. adults who do not
adequately engage in a recommended level of physical activity increased from 60% to 80%
(CDC, 1996). With regard to the percentage of the populations who do not exercise at all, it was
25% in 1996, whereas in 2015, as many as 53.87% of interviewees in the U.S. National Health
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Interview Survey never participated in vigorous physical activity, and 39.64% never practiced a
moderate level of physical activity (CDC, 2016). In several states of the U.S., the age-adjusted
rates of inactive adults remained high or had increased in the past few decades (An et al., 2016).
Health Interventions for Physical Activity
The failure of society to address the need for sustained physical activity requires further
efforts, despite hundreds if not thousands of physical activity interventions. In a review of digital
technology-based physical activity interventions involving websites and email systems
(Vandelanotte et al., 2007), only 53.3% of the reviewed studies (N = 13) achieved enhanced
physical activity among their participants. A little under half of the interventions were
ineffective. Previous physical activity interventions have been mostly instructional – teaching
exercise knowledge and skills. Their approaches included (1) goal-setting (Feil et al., 2000;
Glasgow et al., 2003; Watson et al., 2012), (2) informational education/instructions or online
coaching (Glasgow et al., 2003; Hageman et al., 2005; Napolitano et al., 2003; Plotnikoff et al.
2005; Rozenblum et al., 2019; Spittaels et al., 2007), (3) feedback provision (Rovniak et al.,
2005), and (4) tracking (McKay et al., 2001). Occasionally, interventions may also provide (5)
emotional support elements, i.e., online peer support forums and bulletin boards (Feil et al.,
2000; Glasgow et al., 2003; Harvey-Berino et al., 2002), telephone calls (Harvey-Berino et al.,
2002; Harvey-Berino et al., 2004), and in-person support (Harvey-Berino et al., 2002; Harvey-
Berino et al., 2004). However, as mentioned above, only slightly over half of these website- or
email-based physical activity interventions were effective (Vandelanotte et al., 2007).
The presumption behind these common types of physical activity interventions is that
knowledge and skill-building may enhance perceived competence; nevertheless, it is claimed that
the effects also depend on the impact on perceived self-determination (Deci et al., 1999). These
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traditional physical activity interventions often overlooked the necessity to address participants’
autonomy and intrinsic motivation in incurring healthy behavioral changes, since many people
may relapse during physical activity interventions, looping between contemplation (thinking
about being more physically active) and action (actually performing it). That is, when trying to
build habits of physical activity, it is not guaranteed that an individual will maintain the
behavior. On the contrary, many people fail to do so. Admittedly, physical activity is determined
by various factors: individually, motivations, self-efficacy, exercise history, and skills;
environmentally, access, cost, time barriers, and social and cultural supports (Sherwood &
Jeffery, 2000). Among all these, however, lack of motivation is perhaps one of the biggest
obstacles to engaging in regular physical activity (Trost et al., 2002). Thus, to formulate physical
activity as an autotelic experience (i.e., an activity done for its own sake, such as “play” as
mentioned earlier, with the term “autotelic” having the Greek roots of auto (self) and telos
(goal)), interventions have to foster intrinsic motivation, namely “the experiential state that arises
when individuals engage in skill-related activities under conditions of clear goals, immediate
unambiguous feedback, and a perceived fit of skills and challenge” (Keller & Bless, 2008; p.
198).
Gamification in Fitness Applications and Exergames
Recent development of literature in the gamification of physical activity suggests that
exergames may be a revolutionary tool that directly addresses the lack of intrinsic motivation to
exercise among consumers (Koivisto & Hamari, 2019). As mentioned in Chapter 2, the term
“exergame” is a compound noun consisting of “exercise” and “game.” Through engagement,
entertainment, and immersion, exergames with gamification mechanisms may internalize
extrinsic stimuli to increase users’ intrinsic motivation to exercise. In our previous research about
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mobile fitness apps, for example, we found that gamification features in mobile fitness apps are
more likely to appeal to adult consumers who are younger in age, female, or of higher BMI,
compared to their counterparts who are older in age, male, or of lower BMI (Wang & Collins,
2021). Knowing that a fitness app contains gamification features would thus make some people
more likely to adopt the app. One implication of this finding is that for certain population
subgroups, especially those who do not have the habit of engaging in adequate exercise on a
daily basis, it may not be the fitness education or tracking functions that would help them to
establish the exercising habit; rather, a fun, entertaining, and engaging physical activity
experience may interest them, get them started, and lead them into a series of repeated behaviors
that is eventually more likely to develop into a habitual behavior. Therefore, I have argued that it
may not be a lack of awareness that is failing to popularize physical activity at a population
scale, but a lack of everyday motivational tools that can support consumers to build workout
routines, i.e., habitual physical activity (Wang & Collins, 2021). Mobile fitness apps, as a mobile
alternative to exergames, provide one solution. Although being the least common type of
features compared to educational, tracking, and social features, the gamification features have
been incorporated in approximately 35.7% of mobile fitness apps in the iOS app store (Wang &
Collins, 2021). These gamification features include badges, leaderboards, points, levels,
challenges, quest, and social engagement (Miller et al., 2016), all of which are intended to make
the individual experience of physical activity more enjoyable and sustainable.
Although it has yet to be empirically confirmed in an exergame context, gamification
features in mobile fitness apps often co-occur with other features such as tracking and social
features to provide consumers with companionship and social support (Wang & Collins, 2021).
In this sense, part of gamification’s hypothetical effectiveness in promoting health behaviors is
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closely tied to the social interactions afforded by persuasive health technology. Yet, from the
same research discussed earlier (Wang & Collins, 2021), we found that social features alone are
not sufficiently appealing to consumers, given how narrowly social features have been defined in
previous literature (i.e., sharing workout accompaniments to social media platforms; adding
family, friends, and strangers as in-app friends; or posting feeds to the in-app discussion board),
and how these only minimally address extrinsic motivation such as social approval and thus are
insufficient (Kranz et al., 2013). Previous research suggests a need for an updated investigation
to re-define what kind of social interactions are perceived by consumers as meaningful in a
persuasive health technology context, and more importantly what kind of social interactions can
be afforded along with the gamification principle to amplify gamification’s positive impact on
consumer health.
With exergames becoming less costly and more ubiquitous in everyday households, this
study seeks to extend previous research on gamification for health by evaluating a commercial
off-the-shelf exergame. As mentioned in Chapter 2, gamification can be defined as the process of
applying game-like features to the design of products, systems, services, organizations, and
activities in traditionally non-game contexts (Huotari & Hamari, 2017). These include serious
agenda such as health behavioral interventions. In a health intervention that applies gamification
and game mechanisms, users engage in voluntary plays of a serious health game. Through the
gamified participation in technology-enabled health interventions, it is expected that consumers
will transfer the extrinsic stimuli to a form of intrinsic and autotelic motivation (Koivisto &
Hamari, 2019).
This transformation of motivation from extrinsic to intrinsic through the gamification
principle has been supported by several forms of design, as observed in persuasive technologies
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targeting health behavioral changes. They include: (1) in-game storytelling/narrative (Bormann
& Greitemeyer, 2015; Sailer et al., 2017), (2) customization of character (Peng et al., 2012),
skills and mission choices (Peng et al., 2012), (3) avatars (Brauner et al., 2013, Sailer et al.,
2017), virtual humans (Bickmore et al., 2009; Vardoulakis et al., 2012), virtual pets (Ahn et al.,
2015; Ahn et al., 2019), (4) teammates (Sailer et al., 2017), leaderboards (Hanus & Fox, 2015;
Sailer et al., 2017), weekly challenges and group competition (van Roy & Zaman, 2018), and (5)
quantified achievements: points (Ahn et al., 2019; Mekler et al., 2017; Thom et al., 2012), levels
(Mekler et al., 2017; Thom et al., 2012), badges (Hanus & Fox, 2015; Peng et al., 2012; Sailer et
al., 2017; Thom et al., 2012; van Roy & Zaman, 2018), and performance graphs (Sailer et al.,
2017).
Through evaluating the variety of gamification designs, research to date has found
gamification to be promising in the education and learning domain (see a meta-analysis: Sailer &
Homner, 2020) but less so in changing health behaviors. In a systematic literature review
(Koivisto & Hamari, 2019) on gamification of physical activity interventions, 16 comparison
studies were analyzed. The review found that results from gamification of physical activity were
positively oriented; however, results were less positive in more rigorously designed studies
(Koivisto & Hamari, 2019). That is, the true efficacy of gamifying physical activity interventions
remains a question, considering the inconsistent validity of the studies in the review. Another
objective of the current study, therefore, is to evaluate gamification of physical activity
interventions in more depth and in specific relation to different exergame affordances and
features.
Regarding outcome measures, physical activity, duration of usage, and active time are
found in current literature (Chen & Pu, 2014). A recent study that evaluated Pokémon Go’s
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effects on physical activity used daily steps as the sole indicator of physical activity (Althoff et
al., 2016), but the effect of the game on consumers may go well beyond increasing steps.
Extended research in this field should study not only physical activity but also affective and
mental health indicators, since physical health may also promote mental health by relieving
anxiety, panic disorders, and stress, among other benefits (Anderson & Shivakumar, 2013).
Ring Fit Adventure
Previous literature in exergames (e.g., Görgü et al., 2010) tended to highlight the “obesity
epidemic” as what was tackled through gamification. Yet, as mentioned above, the adverse
health outcomes resulting from physical inactivity and a sedentary lifestyle include increased
risks of various diseases, both physically and mentally (Manson et al., 2002; Saxena et al., 2005).
A mental health epidemic, for example, immediately followed the initial surge of the COVID-19
pandemic due to physical constraints and stay-at-home orders (Marroquín et al., 2020). As
humans collectively move toward a highly industrialized society with more assistive
technologies, physical activity is likely to show declines continually. If more technology
integration in human life is an inevitable trend, then the question would be how to optimize
human-technology relationships to allow technology-based physical activity interventions to
generate social good.
Ring Fit Adventure, as Chapter 2 introduced, is an interactive video exergame running on
Nintendo’s Switch game console. The game was officially launched on October 18, 2019. It
provides physical activities in three modes: adventure, quick play, and custom workouts, with the
adventure mode using a storyline and narrative structure to organize fitness activities in
increments (e.g., as the game level goes up, players can “unlock” new exercise movements to be
added to their workout sessions). All of these three game modes are supported by a handheld
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fitness ring and a wearable leg strap, each connecting to a remote control (i.e., joy-con) with
motion and force sensors. These sensors are intended to create an interactive and immersive
gamified fitness experience, while providing real-time feedback to the game system to inform it
about the player’s movement and posture in real time.
Ring Fit Adventure is not the first exergame on the market. For example, a prior study
had older adults (N = 56) play a video game system, Boom Blox, a video puzzle game on
Nintendo Wii (Whitlock et al., 2011). Following its several predecessors of Nintendo motion
sensing exergames which targeted specific types of sports (e.g. tennis, dancing, boxing), Ring Fit
Adventure is the first of its kind on the market to attempt to introduce the general customer
population to serious full-body fitness training, including aerobic and non-aerobic exercise. The
game presents itself as a timely case worthy of close investigation. While the company may be
arguably more interested in designing the game to be initially more attractive to increase sales,
researchers can evaluate the game’s efficacy in leading to actual effects on consumers’ physical
and mental health and thereafter provide implications for future game research and design.
Sato et al., (2021), for example, compared a Ring Fit Adventure exergaming condition
with an oral medical treatment condition (i.e., non-steroidal anti-inflammatory drugs, tramadol,
and duloxetine) through a randomized control trial. Participants were 20 patients with chronic
pains. Results showed that after playing Ring Fit Adventure for eight weeks, participants
significantly improved in reducing lower back pain and buttock pain, and in increasing pain self-
efficacy, but not in lower limb numbness, pain catastrophizing, and kinesiophobia (i.e., fear of
pain due to movement). Except for Sato et al. (2021), no other studies have empirically evaluated
this game’s effects on consumer health, but one study evaluated Ring Fit Adventure for its safety
and feasibility (Takei et al., 2022).
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Health Risks Involved in Trusting Technology
In the safety and feasibility aspects, using Ring Fit Adventure for strength training was
determined to be safe and feasible for older adults with musculoskeletal conditions, but
researchers recommend providing supervision to older adults when they engage in the exergame
(Takei et al., 2022). Nevertheless, Takei et al. (2022) based its safety evaluation on a single-
session exergaming condition, which is insufficient in external validity as it did not monitor
longitudinal exergaming UX and outcomes. In addition, the evaluation setting of Takei et al.
(2022) essentially varied from a natural household gameplay setting, where the player would not
be accompanied by a researcher but engage with the exergame with minimal or no supervision.
More research needs to be conducted to determine the actual risks associated with exergaming
through Ring Fit Adventure, as reported by actual consumers of this game who had interacted
with the game in their own homes over an extended period of time.
Risk perception is central to health behavior adoption and health technology use. When
humans perceive more risks than benefits resulting from the execution of a certain action, they
are less likely to take the action (Rosenstock, 1974). This logic can be applied to exergames as
well. Ring Fit Adventure is designed to support home-based physical activities. It relies on users
to self-monitor their body movements during exergaming and physical symptoms post-
exergaming without the assistance of a professional fitness trainer. For this reason, the game
entails several design elements that appear to be aimed at risk reduction and injury prevention.
Upon beginning the game, players are instructed to have a spacious environment that would
allow them to move freely and safely.
2
During the exergame, the virtual human fitness trainer,
Tipp, would demonstrate and explain each movement, and Tipp moves in a mirror image along
2
This initiation setup reminder has also been adopted by virtual reality headsets, such as Meta’s Oculus Quest.
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with the players. Players will hear from Tipp which section of their muscle should be involved in
a particular move, what the correct posture is, and what incorrect posture may be like. In
addition, the sensor in the joy-con attached to the leg strap and the sensor in the ring can provide
feedback to the game system. When the sensors detect that a player’s leg or arm may not be
precisely positioned, they trigger the virtual human trainer, Tipp, to use voice alert to remind the
player. In addition to reminding the player during the gameplay sessions, the game will also
suggest that the player exist the game once they have reached a certain amount of exergaming
time in a single session. This is intended to avoid injuries from excessive exercising. Despite
these preventive measures, no research except for Takei et al. (2022) evaluated the safety aspect
and risks of injuries resulting from Ring Fit Adventure.
Importantly, this study acknowledges the difference between the concepts of “actual
risks” and “perceived risks.” Risk perception in trusting technologies is often based on previous
experience, but when information on the actual risks is limited, the extent to which Ring Fit
Adventure players are able to accurately assess the risks involved in playing this game remains
unclear. In fact, my previous observation indicates that with commercial off-the-shelf video
games targeting fitness and health, the risks involved in engaging with these games are often
poorly or insufficiently communicated to consumers. Risk assessment for persuasive
technologies for personal health management is extremely difficult when their long-term effects
are not fully understood, especially from the consumers’ perspective. Therefore, one of the other
objectives in this study is to understand more fully the risks associated with exergaming,
including potential injuries.
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Reddit and Subreddit
Sustaining a long-term effect of interventions has been the utmost challenge
(Vandelanotte et al., 2007), and habits usually take about 10 weeks to form (Gardner et al.,
2012). Prior physical activity interventions that use gamification design, virtual agents, and
interactive tactile interfaces have been mostly short-term, involving limited exposure to the
intervention materials. For instance, Ahn et al. (2015) and Ahn et al. (2019) were novel studies at
the time but unfortunately only able to carry out interventions over a course of three days due to
the constraints of an experiment approach, and their measurement was limited to the time spent
on physical activity during the experiment. Therefore, this study seeks to expand previous
research by shifting focus on short-term gamification efficacy of physical activity interventions
to collecting longitudinal data spanning three years (from October 18, 2019, the release date of
Ring Fit Adventure, to October 18, 2022). Reddit serves as one of the online gamer communities
where players exchange information, and share personal experiences, opinions, and emotions
surrounding the game, all of which offer rich UGC. Yet, it has to be noted that by “longitudinal
data”, this study will not be able to have multiple data points tracking each player on a one-on-
one basis; rather, players may report that they have used the game for certain days and the effect
appears in a certain way or does not appear. UGC data mean that players are not confined by the
knowledge structure of researchers (e.g., the questionnaire approach) or the study conditions
(e.g., the experiment approach). Hence, it is probable that in UGC data players report game
effects in different ways and based on different numbers of days spent on exergaming. This form
of unstructured data in social media UGC offers challenges but invaluably opportunities for this
study to gain in-depth knowledge about exergame UX and effects from the players’ perceptions.
While I expect the online gamer community to center their discussions around the game features
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and effects, it requires empirical evidence to prove that this computational approach followed by
human analysis is indeed feasible and valid for future evaluation of exergame UX and effects.
Reddit, known as a social-news sharing and community site, is structured around
subsidiary threads or thematic groups called “subreddits.” Each subreddit forms a topic-based
community for those who share interests. The subreddit “/r/RingFitAdventure/”
(https://www.Reddit.com/r/RingFitAdventure/), for example, is “a community for Nintendo’s
fitness RPG Ring Fit Adventure, made for the Switch” (RPG stands for Role-Playing Game),
according to its official description. The subreddit was created on September 12, 2019,
approximately one month before the game became available on the market. As of November
2022, the subreddit has had 445,000 members and in the week of November 7, it had 7000 visits.
To view or publish a post in the subreddit, one does not have to be a member of the subreddit.
For this reason, the actual size of the audience and post authors in this subreddit are estimated to
be larger than the size of its members.
In current literature about Reddit communities, numerous researchers have heavily
criticized the platform on the grounds that it promotes toxicity, misogyny, and racism (Maloney
et al., 2019; Massanari, 2017), while others acknowledge its role in supporting user well-being
(Mann & Carter, 2021). Toxicity can be operationally defined as harmful language, which on
social media platforms is partially attributed to the perceived anonymity (Barlett et al., 2018;
Sheth et al., 2021). For example, Massanari (2017) found through a digital ethnography that
Reddit uses its algorithm, governance, and platform culture to normalize certain problematic
aspects of geek masculinity, exacerbating the anti-feminist activism that has been known to be
prevalent on Reddit. The explanation for why Reddit can assert social effects on users has
multiple facets. It includes the content ranking algorithm and the voting mechanism of Reddit,
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where users can upvote or downvote a post, and use of these features can result in emotional
consequences to community members (Davis & Graham, 2021). On the positive side, such
emotional consequences sometimes come in the form of social and emotional support. Among
participants of the r/Parenting subreddit, for instance, previous research has found evidence that
Reddit affords emotional disclosures and reciprocal support for members who are navigating
stressors related to parenting (Mann & Carter, 2021). For the case of Ring Fit Adventure, my
empirical observations indicate that Reddit also serves as a message board system and
community-based social networking site where players seek various types of support, which
makes Reddit not just a news sharing site. Consistent with Davis and Graham’s (2021)
observations with regard to other more general subreddits (i.e., /r/funny, /r/AskReddit, and
/r/todayilearned), emotion and engagement also appear to be an integral part of the
/r/RingFitAdventure subreddit. Thus, in addition to the study objectives mentioned so far, this
study will additionally seek to understand patterns of emotion in online discussions surrounding
this exergame, which will reveal the affective aspect of its UX.
Based on previous research and my empirical observations, this study proposes the
following questions:
RQ1. What are the affective responses of players to Ring Fit Adventure?
RQ2. What kind of social interactions are meaningful in an exergame context to amplify
the effect of gamification?
RQ3. Is gamification useful for changing physical activity and improving physical and
mental health?
RQ4. What risks and negative effects of the game do consumers report, if any?
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Methods
Data and Data Collection
Using the Pushshift API (Baumgartner, 2019; https://github.com/pushshift/api), all
Reddit posts published between October 18, 2019 (i.e., the release date of the game) and October
18, 2022 were exhaustively sampled from the subreddit ‘/r/RingFitAdventure.’ The sampling
time frame spanned three years and covered the COVID-19 pandemic. From an initial dataset (N
= 8,670), duplicates and deleted contents were dropped, resulting in a final sample of unique
posts related to the game (N = 8,386) from 5,350 unique authors. All posts contained a title, but
only about 62.68% of the posts had body text. Thus, for subsequent analyses, the title and the
body text were concatenated at the post level to form the unit of analysis. On average, each unit
of analysis is approximately 65 words in length, with each web link counted as one word but
stripped during the data preprocessing step.
Sentiment and Emotion Analysis
Based on the NRC Word-Emotion Association Lexicon (using the Python package,
NRCLex) (Mohammad & Turney, 2013), words respectively indicating positive sentiment,
negative sentiment, and eight discrete emotions (i.e., anger, anticipation, disgust, fear, joy,
sadness, surprise, and trust) were detected and counted to answer RQ1.
Image Clustering
As the Animal Crossing study stressed, UX classification solely based on textual data
was unsuccessful because Reddit data about games are enriched with images, and it was a missed
opportunity to only analyze textual data without visual data. Thus, for this study, posts with static
image data were identified and downloaded.
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The images were categorized using k-means clustering to answer RQ2 and RQ3. Image
features were extracted using VGG19 (Simonyan & Zisserman, 2014) pre-trained on ImageNet
(Krizhevsky et al., 2017). Images were first processed following a standard procedure
(https://pytorch.org/hub/pytorch_vision_vgg/): resizing, center cropping, and normalization. In
an iterative process, different solutions with cluster number k ranging from 2 to 10 were
compared with the assistance of human understanding to determine the optimal k. According to
del Toro et al., (2015), human interpretation is often essential to make sense of the output from
machine learning algorithms. See Figure 4.2 for a flowchart of the image clustering pipeline.
Figure 4.2. Image clustering pipeline
Qualitative Analysis
A list of hand-crafted keywords related to injuries, weight management, mental health
and sleep, disabilities and substance use were used to filter the text dataset, yielding several
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subsets of data that mentioned each set of the keywords. Qualitative analysis was conducted on
the subsets of data to understand risks involved in exergaming (RQ4) and supplement the
clustering results in evaluating the game’s effect on consumers’ mental and physical health
(RQ3). See Table 4.1 for the search keywords.
Table 4.1. Keywords used for filtering the data to obtain subsets for qualitative analysis
Category Keywords n
Sports Injuries “swollen”, “sciatica”, “concussion”, “sprain”, “edema”,
“tendon”, “tendinitis”, “splint”, “injur”, “pain”, “fracture”,
“hurt”
429
Weight Management “weight”, “lost” 774
Mental Health and
Sleep
“depress”, “anxiety”, “mental health”, “insomnia”, “sleep” 121
Disabilities “disabilit”, “disabled” 28
Substance Use “smok”, “cigar”, “alcohol” 22
Note. There was no mention of drugs, marijuana, or weed in this dataset.
Results
Descriptive Statistics on Posting Activity
Except for 37 days (3.38%) on which there was no posting activity, all other days in the
three-year sample period had at least one post added to the subreddit, r/RingFitAdventure. As
Figure 4.3 shows, the highest peak of posting activity occurred in January, 2021,
3
with 787 posts
published in the entire month; and January 19, 2021 was the date in the entire three years that
3
All dates are in Coordinated Universal Time (UTC). UTC is five hours ahead of Easter Time (ET) and eight hours
ahead of Pacific Time (PT).
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had the most posts (n = 37), compared to an average daily posting amount at 7.65 posts (if
including days that had no postings, n = 1096; or, M = 7.92, Mdn = 7, Mode = 6, SD = 5.62, if
only considering days that had actual postings, n = 1059).
The second peak of posting activity occurred between October 19, 2019 and October 25,
2019, which immediately followed the game’s release. Overall, posting behavior was more
active between early 2020 and midyear 2021, indicating more exergame usage and online
interactions during the COVID-19 pandemic. Since late 2021 to the present, the daily amount of
posts on the subreddit have largely decreased to less than 10 on most of the days.
Figure 4.3. Post frequency by date on r/RingFitAdventure (Oct 18, 2019 – Oct 18, 2022)
Sentiment and Emotion Analysis
This three-year dataset about Ring Fit Adventure had overall 1.73 times of positive
sentiment (n = 27917) compared to negative sentiment (n = 16131), and more positive than
negative or neutral emotions as well: trust (n = 16111), anticipation (n = 15697), joy (n = 10873),
fear (n = 9871), sadness (n = 9520), anger (n = 7587), surprise (n = 6182), and disgust (n =
5137), ranked by frequency counts in a descending order (see Figure 4.4). Consistent with
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findings from the Animal Crossing Reddit dataset, trust and anticipation were among the most
common types of emotion in this Reddit dataset about Ring Fit Adventure.
Figure 4.4. NRCLex sentiment and emotion counts in the Ring Fit Adventure Reddit dataset
Exergame Affordances and Social Interactions in Image Clusters
Metadata of this dataset indicated that there were 1750 posts that contained static images.
These posts compromised 20.87% of all post sample. As mentioned in the Methods section,
k-means clustering was performed on images in an iterative process with k ranging from 2 to 10.
Each clustering solution was closely examined and compared against each other based on human
understanding and interpretation.
Qualitatively judging in-group coherence, between-group distinctiveness, and their
tradeoffs, this study determined that the 6-cluster solution was optimal for showing the most
distinct yet internally coherent clusters among candidate solutions. Each cluster respectively
contains 196, 471, 183, 147, 452, and 300 images.
Cluster 1: In-game Accomplishments (“Level Up”) Screenshots. The first cluster (n =
196) is highly homogenous, in the form of screenshots. Players post them to share in-game
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accomplishments with other players in the subreddit. The accomplishments are unanimously
leveling up, as players advance in the game and gain points and rewards. See Figure 4.5.
Figure 4.5. Cluster 1 image examples
Cluster 2: In-game Accomplishments (“Level Up”) Shown on a Screen in a Home
Environment. The second cluster (n = 471) is the largest cluster. It is also the most similar to
cluster 1 among all clusters in terms of the messages or meanings that the images convey.
However, the way cluster 2 images substantively differ from cluster 1 images is that cluster 2 are
not simply screenshots; rather, they showcase the environment where the players actually use the
exergame. Images in cluster 2 reveal that players would usually connect the Switch game
console to a TV or computer, and project the game scenes to the larger TV or computer screen,
instead of using the game console’s 6.2-inch screen. Images of this cluster show the feasibility of
Ring Fit Adventure of being infused into everyday households. See Figure 4.6.
Figure 4.6. Cluster 2 image examples
Cluster 3: Ring, Game Scenes, and Home Environment. The k-mean clustering
algorithm was able to pick up features to identify the ring in certain images as it is held in front
of a TV or computer screen. The screen would contain a variety of in-game scenes, ranging from
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soothing sceneries with encouraging game-plot lines, the exercise summary board, battles with
the antagonists in the game, leveling up, and sensor device synching and alignment, among
others. Notably, cluster 3 images (n = 183) also appear to be photographed in home
environments. These clusters are highly recognizable and distinct from other clusters for the
presence of the physical ring, which is one of two most important accessories of this exergame.
See Figure 4.7.
Figure 4.7. Cluster 3 image examples
Cluster 4: Animated Virtual Agents and Avatars, Fan Art, and Memes. In the aspect
of visual feature representations, Cluster 4 images (n = 147) are almost exclusively cartoons,
artwork, memes with animated characters, and most often in-game scenes involving avatars and
virtual agents. In Figure 4.8, example images on the first line respectively represent: (1) a player
is choosing to carry out an arm-focused exercise movement in a battle against Dragaux, the
major boss; (2) a player may use the “drink a smoothie” function in the game to enhance the
player’s defense capacity against a group of mini bosses, or Dragaux’s minions; (3) the player
sees a mission alert, “Defeat Dragaux”; (4) in a deep-squat pose, the self-avatar of a player is
synched in movement, with the orange hair resembling a flame during the workout session (the
harder one exercises, the larger the hair flame will be); (5) the player is lined up with NPC
virtual human agents to collaboratively compete against Dragaux.
Cluster 4 is not the largest cluster in size, but it is the most vibrant one with regard to
creative activities and the type of creative works it entails. In addition to taking screenshots of
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stimulating in-game scenes as mentioned above, players also shared two types of content seen in
this cluster: fan art and memes or comics. Fan art is observed in this dataset about Ring Fit
Adventure in a similar way as in the Animal Crossing subreddit. The embroidery in Figure 4.8,
for example, highlights a popular line from the game, “your sweat is so shiny and beautiful.”
This line was featured in multiple images such as the Valentine’s Day comics in Figure 4.8. The
fifth image on line two of Figure 4.8 is of a player who plays both games (Animal Crossing and
Ring Fit Adventure), and she shared to the Ring Fit Adventure subreddit an image of herself with
the ring within the Animal Crossing game world. Such cross-game references are observed in
this cluster, with the Mario memes as another example. Memes in this cluster commonly draw
upon in-game conversations, plot, and game features of Ring Fit Adventure and are indicators of
what game elements most impressed or engaged the players, or what game elements that players
found to be most situationally and socially meaningful.
Figure 4.8. Cluster 4 image examples
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Cluster 5: Faces. The fifth image cluster features faces of real humans (most common),
cats (a small number), dogs (rare), or faces in memes (a small number). It is the second largest
cluster in size (n = 452). Compared to cluster 4 which contains almost exclusively animated
characters, cluster 5 focuses on real-world social actors before, during, or after they interacted
with this exergame. See Figure 4.9 (non-celebrity human faces are anonymized using a grey
block).
Figure 4.9. Cluster 5 image examples
For example, a subset of these images are progress photos posted by players who use the
exergame for weight management. These progress photos, often in the forms of selfies and full-
length portraits, not only demonstrate the physical effects of Ring Fit Adventure on players (i.e.,
muscle gains, weight loss, body fat loss, and supporting balance training) but also hint at its
effects on players’ mental health state. In images that do contain human faces, smiles tend to be
the type of facial expression. When featuring pets and younger children, cluster 1 images tend to
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carry a sense of cuteness (such as a cat snuggling in the ring), projecting the image authors’
sentimental values attached to their pets and children as their pets and children interact with the
game or game devices.
Unlike the memes in cluster 4, faces in cluster 5 memes were often human celebrities,
sometimes representing a movie character, such as Shang-Chi from Shang-Chi and the Legend of
the Ten Rings, and Katniss Everdeen from The Hunger Games. Similar to cluster 4 memes but
only varying in terms of not being animated characters, memes in cluster 5 also apply humor to
discuss specific game features such as the strength sensor enabling in-game archery, or the
sensor not necessarily being accurate in detecting the preciseness of a player’s deep squat
posture.
Cluster 6: Tracking and Exercise Log Data. The last cluster is the third largest cluster
(n = 300). It heavily focused on the sharing of exergame results in the form of tracking and data
logging. Most of these images showcased Ring Fit Adventure’s built-in functions related to
exercise tracking. They included the workout summary board at the end of each session listing
the time spent, calories burnt, and distance ran. Some of these images also showcased the
longitudinal data tracking function of the game, which maps workout sessions and performances
to a calendar. Notably, cross-platform tracking was described in some of the cluster 6 images,
with the exergaming record being monitored by third-party wearable technologies and recorded
in mobile fitness tracking apps. See Figure 4.10.
Figure 4.10. Cluster 6 image examples
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Sports Injuries, Physical Health Risks, and Accessibility
As mentioned in the Methods section (see Table 4.1), keywords were used to filter the
dataset. A subset of posts (n = 429) were identified as being potentially relevant to sports injuries
and risks surrounding exergaming, which constituted 5.12% of all data. To check if the posts
actually discussed sports injuries, pain, and risks associated with the game, or the effects of the
game on consumers’ physical health, a human verification process was performed. Results
showed that the majority (n = 321) of this subset of posts indeed mentioned users’ self-reported
injuries from exergaming, while the rest of the posts discussed chronic pain or acute injuries
prior to playing this exergame, or did not mention injury, or discussed pain and injuries in other
contexts.
Table 4.2 summarizes a wide breadth of sports injuries, pain, and physical health effects
during or after exergaming in Ring Fit Adventure. Multiple parts of the human body were on the
list of affected areas of sports injuries, including neck, shoulder, arm, hand, wrist, abdomen,
back, chest/breast, leg, knee, calf, hip, ankle, and foot. Problems with the knee (n = 53), back (n
= 50), and legs (n = 49) were the top three reported issues. In addition, problems associated with
tendons were also prevalent among players who posted at least once on this subreddit during the
three-year period. This appears to correspond to the design of this exergame, which heavily
focuses on jogging, jumping, and deep squats. As one player wrote:
“If you’ve got good joints, this game is a winner. If you have any real joint issues,
this game is a nightmare. I thought this game would get me through the winter.
But these unending inconveniences are out to destroy my joints, when I can no
longer complete a set, yet the game just stares at me and waits for me to complete
the set.”
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Table 4.2. Sports injuries, pain, and physical effects of the exergame, Ring Fit Adventure
Body Parts Descriptions of Injuries, Pain, and Negative Physical Effects
General (n = 20) “nausea”, “sick/threw up”, “severe fatigue while exergaming during COVID
recovery”, “sore in muscles”, “muscles hurt after playing”, “whole body
hurts”, “muscles aching”, “bone edema”, “dizzy”, “black out”
Neck (n = 8)
Shoulder (n = 20)
Arm (n = 22)
“neck hurts”, “neck pain”, “neck being prone to pain flares”, “severe shoulder
pain”, “hurt the shoulder while playing”, “sore in one-side shoulder”, “sharp
pain in the shoulder for days”, “shoulder injury”, “upper arms on the border of
sharp pain”, “arm muscle imbalance”, “abrasion to the skin on my forearms”,
“triceps strain”, “elbows injury”
Hand (n = 11)
Wrist (n = 11)
“hand/wrist pain”, “pain in hand and wrist”, “tendons overloaded”, “hand
injury”, “wrist injury”, “”
Abdomen (n = 10 ) “abdomen hurts”, “abs hurt”, “sprain a muscle in the abs”
Back (n = 50)
Chest/breast (n = 3)
“hurts in the back”, “lower back hurts after the knee to chest attack”, “middle
back on the border of sharp pain”, “uncomfortable in the back”, “hurts in the
back”, “pain in the lower back”, “back pain”, chronic health conditions (i.e.,
chronic pain) making certain body parts (i.e., lower back) painful after chair
squat, “a pinched nerve/sciatica”, “aching tailbone”, “coccyx hurts badly”
Leg (n = 49)
Knee (n = 53)
Hip (n = 6)
“broke the kneecap”, “fracture”, “squats hurt legs/knees”, “leg pain from
squats”, “discomfort and popping sound in legs”, “leg pain”, “a pulled quad”,
“pain in the knee”, “knee pain when jogging”, “knees hurt”, “injured my left
knee and tore my ligament”, “tendons crack”, “shooting pains (pinched nerve)
in thigh”, “numb thigh”, “calf/calves pain”, “hip pain”, “shin splints”
Ankle (n = 23)
Foot (n = 25)
“ankle pain”, “ankle injury”, “severe sprain or possible ligament injury”,
“hurts in the ankles”, “sprained ankle”, “broke the ankle”, “swollen tendons”,
“feet hurt”, “bruised foot”, “feet hurt”, “pain in foot when playing”, “the
Achilles parts of my feet hurt during running”, “Achilles tendinitis”
Body Parts Positive Physical Effects
General (n = 2) “pain reduction”, “chronic pain reduction (fibromyalgia)”
Neck (n = 1) “reduction of neck pain”
Back (n = 2) “less lower back pain”, “reduction of back pain”
Leg (n = 3) “more leg flexibility”, “it’s working for me” despite chronic health conditions
(i.e., joint conditions, arthritis), “reduction of leg pain”
Note. Frequencies sum up to a value larger than the subgroup size due to comorbidity.
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Unlike the previous exergames on the market, Ring Fit Adventure seems to be
involving more intense full-body physical activity and serious fitness training that can
pose severe physical health threats and risks to the players, especially those who have
pre-existing chronic health conditions. Some of the injuries from playing Ring Fit
Adventure were so severe that they result in a hospital visit, for example:
“I was playing ring fit adventure yesterday. When I was jogging, my legs suddenly
stopped balancing and I fell onto the floor. My right knee had a ball thingy poking
out. I was on the floor and couldn’t move. I immediately called an ambulance to
go to the hospital. When I reached there they helped me pop it back in the
kneecap but told me that it fractured. Now I’m still in the hospital waiting until
my recovery.”
Specific to a household environment, injuries sometimes occur because of certain objects
or activities in the surroundings where the players is situated in while exergaming:
“I was going through a level, thinking I was jogging in place, but I was actually
jogging backwards, into the sofa, where I twisted my ankle and now it’s sprained.
I’m lying here with my ankle iced and elevated, feeling pretty dumb and old. I did
achieve a new low in gameplay time (less than 3 minutes!) but I’m yet to receive
applause/confetti from Tipp for this.”
As this player mentioned, furniture in the living room where the player is physically
located during the workout session can be a risk factor. However, as another player disclosed,
their reason for starting this exergame – like many other players – was the COVID-19 lockdown:
“I picked up the RingFit Adventure game a few months ago so that I could get some exercise
while I’m at home during lockdown.” As expected, Ring Fit Adventure indeed offered a solution
during a time when going to the gym and going outdoors in general are not options for keeping
physically active, leaving the home environment the venue for fitness activity. Nevertheless,
using a home environment for moderate- to intense-level physical activity raised injury concerns
according to these findings.
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This textual finding regarding the home environment increasing sport injury risks echoes
findings from the previously reported image clustering. Both cluster 2 (Figure 4.6) and cluster 3
(Figure 4.7) images revealed that players’ home environments are typically crowded with
various existing household objects, and players may easily bump into the objects in the
surrounding area while they are jogging, jumping, and moving their arms and legs. That is, the
selling point of Ring Fit Adventure for being able to support exergaming “in place”, and
thereafter promote consumers’ physical health, may require more health risk assessment,
communication, and management.
With the variety of risks, injuries, and pain resulting from the exergame, the themed
subreddit r/RingFitAdventure partly served as a digital neighborhood where players can discuss
injury experiences and injury prevention strategies associated with the game and seek advice
from fellow players. An example post, among many others, stated: “Anyone else also
experienced an injury whilst playing? Please share your wisdom.”
Counterintuitively, despite experiencing injuries and pain before, during, or after playing
Ring Fit Adventure, some users would still wish or choose to continue their fitness training with
the game as a way to establish a non-stopped, regular physical activity routine. They expressed
intentions to continue. One player, for example, asked about how to keep “using Ring Fit after
an ankle injury.” Some posts of this type seek tips on how to prevent future injuries from
happening again, but most of them appeared to be from players who hoped to adapt their
negatively impacted health situations to the exergame to continue the play.
“I’ve been running, indoor cycling, and RFAing all at the same time. Especially
during the RFA, I did an excessive amount of squats. As a result of yesterday I
started having sharp pain in my right hamstring. I want to continue doing RFA,
but I also need to rest any activities using my thighs. Is there any way to do so?
Thank you.”
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Like the above examples, players posted on the game’s subreddit to solicit suggestions
from fellow players regarding how to customize the workout sessions in the game so that they
could continue the play while dealing with the pain health conditions. In response, some Reddit
users did share tips on injury prevention with others, while sharing their personal stories of
injuries from playing Ring Fit Adventure. An example post was:
“Stop when your body hurts. About three days in, my shoulders were killing me.
Stopping for a couple of days to recover was sensible. I took a longer break than
normal at the end of last week when I got a bit of hip pain while out walking the
dog.”
Taking exercise break days, stopping whenever one feels pain or gets injured, and
avoiding excessive exercise were among the most popular advice shared within this exergame
player community. Notably, there were a small number of posts that inquired about, discussed,
and shared ideas on whether players should wear shoes or play the game barefoot. To some
people, playing this exergame barefoot caused them pain and injuries, e.g., “I did it barefoot
yesterday, and my ankles, knees, and feet really hurt.” Another player mentioned that they did
not know they were expected to wear shoes when exergaming at home until an advanced level
when the player heard from Tipp that it would be safer to wear shoes than playing barefoot.
Because of a lack of this knowledge, this player got injured.
In the same vein, another player also criticized the game for its design mechanism in
relation to injury prevention and management:
“I have some lower back pain normally and after doing a couple of sets of
Russian twists I noticed much more pain. Of course, the game says not to
overexert yourself, but I believe exercises that aren’t all that great for you
shouldn’t be included, or they should be limited. Perhaps they could be ultimate
moves or something. I’m not sure if other exercises can cause problems but let me
know what you all think!”
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This example showed that some players were able to think of the potential negative
consequences from exergaming, but they lacked the important information and only started to
think of this problem after having initially played this game and felt pain or soreness in their
body:
“While I did feel sore after the first day, I don’t feel like I’m hurting. Would using
RFA to exercise 1-2 times per day 7 days a week cause any short/long term
damage?”
Pain Reduction. In contrast to the majority of the posts in this category discussing post-
exergaming injuries and pain, there was also a group of players who reported exergaming to have
helped reduce or eliminate their chronic pain. In a post titled “loss of constant pain in my life,”
one player shared:
“This is something I brought up in the RFA discord that I didn’t think about until
there. The biggest thing RFA has changed for my lifestyle has been a near
removal of all the dull pain I would have every day since turning 27. It was just
something I never really thought about until I was asked… Back pain, gone. Leg
pain, gone. Neck pains, nonexistent. Even the tightness I had in general is just
slowly evaporating. I’m shocked. It’s just something that felt like an everyday part
of my life that I never really thought about until I intently thought about their
absence. So yeah, points for the yoga exercises for me!”
As mentioned in Table 4.2, there were two posts reporting general pain reduction as a
result of exergaming through Ring Fit Adventure, given previous chronic pain conditions such as
fibromyalgia. Players also reported experiencing reduced pain in the neck (n = 1), back (n = 2),
leg (n = 3), among other underlying health issues such as joint conditions and arthritis. Based on
the qualitative analysis of this category of posts, the game was reported by users to have
strengthened the muscles in the core, increased muscle flexibility, and led continuous players to
“feel more fit” and feel that “movement in general is easier.”
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Accessibility and Disability. Related to the above exergame outcome on pain reduction,
some players intentionally sought to use the game to manage their chronic health conditions. In a
post titled “alternative to running and squatting for the handicapped,” a player stated,
“I can’t figure out how to play without running. I know the game built in squats as
an alternative for running but I’m wondering if anyone has found a reliable
alternative to any sort of lower body activity that might work for my situation. I
know in the combat situations I can just use the attacks that are comfortable for
me and don’t hurt. That makes the combat less effective, but it can work. Open to
all ideas but please keep it constructive and non-dismissive.”
Posts of this type discussed accessibility options of the exergame in allowing users with
disabilities or physical impairments to still be able to play, tailoring the exergame experience to
their own needs. However, based on the data, this need for tailored exercises was not perfectly
attainable, and the effectiveness of the game would be sacrificed if the assistive modes are used.
One player valuably published the following post when expressing their criticism of Ring Fit
Adventure’ lack of accessibility:
“Without trying to break rules here, typically the places these games come from
do not have disabled people where they live, so naturally they’re not accessible.
The localization also failed to address it. Thus, the game is untested and
extremely unpleasant to play.”
Some of these criticisms came in the form of complaints after experiencing injuries or
pain from playing this exergame:
“It’s almost like nobody tested this game either. I remember the squats and chair
poses in the courses, they almost killed my legs, I was getting constant swollen
tendons after every one of those, making it really painful and then uncomfortable
to play.”
As mentioned above, a substantial number of players in this community had chronic
health conditions prior to playing and playing the exergame only helped a small number of
players in pain reduction. Whereas for more players, exergaming worsened their pre-existing
injuries or pain. Ring Fit Adventure’s user-perceived accessibility was overall limited despite its
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several assistive modes. The volume of posts discussing accessibility was also notably smaller
than posts discussing weight loss.
Exergame Effects on Weight Management
Through qualitative analysis of the posts mentioning weight management, it was found
that Ring Fit Adventure exergaming had a widespread effect of weight loss. These self-reported
effects on weight were mostly accompanied with an exact amount of weight lost after playing in
the post (n = 126), in contrast to post reporting not losing weight or even gaining weight (n =
13), and in a worst scenario losing weight to an unhealthy extent while also struggling with an
implicit food disorder (n = 1).
Relevant to the context of the investigation, several players mentioned COVID-19 as a
reason for starting Ring Fit Adventure. Some referred to COVID-19 as a factor contributing to
their weight gain, some referred to COVID-19 recovery as a motivational goal for using the
exergame, while others shared how their contraction of COVID-19 got in the way of their
exergaming routine and that they wanted to get back to the routine. Two example posts are:
“Last year I gained around 10 kg. I lost the love for my own body. In November I
got corona and was very ill and after that I was very tired for a long time. Now
2 months later I can finally start working out again. I’ve never been so
determined to lose weight and feel good about myself again. I’m 3 weeks in now,
and I’ve lost 2kg already. So happy! Getting stronger by the week. Let’s do this
together :)!”
“Got COVID and regained the weight lost from playing RFA. Now I’m getting to
restart the game.”
While COVID-19 presented an acute environmental factor, which contributed to the
adoption of in-door exergaming, the population where most of these effects on weight loss were
observed were especially among players with a larger pre-exergaming weight or who self-
reported to be obese or overweight. Going to the gym was not considered as ideal option for
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them irrespective to the pandemic situation, due to peer pressure. Yet, the pandemic and the
release of the game appeared to have offered this population a reason to get started on
exergaming at a place they feel comfortable.
“I have never been someone who wanted to go to the gym, never felt confident
enough and I’d never want to be feeling pressure from others (real or perceived) -
so using something like RF helps me because I can take my own time, in my own
way and get where I want to go. Especially with lockdowns, this has been
invaluable.”
Gamification was also specifically mentioned as a solution to lack of motivation due to
ease of getting bored from regular non-gamified physical activity:
“I’m a little overweight and wouldn’t mind losing it to be completely honest but I
need to exercise more for my physical and mental well-being. I end up bored with
lots of exercise and drop it but thought maybe a game might motivate me to do
more. It did! As well as make me not feel bad for not being in shape/not able to
work out for long periods of time. The fact that the game encourages you to take
breaks after not long makes me not feel guilty for stopping.”
Table 4.3 shows example posts from this subreddit, which reported exergaming’s effect
on weight loss. Note that some outcomes are not solely results of exergaming, but a combination
of exergaming and healthier diet. Furthermore, the reporting of the effects were usually
accompanied by specifying the frequency, duration, and intensity of the exergame play.
Among the 13 posts that reported not seeing weight loss, some referenced to the ongoing
discussion in the subreddit about other players reporting weight loss:
“I’ve been looking into the game and been seeing people say they lost weight.
However, I can’t lose much. I’m 5’2’’, 110 lbs. I used to be about 105 lbs. and
was getting lower because I struggled to eat constantly. Do people lose a lot of
weight with this game? How can I avoid losing too much weight if I get into the
habit of playing this game?”
This example quote indicated the role of the subreddit for players to discuss the effects of
exergaming, align their expectation with the technology’s affordances, and request informational
support from peers.
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Table 4.3. Posts from r/RingFitAdventure reporting the exergame’s effect on weight loss
Example Posts from a Total Set of 126 Posts
1 “I lost 10 pounds in a month of Ring Fit.”
2 “I lost 5lbs in 2 weeks by fasting and playing Ring Fit Adventure. And I plan to keep going!”
3 “Honestly, one of the best purchases I’ve ever made! I have lost 14 kg (31 lbs.) so far since my son was
born, and I’ve still got some to lose, but this would have never been so swift if it wasn’t for the game.
I’m so pumped! ”
4 “Lost 5 pounds! I’ve played the ring fit 4 times so far since I got it on 12/1. 3 levels in and I recently
switched to doing sets/mini games when my knees hurt. I’ve also been counting my calories and
keeping in deficit. I’m 25, 5’7’’, 275 now. It definitely can help with weight loss for those who have
been wondering.”
5 “Daily RingFit + better food habits is a great combo. 6kg / 13lb lost in 8 weeks.”
6 “I’m 6 feet 7 and 335 lbs right now. Have lost about 20 lbs doing RFA and eating better in the past two
months.”
7 “Lost 10 lbs after 28 active days! (Starting weight 130 lbs, f, 33) never been physically active
consistently in my life but Ring Fit changed it! I usually do 30-60 mins (exercise time), which takes me
1-2 hours actual time. I usually do 2 workout days + 1 rest day, but paused for 14 days in early July and
5 days last week. I feel long breaks are necessary to prevent burnout (or when you already feel burned
out!) My body fat has gone down to 18.9% from 21.4%. I’ve never felt healthier and stronger in my
life! Hopefully I will continue the routine. This community has motivated me a lot, so I’m very
thankful! Hope everyone reaches their goal and has fun with the Ring!”
For those who did not see a significant weight loss, positive results were reported in
relation to general physical activity patterns and movement performance as well. For example,
“I’ve not exactly lost weight with it yet but definitely gained fitness.” Another player made three
posts during the sample period, including the first day of play, and after one week and one month
of playing this game. Here is one of their posts:
“Before ringfit I had 0 exercise in my life and decided I was tired of always being
exhausted and in the worst shape of my life. My goal was to use it 5 days a week.
Today was my 23rd day. As of the end of today my total workout time is 8 hrs and
15 minutes with over 20 miles run. For my first workout I couldn’t even finish 15
minutes of in-game time, so I downgraded to level 10. Currently I’m at difficulty
level 16 and a minimum of 20 minutes in game workout time and even have some
days where I get up to 30-35 minutes. I don’t know how some of you guys get over
an hour in game time, that’s legit insane. Today I hit level 85 and finished world
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10. I am losing a little bit of steam motivation wise, so I guess the reason I’m
making this post is to show myself how far I’ve come, allowing myself to show a
bit of pride in what I’ve accomplished. If you told me a month ago that I would
have chosen to work out for over 8 hours in a month I would have called you
crazy. I’m really proud of myself and I hope I can keep it up!”
Furthermore, weight is not the only measure for body fat reduction. Some players
reported changes in body shape, which corresponds to the image clustering results. The
additional effect outcomes included chest and waist measurements:
“Been exercising for 15 days with RFA. Although my weight is still about 62 kg,
I’ve lost 7 cm around my chest and waist and 3,5 cm around my hips! Just wanted
to share my progress with this fun game :D”; “Achieved 24 hours of exercise time
today on my 36th day playing. I’ve lost 3 inches off my waist. Love ring fit.”
Importantly, losing weight is by no means always a positive health outcome, as it can
also be an indicator or symptom of eating disorders or underlying mental health issues. Although
being the only one of its kind in this dataset, one post mentioned that the author’s weight had
dropped to an unhealthy extent after exergaming, partly also due to her eating disorder.
“When I first started with RFA I had a worse relationship with food then what I
have at the moment. I had lost weight to an unhealthy extent and had some
rigidity with food and tracking that I’m working on and ironing out to be a
healthier me.”
The relationship of exergames to other health communication domains such as body
positivity and eating disorders was implied in this data.
Lastly, not losing weight could also be stressful for a segment of consumers who bought
this exergame with an anticipated outcome of weight loss: “I am still proud of the fact that I’ve
exercised for the first time in my life - especially after 8 weeks on the couch doing nothing, but
I’m upset that I haven’t lost any weight.” This type of posts hinted at the interconnectedness of
physical and mental health, which granted a need for evaluating the exergame’s effect beyond
weight management.
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Exergame Effects on Mental Health, Sleep, and Substance Use
Despite no effect on weight management for some users, sleep quality was reported to
have improved after months of exergaming, along with feeling more energized: “Not saying all
of my health issues are fixed, I haven’t lost much weight and I’m still not in great shape.
However, I am sleeping better and feeling more energized overall.”
Physical activity, as mentioned in the literature review section, tends to naturally generate
positive changes to mental health, and thus often times exergames’ effects on consumers’ mental
and physical health are highly intertwined. One player posted: “It seems that 90 days of RFA has
completely changed how I live, how I eat, and how I feel.” Among all the posts that reported
actual effects of the game, many referenced words and phrases (e.g., 90 days, 8 weeks, consistent
exercise) that conceptualize an extended period of time of engagement with the exergame. Such
wording indicated that the game was effective in sustaining engagement, motivation, and
extended use beyond the initial adoption of the exergame among a subgroup of users.
The game’s effect on players’ mental well-being appeared to also be attributable to a
need for autonomy and uncertainty reduction. Due to the pandemic, a lot of things are beyond
individuals’ control. Ring Fit Adventure was reported to have fulfilled the need of certain users
to feel a sense of achievement and control:
“So, for the past year I’ve been unable to play at all and have been putting on
significant weight. I really need to start turning myself around and try to gain
control of something in my life and I want to use this game to help with that. I’ve
never been much about exercise for the sake of exercise, but this game does give a
fun twist to it that I enjoyed so I think the gamification could help incentivize the
process.”
The above quote directly pointed out the gamification design as the source of
entertainment, enjoyment, incentive, and ease of play. Similarly, positive feelings and self-
esteem can follow a successful exergame session:
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“Yesterday I went jogging a bit which I haven’t done for 4 years, I was surprised
how well it went. I felt like I could immediately jog for as long as I want, it is
something that was never so easy for me to do.”
Some players were more disclosive of the mental health issues (e.g., depression, anxiety)
that they had been grappling with, and mentioned that the symptoms exacerbated during the
pandemic lockdowns. But they reported positive effects of exergaming on their mental health:
“All this is to say that life isn’t easy, so Ring Fit has been vital in keeping
depression at bay and making and keeping my body fit and healthy. Consistent
exercise really helped turn my life around when I was struggling with depression.
Thanks to Nintendo for creating it, and all the wonderful community that has
arisen around it.”
One personal narrative was especially memorable in this dataset, where a player talked
about losing a friend to suicide during the pandemic, and it was that friend who gifted them this
exergame.
“Today my wife and I lost a friend. He had bought this game to try to lose some
weight and have fun doing it. (he was about 6 foot and under 300 lbs) the game
was more than a workout for him. He gave my wife the game since he thought she
might enjoy it, and we have loved playing the game. He struggled with multiple
health issues as well as a family history of depression. This week would have been
his 52nd birthday, and unfortunately instead of reaching out to any of us he took
his own life. Today 9/6/2021 we got a call with the devastating news. We started
cleaning, not knowing what to do, and I picked up the leg strap and pointed out ‘I
thought there was a Velcro patch on this somewhere’, she welled up and said
‘that was from Jim’.... this game will always mean so much more to us now, to
anyone who feels alone, remember you’re not. If you struggle with depression,
reach out to your friends. We can’t help if we don’t know… If you know your
friends struggle, check on them... If you’re reading this, thank you. I appreciate
your time.”
This quote was in line with the findings from the Animal Crossing study, where players’
gameplay experience was closely tied to their real-world friendship and intimate relationships,
and game play helped them cope with loss and grief amidst the pandemic. Partly, the subreddit
gamer communities also served as a computer-mediated digital space where participants can
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openly share their emotional needs and seek for emotional support. As one player posted, “Hi!
I’m so happy that I found this group. I’m getting really motivated by reading all your stories!”
However, the game is not always about positive competition for motivation or a positive
vibe:
“I play on difficulty level 4. I just found myself scrolling obsessively to see what
difficulty everyone else plays at. I suppose the goal was to shame myself into
increasing the difficulty for my own game. I am only doing level 4 which is
somehow higher than what I started at. Which is bananas since I just finished
playing and my entire body is shaking. But I think the beauty of this game is how
you can really make it your own. I have gone from Zero Exercise, to actually
enjoying exercise! ”
The above post revealed a phenomenon similar to one found in the Animal Crossing
dataset, where players were compelled to compare themselves with other friends on their in-
game performances. As a result, social comparison can trigger shame and anxiety in the players.
Other negative mental health effects that were common included shame and stigma
related to fitness and physical activity: “Has anyone else got this game who is REALLY unfit?
Guys I played the game for the first time yesterday, and I didn’t know I was THIS unfit. It
surprised me and actually upset me quite a bit.”
Another player reminded others that relapse and giving up after initial play of the game
was dangerous both physically and mentally:
“Life happened, and I ended up quitting the game for about a month because I
lost the will to keep going due to me relapsing on my diet. Not only have I gained
5 pounds back, my stamina has hit an all-time low. So, for anyone thinking about
giving up I am telling you it’s not worth the regression you will feel both
physically and mentally. Keep at it. Please take my mistake as a lesson and
motivation to keep going. Good luck to everyone trying their hardest.”
As the above quote indicated, the players’ stamina could be negatively impacted by
exergaming relapse. Stamina, the strength that enables a person to do something difficult for a
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long period of time, comprises both physical and mental dimensions, and can be closely related
to motivation, habituation, self-esteem, and the sense of autonomy.
Co-occurrence with Quitting Substance Use and Lifestyle Change. Using keywords
related to substance use, the whole dataset was also filtered to identify posts that discussed
substance use (n = 22) along with the exergame experience. Keywords such as “smok”, “cigar”,
and “alcohol” were used (see Table 4.1 in the Methods section). In their journey of quitting
substance use, some players mentioned the supportive role of Ring Fit Adventure. An example
from a past smoker was:
“Hey, so yesterday I celebrated 6 months without tobacco. It is the longest break I
have from this awful habit in 15 years. I stopped smoking as I couldn’t find time
for it since I didn’t want to smoke before RFA, and I didn’t want to go out after
RFA (as I was sweaty and didn’t want to go outside).”
Another example post that mentioned an intention to fight against depression and alcohol
use while playing this exergame stated:
“Hey all, I’m on day 8 of getting my health back. Life depression and alcohol use
brought my weight up to 352 pounds. But I’m not gonna give up, I’m gonna get
my health back, I’m going to claw my life back anyway I can. Wish me luck! PS
I’m level 22 and exercising at difficulty level 27.”
In summary, fundamental to this persuasive exergame, it was a positive change toward a
healthy lifestyle that players were expecting from continuous exergaming, and some players did
report such a possibility,
“I am not ultra into the game - just doing it for 20 min active time 5-6 times a
week, but the changes in lifestyle are enormous. I have also decided to spend an
extra couple of minutes daily on more detailed hygiene as being sweaty in the
evening is a good incentive to do bath and teeth cleaning correctly.”
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Study Two Discussion
This second study evaluated the effects of an exergame, Ring Fit Adventure, on
consumers’ physical and mental health. With a social media dataset covering three years
(October 18, 2019 to October 18, 2022), it leveraged unstructured data from UGC to reveal the
broad range of UX and users’ affective responses, along with consumers’ self-reported
behavioral outcomes resulting from the exergame. This section discusses the implications of
findings.
On a sentiment and affective level, findings about high levels of anticipation in this
sample suggest that consumers predominantly expected this game to be able to increase their
interest. Anticipation is central to the acceptance and diffusion of everyday automation and
emerging technologies (Pink et al., 2022). Characterized by sentiments such as hope (Pink et al.,
2018), anticipation in an exergame context can mean that consumers were looking forward to
adopting and playing the game to fulfill a goal. The timeline of the posting activity also showed
that the two posting peaks respectively followed the release of the game (October 2019) and the
holiday season of 2020 (January 2021). Given that Ring Fit Adventure was occasionally
mentioned to be a gift from a friend or family member in this dataset, this finding triangulated
the sentiment and emotion analysis results, suggesting that consumers were actively rather than
passively anticipating the game, gameplay, and the effects from playing. As several example
quotations reported in the Results section mentioned, consumers who had recently acquired the
game would make posts in the subreddit, sharing with fellow exergame players that they were
planning to exergame for physical activity amidst the pandemic. In this sense, the anticipation
toward Ring Fit Adventure pertains to a perceived affordance of this exergame, i.e., its properties
that support physical activity in a home environment. While anticipating the release of a new
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game and anticipating enjoyment from it are both common phenomena in gamer communities
for typical games, anticipating specific media effects of gameplay like what was observed with
Ring Fit Adventure is uncommon among players. This finding highlighted the unique
anticipation and expectations that consumers have about emerging exergames, and it granted the
need for this study which evaluated Ring Fit Adventure to determine if outcomes of exergaming
indeed aligned with consumer anticipations.
The evaluation results especially suggest a close connection and unique position of this
exergame to a COVID-19 context. Sentiment and emotion analysis showed that consumers
mostly enjoyed and liked this game, with a high level of positive sentiment, joy, and trust in this
three-year corpus. Findings from the qualitative analysis also suggested that exergaming was
used as a coping mechanism for some players in the face of depression, anxiety, sleep issues, and
general hardship of life that were exacerbated by the pandemic situations. While physical activity
in general leads to better mental health (Anderson & Shivakumar, 2013), it takes regular
physical activity of enough intensity levels to initiate positive physical and mental health change.
Thus, it was implied by these qualitative findings that this exergame, for its gamification
principle, was effective in engaging users over time. With gamification, exergaming not only
supports mood regulation and game enjoyment among children as previous research found (Ho
et al., 2017), but also effectively engages and impacts adult players as demonstrated by this
study. That is, games and gamification can be effective for not only young children, but adults as
well.
Moreover, a direct process of exergaming and an indirect process of socialization with
other players on Reddit fulfilled consumers’ need for both autonomy and agency, as they were
hoping to “gain back control” over their own life. Fan arts found in the image clustering, for
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example, functioned as a form of self-expression and agency for gamers by engaging and sharing
creation and re-creation of contents related to the game’s features and its culture in a connected
community, which was consistent with findings from previous literature on other games (Schott
& Burn, 2007). From a game culture perspective, the sensor device ring photographed in cluster
3 images may be a symbolic representation of this particular exergame and its gameplay
experience. The image clustering results provided an illustrative view of the different social
affordances enabled by this exergame, which reflected both what gamers found to be socially
meaningful within the game and how the visual dimension of the Reddit community is
constructed around mediated social interactions between players.
In image cluster 4, for instance, the fact that players captured scenes of those types and
shared them in the online gamer community indicated that they found meanings in the scenes,
i.e., the game plot afforded by the adventure mode of Ring Fit Adventure. This is one of the three
game modes, and it incorporates a narrative strategy, corroborating previous literature on the
effectiveness of narrative persuasion in communication (de Graaf et al., 2012). In addition,
players’ focus on the defeating-Dragaux “mission” also revealed several game affordances that
users attributed more salience to: goal-setting, competition, social support, social interactions
with NPC virtual agents (either allies or antagonist), and the senses of immersion and presence
enabled by the player’s self-avatar, which is synched in movement because of the sensor devices.
These findings helped understand the empirical application of gamification and HCI elements
and how users responded to them.
In addition to the exergame’s mental health effects found in this study, behavioral
outcomes related to physical activity patterns, weight loss, and general fitness were identified to
be prevalent in this dataset. Specifically, some players noted that the gamification nature of Ring
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Fit Adventure was exactly what initiated their physical activity routine and what changed their
relationship with physical activity. Yet, weight loss is an imperfect measure for health benefits of
exergames, as online communities could have detrimental effects on participants if it celebrates
or over-glorifies weight loss as an achievement, especially for persons battling with eating
disorders (Feldhege et al. 2021).
Along with a positive effect on weight management among players who wish to lose
weight by exergaming, the findings about the co-mentioning of substance use reduction and
health lifestyle change showed future research directions of examining lifestyle intervention
holistically instead of each health behavior individually.
With the widespread effect of this game on weight loss being observed in this online
gamer community, players who expected to lose weight but did not succeed reported suffering
from peer pressure, distress, confusion, and loss of motivation. This finding added to the divided
literature on the role Reddit and subreddit play in impacting participant well-being (Maloney et
al., 2019; Mann & Carter, 2021; Massanari, 2017). On the one hand, multiple quotes referenced
in the Results section thanked r/RingFitAdventure for offering a community and motivation for
them to engage in physical activity as they long wished. On the other hand, a small yet non-
negligible number of participants in this online group also criticized the game for its several
negative effects on physical and mental health and moreover, its lack of accessibility.
While previous evaluation studies of Ring Fit Adventure concluded from human-subject
experiments that the game was safe, feasible, and helpful in pain reduction (Sato et al., 2021;
Takei et al., 2022), this study found more complex behavioral outcomes. Admittedly, a small
number of the posts in this study suggested that exergaming helped relieve or eliminate chronic
pain. Nevertheless, substantively more players reported injuries and pain during or after playing.
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This study began to fill the gap in current exergame evaluation for initial longitudinal
assessments, since the UGC this study relied on were mostly results of extended gameplay, and
this study included more players than any of the previous studies about Ring Fit Adventure.
Findings of this study challenged Takei et al.’s (2022) feasibility and safety study, which focused
on short-term lab testing. However, the suggestion from Takei et al.’s paper (2022) that
supervision should be recommended for exergaming among older adults is consistent with the
implications of the present study.
Besides the methodological implications of this study on UX evaluation, the study also
suggests that it is imperative for future exergame research and discussions to center more around
physical literacy and proper risk communication throughout the exergaming adoption, use, and
engagement phases. In previous research, interactive exergames were found to be able to support
the development of physical health literacy (Sheehan & Katz, 2010). However, findings of the
current study suggest that despite the educational and tracking functions of Ring Fit Adventure
that considered risk prevention and risk reduction, players still frequently experienced injuries
from exergaming. In fact, many players would have to seek informational support from other
players in the subreddit gamer community regarding injury prevention and adaptation. The level
of physical health literacy was also not observed to be benefiting from the exergame per se, but
likely more from the peer network afforded by the themed subreddit.
One concerning finding along this line of physical health literacy and sports injuries was
that some players would wish or choose to continue playing Ring Fit Adventure despite already
being injured or feeling pain after exergaming. While there was not enough evidence to
conceptualize this phenomenon as “exergame addition,” there needs to be more future research
explaining the motivation behind this segment of players.
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In addition, the posting frequency timeline demonstrated more active posting activity
during the early phase of the pandemic, which suggests more adoption and engagement of the
exergame during the lockdowns and stay-at-home orders. However, the fact that posting activity
had been gradually reduced since late 2021, two years after the release of the game, and stayed
consistently low afterwards suggests that much of the buzz in Ring Fit Adventure-related online
discussions as well as purchasing behaviors may be driven by novelty. Novelty is fundamental to
innovation, since emerging technology appeals to adopters by its newness (Wells et al., 2010).
As previous research found, the novelty effect significantly predicts the adoption of new
technologies (Shin et al., 2019; Wells et al., 2010). Increasingly researchers in the digital health
domain have recognized the importance of studying sustained use beyond the novelty period of
health technology adoption (Shin et al., 2019). While this study did investigate a multi-year
dataset, it lacked longitudinal tracking on an individual level, which could be explored in a future
extension of this work.
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CHAPTER 5: GENERAL DISCUSSIONS AND CONCLUSIONS
Implications
This dissertation project set out to examine computer-mediated communication (CMC)
and human-computer interaction (HCI) phenomena holistically in the context of persuasive video
games for health. For both video games studied in this dissertation, the in-game communities and
social media gamer communities augment each other to foster information and emotional support
among players. Drawing upon theoretical constructs in CMC and HCI to guide the investigation,
this dissertation provided empirical evidence to enrich our understanding of whether, how, and
what elements of gamification in persuasive health technologies would impact consumers’
physical, mental, and social well-being. In this investigation, UX information embedded in UGC
was a central construct of interest. The goal of this dissertation was to inform the methods,
theory, and practices in emerging persuasive technologies to optimize digital health
interventions.
Methodologically, this dissertation project validated the feasibility and benefits of a novel
computational mixed method approach for the evaluation of gamification for health involving
virtual agents, avatars, and haptics. It brings about several interesting questions for future
usability testing design: Should usability be measured upon the initial interaction at all; if so,
under what conditions? How much time should we allow the users to familiarize themselves or
feel comfortable with the technology before we consider calling certain features difficult or
inadequate? What would be the topic-specific factors in user background that we must control
for beyond the presumably relevant factors such as age, game experience, and capability related
to emerging technology use? In addition to these questions, a proper usability evaluation must
cover the different phases of user-technology interaction (Whitlock et al., 2011). Most
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importantly, all UX evaluation methods have their advantages and disadvantages; defining the
evaluation objectives, scenarios, and tasks is the first step to choosing the optimal methods.
The theoretical implication of this study is that CMC has been evolving to increasingly
interplay with HCI in profound ways. In both studies, players reported to have engaged in
multiple forms of HCI as well as CMC, and it was the combined form of UX that led to the
outcomes that this dissertation observed. Notably, a comparative review of the two studies’
findings would suggest that the virtual animal agent NPCs and the other players virtual avatars in
ACNH may be of higher levels of agency and affective value to players than the ECAs in Ring
Fit Adventure. Findings supported this speculation, since more UGC mentioned meaningful
social interactions with the virtual agents in the ACNH corpus than in the Ring Fit Adventure
corpus. In the health domain, bridging the two fields of HCI and CMC may serve a novel lens to
evaluate and improve UX associated with emerging health applications in a systematic way,
hence helping to achieve the desired health outcomes more successfully.
One of the other major contributions of this dissertation project was to test empirically
my argument earlier on that an immersive virtual experience does not require the physical world
to be removed. Rather, the transportation can be made through meaningful mediated social
interactions between the players and the in-game ECAs, as well as the synchrony supported by
the projection of virtual agents and the feedback system enabled by sensors and haptic devices. A
virtual reality headset transports the user to an artificial world by relocating the coordinates of
the user’s physical location to align with the coordinates of the virtual world. In comparison,
interactive video games like ACNH and Ring Fit Adventure project the user to the virtual
environment by leveraging the users’ avatar as the interface to connect the two worlds. That is, to
create an immersive virtual environment experience, a virtual reality headset can be helpful but
109
may not be necessary. In addition to haptic and tactile devices, the most essential element may be
the social, relational bonding between humans and virtual agents.
To date, the concept of mobile health technologies (mHealth) is mostly confined to the
domain of mobile applications (apps). However, this dissertation project sheds light to an
emerging type of handheld mobile game console, which can afford persuasive video games to
impact consumer health in everyday life. Contributions of this dissertation work to existing
literature in gamification for health included the following:
1. Persuasive video games have the potential to bring positive effects to consumer
health, but their unintended negative consequences should be better understood
before they adversely impact a widespread consumer group.
2. For health-oriented emerging technologies, trust and anticipation tend to pertain to
their adoption and initial use. Nevertheless, manufacturers may not have sufficiently
conducted the research needed to assess risks involved in gameplay prior to release of
the games and consumers’ actual usage in the field, resulting in a lack of proper risk
communication to consumers and increased risks and negative consequences
regarding consumer health.
3. Pandemic-related physical restriction, social isolation, loss and grief indeed
exacerbated the pre-existing health conditions for many people. Social gaming
provided a coping mechanism.
4. Adoption is heavily driven by a novelty effect; however, gamification may increase
intrinsic motivation and make it more likely for players to stay engaged with a
persuasive technology for a longer period and achieve behavioral changes.
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5. From an equity perspective, if we use digital gaming to address isolation and mental
and physical health in the post-pandemic future, we must structurally tackle digital
divide and technoableism, as they may further marginalize certain communities.
There were multiple instances where injuries happened from knocking into furniture in
the surrounding area while exergaming. The extent to which a player can have access to a large
TV/computer screen, and a spacious living room to play home-based video games such as Ring
Fit Adventure would be highly related to the player’s socioeconomic status. This raises the
question of equity and divide, which are inherent to home-based interactive technologies and
other emerging technologies. Although one of the most appealing features of these games is
perhaps that players can engage with social and physical activities at home, a typical home
environment is usually not built specifically for fitness training. As a result, consideration of
sports safety can be easily neglected from the environmental aspect.
Once a persuasive health technology is released to the market, there come important yet
obscure questions including who is responsible for risks associated with using the technology,
which party is responsible for communicating the risks, how do consumers navigate risk
assessment, risk prevention, and risk management, and when negative consequences do happen,
if consumers would continue the use or quit using the technology.
Few older adults were observed in the datasets of this dissertation project, but the older
adults should not be excluded from the innovations in modern information and communication
technologies. It is the duty of technologists, designers and researchers to provide innovative and
responsible research on the development of technology that includes older adults (Wilkowska et
al., 2018). According to the United Nations (2019), 1 in 11 people in the world was over the age
of 65 as of 2019; population aging will further bring the trend up to 1 in 6 people by 2050. The
111
development of health applications that are accessible to older adults, therefore, may be
fundamentally pertinent to them in their health self-management. Usability and UX are not only
about the later-staged technology use but also the early-staged technology adoption (Goodwin,
1987). Identifying barriers to adoption would be an important step toward more equitable access.
Limitations and Future Research
This dissertation about technology evaluation is framed around pandemic experience.
Given that there is no pre-pandemic data to compare with the pandemic data, the extent to which
the observed effects of the games are specific to the pandemic context may be limited – despite
players’ self-reported situational motivation behind game UX, which is sometimes directly
motivated – explicitly from their perspective – by the pandemic or perceived to have effects on
players’ coping practices and multi-faceted well-being during the pandemic. Future research may
explore ways in which we could control for variables (e.g., geographic locations corresponding
to the gradual lockdowns, and individual differences) to better parse out and argue for a
pandemic effect.
Despite the value of longitudinal UGC data as mentioned in previous chapters, this
dissertation is limited in the diversity of data sources, and it was only possible to infer offline
behaviors from self-reported behaviors in online data. Future extensions of this work will include
the integration of longitudinal behavioral surveys into the existing research pipeline. Relatedly,
in the long term, how would exergaming influence social and physical activity behavior outside
of the games once a player stopped engaging with the two games? It remains unclear for how
long in-game behavior change can be sustained, and how it translates to real-world behaviors and
the overall goal of a healthy lifestyle. Alternatively, experiments could be conducted to test
causal models and identify moderators of gamification’s effects on consumer health. In addition,
112
the influence of social media platforms (algorithms and moderators) on the nature and features of
the sample data is hidden in a black box, which is an inherent limitation of using social media
UGC data despite its large sample size. For example, certain posts were removed by the
algorithms and ranked of lower salience by platform moderators. Future research following this
work will need to make efforts to feature voice of those who were under-represented or not
included in this work.
Conclusions
During the pandemic, social interactions and physical activity significantly decreased,
causing severe challenges to the mental, social, and physical well-being of many people (Brooks
et al., 2020; Marroquín et al., 2020; Viana & de Lira, 2020; Zachary et al., 2020). Playing the
social simulation game of ACNH provided a coping mechanism to some people, and the results
were mostly positive except for occasional anxiety induced in players due to social comparison
on game performances. Players perceived simulated social interaction with avatars and virtual
agents to be meaningful.
To motivate oneself to be physically active during pandemic lockdowns given the
resulting physical constraints, the exergame of Ring Fit Adventure with virtual fitness trainers
was capable of supporting many but not all users to achieve desired health outcomes, both
physically and mentally. Exergame players found meanings in some of the game’s features such
as levels and points, biometric data tracking, the narrative game plot, and the social interactions
with ECAs in the virtual game environments, when the users are physically located at home.
However, physical health risks, sports injuries and negative mental health effects, while less
common, were also reported by consumers.
113
In conclusion, the effects of persuasive video games on consumers’ mental, social, and
physical well-being were primarily positive but can be negative at certain times. The affordances
of gamification are situational and involve a variety of UX and consumer outcomes.
114
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APPENDICES
Appendix A: Coding Scheme for the UX Classification of Reddit Posts
1. Heart-warming screenshots from the game
a. arranging in-game characters or decoration items to express a meaning that may correspond to the real world
b. player interacting with other players within the game
c. (player interacting with) animal villagers, i.e. virtual animals
d. (player interacting with) a game feature, or doing activities , e.g. catching insects, fishing
2. Heart-warming videos screen-recorded from the game
a. arranging in-game characters or decoration items to express a meaning that corresponds to the real world
b. player interacting with other players within the game
c. (player interacting with) animal villagers, i.e. virtual animals
d. (player interacting with) a game feature, or doing activities , e.g. catching insects, fishing
3. Hilarious screenshots from the game
a. use of in-game characters or decoration items to express a meaning that may correspond to the real world.
This includes having in-game characters (player and virtual animals) pose after real-world scenes, e.g. “the
last supper”
b. player interacting with other players within the game
c. (player interacting with) animal villagers, i.e. virtual animals
d. (player) doing activities , e.g. catching insects, fishing
4. Hilarious videos screen-recorded from the game
a. use of in-game characters or decoration items to express a meaning that may correspond to the real world,
e.g. having in-game characters (player and virtual animals) pose after real-world scenes, or original ideas
b. player interacting with other players within the game
c. (player interacting with) animal villagers, i.e. virtual animals
d. (player) doing activities , e.g. catching insects, fishing
5. Showcasing screenshots from the game (“showing off”/expressing pride, happiness)
a. island landscape, outdoor decoration
b. villagers and in-game characters
c. house/ interior design
d. in-game DIY crafts/fabrics/paintings
e. (player) doing activities , e.g. catching insects, fishing
6. Showcasing video screen-recorded from the game (“showing off”/expressing pride, happiness)
a. island landscape, outdoor decoration
b. villagers and in-game characters
c. house/ interior design
d. in-game DIY crafts/fabrics/paintings
e. (player) doing activities , e.g. catching insects, fishing
7. Communicating with fellow players about the gameplay
a. informing game features, offering tips, offering giveaways, offering encouragement
b. sharing unsatisfying UX: flagging system bugs; suggesting possible improvement for game design [but still
appear to me as in a cheerful tone – could mention.]
c. fun facts about the game (e.g. characters’ backstories, the game’s theme music)
d. seeking for help, making a request
8. Fan art (outside of the game console), all picture types
a. Fine art, including paintings and animation
b. Meme, quirky comics
c. photos (not screenshots from the game) featuring the game and/or the game console in real life
d. others (e.g. creating an app for ACNH)
133
Appendix B: Table A1. Themes and Example Tweets of the 20 LDA Topics
†
Topical Theme Example Tweet(s)
Topic #14
Retweeting to get free giveaways of AC “Since everyone is on #lockdown because of #COVID19,
I want to spread some positivity and surprise some
people! I am giving five people that retweets this a free
#AnimalCrossing Nintendo”
Topic #5 Joke about letting Nintendo release Animal
Crossing early forcing people to stay inside
and containing the coronavirus
“Nintendo, do the right thing and release Animal
Crossing today forcing people to stay inside and
containing the coronavirus.”
Topic #2 Porn content wave-riding popular
vocabularies, including “Animal Crossing,”
“Coronavirus,” and many others such as K-
pop, to amplify their visibility – not
semantically meaningful
“fancam bts 18 animal crossing quarantine nintendo
switch giveaway porn follow trick horny netflix anime
sub nsfw sex jikook kpop d*ck nudes gain mutuals rt like
gc promo sugar bg daddy baby leaked reveal kink cock
covid19 tiktok twitter jenlisa blackpink http://*”
Topic #17 News: Animal Crossing Nintendo Switch
Suffers Production Delays in Japan Due to
Coronavirus
“The Animal Crossing themed Nintendo Switch has
suffered a production delay due to the Coronavirus.
https://*”
Topic #9 People organizing ceremonies and
celebrations (e.g. graduation, holidays) on
their AC island to virtually interact with
other players and share love during the
COVID pandemic
“What a lovely example [graduation ceremony] of how
Animal Crossing is being used during the Covid
pandemic.”
“I’m gonna host a Canada Day celebration tomorrow on
my island Ott City Who wants to come Prizes shopping.”
Topic #10 Mediated communication in a virtual world:
Popular ACNH brought people together
during lockdown
“Feature How Animal Crossing New Horizons Brought
Me Closer To My Dad During Lockdown…”
Topic #15 Giveaways for spreading positivity as all are
dealing with coronavirus
“Because we are all dealing with the #coronavirus, I
thought I’d spread some positivity! I’m giving 1 lucky
follower a Nintendo Switch with #AnimalCrossing must
retweet, follow me @* and turn my notification on!
Good Luck To Everyone! #StayAtHomeAndStaySafe”
Topic #13
Following social distancing rules, people got
together in Animal Crossing for activities,
e.g. dating, protesting
“Since me and drake can’t see each other cus of social
distancing we went on an animal crossing date ♥”
Topic #4 Various references (e.g. birthday parties) to
Animal Crossing usually accompanied by
images and may be difficult to understand
with texts alone
“Spending my birthday in lockdown and Pheobe
throwing me a party is so wholesome #AnimalCrossing
#ACNH #NintendoSwitch [video]”
Topic #6 Twitter users posting about the COVID
pandemic in relation to ACNH
“ Lol me writing a letter to my future self in animal
crossing asking if I survived the pandemic I really
had high hope.”
Topic #7 Twitter users posting about ACNH in relation
to the COVID pandemic
“A little island tour 90 hours in thanks to
lockdown.”
134
Topic #3 Resentment of COVID-impacted life, in
contrast to the upside of having Animal
Crossing during the pandemic
“The newest Animal Crossing dropped just as the
global coronavirus pandemic made real life a lot less
palatable than fake life…”
“The fact that I see more people talking about
animal crossing than coronavirus in my timeline
since the game released makes extremely happy and
joyful.”
Topic #8 Sharing fun moments related to ACNH “once again for my people, here’s my freestyle about
playing Animal Crossing because you can’t leave the
house over the KK Slider ‘Cruisin’
1
beat. http://*”
Topic #12 Fan art advocating charity causes to help
people affected by COVID
“Here are the dishes I pixeled for Helping Horizons,
a charity cookbook inspired by #AnimalCrossing!
The proceeds go to good causes: Campaign Zero, to
advocate for ethical policing; Direct Relief, to help
those afflicted by COVID-19. Get it now at @*!
#pixelart”
Topic #0 Staying home during quarantine and playing
Animal Crossing
“What are foxes and butterflies doing in this stay at
home period? Personally, I’ve been playing animal
crossing at home and learning new instrument.”
Topic #16
Referencing to images or videos that feature
activities from ACNH
“This is how #hongkong ppl spend our time during
coronavirus lockdown - villain hitting in
#animalcrossing, the villain is #CarrieLam, the worst
governor in #hongkong history.”
Topic #1 Live streaming of political or leisure events
held in ACNH, e.g. protests, tournaments
“Animal Crossing New Horizons Protest Stream for
bells retweet to enter. Click here to join…”
Topic #19 Follow for a follow back and/or Animal
Crossing giveaway
“ANIMAL CROSSING BUNDLE GIVEAWAY Because
of my Sponsorship with we’re teaming up…”
Topic #11
Short content wave-riding popular
vocabularies, e.g. celebrities, “Animal
Crossing,” and “Coronavirus” to amplify
their visibility – most containing
semantically meaningful massages
“#CoronaVirus Should an adult take Tylenol to stop
the temperature fighting effects of a Fever due to
COVID 19? ubc sfu bcit blackpink jhope yibo
xiaozhan uvic bts fortnite minecraft lol whistler
patriot prepper bitcoin xrp animalcrossing bc”
Topic #18 Announcing fan art commission opening “Commissions OPEN!... My goal is to save for a
workable laptop as well as donate 20% monthly
earnings to #ForOurFarmers and one COVID-19
Donation Drive in the PH. Do help by Like/RT this
post! Queue here: http://* #ACNHCommission
#ACNHArt”
†
Topics are ranked in descending orders for their sizes.
1
KK Slider is a dog-appearing singer in ACNH, and ‘Cruisin’ is one of his 95 songs in the game.
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