Computers in Human Behavior 121 (2021) 106805

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Computers in Human Behavior

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Full length article

Exploring the inverted-U relationship between gamification achievement

and health management performance
Hualong Yang a, *, Dan Li b
a
School of Management, Guangdong University of Technology, 161 Yinglong Road, Guangzhou, Zip: 510520, China
b
School of Business Administration, Guangdong University of Finance, China

A R T I C L E I N F O A B S T R A C T

Keywords: How to improve users’ health management performance is an important challenge for practitioners of digital
Gamification health platforms. Gamification is considered a potential method to encourage individuals to engage in health
Health management management and improve the level of their health management performance. To better understand the role of
Achievement mechanism
gamification in the health management context, this study investigates the influence of the achievement
Social network
mechanism on the health management performance, as well as the moderating effects of social network and
Health condition
health condition. This study collected 1554 users’ data (54.4% female and 45.6% male, age: 18–35) from an
online health community in China and built a regression model combined with the U test estimation algorithm to
examine the research hypotheses. The results of the empirical model show an inverted-U relationship exists
between level of achievement and the level of health management performance. Moreover, our research shows
that the size of the social network and the health condition negatively moderate the inverted-U relationship.
These findings facilitate an understanding of the role of gamification in the health management context. Further,
the study contributes to goal setting theory and provides new insights and suggestions for users and designers of
health management platforms and online health communities.

1. Introduction
With the acceleration of China’s industrialization, urbanization, and
population aging, the effects of lifestyle, ecological environment, and
food security on Chinese residents’ health has gradually emerged. The
number of people with chronic diseases has increased significantly.
According to the report on chronic disease in China,1 70 million-200
million people in China are overweight or obese, 270 million have
high blood pressure, and 96 million have diabetes. Chronic diseases
account for approximately 86% of the disease mortality of China and for
approximately 76% of the disease incidence. China has the largest
number of patients with chronic diseases in the world. Chronic disease
has become a serious threat to the health of Chinese residents and a
major public health problem affecting China’s economic and social
development. How to effectively stimulate the health management of
residents has become the most important social problem in China.
With the development of information technology, online health
communities and mobile health applications have become important
digital platforms used by individuals to manage their health conditions
(Yan, 2018; Yan & Tan, 2014). These health management platforms
generally launch many health tasks (e.g., exercise and diet) to facilitate
individuals’ health management in an appropriate way. When people
use these health management platforms, they engage in a self-care
model by accomplishing health tasks (Yang, Du, Wang, & Deng,
2019). Moreover, users can establish their own social networks to
communicate with friends or other users on these platforms. Through
the social networks of health management platforms, users can obtain
social support, health knowledge, and related health information to help
them manage their health condition (Chen et al., 2020). These health
management platforms have received extensive attention from health­
care institutions and scholars.
However, because of the boring processes involved in health man­
agement and the lack of patients’ interest in managing their health,
health management is stressful for individuals (Yang, Du, wang, & Wu,
2019). How to improve individuals’ motivation and health management
performance is an important challenge for designers of health manage­
ment platforms (Johnson et al., 2016; Sardi et al., 2017). In recent years,
gamification has come to be considered a potential way to motivate

* Corresponding author.
E-mail addresses: yanghl20@gdut.edu.cn (H. Yang), danlihit@163.com (D. Li).
1
https://www.sohu.com/a/343223038_120156763.

https://doi.org/10.1016/j.chb.2021.106805
Received 8 July 2020; Received in revised form 5 March 2021; Accepted 29 March 2021
Available online 1 April 2021
0747-5632/© 2021 Elsevier Ltd. All rights reserved.
H. Yang and D. Li
individuals’ participation in their own health management (Wouters
et al., 2013). Gamification refers to the use of game-design factors in
non-game contexts, and represents an important design system in in­
formation science (Deterding et al., 2011; Suh et al., 2017). In the
process of “playing games”, individuals accomplish health tasks that
designers hope to achieve (Groening & Binnewies, 2019; Xi & Hamari,
2019). Unlike traditional incentives, gamification aims to stimulate in­
dividuals’ intrinsic motivation, enhance their interest, and change their
behavior through entertainment (Karahanna et al., 2018). Gamification
designs of health management platforms can arouse individuals’ interest
in health management and stimulate them to engage in the management
of their own health (Alahäivälä & Oinas-Kukkonen, 2016). It can be
argued that gamification design will become the principal means for
health management platforms to motivate individuals and provide new
ideas for the future development and growth of these platforms.
The achievement mechanism is the most commonly used means of
incentive in gamification (Hamari, 2017). Previous literature (Hamari,
2013; Xi & Hamari, 2020) has identified three principal elements of the
achievement mechanism: points, badges, and leaderboard. Goal setting
is the most important design purpose of gamification. The achievement
mechanism elicits incentives in a clear and direct way similar to classic
goal setting (Landers et al., 2017). Achievement mechanisms can be an
alternative to personal goal setting and perform goal setting functions in
gamification design (Landers & Armstrong, 2017). The achievement
mechanism can be used as a reward system to motivate individuals to
change specific behaviors to obtain specific achievements in return.
Therefore, the achievement mechanism in gamification can be a
powerful technique for improving motivation and executive
performance.
Despite the prevalent use of gamification in different domains,
empirical results have been mixed. Some previous studies on gamifica­
tion have demonstrated that achievement mechanisms positively affect
the performance of individuals’ behavioral performance (Feng et al.,
2018). In contrast, many other studies have found that achievement
mechanisms have no effect or adverse effects on individuals’ behavioral
performance (Attali & Arieli-Attali, 2015; Demarcos et al., 2014; Hanus
& Fox, 2015). To better understand the influence of achievement
mechanisms in gamification, more studies need to be conducted. Unlike
previous research (Groening & Binnewies, 2019; Hamari, 2017), this
paper considers that there may not be a linear relationship between
achievement and performance, but that their relationship is in fact
curvilinear. Achievement will positively affect individual performance
under certain conditions, but with the improvement of achievement and
the limitation of individual ability, the effect of achievement will be
reduced or even negatively affected. Thus, achievement mechanisms
may have an inverted-U effect on the performance of individuals’ health
management.
In addition, individuals’ social networks and health condition could
affect the implementation of gamification and the role of achievement
mechanisms. Firstly, social networks provide opportunities for in­
dividuals to interact with other people and enhance the degree of their
information exposure (Du et al., 2020; Hamari & Koivisto, 2015; Maier
et al., 2015). On a health management platform, when individuals’ level
of achievement is exposed on a social network, their self-efficacy and
sense of achievement can be greatly changed, and then their health
management performance will be affected. Hence, a social network may
moderate the relationship between the level of achievement and the
level of health management performance. Secondly, the primary aim of
gamification design in health management is to improve individuals’
health condition. Users with poor health conditions are the main target
market of health management gamification. Individuals’ general health
condition can affect their health management needs in relation to the
psychological and physiological aspects of health, such as lack of fitness,
depression, and anxiety (Xiao et al., 2012; Yang et al., 2015). Therefore,
the influences of the achievement mechanism on individuals with
different health conditions may differ.
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Computers in Human Behavior 121 (2021) 106805
The purpose of this paper is to examine the potential relationship
between achievement mechanisms of gamification and the level of
health management performance, as well as the moderating effects of
social network size and health condition. We collected data from an
online health community in China and built a regression model com­
bined with the U test estimation algorithm to examine our research
hypotheses.
2. Literature review
2.1. Gamification
Gamification is a type of information system design that appears
often in our daily lives (Aparicio et al., 2019; Santhanam et al., 2016).
Gamification refers to the application of game-design factors in
non-gaming contexts in the hope of achieving similar beneficial
behavioral and motivational outcomes as games (Deterding et al., 2011;
Koivisto & Hamari, 2019). Gamification aims to motivate individual
behavior, change attitudes, foster interest, and improve executive per­
formance through entertainment mechanisms (Huotari & Hamari, 2017;
Suh et al., 2017). Rather than use the mechanisms of traditional extrinsic
motivation, gamification design aims to realize the transformation of
individuals’ intrinsic motivation (Hamari, 2017; Kuo & Chuang, 2016).
Gamification design has become a hot topic in current research because
of its entertainment features. For example, numerous industries have
begun to adopt gamification design to improve individuals’ motivation
and behavioral performance, for example, in the areas of education
(Aparicio et al., 2019), health management (Domínguez-Téllez et al.,
2020), crowdsourcing (Feng et al., 2018; Morschheuser & Hamari,
2019), e-commerce (Xi & Hamari, 2020), logistics (Warmelink et al.,
2018), e-government (Hassan & Hamari, 2020), and electronic service
(Baptista & Oliveira, 2017).
Achievement is the most common motivation mechanism for gami­
fication design (Landers & Armstrong, 2017; Landers et al., 2017). The
achievement mechanism can be used as a reward system to motivate
individuals to change their specific behaviors to obtain specific
achievements in return (Sailer et al., 2014; Seaborn & Fels, 2015).
Achievement mechanisms can be an alternative to personal goal setting
and perform goal setting functions in gamification design (Groening &
Binnewies, 2019). Such achievement mechanisms elicit incentives in a
clear and direct way similar to that of classic goal setting (Sailer et al.,
2014). Previous literature identifies three elements of gamification
achievement: points, badges, and leaderboards (Hamari, 2013, 2015;
Hamari et al., 2014; Seaborn & Fels, 2015). Using points as feedback and
rewards are basic elements of the gamification achievement mechanism.
Badges are a visual representation of the achievement mechanism, and
individuals must complete stipulated tasks and goals to obtain the
badges as achievement rewards. A leaderboard shows individuals’
names based on points or badges ranking, thereby offering evidence of
the individual’s success.
A great deal of research has investigated the effect of gamification
achievement on individuals’ behavioral motivation, activities, and
performance. These empirical studies have found that gamification
achievement difficulties positively affect individuals’ behavioral moti­
vation and performance. Groening and Binnewies (2019) found that
achievement difficulties positively affect individuals’ behavioral moti­
vation and the level of performance, and that individuals adjust their
performance to the number and difficulty level of achievements. Xi and
Hamari (2019) found that in online brand communities, the achieve­
ment mechanism of gamification positively influences users’ brand
engagement and brand equity. Landers et al. (2017) found that when
there is a difficult goal, the leaderboard functions to positively affect
individuals’ task performance. Hamari (2017) found that the use of
badges in gamification significantly increases individuals’ activities.
However, other studies have found that achievement mechanisms of
gamification have no effects or adverse effects on individuals’
H. Yang and D. Li
behavioral performance. For example, Farzan et al. (2008) found that in
online communities, the gamification achievement mechanism has no
significant effect on individuals in the long term, but does have an effect
in the short term. Hamari (2013) did not find evidence to support a
direct effect of the gamification achievement mechanism on individuals’
activities. Clearly, empirical results of gamification in different domains
are mixed.
However, previous literature on gamification has mainly explored
the linear effects of achievement mechanisms on individuals’ behavior
and performance in different domains, rather than a nonlinear rela­
tionship between the achievement mechanism and level of performance.
To fill this research gap, this paper builds a research model to investigate
the inverted-U effect of gamification achievement.
2.2. Social network in gamification
Social networks allow users to communicate ideas and attitudes to
other users, and can influence individual behavior (Yan, 2018). The
degree of social interaction may influence the amount of tasks and ac­
tivities in which users participate (Yang, Du, Wang, & Deng, 2019). A
social network represents the social connection between individual
users and provides users with more opportunities to interact with others
(Maier et al., 2015). Users can obtain social support through interaction
with other users in a social network (Yan & Tan, 2014). This source of
information and emotional support helps individual users cope with
stressful events and affects their behaviors (Chen et al., 2020). More­
over, social influence, stimulate their sense of competition, inspire them
to obtain more achievements and rewards, and affect their satisfaction,
self-esteem, and pride (Hamari & Koivisto, 2015). Thus, social interac­
tion helps individuals maintain beneficial behaviors in gamification
techniques.
Previous studies have investigated the role of social networks and
social interaction in the engagement process of gamification. Yang et al.
(2017) explored how social interaction through gamification in brand
communities affects individuals’ perception of social status and en­
hances participation intention and brand attitude. Hamari and Koivisto
(2015) analyzed the influence of the exposure of social networks on
individuals’ subjective norms, the perception of mutual benefits, atti­
tudes, and participation in relation to gamification. Xi and Hamari
(2020) found that gamification social interaction in online brand com­
munities positively influences users’ brand engagement and brand eq­
uity. Du et al. (2020) found that the social interaction affordance of
gamification positively affects individuals’ enjoyment and social gain,
and then positively affects their intention to use gamification.
Although previous literature on gamification has explored the direct
influence of social networks on individuals’ behaviors, these studies
have overlooked any moderating effect that it may have. To fill this
research gap, we examine the moderating effect of the social network on
the inverted-U relationship between achievement and performance.
2.3. Health management gamification
Facilitating individuals’ engagement in health management and
improving the level of health management performance is an important
issue for governments and healthcare industries (Johnson et al., 2016;
Sardi et al., 2017). With the rise of online health communities and
mobile health applications, gamification has become widely used in
health management platforms (Michie et al., 2011; Wouters et al.,
2013). Gamification design is considered to provide advantages for
application use as an information technology solution that is able to
change health behaviors and increase the level of health management
performance (Pereira et al., 2014; Sola et al., 2015). Gamification can
effectively promote individuals’ enjoyment of health management and
satisfy their inner needs for health management (Park & Bae, 2014;
Sailer et al., 2017).
Many studies have explored the influence of gamification in the
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Computers in Human Behavior 121 (2021) 106805
healthcare domain. Such literature mainly focuses on three aspects.
First, the ability of gamification design to improve health management
performance. For example, Allam et al. (2015) found that gamification
intervention has a positive effect on patients with rheumatoid arthritis
and Riva et al. (2014) found that gamification design enhances the
health management performance of patients with chronic diseases.
Second, the ability of gamification design to change individuals’ health
behaviors. Hamari and Koivisto (2015) compared the effects of gamifi­
cation design and non-gamification design applications on individuals’
physical activities. Koivisto and Hamari (2014) investigated the
moderating effects of users’ age and gender on the relationship between
perceived benefits from gamification and exercise. Third, the ability of
gamification design to promote individuals’ willingness to continue
using health-related information technology. Lee et al. (2017) found
that gamification intervention can improve individuals’ perceived use­
fulness of mHealth, and promote intention to use mHealth. Elias et al.
(2013) found that gamification design can improve the frequency of
using health-related information technology.
Despite the prevalent use of gamification in health management,
previous studies have ignored the role of individuals’ health charac­
teristics in the relationship between gamification design and health
management performance. To fill this research gap, this paper in­
vestigates the moderating effect of health condition on the inverted-U
relationship between achievement and performance.
3. Theoretical background and hypothesis development
3.1. Goal setting theory
Goal setting theory, which was developed by Locke (1968), is useful
for understanding the relationship between goals and performance. This
theory points out that challenging goals are the source of individuals’
behavioral motivation and enhance the performance of behaviors (Fried
& Slowik, 2004). When difficult goals are accepted by individuals, better
performance is achieved than when easy goals are set. This theory ar­
gues that the goal itself has the incentive effect that makes individuals
direct their behavior toward a certain direction (or goal), which in turn
enhances their behavioral results in relation to the established goal
(Locke & Latham, 2002). A goal is established as the purpose of actions
that individuals are trying to accomplish. The goal is the most direct
motivation causing individual behaviors (Landers et al., 2017). Setting
an appropriate goal will make people want to attain the achievement
need of the goal, so the goal setting has a strong incentive effect on in­
dividual behaviors. Therefore, setting an appropriate goal is an impor­
tant part of the process of promoting motivation and behavioral
performance (Locke & Latham, 2002). When the difficulty of the goal
increases, individuals’ performance improves; however, if the individual
lacks identification with the difficult goal, their performance will be
lower (Locke, 1968).
According to goal setting theory (Locke, 1968), an effective goal
should have two basic attributes: clarity and difficulty. First, the content
of goal can be vague or clear. Clear goals mean that it is obvious what
needs to be done and how it should be done. The act of goal setting is a
clear and easy way to evaluate the individual’s ability (Groening &
Binnewies, 2019). Vague goals are not conducive to guiding individuals’
behavior and evaluating their performance. Hence, goal setting must set
a goal that is as clear as possible. Second, the goal set can be simple or
difficult. The difficulty of the goal depends on individuals’ ability and
experience (Hamari, 2017). The same goal may be easy for one person
and difficult for another person. The more difficult the goal is, the harder
it is for people to reach it. Generally, there is a positive relationship
between performance and goal difficulty because people can adjust their
efforts according to the difficulty of different tasks.
Many other factors play important roles in the relationship between
goal difficulty and performance. These factors include goal commit­
ment, feedback, and self-efficacy (Locke, 1968). Goal commitment refers
H. Yang and D. Li
to the degree to which an individual is attracted to a goal, considers it
important, and consistently strives to achieve it (Locke, 1968). In­
dividuals are most likely to commit to the goal and then strive to attain it
when they feel the goal is important to them. Goals and feedback are
combined to improve performance (Locke & Latham, 2002). Goals
indicate to people what kind of goals or results should be achieved, but
they also set a standard for individuals to evaluate their own perfor­
mance. Feedback tells people how well the standards are being met,
what went well, and what needs to be improved (Fried & Slowik, 2004).
The relationship between the effect of goal motivation and individual
self-efficacy is also examined in goal setting theory. Self-efficacy is a
type of self-judgment about how well an individual can do when dealing
with a certain problem (Sun et al., 2012). It is based on the evaluation of
all the resources of an individual, including ability, experience, training,
past performance, and information about tasks (Locke, 1968).
Goal setting theory is widely used to explain why gamification de­
signs can affect individuals’ motivation and behavioral performance
(Landers et al., 2017). This theory provides reasonable explanations
about the influence of achievement mechanisms from the perspective of
personal goals (Hamari, 2017). Compared to other gamification related
theories, such as flow theory, self-determination theory and affordance
theory, goal setting theory mainly focuses on analyzing and explaining
the role of achievement mechanism. Other theories focus more on the
impact of gamification design techniques, such as competition and
interaction mechanisms (Liu et al., 2017). Therefore, we use goal setting
theory as our research basic to establish theoretical model and explain
the influence of achievement mechanism on individuals’ health man­
agement performance.
3.2. Hypothesis development
Goal setting theory indicates that under certain conditions, the dif­
ficulty of goal positively affects the level of behavioral performance (i.e.,
a difficult goal leads to better performance than an easy goal) (Locke,
1968). In the context of gamification, the level of achievement plays the
same role as goal difficulty (Hamari, 2017). Generally, goals can be
divided into self-set and externally provided (Seaborn & Fels, 2015).
Achievement is a type of goal externally provided by the designers of a
gamification application (Koivisto & Hamari, 2019). Previous studies on
gamification have noted that the achievement mechanism functions
similarly to classic goal setting because this mechanism provides clear
and specific behavioral instructions for obtaining achievement returns
(Groening & Binnewies, 2019). Achievement can help individuals
establish a clear and specific requirement to perform behaviors (Hamari,
2017). Individuals can adjust the degree of their effort based on the level
of achievement, direct their actions toward related behaviors, and then
witness the effect of their behavioral performance (Hamari, 2013).
Further, the level of achievement is considered as a type of reward
mechanism that functions as a useful external motivation to satisfy in­
dividuals’ inner needs in relation to reputation and influences their
behaviors (Locke & Latham, 2002). Therefore, the achievement mech­
anism of gamification is a proxy of the externally provided goals and
rewards for individuals that improve their motivation, guide their ac­
tions, and affect their performance (Landers et al., 2017). Because of the
boring process and individuals’ lack of interest, health management is
stressful for individuals (Yang, Du, wang, & Wu, 2019). As discussed, the
achievement mechanism of gamification plays the role of an externally
provided goal to motivate individuals to engage in health management.
With the level of achievement increasing, individuals’ behavioral
motivation and performance is enhanced. To some extent, the level of
achievement can positively affect the level of health management
performance.
Although individuals’ health management performance increases
until it reaches its peak with achievement improvement, it decreases as
achievements continue to increase. This paper considers three possible
reasons for this transformation. The first reason is the limitation of
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Computers in Human Behavior 121 (2021) 106805
individual capability and body condition. Goal setting theory notes that
the influence of goal difficulty on behavioral performance depends on
individuals’ capability (Locke, 1968). When goals are more difficult
than an individual can achieve, the level of behavioral performance will
decrease (Locke & Latham, 2002). The improvement of achievement
means there is greater difficulty of the tasks. In the context of health
management, the limitations of individual capacity and body condition
can mean that when a task reaches a certain degree of difficulty, the
individual can no longer achieve it, which leads to a decrease in health
management performance. The second reason is that individuals tire of
achievement mechanisms. Achievement is a proxy of externally pro­
vided goals rather than a self-set goal by individuals. Although
achievement mechanisms can provide individuals with a sense of
entertainment in the early stage of engaging in health management, they
gradually lose interest in the level of achievement because it cannot
satisfy their internal needs related to health. Achievement improvement
may even eventually lead to individuals experiencing boredom with the
achievement mechanism, which will then negatively affect the level of
performance. The third reason is that gamification may cause in­
dividuals to focus more on achievement improvement and less on health
management. Contrary to the second reason, achievement mechanisms
can significantly affect individuals’ flow experience (Liu et al., 2013),
leading them to become immersed in the achievement mechanism of
gamification but neglect health management performance. For example,
in the health management context, many users of gamification have a
high level of achievement but a low level of performance because they
are more concerned with the accumulation of achievements rather than
their specific health management goals, i.e., users could feed false in­
formation into application. This discussion demonstrates that although
the achievement mechanism positively affects the level of performance
to a certain extent, its effect decreases as the number of achievements
increases (i.e., there may be an inverted-U relationship between
achievement and performance). Therefore, we hypothesize the
following:
H1. An inverted-U relationship exists between the level of achieve­
ment and the performance of health management such that individuals
with low or high achievement have worse performance than individuals
with appropriate achievement.
According to goal setting theory (Locke, 1968), self-efficacy in­
fluences the relationship between goals and performance. When in­
dividuals’ goals are monitored by others, their self-efficacy significantly
changes. For example, if individuals tell friends about their specific goal,
friends will monitor them to perform goals (Locke & Latham, 2002). In
the same way, when individuals’ achievements are exposed on a social
network, their behavioral performance will be monitored by other
members in the network.
A social network not only provides a channel for individuals to
communicate and interact with others, but also provides a way for them
to represent their achievements (Hanus & Fox, 2015). Other users can
also use social networks to discover the individuals’ level of achieve­
ment. The size of the social network in the health management platform
of gamification may negatively moderate the relationship between
achievement and performance. A social network provides an opportu­
nity for individuals to compare their achievements with those of others
(Hamari & Koivisto, 2015). When individuals’ level of achievement is
comparatively low, their self-efficacy may be reduced and then their
performance decreases because low achievement in a big social network
makes individuals feel ashamed because of others’ comparatively high
achievements. For example, if individuals have a low level of achieve­
ment in a social large network, they may feel more ashamed than in­
dividuals with a low level of achievement in a small network. The
positive effect of the achievement mechanism is weakened as the size of
social network increases. In contrast, when individuals are exposed to a
large social network, high achievement makes them focus on the accu­
mulation of achievements but neglect their health management, and
H. Yang and D. Li
then the level of performance decreases. For example, if individuals
have a high level of achievement in a large network, they may become
more concerned with the accumulation of achievements than in­
dividuals in a small networks, which leads them to become immersed in
the achievement mechanism but neglect health management perfor­
mance. The negative effect of the achievement mechanism is strength­
ened as the size of the social network increases. Thus, the size of a social
network negatively moderates the relationship between achievement
and performance, that is, social networks can weaken the positive effects
of achievement and strengthen the negative effects of achievement,
which leads to diminishing the inverted-U relationship between
achievement and performance. Based on what has been discussed above,
we hypothesize the following:
H2. The size of a social network diminishes the inverted-U relationship
between the level of achievement and health management performance
such that a large social network weakens the positive effect of
achievement on performance and strengthens the negative effect of
achievement on performance.
Health condition refers to the level of individuals’ fitness and illness
(Yang, Du, wang, & Wu, 2019). Previous research has found that in­
dividuals’ health condition has a moderating effect on the relationship
between health behaviors and their antecedents (Yan et al., 2016).
Generally, health condition affects individuals psychologically and
physiologically. The psychological aspect refers to individuals’ depres­
sion and anxiety caused by a poor health condition, and the physio­
logical aspect refers to individuals’ perceived the lack of fitness caused
by a poor health condition (Xiao et al., 2012). Both the psychological
and physiological aspects influence individuals’ self-efficacy when
engaging in gamification and individual health management.
Individuals’ health condition negatively moderates the relationship
between achievement and performance. When engaging in health
management tasks, individuals with poor health condition need in­
centives and support more than do individuals with good health con­
dition because of psychological and physiological factors (Xiao et al.,
2012). The achievement mechanism of gamification is an effective inner
incentive for individuals to improve their behavioral motivation and
facilitate their health management (Park & Bae, 2014; Sailer et al.,
2017). Moreover, the achievement mechanism can also serve as a design
tool to provide emotional support to individuals with poor health con­
dition to deal with their psychological factors, such as depression and
anxiety. Therefore, poor health condition may strengthen the positive
effects of achievement and weaken the negative effects of achievement,
thus leading to diminishing the inverted-U relationship between
achievement and performance. Based on this discussion, we hypothesize
the following:
H3. Individuals’ health condition diminishes the inverted-U relation­
ship between the level of achievement and health management perfor­
mance such that poor health condition strengthens the positive effect of
achievement on performance and weakens the negative effect of
achievement on performance.
Fig. 1 presents our research model.
4. Research method
4.1. Data collection and variables
This paper collected research data from a real online health man­
agement platform in China (www.boohee.com) that focuses on users’
weight loss management. This platform provides an ideal research
context for our study for the following three reasons: (1) the platform
has developed gamification function to facilitate users’ health man­
agement; (2) users can establish their homepage and social network to
interact with others; (3) most information and data about the users is
available on the social network (e.g., badges, points, number of friends,
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Computers in Human Behavior 121 (2021) 106805
age, gender, body weight). Therefore, this health management platform
provides sufficient data support for our study. Fig. 2 presents an example
of a user homepage and achievement level. The research was approved
by the Institutional Review Board of the Guangdong University of
Technology and was conducted in accordance with the Declaration of
Helsinki’s statement. Furthermore, according to the legal statement of
website,2 we can use relevant information and content for non-
commercial purposes. These data are voluntarily disclosed online by
users and do not involve their privacy issues and sensitive personal in­
formation. We designed a Java-based web crawler program to collect
users’ relevant data and information from the platform automatically,
and based on that data, calculated the relevant variables. Finally, the
data of 1554 users were collected after excluding invalid data.
Following previous literature (Yang, Du, wang, & Wu, 2019), this
paper uses the results of users’ weight loss as a proxy of health man­
agement performance. In our research context, users post their initial
body weight when they begin using the platform and their current body
weight. The difference between the two body weights (i.e., initial body
weight minus current body weight in kilograms) represents the in­
dividual’s health management performance. The specific measurement
used to calculate the performance is as follows:
Performance = Initial ​ weight(kg) − Current ​ weight(kg)
The main independent variable in our empirical research model is
the level of achievement. In our research context, users obtain badges or
points if they complete the tasks launched by the platform. These badges
and points are a proxy of achievement mechanism and reflect users’
level of achievement. The higher ranking of badges, the higher the
achievement in gamification. Hence, in our main research model, we use
the number of badges to measure the level of achievement.
There are two moderating variables in our empirical model: size of
social network and health condition. First, following previous literature
(Yang, Du, wang, & Wu, 2019), this paper uses the number of friends on
the platform to measure the size of the social network in gamification.
Second, we used individuals’ body mass index (BMI) to measure their
health condition. According to Asian health standards reported by
World Health Organization, BMI in the range of 18.5–24.9 indicates
healthy (good health condition); a BMI range of 24.9–29.9 indicates
overweight (sub-health condition); and a BMI higher than 29.9 indicates
obese (poor health condition, which means people have an increased
risk of death from cancer, heart disease, respiratory disease, kidney
disease, and diabetes). This paper uses 1, 2, and 3 to express good health
condition, sub-health condition and poor health condition, respectively.
The specific method used to calculate BMI is:
Initial ​ weight(kg)
BMI =
Height2 (m)
We add other factors to our empirical model as control variables.
First, the study uses individuals’ age and gender to control for de­
mographic differences. Gender is a dummy variable that is 0 for female
and 1 for male. The study also uses the number of days since individuals
began to use the health management platform to measure their usage
time. One of the most important control variables is users’ goal weight.
Given that everyone has different health needs, there are significant
differences in their goals for health management performance. Con­
trolling for goal weight can effectively control this difference for
different people. The specific measurement used to calculate in­
dividuals’ goal weight is as follows:
Goal = Initial ​ weight(kg) − Goal ​ weight(kg)
2
http://www.boohee.com/boohee/declare.
H. Yang and D. Li Computers in Human Behavior 121 (2021) 106805

Fig. 1. Research model.

Fig. 2. An example of gamification health management.

4.2. Model estimation

Table 1
Variable descriptions.
To test our research hypotheses on the effect of achievement mech­
anism on health management performance, we build the empirical Variable Type Variable Name Symbol Measurement

model to further test the moderating role of social network and health Dependent Performance of Performance The measurement is the
condition. According to the results (the mean and deviation of variables) variable health result of initial body weight
management minus current body weight.
in Table 2, independent and dependent variables are not normally
Independent Achievement Badge The ranking of badges
distributed. To correct for the deviation of the distribution of variables, variable mechanism formed a proxy for users’
this paper uses the log-linear regression as the primary estimation level of achievement.
method. The specific model is as follows: Moderating The size of social Network This paper uses the number
variable network of friends that a user had as
log(performancei) = β0+β1agei+β2genderi+β3log(dayi)+ β4conditioni+β5log a proxy for the size of social
(networki) + β6log(badgei)+ β7log(badgei)2+β8conditioni* log(badgei)+ β9 network.
Health condition Condition According to Body Mass
conditioni*log(badgei) 2 +β10 log(networki)*log(badgei) +β11 log(networki)*
Index (BMI), this paper uses
log(badgei)2+εi 1, 2, and 3 to express good
health condition, sub-
Where i = 1 … N index the user. Here, β0 to β11 are the parameters to health condition and poor
be estimated in the research model. The terms of log(badgei) and log health condition,
(badgei)2 are used to test the linear effect and nonlinear effect on per­ respectively.
formance, respectively. The interaction terms are used to estimate the Control Age Age User’s age
variable Gender Gender Male = 1, Female = 0
moderating effects of health condition and social network on the Usage time Time The number of days since
inverted-U shape. The term εi is an error term associated with obser­ users joined the platform
vation i. Goal health Goal Initial body weight minus
condition goal body weight (the unit
is the kilogram)
4.3. Results

Table 1 presents the variable descriptions. Table 2 presents the

descriptive statistics. Table 3 presents the correlations of variables.
To explore the inverted-U relationship and moderating effects, this

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H. Yang and D. Li Computers in Human Behavior 121 (2021) 106805

Table 2 indicating that there is no significant multicollinearity among the in­

Descriptive statistics. dependent variables. The results of the empirical model and effect size
Variable Min Max Mean Deviation tests are presented in Table 4.
After examining the results of the regression, we used the U test
1. Age 18.000 35.000 28.320 2.480
2. Gender 0.000 1.000 0.455 0.499 estimation algorithm by Lind and Mehlum (2010) to verify the stability
3. Time 3.000 372.000 104.960 17.474 of inverted-U relationship. This algorithm is divided into four steps.
4. Goal 1.000 114.000 59.442 12.114 First, we used the Wald test to evaluate the combined significance of
5. Condition 1.000 3.000 1.670 0.767 different variables (linear term and nonlinear term). Second, we used
6. Achievement 1.000 14.00 4.726 1.767
7. Network 0.000 2418.000 20.2967 119.346
our data to analyze and calculate the slope of the low and high
8. Performance 0.000 68.400 3.466 6.808 achievement curve (according to our research data, low point = 0.69
and high point = 2.79). Third, we used the likelihood ratio test to verify
whether the effect of low achievement on performance increases
study follows previous research (Aiken et al., 1991) in using moderated monotonously and the effect of high achievement on performance de­
regression to establish three empirical models: the linear effects model, creases monotonously. Finally, we used the Fieller and Delta confidence
the nonlinear effects model, and the moderation effects model. Further, interval tests to verify whether the poles of the curve fell within the
the study tests the effect size of variables using Cohen’s f,2 which is a interval of high and low values of achievement. If the poles fell within
measurement of the importance of variables. We used this index to the interval of two values, the inverted-U relationship was considered
measure the importance of the quadratic term and the interaction term. stable. Table 5 presents the results of the U test estimation algorithm.
The results of effect size test show that the inverted-U relationship be­ Moreover, following methods employed in previous literature
tween achievement and performance is stronger than the linear rela­ (Haans et al., 2016), we measured the moderating effect of variables on
tionship (Cohen’s f2: 0.020 > 0.004). In addition, the mean variance the U relationship is as follows:
inflation factor (VIF) statistics of the variables are less than 2.0,

Table 3
Correlations of variables.
Variable 1 2 3 4 5 6 7 8

1. Age 1
2. Gender − 0.042*** 1
3. Time − 0.006 0.186** 1
4. Goal 0.052* 0.506** 0.095** 1
5. Condition 0.172** 0.261** 0.004 0.555** 1
6. Achievement 0.249** − 0.433** 0.110** − 0.259** − 0.122** 1
7. Network 0.008 − 0.096** 0.098** − 0.060* − 0.031 0.334** 1
8. Performance 0.133** − 0.073** 0.076** 0.322** 0.322** 0.107** 0.006 1

** Correlation is significant at the 0.01 level (2-tailed). * Correlation is significant at the 0.05 level (2-tailed).

Table 4
Results of the research model.
Independent Variable Model 1 Model 2 Model 3 Model 4 Effect Size

Linear Nonlinear Moderation Moderation Cohen’s(f)

Control Variable Constant − 2.874*** − 5.985*** − 2.195 − 9.207***

(-8.603) (-9.306) (-1.490) (-6.938)
Age 0.041*** 0.037*** 0.036*** 0.030***
(4.274) (3.891) (3.798) (3.218)
Gender − 0.492*** − 0.470*** − 0.495*** − 0.401***
(-8.767) (-8.447) (-8.862) (− 7.135)
Log(Day) 0.166*** 0.167*** 0.173*** 0.174***
(5.140) (5.227) (5.409) (5.502)
Log(Goal) 0.439*** 0.427*** 0.414*** 0.409***
(9.645) (9.482) (9.171) (9.156)
Linear Effect Condition 0.124*** 0.117*** − 1.974** 0.126*** 0.005
(3.018) (2.858) (-2.501) (3.114)
Log(Network) 0.042** 0.093*** 0.086*** 1.284*** 0.002
(2.423) (4.787) (4.400) (4.849)
Log(Badge) 0.304*** 4.099*** 0.240 7.029*** 0.004
(2.618) (6.006) (0.146) (4.587)
Nonlinear Effect Log(Badge)2 − 1.138*** − 0.193 − 1.709*** 0.020
(-5.641) (-0.415) (-3.808)
Moderation Effect Condition* Log(Badge) 2.131** 0.005
(2.335)
Condition* Log(Badge)2 − 0.512** 0.008
(-1.962)
Log(Network)* Log(Badge) − 1.083*** 0.019
(-3.800)
2
Log(Network)* Log(Badge) 0.232*** 0.004
(3.018)
2
Adjust-R 0.250 0.265 0.270 0.282
F 74.948*** 70.864*** 58.582*** 62.100***

t statistics in parentheses, *p < 0.1, **p < 0.05, ***p < 0.01.

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H. Yang and D. Li Computers in Human Behavior 121 (2021) 106805

Table 5
Results of inverted-U-test estimation algorithm.
Test process and content Result
Wald test (H0: linear = nonlinear = 0) 0.000***
The slope of linear effect 2.530***
The slope of nonlinear effect − 2.063***
A likelihood test 0.000***
Extreme point 1.802
Fieller test (95%)
Low − 0.923
High 2.985
Delta test (95%)
Low − 1.091
High 3.320
t statistics in parentheses, *p < 0.1, **p < 0.05, ***p < 0.01.
Y = β0+β1X+β2X2+β3XZ+β4X2Z+β5Z → Y = β0+(β1+β3Z)X+(β2+β4Z)
X2+β5Z
Y, X and Z indicate the dependent variable, the independent variable,
and the moderating variable, respectively. Measurement of the linear
effect is conducted to compare the differences between (β1+β3Zhigh) and
(β1+β3Zlow), and the nonlinear effect is measured to compare the dif­
ferences between (β2+β4Zhigh) and (β2+β4Zlow).
Hypothesis 1 predicted that an inverted-U relationship exists be­
tween level of achievement and health management performance. Ac­
cording to the empirical results in model 2 of Table 4, the coefficient of
the nonlinear term of achievement is negative and statistically signifi­
cant (β7 = − 1.138, p < 0.01), and the coefficient of the linear term is
positive and statistically significant (β6 = 4.099, p < 0.01). Although the
empirical results show the curvilinear relationship between achieve­
ment and performance, its stability remains unknown. The results of
Table 5 find that the inverted-U relationship between achievement and
performance is stable. When the level of achievement reaches 1.802, the
level of health management performance is highest. If the level of
achievement is less than 1.802, achievement positively affects perfor­
mance. If the achievement exceeds 1.802, the effect of achievement on
performance begins to decline. This result supports Hypothesis 1 that
there is an inverted-U relationship between achievement and perfor­
mance. Fig. 3 presents the inverted-U relationship between achievement
and performance.
Hypotheses 2 predicted that the size of the social network negatively
moderates the inverted-U relationship between the level of achievement
and the level of health management performance. The empirical results
of model 4 in Table 4 demonstrate that the coefficient of the linear term
is positive and statistically significant (β6 = 7.029, p < 0.01, β10 =
− 1.083, p < 0.01), and the coefficient of the square term of achievement
is negative and statistically significant (β7 = − 1.709, p < 0.01, β11 =
0.232, p < 0.01). Based on the related method that was discussed above
(7.029*x-1.709*size*x, − 1.709*x2-0.232*size*x2), the size of the social
network negatively moderates the relationship between achievement
and performance such that the size of the social network weakens the
positive effect (linear) of achievement on the level of performance and
strengthens the negative effect (nonlinear) of achievement on the level
of performance. Fig. 4 shows the moderating effect of social network.
Hypotheses 3 predicted that health condition negatively moderates
the inverted-U relationship between achievement and performance. The
empirical results of model 3 in Table 4 demonstrate that the coefficient
of the linear term is positive and statistically significant (β6 = 0.240, p >
0.01, β10 = 2.131, p < 0.05), and the coefficient of the square term of
achievement is negative and statistically significant (β7 = − 0.193, p >
0.01, β11 = − 0.512, p < 0.05). Based on the related method that was
discussed above (2.131*condition*x, − 0.512*condition*x2), health
condition diminishes the inverted-U relationship between achievement
and performance such that poor health condition strengthens the posi­
tive effect (linear) of achievement on the level of performance and
weakens the negative effect (nonlinear) of achievement on the level of
performance. Fig. 5 presents the moderating effect of health condition.
4.4. Robustness checks
To validate the robustness of the research results, we conducted two
robustness checks. First, we replaced the independent variables to run
the model again, through which we investigated the effects of level of
achievement and health condition using other measurements. In the
main model, we used the ranking of badges as a proxy of the level of
achievement, and used 1, 2, and 3 to express good health condition, sub-
health condition, and poor health condition, respectively. In the
robustness check, we used the value of gamification points as a proxy of
the level of achievement and users’ BMI as a proxy of health condition.
The results of this robustness check are presented in Table 6 and are
consistent with the results of the main model.
Second, we replaced the dependent variable to run the model again,
through which we investigated the role of health management perfor

Fig. 3. Inverted-U relationship between achievement and performance.

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H. Yang and D. Li
Fig. 4. Moderating effect of social network.
Fig. 5. Moderating effect of health condition.
mance using other measurements. In the main model, we used initial
body weight minus current body weight as a proxy of performance and
controlled individuals’ goal weight. In the robustness check, we used the
completion condition of the goal as a proxy of health management
performance. The specific measurement used to calculate performance
is as follows:
Initial ​ weight(kg) − Current ​ weight(kg)
Performance =
Initial ​ weight(kg) − Goal ​ weight(kg)
Moreover, given that the new dependent variable ranges from 0 to 1,
we converted logarithmic regression to normalized linear regression.
The standardization formula we used is as follows:
(x − x)
Standard(x) =
δx
The results of the robustness check are presented in Table 7 and are
consistent with the results of the main model.
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Computers in Human Behavior 121 (2021) 106805
5. Discussion and implications
Our research established a theoretical model to explore the inverted-
U relationship between the achievement mechanism of gamification and
the level of performance, as well as to examine the moderating effects of
social network and health condition. We collected objective data to test
the empirical model we created. By doing so, this research provides
several key findings that contribute to the literature on gamification and
have implications for gamification designers.
5.1. Key findings and discussion
Our research provides three significant key findings. First, we found
that there is an inverted-U relationship between achievement and health
management performance. Unlike previous research (Groening & Bin­
newies, 2019; Hamari, 2017), this paper considers that rather than there
being a linear relationship between achievement and performance, they
have a curvilinear relationship. Initially, the level of health management
H. Yang and D. Li Computers in Human Behavior 121 (2021) 106805

Table 6
Results of robustness check (independent variable).
Independent Variable Model 1 Model 2 Model 3 Model 4

Linear Nonlinear Moderator Moderator

Control Variable Constant − 5.381*** − 7.561*** − 1.728 − 12.728***

(-9.041) (-10.427) (-0.834) (-8.172)
Age 0.042*** 0.038*** 0.038*** 0.037***
(4.415) (4.075) (4.015) (3.916)
Gender − 0.558*** − 0.545*** − 0.552*** − 0.517***
(-10.085) (-9.940) (-10.064) (-9.377)
Log(Day) 0.177*** 0.178*** 0.183*** 0.182***
(5.482) (5.546) (5.693) (5.686)
Log(Goal) 0.360*** 0.350*** 0.341*** 0.342***
(7.188) (7.050) (6.842) (6.906)
Linear Effect Log(BMI) 0.879*** 0.892*** − 0.871 0.900***
(4.658) (4.763) (-1.373) (4.831)
Log(Network) 0.158*** 0.202*** 0.202*** 1.902***
(3.847) (4.869) (4.861) (4.355)
Log(Point) 0.060** 0.793*** − 0.609* 2.509***
(2.459) (5.519) (-1.687) (4.867)
Nonlinear Log(Point)2 − 0.060*** 4.151 − 0.196***
Effect (-5.177) (1.445) (-4.368)
Moderation Log(BMI)* Log(Point) 0.420***
Effect (3.732)
Log(BMI)* Log(Point)2 − 0.017***
(-4.812)
Log(Network)* Log(Point) − 0.568***
(-3.590)
Log(Network)* Log(Point)2 0.045***
(3.170)
Adjust-R Square 0.253 0.265 0.267 0.273
F 76.220*** 71.155*** 63.851*** 59.229***

t statistics in parentheses, *p < 0.1, **p < 0.05, ***p < 0.01.

Table 7
Results of robustness check (dependent variable).
Independent Variable Model 1 Model 2 Model 3 Model 4

Linear Nonlinear Moderation Moderation

Control Variable Constant 0.243*** 0.269*** 0.284 0.273***

(40.296) (37.994) (31.519) (38.254)
S(Age) 0.030*** 0.026*** 0.025*** 0.024***
(4.617) (4.029) (3.913) (3.851)
S(Gender) − 0.078*** − 0.071*** − 0.069*** − 0.073***
(-10.908) (-9.907) (-9.727) (-10.194)
S(Day) 0.026*** 0.027*** 0.027*** 0.027***
(4.072) (4.401 (4.398) (4.391)
Linear Effect S(Condition) 0.049*** 0.048*** 0.062*** 0.048***
(7.678) (7.604) (8.342) (7.583)
S(Network) 0.007** 0.011* 0.011* 0.145**
(1.919) (1.771) (1.657) (2.558)
S(Badge) 0.029*** 0.064*** 0.085** 0.063***
(3.888) (7.088) (5.516) (7.093)
Nonlinear Effect S(Badge)2 − 0.026*** − 0.027** − 0.029***
(-6.780) (-6.572) (-7.093)
Moderation Effect S(Condition)*S(Badge) 0.055***
(2.690)
S(Condition)*S(Badge)2 − 0.013***
(-2.746)
S(Network)* − 0.025***
S(Badge) (-3.099)
S(Network)*S(Badge)2 0.014***
(3.336)
Adjust-R Square 0.158 0.182 0.185 0.188
F 49.617*** 50.332*** 40.129*** 40.940***

t statistics in parentheses, *p < 0.1, **p < 0.05, ***p < 0.01.

performance increases with the growth of individuals’ achievements.
After reaching the peak of inverted-U shape, the level of health man­
agement performance decreases with the increase of achievements. The
achievement mechanism of gamification plays the role of an externally
provided goal to promote individuals’ behavioral motivation to engage
in health management, thus increasing the level of health management
performance. Hence, to some extent, the level of achievement can
positively affect the level of individuals’ health management perfor­
mance. However, after reaching the peak of inverted-U shape, perfor­
mance decreases as achievements continue to increase.
Second, the results of the empirical model indicated that the size of
individuals’ social network negatively moderates the inverted-U

10
H. Yang and D. Li
relationship between achievement and performance. Unlike previous
studies that investigated the direct effects of social network (Du et al.,
2020; Hamari & Koivisto, 2015), this paper measured its moderating
effects. The results of our empirical research found evidence to support
that the size of the social network has a negatively moderating effect.
That is, a large social network weakens the positive effect of achieve­
ment on the level of performance and strengthens the negative effect of
achievement on the level of performance. We provide a possible reason
for this moderating effect: when individuals’ low achievement is
exposed to a large social network, individuals’ self-efficacy may be
decreased and their performance may decrease because low achieve­
ment in a large social network makes individuals feel ashamed. In
contrast, when individuals are exposed to a large social network, high
achievement may make them focus on the achievement mechanism of
gamification but neglect their health management, and this may also
cause the level of performance to decrease. Therefore, a larger size of
social network diminishes the inverted-U relationship between
achievement and performance.
Third, the results of the empirical model demonstrated that in­
dividuals’ health condition negatively moderates the inverted-U rela­
tionship between achievement and performance. The results of our
empirical research found that health condition has a negatively
moderating effect on this inverted-U relationship. That is, poor health
condition strengthens the positive effect of achievement on the level of
performance and weakens the negative effect of achievement on the
level of performance. There is a possible reason for this moderating ef­
fect: because of psychological and physiological influences, people with
poor health condition may have higher health needs in performing
health management, which leads to the poor health condition enhancing
the inverted-U relationship between achievement mechanism and
health management performance.
5.2. Theoretical implications
Our research has several theoretical contributions. First, the study
contributes to the literature on gamification by exploring an inverted-U
relationship between achievement and health management perfor­
mance. Although previous studies on gamification have investigated the
effect of the achievement mechanism on behavioral performance (Koi­
visto & Hamari, 2014; Landers et al., 2017; Suh et al., 2017), these
studies mainly examined the linear effect of achievement, rather than a
nonlinear effect. Employing the theoretical foundation of goal setting
theory (Locke & Latham, 2002), our study established a research model
to test this nonlinear relationship. Our research findings demonstrated
the inverted-U relationship between level of achievement and level of
health management performance. The results of our study help us un­
derstand the effect of the achievement mechanism on the level of health
management performance and contribute to the literature on
gamification.
Second, our research findings enrich the literature on health man­
agement of gamification by identifying the underlying moderating effect
of social network on the achievement mechanism of gamification. Pre­
vious literature on gamification has mainly investigated the direct effect
of social network on individuals’ behavioral performance (Du et al.,
2020; Hamari & Koivisto, 2015) and overlooked the indirect effect of
social network on level of performance. To fill this research gap, we built
an empirical model to investigate the moderating effect of the size of
social network on the inverted-U relationship between achievement and
performance. The empirical results of our research demonstrate that the
size of the social network diminishes the inverted-U relationship. This
finding helps us to understand the role of social network in gamification,
as well as contributes to the literature on health management.
Third, this study extends goal setting theory by creating under­
standing of the moderating effect of health condition on the inverted-U
relationship between achievement and performance. Although many
studies have examined the role of gamification in the health
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Computers in Human Behavior 121 (2021) 106805
management domain (Allam et al., 2015; Lee et al., 2017; Maher et al.,
2015), these research has ignored the influence of individuals’ health
characteristics on health management of gamification. To fill this
research gap, our study explored the moderating effect of individuals’
health condition. The empirical results reveal that health condition di­
minishes the inverted-U relationship between achievement and perfor­
mance. This finding suggests an extension of the health condition
moderator in goal setting theory for gamification health management
research.
5.3. Practical implications
Our research findings provide new insights into the design of gami­
fication and health management platforms, as well as highlighting
several strategies that can be employed by practitioners of health
management platforms.
First, although achievement mechanism is the main incentive factor
of gamification health management, managers should understand the
limitations of the influence of achievement mechanism. According to the
results of this study, the positive impact of achievement mechanism on
the performance of individuals’ weight management is limited. There
may be two main reasons: one is that users are tired of achievement
mechanism; the other is that users pursue achievement level excessively
and obtain points and badges by deception instead of paying attention to
health management performance. For the first reason, managers should
develop more interesting achievement reward schemes to prevent users
from getting bored because of the single way to get achievements. For
the second reason, managers should design more strict management
methods to prevent users from cheating to get achievement awards.
Second, the achievement mechanism of gamification can positively
influence the level of individuals’ weight management performance
until reaching peak, and then the level of performance will decrease as
achievements continue to increase. Therefore, achievement is a short-
term incentive mechanism for individuals’ behavioral performance
rather than a long-term incentive mechanism. Furthermore, given that
individuals’ weight management represents a long-term process,
achievement mechanisms may not be an effective way to consistently
motivate health behaviors and improve performance. In the middle and
late stages of health management platforms, gamification should
develop more effective mechanisms to improve individuals’ self-
efficacy. For example, designers could integrate cooperation, competi­
tion, and supervisory mechanisms with achievement mechanisms to
enhance the level of performance.
Third, although previous literature on gamification and health
management has found that social network positively affects in­
dividuals’ health behavior, our research found the size of the social
network negatively moderates the relationship achievement and per­
formance. Hence, designers should consider both the positive direct and
negative indirect effects of social networks to develop a more effective
gamification design. For example, designers could consider individuals’
level of achievement to design different social network patterns. More­
over, the moderating effect of social network size on the relationship
between achievement and performance may also depend on the per­
sonality characteristics of users. At present, the health management
platform has not paid attention to the influence of personality charac­
teristics and social networks on the performance of gamification health
management. In the future development and design, managers of the
platform should pay more attention to the relationship between per­
sonality characteristics and social network. Managers can investigate
and distinguish users through personality measurement scale. For
extroverted users, designers should enhance their social interaction. For
introverted users, designers should try not to expose their achievement
levels to social networks.
Fourth, different achievement mechanisms should be used for users
with different health conditions. Differences in health condition lead to
different effects of the same achievement mechanism on different users.
H. Yang and D. Li
Since the influence of achievement mechanism is better for users with
higher BMI value, managers of health platform do not need to use a
special way to design achievement mechanism. However, for healthy
users, the impact of achievement mechanism is relatively low, and
managers of health platform should adopt more special incentive
methods for these users. Thus, designers should develop and design
personalized achievement mechanisms based on individuals’ health
characteristics. For example, there could be different badges, points, and
leaderboards offered based on an individual’s BMI.
5.4. Limitations and future research
This research has some limitations in the representativeness of the
empirical data set and coverage of the control variables. First, the
research was conducted using data from one specific health manage­
ment platform. Although the selected platform shares similar charac­
teristics with other health management platforms, other platforms have
different types of achievement mechanisms. This difference may result
in different relationships between achievement and level of performance
and thus limit the generalizability of our study to other health man­
agement platforms. In future research, we plan to collect data from
several different websites to further test the inverted-U relationship and
provide a more generalizable conclusion. Second, our research collected
cross-sectional data to test all research hypotheses in an empirical
model. Although the study added control variables to deal with het­
erogeneity and endogeneity in the empirical model, the study lacks
relevant information about the dynamic effects of the achievement
mechanism on the level of health management performance. In future
research, we plan to collect panel data that tracks the variances of
variables to investigate the dynamic effects of the achievement
mechanism.
6. Conclusion
In the empirical model of this paper, we focused on investigating the
nonlinear effect of achievement mechanism on individuals’ health
management performance. Our research questions intended to answer,
if there is an inverted-U relationship between achievement mechanism
and the health management performance, and, if social network size and
individuals’ health condition moderate the inverted-U relationship. We
collected data from an online health community in China to test the
research hypotheses. Our empirical results support all research hy­
potheses. The results of the empirical research found that there is an
inverted-U relationship between level of achievement and level of health
management performance. Moreover, we found that the size of social
network diminishes the inverted-U relationship and individuals’ health
condition diminishes the inverted-U relationship. Overall, these findings
facilitate an understanding of the role of gamification in the health
management context. Further, the findings contribute to goal setting
theory and provide new insights and suggestions for users and designers
of health management platforms and online health communities.
Author statement
All authors concur with the content of this paper, and agree to submit
it to Computers in Human Behavior. There are no conflicts of interest
exist.
Acknowledgements
This study was partially funded by the National Natural Science
Foundation of China Grants (71901073; 72001049). The authors highly
appreciate the Editors and anonymous reviewers for their insightful
comments and suggestions. All errors remain ours.
12
Computers in Human Behavior 121 (2021) 106805
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