Effects of Gamification-Based Motivation in Mobile Health Apps on Users’ Continuance Intention

Gamification is widely used in mobile health (mHealth) applications, yet sustaining user participation remains difficult. Based on Self-Determination Theory (SDT) and the Expectation-Confirmation Model (ECM), this study examines how gamified design features support autonomy, competence, and relatedness, and how these needs influence intrinsic motivation, perceived usefulness, satisfaction, and continuance intention. Using 574 valid responses, confirmatory factor analysis (CFA) and structural equation modeling (SEM) showed acceptable model fit (χ²/df=1.776, CFI=0.948, TLI=0.945, RMSEA=0.037). Bootstrapping (5,000 resamples) tested indirect effects. Results showed that continuance intention was shaped indirectly: confirmation increased perceived usefulness and satisfaction, which improved continuance intention, while intrinsic motivation enhanced satisfaction, reinforcing the willingness to continue.