A Reusable Catalog of Requirements for Gamified Mobile Health

Applications

Lamyae Sardi

, Ali Idri

2,3

, Leanne M. Redman

, Hassan Alami

and José Luis Fernández-Alemán

Department of Computer Science, Faculty of Sciences, Mohammed V University, Rabat, Morocco

Software Project Management Research Team, ENSIAS, Mohammed V University, Rabat, Morocco

MSDA, Mohammed VI Polytechnic University, Ben Guerir, Morocco

Reproductive Endocrinology and Women’s Health Lab, Pennington Biomedical Research Center, Baton Rouge, LA, U.S.A.

Faculty of Medicine, Mohammed V University and Maternity Les orangers, University Hospital of Rabat, Rabat, Morocco

Department of Informatics and Systems, Faculty of Computer Science, University of Murcia, Murcia, Spain

Keywords: m-Health, Gamification, Requirements, Catalog, ISO/IEC 25010.

Abstract: The new era of mobile technologies has revolutionized all fundamental human pursuits in that many sectors

have been reshaped and tangibly improved, such as education, finance, and healthcare. Referred to as mHealth,

the use of mobile technologies to track and improve health outcomes is a rapidly expanding trend. A plethora

of mobile health applications (mHealth apps) are being constantly developed thanks to the rapid adoption of

mobile devices. From basic exercise trackers to powerful self-management tools, mHealth apps play several

roles towards the provision of better healthcare. To induce playful experiences and boost engagement,

gamification has proven to be extremely effective with mHealth apps. This paper presents a catalog of reusable

requirements for gamified mHealth apps in terms of gamification, functional suitability, usability, and security,

Further improvements are intended to be made continuously to the catalog by adding additional requirements

scattered from other standards and information sources.

1 INTRODUCTION

As the world becomes gradually digitized, there is a

growing potential for digital technologies to improve

many aspects of health and social care provision

(Bhavnani, Narula, and Sengupta 2016). Referred to

as mHealth, the use of mobile technologies to track

and improve health outcomes is a rapidly expanding

trend. Efforts to adopt digital health apps into medical

and clinical practice have progressed significantly,

leading to a steadily proliferation of the mHealth

industry. There are now over 318,000 mobile health

applications (mHealth apps) available at the top app

stores worldwide, namely, Google Play Store and

Apple App Store, accounting for more than 200 apps

being added each day (INSTITUTE. 2017). This

staggering number is fuelled by a combination of

factors including the increased penetration and

ownership of smartphones, tablets, and other mobile

platforms, the high burden of chronic disease

prevalence, and the shift towards a patient-centric

healthcare delivery (Pankomera and Greunen 2018).

Besides, the rising need for tracking daily activities,

changing lifestyles and behaviours substantially

results in the widespread use of mHealth apps

(Baldwin et al. 2017). In this respect, mHealth apps

promise to empower patients and healthcare

providers at different levels and through a myriad of

ways including ubiquitous access to accurate health

information (Pankomera and Greunen 2018),

consistent remote monitoring and vital signs self-

management along with startling treatment adherence

support (Baldwin et al. 2017; Byambasuren 2018).

Another prevalent benefit of mHealth apps is shifted

towards motivating positive health behaviour change,

which is considered as the most frequently targeted

lever for reducing the burden of preventable disease

and enhancing wellbeing (Carroll et al. 2017; Johnson

et al. 2016). Accordingly, gamification has

persuasively proven to positively impact ingrained

health behaviours. Typically defined as the use of

game design elements in non-game contexts and

settings, gamification is a vastly growing technique

that can be used to motivate participation,

engagement and loyalty (Sardi, Idri, and Fernández-

alemán 2017a). Indeed, gamification can play a

Sardi, L., Idri, A., Redman, L., Alami, H. and Fernández-Alemán, J.

A Reusable Catalog of Requirements for Gamiﬁed Mobile Health Applications.

DOI: 10.5220/0011071700003176

In Proceedings of the 17th International Conference on Evaluation of Novel Approaches to Software Engineering (ENASE 2022), pages 435-442

ISBN: 978-989-758-568-5; ISSN: 2184-4895

435

central role in boosting user engagement with apps,

particularly with mHealth apps (Lister et al. 2014).

The use of gamification has already been recognized

in fields such as business, training, and marketing,

and it is increasingly tapping into the healthcare

domain (Johnson et al. 2016). Conforming with a

previous systematic literature review conducted on

papers dealing with gamification in digital healthcare

settings (Sardi et al. 2017a), gamification is largely

leveraged to inspire users to exercise more effectively

and more regularly and to help them manage their

chronic conditions. The underlying idea of

gamification is to harness people’s innate motivation

alongside the natural desire to learn, socialize, master

tasks, compete, record achievements, build status,

participate in self-expression and have fun. Appealing

to these intrinsic motivators, the gamified technology

employs rewards and competitive game features to

induce user immersion in the app environment

(Johnson et al. 2016). These incentives typically

include earning points, achievement badges, and

virtual currency or new levels, challenges and

progress bars. The use of leader boards and making

rewards visible to other users are ways of fostering

user competition Through integrating these

motivating elements, gamified apps are a natural

pairing between psychology and technology, which

adds more complexity to the process of their

conception and development. To fulfil their ultimate

goal, these apps should be developed in a way that

complies with a set of requirements. Nevertheless,

mobile technologies are growing at an ever-faster rate

where user requirements and expectations are

frequently changing. Therefore, software engineers

should perform a series of requirements engineering

steps to build efficient and reliable software products.

Generally, the success of a software product is

often defined as one that is delivered on time, on

budget, and with all the features as originally

specified. In this context, requirements reuse has been

proposed as an advanced requirements elicitation

technique that has a great deal of potential in terms of

achieving maximum productivity, quality, and

consistency throughout the product development

lifecycle (Palomares, Quer, and Franch 2017).

Pacheco et al. have proposed a structuring approach

using software requirements catalogs (SRC) to

support software reuse (Ivan et al. 2016). This

approach structures requirements belonging to the

same domain in sorted lists (i.e., catalogs), in which

each one of the software requirements has to be

described in terms of its functionality and classified

conforming to its importance. Moreover, these

requirements must be identified in a unique way to

facilitate the search within the catalog. A

requirements catalog is versatile as it can be adapted

into different projects. The SRC approach is oriented

to small-sized software enterprises that develop

custom-built software products. Health apps are a

good instance of this specific type of software

products.

To the best of our knowledge, there is no

requirements catalog dealing specifically with the

relevant characteristics of gamified software products

for healthcare. Subsequently, the major contribution

of the present paper is the definition of a conventional

reusable requirements catalog for gamified mHealth

apps, which covers gamification aspects and a few

important quality characteristics. This catalog,

denominated as ‘GHA-CAT’ is chiefly concerned

with the specification of a well-founded set of

gamification aspects that are likely to meet the

desired needs of stakeholders and developers of any

category of mHealth apps. Despite the hype

surrounding gamification, neither an agreed standard

nor a requirements catalog is currently available for

gamification, specifically in health settings. The

quality characteristics addressed in the proposed

catalog are drawn from the ISO/IEC 25010 product

quality model and are limited in Functional

Suitability, usability and security. In fact, the

satisfaction and pleasure induced by gamification, its

effectiveness, and usefulness are closely associated

with the degree of ease of use and of

understandability engendered by gamification while

using the fully fledged health-related gamified

software (Vargas Enríquez 2016). Besides, given the

sensitive nature of the data collected, stored, and

shared among most of the gamified mHealth apps,

security has to be considered throughout the

development cycle of these apps to preserve the

integrity, confidentiality and privacy of users’ data

which will likely enhance user trust and engagement

with the software (Martínez-pérez, Torre-díez, and

López-coronado 2015; Mavroeidi et al. 2019).

2 GHA-CAT: A REUSABLE

REQUIREMENTS CATALOG

FOR GAMIFIED mHealth APPS

The elaboration of the requirements catalog for

gamified mHealth apps ‘GHA-CAT’ builds on a

requirements engineering approach called SIREN

(SImple REuse of software requiremeNts). Proposed

and developed by a research group from the

University of Murcia (Toval et al. 2002), this

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436

practical approach aims at reducing the total effort

and cost of software development along with

increasing the overall software productivity and

quality (Ivan et al. 2016), through the creation,

selection and elicitation of reusable requirements.

Several studies in the health area have used SIREN

methodology for the development of reusable

requirements catalogs (Ouhbi, Fernández-alemán, et

al. 2017; Zapata et al. 2018). The GHA-CAT was

developed following the process depicted in Figure 1.

First, the main information sources were identified.

Literature and formal documents such as standards

and guidelines were considered. Next, relevant

requirements for the development of gamified

mHealth apps were extracted from the sources

previously selected. Then, the catalog GHA-CAT

was generated from these requirements following the

IEEE standards’ structure. Finally, the generated

catalog is maintained and updated regularly upon

changes and/or modifications in standards, policies,

and legislations. This last phase is paramount as it

facilitates the requirements’ adaptation into new

projects. Furthermore, it addresses catalogs’

incompleteness and performs a change control

strategy for establishing a baseline for each developed

catalog before potential modifications (Ivan et al.

2016)

Figure 1: Catalog generation process.

2.1 Information Sources

Requirements for the GHA-CAT have been derived

from the literature on gamified solutions (e.g.

(Darejeh, Darejeh, and Salim 2016; Johnson et al.

2016; Morschheuser et al. 2017; Sardi et al. 2017a)

and from a number of studies dealing with software

quality particularly with regard Usability, Operability

and Security, including requirements catalogs (

Jensen et al. 2009; Toval et al. 2002; Zapata et al.

2018), evaluation studies (Moumane, Idri, and Abran

2016; Ouhbi et al. 2015; Rodríguez, Oviedo, and

Piattini 2016) and reviews (Martínez-pérez et al.

2015; Salinesi and Comyn-wattiau 2015). In addition,

the following international standards and technical

reports have been used to specify these requirements.

• ISO/IEC 25010 standard for software product

evaluation, which defines a quality in-use model

and a product quality model that are relevant for

all software products and computer systems

(ISO/IEC-25010 2011).

• ISO/IEC 25023 standard provides quality

measures for quantitatively evaluating system

and software product quality in terms of

characteristics and sub-characteristics defined in

ISO/IEC 25010 (ISO/IEC-25023 2016).

• ISO/IEC 25040 standard provides a process

description for evaluating software product

quality and clarifies the general concepts

(25040:2011 2011).

• ISO/IEC 27799 standard for information

security management in health ( ISO/IEC 27799

2016).

• CEN/TR 15640 standard provides measures

with which to ensure the safety of patients using

health software (CEN/TR 15640.).

• ISO 9241-210 standard for ergonomics of

human-system interaction (9241-210 2019).

• The W3C standards for web and mobile devices

(W3C n.d.).

2.2 Requirements’ Specification

Following the identification of relevant standards and

information sources, requirements related to the focal

areas of the present study were analysed and

specified. The requirements specification process was

conducted based on the recommendations and

guidelines provided by the IEEE 29148 standard

(IEEE 29148) which not only describes in a

comprehensive manner the processes related to

requirements engineering activities but also defines a

complete and normative guide for the proper

preparation of Software Requirements Specification

(SRS). A thoughtful and well-organized SRS

document reduces significantly the development cost

and is a prerequisite to high-quality software product.

Drawing on this guidance, the general structure of the

catalog was organized in a way that complies with the

contents of an SRS recommended by IEEE 29148 as

shown in Table 1. Accordingly, all requirements of

the GHA-CAT are encompassed in Specific

requirements sections and are organized under their

corresponding subsection. With the recommendation

of the IEEE 29148 standard with regards to additional

requirements, gamification requirements are

organized under a separate section labelled ‘other

requirements’. What follows is the presentation of

each category of these requirements.

A Reusable Catalog of Requirements for Gamiﬁed Mobile Health Applications

437

2.2.1 Gamification Requirements

Perhaps the core pillar delineating the success and

effectiveness of gamified mHealth apps is the

efficient use of appropriate game design elements.

Gamification requirements therefore constitute an

important section in GHA-CAT. Due to the absence

of standardized guidance on building gamified

mHealth apps, some developed gamified apps may

negatively impact the overall user experience,

resulting in unintended or unethical behaviour. An

effective gamified health solution should include a

combination of game design elements that promote

most of the following persuasive strategies:

• Relatedness and social influence

• Purpose and goal setting

• Mastery

• Reinforcement and progress tracking

• Autonomy

• Fun and playfulness

2.2.2 Functional Suitability Requirements

Functional suitability is one of the most important

quality characteristics, since it entails that a software

product meets the needs and requirements of its users.

Besides functional appropriateness, it covers

functional correctness which alludes to the degree of

the system to generate correct results with the needed

level of precision, and functional completeness that

stands for the system’s capacity to provide all the

functions specified by the user (ISO/IEC-25010

2011).

2.2.3 Usability Requirements

Usability has long been recognized as an influential

factor affecting the productivity and success of

interactive systems and products (9241-210 2019;

Rajanen and Rajanen 2017). As a product quality

characteristic, usability is defined in the ISO standard

(ISO/IEC-25010 2011) as “the extent to which a

product, system, or service can be used by specified

users to attain specified goals with effectiveness,

efficiency, freedom of risk and satisfaction in a

specified context of use”. Six attributes are

encountered under the usability characteristic which

are: appropriateness, recognizability, learnability,

operability, user interface aesthetics, user error

protection, and accessibility.

Table 1: Table of contents (IEEE 29148-2011).

1. Introduction

1.1. Purpose

1.2. Product scope

1.3. Product overview

1.3.1. Product perspectives

1.3.2. Product functions

1.3.3. User characteristics

1.3.4. Limitations

1.4. Definitions

2. References

3. S

ecific re

uirements

3.1. External interfaces

3.2. Functions

3.3. Usabilit

uirements

3.3.1. Learnability

3.3.2. O

erabilit

3.3.3. User interface aesthetics

3.4. Performance re

uirements

3.5. Logical database requirements

3.6. Desi

n constraints

3.7. Software system quality attributes

3.7.1. Functional suitabilit

3.7.1.1. Functional appropriateness

3.7.2. Reliabilit

3.7.3. Availabilit

3.7.4. Securit

3.7.4.1. Confidentiality and privac

3.7.4.2. Inte

rit

3.7.4.3. Authenticit

3.7.5. Maintainabilit

3.7.6. Portabilit

3.8. Su

ortin

information

3.9. Other requirements

3.9.1. Gamification requirements

4. Appendices

4.1. Assumptions and dependencies

4.2. Acronyms and abbreviations

2.2.4 Security Requirements

Security and data privacy issues are one of the major

hurdles threatening the effectiveness of mobile health

applications. Being one of the central quality

characteristics, security is defined as the degree of

information and data protection provided by a

software product so that users have a level of data

access appropriate to their types and levels of

authorization (ISO/IEC 27799; ISO/IEC-25010

2011). It covers five sub-characteristics which are

confidentiality, authenticity, integrity, non-

repudiation, accountability.

2.3 Generation of the Catalog

With the purpose of simplifying the search and reuse

of the requirements identified in the GHA-CAT and

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438

in conjunction with their integration with the existing

requirements documents, each category of

requirements investigated in the present study is

incorporated in the corresponding subsection of the

SRS. Due to space constraints, only a few

requirements for each subsection are shown in Table

2. The identification of requirements has been

performed in a way that adheres to ‘loose coupling

and high cohesion’ guideline, in order to ensure a

high degree of flexibility of the whole system. Each

requirement has a unique identifier and a clear

description. Additional attributes may be completed

to capture further information about the requirement

such as source, date, priority, status, rationale and risk

(Wheatcraft, Ryan, and Dick 2016). These attributes

can subsequently be used to manage both the

requirements and the project along with helping to

track the status of the project and its underlying

engineering activities throughout the system

lifecycle. Requirement’s traceability is an

overarching requirements management practice that

not only defines requirements dependencies but also

allows for analysis of how potential changes in

requirements impact other requirements and the

project as a whole. Tracing requirements can take

different forms such as dependency, derivation,

inclusion, exclusion, satisfaction and validation.

Table 2: CAT-GHA Requirements specification.

Gamification re

uirements

G1 The a

shall be use

-centered in that it reflects user

erce

tions.

G2 The app shall integrate a combination of game mechanics.

G3 Gamification elements shall be well and seamlessl

inte

rated.

G4 The a

shall stand u

on a clear set of

uidin

rules to avoid rewar

-driven behavior and cheatin

G5 Gamification elements shall not crowd out the intrinsic motivation for

erformin

interestin

tasks.

G6 The a

shall enable social discover

between users.

G7 Basic information in user

rofiles shall be

ublic within the a

communit

romote social interaction.

G8 The a

shall

rovide at least one social interaction mechanism

(

commentin

, ta

, instant messa

, etc

)

G9 The app shall enable users to build and/or join communities of users that truly match their areas of interest and

oals.

G10 The a

shall scale the difficult

and hel

users ac

uire new skills.

G11 The a

shall scale the challen

es accordin

to the user’s current ca

abilities.

Functionality Suitability requirements

FS1 The functional content of the a

shall be useful for users in a wa

that matches their needs and ex

ectations.

FS2 The features and functionalities of the a

shall be clear and sim

le to access and use.

FS3 The features and functionalities of the a

shall be consistent and well-inte

rated.

FS4 Throu

h its different sections, the a

shall

rovide utile and ade

uate content to the users.

Usability requirements

U1 The user shall be able to easil

learn to use the a

and its features.

U2 The desi

n of the a

shall be com

rehensible b

the user.

U3 The interaction desi

n of the a

shall be intuitive, eas

to learn and e

uall

eas

to remember.

U4 The app user interface should be simple with succinct elements and clear features.

The app shall include a help section.

[U6-1] The help section shall be well complete, easy to scan and effortlessly searchable.

[U6-2] The help section shall have all resources and contact information accessible at any given point.

[U6-3] The hel

section shall be context sensitive and shall ex

lain how to achieve common tasks.

Securit

uirements

S1 The app shall provide a privacy policy.

[S1-1] privacy policy shall be understandable and conspicuously posted.

[S1-2] The privacy policy shall clearly inform users of the information accessed, collected, or transmitted by the

app and how that information is used, secured, and disclosed.

S2 Functionality that may infringe the privacy and security of users shall not be activated before the

user voluntaril

and in the knowled

e of the related ris

ives his/her consent.

S3 The a

data stored in the user device shall be encr

ted to

revent leaka

S4 The personal data shall be adequate, relevant, and limited to what is necessary to the purposes for which they

are processed.

[S4-1] Onl

ersonal data necessar

for the

ose

(

)

shall be

rocessed.

A Reusable Catalog of Requirements for Gamiﬁed Mobile Health Applications

439

3 RESULTS

This section illustrates the applicability of the catalog

GHA-CAT using a gamified mHealth app. The

selected app for evaluation using this catalog is Blood

Donor which is perhaps the most gamified app in

blood donation field. Blood Donor is a free app

developed by the American Red Cross to motivate

people to donate blood through gamification

principles. The app is available in both Google play

and Apple app stores. In this evaluation, the iOS

version of the Blood Donor app has been used. A

checklist has therefore been generated from the

adapted catalog GHA-CAT* which included major

aspects in terms of gamification, functional

suitability, usability and security. The checklist took

the form of a questionnaire regrouping 29 items. The

possible answer to these questions is either ‘Yes’,

‘No, ‘Partially’ or ‘N/A’ which means not applicable.

Table 3 summarizes the results of the evaluation

perform on the Blood Donor app. The answers to the

questionnaire are as follows: Yes: 26, No: 3.

4 DISCUSSION

Despite the growing popularity of gamification in

mHealth apps, no specific standard has been found

that clearly defines reusable requirements in terms of

the integration of gamification elements. Thus, the

GHA-CAT is very useful for developers and

designers of gamified mHealth apps. Conjointly with

gamification core pillars, the GHA-CAT also

includes reusable relevant quality requirements of

which developers can elicit and specify their needs

with regards functional suitability, usability and

security as being considered highly effective within

gamified systems (Vargas Enríquez 2016).

Table 3: Checklist to assess the Blood Donor app.

ID Question Result

Does the app integrate a combination of game mechanics?

Yes

Are the gamification elements well and seamlessly integrated into the application?

Yes

Does the app provide at least one social interaction mechanism (commenting, tagging, instant

messaging, etc.)?

Yes

Does the app enable the user to build and/or join communities of users that truly match their

areas of interest and

oals?

Yes

Does the app scale the challenges according to the user’s current capabilities?

Yes

Does the app include small attainable goals to help users begin new behaviors and keep

commitment?

Yes

Does the app provide the user with immediate feedback on their performance?

Yes

Does the app enable the user to constantly track their progress?

Yes

Does the app reward user progress through extrinsic incentives (e.g., points, badges)?

Yes

Q10

Does the app grant users with the possibility to redeem their virtual rewards?

Yes

Q11

Does the app include a sense of game-like playfulness while serving a serious purpose?

Yes

Q12

Are the features and functionalities of the app clear and simple to access and use?

Yes

Q13

Are the features and functionalities of the app consistent and well-integrated?

Yes

Q14

Is the design of the app easily comprehensible by the users?

Yes

Q15

Is the interaction design of the app intuitive, easy to learn and equally easy to remember?

Yes

Q16

Does the app include a help section?

Yes

Q17

Does the app handle errors in a right way?

Yes

Q18

Are the error messages polite, friendly, and jargon-free?

Yes

Q19

Is the informational content of the app categorized adequately?

Yes

Q20

Is the undo function available for most operations?

Yes

Q21

Does the app enable users to configure language settings to suit their preferences?

Q22

Does the app enable users to handle both screen orientations?

Q23

Is the content of the app well-presented and well-ordered?

Yes

Q24

Are the fonts used for text in the app appropriate?

Yes

Q25

Is the color scheme used on the user interface of the app adequate?

Yes

Q26

Does the app provide a privacy policy?

Q27

Does the app process only relevant personal data?

Yes

Q28

Does the app allow input validation to check the data supplied?

Yes

Q29

Does the app provide a strong authentication mechanism?

Yes

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440

Considering the fulfilled items among those in the

checklist, the Blood Donor app yielded a coverage

score of 89.7%. In fact, the Blood Donor app has a

few minor flaws with regards usability and security.

Therein, this app lacks the ability of screen

orientation which it is not only helpful for users with

low vision but also provides opportunities to create

better user experience as it offers an additional layout

with a simple turn of the device. Further, the app does

not implement a multi-language support,

undoubtedly, because it is intended for American

residents, however, the United States has always been

a country noted for its linguistic diversity. It goes

without saying that English language apps tend to fare

well in many parts of the world but adopting the

native language of users is paramount as it avoids

miscommunication, widens reachability and builds

loyalty and user trust. Furthermore, the absence of the

privacy. Although being included in the website of

the app, it is highly recommended to present an inapp

moment (Martínez-pérez et al. 2015).

5 CONCLUSIONS

In spite of the unquestionable popularity of

gamification in health care area, there is no formal

standard that regulates its implementation. The

present paper therefore proposed a catalog of

requirements for gamified mHealth apps. Originated

from recommended standards and multiple

information sources, the GHA-CAT encompasses the

most relevant requirements in relation to

gamification, functional suitability, usability and

security. This catalog is therefore intended to help

stakeholders and developers in eliciting, specifying

and validating requirements of gamified mHealth

apps. It can be used for audit purposes as well.

For future work, it is intended to prioritize the

catalog items using an appropriate requirements

prioritization technique in order to guarantee the

usefulness of the catalog even in critical

circumstances (i.e., tight deadlines, budgetary

constraints). It is also expected to continuously

improve the content of the catalog using additional

information sources such as new standards or other

stakeholders’ needs.

ACKNOWLEDGEMENTS

This work was conducted within the research project

PEER, 7-246 supported by the US Agency for

International Development. The authors would like to

thank the NAS and USAID for their valued support.

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