Game not over: Explaining older adults' use and intention to continue using a gamified eHealth service

Background Gamification within eHealth services can increase eHealth adoption. However, little is known about factors affecting adoption of gamified eHealth among older adults. In this study, we sought to explain the (continued) use of a gamified eHealth service among older adults (55+). Methods Participants used a gamified eHealth service, focusing on falls prevention, for 4 weeks and completed a post-test questionnaire based on the Technology Acceptance Model. We used Partial Least Squares Structural Equation Modeling to analyse our data. Results Seventy-two older adults participated with a mean age of 65.1 years (SD = 7.0). Our results show that first, perceived ease of use affected use of the service (use duration: beta = 0.303, R-2 = 0.130, and use frequency: beta = 0.304, R-2 = 0.107). Second, perceived usefulness affected the intention to continue using the service (beta = 0.754, R-2 = 0.640). Third, use of the service did not predict the intention to continue using it. Furthermore, enjoyment affected perceived usefulness (beta = 0.783, R-2 = 0.563) and aesthetics affected perceived ease of use (beta = 0.634, R-2 = 0.652). Conclusions This study refutes the expected relation between use and intention to continue use a gamified eHealth service. Additionally, we learned that using theoretical approaches focusing on technology acceptance, are not suitable for explaining (continued) use of gamified eHealth services.