University of Oulu

Giunti G, Mylonopoulou V, Rivera Romero O. More Stamina, a Gamified mHealth Solution for Persons with Multiple Sclerosis: Research Through Design. JMIR Mhealth Uhealth 2018;6(3):e51. DOI: 10.2196/mhealth.9437. PMID: 29500159

More stamina, a gamified mHealth solution for persons with multiple sclerosis : research through design

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Author: Giunti, Guido1,2; Mylonopoulou, Vasiliki2; Rivera Romero, Octavio3
Organizations: 1Salumedia Tecnologias
2University of Oulu
3Universidad de Sevilla
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 1.7 MB)
Persistent link:
Language: English
Published: JMIR Publications, 2018
Publish Date: 2018-03-05


Background: Multiple sclerosis (MS) is one of the world’s most common neurologic disorders. Fatigue is one of most common symptoms that persons with MS experience, having significant impact on their quality of life and limiting their activity levels. Self-management strategies are used to support them in the care of their health. Mobile health (mHealth) solutions are a way to offer persons with chronic conditions tools to successfully manage their symptoms and problems. Gamification is a current trend among mHealth apps used to create engaging user experiences and is suggested to be effective for behavioral change. To be effective, mHealth solutions need to be designed to specifically meet the intended audience needs. User-centered design (UCD) is a design philosophy that proposes placing end users’ needs and characteristics in the center of design and development, involving users early in the different phases of the software life cycle. There is a current gap in mHealth apps for persons with MS, which presents an interesting area to explore.

Objective: The purpose of this study was to describe the design and evaluation process of a gamified mHealth solution for behavioral change in persons with MS using UCD.

Methods: Building on previous work of our team where we identified needs, barriers, and facilitators for mHealth apps for persons with MS, we followed UCD to design and evaluate a mobile app prototype aimed to help persons with MS self-manage their fatigue. Design decisions were evidence-driven and guided by behavioral change models (BCM). Usability was assessed through inspection methods using Nielsen’s heuristic evaluation.

Results: The mHealth solution More Stamina was designed. It is a task organization tool designed to help persons with MS manage their energy to minimize the impact of fatigue in their day-to-day life. The tool acts as a to-do list where users can input tasks in a simple manner and assign Stamina Credits, a representation of perceived effort, to the task to help energy management and energy profiling. The app also features personalization and positive feedback. The design process gave way to relevant lessons to the design of a gamified behavioral change mHealth app such as the importance of metaphors in concept design, negotiate requirements with the BCM constructs, and tailoring of gamified experiences among others. Several usability problems were discovered during heuristic evaluation and guided the iterative design of our solution.

Conclusions: In this paper, we designed an app targeted for helping persons with MS in their fatigue management needs. We illustrate how UCD can help in designing mHealth apps and the benefits and challenges that designers might face when using this approach. This paper provides insight into the design process of gamified behavioral change mHealth apps and the negotiation process implied in it.

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Series: JMIR mHealth and uHealth
ISSN: 2291-5222
ISSN-E: 2291-5222
ISSN-L: 2291-5222
Volume: 6
Issue: 3
Article number: e51
DOI: 10.2196/mhealth.9437
Type of Publication: A1 Journal article – refereed
Field of Science: 113 Computer and information sciences
217 Medical engineering
3111 Biomedicine
3124 Neurology and psychiatry
315 Sport and fitness sciences
318 Medical biotechnology
6132 Visual arts and design
Funding: Guido Giunti MD and Vasiliki Mylonopoulou gratefully acknowledge the grant number 676201 for the Connected Health Early-stage researcher Support System (CHESS ITN) from the Horizon 2020 Framework Programme of the European Commission.
EU Grant Number: (676201) CHESS - Connected Health Early Stage Researcher Support System
Copyright information: © Guido Giunti, Vasiliki Mylonopoulou, Octavio Rivera Romero. Originally published in JMIR Mhealth and Uhealth (, 02.03.2018. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.