ENTREPRENEURIAL DECISION-MAKING LOGICS IN ADOPTING GAMIFICATION TO HEALTHCARE AND WELL-BEING
Nguyen Ngoc Phuong Dung Master’s thesis _ 285318
Health and Business Management University of Eastern Finland Department of Health and Social Management
December 2020
UNIVERSITY OF EASTERN FINLAND, Faculty of Social Sciences and Business Studies
Department of Health and Social Management, health and business
NGUYEN, NGOC PHUONG DUNG: Entrepreneurial decision-making logics in adopting gamification to healthcare and well-being
Master's thesis, 59 pages
Thesis Supervisors: Ville-Veikko Piispanen PhD (Economics, Business Administration) December 2020
Keywords: decision-making logics, causation, effectuation, gamification, healthcare and well-being
Decision making is an indispensable component in business management. The entrepreneurship literature has investigated studies supporting the topic of decision- making process. Out of the contributions, the study of Sarasvathy conducted in the year 2000 is most remarkable for decision-making models built on causation and effectuation logics.
The gamification phenomenon is emerging field in recent years, attracting increasing among researchers and practitioners. Gamification is used in diverse fields, such as education, e-marketing, intra-organizational management, also increasingly in healthcare and well-being. Because the phenomenon is still new, investment in this industry could be considered as a venture. Therefore, it requires thorough but flexible decision-making process.
My thesis aims to explore decision-making logics entrepreneurs used to entering the gamification industry, to adopt this new technology to healthcare and well-being domain.
Decision-making logics here are based on causation and effectuation.
Narrative research and semi-structured interviews were used in the process of collecting, analyzing and interpreting empirical data. There were four participants in total engaging in the study. They are owners and manager of companies providing healthcare and well- being solutions in Finland.
The findings disclosed that in four narrative cases, three decision-makers used both causation and effectuation logics in their investment. The findings overall help to get considerable insight of decision-makers’ experience from their own view. Further studies are also strongly suggested for improvement in research methodology to gain more detailed understanding of reasoning used in decision-making process, especially separate research on business-to-business companies operating in the gamification industry.
TABLE OF CONTENTS
1 INTRODUCTION ... 1
2 THEORETICAL BACKGROUND ... 6
2.1 Entrepreneurial decision-making process ... 6
2.1.1 The explanation of decision-making in entrepreneurship ... 6
2.1.2 Causation and effectuation ... 8
2.2 Gamification-related business ... 14
2.2.1 The concept and principles of gamification ... 14
2.2.2 Effectiveness of gamified solutions to healthcare domain ... 16
2.3 Theoretical framework in this study ... 17
2.4 Synthesis of gamification-related business and two decision-making models from prior researches ... 24
3 METHODOLOGY ... 26
3.1 Methodological approach ... 26
3.2 Data collection ... 27
3.3 Analysis of the data ... 29
4 INTERPRETATION OF FINDINGS ... 32
4.1 Entrepreneur A ... 32
4.2 Entrepreneur B ... 35
4.3 Manager C ... 37
4.4 Entrepreneur D ... 40
4.1 Key findings ... 42
5 DISCUSSION AND CONCLUSION ... 51
6 REFERENCES ... 57
FIGURES FIGURE 1 Causal logic ... 9
FIGURE 2: Effectual logic ... 11
FIGURE 3 : Framework of gamification principles ... 15
TABLES
TABLE 1. Stages of decision-making process ... 8
TABLE 2. Differences between causation and effectuation modes ... 13
TABLE 3. The participants’ information and interview process ... 29
TABLE 4. Description of coding scheme ... 30
TABLE 5. Summarized results from entrepreneur A’s decision-making logic ... 44
TABLE 6. Summarized results from entrepreneur B’s decision-making logic ... 45
TABLE 7. Summarized results from manger C’s narrative ... 47
TABLE 8. Summarized results from entrepreneur D’s decision-making logic ... 49
Acknowledgements
Throughout the writing of my thesis I have received a great deal of support and assistance.
I would first like to thank my supervisor, Ph.D Ville-Veikko Piispanen who instructed me to do my thesis , and give useful comments and advice on how to improve the content.
I would like to thank and truly appreciate the participants who engaged in my interviews and assisted me in doing and completing my Master’s thesis that also helps me finish my study programme.
1 INTRODUCTION 1.1 The research topic
Deciding is one of principle element in organizational activities. “A very large and growing fraction of people in business struggle with numerous and diverse decisions daily” (Sarasvathy 2001, 244). “Deciding which opportunities to pursue and how to exploit them are defining features of entrepreneurship” (Shane and Venkataraman 2000;
Bryant 2007, 732). Accordingly, entrepreneurship is defined “as the process of identifying, evaluating, and evaluating and exploiting opportunities” (Bacq and Janssen (2011, 376) which in turn leads to product creation, or new market entry.
From entrepreneurs’ perspective, opportunities are recognized from complex and changing contexts, such as increasing pace of technological development, economic conditions, market demand, socio-political environment and so forth. Thus, evaluating the viability of opportunities requires entrepreneurs to utilize specific skills and capabilities of making rational decisions. Those decisions may involve analyzing information, assessing resources, develop cost-effective solutions to resolve problems or fulfil demads in the marketplace.
Since decision-making process determines either positive or negative business outcome, it is regarded as an indispensable component in entrepreneurship.
As Reymen et al. (2015, 352) report, “the entrepreneurship literature describes several approaches to decision making in the face of uncertainty, including approaches that stress planning and control” (Brinckmann, Grichnik, and Kapsa 2010; Delmar and Shane 2003;
Miller and Cardinal 1994), “approaches that emphasize more flexible, adaptive, and collaborative decision making, such as improvisation” (Baker, Miner, and Eesley 2003),
“bricolage” (Baker and Nelson 2005), or “effectuation” (Sarasvathy 2001).
According to Saatci et al. (2014, 143-155), “the decision-making process used by entrepreneurs is influenced by organizational context, individual characteristics and environment factors” (for example availability of financial, human resource; accessibility of suppliers, customers and so on). Technological change is one of the most determining external factors that may impact entrepreneurial decision-making reasoning.
In parallel with a rapid rise of computing technology, Alahäivälä and Oinas-Kukkonen (2016, 62) demonstrate that “healthcare providers are constantly looking for effective ways to help people improve their health behaviours. Promoting healthy lifestyles to prevent diseases, supporting self-management of treatments, and raising public awareness are being carried out increasingly through information technology. It is important that these systems are designed in a manner of engaging and motivating the users so as to achieve the desired health behaviour and maintain sustainable well-being”.
The game-like design has been adapted for healthcare-related systems is associated primarily with entertainment. Many instances of healthcare applications (behaviroural games, rehabilitation games) require physical activity as input that are beneficial to self- regulation of nutrition control, or stroke rehabilitation. Those applications above drive the upgrowth of the term “gamification”.
Gamification is considered as technological applications with a potentially high impact on the contexts such as healthcare (Blohm and Leimeister 2013, Conaway and Garay 2014; Koivisto and Hamari 2019; Seaborn and Fels 2015; Wünderlich et al. 2020), sustainability, retail, media, consumer goods, transportation, education, among others. “It represents the use of actual games, real-world simulation or game theory in organizational settings” (Keys and Wolfe 1990, Camerer 2003; K. Robson et al. 2015, 412).
Based on the source mycustomer.com, I have found an interesting example of gamification which is called NikeFuel, a campaign launched Nike corporation. NikeFuel is a proprietary unit of measurement for tracking fitness activity that allow users to compete against each other in terms of the amount of daily physical activity. All the activities will be recorded by the application on their smartphone and converted into points. The users will attain special trophies and rewards after reaching a certain level.
The campaign aims to not only generate Nike’s customers’ motivation for playing sports but also increase the brand’s visibility.
Undoubtedly, gamification “provides promising possibilities for supporting behavior change in healthcare” (Alahäivälä and Oinas-Kukkonen 2016, 62). Hence, “turning health communication or health behaviour change programs into games might be a good way to intrinsically motivate users to expose themselves and continually engage with these programs” (Baranowski et al. 2008; Wouters et al. 2013; Johnson 2016, 90).
However, the broad adoption of gamification to healthcare and well-being has faced major difficulties and challenges due to high production cost and design complexity. For instance, gamification requires “users to create committed spaces and times in their life for gameplay” (Johnson et al. 2016, 7) through dedicated devices that may cause interruption to their regular routine or work schedule.
1.1 The purpose of the study
The purpose of my thesis is to examine decision-making logics entrepreneurs used to entering the gamification industry. Through this study, broad understanding of the gamification industry is acquired.
Investment in gamification has not been yet discussed in entrepreneurship studies concerning decision-making process so far. Notably, in the healthcare and wellbeing domain, gamification had been summarized based on prior researches performed by Johnson et al. (2016). The research has reported gamification as empirical evidence on supporting health behaviour change. Nonetheless, the effectiveness of gamification has been evaluated independently from users’ perspective instead of from providers’ one.
My thesis is thus crucial to conducting and supplementing shortcoming in extant literature. The study is analyzed from gamification providers’ view, thereby raising awareness of the effectiveness of gamification in healthcare and well-being sector.
Accordingly, the research question is taken into consideration as follows:
- How do entrepreneurs decide to adopt gamification to healthcare and well-being?
Analyzing the research question primarily relies on the decision-making frameworks developed by Sarasvathy (2001). The frameworks comprise a demonstration of effectual and causal logics as well as a comparison between the two logics. Gamification is not a considerable section of my thesis because it plays a role as an external factor that stimulates entrepreneurs to enter the gamification industry. For this reason, gamification is described in my thesis concerning what it is, how it works, and what benefits it brings about especially in healthcare and well-being sphere.
Narrative research is the most desired methodological approach to my thesis since it is appropriate to answer the research question. This approach allows the researcher to collect stories from participants for the purposes of analysis, such as conducting interviews that focus on stories about a certain type of experience (Allen 2017, 1069). Applying this explanation for my thesis, narrative research allows me to collect entrepreneurs’ stories or their sharing from which I can gain insight of their experience in deciding.
1.2 Key concepts of the study
Key concepts in my study include: decision making or decision-making process, causation, effectuation, gamification, gamified healthcare and well-being solutions (gamified solutions, in short).
Decision making is “defined as the process of selecting a specific course of action among alternatives to achieve certain results” (Das 2016, 52).
Causation is defined as “the process takes a particular effect as given and focus on selecting between means to create that effect” (Sarasvathy 2001, 245). Simply put, causation points out planning-based approaches referring to a decision-making logic.
These terms, “causation”, “causation logic”, “causal logic”, “causation reasoning” are used interchangeably in my thesis.
In contrast, effectuation “take a set of means as given and focus on selecting between possible effects that can be created with that set of means” (Sarasvathy 2001, 245).
Simply put, effectuation points out flexible, collaborative and adaptive approaches referring to a decision-making logic. These terms, “effectuation”, “effectuation logic”,
“effectual logic”, “effectuation reasoning” are used interchangeably in my thesis.
“Gamification refers to the use of gamification mechanics to create a gamified experience and to influence behaviors and emotions in traditionally non-game contexts” (Robson et al. 2015, Hammedi et al. 2017).
Gamified healthcare and well-being solutions mentioned refers to methods, applications, or products designed using game-oriented principles.
1.3 Structure of the thesis
My thesis incorporates four main sections. The first section presents the existing literature on entrepreneurial decision-making process, logics that entrepreneurs use to make decisions, and gamification. The next section reports methodological approach in conjunction with the findings. The final section opens discussion about the findings, limitations, and further research needed for improvement.
2 THEORETICAL BACKGROUND
2.1 Entrepreneurial decision-making process
2.1.1 The explanation of decision-making in entrepreneurship
Decision-making is an essential part of modern management and plays an important role in entrepreneurial studies. “The term decision was created to indicate that the end of deliberation has been achieved and then the implementation of action has begun”
(Buchanan and Connell 2006; Winnaar and Scholtz 2019, 1283).
Decision making studies are delineated by either behaviour- or cognition-based theory.
Das (2016, 52) defines decision making as “the process of selecting a specific course of action among alternatives that are expected to enable the decision maker to achieve certain results. It involves processing of a vast amount of information and making judgment about costs and benefits of options whose outcomes are unknown in advance.”
Due to the fundamental premise of entrepreneurship, making decision consciously or subconsciously every day is indispensable for entrepreneurs. It encompasses capital or venture investment, profit maximization, and risk mitigation simultaneously in the business context. Furthermore, decision making encompasses all organizational functions namely planning, managing, staff training and so on. For instance, managers performing planning function will choose appropriate goals and directions for action, decide when, how and who will carry out a separate work activity.
The current studies on decision making are built upon rationality; bounded rationality;
and cognitive bias and emotion theory.
- Rationality theory proposes that decision-making process is fully “rational and enter situations with predetermined objectives and knowledge of the consequences of each alternative (Eisenhardt and Zbaracki 1992; Pettigrew 2014;
Winnaar and Scholtz 2019, 1285).
- In the meantime, bounded rationality theory contends that human decision- making models should rely on what individual knows and not on assumptions using probability laws (Simon 2000; Frankl 2015, 3). Nonetheless, Simon (2000)
stresses that the influence of internal and external environment hinders individuals’ capabilities from reaching completely rational decisions.
In short, bounded rationality implies that decision-making is determined not only by oriented objectives but also by the decision maker’s (Winnaar and Scholtz 2019, 1287) competence in evaluating the consequences of varied options whilst balancing competing demands.
- Cognitive bias is defined as “common types of mental shortcuts used to make judgments” (Simon 2000, 113; Winnaar and Scholtz 2019, 1287). In other words,
“it underlines the utility of non-rational decision making” Busenitz and Barney (1997, 13).
Pitz and Sachs (1984) contend that “under conditions of environmental uncertainty and complexity, cognitive bias and emotion can be an effective and efficient guide to approximate the appropriate decisions”. They are perceived as a prompt response and
“trade-off between effort and accuracy” (Payne et al. 1988, Gilbert-Saad 2018, 76) which entrepreneurs often rely on to reach decisions when analytical methods are not feasible because of financial, time constraints or incomplete information.
Notwithstanding, mental model-related approaches such as emotion, speculative formulation results in less rational and comprehensive decisions. Hence, to overcome these biases, it is proposed that entrepreneurs should adopt policies requiring collection of more data and higher level of group decision making, encouraging skepticism, and increasing accountability.
It is posited that “rational choice theory can be broken down into six simple stages which are known as identifying the problem, generating alternatives, evaluating alternatives, choosing an alternative, implementing the decision” (Lunenburg 2011; Winnaar and Scholtz 2019, 1287).
TABLE 1. Stages of decision-making process (Lunenburg 2011; Winnaar and Scholtz 2019, 1287)
Despite the fact that theoretical foundation for decision making derives from rationality, it cannot provide comprehensive knowledge for entrepreneurs. Complex and unstable business environments today possibly affect the way entrepreneurs make decisions as they cannot grasp all unknown facts and pertinent consequences.
Therefore, it is believed that “entrepreneurs have cognitive preferences and mental frameworks which influence their decision making” (Mitchell et al. 2002; Shane and Venkataraman 2000; Maine et al. 2014, 2) in uncertain and complex conditions. Biases and heuristics are notable examples of such cognitive preferences and mental frameworks that can be utilized in entrepreneurial decision making.
Busenitz and Barney (1997, 12) assert that “biases and heuristics are decision rules, cognitive mechanisms, and subjective opinions people use to assist in making decisions.
Frequently, the use of biases and heuristics yields acceptable solutions to problems for individuals in an effective and efficient manner”.
The two modes, namely causation and effectuation, reflect extremes of such strategies inferred by Sarasvathy (2001).
2.1.2 Causation and effectuation Causation
According to Savarvathy (2001, 245), “causation process takes a particular effect as given and focus on selecting between means to create that effect”. Simplistically speaking,
“causation is defined as a goal-driven and deliberate model of decision making”
(Savarvathy 2001, 245). Fisher (2012, 1021-1022) describe a traditional perspective on entrepreneurship that “under a causation mode, an individual entrepreneur decides on a goal and then plans how to achieve the goal” he/she predefine as well as all possible problems involved in.
To reach a decision, the utility of a sequential screening process is conducted to identify and analyze alternative approaches which involve environmental analysis such as competitors, the market, competitive advantages and positioning. “The alternative with the highest expected return is selected and implemented” (Fiet 2002). “The entrepreneur will elaborate a tactical blueprint and gather necessary means to attain the goals”
(Savarvathy 2008; Stroe et al. 2018, 266).
FIGURE 1 Causal logic (Duening et al. 2012, 206)
It is conceded that causal reasoning is beneficial for most cases related to engineering projects with clearly defined goals. For example, “many constructions would fit this description, such as building an office from the blueprint that follows established codes and uses approved building materials” (Azcentral 2018). By specifying the number of processing stages, causation model of the project will reduce distraction and eliminate waste of materials and time (Burch 2018).
Another interesting example of causation model is “a chef assigned the task of cooking
dinner. If a client picks out a menu in advance, all the chef needs to do is list the ingredients needed, shop for them, and then actually cook the meal” (Aalto University School of Business 2015). The example highlights causation logic as it begins with a given menu and concentrate on choosing efficient approaches to prepare the meal.
Causation or causal decision-making underscores prediction-based mode with a business plan development, systematic processing, exploit pre-existing information, the existence of a market for example, and try to predict an uncertain future.
Entrepreneurs pursuing causation or predictive decision-making logic well adhere to goal orientation. Sarasvathy (2001, 252) deduces that causation process “focuses on the predictable aspects of an uncertain future with the logic declared: to the extent that entrepreneurs can predict future, they can control it.”
Accordingly, they incline to apply predictive strategies to future outcome measure that include “forecasting scenarios, evaluating consequences, and formulating refined portfolio” (Wiltbank, Read, Dew and Sarasvathy 2009). By considering various alternatives, “accurate factual predictions of expected future outcome are given to attain success” (Stroe et al. 2018, 266).
“In a complex and uncertain setting such as the entrepreneurial context, however, predictions are less accurate and useful” (Dew et al. 2009; Stroe et al. 2018, 265).
Forecasting becomes increasingly complex, thereby requiring entrepreneurs to employ decision logics that reduce the need for prediction. Effectuation offers such an approach.
Effectuation
In contrast to causation, effectuation or effectual logic does not define a prior goal in mind. Sarasvathy (2001, 245) states that effectuation approaches “take a set of means as given and focus on selecting between possible effects that can be created with that set of means.” This way of thinking emphasizes decision-making process with the resources currently controlled in an “uncertain operating environment that is difficult to predict”
Sarasvathy and Dew 2005). “Effectuation allows the entrepreneur to adapt flexibly to changes in the environment” (Sarasvathy and Dew 2005) whereby they might pursue new
business opportunities, switch initial goals, or courses based upon the new information or pertinent contingencies.
Effectual logic is interpreted as an explanation of why the entrepreneur attempts to exploit a variety of contingencies brought on by the unstable environment, thus creating alternative future outcomes. A good example of effectuation process is preparation for a meal without a planned menu. The meal then is cooked based on ingredients which are available in the kitchen cupboards.
FIGURE 2: Effectual logic (Duening et al. 2012, 206)
Effectuation process is encapsulated in five fundamental principles by Sarasvathy (2001, 252) and Duening et al. (2012, 207-209).
- Accessible set of means
A set of means is described as resources that the entrepreneur can acquired at hand including three categories: “who they are, what they know, and whom they know”
(Sarasvathy 2001, 245). “Effectual logic differs from causal logic in that it starts from the entrepreneur’s resources, focuses on increasing and optimizing performance using these resources” (Sarasvathy and Dew 2005; Stroe et al. 2018, 266).
In effectual process, the entrepreneur replies upon various resources like capital, physical equipment, specialized knowledge, patents, or personal connection to establish the corresponding objective which is not clearly formed at an initial stage of a venture. Thanks to this distinctive principle, “effectuation as a decision- making mode allows greater resilience to external shocks and setbacks” (Maine et al. 2015, 55).
- Affordable loss
“Effectual entrepreneurs embrace the intrinsic ambiguity of the entrepreneurial context and follow a principle of affordable loss. For entrepreneurs who adopt an effectual logic, the focus is not on high investments that maximize potential future returns, but rather on available resources and small investments to ensure that the new venture does not suffer if these investments are lost” (Read and Sarasvathy 2005; Dew et al. 2009; Stroe et al. 2018, 267).
- Strategic alliance
Effectual logic, “on the other hand, is an adaptive process whereby entrepreneurs seek out, incorporate external feedback, and getting pre-commitments from potential suppliers, competitors and customers” (Chandler et al. 2011). It emphasizes partnership building and encourages committed stakeholders’
participation and contribution. “They offer their own resources, co-create the firm’s development and emerging objectives” (Stroe et al 2018, 266) and provide the firm with helpful feedback on the prototype of products, hence reduction in uncertainty.
- Exploitation of contingencies
The effectual entrepreneur recognizes contingencies “as opportunities for novelty creation hence to be leveraged” (Heydenrych 2013). He/she will embrace and
“learn to transform both positive and negative contingencies into useful component of new opportunities” (Denrell and March 2001).
- Controlling an unpredictable future
“Effectuation argues that entrepreneurs themselves exploit the logic of non- predictive control to transform means at hand into new outcomes, even if they may not have initially envisaged those outcomes” (Ericsson 2006).
Sarasvathy's study (2001) and the subsequent empirical studies (Dew et al. 2009;
Sarasvathy and Kotha 2001; Sarasvathy et al. 1998) have emphasized that “entrepreneurs following an effectual logic are less likely to try to predict the future and are more likely to change their initial goals and visions for the new venture. Rather than predicting the future, they are more likely to work with means within their control and make adjustments as necessary” (Dew et al. 2009; Chandler et al. 2009, 377).
Comparison and synthesis
In summary, the theoretical foundation of causation process derives from the rational decision-making perspective (Chandler et al. 2009, 377), endorsing “the use of logical reasoning as a predictive instrument. Causation comprises elements of strategic planning as it aims at predicting uncertain future” (Ansoff 1979; Mintzberg 1978; Smolka et al.
2016, 3), “a strict goal orientation with a focus on profit maximization” (Friedman 1953;
Bourgeois 1985; Bird 1989).
In contrast, effectuation is a decision-making logic emphasizing the use of non-predictive strategies to develop products and market such as “flexible courses of action that are based on available means of who a person is, what they know and whom they know”
(Chandler et al. 2011); loss limitation to an affordable level; partnership co-creation; and experimentation.
“As such, effectuation is a more proactive and emergent way of dealing with uncertain environments” (Smolka et al. 2016, 3).
The main differences between the two decision-making frameworks are summarized in the Table 2 below.
TABLE 2. Differences between causation and effectuation modes (Sarasvathy 2001; Dew et al. 2009, 290)
2.2 Gamification-related business
2.2.1 The concept and principles of gamification
In recent years, technology has increasingly influenced people’s life in an attempt to encourage their healthy behaviour. Gamification is “the most popular development in this area, which refers to technology promoting intrinsic motivations towards various activities by employing game characteristics in non-game contexts” (Hamari and Koivisto 2015, 419).
Robson et al. (2015, 412) explain that “gamification is the application of lessons from the gaming domain to change behaviors in non-game situations”. Further, game-like incentives, points, interaction, badges, goals, leadership, competition, rewards, rules, interface, feedback for example are indispensable elements in gamification.
In addition, Robson et al (2015, 413-416) suggest three types of elements as the main principles of gamification, which include mechanics, dynamics, and emotions.
- As the authors delineate, “mechanics are the decisions that designers make to specify the goals, the rules, the setting, the context, the types of interactions, and the boundaries of the situation to be gamified” (Robson et al 2015, 414).
- Dynamics describe in-game players’ behaviour, their strategic actions, interaction, and experience during participation process. This attribute stipulates
“how players follow the mechanics chosen by designers” (Robson et al 2015, 414).
- Emotions are “the mental affective states and reactions evoked among individual players when they participate in a gamified experience” (Robson et al 2015, 416).
FIGURE 3 : Framework of gamification principles (Robson et al. 2015, 416)
“Gamification is used in various domains, such as e-commerce (Insley and Nunan 2014), mobile marketing Hofacker et al. 2016), innovation (Fuller 2006, 2011), education, and intra-organizational management” (Farzan and Brusilovsky 2011), but also increasingly in healthcare and well-being (Hammedi et al. 2017, 644)
Gamified systems using mobile phones or activity trackers inspire players to organize daily exercises in a more conducive manner which contributes to “generating positive experience of basic psychological need satisfaction as well as other elements of well- being like positive emotions, engagement, relationships, meaning, and accomplishment”
(Johnson, Jones, Scholes & Carras 2013; Johnson 2016, 10).
“Companies have widely accepted and adopted gamification as a means to increase initiation and retention of desired behaviors” (Fankhauser 2013; Chenyu 2017, 23). A notable application of this concept is exergames, which are defined as technology-driven physical activities, such as video games requiring users to move and interact physically with the games.
Fitocracy is another example of game-based exercise application that helps participants improve their fitness. Points are given to the participants and accumulated during workout that will advocate him in continue practicing next levels and receive more special rewards, such as achievable badges. Besides, the application is a social network of like- minded people who have a passion for fitness. It enables participants to share their
interests and their exercise progress to each other which will increase the ones’ motivation in return.
2.2.2 Effectiveness of gamified solutions to healthcare domain
It is believed that gamified application could be “a promising new approach to health behaviour change” (Pereira et al. 2014, Sola et al. 2015; Johnson et al. 2016, 90). Indeed,
“gamified systems can intrinsically motivate the initiation and continued performance of health and well-being behaviour” (King et al., 2013; Munson et al., 2015; Johnson et al.
2016, 91) through equipped platforms with powerful sensing, processing, storage, and display capacities.
“Current health gamification domains cover all major chronic health risks: physical activity, diet and weight management, medication adherence, rehabilitation, mental well- being, drug use, patient activation around chronic diseases, diabetes for instance”. (Sola et al. 2015; Johnson et al. 2016, 91).
“Studies have shown that gamifying physiotherapy increases activity-levels and facilitates patients’ rehabilitation” (Taylor et al. 2011). Physical inactivity can lead to major health problems that can be alleviated by at least 30 minutes of moderate-intensity exercise five days a week. Exergames have the potential to facilitate rehabilitation, especially intensive repetitive movements that patients might find boring” (McGlinchey et al. 2015). Furthermore, they can be used as evaluation tools that is “better perceived by patients than other conventional medical interventions” (Mira blog 2020).
A systematic review conducted by Bonnechère et al. (2016) shows “video game training in physical rehabilitation offer similar results as conventional therapy”. Many therapists have adopted this kind of training into their therapy sessions with patients. Thus, it is contended that “video games could be added as an adjunct treatment in rehabilitation for various pathologies to stimulate patient motivation” Bonnechère et al. (2016) and maintain well-being benefits.
Still, rehabilitation-orientated gamification has been improving the supply of external devices in order to promote aerobic conditioning, strengthening and balance. The
collaboration between clinicians and patients also plays a crucial role to the games’
appropriateness and effectiveness.
2.3 Theoretical framework in this study
Theoretical framework for this thesis stresses two logics entrepreneurs used in their decision-making process that are causation and effectuation. Before illuminating the two logics, I use the following articles mentioning entrepreneurs’ decisions to outline what is decision is, why and how entrepreneurs make decisions in their daily business operation.
Decision-making process
Four articles below present entrepreneurial decision-making process:
“Differences between entrepreneurs and managers in large organizations: biases and heuristics in strategic decision-making” of Busenitz and Barney (1997) explores differences between entrepreneurs and managers in large organizations. The authors argue that biases and heuristics can be an efficient guide to decision-making under conditions of environmental uncertainty and complexity.
“Self-regulation and decision heuristics in entrepreneurial opportunity evaluation and exploitation” of Bryant (2007) explores self-regulation in heuristics decision making
“whereby individuals set goals and then direct their own thought and behaviour to achieve such goals” (Zeidner et al. 2000). The author adopts both qualitative and quantitative techniques to investigate complex cognitive phenomena in organizational contexts (Creswell et al 2003). The results suggest that self-regulation does indeed play a significant role in the use of decision heuristics by entrepreneurs.
“Entrepreneurial decision-making: new conceptual perspectives” of Winnaar and Scholtz (2019) provides a more inclusive mechanism for the study of how entrepreneurs make decisions, with a more holistic approach to be utilized in their respective fields.
“Decision and design heuristics in the context of entrepreneurial uncertainties” of Gilbert-Saad et al. (2018) proposes a more realistic framework to explain the strategic use of heuristics. The authors prove distinction between decision and design heuristics; and argue that useful heuristics follow inherently distinct mechanism under absolute uncertainty.
And one e-book “Business decision making: streamlining the process for more effective results” is published by Frankl in the year 2015. This book is a good reference to learn about heuristics-based decision-making model.
Causation and effectuation logics
The article “Causation and effectuation: Toward a theoretical shift from economic inevitability to entrepreneurial contingency” written by Sarasvathy in 2001 is a relatively rigorous research. She utilizes a grounded theory methodology to identify the constructs of causation and effectuation. It impresses me that the clarification of two concepts is vividly depicted through two different business models of an imaginary restaurant. The author is excellent at not only defining causation and effectuation processes but also comparing differences the two logics. The research also sets a foundation for further studies on the two logics.
Another article “Causation and effectuation process: A validation study” of Chandler et al. published in 2009 continues developing two approaches evaluation from the original study of Sarasvathy. The research has investigated entrepreneurial decision making under conditions of uncertainty that hinges on dimensions of causation and effectuation constructs. The authors follow quantitative methodology that involves questionnaire and semi-structured interviews with entrepreneurs of young firms to collect data. The results have added pre-commitment dimension which is important to both processes. However, I think it is still not a significant contribution because the research has not clarified yet which approach those entrepreneurs tend to choose in the early stage of venture.
The study, How entrepreneurs think: why effectuation and effectual logic may be the key to successful enterprise entrepreneurship, by Duening et al. (2012) reports the application of effectual logic to key innovation process in the enterprise setting, herein to the new product development and the software development process. Discourse analysis is used to outline the authors’ general views on effectuation’s beneficial effect in innovation and there is no empirical evidence, which impose limitation on the study’s findings.
Nonetheless, this study is still helpful for me to perceive effectuation adoption in uncertain business environments that is akin to the gamification context in my thesis.
The next article “Effectuation, an emerging theory of entrepreneurship – towards a mature stage of the development” written by Matalamäki (2017) can be regarded as a critical research. Review is given based on prior studies that build and argue effectuation theory development (from the year 1998 to the end of the year 2016). The research contributes four main streams effectuation theory concerning innovation and product development, internationalization, effectuation and causation that can work simultaneously, and entrepreneurial expertise. This article provides me with a broad comprehension of effectual logic theory.
The research “Effectuation or causation: An fsQCA analysis of entrepreneurial passion, risk perception, and self-efficacy”, conducted by Stroe et al. in 2018, explores when and under what circumstances individual entrepreneurs’ passion, entrepreneurial self- efficacy, and risk perception lead to a causal or effectual decision-making logic. The study contributes and examines individual-level predictors of effectual and causal decision processes. I use this study as a source of reference to complement the theory section of two approaches.
The study “The role of entrepreneurial decision-making in opportunity creation and recognition” of Maine et al. (2015) investigates effectuation and causation as two opposing decision-making modes leading to opportunity creation and recognition. Case study method is employed to measure the decision-making processes of biotechnology entrepreneurs who has run their ventures for over ten years. The findings reveal that entrepreneurs recognize opportunities through either effectuation or a combination of effectuation and causation.
The study is well researched, informative, in conjunction with insightful discussion. The most interesting point I see is a proposed model of entrepreneurial decision-making in opportunity generation. The authors argue that the interplay between the environment and entrepreneurial decision-making modes describes when and how entrepreneurs adapt their responses and actions, and the role of external constraints explains the shift from effectuation to causation.
The article “Effectual versus predictive logics in entrepreneurial decision-making:
differences between experts and novice” of Dew et al. published in 2009 presents
differences in decision-making logics between expert and novice entrepreneurs. The authors apply Sarasvathy’s theoretical foundation along with quantitative methodology to evaluating differences in venture creation. In my view, the research is an exciting discovery since it proves that expert entrepreneurs tend to deploy effectuation, whereas novice entrepreneurs tend to deploy causation. Accordingly, I highly appreciate this research thanks to the new findings which also have a strong contribution to literature on two decision-making logics in particular and entrepreneurial expertise in general.
Additionally, I use this research as a source of reference to complete the theory section of the two logics.
The article “Effectuation logic in digital business model transformation: Insights from Japanese high-tech innovators”, studied by Baber et al. in 2019, examines how effectuation and causation logics are used in digital business models’ evolution. Studied firms are from Japan. The findings show the case firms’ evolution follows both effectuation and causation logics. Multiple case study is used to investigate incremental change combined with semi-structured interviews with the key decision-makers from the case firms. The study offers several implications for managers of digital businesses and contributes to the authors’ understanding of digital innovators’ business model changes based on various decisions when they move to new digital platforms.
In my opinion, this article presents rigorous research, especially the process of analyzing data. I highly appreciate the findings’ contribution to practical implication, apart from the purpose of doing the research. The article provides good reference to researching decision-making process in technological firms, and to a sample of analyzing decisions based on effectuation and causation reasoning. I believe that this article is well worth considering because the study content is similar to the context in my thesis.
The study, “Effectuation-causation: what happens in new product development?”, by Ortega et al. (2017) reports that in the context of new product development, causation reasoning is mainly adopted, in which planning plays an important role. On the contrary, as the level of innovation increases, the effectuation reasoning proves a more appropriate alternative. The study adopts action research, using documentary analysis, content analysis and alternate templates to analyze four new product development projects in food industry in Spain. The findings confirm appearance of both causation and effectuation
reasoning in all projects, effectuation emerges as dominant logic in the project linked to a greater degree of innovation and uncertainty. The study contributes to utilizing effectuation reasoning as a means engaging in projects that entail a higher degree of innovation, since it offers ways of dealing with the uncertainty linked to such projects.
I am fascinated by the research method used in the study because action research enables the authors to solve a practical business problem by engaging in the real projects, hence improvement in the impact and image of business research. The article offers good reference to linkage between innovation and the utilization of both decision-making logics.
The research “Effectuation and foreign market entry of entrepreneurial firms” of Chetty et al. (2015) explores decision-making process in the context of internationalization. The findings infer firms using causation logic are learning more rapidly
about foreign markets than the timid ones using effectuation logic and learning in
incremental steps. Both causation and effectuation logics are intertwined as alternate approach to foreign market selection and foreign market entry. A multiple case study is used for research method, including software firms from Finland and New Zealand.
The findings imply requirement for entrepreneurs’ flexibility in recognizing and creating opportunities as well as combining both the logics during internationalization.
I recognize that this is an interesting research as decision-making process using both the logics is discovered in the context of internationalization which goes through complex processes, risks, and entrepreneurs’ liability.
The study “Use of effectuation by established micro businesses: short-term gain, long- term pain?” of McGowan published 2020 investigate the efficacy and impact of effectual logic used by owner-managers of established micro firms when making buying decisions.
This study contributes to the utilization of effectual logic by a micro firm owner-manager in order to develop relationships with trusted suppliers. Additionally, the findings suggest effectuation positively promotes flexibility and reduces loss potential, thus positively affecting the price that the owner-manager is willing to pay. The study is carried out by semi-structured interviews with thematic analysis. The study provides a simple research method with a new discovery of relationship between effectuation and purchasing and selling activities.
Gamification
Gamification just accounts for a minor part in my thesis since it is considered as a context that drives entrepreneurs’ decision-making process. The following articles explain the concept, principles, effectiveness, and its application to healthcare and well-being domain in reality.
The article “Is it all a game? Understanding the principles of gamification” was published by Robson et al. in 2015. It presents the fundamentals of gamification and explains how it prompts managers to think about business practice in new and innovative ways. The authors display a framework of three gamification principles - mechanics, dynamics, and emotions to illustrate how gamified experiences can be created. An extended illustration of gamification is then provided with suggestion for future research and application opportunities.
“Why do people use gamification services” was researched by Hamari and Koivisto in 2015. The article aims to explore what benefits motivate people to use gamification services. Quantitative research is carried out in conjunction with questionnaire gathered from the users of a gamification service. the results of the study suggest that social and perceived usefulness aspects are more prone to positively reflect on attitude formation, whereas the perceived enjoyment show weak relationship with attitudes. Social factors are strongly associated with attitude, but show only a weak further association with the intention to continue the use of a gamification service.
“Gamification for health and wellbeing: A systematic review of the literature” was written by Johnson et al. in 2016. The study aims to assess the amount and quality of empirical support for the advantages and effectiveness of gamification applied to health and well- being. Critical research is used to identify advantages of gamification combine with systematic literature review of empirical studies on gamification for health and well- being. The evidence supports that gamification can have a positive impact in health and well-being, particularly for health behaviours. However, further research is needed to determine its effectiveness in the domain mentioned above.
The study “The use of gamification mechanics to increase employee and user engagement in participative healthcare services - A study of two cases” of Hammedi et al. published
in 2017 investigates the effects of gamification mechanics, or game design principles on user engagement in gamified healthcare services. The findings reveal that gamification mechanics produce four distinct experiential outcomes in patients: challenge, entertainment, social dynamics, and escapism. But patients’ age and the severity of their disease may affect the engagement. It is recommended that health professionals adapt alternative options to increase patient well-being in the case of progressively decreasing capabilities. Many approaches are used to conduct the research, comprising observations, two case studies, and desk materials.
The article “Gamification in Apps and Technologies for Improving Mental Health and Well-Being: Systematic Review” of Bakker et al. (2019) analyzes current applications of gamification for mental health and well-being. The findings report that gamification is being applied to a greater range of mental health and well-being domains compared with previous reviews and a greater diversity of gamification elements is being used, such as levels or progress feedback, points or scoring, rewards or prizes, narrative or theme and so forth.
The most commonly observed mental health and well-being domains are anxiety disorders and well-being, whereas the least commonly observed domains are conduct disorder and bipolar disorders. Systematic review in the literature between the years 2013 and 2018 is used for the study with gathering data from various secondary sources.
The article “Engagement, compliance and retention with a gamified online social networking physical activity intervention” of Ryan et al. (2017) examine user engagement, compliance and retention with Active Team - a gamified physical activity intervention delivered by via an online Facebook application. The findings reveal individual differences in engagement with Active Team, highlighting a need to tailor interventions to the target audience. The study employs a randomized controlled trial to test the efficacy of the Active Team intervention.
The study “Gamification of nutrition: A preliminary study on the impact of gamification on nutrition knowledge, attitude, and behaviour of adolescents in Nigeria” was researched by Ezezika et al. in 2018. This is a pilot study aiming to understand whether and how gamification of nutrition can have an impact on addressing the problem of unhealthy eating among Nigerian adolescents. The findings show gamifying nutrition
through a board game intervention positively affect the knowledge, attitude and behaviour of adolescents and provide and an environment conducive to healthy eating habits. Semi- structured focus groups were conducted with grade 11 and 12 students in three secondary schools in Abuja, Nigeria over a span of three to four months.
2.4 Synthesis of gamification-related business and two decision-making models from prior researches
According to the reference articles, the contemporary empirical findings of effectuation and causation logics just cover within the scope of digital business model transformation, new product development, foreign market entry, connection with resilience in uncertain environment, and its impact on buying decisions.
Prior findings reveal firms do not hold strictly one logic in their decision making, and decisions hinge on a firm’s situation in the market. “Causation and effectuation do not seem to be diametrically opposed, but firms are, to a large extent, able to merge features of both” (Harms and Schiele 2012; Fisher2012; Reymen et al., 2015; Ortega et al. 2017, 1729). Indeed, Sarasvathy (2001, 245) indicates “causation and effectuation seem to function as integral parts of human reasoning that can occur simultaneously, overlapping and interweaving over different contexts of decisions and actions”.
The findings of the research conducted by Baber et al. (2019, 824) indicate that “even though effectuation has an important role in one business model element, causation logic might dominate another element”. Specifically, the role of effectuation is important to
“digital business model evolution related to fast and unpredictably changing digital technology” (Austin et al. 2012; Dattee et al. 2018; Nylen and Holmstrom 2018), whereas causation logic had the main role in the value delivery element. Still, it is ascertained that causal logic has a stronger role when technologies are mature and have become more predictable.
The study of Ortega et al. (2017, 1730) finds that the studied firms involved in the research follow a predominantly causal logic so as to unearth and exploit opportunities for new product development. The logic of “effectuation might afford a means of engaging in projects that entail a higher degree of innovation, since it offers ways of dealing with the uncertainty linked to such projects” (Ortega et al. 2017)
It is also concluded that “small firms use effectuation at the early stage when seeking options with the available means, and causation in the latter stage when establishing objectives, planning activities, and investing resources in an effort to achieve them “ (Laaksonen et al. 2010; Berend et al. 2013). “Evidence in entrepreneurship literature suggests that the causation logic seems to correlate positively with core aspects of effectuation such as affordable loss and particularly pre-commitment” (Chandler et al.
2011; Harms and Schiele 2012; Ortega et al. 2017, 1730).
Likewise, the study of Chetty et al. (2015, 1453) “propose that is meaningless to
consider causation and effectuation logics as opposites on a continuum”; instead, the two logics are considered as substitutes relating to the context of the decision-making.
Additionally, the study infers that in the context of internationalization, “firms using causation logic are learning more rapidly about foreign markets than the timid ones using effectuation logic and learning in incremental steps” (Chetty et al. 2015).
On the other hand, the findings of the article researched by McGowan (2020) suggests that “a micro firm owner-manager may apply effectual logic when making a buying decision” (Sarasvathy 2009); specifically he/she will “take personal control of buying decisions so as to develop personal relationships that, in turn, lead to supplier flexibility”
(McGowan 2020).
Meanwhile, the existing gamification studies within the sphere of healthcare and well- being mainly address the benefits and effects of gamification from users’ view rather than from providers’ one. It seems that there is limited amount of researches investigating decision-making logics in employing gamification in healthcare and well-being domain.
For this reason, my thesis desires to supplement literature on what the reasoning decision- makers utilize for their investment in the context of increasingly popularity of gamification-based products.
3 METHODOLOGY
3.1 Methodological approach
My thesis follows qualitive research. D. Myers (2013, 23) emphasizes that “qualitative research approaches are designed to help researchers understand people, what they say and do. One of the key benefits of qualitative research is that it allows a researcher to see and understand the context within which decisions and actions take place”. In fact, my thesis aims to find out entrepreneurs’ decision-making model, to understand how they make decisions (what they have done). The context is businesses offering gamification, particularly gamified solutions to healthcare and well-being services.
Accordingly, the purpose and question of my thesis fit the characteristics of qualitative research.
Moreover, “qualitative research is particularly relevant when prior insights about a phenomenon under scrutiny are modest” (Ghauri and Gronhaug 2005, 202; Eriksson and Kovalainen 2008, 4). When searching related articles, and material, it seems that causation and effectuation reasoning is investigated from business management side, such as marketing, product innovation, firm performance, and so forth. Inversely, gamification themes surround primarily end users’ interaction and experience like brand engagement, student learning, enjoyment, productivity, leadership, etc. Research in relation between the two logics and gamification has not been heavily exploited so far. Consequently, qualitative research is the most appropriate choice for my study.
It is confirmed that there is nine different approaches involved in qualitative research:
case study research, ethnographic research , grounded theory research, focus group research, action research, narrative research, discursive research, critical research, and feminist research. I choose narrative research as main approach to interpreting empirical data. As Eriksson and Kovalainen (2008, 115) describe, “individual case, an employee, a manager, or a customer for example, could be reported as a narrative of the lived experience of the individual in a specific economic and business context”.
Because individual cases in my thesis are decision-makers involving CEOs, founders, and manager, narrative research was more reasonable to analyze their experience than other
methods. Using narrative approach would help me to get insight of their experience in deciding, and to answer the research question as well:
- How do entrepreneurs decide to adopt gamification to healthcare and well-being?
3.2 Data collection
As mentioned earlier, my thesis aims to investigate entrepreneurs’ decision-making reasoning. For this reason, in-depth interviews were crucial to acquire understanding of how they made decisions as well as examine the theory of causation and effectuation. In my thesis, interviews played a key part in research method. The entrepreneurs were selected among gamified healthcare and well-being solution providers. Their shared experience was retold by the thesis’ author.
Semi-structured interviews were employed because this format provided informants with the freedom to respond in an idiosyncratic manner (Walle 2014, 72). “The flow of the interview, however, is more controlled by the field worker in order to gather certain information” (Drever 1997; Walle 2014, 72), which was helpful for me to collect necessary specialized information since I was still a novice student in doing qualitative interviews. The style of semi-structured interviews was conversational, and it permitted the researcher to steer the interview in a particular direction.
An interview protocol included interview request and reminder letter, opening statement, key interview questions, and thank-you letter sent by email thereafter. Interview request letters were sent to entrepreneurs via email based on their enterprises’ information that was published on their website. Opening statements provided the introduction of the participants, their job title and business enterprises. Key interview questions disclosed their decision-making process. Thank-you letters were sent to the participants after interviewing with the purpose of showing the author’s appreciation and requesting clarification from the participants if necessary.
The list of interview questions was designed in accordance with semi-structured interview format, and was prepared during two weeks after I completed the theoretical framework section, mainly hinged on my comprehension of two decision-making models (as shown in Table 2). Specifically, interview questions were based on five elements of causation and effectuation logics built by Sarasvathy (2001, 250-252) , incorporating:
- View of the future - Basis for taking action
- Predisposition toward risk and resources - Attitude toward outsiders
- Attitude toward exploiting contingencies
The content of interview questions was also taken into account and divided into three main parts. The first part referred to how the participants made decision in daily routine, the second part described their decisions relating to the process of implementing gamification business, and the third part mentioned outcome and their future planning.
There were 16 interview questions in total, including 12 open-ended questions and 4 close-ended ones. I asked for assistance from Business Finland public agency and Neogames – hub of Finnish game industry in order to receive a list of enterprise engaging in offering gamified healthcare and well-being solutions.
The list of interview questions was sent to 13 recipients in the first phase from October 13 to October 16 in the year 2020. The participants were CEOs, founders, and manager of health game companies located throughout Finland. The reminder letters were sent after one week through email or other social media platform – Facebook. Facebook was only used if the author saw strong interaction between audience and the participants’
enterprises. The purpose was to increase possibility of responses from the participants.
Of these, three agreed to participate in my study.
Request for interview was sent to 8 more recipients in the second phase from October 26 to November 5 in the same year. Being similar to the first phase, the reminder letters were sent one week thereafter. Of these, one agreed to participate in my study.
There were four participants in total. All interviews were hold remotely, including mobile phone and online interviews. Online interviews were conducted via a communication platform – Zoom. The average amount of time for all interviews was from fifty minutes to one hour. Permission for recording conversations was asked at the beginning of every interview. Moreover, all interviewees were asked about anonymity after finishing interviews. As agreed, the information of all participants and their companies remained anonymous. To remain consistent in addressing all the interviewees, participants were
identified as entrepreneur A (of the company A), entrepreneur B (of the company B), manager C (of the company C), and entrepreneur D (of the company D) respectively, which also helped me present interpretation neatly.
TABLE 3. The participants’ information and interview process Interviewee Job title Business
type Interview schedule
Interview
techniques Duration Entrepreneur A CEO
Business- to- customer
October 23, 2020
Mobile phone, one- to-one interview
In the first phase
Entrepreneur B Co-founder and senior partner
Business- to- customer
October 28, 2020
Zoom, one-to-one interview
In the first phase
Manager C Project manager Business- to-business
November 3, 2020
Zoom, one-to-one interview
In the first phase
Entrepreneur D Founder and CEO
Business- to- customer
November 10, 2020
Zoom, one-to-one interview
In the second phase
Published version of my thesis would be sent to the participant thereafter. Raw interview data will be destroyed after being stored in the author’s personal computer for six months.
Furthermore, I got additional information from the websites of the participants’
enterprises to take a holistic view about the companies’ size, their work experience and knowledge that might be useful for interpretating data.
3.3 Analysis of the data
The interviews with entrepreneurs and managers were analyzed by using narrative analysis, an approach in narrative research. This approach allows the researcher to
“organize and interpret empirical data that describe some more or less consistent events, happenings and actions” as Eriksson and Kovalainen (2008, 217) explain.
Likewise, Allen (2017, 1069) posits that “narrative analysis focuses on collecting stories about a certain type of experience”. Hence, I used narrative analysis to understand the participants’ stories about their experience in doing gamification business.
My analysis proceeded in stages. The interviews were recorded, then transcribing, reading and coding, re-coding, grouping into themes, and interpreting findings.
Transcribing interviews into textual data was done manually. Reading text was done many times to have comprehensive understanding of the participants’ stories they shared.
The purpose of coding was to identify different themes and the relationships between them. “Coding is one of the simplest ways to analyze qualitative data. A code can be a word that is used to describe or summarize a sentence, a paragraph, or even a whole piece of text, such as an interview” (Myers 2013, 253). “Codes are tags or labels for assigning units of meaning to the descriptive or inferential information compiled during a study.
Codes are useful for retrieving and organizing the data, and they speed up the analysis”
(Miles and Huberman 1994; Myers 2013, 253).
Being comparable to the stage of transcribing, coding was also conducted manually.
The stage of recoding highlighted the classification of code into specific settings which then helped emerge themes, or similar subjects.
Coding data provided same results of content. Specifically, all the participants were directed to share their experience in: decision-making pattern, resource availability for gamification investment, organizational resources, purposes, expectation, strategies, experiencing that mentioned challenges, problems, incidents and problem-solving approach, self-evaluation, learning, future planning. Afterwards, these results were grouped into three stage of investment, comprising the preparation stage (stage 1), the implementation process (stage 2), and outcome and further development (stage 3).
Detailed classification was given as follows:
TABLE 4. Description of coding scheme
Description of coding Chronological order Decision-making pattern
The preparation stage Resource availability for gamification
investment, organizational resources Purposes, expectation
Strategies
The implementation process Experiencing that mentioned challenges,
problems, incidents, and problem-solving approach
Self-evaluation, learning, future planning Outcome and further development
Findings were interpreted in the form of narrative and in chronological order as indicated in Table 4 above.
