Interleaving Health and Entertainment: Toward a Modular Architecture for Ethically Enabled Dark Patterns in Digital Interventions

Digital health interventions using mobile technologies such as mHealth apps and wearables have the potential to promote healthy behavior change in individuals at a scale larger than traditional interventions. However, the lack of user retention with these interventions still limits their long-term effectiveness in health outcomes. Gamification increases user engagement, however, gamification does not increase the entertainment value of the content, which is often perceived as unengaging by users. In contrast, popular entertainment focused mobile games do foster retention due to their engaging content, and often augmented through the use of persuasive dark patterns. Although dark patterns are ethically questionable techniques for driving engagement, there is potential for ethically enabled dark patterns to increase engagement in health interventions. In this feasibility study, we present the Health Intervention Minigame Framework that enables the embedding of entertainment games into digital health interventions. We demonstrate a proof of concept prototype that supports three entertainment games with ethically enabled dark patterns. Although the framework is a first step towards the implementation of ethically-enabled dark patterns in entertainment games, it is still unclear whether the potential increased engagement with real-world health activities of such implementations outweighs their psychological cost.