A recent meta-analysis concluded that the badge of status hypothesis is the most parsimonious explanation for an observed association between measures of aggression and the degree or area of coloration across animals. We argue that the premise for the conclusion that aggression and coloration are positively associated relies on a biased, largely incomplete and heterogeneous representation of the available evidence. In addition, we identified severe problems with the calculation and interpretation of the correlations and the heterogeneity, as well as with data extraction and the publication bias tests. Our re-analyses challenge the original conclusions. Once heterogeneity-which, in contrast to the original study, our re-analysis shows to be high-and publication bias are properly assessed and accounted for, we find low generality of the relationship between aggression and coloration across animals. In addition, our analyses suggest that evidence changes dramatically depending on the source of the effect size, with evidence obtained directly from correlations and mean group comparisons being statistically nonsignificant and largely different from evidence obtained by transforming inferential statistics (t, F, and χ 2), which raises strong methodological concerns. Furthermore, by re-extracting 11 out the 74 studies included in the original meta-analysis (15%), we found errors and inconsistencies that raise further concerns about the validity of the full dataset. We give directions to guide future meta-analytic efforts in this and other topics, showcasing common misunderstandings in systematic reviews and meta-analyses, including effect size calculation and transformation. We conclude that after 50 years since its conception, the jury is still out regarding the validity and generality of the badge of status hypothesis to explain individual differences in coloration traits across animals.
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Assembly quality is frequently assessed using independent measures of assembly span, contiguity, sequence composition, and completeness. Among contiguity metrics, contig, and scaffold N50 have perhaps gained the most traction, despite well-known limitations. Several authors have suggested considering the complete Nx curve rather than just the N50 value, but while using N90 values or considering the area under the Nx curve with auN statistics provide more complete measures of contiguity, they share the limitation of being unsuited to direct comparison across a range of genome sizes. We introduced snail plots to provide a genome-size-independent way to summarize a range of commonly used assembly metrics. Here, we demonstrate that easily learnt visual differences between snail plots allow simultaneous consideration of metrics across several key areas of assembly quality to rapidly identify high- and low-quality assemblies. We show that prominent features in snail plots of high-quality assemblies effectively highlight N50, N90, and auN contiguity statistics. As the presentation is scaled to the longest scaffold, we also show that plots can be compared effectively across a wide range of taxa and assembly sizes. We use the core features of a snail plot to derive a proportional measure of assembly quality based on auN, adjusted for non-ATGC bases and scaled to the length of the longest scaffold. We show that this "snail score" value corresponds closely to a qualitative assessment of overall assembly quality from visual interpretation of a snail plot and supports corrections for expected genome size.
Social connection is essential for well-being, yet people often avoid interacting with strangers due to concerns about conversation quality or a lack of shared interests. This study investigates whether the Happy to Chat badge can act as a behavioural nudge to promote social connectedness. Using a nationally representative online sample of 1,738 adults in England (via YouGov), we tested whether wearing the badge influences perceptions of friendliness, trustworthiness, and interest in conversation, as well as social behaviours such as smiling, eye contact, nodding, and willingness to initiate a chat. Results show that badge wearers are perceived as significantly more friendly, trustworthy, and open to conversation, and are more likely to receive social acknowledgements, although wearing the badge did not significantly increase others' intention to initiate conversation. Age and gender effects were also observed, with older and female targets generally receiving more favourable social responses. These findings suggest that while the badge effectively promotes social recognition, it may be insufficient on its own to overcome deeper psychological barriers to initiating conversations with strangers. This paper confirms the effectiveness of the Happy to Chat badge as a nudge to promote social connectedness within communities and highlights its practical implications.
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Gamification has emerged as a transformative pedagogical strategy in health sciences education, offering innovative ways to enhance student engagement, motivation and competency development. This state-of-the-art commentary explores the integration of digital badges into the third-year Medicine and Surgery course for occupational therapy and physiotherapy students at a public university in South Africa. Originally introduced to address contextual and educational challenges, digital badges acted as engagement tools aligned with specific learning outcomes and professional competencies. The inclusion of badges was organically developed by lecturers in response to contextual challenges, including inconsistent face-to-face teaching, low engagement, limited interdisciplinary interaction in an online learning environment, and the need to prepare students for clinical practice in resource-constrained settings. Gamification elements were embedded in Moodle, the learning management system, to scaffold learning progression and support the core competencies outlined by the Health Professions Council of South Africa (HPCSA), including therapeutic and professional relationships, professionalism, communication and ethical practice. The introduction of gamification and badges may improve clinical, interdisciplinary, and communication skills among undergraduate students. Contextual relevance, inclusive design, and ongoing evaluation incorporating the students' voices are recommended in sound instructional design through active engagement with gamification practices in health sciences education.
Background: To compare the amount of radiation exposure received by the surgeon during volar locking plate fixation for distal radius fractures using an image intensifier (II) and a flat panel detector (FPD). Methods: We included 40 patients who underwent open reduction and internal fixation using a volar locking plate for isolated distal radius fractures. Surgeons wore thermoluminescent dosimeter badges at six anatomical sites: both thumbs, thyroid, at eye level (to estimate the eye lens dose), chest (under the protector) and abdomen (under the protector). The badges were replaced monthly, and equivalent radiation doses were measured. Fluoroscopy time was recorded from operative notes. Sixteen cases operated using an II-equipped C-arm between August and October 2020 were classified as Group II. Twenty-four patients treated between September and November 2024 using an FPD-equipped system comprised Group FPD. Results: Operative time was similar between groups (57 vs. 56 minutes). Fluoroscopy time was 324 seconds in Group II and 239 seconds in Group FPD and air kerma per case was comparable (6.6 vs. 5.8 mGy). Equivalent dose per second was higher with FPD for both thumbs (right: 2.23 vs. 1.70 μSv/s; left: 9.57 vs. 2.07 μSv/s), with no significant differences in eye-lens or thyroid exposure. Conclusions: The equivalent radiation dose per second of fluoroscopy was significantly higher in Group FPD for both thumbs compared to II systems. No significant differences were observed in radiation exposure to the lens or thyroid between groups. Level of Evidence: Level IV (Therapeutic).
BACKGROUND: The cluster randomized controlled trial interprof ACT evaluated the effects of a complex intervention designed to improve collaboration between general practitioners (GPs) and registered nurses (RNs) in nursing homes (NHs). The intervention includes six components (“Name badges”, “Mandatory availability rules”, “Designated contact persons”, “Standardized GPs’ home visits”, “Pro re nata medication”, “Shared goal setting”). The findings showed a nonsignificant reduction in hospital admissions in the intervention group (IG) compared to the control group (CG) within twelve months. The aims of this process evaluation were to describe (1) the dose, reach and fidelity of implementation (“implementation performance”), (2) the effects on the quality of RN-GP collaboration, and (3) potential moderating factors. METHODS: Process evaluation with a mixed-methods triangulation design involving all clusters (17 NHs per IG and CG) and 323 nursing home residents (NHRs) (n = 166 IG, n = 157 CG): We collected quantitative and qualitative data from multiple perspectives (e.g., RNs, GPs, NHRs) at several measurement points. We quantitatively compared groups by means of medians, interquartile ranges, proportions (all outcome domains) or Mann‒Whitney U tests (implementation performance) and analyzed qualitative data inductively via content analysis. The key findings were triangulated narratively and via a joint display. RESULTS: Compared to those in the CG, we noted relevant improvements in the implementation of “Name badges”, “Mandatory availability rules”, “Designated contact persons” and “Pro re nata medication” in ≥50% of the IG clusters, of which the group difference for “Mandatory availability rules” reached statistical significance. The implementation performance of IG clusters was moderated by resource-related and other organizational attributes of NHs and GP offices and attributes of involved professionals, especially their attitudes and awareness. Implementation of the components induced greater standardization of care processes together with positive changes in interprofessional communication and coordination among GPs and RNs. CONCLUSIONS: Implementation of the interprof ACT components varied between components and NHs but showed potential for improving RN-GP collaboration. The standardization of shared care procedures emerged as a key mediator for improvement. For larger and more sustainable implementation we recommend a stronger focus on locally available resources and communication of potential benefits for all involved parties. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03426475; registered 07 February 2018, https://www.clinicaltrials.gov/study/NCT03426475?lead=NCT03426475%26;rank=1 .
EFL (English as a Foreign Language) learners' engagement is a crucial determinant influencing learning outcomes in English vocabulary learning. In recent years, gamification elements such as points, badges, and leaderboard have been increasingly used in mobile-assisted language learning to promote EFL learners' engagement. However, empirical evidence comparing learners' engagement in multi-element and points-only gamified mobile apps remains limited, particularly across multiple engagement dimensions. To address this gap, the present study employed a quasi-experimental design with pretest, posttest and delayed posttest measures to compare the immediate and delayed effects of multi-element versus points-only gamified mobile apps on EFL learners' overall engagement and its dimensions (cognitive, emotional, and behavioural engagement) in English vocabulary learning. In this study, the experimental group (n = 35) used a gamified mobile app incorporating points, badges, and leaderboard, while the comparison group (n = 31) used a points-only gamified mobile app. The results indicated that EFL learners using the multi-element gamified mobile app reported significantly higher overall engagement and all three engagement dimensions immediately after the intervention. However, these positive effects were not maintained at the delayed posttest, suggesting that the initial effects may weaken over time. These findings provide cautious quasi-experimental evidence of the immediate and delayed effects of multi-element and points-only gamified mobile apps on EFL learners' engagement in English vocabulary learning.
The International Commission on Radiation Units and Measurements (ICRU), in collaboration with the International Commission on Radiological Protection (ICRP), has introduced new operational quantities in ICRU Report 95. Among these, the personal dose Hp addresses the significant limitations of the currently used Hp (10), which can overestimate the effective dose by up to a factor of 5.5 at photon energies below 70 keV. These changes necessitate a re-estimation of dosemeter response to evaluate potential modifications in dose algorithms and detector design. In this study, the performance of CaSO4:Dy thermoluminescent dosemeter (TLD) badges was investigated for the new operational quantity Hp and compared with the existing Hp (10). The badge response was simulated over photon energy range 12.3-1250 keV using the Monte Carlo Simulation code FLUKA and benchmarked against experimental validation. To correct for energy-dependent overestimation at lower photon energies, a new dose evaluation algorithm for Hp was developed based on disc dose ratio (R12). The disc dose ratio (R12) refers to the ratio of absorbed doses measured in CaSO₄:Dy TL discs D1 and D2 positioned under different filtration conditions within the badge and serves as an energy-sensitive parameter for correcting the over-response of the dosemeter in terms of Hp. The proposed algorithm demonstrated strong compliance with IEC 62387:2020 performance criteria (acceptance range 0.71-1.67), with 95% of estimated Hp values lying within 0.9-1.3 of the delivered dose. These results confirm that CaSO4:Dy TLD badges, when combined with the improved algorithm, are fully compatible with the new operational quantities recommended in ICRU Report 95, ensuring reliable application in personnel dosimetry.
Effective translation relies on high performance teams integrating diverse disciplines to bring new drugs, medical devices, diagnostics or behavioral interventions into improved health. Despite substantial advancements informed by the Science of Team Science (SciTS), challenges remain in effective translational team (TT) operations, while limited institutional, scholarly, and practitioner legitimacy of team science expertise constrains efforts to address them. Here, we describe an essential member of the TT, the Team Science Professional (TSP). Serving as a team educator and facilitator of team interventions, the TSP plays a pivotal role in facilitating effective team performance. Current challenges faced by this nascent profession are defining career pathways and establishing competencies needed for expert performance. To address these challenges, the authors, representing a spectrum of academic universities organized as a special interest group (SIG) of the Association of Clinical and Translational Science (ACTS), propose a suite of individualized, standardized and pathway-selective micro-credentials (digital badges). Digital badges in "Team Science (TS) Fundamentals," "TS Practitioner," "TT Trainer" and "TT Intervention Expert" are described, along with preliminary feasibility and usability evaluations of the submission process. These stackable credentials provide a customizable, portable recognition of skills and help advance career pathways for TSPs. In so doing, the Digital Badge Initiative will enhance the capacity of translational science "Hubs" such as those supported by Clinical and Translational Science Awards to conduct effective and rigorous translation. Moving forward, the ACTS TSP SIG will be examining the impact of digital badging on standardization and its effect on career recognition and retention.
Across three preregistered experiments (total N = 1,135), we tested whether an inductive learning (IL) intervention improved participants' news veracity discernment (i.e., ability to distinguish between true and false news). IL involves learning categories by observing or classifying exemplars. Therefore, in this research, IL involved observing true and false news headlines and classifying them as either "true" or "false," with immediate feedback on accuracy. In Experiment 1 (N = 214), the IL intervention significantly improved participants' news veracity discernment compared to the control, but the Bayesian evidence was only anecdotal. In Experiment 2 (N = 483), we incorporated game-design elements into the IL intervention, including performance-contingent badges. Unexpectedly, the effect of the IL intervention decreased. We reasoned that, because the IL intervention involved easy-to-hard classification training, the provision of performance-contingent badges inadvertently made participants more aware of their declining performance. This awareness may have undermined their motivation to learn as the training progressed. Therefore, in Experiment 3 (N = 438), we implemented hard-to-easy classification training instead, and the IL intervention significantly improved participants' news veracity discernment, now with strong Bayesian evidence. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Mobile health (mHealth) apps are increasingly used to support healthy lifestyle behaviors through features such as health tracking and personalized reminders. Personalized messaging, tailored to users' profiles, has been shown to improve engagement and retention in health-related contexts. Prior research has linked personality traits, based on the Big Five model, to preferences for specific app mechanisms, leading to the development of a preference matrix for personalizing mHealth apps. This matrix comprises 15 mechanisms derived from behavior change techniques and gamification elements, intended to guide developers in optimizing engagement according to user profiles. This study aimed to validate this preference matrix by examining whether the associations between mechanisms and Big Five personality traits reported in the literature align with user preferences observed in an experimental setting. A cross-sectional study was conducted using an online survey that collected demographic data, mHealth app usage, and personality traits. Participants were presented with mockups illustrating 15 mechanisms and were asked to select their preferred options. Logistic regression and ordinal logistic regression analyses were performed to examine associations between personality traits, mechanism selection, and motivation scores. All analyses were adjusted using the Bonferroni correction to account for multiple comparisons. A total of 214 participants completed the survey (mean age 29.42, SD 10.41 y; n=118, 55.1% women; n=89, 41.6% men; n=5, 2% identifying as other; and n=2, 1% nonrespondents). Higher conscientiousness significantly increased the likelihood of selecting the collection mechanism (eg, collecting badges or points; odds ratio [OR] 1.87, 95% CI 1.27-2.75). For competition (eg, competing with other users), conscientiousness (OR 3.22, 95% CI 1.73-6.00) and agreeableness (OR 1.93, 95% CI 1.08-3.45) were significant predictors. Preferences for rewards (eg, virtual incentives such as points or virtual currency) were associated with conscientiousness (OR 2.36, 95% CI 1.53-3.63) and neuroticism (OR 1.97, 95% CI 1.36-2.86). Additionally, 4 mechanisms-self-monitoring, progression, challenge, and quest-were selected by more than half of the participants, independent of personality traits. The findings partially validate the proposed preference matrix. Conscientiousness consistently emerged as a key predictor of preference across multiple mechanisms, highlighting its central role in engagement with gamified mHealth features. While some mechanisms appear to have universal appeal, others show personality-specific preferences, underscoring the value of combining baseline mechanisms with targeted personalization strategies in mHealth app design.
BACKGROUND: Gamification has emerged as an innovative educational approach to enhance learner engagement and motivation in health professions education. In nursing education, accurate interpretation of cardiac rhythms is a critical competency that requires repeated practice and timely feedback. This study aimed to design, develop, and evaluate a gamified mobile application (RhythmPath) to support nursing students’ learning of cardiac rhythm interpretation. METHODS: A quasi-experimental pretest–posttest study without a control group was conducted during the fall semester of 2024 among 13 seventh-semester nursing students at Kerman University of Medical Sciences, Iran. The RhythmPath application was developed using Unity 2021 and incorporated gamification elements such as points, badges, leaderboards, and timed assessments. Students used the application for two weeks. Knowledge of cardiac rhythm interpretation was assessed before and after the intervention using equivalent validated multiple-choice tests. Software quality and usability were evaluated using a validated questionnaire. Paired t-tests were used to compare pretest and posttest scores. RESULTS: Mean knowledge scores increased significantly from 39.48 ± 19.52 at pretest to 51.79 ± 25.98 at posttest (t (12) = 2.45, p = 0.03). Participants spent an average of 7.2 ± 1.8 h using the application during the intervention period. Overall user satisfaction with the application was high (mean score = 4.45 ± 0.67 on a 5-point Likert scale), with ease of use and information quality receiving the highest ratings. CONCLUSIONS: The RhythmPath gamified mobile application demonstrated potential for improving nursing students’ knowledge of cardiac rhythm interpretation and achieving high user satisfaction. As a small-sample pilot study, these findings provide preliminary evidence supporting the use of gamified mobile learning tools in nursing education. Further studies with larger samples, control groups, and longer follow-up periods are recommended to confirm effectiveness and assess long-term learning outcomes.
LGBTQIA+ students in Indian health professional education (HPE) institutions face stigma and discrimination. To pioneer a year-long TransCare Queer Ambassador (QA) model to promote LGBTQIA+ inclusion in admissions, classrooms, residences, and infrastructure; build awareness; and strengthen the on-campus queer community by systematically supporting LGBTQIA+ student ambassadors across HPEs in India. Eight QAs represented eight HPE institutions across seven Indian states, including Bachelor of Medicine and Bachelor of Surgery (MBBS) and Master of Public Health (MPH) students. Through mentorship, peer learning, and training in creative humanities methods like reflective writing, photography, and Forum Theatre, QAs co-developed solutions tailored to their respective institutional contexts. Among Kirkpatrick Model of training evaluation level 4 results, QAs built strong peer-support networks by initiating LGBTQIA+ clubs on campus and forming online communities. They enhanced awareness and visibility through distributing pronoun badges and handbooks about the queer community, holding arts events around lived experiences, and starting dialogue around sexual harassment of LGBTQIA+ students. QAs established gender-neutral washrooms, and inclusive admissions forms and residencies. Despite challenges, if scaled up in India and globally, the QA model could create inclusive spaces and an affirmative health workforce for queer persons. Not applicable.
This study explores how older adults with chronic back pain (CBP) evaluate different user interface (UI) designs and gamification elements for an ultrasound-based wearable providing real-time biofeedback during segmental stabilization exercises (SSE). The aim is to identify design preferences and motivational factors to enhance usability, engagement, and adherence in this specific population. We conducted a mixed-methods study with 15 older adults (aged ≥ 65) experiencing CBP. Participants interacted with three UI mockups (simple, anatomical, and playful) via a Wizard-of-Oz simulation and evaluated additional motivational elements (e.g., points, badges, progress charts). Semi-structured interviews and the Technology Usage Inventory (TUI) subscales were used to assess usability, acceptance, and intention to use. Participants preferred the simple and anatomical UI designs, citing clarity, professionalism, and ease of interpretation. The playful design was viewed as less appropriate due to perceived infantilization. Game elements such as progress tracking, points, and levels were positively received, while competitive features like leaderboards were viewed critically. Most participants expressed interest in integrating pain education, favoring multimedia formats. Digital health tools for older adults must prioritize intuitive, medically reliable interfaces and allow personalization of motivational and educational components. The findings highlight the need for age-appropriate UI design and suggest that well-balanced gamification and educational features may enhance perceived acceptance and have the potential to support long-term use, which should be evaluated in longitudinal studies.
Despite the notable proliferation of smoking cessation mobile apps, to date, no validated, Spanish-language, culturally tailored mobile intervention exists for Spanish speakers in the United States. The aim of this study was to conduct formative research to inform the adaptation of an evidence-based smoking cessation intervention developed for Spanish-speaking Hispanic and Latino individuals from a printed format into a mobile app. Guided by a user-centered approach and in collaboration with product design industry experts, wireframes were developed to present the app's layout and functionality. Focus groups were conducted over Zoom (Zoom Communications) with Spanish-speaking individuals who currently smoke to assess their previous mobile app experience, attitudes toward mobile apps, and feedback on app architecture and design. Two independent reviewers (RB in collaboration with another member from the qualitative core) trained in qualitative methods coded the focus group data using a thematic analysis approach and identified emerging themes. The app wireframes included 4 navigation buttons on the home screen to organize and deliver evidence-based intervention content-Home (Inicio), Learn (Aprende), My Coach (Mi Couch), and Profile (Perfil). Different wireframe designs were generated in distinct color palettes. Data saturation was reached after three focus groups. Participants were 54% (7/13) women, had a mean age of 56 (SD 14.9) years, 39% (5/13) had an education ≤high school, and 31% (4/13) were married or cohabitating. All participants smoked daily, a mean of 14 (SD 7.8) cigarettes per day, for 32 (SD 16.9) years, and 54% (7/13) smoked ≤30 minutes of waking. Participants reported using social media, news, shopping, and gaming apps, but few used mobile health apps. Salient barriers for app use included worries regarding privacy breaches and fears about misinformation. Desired features included community-building elements, personalization, reward badges, knowledge checks, and audiovisual presentation of content within the app. Participants disliked having a countdown to quit date, preferring an "I quit" button to initiate monitoring progress. They also viewed sharing progress with support networks as a source of unwanted pressure, although a few saw it as motivational. Overall, participants liked the app design and indicated willingness to use it. This formative research provides critical insights into preferences related to the development of culturally tailored mobile smoking cessation interventions for Spanish-speaking individuals. Key findings highlighted enthusiasm for a smoking cessation app and the importance of including features that foster social connection and allow for personalization.
Serious games (SGs) have emerged as a promising tool in nursing education, providing interactive learning environments for clinical simulation, skill development, and feedback. These games enhance knowledge, clinical reasoning, and psychomotor skills. However, evidence on their effectiveness is dispersed across various platforms and outcome measures, making it difficult to derive clear guidelines for their integration into nursing curricula. This scoping review aimed to systematically identify and map existing evidence on the use of SGs in nursing education, analyze game characteristics, and identify critical gaps to inform future research and practice development. This scoping review followed the JBI framework and the PRISMA-ScR checklist. Nine databases (PubMed, Web of Science, Embase, CINAHL, the Cochrane Library, CBM, Wanfang Data, CNKI, and VIP) were searched from inception to January 15, 2026. Eligible studies were those reporting on original research on SGs in nursing education. Two reviewers screened titles, abstracts, and full texts. Risk of bias was assessed using a standardized checklist. The extracted data encompassed study characteristics, study design, participant information, sample sizes, application context, teaching content, and SG characteristics. Data were extracted and synthesized with descriptive statistics and content analysis. An evidence gap map was created to show the study distribution across course categories and outcome domains. We screened 6078 records and included 24 studies. Publications were from 2021 to 2025 (n=13, 54%), with the majority conducted in Europe (n=13, 54%). Quasi-experimental designs (n=10, 42%) and randomized controlled trials (n=8, 33%) were predominant. SGs were mainly used in fundamental or skills training and adult nursing courses. Scenario-based decision points (n=20, 83%) and points, badges, or leaderboards (n=20, 83%) were the most common game mechanics, while progression or unlocking and collaborative elements were less frequent. Outcomes most often assessed were knowledge (n=16, 67%), skills (n=10, 42%), and engagement or usability (n=13, 54%). Objective use metrics were rarely reported (n=1, 4%), indicating limited data on in-platform learning behaviors. Most SGs were delivered as digital non-virtual reality applications or computer-based simulation games. Follow-up assessment beyond immediate postintervention outcomes was infrequent. An evidence gap map showed studies concentrated in skills-based training and adult nursing, with fewer studies in maternity or neonatal nursing, critical care, and foundational sciences. This review extends earlier work on SGs in nursing education by mapping evidence across curricular areas, intervention reporting, and outcome assessment, rather than focusing mainly on effectiveness or specific formats. It shows where evidence is concentrated and where important gaps remain, particularly in underrepresented course areas, intervention descriptions, follow-up assessments, and objective use data. These findings provide a clearer picture of the evidence base and can inform curriculum planning; the use of SGs in skills-based and clinical training; and future decisions about their design, implementation, and evaluation.
Digital wellness interventions for preventive health, such as prediabetes management, often face high dropout rates due to insufficient personalisation and motivational support. This design science research study presents a self-determination theory (SDT)-informed gamification framework to address these challenges. Drawing on a systematic literature review, the study identifies engagement barriers, facilitators, and empirical evidence to guide design. The framework maps strategies to SDT's core constructs: autonomy (user-defined goals with structured guidance and selectable difficulty levels), competence (adaptive challenges with badges and points), and relatedness (collaboration-focused progress sharing). The framework was co-designed with 20 young adults in Australia and validated by six multidisciplinary experts. The study revealed that 60% of participants felt overwhelmed with fully open goal setting, highlighting that structured guidance is essential for autonomy support in preventive wellness applications. These findings informed the development of MiCARE, a progressive web app that operationalises the framework with user-centred, motivationally aligned features. This study offers a replicable, theory-driven approach for designing engaging preventive wellness interventions.