The merits of gamification as a learner-centered pedagogy that positively influences learner engagement and motivation are widely established in the literature; yet, few studies have ventured beyond motivation to consider the impact gamification has on self-efficacy. Moreover, guidance for the effective design and development of gamified instruction is lacking. This study describes formative research conducted on the Gamification for Enhancing Learner Self-Efficacy (GELSE) instructional design theory, which was developed to guide the design of gamification aimed at fostering self-efficacy. The goal of formative research is to identify improvements for an instructional design theory based on a designed instance of the theory. The GELSE theory was applied to an undergraduate community health nursing course in a fully online, accelerated degree program. The theory was evaluated by answering the following questions: 1) What methods of the GELSE instructional design theory were perceived to be more effective?, 2) What methods of the GELSE instructional design theory were perceived to be less effective?, and 3) What improvements can be made to the GELSE instructional design theory?. Data was collected in this qualitative study through open-ended questionnaires, focus group interviews, semi-structured one-on-one interviews, and observations of online learner activities and social interactions. The results show that the GELSE instructional design theory is effectual for guiding the design of gamified instruction intended to foster learner self-efficacy. Additionally, the findings from the research yielded a number of recommendations for improving the GELSE theory. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com.bibliotheek.ehb.be/en-US/products/dissertations/individuals.shtml.]