Game On? Smoking Cessation Through the Gamification of mHealth: A Longitudinal Qualitative Study

BACKGROUND: Finding ways to increase and sustain engagement with mHealth interventions has become a challenge during application development. While gamification shows promise and has proven effective in many fields, critical questions remain concerning how to use gamification to modify health behavior. OBJECTIVE: The objective of this study is to investigate how the gamification of mHealth interventions leads to a change in health behavior, specifically with respect to smoking cessation. METHODS: We conducted a qualitative longitudinal study using a sample of 16 smokers divided into 2 cohorts (one used a gamified intervention and the other used a nongamified intervention). Each participant underwent 4 semistructured interviews over a period of 5 weeks. Semistructured interviews were also conducted with 4 experts in gamification, mHealth, and smoking cessation. Interviews were transcribed verbatim and thematic analysis undertaken. RESULTS: Results indicated perceived behavioral control and intrinsic motivation acted as positive drivers to game engagement and consequently positive health behavior. Importantly, external social influences exerted a negative effect. We identified 3 critical factors, whose presence was necessary for game engagement: purpose (explicit purpose known by the user), user alignment (congruency of game and user objectives), and functional utility (a well-designed game). We summarize these findings in a framework to guide the future development of gamified mHealth interventions. CONCLUSIONS: Gamification holds the potential for a low-cost, highly effective mHealth solution that may replace or supplement the behavioral support component found in current smoking cessation programs. The framework reported here has been built on evidence specific to smoking cessation, however it can be adapted to health interventions in other disease categories. Future research is required to evaluate the generalizability and effectiveness of the framework, directly against current behavioral support therapy interventions in smoking cessation and beyond

The Role of Gamification in Health Behavior Change: A Review of Theory-driven Studies

Gamification is increasingly being recognized as a tool to support a change in individuals’ health behaviors. However, how and under which circumstances gamification is able to support health behavior change is still largely unexplored. This study follows the call for more theory-driven research on gamification by investigating the role of gamification in health behavior change theories (HBCTs). In order to do so, we conducted a systematic review of extant literature and identified 25 studies that explore the role of gamification in the process of health behavior change to some extent. We found large discrepancies in how the authors of these studies conceptualized the role of gamification in their theory-driven health interventions. To further strengthen theory-driven research on gamification in health and well-being, we additionally propose concrete research questions. These may guide future researchers to identify valuable avenues for further explaining and predicting the influences of gamification on health behavior change

What’s in the Game? Developing a Taxonomy of Gamification Concepts for Health Apps

Gamification is a promising approach to tackle users’ infrequent and decreasing use of health apps. For this purpose, extant research provides developers of health apps with a vast number of different game elements. By abstracting from the implementation of single game elements and choosing a more holistic approach to gamification concepts, we iteratively develop a taxonomy of gamification concepts for health apps using inductive and deductive approaches and discuss its transferability to other gamification contexts. We contribute to a profound understanding of the main characteristics of gamification concepts and enable researchers and practitioners to classify and distinguish them. Our results provide interesting insights into the essential characteristics of health apps’ gamification concepts

The Impact of Gamification Design on the Success of Health and Fitness Apps

Gamification has been increasingly employed in health-related apps in recent years. However, the effect of gamification design on the success of health and fitness apps remains unknown and has not been investigated before. This study attempts to identify what gamification elements are frequently used in the design of health and fitness apps and to empirically quantify their effects on app downloads and user ratings of these apps. We construct a rich dataset that includes information about the daily downloads, ratings and gamification design elements of 2,462 health and fitness apps on the Apple App Store. Our sample contains 924 paid apps and 1,538 free apps. This study contributes to both the gamification and mobile app literatures and provides important implications for app developers who intend to adopt gamification in mobile app design

Gamification for Health and Wellbeing : A Systematic Review of the Literature

Background: Compared to traditional persuasive technology and health games, gamification is posited to offer several advantages for motivating behaviour change for health and well-being, and increasingly used. Yet little is known about its effectiveness. Aims: We aimed to assess the amount and quality of empirical support for the advantages and effectiveness of gamification applied to health and well-being. Methods: We identified seven potential advantages of gamification from existing research and conducted a systematic literature review of empirical studies on gamification for health and well-being, assessing quality of evidence, effect type, and application domain. Results: We identified 19 papers that report empirical evidence on the effect of gamification on health and well-being. 59% reported positive, 41% mixed effects, with mostly moderate or lower quality of evidence provided. Results were clear for health-related behaviors, but mixed for cognitive outcomes. Conclusions: The current state of evidence supports that gamification can have a positive impact in health and wellbeing, particularly for health behaviors. However several studies report mixed or neutral effect. Findings need to be interpreted with caution due to the relatively small number of studies and methodological limitations present in many studies (e.g., a lack of comparison of gamified interventions to non-gamified versions of the intervention)

Gamification and older adults: Opportunities for gamification to support health promotion initiatives for older adults in the context of COVID-19

The COVID-19 pandemic has increased reliance on digital service delivery, including the delivery of health promotion initiatives. Health promotion interventions need to carefully consider user engagement. Gamification is a strategy used to engage and motivate people, and evidence shows overall cautious positive results in the use of gamification for older people across a range of health areas although more evidence is needed. Gamification has been used as a strategy in COVID-19 related initiatives and there is potential to build on the evidence to further develop gamification initiatives for those living in the Western Pacific region to impact positively on healthy behaviours and health outcomes

Autonomy in Video Games and Gamification

In the past decade, gamification (using game elements in non-gaming tasks to enhance motivation and engagement) has become a popular concept in many industries, but few studies have explored the principles under which it works. Self-determination theory suggests three psychological needs that gamification fulfills: competence, relatedness, and autonomy. Autonomy, a person\u27s perception that they have the ability to act however they choose, has emerged as an important, yet less-studied aspect in gamification. Inclusion of autonomy in gamification should foster engagement, enjoyment, and better performance. An experiment inspired by the above was carried out in which a sample of college students (N = 57) played a video game called Super Mario Bros. Crossover with either the choice to customize the aesthetics of their character and background (autonomy-supportive) or no choice of aesthetics (non-supportive). It was hypothesized that conditions involving more choice would lead to higher perceived autonomy and performance, and that perceived autonomy would be positively correlated with engagement, enjoyment, and performance. The manipulation resulted in no significant difference in perceived autonomy or performance, and perceived autonomy was only significantly positively correlated with enjoyment. Prior Super Mario Bros. experience was also found to positively correlate with perceived autonomy in the autonomy-supportive condition. The choice of aesthetics does not appear to have been sufficiently strong enough to increase perceived autonomy in this context

Exploring achievement gamification on online medical quality based on machine learning and empirical analysis

How to improve online medical quality is an important challenge for practitioners of digital health platforms. Gamification creates new opportunities to deal with the problem persistent in online health services. To better understand the role of gamification in online health services context, this study intends to use the research method of machine learning and natural experiment to explore the impact of achievement gamification on online medical quality in online health services, as well as the moderating effects of doctors’ personality and image. Theoretically, this study will expand the application of game strategy in the field of healthcare, and make up for the deficiency of the effects of gamification on online medical quality. Practically, it provides guidance for promoting doctors\u27 online participation behavior, improves the quality of online health services, and suggests ways for optimizing the rational allocation of online health resources