Gamification applied for health promotion: does it really foster long-term engagement? A scoping review

Gamification is a popular design approach with the purpose to increase engagement and continuous use of Health Behaviour Change Support Systems (HBCSS) with the purpose to establish health and wellbeing. It is widely employed for promoting healthier life choices or for supporting people with chronic diseases in their daily activities. Yet, there is a lack of evidence concerning gamification and its ability to sustain favourable effects on health behaviour change. This paper presents a scoping review about the long-term perspective in gamified HBCSS, focusing primarily on IT-reliant systems that treat individual lifestyle habits like healthy nutrition, exercise or smoking cessation. We systematically selected studies that consider gamified HBCSS for health promotion and discuss to what extent long- term engagement is explicitly included in their design. Our results underline a deficit of consideration of the long-term perspective as well as a lack of measurement related to the lasting effects of gamification. We therefore propose to intensify the use of longitudinal and prospective observational studies in the context of HBCSS, in order to increase the level of evidence of gamification interventions

Implementing data-driven systems for work and health: The role of incentives in the use of physiolytics

Following the recent success of health wearable devices (smartwatches, activity trackers) for personal and leisure activities, organizations have started to build digital occupational health programs and data-driven health insurance around these systems. In this way, firms or health insurance companies seek to both support a new form of health promotion for their workforce/clients and to take advantage of large amounts of collected data for organizational purposes. Still, the success in the implementation of wearable health devices (also known as physiolytics) in organizational settings is entirely dependent on the individual motivation to adopt and use physiolytics over time (since organizations cannot establish a mandated use). Therefore, organizations often use incentives to encourage individuals to participate in such data-driven programs. Yet, little is known about these mechanisms that serve to align the interests of an organization with the interests of a group of individuals. This is an important challenge because these incentives may blunder the frontiers between what is voluntary and what is not. Against this background, this thesis aims, from a critical realist perspective, to build general knowledge regarding incentives in physiolytics-centered organizational programs. By doing so, individuals may be able to recognize challenges linked to participation in such programs; organizations may create sensible incentives; policymakers may identify new social issues that appear with this form of digitalization in organizations; and, finally, researchers may investigate new practical and social challenges regarding digitalization in organizations. In concrete terms, the first explorative phase of the thesis shows that feedback, gamification features and financial incentives are the most implemented incentives in physiolytics-centered organizational programs. There is also an overrepresentation of financial incentives for data-health plans, indicating that health insurance companies are building their strategy on external motivators. A second, more explanatory phase serves to further explore these types of incentives and specify recommendations by taking a higher perspective than normative views, so that it is possible to create more alternative managerial strategies or develop other policy perspectives. This part principally shows that the most influential incentives on user behavior are the ones that are transparent, that stimulate individual empowerment, and that propose defined benefits. In terms of contributions, this thesis allows individuals to evaluate how their autonomy and integrity is impacted by incentives in such data-driven programs. This thesis also outlines the necessity for organizations to invest time and resources to know their audience. Organizations additionally need to develop several strategies, by mixing incentives or gradually introducing them. Policymakers must ensure that regulations permit the clear consent of participants; guarantee a proportionality of incentives, and involve entities that can guide individuals through data-sharing. Finally, this thesis enables researchers to further investigate how organizations can develop appropriate and desirable environments regarding data-driven technology, so that individuals may enhance their decision-making processes and organizations may succeed in their implementation