Effectiveness of Behaviorally Designed Gamification Interventions With Social Incentives for Increasing Physical Activity Among Overweight and Obese Adults Across the United States

Abstract

the use of game design elements in nongame contexts, is increasingly being used in workplace wellness programs and digital health applications. However, the best way to design social incentives in gamification interventions has not been well examined. OBJECTIVE To assess the effectiveness of support, collaboration, and competition within a behaviorally designed gamification intervention to increase physical activity among overweight and obese adults. DESIGN, SETTING, AND PARTICIPANTS This 36-week randomized clinical trial with a 24-week intervention and 12-week follow-up assessed 602 adults from 40 states with body mass indexes (calculated as weight in kilograms divided by height in meters squared) of 25 or higher from February 12, 2018, to March 17, 2019. INTERVENTIONS Participants used a wearable device to track daily steps, established a baseline, selected a step goal increase, were randomly assigned to a control (n = 151) or to 1 of 3 gamification interventions (support [n = 151], collaboration [n = 150], and competition [n = 150]), and were remotely monitored. The control group received feedback from the wearable device but no other interventions for 36 weeks. The gamification arms were entered into a 24-week game designed using insights from behavioral economics with points and levels for achieving step goals. No gamification interventions occurred during follow-up. MAIN OUTCOMES AND MEASURES The primary outcome was change in mean daily steps from baseline through the 24-week intervention period. RESULTS A total of 602 participants (mean [SD] age, 39 [10] years; mean [SD] body mass index, 30 [5]; 427 [70.9%] male) were included in the study. Compared with controls, participants had a significantly greater increase in mean daily steps from baseline during the intervention in the competition arm (adjusted difference, 920; 95% CI, 513-1328; P < .001), support arm (adjusted difference, 689; 95% CI, 267-977; P < .001), and collaboration arm (adjusted difference, 637; 95% CI, 258-1017; P = .001). During follow-up, physical activity remained significantly greater in the competition arm than in the control arm (adjusted difference, 569; 95% CI, 142-996; P = .009) but was not significantly greater in the support (adjusted difference, 428; 95% CI, 19-837; P = .04) and collaboration (adjusted difference, 126; 95% CI, −248 to 468; P = .49) arms than in the control arm. CONCLUSIONS AND RELEVANCE All 3 gamification interventions significantly increased physical activity during the 24-week intervention, and competition was the most effective. Physical activity was lower in all arms during follow-up and only remained significantly greater in the competition arm than in the control arm. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03311230

Choice architecture interventions to change physical activity and sedentary behavior: a systematic review of effects on intention, behavior and health outcomes during and after intervention

“…The four interventions that encouraged competition all effectively increased physical activity in presence of the intervention. For two of the interventions, effects were also measured after removal of the intervention [114,115]; these effects were significant in one study [115]. Finally, the three studies that provided information about physical activity performances of others all reported a significant effect on physical activity during the intervention.…”

“…A total of 23 studies were conducted in a laboratory setting (85-87, 89-103, 105-107) 1 . The remaining studies implemented an intervention through a mobile phone application or website (n = 8) [38,47,113,[115][116][117][118]120], mobile text messages (n = 2) [51,89] or e-mail (n = 2) [40,119].…”

“…For behavior, 67.6% of the interventions were effective (38, 40, 41, 43, 45-49, 52, 56-61, 65-70, 73, 75-84, 102, 109, 110, 112-120) 1 , 13.2% showed mixed effects [51,52,55,64,72,73,75,103] and 19.1% did not show an effect in presence of the intervention [43,45,56,63,65,66,89,95,101,105,109,111]. After removal of the intervention, 47.1% of the interventions showed a significant effect (40,43,45,47,49,58,61,67,77,82,86,97,110,118) 1 , 14.7% showed mixed effects [39,52,75,112,115] and 38.2% did not show an effect [43,49,69,73,81,90,93...…”

“…Twelve studies used social influence interventions (108-118) 1 , including descriptive social norms (n = 4) (108-110) 1 , behavioral modeling (n = 3) [111][112][113], encouragement of competition between individuals or teams (n = 4) [114][115][116][117], and facilitation of social comparison through information about the performance of others (n = 3) [113,115,118]. All studies providing a descriptive social norm (i.e.…”

“…Finally, the three studies that provided information about physical activity performances of others all reported a significant effect on physical activity during the intervention. Measures after removal of the intervention were performed in two of these studies [115,118]; the effect was significant in one study [118].…”