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

Abstract

BackgroundFinding 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.ObjectiveThe 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.MethodsWe 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.ResultsResults 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.ConclusionsGamification 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.

Effective Behavioral Changes through a Digital mHealth App: Exploring the Impact of Hedonic Well-Being, Psychological Empowerment and Inspiration (Preprint)

“…The findings of this study offer relevant and potentially provocative insights into effective app design for digital mHealth apps [19,20]. In particular, the findings related to which elements of app design are more conducive to smoking cessation are intriguing and extend current knowledge about the design of evidence-based smoking cessation mHealth apps [25].…”

“…For instance, studies have shown that aspects of gamification can be twice as effective in frequency of self-monitored exercise for weight loss program compared to a standard paper diary [18]. Ultimately, applications that incorporate behavior change techniques tend to be associated with increased intervention effectiveness [19].…”

“…challengeability balance, meaningful framing, personalization, fun or user-centered design [6,19]) affect behavior change by psychologically empowering users, enhancing their well-being, and giving them inspiration. Such gamification tactics, among others, have been identified to elicit behavior change within the health and healthcare settings, yet there is no clear pattern as to the type of behavior change strategy that is most effective [20].…”

Potential of an Interactive Drug Prevention Mobile Phone App (Once Upon a High): Questionnaire Study Among Students (Preprint)

“…money or presents) do not come into question in case of such prevention programs. Based on the findings of ElHilly and colleagues [57], it is intrinsic motivation that may function as a positive drive to engagement in a prevention program and to a positive health behavior as well, while external social influences might rather have a negative impact on the overall efficacy of gamification. Similar results were published by Habgood and Ainsworth [58], indicating that in-game intrinsic motivators are more effective than extrinsic ones in case of educational games.…”

Connecting With Your Dentist on Facebook: Patients� and Dentists� Attitudes Towards Social Media Usage in Dentistry (Preprint)

“…Social media may allow dental professionals to deliver the help outside a dental practice environment. Notably, some features of social media such as gamification [29,30] and engaging website design [31] may be particularly relevant to address and inform patients about critical health-related issues and educate them, which can also help increase their trust and appreciate the level of service received [32][33][34]. Research studying the role of how social media may help reduce patients' dental anxiety is a worthwhile and exciting endeavor.…”