Gamification and Adherence to Web-Based Mental Health Interventions: A Systematic Review

Abstract

BackgroundAdherence to effective Web-based interventions for common mental disorders (CMDs) and well-being remains a critical issue, with clear potential to increase effectiveness. Continued identification and examination of “active” technological components within Web-based interventions has been called for. Gamification is the use of game design elements and features in nongame contexts. Health and lifestyle interventions have implemented a variety of game features in their design in an effort to encourage engagement and increase program adherence. The potential influence of gamification on program adherence has not been examined in the context of Web-based interventions designed to manage CMDs and well-being.ObjectiveThis study seeks to review the literature to examine whether gaming features predict or influence reported rates of program adherence in Web-based interventions designed to manage CMDs and well-being.MethodsA systematic review was conducted of peer-reviewed randomized controlled trials (RCTs) designed to manage CMDs or well-being and incorporated gamification features. Seven electronic databases were searched.ResultsA total of 61 RCTs met the inclusion criteria and 47 different intervention programs were identified. The majority were designed to manage depression using cognitive behavioral therapy. Eight of 10 popular gamification features reviewed were in use. The majority of studies utilized only one gamification feature (n=58) with a maximum of three features. The most commonly used feature was story/theme. Levels and game leaders were not used in this context. No studies explicitly examined the role of gamification features on program adherence. Usage data were not commonly reported. Interventions intended to be 10 weeks in duration had higher mean adherence than those intended to be 6 or 8 weeks in duration.ConclusionsGamification features have been incorporated into the design of interventions designed to treat CMD and well-being. Further research is needed to improve understanding of gamification features on adherence and engagement in order to inform the design of future Web-based health interventions in which adherence to treatment is of concern. Conclusions were limited by varied reporting of adherence and usage data.

Chances and Limitations of Video Games in the Fight against Childhood Obesity—A Systematic Review

“…Furthermore, using screen media increasingly means using different screen media at the same time (Sigman, 2012b). The elements of games increase interest, motivation, enjoyment and thus engagement (Brown et al, 2016;Cugelman, 2013). Although screen time is associated with childhood obesity and considered to be a risk factor (Arango et al, 2014;Ballard, Gray, Reilly, & Noggle, 2009;Boone, Gordon-Larsen, Adair, & Popkin, 2007;Dietz & Gortmaker, 1985), computer and video games are considered to be less harmful than television (Rey-López, Vicente-Rodríguez, Biosca, & Moreno, 2008).…”

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

“…From the perspective of health behavior, gamification has shown promising results in encouraging physical activity by turning the ‘work of exercise’ into a game [17]. A recent review published in JMIR Mental Health found no studies had been published explicitly examining the role of gamification features on program adherence with Web-based interventions to manage common mental health disorders [18]. …”

Cognitive Behavior Therapy for Anxious and Depressed Youth: Improving Homework Adherence Through Mobile Technology

“…In particular, given the essential role of homework in CBT, they have been conceptualized as a means by which the therapy setting can reach beyond the clinic to the patient’s everyday environment [41]. A mobile homework app may support learning between sessions in numerous ways, including making homework materials accessible and easy to keep track of; aiding memory and understanding of the lesson learned during the treatment session; providing coaching and suggestions (eg, through a help function); promoting intrinsic motivation (eg, through goals and challenges, rewards, feedback on progress [42,43]); facilitating self-monitoring of symptoms and changes (eg, through visual displays); and enhancing homework review and troubleshooting (eg, by summarizing results for discussion). In summary, mobile delivery of homework may provide a means of supporting the continuation of learning during the intervals in between treatment sessions.…”