Gamification and Behavior Change Techniques in Diabetes Self-Management Apps

Abstract

Background: Diabetes management apps may have positive effects on diabetes self-management. It remains unclear, however, which app features are particularly effective and encourage sustained app usage. Behavior change techniques (BCTs) and gamification are promising approaches to improve user engagement. However, little is known about the frequency BCTs and gamification techniques (GTs) are actually used. This app review aims to provide an overview of BCTs and GTs in current diabetes management apps. Methods: Google’s Play Store was searched for applications using a broad search strategy (keyword: “diabetes”). We limited our research to freely available apps. A total of 56 apps matched the inclusion criteria and were reviewed in terms of the features they offer to support self-management. We used a taxonomy comprising 29 BCTs and 17 GTs to evaluate the applications. Two independent raters tested and evaluated each app. Results: Interrater agreement was high (ICC = .75 for BCTs; ICC = .90 for GTs). An average of 7.4 BCTs (SD = 3.1) and an average of 1.4 out of 17 GTs (SD = 1.6) were implemented in each app. Five out of 29 BCTs accounted for 55.8% of the BCTs identified in total. The GT most often identified was “feedback” and accounted for 50% of the GTs. Conclusions: The potential of BCTs and GTs in diabetes management apps has not been fully exploited yet. Only very restricted sets of BCTs and gamification features were implemented. Systematic research on the efficacy of specific BCTs and GTs is needed to provide further guidance for app design.

My Diabetes Coach, a Mobile App–Based Interactive Conversational Agent to Support Type 2 Diabetes Self-Management: Randomized Effectiveness-Implementation Trial

“…Interestingly, program exposure (an average of 18 appointments with Laura ) is very similar to the TLC diabetes program previously developed and evaluated by our team in Australia [ 34 ]; however, the program is more intensive than a human-delivered program that is widely available in Australia (a maximum of eight face-to-face group sessions per calendar year) [ 35 ]. Some gamification elements and human-like characteristics were utilized in the MDC program design, as suggested by previous studies [ 36 ]. The recently published and separate evaluation from MDC users demonstrated that these techniques did increase users’ engagement with the program but were insufficient to ensure engagement among all users [ 37 ].…”

Analysis of Effectiveness and Psychological Techniques Implemented in mHealth Solutions for Middle-Aged and Elderly Adults with Type 2 Diabetes: A Narrative Review of the Literature

“…Also, age-related decline in cognitive flexibility, processing speed, and other cognitive functions in old age can make it challenging to adopt and manage these solutions well, which could mean a low adherence [ 63 ]. Other aspects to be carefully considered when developing mHealth solutions for the elderly are short-set ups and onboarding processes, and user-friendly and graphic visual cues facilitating the understandability of the mHealth solution [ 29 , 30 , 31 , 84 ]. Acceptance and usability requirements of the elderly diabetic patients were insufficiently considered despite these growing populations representing a large target group that could benefit from diabetes apps [ 85 ].…”

“…When it comes to acceptance and usability requirements for older adults with diabetes, this is especially relevant because, in this sample, several barriers could be found. For instance, the lack of technological skills [ 29 , 30 , 31 ], availability and access to the internet [ 32 ], differences in motivational aspects [ 33 ], and also functional and sensory limitations hampering the use of these technologies. A systematic review of all currently available diabetes apps for iOS and Android revealed that usability of diabetes apps for patients aged ≥50 was moderate to good when applied mainly to apps offering a small range of functions.…”

Status of the research in fitness apps: A bibliometric analysis

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