Gamification in Apps and Technologies for Improving Mental Health and Well-Being: Systematic Review

Abstract

Background There is little research on the application of gamification to mental health and well-being. Furthermore, usage of gamification-related terminology is inconsistent. Current applications of gamification for health and well-being have also been critiqued for adopting a behaviorist approach that relies on positive reinforcement and extrinsic motivators. Objective This study aimed to analyze current applications of gamification for mental health and well-being by answering 3 research questions (RQs). RQ1: which gamification elements are most commonly applied to apps and technologies for improving mental health and well-being? RQ2: which mental health and well-being domains are most commonly targeted by these gamified apps and technologies? RQ3: what reasons do researchers give for applying gamification to these apps and technologies? A systematic review of the literature was conducted to answer these questions. Methods We searched ACM Digital Library, CINAHL, Cochrane Library, EMBASE, IEEE Explore, JMIR, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science for qualifying papers published between the years 2013 and 2018. To answer RQ1 and RQ2, papers were coded for gamification elements and mental health and well-being domains according to existing taxonomies in the game studies and medical literature. During the coding process, it was necessary to adapt our coding frame and revise these taxonomies. Thematic analysis was conducted to answer RQ3. Results The search and screening process identified 70 qualifying papers that collectively reported on 50 apps and technologies. The most commonly observed gamification elements were levels or progress feedback, points or scoring, rewards or prizes, narrative or theme, personalization, and customization; the least commonly observed elements were artificial assistance, unlockable content, social cooperation, exploratory or open-world approach, artificial challenge, and randomness. The most commonly observed mental health and well-being domains were anxiety disorders and well-being, whereas the least commonly observed domains were conduct disorder and bipolar disorders. Researchers’ justification for applying gamification to improving mental health and well-being was coded in 59% (41/70) of the papers and was broadly divided into 2 themes: (1) promoting engagement and (2) enhancing an intervention’s intended effects. Conclusions Our findings suggest that the current application of gamification to apps and technologies for improving mental health and well-being does not align with the trend of positive reinforcement critiqued in the greater health and well-being literature. We also observed overlap between the most commonly used gamification techniques and existing behavior change frameworks. Results also suggest that the application of gamification is not driven by health behavior change theory, and that many researchers may treat gamification as a black box without consideration for its underlying mechanisms. We call for the inclusion of more comprehensive and explicit descriptions of how gamification is applied and the standardization of applied games terminology within and across fields.

Project Synergy: co‐designing technology‐enabled solutions for Australian mental health services reform

“…Both the co‐design and knowledge translation processes acknowledged engagement and user retention problems, which have been increasingly documented . These problems were addressed by developing a tips‐and‐advice feature, integrating the prototype with university social media channels and including a 21‐day online challenge (Box 1).…”

LiveWell RERC State of the Science Conference Report on ICT Access to Support Community Living, Health and Function for People with Disabilities

“…Leveraging the principles of commercial e-gaming (goal setting, the accumulation of points, dashboards for real-time feedback, multiple levels of difficulty, rewards and badges, and in-game communication with other participants), gamification offers the potential to support behavior modification to promote physical activity, healthy lifestyles, medication adherence, and mental health, among other positive behaviors and outcomes [13]. Despite the potential benefits of gamification, more research and development are needed to ensure the incorporation of proper behavior modification principles into the design of technology-based interventions [14] and the durability of positive health outcomes [15].…”

Validation of a mobile game-based assessment of cognitive control among children and adolescents

“…We used the Korean version of the Stroop Color-Word Test for children in this study. Its reliability (Cronbach's α) has been found to be 0.72 among the normative population and 0.73 among the clinical population [24]. The Korean norms for this test are available for those who are between the ages of 5 to 14 years.…”

“…According to the conclusions of Cheng, Davenport, Johnson, Vella, and Hickie [24]'s systematic review of articles on gamification, the most commonly targeted mental health problems are anxiety disorder and a poor wellbeing, whereas the least commonly targeted mental health problems are conduct disorder, bipolar disorder, self-injurious behaviors, schizophrenia, and ADHD. They have also observed that gamification may serve as a new means by which human behavior can be changed (i.e., when compared to the traditional approach).…”

“…However, only a small proportion of academic reports have documented the effectiveness of mobile application-based assessments that use gamification among these demographic groups [26] [27]. In particular, gamification is a very useful method to evaluate and intervene in behavioral problems among children and adolescents, but the efficacy study of mobile application-based assessments that use gamification to target conduct disorder, self-injurious behaviors, and ADHD was not reported, even though conduct disorder, self-injurious behaviors and ADHD are mostly related to dysfunctional cognitive control and are more common among children and adolescents [24].…”