The Role of Gamification in Health Behavior Change: A Review of Theory-driven Studies

Abstract

Gamification is increasingly being recognized as a tool to support a change in individuals' health behaviors. However, how and under which circumstances gamification is able to support health behavior change is still largely unexplored. This study follows the call for more theory-driven research on gamification by investigating the role of gamification in health behavior change theories (HBCTs). In order to do so, we conducted a systematic review of extant literature and identified 25 studies that explore the role of gamification in the process of health behavior change to some extent. We found large discrepancies in how the authors of these studies conceptualized the role of gamification in their theory-driven health interventions. To further strengthen theory-driven research on gamification in health and well-being, we additionally propose concrete research questions. These may guide future researchers to identify valuable avenues for further explaining and predicting the influences of gamification on health behavior change.

Participant Perceptions of Facilitators and Barriers to Adherence in a Digital Mental Health Intervention for a Nonclinical Cohort: Content Analysis

“…Considerable research has been undertaken by researchers and program developers to facilitate optimum adherence to digital health initiatives. Methods used to promote participant adherence include the adoption of a robust set of persuasive system design principles [ 2 , 4 , 5 ], provision of rewards and incentives, positive feedback [ 6 ], implementation of gamification techniques [ 7 , 8 ], and various forms of human support [ 9 ]. However, adherence to digital interventions remains to be problematic [ 3 ], and there is a paucity of research elucidating participant perspectives on the factors that impact adherence [ 10 ] in community-based, nonclinical groups.…”

Are Gamification Projects Different? An Exploratory Study on Software Project Risks for Gamified Health Behavior Change Support Systems

“…It was also interesting to see that many experts approach gamification from a self-determination theory (SDT) perspective, which is by far the most prominent theoretical lens on gamification [25]. While we acknowledge the value of approaching gamification from an SDT perspective, we think that future research should also consider other theoretical perspectives that are more closely related to the context that gamification is applied in (e.g., theories unique to the health context for HBCSSs [26]).…”

Recommendations for Implementing Gamification for Mental Health and Wellbeing

“…For example, Earle et al (2018) describe an adaptation of personalized normative feedback for problematic alcohol use, while Vella et al (2018) describe a gamified wellbeing app that adapts techniques from acceptance and commitment therapy and positive psychology. However, previous research has identified a lack of application of health behavior change theory in gamified health and wellbeing technologies ( Lister et al, 2014 ; Schmidt-Kraepelin et al, 2020 ). Furthermore, applications of gamification for health and wellbeing also appear to lack adequate reference to motivational theory ( Johnson et al, 2016 ).…”

“…Then, in the next section, “Interrogating Gamification for Mental Health and Wellbeing,” it examined the complexities of the game form to demonstrate that gamification is not just implementing surface-level game mechanics such as points, badges, or leaderboards. In the following section, “Developing and Evaluating Gamified Technologies for Mental Health and Wellbeing,” this article further explored the process of designing, developing, and clinically evaluating gamified technologies for mental health and wellbeing, through the application of theory, methodologies, processes, and frameworks which are standard in their fields of origin, but rarely combined (as identified by, e.g., Schmidt-Kraepelin et al, 2020 ).…”

“…Additionally, a systematic review by Cheng et al (2019) used relatively broad criteria to capture researcher justification for including gamification in their apps or technologies for mental health, and found that 41% (39/70) of the papers in their sample did not provide any reason for doing so. More recently, Schmidt-Kraepelin et al (2020) conducted a systematic review of studies investigating health behavior change theories and gamification and found that of the 25 papers reviewed, seven only briefly mentioned a health behavior change theoretical framework, and only five had fully integrated a health behavior change theory into the gamified technology.…”