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Gamification for health promotion: systematic review of behaviour change techniques in smartphone apps

Gamification for health promotion: systematic review of behaviour change techniques in smartphone apps
Gamification for health promotion: systematic review of behaviour change techniques in smartphone apps
Objective: Smartphone games that aim to alter health behaviours are common, but there is uncertainty about how to achieve this. We systematically reviewed health apps containing gaming elements analysing their embedded behaviour change techniques.

Methods: Two trained researchers independently coded apps for behaviour change techniques using a standard taxonomy. We explored associations with user ratings and price.

Data sources: We screened the National Health Service (NHS) Health Apps Library and all top-rated medical, health and wellness and health and fitness apps (defined by Apple and Google Play stores based on revenue and downloads). We included free and paid English language apps using ‘gamification’ (rewards, prizes, avatars, badges, leaderboards, competitions, levelling-up or health-related challenges). We excluded apps targeting health professionals.

Results: 64 of 1680 (4%) health apps included gamification and met inclusion criteria; only 3 of these were in the NHS Library. Behaviour change categories used were: feedback and monitoring (n=60, 94% of apps), reward and threat (n=52, 81%), and goals and planning (n=52, 81%). Individual techniques were: self-monitoring of behaviour (n=55, 86%), non-specific reward (n=49, 82%), social support unspecified (n=48, 75%), non-specific incentive (n=49, 82%) and focus on past success (n=47, 73%). Median number of techniques per app was 14 (range: 5–22). Common combinations were: goal setting, self-monitoring, non-specific reward and non-specific incentive (n=35, 55%); goal setting, self-monitoring and focus on past success (n=33, 52%). There was no correlation between number of techniques and user ratings (p=0.07; rs=0.23) or price (p=0.45; rs=0.10).

Conclusions: Few health apps currently employ gamification and there is a wide variation in the use of behaviour change techniques, which may limit potential to improve health outcomes. We found no correlation between user rating (a possible proxy for health benefits) and game content or price. Further research is required to evaluate effective behaviour change techniques and to assess clinical outcomes.

Trial registration number: CRD42015029841.
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Edwards, E.A.
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Lumsden, J.
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Rivas, C.
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Steed, L.
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Edwards, L.A.
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Thiyagarajan, A.
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Sohanpal, R.
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Caton, H.
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Griffiths, C.J.
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Munafo, M.R.
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Taylor, S.
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Walton, R.T.
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Edwards, E.A.
a63ed07b-c8f0-4fdf-8c93-acc9827d6f4d
Lumsden, J.
8aed9bec-1ba8-46d2-a1ca-0b92d1ae6313
Rivas, C.
040bfbc1-0aef-4826-ab58-e85743fea9d4
Steed, L.
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Edwards, L.A.
dfc08963-007f-4492-868f-1f24e45187e0
Thiyagarajan, A.
18c465c6-e1df-4488-81fa-64c00ab64054
Sohanpal, R.
002aec52-e7bb-4add-b153-57c8042ce000
Caton, H.
0146a6ed-7961-466b-84af-1300acf7f64e
Griffiths, C.J.
412c71b1-23e4-477c-93a3-e2d1908d6cd3
Munafo, M.R.
9f08cda8-d2ed-4e48-b7f8-7f29fa33efc9
Taylor, S.
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Walton, R.T.
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Edwards, E.A., Lumsden, J., Rivas, C., Steed, L., Edwards, L.A., Thiyagarajan, A., Sohanpal, R., Caton, H., Griffiths, C.J., Munafo, M.R., Taylor, S. and Walton, R.T. (2016) Gamification for health promotion: systematic review of behaviour change techniques in smartphone apps. BMJ Open, 6 (e012447), 1-10. (doi:10.1136/bmjopen-2016-012447).

Record type: Article

Abstract

Objective: Smartphone games that aim to alter health behaviours are common, but there is uncertainty about how to achieve this. We systematically reviewed health apps containing gaming elements analysing their embedded behaviour change techniques.

Methods: Two trained researchers independently coded apps for behaviour change techniques using a standard taxonomy. We explored associations with user ratings and price.

Data sources: We screened the National Health Service (NHS) Health Apps Library and all top-rated medical, health and wellness and health and fitness apps (defined by Apple and Google Play stores based on revenue and downloads). We included free and paid English language apps using ‘gamification’ (rewards, prizes, avatars, badges, leaderboards, competitions, levelling-up or health-related challenges). We excluded apps targeting health professionals.

Results: 64 of 1680 (4%) health apps included gamification and met inclusion criteria; only 3 of these were in the NHS Library. Behaviour change categories used were: feedback and monitoring (n=60, 94% of apps), reward and threat (n=52, 81%), and goals and planning (n=52, 81%). Individual techniques were: self-monitoring of behaviour (n=55, 86%), non-specific reward (n=49, 82%), social support unspecified (n=48, 75%), non-specific incentive (n=49, 82%) and focus on past success (n=47, 73%). Median number of techniques per app was 14 (range: 5–22). Common combinations were: goal setting, self-monitoring, non-specific reward and non-specific incentive (n=35, 55%); goal setting, self-monitoring and focus on past success (n=33, 52%). There was no correlation between number of techniques and user ratings (p=0.07; rs=0.23) or price (p=0.45; rs=0.10).

Conclusions: Few health apps currently employ gamification and there is a wide variation in the use of behaviour change techniques, which may limit potential to improve health outcomes. We found no correlation between user rating (a possible proxy for health benefits) and game content or price. Further research is required to evaluate effective behaviour change techniques and to assess clinical outcomes.

Trial registration number: CRD42015029841.

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More information

Accepted/In Press date: 8 September 2016
e-pub ahead of print date: 4 October 2016
Published date: 4 October 2016
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 401172
URI: https://eprints.soton.ac.uk/id/eprint/401172
PURE UUID: 8c3ac91d-464b-42ea-9446-53897ccb4ca4

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Date deposited: 10 Oct 2016 13:15
Last modified: 17 May 2018 16:31

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Contributors

Author: E.A. Edwards
Author: J. Lumsden
Author: C. Rivas
Author: L. Steed
Author: L.A. Edwards
Author: A. Thiyagarajan
Author: R. Sohanpal
Author: H. Caton
Author: C.J. Griffiths
Author: M.R. Munafo
Author: S. Taylor
Author: R.T. Walton

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