JMIR Publications

ABSTRACT

Background:

While gamification has received considerable interest from the health community in recent years, there is little research on its application 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 behaviourist approach that relies on positive reinforcement and extrinsic motivators.

Objective:

To gain an improved understanding of the current state of the field, we developed three research questions: 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; and RQ3) what reasons do researchers give for applying gamification to these apps and technologies. To answer these questions, we conducted a systematic review of the literature.

Methods:

We searched ACM Digital Library, CINAHL, Cochrane Library, Embase, IEEE Explore, JMIR, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science for qualifying articles published within the last five years (2013–18). To answer RQ1 and RQ2, articles were coded for gamification elements and mental health and well-being domains according to existing taxonomies in the game studies and medical literatures. 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 articles that collectively reported on 50 apps and technologies. The most commonly observed gamification elements were levels/progress feedback, points/scoring, rewards/prizes, narrative/theme, personalisation, and customisation; while the least commonly observed were artificial assistance, unlockable content, social cooperation, exploratory/open-world approach, artificial challenge, and randomness. The most commonly observed mental health and well-being domains were anxiety disorders and well-being; while the least commonly observed were conduct disorder and bipolar disorders. Researcher justification for applying gamification to improving mental health and well-being was coded in 59% (41/70) articles and was broadly divided into two 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 behaviour change frameworks. Results also suggest that the application of gamification is not driven by health behaviour 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 standardisation of the usage of applied games terminology within and across fields.