JMIR Publications

ABSTRACT

Game-based approaches are increasingly used to improve user engagement of digital mental health interventions (DMHI) while specific game mechanics may yield therapeutic effects per se and thereby contribute to DMHI efficacy. Yet, game-based interventions have seen only limited commercial usage. We suggest that the challenges reflect the tension between the two underlying paradigms—healthcare and entertainment—that have disparate goals, and consequently, different approaches to intervention development. We describe three approaches currently used to negotiate the paradigms: gamification of healthcare software, designing serious games, and purpose-shifting existing entertainment games. We advance an integrative TEME framework to support the research and development of these game-based digital mental health interventions (gDMHI). The framework focuses on the interdependencies between the Target audience, user Engagement, the Mechanisms of action, and health-related Effectiveness. On each theme, we exhibit how the two paradigms complement each other. We elaborate the framework by considering its implications through the development from concept to production.