JMIR Publications

Background:

Gamification is a promising strategy to increase the effectiveness of Web-based mental health interventions by enhancing engagement. However, because most studies focus on the longer term effects of gamification (eg, effectiveness or adherence at the end of the intervention period), there is limited insight into how gamification may enhance engagement. Research implies that gamification has a direct impact at the time of use of the intervention, which changes the experience of the users, and thereby motivates users. However, it is unclear what this direct impact of gamification might be and how it can be measured.

Objective:

The objective of this study was to explore the direct impact of gamification on behavioral, cognitive, and affective engagement in the context of a Web-based mental health intervention and to explore whether and how the different components of engagement are related.

Methods:

A pilot (n=19) and a real-life (n=75) randomized between-groups experiment was carried out, where participants used a gamified or nongamified version of the same Web-based well-being intervention for a single session. Participants (68%, 64/94 female, mean age 23 years) were asked to use the intervention in one session for research purposes. Gamification elements included a map as visualization of the different lessons, a virtual guide, and badges. Later, behavioral, cognitive, and affective engagement were measured.

Results:

The pilot experiment showed no differences between the gamified and nongamified intervention. However, in the real-life experiment, participants in the gamified intervention scored higher on cognitive engagement, that is, involvement (P=.02) and some elements of affective engagement, that is, flow as a combination of cognitive and affective engagement (P=.049), and the emotions ”interest” (P=.03) and “inspiration” (P=.009). Furthermore, the effect of gamification on cognitive engagement was mediated by the influence of gamification on specific positive emotions.

Conclusions:

The gamified intervention seemed to be able to increase cognitive engagement and the combination of cognitive and affective engagement but not behavioral and affective engagement alone. However, positive emotions seem to play an important role in mediating the effect of gamification on engagement. In conclusion, we cannot say that gamification ”works” but that the design of an intervention, in this case, gamification, can have an impact on how participants experience the intervention.