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Cited by 280Educational Games and GamificationDigital Mental Health InterventionsMobile Health and mHealth Applications

Gamification in apps and Technologies for Improving Mental Health and Well-Being: systematic review

Open access
Cheng, Vanessa Wan Sze, Davenport, Tracey, Johnson, Daniel, Vella, Kellie, Hickie, Ian B·2019·JMIR Mental Health
DOI 10.2196/13717PMC PMC6617915

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Abstract

BACKGROUND: There is little research on the application of gamification 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 behaviorist approach that relies on positive reinforcement and extrinsic motivators. OBJECTIVE: This study aimed to analyze current applications of gamification for mental health and well-being by answering 3 research questions (RQs). 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? RQ3: what reasons do researchers give for applying gamification to these apps and technologies? A systematic review of the literature was conducted to answer these questions. METHODS: We searched ACM Digital Library, CINAHL, Cochrane Library, EMBASE, IEEE Explore, JMIR, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science for qualifying papers published between the years 2013 and 2018. To answer RQ1 and RQ2, papers were coded for gamification elements and mental health and well-being domains according to existing taxonomies in the game studies and medical literature. 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 papers that collectively reported on 50 apps and technologies. The most commonly observed gamification elements were levels or progress feedback, points or scoring, rewards or prizes, narrative or theme, personalization, and customization; the least commonly observed elements were artificial assistance, unlockable content, social cooperation, exploratory or open-world approach, artificial challenge, and randomness. The most commonly observed mental health and well-being domains were anxiety disorders and well-being, whereas the least commonly observed domains were conduct disorder and bipolar disorders. Researchers' justification for applying gamification to improving mental health and well-being was coded in 59% (41/70) of the papers and was broadly divided into 2 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 behavior change frameworks. Results also suggest that the application of gamification is not driven by health behavior 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 standardization of applied games terminology within and across fields.

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  • Many internet interventions use interactive elements to maintain motivation and reinforce the desired effect of the intervention.

    “Many internet interventions use interactive elements to maintain motivation and reinforce the desired effect of the intervention (60).”

    From Improving mental well-being in psychocardiology—a feasibility trial for a non-blended web application as a brief metacognitive-based intervention in cardiovascular disease patients (2023) · cites this paper as [60]

    In the Discussion (Research Question 3; page unavailable), the review reports that gamification was used to encourage engagement in 31 of 41 papers and to encourage intended behaviors in 14. This supports the stated purposes of interactive features, but the review covers gamified mental-health and well-being apps and technologies, not internet interventions generally; it also says their effects need further study. (LLM, conf=0.84)

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  1. [3]Schmidt R Emmerich K Schmidt B Chorianopoulos K Divitini M Baalsrud Hauge J Jaccheri L Malaka R Applied games – in search of a new definition Entertainment Computing - ICEC 2015. ICEC 2015. Lecture Notes in Computer Science, vol 9353 2015 Cham Springer
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Authors
Cheng, V. W. S., Davenport, T., Johnson, D., Vella, K., & Hickie, I. B.
Affiliations
  • The University of Sydney (AU)
  • Queensland University of Technology (AU)
Corresponding author
Cheng, Vanessa Wan Sze
ORCID
Venue
JMIR Mental Health
Publisher
JMIR Publications Inc.
Published
2019-06-26
Volume
6
Issue
6
Pages
e13717
ISSN
2368-7959 (ISSN-L)
DOI
10.2196/13717
PMC
PMC6617915
OpenAlex
W2947812004
Cited by
280
References
55
Citations by year
2026: 28 · 2025: 55 · 2024: 48 · 2023: 45 · 2022: 28 · 2021: 53 · 2020: 20 · 2019: 3
FWCI
5.54
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JMIR Mental Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • QUT ePrints (Queensland University of Technology) (submittedVersion, cc-by)
Funders
Movember Foundation
Topics
  • Social Sciences › Psychology › Developmental and Educational Psychology › Educational Games and Gamification
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Keywords
gamification, mental health apps, well-being, game elements, behaviour change interventions, positive reinforcement, extrinsic motivation, behaviorism, user engagement, anxiety disorders, conduct disorder, bipolar disorder, digital health interventions, progress feedback, user-centered design, user satisfaction

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