User Engagement and Attrition in an App-Based Physical Activity Intervention: Secondary Analysis of a Randomized Controlled Trial
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Abstract
Background: The success of a mobile phone app in changing health behavior is thought to be contingent on engagement, commonly operationalized as frequency of use. Objective: This subgroup analysis of the 2 intervention arms from a 3-group randomized controlled trial aimed to examine user engagement with a 100-day physical activity intervention delivered via an app. Rates of engagement, associations between user characteristics and engagement, and whether engagement was related to intervention efficacy were examined. Methods: Engagement was captured in a real-time log of interactions by users randomized to either a gamified (n=141) or nongamified version of the same app (n=160). Physical activity was assessed via accelerometry and self-report at baseline and 3-month follow-up. Survival analysis was used to assess time to nonuse attrition. Mixed models examined associations between user characteristics and engagement (total app use). Characteristics of super users (top quartile of users) and regular users (lowest 3 quartiles) were compared using t tests and a chi-square analysis. Linear mixed models were used to assess whether being a super user was related to change in physical activity over time. Results: Engagement was high. Attrition (30 days of nonuse) occurred in 32% and 39% of the gamified and basic groups, respectively, with no significant between-group differences in time to attrition (P=.17). Users with a body mass index (BMI) in the healthy range had higher total app use (mean 230.5, 95% CI 190.6-270.5; F2=8.67; P<.001), compared with users whose BMI was overweight or obese (mean 170.6, 95% CI 139.5-201.6; mean 132.9, 95% CI 104.8-161.0). Older users had higher total app use (mean 200.4, 95% CI 171.9-228.9; F1=6.385; P=.01) than younger users (mean 155.6, 95% CI 128.5-182.6). Super users were 4.6 years older (t297=3.6; P<.001) and less likely to have a BMI in the obese range (χ22=15.1; P<.001). At the 3-month follow-up, super users were completing 28.2 (95% CI 9.4-46.9) more minutes of objectively measured physical activity than regular users (F1,272=4.76; P=.03). Conclusions: Total app use was high across the 100-day intervention period, and the inclusion of gamified features enhanced engagement. Participants who engaged the most saw significantly greater increases to their objectively measured physical activity over time, supporting the theory that intervention exposure is linked to efficacy. Further research is needed to determine whether these findings are replicated in other app-based interventions, including those experimentally evaluating engagement and those conducted in real-world settings. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617000113358; https://www.anzctr.org.au/ACTRN12617000113358.aspx
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In mobile health and education applications, gamified features increase the frequency and duration of user sessions and reduce dropout rates.
“For example, in mobile health (mHealth) and education applications, gamified features have been found to increase the frequency and duration of user sessions, as well as reduce dropout rates (Edney et al., 2019; Poondej & Lerdpornkulrat, 2016).”
From An Experimental Analysis of Gamification’s Impact on Customer Engagement and Retention in Subscription-Based Business Models (2026) · cites this paper as Edney et al., 2019
The Results (Daily Active Users; page unavailable) found significantly more daily users in the gamified mHealth app group, supporting increased use. The study did not report session duration or examine education apps. The Results (Nonuse Attrition; page unavailable) found numerically lower dropout in the gamified group, but the between-group difference in time to attrition was not statistically significant. (LLM, conf=0.89)
Experimental — accuracy not yet measuredStreak mechanics specifically interrupt the honeymoon-decline pattern characteristic of subscription services.
“This finding extends Edney et al. ' s (2019) work on attrition reduction by demonstrating that streak mechanics specifically interrupt the honeymoondecline pattern characteristic of subscription services, converting initial interest into habitual behaviour as theorised by Litvin et al. (2020).”
From An Experimental Analysis of Gamification’s Impact on Customer Engagement and Retention in Subscription-Based Business Models (2026) · cites this paper as Edney et al. ' s (2019)
Edney et al. studied app engagement and nonuse attrition, so the description of their work is broadly apt. However, the Results (Nonuse Attrition; page unavailable) found no statistically significant difference in time to attrition between the gamified and basic apps. The citing sentence presents streak mechanics and the subscription-service honeymoon-decline pattern as its own new finding, not as findings from Edney et al. (LLM, conf=0.85)
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Cites
Nonparametric Estimation from Incomplete Observations
Kaplan, E. L., & Meier, P. (1958) · Journal of the American Statistical Association · doi:10.1080/01621459.1958.10501452 · Cited by 39,158 · see citing works
Venkatesh, V., Thong, J. Y. L., & Xu, X. (2012) · MIS Quarterly · doi:10.2307/41410412 · Cited by 15,756 · see citing works
From game design elements to gamefulness: defining "gamification"
Deterding, S., Dixon, D., Khaled, R., & Nacke, L. (2011) · Proceedings of the 15th International Academic MindTrek Conference: Envisioning Future Media Environments · doi:10.1145/2181037.2181040 · Cited by 8,402 · see citing works
Health benefits of physical activity: the evidence
Warburton, D. E. R. (2006) · Canadian Medical Association Journal · doi:10.1503/cmaj.051351 · Cited by 8,007 · see citing works
Deci, E. L., Koestner, R., & Ryan, R. M. (1999) · Psychological Bulletin · doi:10.1037/0033-2909.125.6.627 · Cited by 7,176 · cited 1× · see citing works
“This should be considered with the caveat that there is ongoing debate around whether external motivation provided by gamification undermines intrinsic motivation for participating in PA [60-64].”
Penedo, F. J., & Dahn, J. R. (2005) · Current Opinion in Psychiatry · doi:10.1097/00001504-200503000-00013 · Cited by 2,851 · see citing works
Eysenbach, G. (2005) · Journal of Medical Internet Research · doi:10.2196/jmir.7.1.e11 · Cited by 2,524 · see citing works
Bonevski, B., Randell, M., Paul, C. L., Chapman, K. L., Twyman, L., Bryant, J., Brozek, I., & Hughes, C. (2014) · BMC Medical Research Methodology · doi:10.1186/1471-2288-14-42 · Cited by 1,495 · see citing works
Persuasive System Design Does Matter: a Systematic Review of Adherence to Web-based Interventions
Kelders, S. M., Kok, R. N., Ossebaard, H. C., & Van Gemert-Pijnen, J. E. (2012) · Journal of Medical Internet Research · doi:10.2196/jmir.2104 · Cited by 1,308 · see citing works
Gamification for health and wellbeing: A systematic review of the literature
Johnson, D., Deterding, S., Kuhn, K.-A., Staneva, A., Stoyanov, S., & Hides, L. (2016) · Internet Interventions · doi:10.1016/j.invent.2016.10.002 · Cited by 1,237 · see citing works
Perski, O., Blandford, A., West, R., & Michie, S. (2017) · Translational Behavioral Medicine · doi:10.1007/s13142-016-0453-1 · Cited by 1,210 · see citing works
A systematic review of gamification in e-Health
Sardi, L., Idri, A., & Fernández‐Alemán, J. L. (2017) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2017.05.011 · Cited by 1,041 · see citing works
Dennison, L., Morrison, L., Conway, G., & Yardley, L. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2583 · Cited by 895 · see citing works
Understanding the Hawthorne effect
Sedgwick, P., & Greenwood, N. (2015) · BMJ · doi:10.1136/bmj.h4672 · Cited by 824 · see citing works
Samdal, G. B., Eide, G. E., Barth, T., Williams, G., & Meland, E. (2017) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-017-0494-y · Cited by 788 · see citing works
Maher, C. A., Lewis, L. K., Ferrar, K., Marshall, S., De Bourdeaudhuij, I., & Vandelanotte, C. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.2952 · Cited by 733 · see citing works
Self-citationLaranjo, L., Arguel, A., Neves, A. L., Gallagher, A. M., Kaplan, R., Mortimer, N., Mendes, G. A., & Lau, A. Y. S. (2015) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2014-002841 · Cited by 661 · see citing works
Validation of the GENEA Accelerometer
ESLIGER, D. W., ROWLANDS, A. V., HURST, T. L., CATT, M., MURRAY, P., & ESTON, R. G. (2011) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e31820513be · Cited by 625 · see citing works
Wickström (2000) · doi:10.5271/sjweh.555 · Cited by 526 · see citing works
Can smartphone apps increase physical activity? Systematic review and meta-analysis
Romeo, A., Edney, S., Plotnikoff, R., Curtis, R., Ryan, J., Sanders, I., Crozier, A., & Maher, C. (2019) · Journal of Medical Internet Research · doi:10.2196/12053 · Cited by 487 · see citing works
Self-citationWebsite-Delivered Physical Activity Interventions
Vandelanotte, C., Spathonis, K. M., Eakin, E. G., & Owen, N. (2007) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2007.02.041 · Cited by 475 · see citing works
Self-citationPlotnikoff, R. C., Costigan, S. A., Williams, R. L., Hutchesson, M., Kennedy, S. G., Robards, S. L., Allen, J., Collins, C. E., Callister, R., & Germov, J. (2015) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-015-0203-7 · Cited by 446 · see citing works
Self-citationDoes gamification increase engagement with online programs? A systematic review
Looyestyn, J., Kernot, J., Boshoff, K., Ryan, J. C., Edney, S. M., & Maher, C. A. (2017) · PLoS ONE · doi:10.1371/journal.pone.0173403 · Cited by 412 · see citing works
Self-citationShort, C. E., DeSmet, A., Woods, C., Williams, S. L., Maher, C., Middelweerd, A., Müller, A. M., Wark, P. A., Vandelanotte, C., Poppe, L., et al. (2018) · Journal of Medical Internet Research · doi:10.2196/jmir.9397 · Cited by 400 · see citing works
Self-citationVandelanotte, C., Müller, A. M., Short, C. E., Hingle, M., Nathan, N., Williams, S. L., Lopez, M. L., Parekh, S., & Maher, C. A. (2016) · Journal of Nutrition Education and Behavior · doi:10.1016/j.jneb.2015.12.006 · Cited by 396 · see citing works
Self-citationOnline Prevention Aimed at Lifestyle Behaviors: A Systematic Review of Reviews
Kohl, L. F., Crutzen, R., & de Vries, N. K. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2665 · Cited by 388 · see citing works
Kyewski, E., & Krämer, N. C. (2017) · Computers & Education · doi:10.1016/j.compedu.2017.11.006 · Cited by 327 · see citing works
Shin, G., Jarrahi, M. H., Fei, Y., Karami, A., Gafinowitz, N., Byun, A., & Lu, X. (2019) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2019.103153 · Cited by 326 · see citing works
Clawson, J., Pater, J. A., Miller, A., Mynatt, E. D., & Mamykina, L. (2015) · ACM International Joint Conference on Pervasive and Ubiquitous Computing (UbiComp) · doi:10.1145/2750858.2807554 · Cited by 312 · see citing works
Computer use among older adults in a naturally occurring retirement community
Carpenter, B. D., & Buday, S. K. (2006) · Computers in Human Behavior · doi:10.1016/j.chb.2006.08.015 · Cited by 259 · see citing works
Gal, R., May, A. M., van Overmeeren, E. J., Simons, M., & Monninkhof, E. M. (2018) · Sports Medicine - Open · doi:10.1186/s40798-018-0157-9 · Cited by 257 · see citing works
Enhancing User Engagement through Gamification
Suh, A., Wagner, C., & Liu, L. (2016) · Journal of Computer Information Systems · doi:10.1080/08874417.2016.1229143 · Cited by 251 · see citing works
Mobile App-Based Health Promotion Programs: A Systematic Review of the Literature
Lee, M., Lee, H., Kim, Y., Kim, J.-H., Cho, M., Jang, J., & Jang, H. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15122838 · Cited by 237 · see citing works
Stages of Change Across Ten Health Risk Behaviors for Older Adults
Nigg, C. R., Burbank, P. M., Padula, C., Dufresne, R., Rossi, J. S., Velicer, W. F., Laforge, R. G., & Prochaska, J. O. (1999) · The Gerontologist · doi:10.1093/geront/39.4.473 · Cited by 236 · see citing works
Patel, M. S., Benjamin, E. J., Volpp, K. G., Fox, C. S., Small, D. S., Massaro, J. M., Lee, J. J., Hilbert, V., Valentino, M., Taylor, D. H., et al. (2017) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2017.3458 · Cited by 218 · see citing works
Users' experiences of wearable activity trackers: a cross-sectional study
Maher, C., Ryan, J., Ambrosi, C., & Edney, S. (2017) · BMC Public Health · doi:10.1186/s12889-017-4888-1 · Cited by 180 · see citing works
Self-citationMüller, A. M., Maher, C. A., Vandelanotte, C., Hingle, M., Middelweerd, A., Lopez, M. L., DeSmet, A., Short, C. E., Nathan, N., Hutchesson, M. J., et al. (2018) · Journal of Medical Internet Research · doi:10.2196/jmir.8954 · Cited by 180 · see citing works
Self-citationMaher, C., Ferguson, M., Vandelanotte, C., Plotnikoff, R., De Bourdeaudhuij, I., Thomas, S., Nelson-Field, K., & Olds, T. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.4086 · Cited by 171 · see citing works
Self-citationGuertler, D., Vandelanotte, C., Kirwan, M., & Duncan, M. J. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.4339 · Cited by 147 · see citing works
Self-citationPham, Q., Graham, G., Carrion, C., Morita, P. P., Seto, E., Stinson, J. N., & Cafazzo, J. A. (2019) · JMIR mHealth and uHealth · doi:10.2196/11941 · Cited by 131 · see citing works
Attig, C., & Franke, T. (2018) · International Journal of Human-Computer Studies · doi:10.1016/j.ijhcs.2018.04.007 · Cited by 126 · see citing works
Danaher, B. G., Brendryen, H., Seeley, J. R., Tyler, M. S., & Woolley, T. (2015) · Internet Interventions · doi:10.1016/j.invent.2015.01.002 · Cited by 102 · see citing works
Nelson, L. A., Coston, T. D., Cherrington, A., & Osborn, C. Y. (2016) · Current Diabetes Reports · doi:10.1007/s11892-016-0755-1 · Cited by 83 · see citing works
Smoking Cessation Intervention on Facebook: Which Content Generates the Best Engagement?
Thrul, J., Klein, A. B., & Ramo, D. E. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.4575 · Cited by 72 · see citing works
Vandelanotte, C., Duncan, M. J., Maher, C. A., Schoeppe, S., Rebar, A. L., Power, D. A., Short, C. E., Doran, C. M., Hayman, M. J., & Alley, S. J. (2018) · Journal of Medical Internet Research · doi:10.2196/11321 · Cited by 68 · see citing works
Self-citationCharacterizing user engagement with health app data: a data mining approach
Serrano, K. J., Coa, K. I., Yu, M., Wolff-Hughes, D. L., & Atienza, A. A. (2017) · Translational Behavioral Medicine · doi:10.1007/s13142-017-0508-y · Cited by 67 · see citing works
Davies, C., Corry, K., Itallie, A. K. V., Vandelanotte, C., Caperchione, C. M., & Mummery, W. K. (2012) · Journal of Medical Internet Research · doi:10.2196/jmir.1792 · Cited by 66 · see citing works
Self-citationSocial support for physical activity—role of Facebook with and without structured intervention
Cavallo, D. N., Tate, D. F., Ward, D. S., DeVellis, R. F., Thayer, L., & Ammerman, A. S. (2014) · Translational Behavioral Medicine · doi:10.1007/s13142-014-0269-9 · Cited by 66 · see citing works
Edney, S. M., Plotnikoff, R. C., Vandelanotte, C., Olds, T., Bourdeaudhuij, I. D., Ryan, J. C., & Maher, C. A. (2017) · BMC Public Health · doi:10.1186/s12889-017-4882-7 · Cited by 66 · see citing works
Self-citationIs obesity associated with injuries among young people?
Bazelmans, C., Coppieters, Y., Godin, I., Parent, F., Berghmans, L., Dramaix, M., & Lev�que, A. (2004) · European Journal of Epidemiology · doi:10.1007/s10654-004-0158-5 · Cited by 66 · see citing works
van Woudenberg, T. J., Bevelander, K. E., Burk, W. J., Smit, C. R., Buijs, L., & Buijzen, M. (2018) · BMC Public Health · doi:10.1186/s12889-018-5451-4 · Cited by 61 · see citing works
Health Risks Associated With Weight Loss and Obesity Treatment Programs
Berg, F. M. (1999) · Journal of Social Issues · doi:10.1111/0022-4537.00116 · Cited by 50 · see citing works
Corepal, R., Best, P., O’Neill, R., Tully, M. A., Edwards, M., Jago, R., Miller, S. J., Kee, F., & Hunter, R. F. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-019663 · Cited by 49 · see citing works
Ryan, J. C., Edney, S. M., & Maher, C. A. (2017) · Translational Behavioral Medicine · doi:10.1007/s13142-017-0499-8 · Cited by 48 · see citing works
Self-citationBoekhout, J. M., Peels, D. A., Berendsen, B., Bolman, C. A. W., & Lechner, L. (2017) · JMIR Research Protocols · doi:10.2196/resprot.8093 · Cited by 47 · see citing works
Vandelanotte, C., Duncan, M. J., Kolt, G. S., Caperchione, C. M., Savage, T. N., Itallie, A. K. V., Oldmeadow, C. J., Alley, S., Tague, R., Maeder, A. J., et al. (2018) · British Journal of Sports Medicine · doi:10.1136/bjsports-2018-099437 · Cited by 44 · see citing works
Self-citationPerceived constraints on physical exercise among obese and non-obese older people
SALLINEN, J. M., Leinonen, R., Hirvensalo, M. H., Lyyra, T.-M., Heikkinen, E. M., & Rantanen, T. (2009) · Preventive Medicine · doi:10.1016/j.ypmed.2009.10.001 · Cited by 43 · see citing works
Kolt, G. S., Rosenkranz, R. R., Vandelanotte, C., Caperchione, C. M., Maeder, A. J., Tague, R., Savage, T. N., Itallie, A. K. V., Mummery, W. K., Oldmeadow, C. J., et al. (2017) · British Journal of Sports Medicine · doi:10.1136/bjsports-2016-096890 · Cited by 41 · see citing works
Self-citationGamification of Older Adults’ Physical Activity: An Eight-Week Study
Kappen, D. L., Mirza-Babaei, P., & Nacke, L. E. (2018) · Hawaii International Conference on System Sciences (HICSS) · doi:10.24251/hicss.2018.149 · Cited by 39 · see citing works
A Statewide Intervention Reduces BMI in Adults: Shape Up Rhode Island Results
Wing, R. R., Pinto, A. M., Crane, M. M., Kumar, R., Weinberg, B. M., & Gorin, A. A. (2009) · Obesity · doi:10.1038/oby.2008.655 · Cited by 38 · see citing works
Vandelanotte, C., Kolt, G. S., Caperchione, C. M., Savage, T. N., Rosenkranz, R. R., Maeder, A. J., Itallie, A. K. V., Tague, R., Oldmeadow, C. J., Mummery, W. K., et al. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.8484 · Cited by 34 · see citing works
Self-citationAnnesi, J. J., Porter, K. J., Hill, G. M., & Goldfine, B. D. (2017) · Research Quarterly for Exercise and Sport · doi:10.1080/02701367.2017.1336280 · Cited by 33 · see citing works
Lee, D., Frey, G. C., Cheng, A., & Shih, P. C. (2018) · International Conference on Virtual Worlds and Games for Serious Applications (VS-Games) · doi:10.1109/vs-games.2018.8493439 · Cited by 29 · see citing works
Murray, J., French, D., Patterson, C., Kee, F., Gough, A., Tang, J., & Hunter, R. F. (2019) · Journal of Medical Internet Research · doi:10.2196/11394 · Cited by 26 · see citing works
Vandelanotte, C., & Maher, C. A. (2015) · American Journal of Health Promotion · doi:10.4278/ajhp.141204-cit-605 · Cited by 15 · see citing works
Self-citation
Flagged first, then by citations
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Sorted by citations
Jakob, R., Harperink, S., Rudolf, A. M., Fleisch, E., Haug, S., Mair, J. L., Salamanca-Sanabria, A., & Kowatsch, T. (2022) · Journal of Medical Internet Research · doi:10.2196/35371 · Cited by 446 · see citing works
Chew, H. S. J. (2022) · JMIR Medical Informatics · doi:10.2196/32578 · Cited by 136 · see citing works
Mclaughlin, M., Delaney, T., Hall, A., Byaruhanga, J., Mackie, P., Grady, A., Reilly, K., Campbell, E., Sutherland, R., Wiggers, J., et al. (2021) · Journal of Medical Internet Research · doi:10.2196/23180 · Cited by 105 · see citing works
Warsinsky, S., Schmidt-Kraepelin, M., Rank, S., Thiebes, S., & Sunyaev, A. (2021) · Journal of Medical Internet Research · doi:10.2196/30390 · Cited by 100 · see citing works
Hensher, M., Cooper, P., Dona, S. W. A., Angeles, M. R., Nguyen, D., Heynsbergh, N., Chatterton, M. L., & Peeters, A. (2021) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocab041 · Cited by 80 · see citing works
Spaulding, E. M., Marvel, F. A., Piasecki, R. J., Martin, S. S., & Allen, J. K. (2021) · JMIR Cardio · doi:10.2196/18834 · Cited by 70 · see citing works
Daniore, P., Nittas, V., & von Wyl, V. (2022) · Journal of Medical Internet Research · doi:10.2196/39910 · Cited by 60 · see citing works
Tersa-Miralles, C., Bravo, C., Bellon, F., Pastells‐Peiró, R., Rubinat, E., & Rubí‐Carnacea, F. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-054288 · Cited by 52 · see citing works
Landers, M. R., & Ellis, T. D. (2020) · JMIR mhealth and uhealth · doi:10.2196/18985 · Cited by 49 · see citing works
Mair, J. L., Hashim, J., Thai, L., Tai, E. S., Ryan, J. C., Kowatsch, T., Müller‐Riemenschneider, F., & Edney, S. M. (2025) · Translational Behavioral Medicine · doi:10.1093/tbm/ibaf010 · Cited by 47 · see citing works
Self-citationMcLaughlin, M. J., Delaney, T. M., Hall, A. E., Byaruhanga, J., Mackie, P., Grady, A., Reilly, K., Campbell, E. M., Sutherland, R., Wiggers, J. H., et al. (2021) · Journal of Medical Internet Research · doi:10.2196/29094 · Cited by 46 · see citing works
Yang, Y., Boulton, E., & Todd, C. J. (2022) · Journal of Medical Internet Research · doi:10.2196/30817 · Cited by 43 · see citing works
Adhärenz digitaler Interventionen im Gesundheitswesen: Definitionen, Methoden und offene Fragen
Kernebeck, S., Busse, T. S., Ehlers, J. P., & Vollmar, H. C. (2021) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-021-03415-9 · Cited by 41 · see citing works
Maher, C. A., Olds, T., Vandelanotte, C., Plotnikoff, R. C., Edney, S. M., Ryan, J. C., DeSmet, A., & Curtis, R. (2022) · Games for Health Journal · doi:10.1089/g4h.2021.0207 · Cited by 40 · see citing works
Self-citationKim, M., Yang, J., Ahn, W.-Y., & Choi, H. J. (2021) · Journal of Medical Internet Research · doi:10.2196/27218 · Cited by 41 · see citing works
Werner, N. E., Brown, J. C., Loganathar, P., & Holden, R. J. (2022) · JMIR mhealth and uhealth · doi:10.2196/33863 · Cited by 36 · see citing works
Gamified Wearable Fitness Tracker for Physical Activity: A Comprehensive Literature Review
Cho, I., Kaplanidou, K. K., & Sato, S. (2021) · Sustainability · doi:10.3390/su13137017 · Cited by 37 · see citing works
Grady, A., Pearson, N., Lamont, H., Leigh, L., Wolfenden, L., Barnes, C., Wyse, R., Finch, M., McLaughlin, M. J., Delaney, T. M., et al. (2023) · Journal of Medical Internet Research · doi:10.2196/47987 · Cited by 38 · see citing works
Smith, N., & Liu, S. (2020) · Internet Interventions · doi:10.1016/j.invent.2020.100344 · Cited by 32 · see citing works
Lavikainen, P., Mattila, E., Absetz, P., Harjumaa, M., Lindström, J., Järvelä‐Reijonen, E., Aittola, K., Männikkö, R., Tilles‐Tirkkonen, T., Lintu, N., et al. (2022) · Journal of Medical Internet Research · doi:10.2196/31530 · Cited by 28 · see citing works
Yfantidou, S., Sermpezis, P., & Vakali, A. I. (2023) · ACM Transactions on Computing for Healthcare · doi:10.1145/3592621 · Cited by 33 · see citing works
Maenhout, L., Peuters, C., Cardon, G., Crombez, G., DeSmet, A., & Compernolle, S. (2022) · JMIR mhealth and uhealth · doi:10.2196/36404 · Cited by 25 · see citing works
Nelson, L. A., Spieker, A. J., Mayberry, L. S., McNaughton, C., & Greevy, R. A. (2021) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocab254 · Cited by 23 · see citing works
Kaye, L., Gondalia, R., Thompson, A., Stempel, D. A., & Barrett, M. (2021) · Scientific Reports · doi:10.1038/s41598-021-03827-2 · Cited by 21 · see citing works
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Aydın, S. Ö., & Argan, M. (2021) · Journal of Social Marketing · doi:10.1108/jsocm-09-2019-0137 · Cited by 23 · see citing works
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Simmich, J., Mandrusiak, A., Smith, S., Hartley, N., & Russell, T. G. (2020) · JMIR Serious Games · doi:10.2196/23069 · Cited by 17 · see citing works
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Edwardson, C. L., Abell, L., Clarke-Cornwell, A. M., Dunstan, D. W., Gray, L. J., Healy, G. N., Hadjiconstantinou, M., Wilson, P., Maylor, B. D., Munir, F., et al. (2023) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-023-01548-5 · Cited by 16 · see citing works
Eicher‐Miller, H. A., Prapkree, L., & Palacios, C. S. (2021) · Advances in Nutrition · doi:10.1093/advances/nmab022 · Cited by 15 · see citing works
Lisowska, A., Szymon Wilk, A., & Mor Peleg, B. (2022) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2022.104276 · Cited by 15 · see citing works
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Self-citationYoung, C., Mohebbi, M., Staudacher, H. M., KAY‐LAMBKIN, F. J., Berk, M., Jacka, F. N., & O'Neil, A. E. (2021) · JMIR Mental Health · doi:10.2196/24871 · Cited by 14 · see citing works
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Kanai, M., Toda, T., Yamamoto, K., Akimoto, M., & Hagiwara, Y. (2022) · Circulation Reports · doi:10.1253/circrep.cr-22-0024 · Cited by 14 · see citing works
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Lau, E. Y., Mitchell, M., & Faulkner, G. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.914433 · Cited by 16 · see citing works
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Alj, Z., & Bouayad, A. (2024) · Emerging Science Journal · doi:10.28991/esj-2024-sied1-08 · Cited by 14 · see citing works
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Self-citationMehta, P., Moore, S. L., Bull, S. S., & Kwan, B. M. (2021) · Digital Health · doi:10.1177/20552076211019877 · Cited by 11 · see citing works
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Li, J., Yu, K., Bao, X., Liu, X., & Yao, J. (2021) · Journal of Medical Internet Research · doi:10.2196/29299 · Cited by 9 · see citing works
Lorenzi, L. J., Belo, L. F., Frohlich, D. M., Dourado, V. Z., Castro, P. C., & Gomes, G. A. D. O. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-052414 · Cited by 9 · see citing works
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Rubin, D. S., Severin, R. S., Arena, R. A., & Bond, S. (2020) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2020.10.007 · Cited by 9 · see citing works
Daniels, K., Vonck, S., Robijns, J., Quadflieg, K., Bergs, J., Spooren, A. I. F., Hansen, D., & Bonnechère, B. (2024) · JMIR Aging · doi:10.2196/63348 · Cited by 13 · see citing works
Okamoto, M., Saito, Y., Nakamura, S., Nagasawa, M., Shibuya, M., Nagasaka, G., & Narimatsu, H. (2024) · JMIR Formative Research · doi:10.2196/53759 · Cited by 8 · see citing works
Stewart, C., Ranjan, Y., Conde, P., Rashid, Z., Sankesara, H., Bai, X., Dobson, R., & Folarin, A. (2021) · JMIR Research Protocols · doi:10.2196/32587 · Cited by 8 · see citing works
Fillol, F., Paris, L., Pascal, S., Mulliez, A., Roques, C.-F., Rousset, S., & Duclos, M. (2022) · Journal of Medical Internet Research · doi:10.2196/29640 · Cited by 8 · see citing works
Liu, C., Messer, M., Linardon, J., & Fuller‐Tyszkiewicz, M. (2025) · Frontiers in Digital Health · doi:10.3389/fdgth.2025.1380088 · Cited by 7 · see citing works
Wu, D., Huyan, X., She, Y., Hu, J., Duan, H., & Deng, N. (2021) · JMIR mhealth and uhealth · doi:10.2196/33189 · Cited by 7 · see citing works
Vandelanotte, C., Hooker, C., Itallie, A. K. V., Urooj, A., & Duncan, M. J. (2022) · PLoS ONE · doi:10.1371/journal.pone.0274975 · Cited by 7 · see citing works
Self-citationUlmer, T., & Baldauf, M. (2022) · Lecture notes in computer science · doi:10.1007/978-3-031-05412-9_31 · Cited by 7 · see citing works
Coumans, J. M. J., Oenema, A., Bolman, C. A. W., & Lechner, L. (2021) · JMIR Formative Research · doi:10.2196/22390 · Cited by 7 · see citing works
Boudreau, F., Dagenais, G. R., de Vries, H., Walthouwer, M. J. L., Côté, J., Turbide, G., Bourlaud, A.-S., & Poirier, P. (2020) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2020.1850287 · Cited by 6 · see citing works
Jakob, R., Narauskas, J., Fleisch, E., König, L. M., & Kowatsch, T. (2024) · Computers in Human Behavior Reports · doi:10.1016/j.chbr.2024.100445 · Cited by 7 · see citing works
Fiedler, J., Seiferth, C., Eckert, T., Wöll, A., & Wunsch, K. (2022) · German Journal of Exercise and Sport Research · doi:10.1007/s12662-022-00809-y · Cited by 6 · see citing works
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Sandborg, J., Markides, B. R., Simmons, S., Downing, K. L., Nicholson, J. M., Orellana, L., Koorts, H., Carson, V., Salmon, J., & Hesketh, K. D. (2025) · JMIR mhealth and uhealth · doi:10.2196/60478 · Cited by 4 · see citing works
Sandborg, J., Downing, K. L., Orellana, L., Taylor, R. W., Barnett, L. M., Carson, V., & Hesketh, K. D. (2025) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-025-01764-1 · Cited by 4 · see citing works
Kay, M. C., Miller, H., Askew, S., Spaulding, E. M., Chisholm, M., Christy, J., Yang, Q., & Steinberg, D. (2022) · AJPM Focus · doi:10.1016/j.focus.2022.100037 · Cited by 4 · see citing works
Buller, D. B., Pagoto, S., Henry, K. L., Baker, K., Walkosz, B. J., Hillhouse, J., Berteletti, J., & Bibeau, J. (2022) · Journal of Health Communication · doi:10.1080/10810730.2022.2113839 · Cited by 4 · see citing works
Bent, M. A., Valenzuela-Moss, J. N., Smith, K., Castillo, P., Speybroeck, A. L. V., Omar, H. N., Antoniak, K. S., Lin, A. J., & Wren, T. A. L. (2023) · Journal of Spinal Cord Medicine · doi:10.1080/10790268.2023.2231675 · Cited by 3 · see citing works
Kim, G. S., Baek, S., Kim, L., & Kwon, S. (2025) · Journal of Medical Internet Research · doi:10.2196/78810 · Cited by 3 · see citing works
Low, K. M. Y., Chan, C. M. J., Ang, I. Y. H., Chong, M. F., & Ali, S. H. (2025) · Current Developments in Nutrition · doi:10.1016/j.cdnut.2025.107523 · Cited by 3 · see citing works
Ester, M., McDonough, M. H., Bansal, M., Dreger, J., Daun, J. T., McNeely, M. L., Luu, T., & Culos-Reed, S. N. (2024) · Current Oncology · doi:10.3390/curroncol31030120 · Cited by 3 · see citing works
Nataletti, S., Banerjee, A., Macaluso, R., Prokup, S., Jayaraman, A., & Wong, A. (2024) · Disability and health journal · doi:10.1016/j.dhjo.2024.101667 · Cited by 3 · see citing works
Edney, S. M., Mair, J. L., Topothai, T., Chua, X. H., Na, W., & Müller‐Riemenschneider, F. (2025) · Journal of Physical Activity and Health · doi:10.1123/jpah.2025-0151 · Cited by 3 · see citing works
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Mamun, A., Leonard, K. S., Buman, M. P., & Ghasemzadeh, H. G. (2022) · Wearable and Implantable Body Sensor Networks · doi:10.1109/bsn56160.2022.9928521 · Cited by 3 · see citing works
Ekpezu, A. O., Wiafe, I., & B, H. O.-K. A. (2024) · Behaviour and Information Technology · doi:10.1080/0144929x.2024.2421448 · Cited by 3 · see citing works
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Aydın, S. Ö. (2022) · Advances in business strategy and competitive advantage book series · doi:10.4018/978-1-7998-9223-6.ch009 · Cited by 3 · see citing works
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Yfantidou, S., Sermpezis, P., & Vakali, A. I. (2021) · arXiv (Cornell University) · Cited by 3 · see citing works
Vermeir, J. F., White, M. J., Johnson, D. M., Crombez, G., & Ryckeghem, D. M. L. V. (2024) · JMIR Serious Games · doi:10.2196/50635 · Cited by 2 · see citing works
Wei, C., Tian, Y., & Na, M. (2025) · Brain and Behavior · doi:10.1002/brb3.70593 · Cited by 2 · see citing works
Rekola, H., Tolmunen, T., Mattila, E., Strömmer, J., Lakka, T. A., Länsimies, H., & Mäki-Opas, T. E. (2025) · JMIR mhealth and uhealth · doi:10.2196/68982 · Cited by 2 · see citing works
Iribarren, S., Rupp, J., Sprecher, J., Lutz, B. R., & Rubinstein, F. (2026) · PLOS Digital Health · doi:10.1371/journal.pdig.0001457 · Cited by 2 · see citing works
Murphy, L. L., Dascombe, B. J., Murawski, B., Rayward, A. T., Brown, W. J., Plotnikoff, R. C., Vandelanotte, C., Holliday, E. G., & Duncan, M. J. (2023) · Journal of Activity Sedentary and Sleep Behaviors · doi:10.1186/s44167-022-00013-1 · Cited by 2 · see citing works
Self-citationPrapkree, L., Deringer, R., Coccia, C. C., Huffman, F. G., & Palacios, C. S. (2024) · Journal of American College Health · doi:10.1080/07448481.2024.2337008 · Cited by 2 · see citing works
Tersa-Miralles, C., Bravo, C., Bellon, F., Masbernat, M. A., Rubí‐Carnacea, F., & Rubinat, E. (2025) · PLoS ONE · doi:10.1371/journal.pone.0325376 · Cited by 1 · see citing works
Tracking Narrative Dynamics Using Churn Management on Social Networks
Al‐Taweel, A., Agarwal, N., & Quadri, A. (2025) · Studies in computational intelligence · doi:10.1007/978-3-031-82435-7_19 · Cited by 1 · see citing works
Joo, J., Lee, M., Yoon, J., Cho, H., Warrier, G., Thrul, J., & Cho, J. (2025) · JMIR mhealth and uhealth · doi:10.2196/66227 · Cited by 1 · see citing works
Development of a 24-hour movement index: exploring acceptability among Canadian parents
Zhan, J. K., Khan, K. M., Tremblay, M. S., & Faulkner, G. (2025) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2025.1571207 · Cited by 1 · see citing works
Israfilzade, K., & Pathania, D. (2026) · Management of Organizations: Systematic Research · doi:10.2478/mosr-2026-0005
“For example, in mobile health (mHealth) and education applications, gamified features have been found to increase the frequency and duration of user sessions, as well as reduce drop-out rates (Edney et al., 2019; Poondej & Lerdpornkulrat, 2016).”
Mobile Applications for Behavioral Change
Ofori, M. Q., & El-Gayar, O. (2020) · Advances in medical technologies and clinical practice book series · doi:10.4018/978-1-5225-6067-8.ch011
Daniore, P., Nittas, V., & von Wyl, V. (2022) · doi:10.2196/preprints.39910
Gamified web-delivered attentional bias modification training for the management of chronic pain
Vermeir, J. F. (2023) · Queensland University of Technology · doi:10.5204/thesis.eprints.242456
Heraz, A., Chen, L., & Ashish, B. K. K. (2024) · doi:10.2196/preprints.57293
Joo, J., Lee, M., Yoon, J., Cho, H., Warrier, G., Thrul, J., & Cho, J. (2024) · doi:10.2196/preprints.66227
Rekola, H., Tolmunen, T., Mattila, E., Strömmer, J., Lakka, T. A., Länsimies, H., & Mäki-Opas, T. E. (2024) · doi:10.2196/preprints.68982
Hagiwara, Y., Adachi, T., Kanai, M., Shimizu, K., Ishida, S., & Miki, T. (2025) · Interactive Journal of Medical Research · doi:10.2196/65863
Al-Majarfi, W. K. (2023) · Psychology and Mental Health Care · doi:10.31579/2637-8892/237
Kim, H. S., & Chung, M.-Y. (2025) · Health & New Media Research · doi:10.22720/hnmr.2025.00052
Özsoy, A., Yıldız, N. O., Çar, B., Salamone, E. A., Mazzara, F., Gürer, M., Agbulut, B., Erkadam, E. K., Karakus, Z., Ahraz, A. O., et al. (2025) · Spor Bilimleri Araştırmaları Dergisi · doi:10.25307/jssr.1591617
Game Connect: A Middleware that Flexibly Connects Games to their Health Goals
Lee, G., & Julien, C. (2025) · IEEE/ACM Conference on Connected Health: Applications, Systems and Engineering Technologies · doi:10.1145/3721201.3721376
Edwardson, C. L., Abell, L., Clarke-Cornwell, A., Dunstan, D. W., Gray, L. J., Healy, G. N., Hadjiconstantinou, M., Wilson, P., Maylor, B. D., Munir, F., et al. (2023) · Figshare · doi:10.6084/m9.figshare.24873031
Promoting Physical Activity With Text Messaging: Does Advisor Personalization Matter?
Royer, M. F., Campero, M. I., Garcia, D. M., Corral, C., Espinosa, P. R., & King, A. C. (2026) · American Journal of Health Promotion · doi:10.1177/08901171261426728
Huang, Y., Taylor, D., Kubler, M., Burger, S.-A., Itallie, A. K. V., Vandelanotte, C., & Robinson, M. (2026) · Journal of Physical Activity and Health · doi:10.1123/jpah.2025-0740
Self-citation
- Authors
- Edney, S., Ryan, J. C., Olds, T., Monroe, C., Fraysse, F., Vandelanotte, C., Plotnikoff, R., Curtis, R., & Maher, C.
- Affiliations
- University of South Australia (AU)
- Commonwealth Scientific and Industrial Research Organisation (AU)
- University of South Carolina (US)
- Central Queensland University (AU)
- University of Newcastle Australia (AU)
- Corresponding author
- Edney, Sarah
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2019-11-27
- Volume
- 21
- Issue
- 11
- Pages
- e14645
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC6906621
- OpenAlex
- W2991585848
- Cited by
- 104
- References
- 65
- Citations by year
- 2026: 8 · 2025: 18 · 2024: 12 · 2023: 13 · 2022: 24 · 2021: 23 · 2020: 6
- FWCI
- 18.06
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Acquire (CQUniversity) (submittedVersion, cc-by)
- National University of Singapore (submittedVersion)
- Figshare (submittedVersion, cc-by)
- UniSA Research Outputs Repository (University of South Australia) (submittedVersion)
- NOVA (University of Newcastle Australia) (submittedVersion, cc-by)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- user engagement, gamification, mobile health, exercise behavior change, superusers, body mass index, age differences, intervention efficacy, accelerometer-measured activity, health behavior change interventions
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Patient Participation, Exercise, Mobile Applications
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