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Cited by 27Educational Games and GamificationMobile Health and mHealth ApplicationsDiabetes Management and Education

Effectiveness of Digital Health Interventions Containing Game Components for the Self-management of Type 2 Diabetes: Systematic Review

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Ossenbrink, Linda, Haase, Tina, Timpel, Patrick, Schoffer, Olaf, Scheibe, Madlen, Schmitt, Jochen, Deckert, Stefanie, Harst, Lorenz·2023·JMIR Serious Games
DOI 10.2196/44132PMC PMC10273035

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Abstract

Background: Games and game components have become a major trend in the realm of digital health research and practice as they are assumed to foster behavior change and thereby improve patient-reported and clinical outcomes for patients with type 2 diabetes. Objective: The aim of this systematic review was to summarize and evaluate the current evidence on the effectiveness of digital health interventions containing game components on behavioral, patient-reported, and clinical outcomes for patients with type 2 diabetes. Methods: An electronic search was conducted in MEDLINE and PsycINFO in April 2020; updated in April 2022; and supplemented by additional searches via Google Scholar, Web of Science (which was used for forward citation tracking), and within the references of the included records. Articles were identified using predefined inclusion and exclusion criteria. In total, 2 reviewers independently conducted title, abstract, and full-text screening and then individually performed a critical appraisal of all the included studies using the Cochrane risk-of-bias tool version 2. A consensus was reached through discussion. Results: Of 2325 potentially relevant titles (duplicates excluded), 10 (0.43%) randomized controlled trials were included in this review. Quality assessment revealed a high risk of bias for all randomized controlled trials except for 10% (1/10), with performance bias due to the lack of blinding being the major source of bias. There is evidence suggesting that digital health interventions containing game components can substantially improve motivation for physical activity (1/1, 100% of the studies dealing with PA motivation), exercise intensity (3/5, 60%), dietary behavior (4/4, 100%), health literacy (1/3, 33%), mental quality of life (2/2, 100%), glycated hemoglobin level (2/6, 33%), BMI (1/3, 33%), fasting plasma glucose level (1/2, 50%), waist circumference (1/1, 100%), and aerobic capacity (1/1, 100%). Conclusions: Published studies indicated that digital health interventions containing game components might improve health behavior patterns, quality of life, and clinical outcomes in patients with type 2 diabetes. However, the intervention types and outcomes studied were heterogeneous, and study quality was mostly low, which translates to ambiguous results. Future research should focus on sound methodology and reporting as well as on identifying game components that contribute to significant positive effects. Trial Registration: PROSPERO CRD42020209706; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209706

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  • Digital health interventions significantly enhance patients' health behavior patterns.

    “They significantly enhance patients' health behavior patterns (16)”

    From The effectiveness of digital health intervention on glycemic control and physical activity in patients with type 2 diabetes: a systematic review and meta-analysis (2025) · cites this paper as [16]

    The Results (Effects of Gamified Health Interventions on Health Behavior; page not provided) report significant improvements in some behaviors, including eating habits and physical activity. But the Discussion (Conclusions; page not provided) says interventions containing game components “might improve” health behavior patterns, and the findings were heterogeneous. The claim overstates the certainty and extends the finding beyond the interventions reviewed. (LLM, conf=0.88)

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Cited by

Sorted by citations

Authors
Ossenbrink, L., Haase, T., Timpel, P., Schoffer, O., Scheibe, M., Schmitt, J., Deckert, S., & Harst, L.
Affiliations
University Hospital Carl Gustav Carus (DE)
Corresponding author
Harst, Lorenz
ORCID
Venue
JMIR Serious Games
Publisher
JMIR Publications Inc.
Published
2023-06-01
Volume
11
Pages
e44132
ISSN
2291-9279 (ISSN-L)
DOI
10.2196/44132
PMC
PMC10273035
OpenAlex
W4378953364
Cited by
27
References
15
Citations by year
2026: 4 · 2025: 14 · 2024: 9
FWCI
1.56
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JMIR Serious Games (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Qucosa (Saxon State and University Library Dresden) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Social Sciences › Psychology › Developmental and Educational Psychology › Educational Games and Gamification
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
type 2 diabetes, digital health interventions, game-based intervention, gamification, self-management, exercise motivation, exercise intensity, dietary behavior, health literacy, HbA1c, quality of life, body mass index, risk of bias, randomized controlled trials, behavior change, cardiorespiratory fitness, waist circumference, fasting blood glucose, mental health outcomes, patient-reported outcomes

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