The effect of social support features and gamification on a Web-based intervention for rheumatoid arthritis patients: randomized controlled trial
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BACKGROUND: Rheumatoid arthritis (RA) is chronic systematic disease that affects people during the most productive period of their lives. Web-based health interventions have been effective in many studies; however, there is little evidence and few studies showing the effectiveness of online social support and especially gamification on patients' behavioral and health outcomes. OBJECTIVE: The aim of this study was to look into the effects of a Web-based intervention that included online social support features and gamification on physical activity, health care utilization, medication overuse, empowerment, and RA knowledge of RA patients. The effect of gamification on website use was also investigated. METHODS: We conducted a 5-arm parallel randomized controlled trial for RA patients in Ticino (Italian-speaking part of Switzerland). A total of 157 patients were recruited through brochures left with physicians and were randomly allocated to 1 of 4 experimental conditions with different types of access to online social support and gamification features and a control group that had no access to the website. Data were collected at 3 time points through questionnaires at baseline, posttest 2 months later, and at follow-up after another 2 months. Primary outcomes were physical activity, health care utilization, and medication overuse; secondary outcomes included empowerment and RA knowledge. All outcomes were self-reported. Intention-to-treat analysis was followed and multilevel linear mixed models were used to study the change of outcomes over time. RESULTS: The best-fit multilevel models (growth curve models) that described the change in the primary outcomes over the course of the intervention included time and empowerment as time-variant predictors. The growth curve analyses of experimental conditions were compared to the control group. Physical activity increased over time for patients having access to social support sections plus gaming (unstandardized beta coefficient [B]=3.39, P=.02). Health care utilization showed a significant decrease for patients accessing social support features (B=-0.41, P=.01) and patients accessing both social support features and gaming (B=-0.33, P=.03). Patients who had access to either social support sections or the gaming experience of the website gained more empowerment (B=2.59, P=.03; B=2.29, P=.05; respectively). Patients who were offered a gamified experience used the website more often than the ones without gaming (t91=-2.41, P=.02; U=812, P=.02). CONCLUSIONS: The Web-based intervention had a positive impact (more desirable outcomes) on intervention groups compared to the control group. Social support sections on the website decreased health care utilization and medication overuse and increased empowerment. Gamification alone or with social support increased physical activity and empowerment and decreased health care utilization. This study provides evidence demonstrating the potential positive effect of gamification and online social support on health and behavioral outcomes. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 57366516; http://www.controlled-trials. com/ISRCTN57366516 (Archived by webcite at http://www.webcitation.org/6PBvvAvvV).
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Allam et al. (2015) found that rewards (points, badges and medals in combination with leaderboards) were associated with increased physical activity and sense of empowerment as well as decreased health care utilization among Rheumatoid Arthritis patients.
“Allam et al. (2015) found that rewards (points, badges and medals in combination with leaderboards) were associated with increased physical activity and sense of empowerment as well as decreased health care utilization among Rheumatoid Arthritis patients.”
From Gamification for health and wellbeing: A systematic review of the literature (2016) · cites this paper as Allam et al. (2015)
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredGamification was found to have a positive influence on healthcare utilization, reduction of medication misuse, and blood glucose monitoring.
“Gamification was found to have a positive influence on healthcare utilization (Allam et al., 2015), the reduction of medication misuse (Allam et al., 2015, Riva et al., 2014) and blood glucose monitoring (Cafazzo et al., 2012).”
From Gamification for health and wellbeing: A systematic review of the literature (2016) · cites this paper as Allam et al., 2015
The Discussion (Principal Findings; page not provided) associates gamification with a significant decrease in health care utilization. The Results (Multilevel Model Evaluation; page not provided) report a marginally significant decrease in prescription medication overuse only for the social-support group, not the gaming groups. The citing sentence attributes blood glucose monitoring to a different source, so that part is not judged here. (LLM, conf=0.90)
Experimental — accuracy not yet measuredIn two studies, changes in illness-related outcomes were also associated with a positive influence on patient empowerment.
“In two studies these changes were also associated with a positive influence on patient empowerment (Allam et al., 2015, Riva et al., 2014).”
From Gamification for health and wellbeing: A systematic review of the literature (2016) · cites this paper as Allam et al., 2015
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- Authors
- Allam, A., Kostova, Z., Nakamoto, K., & Schulz, P. J.
- Affiliations
- Università della Svizzera italiana (CH)
- Virginia Tech (US)
- Corresponding author
- Allam, Ahmed
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2015-01-09
- Volume
- 17
- Issue
- 1
- Pages
- e14
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC4296094
- OpenAlex
- W2055539671
- Cited by
- 274
- References
- 70
- Citations by year
- 2026: 7 · 2025: 13 · 2024: 19 · 2023: 21 · 2022: 22 · 2021: 29 · 2020: 82 · 2019: 23 · 2018: 20 · 2017: 22 · 2016: 11 · 2015: 5
- FWCI
- 35.27
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- VTechWorks (Virginia Tech) (submittedVersion, cc-by)
- Funders
- National Science Foundation
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Developmental and Educational Psychology › Educational Games and Gamification
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- rheumatoid arthritis, online intervention, gamification, online social support, physical activity, health care utilization, medication overuse, patient empowerment, disease knowledge, internet use, chronic disease self-management, digital health interventions, Italian-speaking Switzerland, Ticino River, Ticino valley
- MeSH terms
- Adult, Arthritis, Rheumatoid, Female, Health Resources, Health Services Misuse, Humans, Male, Middle Aged, Motor Activity, Patient Education as Topic, Power, Psychological, Surveys and Questionnaires, Self Care, Social Support, Switzerland, Single-Blind Method, Video Games, Internet
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