Gamification and Adherence to Web-Based Mental Health Interventions: A Systematic Review
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Background: Adherence to effective Web-based interventions for common mental disorders (CMDs) and well-being remains a critical issue, with clear potential to increase effectiveness. Continued identification and examination of “active” technological components within Web-based interventions has been called for. Gamification is the use of game design elements and features in nongame contexts. Health and lifestyle interventions have implemented a variety of game features in their design in an effort to encourage engagement and increase program adherence. The potential influence of gamification on program adherence has not been examined in the context of Web-based interventions designed to manage CMDs and well-being. Objective: This study seeks to review the literature to examine whether gaming features predict or influence reported rates of program adherence in Web-based interventions designed to manage CMDs and well-being. Methods: A systematic review was conducted of peer-reviewed randomized controlled trials (RCTs) designed to manage CMDs or well-being and incorporated gamification features. Seven electronic databases were searched. Results: A total of 61 RCTs met the inclusion criteria and 47 different intervention programs were identified. The majority were designed to manage depression using cognitive behavioral therapy. Eight of 10 popular gamification features reviewed were in use. The majority of studies utilized only one gamification feature (n=58) with a maximum of three features. The most commonly used feature was story/theme. Levels and game leaders were not used in this context. No studies explicitly examined the role of gamification features on program adherence. Usage data were not commonly reported. Interventions intended to be 10 weeks in duration had higher mean adherence than those intended to be 6 or 8 weeks in duration. Conclusions: Gamification features have been incorporated into the design of interventions designed to treat CMD and well-being. Further research is needed to improve understanding of gamification features on adherence and engagement in order to inform the design of future Web-based health interventions in which adherence to treatment is of concern. Conclusions were limited by varied reporting of adherence and usage data.
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Gamification is commonly offered as a key opportunity to improve both appeal and adherence.
“Gamification (ie, the use of game design elements and features in nongame contexts) is commonly offered as a key opportunity to improve both appeal and adherence, which fits with the preferences of participants in this study, who favored gamification elements such as rewards, mini-games, and character stories [29,59].”
From Feasibility and Acceptability of the Aboriginal and Islander Mental Health Initiative for Youth App: Nonrandomized Pilot With First Nations Young People (2023) · cites this paper as [59]
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Digital interventions for substance use disorders in young people: rapid review
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“One potential strategy to realize this principle could be the implementation of further gamification approaches [70].”
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“…the gamification of technology-based CBT for pediatric mental health (see SPARX [108]), where incorporating game-design elements such as Praise and Rewards are regularly used to enhance program use and engagement [109], demonstrate the potential benefits that the use of these features may have.”
BackgroundGamification in Health Behavior Change Support Systems - A Synthesis of Unintended Side Effects
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The peril of self-reported adherence in digital interventions: A brief example
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A Systematic Review of the Effect of Gamification on Adherence Across Disciplines
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Issues for eHealth in Psychiatry: Results of an Expert Survey
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A Review of Research on Gamification Approach in Education
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Gamification in Health Care Management: Systematic Review of the Literature and Research Agenda
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A conceptual framework for transformative gamification services
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A self-control training app to increase self-control and reduce aggression – A full factorial design
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Why Digital Tools Have Not Yet Revolutionized Adolescent Health Research and What We Can Do
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Preferences for Digital Smartphone Mental Health Apps Among Adolescents: Qualitative Interview Study
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“…use of game design elements and features in nongame contexts) is commonly offered as a key opportunity to improve both appeal and adherence, which fits with the preferences of participants in this study, who favored gamification elements such as rewards, mini-games, and character stories [29,59].”
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Understanding how gamification influences consumers’ dietary preferences
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Gamified Cognitive Control Training for Remitted Depressed Individuals: User Requirements Analysis
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Gamification of motor imagery brain-computer interface training protocols: A systematic review
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Using Applied Games to Engage mHealth Users
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- Authors
- Brown, M., O'Neill, N., van Woerden, H., Eslambolchilar, P., Jones, M., & John, A.
- Affiliations
- Swansea University (GB)
- NHS Highland (GB)
- Corresponding author
- Brown, Menna
- Venue
- JMIR Mental Health
- Publisher
- JMIR Publications Inc.
- Published
- 2016-08-24
- Volume
- 3
- Issue
- 3
- Pages
- e39
- ISSN
- 2368-7959 (ISSN-L)
- PMC
- PMC5014987
- OpenAlex
- W2513068937
- Cited by
- 178
- References
- 72
- Citations by year
- 2026: 10 · 2025: 15 · 2024: 23 · 2023: 20 · 2022: 15 · 2021: 34 · 2020: 14 · 2019: 21 · 2018: 13 · 2017: 11 · 2016: 2
- FWCI
- 2.55
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Mental Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Cronfa (Swansea University) (submittedVersion, cc-by)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Funders
- Health and Care Research Wales (SCS-14-06)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Developmental and Educational Psychology › Educational Games and Gamification
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- gamification, medication adherence, online intervention, common mental disorders, well-being, game elements, depression, cognitive behavioral therapy, user engagement, intervention duration
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