Introduction and objectives Increasing emphasis has been placed on behavioural therapy in smoking cessation efforts. mHealth aims to join today’s arsenal of smoking cessation techniques. Many apps are utilising ‘gamification’ (the use of game design elements in non-game contexts) as a tool to drive positive behaviour change. However, a significant knowledge gap currently remains regarding how gamification can affect health behaviour. Our study seeked to elucidate the motivational mechanisms exploited by gamification in promoting positive health behaviours in the context of smoking cessation, with a view to generating recommendations on how to create effective gamified mHealth interventions.
Methods We conducted a qualitative longitudinal study using a sample of 16 smokers divided into two cohorts. The first cohort used a non-gamified mHealth intervention, whilst the second used a gamified mHealth intervention. The added game components allowed us to isolate the effects of gamification. Each participant underwent 4 one-on-one, semi-structured interviews over a period of 5 weeks. Interviews were transcribed verbatim after which thematic analysis was undertaken.
Results We observed that perceived behavioural control and intrinsic motivation acted as positive drivers to game engagement and consequently positive health behaviour. Importantly, external social influences exerted a negative effect. We identified three critical factors, whose presence was necessary for game engagement; purpose (explicit purpose known by the user), user alignment (congruency of game and user objectives), functional utility (a well-designed game). We summarise these findings in a framework (Figure 1), which we propose to guide the development of gamified mHealth interventions.
Conclusions Our framework outlines the characteristics critical to consider when developing any gamified mHealth intervention to promote a particular health behaviour. Gamification holds the potential for low-cost, highly effective mHealth solutions that may replace or supplement the behavioural support component found in current smoking cessation programmes. Our proposed framework has been built on evidence specific to smoking cessation, but is versatile and can be extended to health interventions in other disease categories. Future research is now required to evaluate the effectiveness of the above framework directly against current behavioural support therapy interventions in smoking cessation.
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