The Model of Gamification Principles for Digital Health Interventions: Evaluation of Validity and Potential Utility.

BACKGROUND: Although gamification continues to be a popular approach to increase engagement, motivation, and adherence to behavioral interventions, empirical studies have rarely focused on this topic. There is a need to empirically evaluate gamification models to increase the understanding of how to integrate gamification into interventions. OBJECTIVE: The model of gamification principles for digital health interventions proposes a set of five independent yet interrelated gamification principles. This study aimed to examine the validity and reliability of this model to inform its use in Web- and mobile-based apps. METHODS: A total of 17 digital health interventions were selected from a curated website of mobile- and Web-based apps (PsyberGuide), which makes independent and unbiased ratings on various metrics. A total of 133 independent raters trained in gamification evaluation techniques were instructed to evaluate the apps and rate the degree to which gamification principles are present. Multiple ratings (n≥20) were collected for each of the five gamification principles within each app. Existing measures, including the PsyberGuide credibility score, mobile app rating scale (MARS), and the app store rating of each app were collected, and their relationship with the gamification principle scores was investigated. RESULTS: Apps varied widely in the degree of gamification implemented (ie, the mean gamification rating ranged from 0.17≤m≤4.65 out of 5). Inter-rater reliability of gamification scores for each app was acceptable (κ≥0.5). There was no significant correlation between any of the five gamification principles and the PsyberGuide credibility score (P≥.49 in all cases). Three gamification principles (supporting player archetypes, feedback, and visibility) were significantly correlated with the MARS score, whereas three principles (meaningful purpose, meaningful choice, and supporting player archetypes) were significantly correlated with the app store rating. One gamification principle was statistically significant with both the MARS and the app store rating (supporting player archetypes). CONCLUSIONS: Overall, the results support the validity and potential utility of the model of gamification principles for digital health interventions. As expected, there was some overlap between several gamification principles and existing app measures (eg, MARS). However, the results indicate that the gamification principles are not redundant with existing measures and highlight the potential utility of a 5-factor gamification model structure in digital behavioral health interventions. These gamification principles may be used to improve user experience and enhance engagement with digital health programs.

Principles of gamification for Internet interventions.

Gamification is a popular method used to add entertaining and appealing dimensions to nongaming activities. Researchers of technology-based behavioral and mental-health-focused interventions have shown considerable interest in gamification to enhance engagement and adherence. There have been a number of gamification frameworks proposed, each with differences in focus but with overlapping similarities. A review of these frameworks highlight critical issues in gamification-lack of clear definitions, standards, and a need for an overarching model for applying gamification, rather than simply describing gamification. These issues leave researchers challenged to apply gamification to its full potential. This paper explores gamification as a construct and endeavors to define its core features. A useful way of evaluating the potential utility of gamification features in the context of an intervention is by distinguishing between exogenous applications of gamification (layering game mechanics externally upon a system) and endogenous application of gamification (developing mechanics intrinsic to the given experience). By then comparing and contrasting six gamification frameworks, components are identified that lay at the intersection and a theoretical model is proposed. A theory-driven set of gamification principles, organized into four categories, is developed and presented. Of particular interest is the utilization of this model as it relates to behavioral and mental-health-focused Internet-based interventions. To demonstrate the potential of this gamification framework, the generated principles are overlaid onto the established Model for Internet Interventions, extending it, and providing a more concrete foundation for researchers of Internet interventions. The presented model will assist researchers and developers who are interested in applying gamification to Internet interventions.