mHealth-Based Gamification Interventions Among Men Who Have Sex With Men in the HIV Prevention and Care Continuum: Systematic Review and Meta-Analysis.

Background: In the past few years, a burgeoning interest has emerged in applying gamification to promote desired health behaviors. However, little is known about the effectiveness of such applications in the HIV prevention and care continuum among men who have sex with men (MSM). Objective: This study aims to summarize and evaluate research on the effectiveness of gamification on the HIV prevention and care continuum, including HIV-testing promotion; condomless anal sex (CAS) reduction; and uptake of and adherence to pre-exposure prophylaxis (PrEP), postexposure prophylaxis (PEP), and antiretroviral therapy (ART). Methods: We comprehensively searched PubMed, Embase, the Cochrane Library, Web of Science, Scopus, and the Journal of Medical Internet Research and its sister journals for studies published in English and Chinese from inception to January 2024. Eligible studies were included when they used gamified interventions with an active or inactive control group and assessed at least one of the following outcomes: HIV testing; CAS; and uptake of and adherence to PrEP, PEP, and ART. During the meta-analysis, a random-effects model was applied. Two reviewers independently assessed the quality and risk of bias of each included study. Results: The systematic review identified 26 studies, including 10 randomized controlled trials (RCTs). The results indicated that gamified digital interventions had been applied to various HIV outcomes, such as HIV testing, CAS, PrEP uptake and adherence, PEP uptake, and ART adherence. Most of the studies were conducted in the United States (n=19, 73%). The most frequently used game component was gaining points, followed by challenges. The meta-analysis showed gamification interventions could reduce the number of CAS acts at the 3-month follow-up (n=2 RCTs; incidence rate ratio 0.62, 95% CI 0.44-0.88). The meta-analysis also suggested an effective but nonstatistically significant effect of PrEP adherence at the 3-month follow-up (n=3 RCTs; risk ratio 1.16, 95% CI 0.96-1.38) and 6-month follow-up (n=4 RCTs; risk ratio 1.28, 95% CI 0.89-1.84). Only 1 pilot RCT was designed to evaluate the effectiveness of a gamified app in promoting HIV testing and PrEP uptake. No RCT was conducted to evaluate the effect of the gamified digital intervention on PEP uptake and adherence, and ART initiation among MSM. Conclusions: Our findings suggest the short-term effect of gamified digital interventions on lowering the number of CAS acts in MSM. Further well-powered studies are still needed to evaluate the effect of the gamified digital intervention on HIV testing, PrEP uptake, PEP initiation and adherence, and ART initiation in MSM.

Gamification and motivation: Impact on delay discounting performance.

Delay discounting is a phenomenon strongly associated with impulsivity. However, in order for a measured discounting rate in an experiment to meaningfully generalize to choices made elsewhere in life, participants must provide thoughtful, engaged answers during the assessment. Classic discounting tasks may not optimize intrinsic motivation or enjoyment, and a participant who is disengaged from the task is likely to behave in a way that provides a biased estimate of their discounting function. We assessed degree of delay discounting in a task intended to vary level of participant motivation. This was accomplished by introducing varying levels of gamification, the application of game design principles to a non-game context. Experiment 1 compared three versions of the delay discounting task with differing degrees of gamification and compared performance and task enjoyment across those variations, while Experiment 2 used two conditions (one gamified, one not). Participants found more gamified versions of the task more enjoyable than the other conditions, without producing substantial between-group differences in most cases. Thus, more polished task gameplay can provide a more enjoyable experience for participants without undermining delay discounting effects commonly reported in the literature. We also found that in all experimental conditions, higher levels of interest in or enjoyment of the task tended to be associated with more rapid discounting. This may suggest that low task motivation may result in less impulsive choice and suggests that participants who find delay discounting experiments sufficiently boring may bias assessments of value across delays.

Effectiveness of gamification in nursing degree education.

Background: Previous research in nursing has found favorable results from the use of teaching methodologies alternative to lectures. One of the complementary methodologies used for university teaching is gamification, or the inclusion of game elements, creating a dynamic learning environment that allows the acquisition of knowledge and the development of other skills necessary for nursing students. The purpose of this study was to evaluate the effect of a gamification session on student satisfaction and knowledge scores in nursing students in simulated laboratory practice. Methods: A pre-post quasi-experimental study was conducted with 122 students from the nursing degree program who participated in the research. The evaluation consisted of four sessions of three hours each. In two sessions, participants were trained through a vertical methodology, by means of theoretical training provided by teaching staff, and two hours of clinical simulation, where the students were able to practice the techniques on professional simulators. At the other two sessions, participants received an explanation of the theoretical aspects of the session, one hour of clinical simulation, and one hour of gamification, in which they had to pass tests based on the performance of practical activities on the subject of the session. At the end of the gamification session, all the participants received a certificate as winners of the "nursing game". Results: There was an improvement in the satisfaction and the knowledge level in the gamification sessions. Both were statistically significant (P < 0.001). There was an improvement in the items related to the development of critical thinking and the mobilizing concepts from theory to practice in the gamification sessions. Conclusion: The intervention was effective in improving the satisfaction of the sessions received and in knowledge development.

Attraction and achievement as two attributes of gamification in healthcare: an evolutionary concept analysis.

PURPOSE: This study conducted a conceptual analysis of gamification in healthcare utilizing Rogers' evolutionary concept analysis methodology to identify its attributes and provide a method for its applications in the healthcare field. Gamification has recently been used as a health intervention and education method, but the concept is used inconsistently and confusingly. METHODS: A literature review was conducted to derive definitions, surrogate terms, antecedents, influencing factors, attributes (characteristics with dimensions and features), surrogate concepts, consequences, implications, and hypotheses from various academic fields. A total of 56 journal articles in English and Korean, published between August 2 and August 7, 2023, were extracted from databases such as PubMed Central, the Institute of Electrical and Electronics Engineers, the Association for Computing Machinery Digital Library, the Research Information Sharing Service , and the Korean Studies Information Service System, using the keywords "gamification" and "healthcare." These articles were then analyzed. RESULTS: Gamification in healthcare is defined as the application of game elements in health-related contexts to improve health outcomes. The attributes of this concept were categorized into two main areas: attraction and achievement. These categories encompass various strategies for synchronization, enjoyable engagement, visual rewards, and goal-reinforcing frames. CONCLUSION: Through a multidisciplinary analysis of the concept's attributes and influencing factors, this paper provides practical strategies for implementing gamification in health interventions. When developing a gamification strategy, healthcare providers can reference this analysis to ensure the game elements are used both appropriately and effectively.

Comparison of gamification and role-playing education on nursing students' cardiopulmonary resuscitation self-efficacy.

BACKGROUND: Cardiopulmonary resuscitation (CPR) is one of the most fundamental skills a nursing student should be trained in. Gamification in education involves using game elements to increase motivation, engagement, and personalization of the learning process. The gamification method creates competition among students using various methods, comparing to the role-playing method which is a teaching method that allows individuals to actively engage in simulated scenarios. Therefore, this research aimed to compare the effect of CPR education using gamification and role-playing on the self-efficacy of nursing students. METHODS: This research was a quasi-experimental intervention type with three groups. A total of 154 nursing students participated in this study and were divided into intervention with role-playing (n = 53), gamification (n = 60) and conventional (lecture) (n = 41) groups. In the conventional method, CPR skills were taught to students using practical exercises. In the role-playing method, after training with moulages, a scenario was presented, and students were assigned roles. In the gamification method, after training with moulages, a scenario was presented, and after that, Kahoot software was used to create a sense of competition and excitement in the game. Self-efficacy scores were measured before and after interventions. Self-efficacy in CPR, knowledge, and skills of nursing students in CPR were assessed in each of the three groups using The Basic Resuscitation Skills Self- Efficacy Scale. RESULTS: In the present study, 154 nursing students, including 92 females and 62 males, participated. There was a statistically significant difference in the mean self-efficacy scores before and after training in both the gamification and role-playing groups (P < 0.05). There was a statistically significant difference in the mean self-efficacy scores among the three groups (gamification, role-playing, and lecture) (P < 0.05). CONCLUSION: Based on results it can be concluded that the teaching method used in CPR training affects the self-efficacy of CPR. Active methods, have a greater impact on CPR self-efficacy.

Development of a crowdsourcing- and gamification-based mobile application to collect epidemiological information and promote healthy lifestyles in Mexico.

We developed a mobile application to promote healthy lifestyles and collect non-communicable disease (NCD) data in Mexico. Its theoretical foundations are supported by a framework-guided literature review. With design sprints, Scrum, Model-View-Controller, and Representational State Transfer architecture, we operationalized evidence-based nutrition/physical activity information into a crowdsourcing- and gamification-based application. The application was piloted for three months to monitor the response of 520 adults. Potential improvements were characterized, considering benchmarking, expert guidance, and standards. Salud Activa (English: Active Health) has two crowdsourcing modules: Nutritional scanner, scanning products' bar codes, providing nutritional data, and allowing new product registry feeding our databases; Surveys, comprising gradually-released NCD questions. Three intervention modules were generated: Drinks diary, a beverage assessment component to receive hydration recommendations; Step counter, monitoring users' steps via Google Fit/Health-iOS; Metabolic Avatar, interconnecting modules and changing as a function of beverage and step records. The 3-month median of Salud Activa use was seven days (IQR = 3-12), up to 35% of participants completed a Survey section, and 157 food products were registered through Nutritional scanner. Better customization might benefit usability and user engagement. Quantitative and qualitative data will enhance Salud Activa's design, user uptake, and efficacy in interventions delivered through this platform.

Gamification-augmented home-based exercise for peripheral artery disease: Rationale and design of the GAMEPAD Study.

BACKGROUND: Supervised exercise therapy improves walking performance, functional capacity, and quality of life in patients with peripheral artery disease (PAD). However, few patients with PAD are enrolled in supervised exercise programs, and there are a number of logistical and financial barriers to their participation. A home-based walking intervention is likely to be more accessible to patients with PAD, but no fully home-based walking program has demonstrated efficacy. Concepts from behavioral economics have been used to design scalable interventions that increase daily physical activity in patients with atherosclerotic vascular disease, but whether a similar program would be effective in patients with PAD is uncertain. STUDY DESIGN AND OBJECTIVES: GAMEPAD (NCT04536012) is a pragmatic, virtual, randomized controlled trial designed to evaluate the effectiveness of a gamification strategy informed by concepts from behavioral economics to increase daily physical activity in patients with PAD who are seen in cardiology and vascular surgery clinics affiliated with the University of Pennsylvania Health System. Patients are contacted by email or text message, and complete enrollment and informed consent on the Penn Way to Health online platform. A GAMEPAD substudy will evaluate the effectiveness of opt-in versus opt-out framing when approaching patients for study participation. Patients are then provided with a wearable fitness tracker, establish a baseline daily step count, set a goal to increase daily step count by 33%-50%, and are randomized 1:1 to the gamification or control arms. Interventions continue for 16 weeks, including a 4-week period during which goal step count is gradually increased in the gamification arm, with follow-up for an additional 8 weeks to evaluate the durability of behavior change. The trial has met its enrollment goal of 102 participants, with a primary endpoint of change from baseline in daily steps over the 16-week intervention period. Key secondary endpoints include change from baseline in daily steps over the 8-week postintervention follow-up period and changes in patient-reported measures of PAD symptoms and quality of life over the intervention and follow-up periods. CONCLUSIONS: GAMEPAD is a virtual, pragmatic randomized clinical trial of a novel, fully home-based walking intervention informed by concepts from behavioral economics to increase physical activity and PAD-specific quality of life in patients with PAD. Its results will have important implications for the application of behavioral economic concepts to scalable home-based strategies to promote physical activity in patients with PAD and other disease processes where physical activity is limited by exertional symptoms. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov; NCT04536012.

Making physical activity fun and accessible to adults with intellectual disabilities: A pilot study of a gamification intervention.

BACKGROUND: Only about 9% of individuals with intellectual disabilities reach the government's physical activity (PA) recommendations. Combining gamification and technology seems particularly promising in overcoming personal and environmental barriers to PA participation. METHOD: Eighteen adults with varying levels of intellectual disabilities completed a pilot study to assess the initial effects of a cycling gamification intervention on levels of PA, fitness, psychosocial outcomes, and challenging behaviours. The study comprised three designs: pre-post single group, AB single-case, and qualitative. Social validity, implementation barriers and facilitators were also explored. RESULTS: Nearly all 18 participants cycled daily. Time and distance cycled daily increase during the intervention while a decrease in stereotyped behaviours was observed. Participants and staff found the intervention enjoyable and socially valid. CONCLUSIONS: Results of the multiple-design study suggest that gamification interventions may be a suitable, enjoyable, and promising way to contribute to PA participation of adults with intellectual disabilities.

Virtual reality cricothyrotomy - a case-control study on gamification in emergency education.

BACKGROUND: Cricothyrotomy is an invasive and rare emergency intervention to secure the airway in a "cannot intubate, cannot ventilate" situation. This leads to lack of routine. Cricothyrotomy is performed only hesitantly. Therefore, we aim to improve teaching by including a virtual reality (VR) cricothyrotomy as a learning tool. METHODS: We programmed the VR cricothyrotomy in the C# programming language on the open-source Unity platform. We could include 149 students that we randomly assigned to either a study group (VR cricothyrotomy) or control group (educational video). We asked the study group to subjectively rate the VR cricothyrotomy. To evaluate our intervention (VR cricothyrotomy) we took the time participants needed to perform a cricothyrotomy on a plastic model of a trachea and evaluated the correct procedural steps. RESULTS: The majority of students that performed the VR simulation agreed that they improved in speed (81%) and procedural steps (92%). All participants completed the cricothyrotomy in 47s ± 16s and reached a total score of 8.7 ± 0.7 of 9 possible points. We saw no significant difference in time needed to perform a cricothyrotomy between study and control group (p > 0.05). However, the total score of correct procedural steps was significantly higher in the study group than in the control group (p < 0.05). CONCLUSIONS: Virtual reality is an innovative learning tool to improve teaching of emergency procedures. The VR cricothyrotomy subjectively and objectively improved correct procedural steps. Digitized education fills an educational gap between pure haptic experience and theoretical knowledge. This is of great value when focusing on extension of factual knowledge. TRIAL REGISTRATION: DRKS00031736, registered on the 20th April 2023.

A randomized controlled mHealth trial that evaluates social comparison-oriented gamification to improve physical activity, sleep quantity, and quality of life in young adults.

INTRODUCTION: The integration of gamification in mHealth interventions presents a novel approach to enhance user engagement and health outcomes. This study aims to evaluate whether comparison-oriented gamification can effectively improve various aspects of health and well-being, including physical activity, sedentary behavior, sleep, and overall quality of life among young adults. METHODS: Potential 107 young adults (from 19 to 28 years old) participated in an 8-week trial. Participants were assigned to either a gamified mHealth intervention (LevantApp) with daily leaderboards and progress bars (n = 53, 26 % dropped-out), or a control condition without gamification (n = 52, 29 % dropped-out). Physical activity (number of steps, moderate and moderate-to-vigorous physical activity -MVPA-) and sleep quantity were measured objectively via accelerometry and subjectively using the International Physical Activity Questionnaire(IPAQ), Pittsburgh Sleep Quality Index(PSQI), Sedentary Behavior Questionnaire(SBQ), and Short Form Health Survey(SF-36). RESULTS: This mHealth intervention with social comparison-oriented gamification significantly improved moderate physical activity to a greater extent than the control group. Additionally, the intervention group showed improvements in the number of steps, moderate physical activity, sedentary time, emotional wellbeing, and social functioning. However, no significant group by time interaction was observed. No significant differences were observed in sleep quality or quantity. CONCLUSION: s: The LevantApp gamified mHealth intervention was effective in improving moderate physical activity, physical functioning, and role-emotional in young adults. No significant effects were found on step counts, MVPA or sleep, suggesting that while gamification can enhance specific aspects of physical activity and quality of life, its impact may vary across different outcomes.

Gamification in medical education: identifying and prioritizing key elements through Delphi method.

BACKGROUND: Gamification has gained popularity in medical education, but key elements have not been formally identified. This study aimed to generate and prioritize a list of key elements of gamification in medical education. METHODS: This study utilized a two-stage approach, including the Delphi method and qualitative interview. Nineteen medical educators with expertise in gamification participated in the Delphi method stage. Experts who had more than three years of experience with gamification in medical education constituted the expert panel. The experts were then asked to rate the gamification elements using the Likert five-point scale through at least two consensus-seeking rounds. Consensus for key elements was predefined as ≥ 51% of respondents rating an element as 'important' or"very important." In the qualitative interview stage, 10 experts provided feedback on the application of these key gamification elements. RESULTS: Eighteen participants (11 males and 7 females) completed the entire Delphi process for this study. After two rounds of surveys, the consensus was reached on all elements. Thirteen elements scored more than 4 points (37%) and reached the criteria of key elements of gamification in medical education. The top five key elements were integration with instruction objectives, game rules, rapid feedback, fairness, and points/scoring. The thirteen key elements for successful gamification in medical education were further organized into two main categories: (1) gamification design principles and (2) game mechanisms. CONCLUSIONS: Integration with educational objectives, gamification in curriculum design and teaching methods, and balancing between the mechanisms and principles were the three key components for successful gamification. This study explored the gamification key elements, providing practical tips for medical educators in their efforts to gamify medical education. Future studies involving learners could be performed to examine the efficacy of these key elements in gamification.

Informing Personalised Gamification Interventions Through a Novel Gamified Quiz.

Nonadherence to medical interventions and other advice leads to increased care costs and poorer health outcomes across a range of medical fields. An approach to increasing adherence is gamification. To maximize the benefits of gamification, a more structured and informed implementation is required. In this paper, a novel web-based personality determiner has been outlined, the integration of which could provide the personalisation required for an optimized gamification implementation.

"CARBGAME" (CARd & Board GAmes in Medical Education): a gamification innovation to foster active learning in biochemistry for medical students.

Diving into the realm of game-based learning, the "CARBGAME"(CARd & Board GAmes in Medical Education) is an innovative series of games that reimagines the way medical students learn complex but essential chapters. In the pilot study, there was a highly significant improvement in the academic performance of students in the chapter "Vitamins." All the students perceived CARBGAME to be highly rewarding in terms of creating engaging and meaningful learning experiences. Recognizing the benefit of games in medical education, we strongly recommend the implementation of CARBGAME for essential topics in physiology education to create a more dynamic and engaging learning environment for students.NEW & NOTEWORTHY "CARBGAME" (CARd & Board GAmes in Medical Education) creates a unique and fun-filled educational environment where students learn complex but essential medical chapters in a gamified manner using cards and boards. This customizable innovation is strengthened with fundamental educational principles to promote engaging and meaningful learning experiences for students.

The combined effects of an anatomy program integrating drawing and gamification on basic psychological needs satisfaction among sport sciences students: Results of a natural experiment.

According to self-determination theory, the need for competence, autonomy, and relatedness has been associated with intrinsic motivation. Fulfilling basic psychological needs can lead to better learning, academic performance, and well-being. In this study, an anatomy program integrated gamification and drawing methods to explore their influence on basic psychological needs satisfaction and potential learning implications. Basic psychological needs outcomes of sport sciences students were compared to test the effects of the Observe-Reflect-Draw-Edit-Repeat (ORDER) method and gamification (experimental condition) versus a non-ORDER and non-gamified program (control condition). These two different 30-h (7-week) anatomy education programs were implemented at two Spanish public universities with 116 first-year sport sciences students. Pre and post-treatment measurements were collected using the Basic Psychological Needs Satisfaction Scale. Statistical analyses included independent samples t-tests, ANCOVAs, and factorial repeated measures ANOVAs 2 × 2 (time × treatment). The gamified ORDER program achieved higher satisfaction scores in basic psychological needs compared to the control group (t = 2.98, p = 0.004, d = 0.54). Additionally, an interaction effect between time and treatment was observed (p = 0.042, η p 2 = 0.038). Treatment and interaction effects were observed for 'autonomy' (p = 0.003, η p 2 = 0.074) and 'competence' satisfaction (p = 0.048, η p 2 = 0.035). A time effect was found for 'relatedness' in the control group, but no significant treatment or interaction effects were identified. The causes of these effects are debated in the study, as well as the limitations. These findings support the notion that students' basic psychological needs are better satisfied in anatomy education with the implementation of this multimethod educational intervention based on ORDER and gamification.

Gamification using technologies for occupational safety training in the civil construction sector.

BACKGROUND: Although regulatory norms on work safety offer guidelines for organizing and preventing accidents, the construction site is an environment susceptible to deviations, sometimes due to the lack of effective training. To this end, technologies such as virtual reality become possibilities for innovations with great advantages, as they allow simulations, modeling, exploratory environments and games, which allow the user to create a greater connection and interest in the subject in question. OBJECTIVE: This study aimed to present the technological advances applied in safety-oriented training in the construction industry worldwide, emphasizing serious games through a systematic review of the literature. METHODS: The review was carried out using five scientific databases, with a research protocol to answer questions about the application of gamification to guarantee the safety of workers. RESULTS: Fifteen articles were evaluated, with descriptive, observational research and case studies. It was found that the use of technologies in construction safety is not yet a common reality in the sector, as it presents challenges and limitations, such as gameplay and issues related to cost. However, they show great potential as a dynamic solution in the training of civil construction workers, effectively collaborating in accident prevention and work safety. CONCLUSION: Several software programs and applications were found for creating three-dimensional scenes and for providing users with a customized experience according to the needs observed in the virtual interaction; building information modeling tools, which promote realistic project modeling; and equipment to visualize the scenes created. Furthermore, the possibility of combining traditional theoretical teaching with serious games was verified. However, gamification applicability is an alternative that still has limitations, in addition to the lack of flexibility in the rules imposed on the game, hampering users' authenticity in making decisions.

Escape the Room! Utilizing Gamification in a Preceptor Training Workshop.

Gamification is an innovative pedagogy involving immersive technology that acknowledges learner-centric milieus and dynamic teaching practices. Gamification is positioned well in nursing education because learners can translate tools from team experiences, communication, and critical thinking questions into the healthcare setting. This article introduces an escape-the-room format that was constructed for a preceptor program at a large academic medical center. The results of the implementation encourage gamification as an engaging methodology in clinical education.

Gamification and neurological motor rehabilitation in children and adolescents: a systematic review.

INTRODUCTION: Gamification consists of the use of games in non-playful contexts. It is widely employed in the motor rehabilitation of neurological diseases, but mainly in adult patients. The objective of this review was to describe the use of gamification in the rehabilitation of children and adolescents with neuromotor impairment. METHODS: We performed a systematic review of clinical trials published to date on the MEDLINE (PubMed), Scielo, SCOPUS, Dialnet, CINAHL, and PEDro databases, following the PRISMA protocol. The methodological quality of the studies identified was assessed using the PEDro scale. RESULTS: From a total of 469 studies, 11 clinical trials met the inclusion criteria. We analysed the gamification systems used as part of the rehabilitation treatment of different neuromotor conditions in children and adolescents. Cerebral palsy was the most frequently studied condition (6 studies), followed by developmental coordination disorder (3), neurological gait disorders (1), and neurological impairment of balance and coordination (1). CONCLUSION: The use of gamification in rehabilitation is helpful in the conventional treatment of neuromotor disorders in children and adolescents, with increased motivation and therapeutic adherence being the benefits with the greatest consensus among authors. While strength, balance, functional status, and coordination also appear to improve, future research should aim to determine an optimal dosage.

Empowering human anatomy education through gamification and artificial intelligence: An innovative approach to knowledge appropriation.

Gamification has appeared as an alternative educational methodology to traditional tools. Specifically, in anatomy teaching, multiple technological applications have emerged in response to the difficulties of accessing cadaveric material; however, there is insufficient information about the effects of these applications on the performance achieved by students, or about to the best way to adapt learning to meet their educational needs. In this study, we investigated how teaching human anatomy through a mobile gamified technological tool containing recommendation systems can be combined with a virtual assistant to improve the learning and academic performance of medical students in the Anatomy Department at the Universidad de La Frontera in Temuco, Chile and the Anatomy Department at the Pontificia Universidad Católica de Chile. In total, 131 students participated in the experiment, which was divided into two case studies. The main findings led to the conclusion that gamified components support students in learning anatomy. In addition, the predictions and recommendations provided by the virtual assistant enabled the academic aspects that the students needed to improve to be extracted adequately. Future work is expected to support adaptive learning by incorporating new artificial intelligence in education elements that can generate personalized scenarios for studying anatomy based on the application.

Motivating school communities towards behavior change and local ownership: a gamification intervention to prevent trachoma at primary schools in southern Ethiopia.

BACKGROUND: Ethiopia alone carries 49% of the global burden of trachoma, associated with a lack of safe water, sanitation and hygiene (WASH) and poor health practices. The aim of this study was to examine whether gamification among schoolchildren and promotion of local ownership of school WASH is associated with healthy behaviors and WASH infrastructure improvements. METHODS: Application of the Accelerate gamification intervention for elimination of trachoma, with an emphasis on gamification among schoolchildren and community involvement in motivating face-washing, handwashing and functional use of latrines, was undertaken. RESULTS: The study was conducted over 9 mo in 223 rural schools from six districts within the intervention area, reaching 93 518 schoolchildren. At baseline, students were observed washing their hands after using latrines in 23 (10.3%) schools. This increased to 132 (59%) schools (p≤0.001) at follow-up. The number of latrines increased from 585 at baseline to 594 at follow-up (p=0.031). The availability of handwashing stations in schools increased from 31 (13.9%) with water access (8%) and soap (5%) to 155 (69.5%) schools with handwashing stations with water access in 153 (98.7%) (p<0.001) and soap in 121 (78%) (p<0.001). CONCLUSIONS: Motivational strategies such as gamification among schoolchildren and promotion of local ownership of school WASH may be associated with healthy behaviors and WASH infrastructure improvements.

Impact of gamification on green consumption behavior integrating technological awareness, motivation, enjoyment and virtual CSR.

Gamification entails integrating game design elements, including rewards, points, competition, and interactive challenges, into non-game contexts to engage and motivate individuals. In the context of green consumption, gamification can encourage individuals to acquire more sustainable consumption behaviors. The proposed study aims to examine the influence of gamification on green consumption behavior among Chinese university students. However, university students are considered an important target group for such interventions due to their technological savvy and high interest in environmental issues. A self-determination theory (SDT) was used to measure the motivating factors of gamification for adopting green consumption behavior-a convenience sampling technique in which survey-based research designs were used to collect the data. A survey was conducted on a sample of 332 university students in China, using a questionnaire with structural equation modeling (SEM) to test the hypotheses and assess the proposed relationships between the variables. The finding of this study reveals that gamification has a significant negative relation with green consumption behavior. Further, technological awareness, hedonic motivation, and perceived enjoyment significantly mediate the relationship between gamification and green consumption behavior. Additionally, virtual CSR significantly moderates the relationship between gamification and technological awareness, hedonic motivation, and perceived enjoyment. The findings of this study could have implications for the development of more effective interventions for policy makers and industrialists aimed at promoting sustainable consumption behaviors in China.