Gamification and Adherence to Web-Based Mental Health Interventions: A Systematic Review

Area of Science:

• Digital Health
• Mental Health Interventions
• Human-Computer Interaction

Background:

• Adherence to web-based interventions for common mental disorders (CMDs) and well-being is crucial for effectiveness.
• Gamification, using game design in non-game contexts, is increasingly applied to health interventions to boost engagement.
• The influence of gamification on adherence in web-based CMD interventions remains underexplored.

Purpose of the Study:

• To systematically review the literature and examine if gamification features predict or influence adherence rates in web-based interventions for CMDs and well-being.
• To identify commonly used gamification elements in digital mental health interventions.

Main Methods:

• A systematic review of peer-reviewed randomized controlled trials (RCTs) was conducted.
• Studies included interventions for CMDs or well-being that incorporated gamification features.
• Seven electronic databases were searched to identify relevant RCTs.

Main Results:

• 61 RCTs involving 47 unique intervention programs met the inclusion criteria; most targeted depression using cognitive behavioral therapy.
• Eight common gamification features were reviewed, with 'story/theme' being the most frequent; 'levels' and 'game leaders' were notably absent.
• No studies explicitly investigated the impact of gamification on adherence, and usage data were infrequently reported. Longer interventions (10 weeks) showed higher adherence than shorter ones (6-8 weeks).

Conclusions:

• Gamification elements are present in web-based interventions for CMDs and well-being, but their specific effect on adherence requires further investigation.
• Varied reporting of adherence and usage data limits current understanding.
• Future research should focus on elucidating the relationship between gamification features, adherence, and engagement to optimize digital health intervention design.