The impact of gamification on smoking cessation: A systematic review and meta-analysis

The rise of mobile health (mHealth) has led to increased adoption of mobile apps for smoking cessation. The integration of gamification has been found to be positively associated with higher app engagement, smokers' self-efficacy and motivation to quit. This systematic review and meta-analysis aimed to identify and assess the game elements incorporated into smoking cessation applications and evaluate the effectiveness of gamified interventions on smoking cessation outcomes.

A comprehensive search was conducted in PubMed, Web of Science, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and WHO International Clinical Trials Registry Platform (ICRTP) and ClinicalTrials.gov databases from inception to November 2024. Eligible studies included interventional trials comparing gamification-based smoking cessation strategies with non-gamified control groups. Two independent reviewers performed study screening, data extraction, and quality assessment using the Cochrane Handbook for Systematic Reviews. Outcomes were narratively synthesized, and comparable studies were pooled based on follow-up time and abstinence duration. A random-effects meta-analysis assessed smoking abstinence using relative risk (RR) as the effect measure. Heterogeneity was evaluated using Cochran's Q and I² index. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the reference number CRD42024611631.

Fifteen randomized controlled trials (RCTs) with a total of 5075 participants met the inclusion criteria. Key gamification elements included competition, milestone recognition, storytelling, and rewards. The pooled meta-analysis demonstrated a significant impact of gamified interventions on smoking abstinence. The strongest effects were observed within the first six months of intervention (RR=1.91; 95% CI: 1.47-2.47, p<0.001). Long-term effects remained significant beyond six months (RR=1.37; 95% CI: 1.05-1.79, p=0.02). Sensitivity analysis confirmed the robustness of these findings.

Gamification-based interventions significantly improve smoking cessation outcomes, particularly in the short-term. However, the diminishing effects over time highlight the importance of long-term engagement. While these findings are promising, limitations such as heterogeneity in follow-up periods, reliance on some self-reported outcomes, and the inability to isolate specific gamification components may affect the generalizability of results. Leveraging gamification's potential can still transform smoking cessation efforts, offering scalable and engaging solutions for lasting behavioral change.