IMPORTANCE: Gamification, the use of game design elements in nongame contexts, is increasingly being used in workplace wellness programs and digital health applications. However, the best way to design social incentives in gamification interventions has not been well examined. OBJECTIVE: To assess the effectiveness of support, collaboration, and competition within a behaviorally designed gamification intervention to increase physical activity among overweight and obese adults. DESIGN, SETTING, AND PARTICIPANTS: This 36-week randomized clinical trial with a 24-week intervention and 12-week follow-up assessed 602 adults from 40 states with body mass indexes (calculated as weight in kilograms divided by height in meters squared) of 25 or higher from February 12, 2018, to March 17, 2019. INTERVENTIONS: Participants used a wearable device to track daily steps, established a baseline, selected a step goal increase, were randomly assigned to a control (n = 151) or to 1 of 3 gamification interventions (support (n = 151), collaboration (n = 150), and competition (n = 150)), and were remotely monitored. The control group received feedback from the wearable device but no other interventions for 36 weeks. The gamification arms were entered into a 24-week game designed using insights from behavioral economics with points and levels for achieving step goals. No gamification interventions occurred during follow-up. MAIN OUTCOMES AND MEASURES: The primary outcome was change in mean daily steps from baseline through the 24-week intervention period. RESULTS: A total of 602 participants (mean (SD) age, 39 (10) years; mean (SD) body mass index, 30 (5); 427 (70.9%) male) were included in the study. Compared with controls, participants had a significantly greater increase in mean daily steps from baseline during the intervention in the competition arm (adjusted difference 920; 95% CI 513 to 1,328; p < 0.001), support arm (adjusted difference 689; 95% CI 267 to 977; p < 0.001), and collaboration arm (adjusted difference 637; 95% CI 258 to 1,017; p = 0.001). During follow-up, physical activity remained significantly greater in the competition arm than in the control arm (adjusted difference 569; 95% CI 142 to 996; p = 0.009) but was not significantly greater in the support (adjusted difference 428; 95% CI 19 to 837; p = 0.04) and collaboration (adjusted difference 126; 95% CI -248 to 468; p = 0.49) arms than in the control arm. CONCLUSIONS AND RELEVANCE: All 3 gamification interventions significantly increased physical activity during the 24-week intervention, and competition was the most effective. Physical activity was lower in all arms during follow-up and only remained significantly greater in the competition arm than in the control arm. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT03311230.

Full text (sometimes free) may be available at these link(s):      help

• PubMed Central
• DOI
• PubMed
• PDF locator
• publisher