“Health is a serious game”: Gamification as a tool for primary prevention in Public Health

BACKGROUND: Gamification, according to literature, is the use of game design elements in non-game contexts. Rewards (e.g. points, badges and rankings) are a gamification strategy to entice users to complete required tasks and could be useful for Public Health (PH) interventions to promote healthy lifestyles. This study aims to find out which gamification approaches are most useful in PH. METHODS: We investigated PubMed, Scopus and Web of Science databases to conduct our systematic review, including articles published up to February 3, 2023. Prisma Statement 2020 guidelines were used. No time limits were included. Only articles in Italian or English that discussed gamification interventions in PH, effectiveness and user satisfaction were taken into account. The quality of the studies will be assessed using the NIH quality assessment tool. RESULTS: 327 articles were found, 27 of which were included in the review. Pre-post studies were the most included (n = 12), conducted in Europe (n = 7) and USA (n = 6). The target population was mainly young adults and teens (n = 7). Most gamification interventions involved physical activity (n = 13), nutrition (n = 5) and smoking cessation (n = 2). Overall, the interventions proved to be all effective, but the ones about physical activity were the most useful, engaging and with longer-lasting results over time. Where satisfaction was assessed (n = 16), users gave positive feedback. CONCLUSIONS: The research outcomes have shown how gamification may engage not only individuals, but masses, using game design elements in different Public Health areas. The implementation of gamification tools in PH is an innovative intervention that often uses graphic language to simplify and deliver messages to all kinds of users. Gamification is easy to use and could be a good strategy for primary prevention, to support a sustainable behavior change following the game period. More large scale controlled trials are needed in order to confirm these results. KEY MESSAGES: • Gamification is an important tool in public health useful for primary prevention. • The mass appeal of gamification can reach many users leading to healthier lifestyles, especially among young adults.