title: Gamification for health promotion: systematic review of behaviour change techniques in smartphone apps.
abstract: Smartphone games that aim to alter health behaviours are common, but there is uncertainty about how to achieve this. We systematically reviewed health apps containing gaming elements analysing their embedded behaviour change techniques.
  
  
  
  Two trained researchers independently coded apps for behaviour change techniques using a standard taxonomy. We explored associations with user ratings and price.
  
  
  
  We screened the National Health Service (NHS) Health Apps Library and all top-rated medical, health and wellness and health and fitness apps (defined by Apple and Google Play stores based on revenue and downloads). We included free and paid English language apps using 'gamification' (rewards, prizes, avatars, badges, leaderboards, competitions, levelling-up or health-related challenges). We excluded apps targeting health professionals.
  
  
  
  64 of 1680 (4%) health apps included gamification and met inclusion criteria; only 3 of these were in the NHS Library. Behaviour change categories used were: feedback and monitoring (n=60, 94% of apps), reward and threat (n=52, 81%), and goals and planning (n=52, 81%). Individual techniques were: self-monitoring of behaviour (n=55, 86%), non-specific reward (n=49, 82%), social support unspecified (n=48, 75%), non-specific incentive (n=49, 82%) and focus on past success (n=47, 73%). Median number of techniques per app was 14 (range: 5-22). Common combinations were: goal setting, self-monitoring, non-specific reward and non-specific incentive (n=35, 55%); goal setting, self-monitoring and focus on past success (n=33, 52%). There was no correlation between number of techniques and user ratings (p=0.07; rs=0.23) or price (p=0.45; rs=0.10).
  
  
  
  Few health apps currently employ gamification and there is a wide variation in the use of behaviour change techniques, which may limit potential to improve health outcomes. We found no correlation between user rating (a possible proxy for health benefits) and game content or price. Further research is required to evaluate effective behaviour change techniques and to assess clinical outcomes.
  
  
  
  CRD42015029841.
authors.affiliation: Centre for Primary Care and Public Health, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: E A
authors.identifier: 0000-0002-3277-1446
authors.initials: EA
authors.lastname: Edwards
authors.affiliation: School of Experimental Psychology, University of Bristol, Bristol, UK MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK.
authors.forename: J
authors.initials: J
authors.lastname: Lumsden
authors.affiliation: Centre for Primary Care and Public Health, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK Faculty of Health Sciences, University of Southampton, Southampton, UK.
authors.forename: C
authors.initials: C
authors.lastname: Rivas
authors.affiliation: Centre for Primary Care and Public Health, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Steed
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, UK.
authors.forename: L A
authors.identifier: 0000-0002-8222-4555
authors.initials: LA
authors.lastname: Edwards
authors.affiliation: Centre for Primary Care and Public Health, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Thiyagarajan
authors.affiliation: Centre for Primary Care and Public Health, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Sohanpal
authors.affiliation: Department of Computing and Information Systems, Kingston University, London, UK.
authors.forename: H
authors.initials: H
authors.lastname: Caton
authors.affiliation: Centre for Primary Care and Public Health, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: C J
authors.initials: CJ
authors.lastname: Griffiths
authors.affiliation: School of Experimental Psychology, University of Bristol, Bristol, UK MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK.
authors.forename: M R
authors.initials: MR
authors.lastname: Munafò
authors.affiliation: Centre for Primary Care and Public Health, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Taylor
authors.affiliation: Centre for Primary Care and Public Health, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: R T
authors.initials: RT
authors.lastname: Walton
mesh_terms: D001521:Behavior Therapy; D006040:Goals; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D063731:Mobile Applications; D009042:Motivation; D012201:Reward; D000068997:Smartphone; D018910:Video Games
keywords: PUBLIC HEALTH