title: Game On? Smoking Cessation Through the Gamification of mHealth: A Longitudinal Qualitative Study.
abstract: BACKGROUND
  Finding ways to increase and sustain engagement with mHealth interventions has become a challenge during application development. While gamification shows promise and has proven effective in many fields, critical questions remain concerning how to use gamification to modify health behavior.
  
  
  OBJECTIVE
  The objective of this study is to investigate how the gamification of mHealth interventions leads to a change in health behavior, specifically with respect to smoking cessation.
  
  
  METHODS
  We conducted a qualitative longitudinal study using a sample of 16 smokers divided into 2 cohorts (one used a gamified intervention and the other used a nongamified intervention). Each participant underwent 4 semistructured interviews over a period of 5 weeks. Semistructured interviews were also conducted with 4 experts in gamification, mHealth, and smoking cessation. Interviews were transcribed verbatim and thematic analysis undertaken.
  
  
  RESULTS
  Results indicated perceived behavioral control and intrinsic motivation acted as positive drivers to game engagement and consequently positive health behavior. Importantly, external social influences exerted a negative effect. We identified 3 critical factors, whose presence was necessary for game engagement: purpose (explicit purpose known by the user), user alignment (congruency of game and user objectives), and functional utility (a well-designed game). We summarize these findings in a framework to guide the future development of gamified mHealth interventions.
  
  
  CONCLUSIONS
  Gamification holds the potential for a low-cost, highly effective mHealth solution that may replace or supplement the behavioral support component found in current smoking cessation programs. The framework reported here has been built on evidence specific to smoking cessation, however it can be adapted to health interventions in other disease categories. Future research is required to evaluate the generalizability and effectiveness of the framework, directly against current behavioral support therapy interventions in smoking cessation and beyond.
authors: Faculty of Medicine, Department of Medicine, Imperial College London, London, United Kingdom.
authors: Abdulrahman Abdulla
authors: http://orcid.org/0000-0002-5625-4419
authors: AA
authors: El-Hilly
authors: Sheeraz Syed
authors: http://orcid.org/0000-0001-7454-3903
authors: SS
authors: Iqbal
authors: Maroof
authors: http://orcid.org/0000-0003-1057-6583
authors: M
authors: Ahmed
authors: Yusuf
authors: http://orcid.org/0000-0002-2027-9550
authors: Y
authors: Sherwani
authors: Mohammed
authors: http://orcid.org/0000-0002-1607-4464
authors: M
authors: Muntasir
authors: Sarim
authors: http://orcid.org/0000-0002-4909-316X
authors: S
authors: Siddiqui
authors: Zaid
authors: http://orcid.org/0000-0003-1944-4851
authors: Z
authors: Al-Fagih
authors: Omar
authors: http://orcid.org/0000-0002-4367-254X
authors: O
authors: Usmani
authors: Andreas B
authors: http://orcid.org/0000-0001-5531-4662
authors: AB
authors: Eisingerich
keywords: behavioral support; gamification; health behavior; health policy; mhealth; mobile health; public health; smoking cessation