title: Quittr: The Design of a Video Game to Support Smoking Cessation.
abstract: BACKGROUND
  Smoking is recognized as the largest, single, preventable cause of death and disease in the developed world. While the majority of smokers report wanting to quit, and many try each year, smokers find it difficult to maintain long-term abstinence. Behavioral support, such as education, advice, goal-setting, and encouragement, is known to be beneficial in improving the likelihood of succeeding in a quit attempt, but it remains difficult to effectively deliver this behavioral support and keep the patient engaged with the process for a sufficient duration. In an attempt to solve this, there have been numerous mobile apps developed, yet engagement and retention have remained key challenges that limit the potential effectiveness of these interventions. Video games have been clearly linked with the effective delivery of health interventions, due to their capacity to increase motivation and engagement of players.
  
  
  OBJECTIVE
  The objective of this study is to describe the design and development of a smartphone app that is theory-driven, and which incorporates gaming characteristics in order to promote engagement with content, and thereby help smokers to quit.
  
  
  METHODS
  Game design and development was informed by a taxonomy of motivational affordances for meaningful gamified and persuasive technologies. This taxonomy describes a set of design components that is grounded in well-established psychological theories on motivation.
  
  
  RESULTS
  This paper reports on the design and development process of Quittr, a mobile app, describing how game design principles, game mechanics, and game elements can be used to embed education and support content, such that the app actually requires the user to access and engage with relevant educational content. The next stage of this research is to conduct a randomized controlled trial to determine whether the additional incentivization game features offer any value in terms of the key metrics of engagement-how much content users are consuming, how many days users are persisting with using the app, and what proportion of users successfully abstain from smoking for 28 days, based on user-reported data and verified against a biochemical baseline using cotinine tests.
  
  
  CONCLUSIONS
  We describe a novel, and theoretically-informed mobile app design approach that has a broad range of potential applications. By using the virtual currency approach, we remove the need for the game to comprehensively integrate the healthy activity as part of its actual play mechanics. This opens up the potential for a wide variety of health problems to be tackled through games where no obvious play mechanic presents itself. The implications of this app are that similar approaches may be of benefit in areas such as managing chronic conditions (diabetes, heart disease, etc), treating substance abuse (alcohol, illicit drugs, etc), diet and exercise, eating disorders (anorexia, bulimia, and binge eating), and various phobias.
authors.affiliation: University of Tasmania, Hobart, Australia.
authors.forename: Ivan
authors.identifier: http://orcid.org/0000-0002-8170-8339
authors.initials: I
authors.lastname: Bindoff
authors.affiliation: University of Tasmania, Hobart, Australia.
authors.forename: Kristy
authors.identifier: http://orcid.org/0000-0002-2552-5108
authors.initials: K
authors.lastname: de Salas
authors.affiliation: University of Tasmania, Hobart, Australia.
authors.forename: Gregory
authors.identifier: http://orcid.org/0000-0003-4610-1782
authors.initials: G
authors.lastname: Peterson
authors.affiliation: University of Tasmania, Hobart, Australia.
authors.forename: Tristan
authors.identifier: http://orcid.org/0000-0003-4361-5294
authors.initials: T
authors.lastname: Ling
authors.affiliation: University of Tasmania, Hobart, Australia.
authors.forename: Ian
authors.identifier: http://orcid.org/0000-0001-7160-9364
authors.initials: I
authors.lastname: Lewis
authors.affiliation: University of Tasmania, Hobart, Australia.
authors.forename: Lindsay
authors.identifier: http://orcid.org/0000-0002-0195-5648
authors.initials: L
authors.lastname: Wells
authors.affiliation: University of Tasmania, Hobart, Australia.
authors.forename: Peter
authors.identifier: http://orcid.org/0000-0002-9193-7813
authors.initials: P
authors.lastname: Gee
authors.affiliation: University of Tasmania, Hobart, Australia.
authors.forename: Stuart G
authors.identifier: http://orcid.org/0000-0001-7378-3497
authors.initials: SG
authors.lastname: Ferguson
keywords: mobile phone; motivation; smoking cessation; video games