The rise of motivational information systems: A review of gamification research

Effects of game-based digital interventions for mental disorders: A meta-analysis

With increasing research attention on game-based digital interventions for mental disorders, a number of studies have been conducted to explore the effectiveness of digital game-based interventions on mental disorders. However, findings from previous research were inconsistent. Thus, we conducted a comprehensive meta-analytic review of the effectiveness of game-based digital interventions for mental disorders. By searching the articles in databases, we identified 53 studies in which 2433 participants were involved, and 282 effect sizes were extracted. Among the 53 studies, 14 employed within-group (pre/post) designs, and the remaining 39 utilized controlled trial designs. Using a three-level random-effects meta-analytic model, a medium effect size of game-based digital interventions (g = 0.47, 95 % CI: 0.33, 0.61) was revealed in the controlled trial designs and a close-to-medium effect size (g = 0.45, 95 % CI: 0.32, 0.58) was found in the within-group (pre/post) designs, indicating close-to-medium-sized efficacy of game-based digital interventions for mental disorders. Moderator analyses showed that age in the controlled trial designs had contributed to the heterogeneity in previous studies, suggesting that interventions might be more effective for the elderly. However, given that only a limited number of studies were focused on the elderly, more studies with older participants should be conducted in the future to provide more robust evidence and explore the mechanisms of how digital gaming interventions can be more effective in improving mental disorders symptoms.

Paths from simple game-targeted pro-environmental behaviors to more diverse pro-environmental behaviors: Empirical evidence from the Ant Forest app

Game interventions have drawn much attention for their playful features and "painless" promotion of simple game-targeted pro-environmental behaviors (GPEBs), which could spill over to more "costly" prosocial behaviors for pro-environmental causes (PSBPs). The literature places much emphasis on game-targeted mechanisms (e.g., enjoyment and competition) to explain the impacts of game interventions, but pays little attention to non-game-targeted mechanisms to explore their spillover effect. Using online survey data from 1246 Chinese residents, this paper first compares players' and nonplayers' levels of engagement with GPEBs and with two common PSBPs, finding a positive spillover effect from game-targeted simple behaviors to more diverse PSBPs. Based upon goal theory, self-perception theory, and learning theory, the paper then examines the underlying mediating mechanisms of the positive relationship between GPEBs and PSBPs for subsamples of players and nonplayers respectively. The results demonstrate that individual awareness of problem and self-efficacy could be enhanced through engaging in simple GPEBs, which could spill over to more challenging and "costly" PSBPs, including charitable giving and volunteering for pro-environmental causes. The study provides important insights on helping to encourage specific types of more challenging PSBPs not directly targeted by the game.

Branching Path Simulation for Pediatric Nurse Practitioner Students to Promote Critical Thinking: A Quasi-Experimental Study

INTRODUCTION

Branching path simulation (BPS) is an active learning pedagogy incorporating gaming principles in a low-stakes, safe environment. No study has explored the use of BPS in advanced practice nursing education. This study measured pediatric nurse practitioner students' perception of the integration of BPS in one graduate-level course.

METHOD

This study used a one group, post-test only quasi-experimental design with a convenience sample of 22 pediatric nurse practitioner students over 2 years enrolled in a university in the Pacific Northwest United States.

RESULTS

Responses to BPS were positive: design (M = 4.8; SD ± 0.4), usability (M = 4.3; SD ± 1.0), self-confidence (M = 4.2; SD ± 0.8) and satisfaction (M = 4.8; SD ± 0.4).

DISCUSSION

BPS was well received by learners. It not only provides immediate feedback and encourages students to identify their clinical management weaknesses and strengths but it also can be customized to needs in a course at a significant cost saving.

Brain imaging of a gamified cognitive flexibility task in young and older adults

The study aimed to develop and validate a gamified cognitive flexibility task through brain imaging, and to investigate behavioral and brain activation differences between young and older adults during task performance. Thirty-one young adults (aged 18-35) and 31 older adults (aged 60-80) were included in the present study. All participants underwent fMRI scans while completing the gamified cognitive flexibility task. Results showed that young adults outperformed older adults on the task. The left inferior frontal junction (IFJ), a key region of cognitive flexibility, was significantly activated during the task in both older and young adults. Comparatively, the percent signal change in the left IFJ was stronger in older adults than in young adults. Moreover, older adults demonstrated more precise representations during the task in the left IFJ. Additionally, the left inferior parietal lobule (IPL) and superior parietal lobule in older adults and the left middle frontal gyrus (MFG) and inferior frontal gyrus in young adults were also activated during the task. Psychophysiological interaction analyses showed significant functional connectivity between the left IFJ and the left IPL, as well as the right precuneus in older adults. In young adults, significant functional connectivity was found between the left IFJ and the left MFG, as well as the right angular. The current study provides preliminary evidence for the validity of the gamified cognitive flexibility task through brain imaging. The findings suggest that this task could serve as a reliable tool for assessing cognitive flexibility and for exploring age-related differences of cognitive flexibility in both brain and behavior.

Adaptation and psychometric investigation of the Gameful Experience Questionnaire (GAMEFULQUEST) in Brazilian Portuguese

Over the years, the use of questionnaires has become one of the most used methods for analyzing individuals' experiences. Especially in the area of gameful environments (e.g., games, gamification, and simulators), the Gameful Experience Questionnaire, a self-report instrument to measure gameful experience, became one of the most popular. Despite the instrument's popularity, there is no Brazilian Portuguese version, preventing studies from being carried out in Brazil (i.e., a country with more than 200 million inhabitants), where only 5.1% of the population have adequate English comprehension skills. To face this challenge, we conducted a cross-cultural adaptation of the Gameful Experience Questionnaire, providing a version of the questionnaire in the Brazilian Portuguese language. For this process, we conducted a mixed-methods (i.e., qualitative and quantitative) psychometric study (N = 384) organized in six steps (i.e., (i) translation, (ii) synthesis, (iii) experts evaluation, (iv) target audience evaluation, (v) adapted instrument application, and (vi) validation (i.e., confirmatory factor analysis)). The results indicate that the cross-cultural adaptation took place efficiently, where the resulting instrument maintained the psychometric properties of the original, measuring the construct of interest with similar effectiveness (i.e.,χ 2 / d f = 2.4, RMSEA = 0.061, CFI = 0.991, TLI = 0.989, GFI = 0.986 and SRMR = 0.061), enabling its application with Brazilian Portuguese speakers. With this study, we contribute to researchers and practitioners in the field of gameful environments by providing an instrument to measure gameful experience in the Brazilian Portuguese language.

Pilot Study of Home-Based Virtual Reality Fitness Training in Post-Discharge Rehabilitation for Patients with Spinal Cord Injury: A Randomized Double-Blind Multicenter Trial

Spinal cord injury (SCI) patients require continuous rehabilitation post-discharge to ensure optimal recovery. This study investigates the effectiveness of home-based virtual reality fitness training (VRFT) as a convenient and accessible rehabilitation method for SCI patients. This randomized, double-blind, multicenter trial will enroll 120 participants, assigning them to either an 8-week VRFT program (exercise group) or a control group engaging in regular daily activities. The outcomes measured include muscle function, cardiopulmonary fitness, body composition, and physical performance. Our study will determine the safety and feasibility of VRFT in a home setting for SCI patients and evaluate whether these patients can effectively participate in such a program post-discharge. The results of this study are expected to inform future exercise protocols for SCI rehabilitation, offering valuable insights into the utility of VRFT as a therapeutic tool.

Gamification in marketing: Insights on current and future research directions based on a bibliometric and theories, contexts, characteristics and methodologies analysis

Gamification involves using game design elements in non-game contexts. It is an emerging strategy that, being able to motivate consumer engagement with brands, has been increasingly used by companies in marketing activities. Recently, the application of gamification to marketing has become increasingly popular, with an increasing amount of research outputs. However, a clear overview of the field, a theoretical orientation or an agenda for research are still missing, which justifies the analysis of the existing literature joining these two fields of research. The motivation for conducting this review was twofold: Firstly, it is helpful to attain a broad overview of this developing field, synthesizing the existing knowledge in a structured way, understanding how gamification research in marketing has progressed and what type of knowledge has been acquired; secondly, it allows us to provide valuable information that will guide future research. Thus, this study provides a hybrid review, which integrates a bibliometric and TCCM analysis, of gamification in marketing by analyzing 114 articles. The data was retrieved from the Scopus scientific database. The bibliometric analysis showed the existence of 8 clusters, mostly representing current areas of research. It was found that the focus of the literature, so far, has been on studying which game elements should be implemented in a gamification system, as well as examining the impact of gamification experiences on engagement and consumer's behaviors. The TCCM analysis revealed the major theories and methodological approaches explored in published articles. The use of self-determination theory and quantitative methodology, based on primary data using online surveys, stands out. These complementary analyzes allowed to provide future research directions to scholars and practitioners working in this domain, promoting the advancement of scientific knowledge, contextual relevance and methodological rigor. Moreover, this review also helps marketers make more informed strategic decisions and supports successful gamification design.

Gamification Approach to Provide Support About the Deferral Experience in Blood Donation: Design and Feasibility Study

BACKGROUND

Multiple studies have examined the impact of deferral on the motivation of prospective blood donors, proposing various policies and strategies to support individuals who undergo this experience. However, existing information and communications technology systems focused on blood donation have not yet integrated these ideas or provided options to assist with the deferral experience.

OBJECTIVE

This study aims to propose an initial gamified design aimed at mitigating the impact of the deferral experience by addressing the drivers of awareness and knowledge, interaction and validation, and motivation. Additionally, the study explores the feasibility of implementing such a system for potential users.

METHODS

We conducted a literature review focusing on the dynamics of motivation and intention related to blood donation, as well as the deferral situation and its impact on citizens. Through this review, we identified weak donor identity, lack of knowledge, and reduced motivation as key factors requiring support from appropriate interventions. These factors were then defined as our key drivers. Taking these into account, we proposed a gamification approach that incorporates concepts from the MDA framework. The aim is to stimulate the aforementioned drivers and expand the concept of contribution and identity in blood donation. For a preliminary evaluation, we designed a prototype to collect feedback on usability, usefulness, and interest regarding a potential implementation of our proposed gamification approach.

RESULTS

Among the participants, a total of 11 citizens interacted with the app and provided feedback through our survey. They indicated that interacting with the app was relatively easy, with an average score of 4.13 out of 5 when considering the 11 tasks of interaction. The SUS results yielded a final average score of 70.91 from the participants' answers. Positive responses were received when participants were asked about liking the concept of the app (3.82), being likely to download it (3.55), and being likely to recommend it to others (3.64). Participants expressed positivity about the implementation of the design but also highlighted current shortcomings and suggested possible improvements in both functionality and usability.

CONCLUSIONS

Although deferral is a common issue in blood donation, there is a missed opportunity in existing ICT services regarding how to effectively handle such experiences. Our proposed design and implementation seem to have captured the interest of prospective users due to its perceived positive usefulness and potential. However, further confirmation is needed. Improving the design of activities that currently rely heavily on extrinsic motivation elements and integrating more social components to create an enhanced activity loop for intrinsic motivation could further increase the value of the proposed project. Future research could involve conducting a more specialized and longitudinal design evaluation with a larger sample size.

Protocol for a randomised controlled field experiment on the effect of different gamification designs of physical activity

Gamification is finding growing application in the field of physical activity, promising engaging and motivating experiences that foster behavioural change. However, existing empirical work has insufficiently scrutinised whether the reported positive outcomes emerge because of gamification and what type of gamification design leads to optimal results. This protocol for a parallel four-arm randomised controlled field experiment was purposely designed to investigate the effect of different gamification designs on motivation, perceived usefulness, and the intended behavioural change in physical activity (increase in step counts). Participants were randomly assigned to either: 1) a competitive gamified group; 2) a cooperative gamified group; 3) a hybrid (competitive-cooperative) gamified group; or 4) a control group. The design of the gamified interventions was guided by gamification design frameworks identified in literature. The data gathered includes: 1) a longitudinal panel dataset of step counts to investigate the causal effect of gamification on physical activity behaviour; and 2) self-reported data to examine the effect of gamification on the users' intrinsic motivation and perceived usefulness of the experience. This protocol outlines the procedure and processes followed during this experiment to facilitate replicability for future studies.

Framework proposal for Role-Playing Games as mental health intervention: the Critical Skills methodology

Gamified interventions are an emerging approach in mental health treatment and prevention. Their positive effects on managing various clinical conditions stem from enhancing social skills. However, cost-effective options like Table-top Role-Playing Games (TTRPGs), which offer similar benefits to other game-based interventions, lack standardized methods for ensuring replicability. In this regard, the method outlined in this study endeavors, in a structured and guided manner drawing from the Consolidated Framework for Implementation Research (CFIR), to establish a six-step protocol for developing an intervention method utilizing TTRPGs. In all Steps, we aim to anchor ourselves in robust literature concerning social skills training (SST), cognitive behavioral therapy (CBT), and gamification comprehensively. Thus, the method presented encompasses the objectives of SST, the strategies of CBT, and the dynamics of gamification via TTRPGs. Furthermore, we demonstrate a possible application of the method to illustrate its feasibility. Ultimately, the final method is structured, evidence-based, easily applicable, cost-effective, and thus viable. Mental health professionals seeking a structured and instructional tool for protocol development will find support in the method proposed here.

"Pharmacotrophy": a playful tournament for game- and team-based learning in pharmacology education - assessing its impact on students' performance

BACKGROUND

At the Faculty of Pharmacy of Paris, we conducted a pharmacology tournament in 2021 and 2022, named "Pharmacotrophy", to offer a game-, team- and competitive-based learning innovation based on fun and challenge. This article aims to (1) provide a detailed overview of the organisation of "Pharmacotrophy," (2) present and compare feedback from both students and teachers, and (3) assess the impact of student participation on their exam marks.

METHODS

"Pharmacotrophy" took place in 2021 and 2022 over a two-week period at the beginning of the exam revision phase. It involved a combination of remote matches using the online quiz creation tool Kahoot!® and in-person matches. Teams, consisting of three students from the 4th or 5th year, participated in several selection rounds leading up to the final match. The questions covered various topics from the pharmacology curriculum. Using an anonymous online survey, we collected the feedback from students and teacher regarding the organisation of the tournament and the interest and difficulty of the different type of questions. We retrospectively compared the exam marks of 4th year students who took part in "Pharmacotrophy" (n2021 = 19 and n2022 = 20) with those of the rest of the 4th year (n2021 = 315-320 and n2022 = 279-281), both in the year before "Pharmacotrophy" and just after the tournament.

RESULTS

Students highlighted the educational benefits of team-based and game-based learning. This novel approach positively and constructively motivated students to review pharmacology. Additionally, students appreciated the establishment of a trust-based relationship with their teachers. All students had a similar pharmacology level based on their exam results in the year before "Pharmacotrophy." After the tournament, participants had marks 20.1% higher in pharmacology questions compared to non-participants (p = 0.02), while they had comparable overall levels, as evidenced by their final grade averages and marks in non-pharmacology questions. Moreover, participants who advanced further in the competition achieved higher marks in pharmacology questions compared to those who were eliminated early in the tournament.

CONCLUSION

The implementation of "Pharmacotrophy" provided students with an enjoyable way to review pharmacology coursework and revived the interest in pharmacology for some. Specifically, participating in "Pharmacotrophy" led to an increase in pharmacology marks for students who were not among the top performers in the class or did not excel in pharmacology in the previous year. This study quantified the pedagogical value of this innovative curriculum in terms of knowledge acquisition.

The motivating effect of monetary over psychological incentives is stronger in WEIRD cultures

Motivating effortful behaviour is a problem employers, governments and nonprofits face globally. However, most studies on motivation are done in Western, educated, industrialized, rich and democratic (WEIRD) cultures. We compared how hard people in six countries worked in response to monetary incentives versus psychological motivators, such as competing with or helping others. The advantage money had over psychological interventions was larger in the United States and the United Kingdom than in China, India, Mexico and South Africa (N = 8,133). In our last study, we randomly assigned cultural frames through language in bilingual Facebook users in India (N = 2,065). Money increased effort over a psychological treatment by 27% in Hindi and 52% in English. These findings contradict the standard economic intuition that people from poorer countries should be more driven by money. Instead, they suggest that the market mentality of exchanging time and effort for material benefits is most prominent in WEIRD cultures.

Acceptability Assessment of an Executive Function Training Game FISHERMAN for Older Adults

Objective: In recent years, an increasing number of gamification tools have been developed for older adults; however, few studies have explored the acceptability of these tools after initial use and sustained use in older adults. In the current study, we focus on "FISHERMAN," an executive function training game containing a cognitive game and an exergame, with the aim of investigating and comparing the acceptability of both versions of "FISHERMAN" after initial use and 3 months of sustained use in older adults. Materials and Methods: Seventy-six older adults were randomly assigned to the cognitive game training group or the exergame training group. Participants completed two 1-hour sessions per week for 12 weeks. Acceptability was evaluated through a validated, 7-point, self-rating, Interactive Technology Art Installation Technology Acceptance Model Questionnaire after the first and last training sessions, with higher ratings representing higher acceptability. The questionnaire included 22 items and 9 acceptability dimensions: usage behavior, intention to use, perceived usefulness, perceived ease of use, perceived playfulness, subjective norm, image, output quality, and result demonstrability. Descriptive statistics were conducted to evaluate acceptability after initial and sustained use. Two-way (time: initial use and sustained use; group: cognitive game group and exergame group) repeated ANOVAs were conducted to investigate the differences in acceptability. Post hoc, within-group, paired-sample t test analyses were performed to evaluate changes in game acceptability for each group over time. Results: After initial use and 3 months of sustained use, the average scores for overall acceptability and individual dimensions exceeded 5.5 of 7 points in both groups. The two groups presented different changes from initial use to sustained use. The overall acceptability, usage behavior, perceived usefulness, and perceived ease of use were significantly improved after training within the cognitive game group, while perceived playfulness was significantly reduced within the exergame group. Conclusions: The current study provided preliminary evidence that older adults had high acceptability for both the cognitive game and exergame versions of "FISHERMAN." After sustained use, acceptability of the cognitive game increased and acceptability of the exergame decreased, highlighting the importance of assessing game acceptability after initial and sustained use.

Motivation crowding effects on the intention for continued use of gamified fitness apps: a mixed-methods approach

It has become an emerging idea for fitness apps to be gamified to intrinsically and extrinsically motivate user's usage intention or behavior. For the long-term success of gamified fitness apps, understanding what and how various motivations affect continued use is critical. A combination of qualitative and quantitative methodologies was used to explore two research questions concerning gamified fitness applications. Specifically, the research questions focused on understanding the impacts of intrinsic and extrinsic motivations on continued usage. Additionally, the study aimed to investigate whether extrinsic motivations enhance or diminish the influence of intrinsic motivations. Results from qualitative study identified three intrinsic motivations (self-development, self-control and hedonic motivation) and two extrinsic motivations (social recognition and financial reward) in gamified fitness apps. Results from quantitative study indicated that intrinsic motivations (formed by self-development, self-control and hedonic motivation), financial reward and social recognition could significantly improve intention for continued use; and further, both financial reward and social recognition could crowd-in intrinsic motivations. This research offers insights into the phenomenon of motivation crowding effects on the intention to continue using gamified fitness apps.

Gamification preferences in nutrition apps: Toward healthier diets and food choices

Background

Unhealthy eating habits are costly and can lead to serious diseases such as obesity. Nutrition apps offer a promising approach to improving dietary behavior. Gamification elements (GEs) can motivate users to continue using nutrition apps by making them more enjoyable, which can lead to more positive behavioral changes regarding dietary choices. However, the effects of users' preferences and individual characteristics on gamified systems are not yet understood. Current calls for research suggest that personalized gamified systems might lead to user satisfaction, continuous app use, and-ultimately-long-term improvements in diet.

Objective

The aim was to determine the most preferred GEs in nutrition apps and to define clusters of GEs preferences in terms of personality and socio-demographic characteristics.

Methods

We surveyed 308 people to measure their preferences regarding GEs in nutrition apps and applied best-worst scaling to determine the most preferred GEs. Furthermore, we used cluster analysis to identify different user clusters and described them in terms of personality and socio-demographic characteristics.

Results

We determine that GEs most favored are goals, progress bars, and coupons. We revealed three distinct user clusters in terms of personality and socio-demographic characteristics. Based on the individual factors of openness and self-perception, we find that significant differences exist between the preferences for leaderboards and coupons.

Conclusion

We contribute by shedding light on differences and similarities in GE preferences relating to specific contexts and individual factors, revealing the potential for individualized nutrition apps. Our findings will benefit individuals, app designers, and public health institutions.

Distal and proximal factors of wearable users' quantified-self dependence: A cognitive-behavioral model

Objective

While using self-tracking devices for physical health has become ubiquitous, the potential for quantified-self (QS) dependence as a detrimental outcome for mental health is under-explored. This study examined the mechanism of wearable users' QS dependence by investigating both the distal and proximal factors based on a cognitive-behavioral model.

Methods

A total of 535 wearable users aged 18-35 years were surveyed in this study. The surveys included control variable questions related to age, gender, monthly income, BMI, and wearable use experience. Key variable measures included distal factor (habitual use of wearables), proximal factors (perceived external regulation, recognition, and perceived irreplaceability), and perceived QS dependence. Structural equation modeling (SEM) was used to test research hypotheses.

Results

The results revealed that habitual use of wearables as a distal factor alone was negatively associated with perceived QS dependence. However, it positively influenced perceived external regulation, recognition, and perceived irreplaceability, which in turn significantly contributed to perceived QS dependence, suggesting the suppression effect of the proximal factors.

Conclusions

The relationships between habitual use of wearables and QS dependence are complex. Although habitual use may seem apparently harmless, it can indirectly foster maladaptive cognitions, thereby promoting dependence. These findings underscore the potential threats of maladaptive cognitions that may arise from leveraging technology to promote physical health, thus offering guidance to technology designers for interventions.

Impact of gamification on green consumption behavior integrating technological awareness, motivation, enjoyment and virtual CSR

Gamification entails integrating game design elements, including rewards, points, competition, and interactive challenges, into non-game contexts to engage and motivate individuals. In the context of green consumption, gamification can encourage individuals to acquire more sustainable consumption behaviors. The proposed study aims to examine the influence of gamification on green consumption behavior among Chinese university students. However, university students are considered an important target group for such interventions due to their technological savvy and high interest in environmental issues. A self-determination theory (SDT) was used to measure the motivating factors of gamification for adopting green consumption behavior-a convenience sampling technique in which survey-based research designs were used to collect the data. A survey was conducted on a sample of 332 university students in China, using a questionnaire with structural equation modeling (SEM) to test the hypotheses and assess the proposed relationships between the variables. The finding of this study reveals that gamification has a significant negative relation with green consumption behavior. Further, technological awareness, hedonic motivation, and perceived enjoyment significantly mediate the relationship between gamification and green consumption behavior. Additionally, virtual CSR significantly moderates the relationship between gamification and technological awareness, hedonic motivation, and perceived enjoyment. The findings of this study could have implications for the development of more effective interventions for policy makers and industrialists aimed at promoting sustainable consumption behaviors in China.

Studying environmental and economic considerations on tourism activities in achieving sustainable development goals: implications for sustainability

The study aims to extend the understanding of environmental and economic considerations on tourism activities in achieving sustainable development goals. The motivation of the study is to provide the empirical inference of variables based on study topicality and the implications to achieve SDG 8 and SDG 9 specifically. The study used panel data from 2000 to 2021 to check for cross-sectional dependency and performed various panel unit root tests to verify the unit root properties of the variables. With the help of Pedroni and Kao's statistical results, we confirm variables are integrated. The results from OLS modified and dynamic demonstrate the correlation between transformation, measured by patents and publications, and higher economic performance and lower environmental hazard, emphasizing the role of transformation. The results also show that tourism arrivals have a significant positive effect on reducing pollution hazards and increasing economic performance, which shows progress toward sustainable development. Based on the study, it was determined that the contribution of asylum seekers did not positively impact the host countries' economic conditions or environmental improvement initiatives. It was found that higher levels of education play a crucial role in promoting sustainable development through economic growth and mitigating environmental risks. To achieve sustainable development in the G20 economies, promoting tourism, undertaking transformational measures, and enhancing higher education are recommended. These results have significant implications for policymakers, firms, and an agenda of the United Nations sustainable development program.

Home-Based Virtual Reality Exergame Program after Stroke Rehabilitation for Patients with Stroke: A Study Protocol for a Multicenter, Randomized Controlled Trial

It is essential for stroke patients to maintain their therapy even after discharging inpatient rehabilitation. This is because recovery is an ongoing process that requires consistent effort. Virtual reality exergame training (VRET) is becoming widely used in stroke rehabilitation to improve physical, social, and psychological outcomes. Home-based VRET may be a more convenient and accessible option for stroke rehabilitation. This study will aim to determine the effectiveness of home-based VRET for patients with stroke who have been discharged from the hospital. This trial will randomly assign 120 participants to 8 weeks of either a VRET (intervention group) or daily life (control group). The study will measure cardiopulmonary endurance, muscular strength, functional capacity, gait, activities of daily living, and quality of life. Our main objective is to determine whether it is safe for patients to undergo VRET at home after they have been discharged from the hospital with a doctor's note. Additionally, we aim to examine whether stroke patients are capable of exercising at home after being discharged from the hospital. This study's outcome could pave the way for developing more comprehensive exercise protocols for stroke patients. Our findings will provide valuable insights into the efficacy of VRET as a therapeutic tool for stroke patients.

Learning Landscape in Gamification: The Need for a Methodological Protocol in Research Applications

In education, the term "gamification" refers to of the use of game-design elements and gaming experiences in the learning processes to enhance learners' motivation and engagement. Despite researchers' efforts to evaluate the impact of gamification in educational settings, several methodological drawbacks are still present. Indeed, the number of studies with high methodological rigor is reduced and, consequently, so are the reliability of results. In this work, we identified the key concepts explaining the methodological issues in the use of gamification in learning and education, and we exploited the controverses identified in the extant literature. Our final goal was to set up a checklist protocol that will facilitate the design of more rigorous studies in the gamified-learning framework. The checklist suggests potential moderators explaining the link between gamification, learning, and education identified by recent reviews, systematic reviews, and meta-analyses: study design, theory foundations, personalization, motivation and engagement, game elements, game design, and learning outcomes.

A systematic review on the efficacy of virtual reality and gamification interventions for managing anxiety and depression

This systematic review aims to assess the effectiveness of virtual reality (VR) and gamification interventions in addressing anxiety and depression. The review also seeks to identify gaps in the current VR treatment landscape and provide guidelines for future research and development. A systematic literature search was conducted using Scopus, Web of Science, and PubMed databases, focusing on studies that utilized VR and gamification technology to address anxiety and depression disorders. A total of 2,664 studies were initially identified, 15 of those studies fulfilled the inclusion criteria for this systematic review. The efficacy of VR in addressing anxiety and depression was evident across all included studies. However, the diversity among VR interventions highlights the need for further investigation. It is advised to incorporate more diverse participant samples and larger cohorts and explore a broader spectrum of therapeutic approaches within VR interventions for addressing anxiety and depression to enhance the credibility of future research. Additionally, conducting studies in varying socioeconomic contexts would contribute to a more comprehensive understanding of their real-world applicability.

Harnessing technology and gamification to increase adult physical activity: a cluster randomized controlled trial of the Columbia Moves pilot

BACKGROUND

The use of health technologies and gamification to promote physical activity has increasingly been examined, representing an opportunistic method for harnessing social support inherent within existing social ties. However, these prior studies have yielded mixed findings and lacked long-term follow-up periods. Thus, a pilot cluster randomized controlled trial was conducted to gauge the feasibility and preliminary efficacy of a digital gamification-based physical activity promotion approach among teams of insufficiently active adults with existing social ties.

METHODS

Teams (N = 24; 116 total participants) were randomized to either a 12-week intervention (Fitbit, step goals, app, feedback; TECH) or the same program plus gamification (TECH + Gamification). Mixed effects models were used to compare group differences in treatment adherence, and changes in social support, steps, and moderate-to-vigorous physical activity at 12 weeks and 52 weeks from baseline, adjusted for sociodemographic characteristics and team size.

RESULTS

TECH had a lower mean number of days of Fitbit self-monitoring versus TECH + Gamification during the intervention (adjusted difference: -.30; 95% CI, -.54 to -.07; P = .01). Post-intervention, TECH had 47% lower odds of self-monitoring 7 days per week versus TECH + Gamification (.53; 95% CI, .31 to .89; P = .02). No differences were observed between TECH + Gamification and TECH in increases in social support (0.04; 95% CI, -.21 to .29; P = .76), ActiGraph-measured daily steps (-425; 95% CI, -1065 to 215; P = .19), or moderate-to-vigorous physical activity minutes (-3.36; 95% CI, -8.62 to 1.91; P = .21) from baseline to 12 weeks or in the regression of these improvements by 1 year (Ps > .05). Although not significant in the adjusted models (Ps > .05), clinically meaningful differences in Fitbit-measured daily steps (TECH, 7041 ± 2520; TECH + Gamification, 7988 ± 2707) and active minutes (TECH, 29.90 ± 29.76; TECH + Gamification, 36.38 ± 29.83) were found during the intervention.

CONCLUSIONS

A gamified physical activity intervention targeting teams of adults with existing social ties was feasible and facilitated favorable, clinically meaningful additive physical activity effects while in place but did not drive enhanced, long-term physical activity participation. Future investigations should explore optimal team dynamics and more direct ways of leveraging social support (training teams; gamifying social support).

TRIAL REGISTRATION

Clinicaltrials.gov ( NCT03509129 , April 26, 2018).

Psychometric investigation of the gamification Hexad user types scale with Brazilian Portuguese adolescents speakers

Gamification has been applied in different fields over the last years, impacting the development of technologies, services, and products towards a more game-like world. Albeit its success, some results indicated personal differences influencing the success of its application, leading to the creation of user models (e.g., Hexad), a way to represent user profiles in gamified environments. Even though a great effort has been made to create and discuss instruments to represent these user models, many of them lack investigation into their psychometric properties. At the same time, although gamification can be particularly interesting in engaging adolescents, few attempts analyzed instruments considering this population. Addressing this lack, in this study, we evaluated the psychometric properties of the gamification Hexad scale in Brazilian Portuguese considering a sample ([Formula: see text]) of adolescents aged between 13 and 16 years old. Through a quantitative study (i.e., confirmatory factor analysis and correlation), we analyzed the psychometric properties of the scale and the correlations between user types when using data collected from adolescents. Results demonstrated that the current version of the scale needs improvements to better assess the user types of the Brazilian adolescent population, especially regarding the Disruptor user type. Also, the user types presented fewer correlations when compared with the adult sample. At the same time that the results of this study can be used in the academy and industry as a source of measurement of user types from Brazilian adolescents, it also opens several possibilities for new studies in personalized gamification considering this population.

Gamified online surveys: Assessing experience with self-determination theory

We developed four online interfaces supporting citizen participation in decision-making. We included (1) learning loops (LLs), good practice in decision analysis, and (2) gamification, to enliven an otherwise long and tedious survey. We investigated the effects of these features on drop-out rate, perceived experience, and basic psychological needs (BPNs): autonomy, competence, and relatedness, all from self-determination theory. We also investigated how BPNs and individual causality orientation influence experience of the four interfaces. Answers from 785 respondents, representative of the Swiss German-speaking population in age and gender, provided insightful results. LLs and gamification increased drop-out rate. Experience was better explained by the BPN satisfaction than by the interface, and this was moderated by respondents' causality orientations. LLs increased the challenge, and gamification enhanced the social experience and playfulness. LLs frustrated all three needs, and gamification satisfied relatedness. Autonomy and relatedness both positively influenced the social experience, but competence was negatively correlated with challenge. All observed effects were small. Hence, using gamification for decision-making is questionable, and understanding individual variability is a prerequisite; this study has helped disentangle the diversity of responses to survey design options.

Examining the effectiveness of gamification as a tool promoting teaching and learning in educational settings: a meta-analysis

The integration of gamification into educational settings has gained recognition for its potential to boost student motivation, engagement, interest, and learning outcomes. Despite its popularity, research on gamification has produced mixed results regarding student learning outcomes. This meta-analysis aims to synthesize the existing empirical evidence on the effectiveness of gamification as a tool for promoting teaching and learning in educational settings. Forty-one studies with 49 independent samples involving more than 5,071 participants were included in our analysis. Results from random effects models showed an overall significant large effect size (g = 0.822 [0.567 to 1.078]). The research performed the moderator analysis to scrutinize the effects of a number of factors on the relationship between gamification and student learning outcomes. The study uncovered significant moderating effects for user type, educational discipline, design principles for educational gamification, duration of "gameful" experience, and learning environment. However, measurement of student outcomes and publication type did not appear to have any significant moderating effect. Those findings hold important implications for improving and implementing gamification to promote teaching and learning in future research.

Envisioning gamification in anesthesia, pain management, and critical care: basic principles, integration of artificial intelligence, and simulation strategies

Unlike traditional video games developed solely for entertainment purposes, game-based learning employs intentionally crafted approaches that seamlessly merge entertainment and educational content, resulting in captivating and effective learning encounters. These pedagogical methods include serious video games and gamification. Serious games are video games utilized as tools for acquiring crucial (serious) knowledge and skills. On the other hand, gamification requires integrating gaming elements (game mechanics) such as points, leaderboards, missions, levels, rewards, and more, into a context that may not be associated with video gaming activities. They can be dynamically (game dynamics) combined developing various strategic approaches. Operatively, gamification adopts simulation elements and leverages the interactive nature of gaming to teach players specific skills, convey knowledge, or address real-world issues. External incentives stimulate internal motivation. Therefore, these techniques place the learners in the central role, allowing them to actively construct knowledge through firsthand experiences.Anesthesia, pain medicine, and critical care demand a delicate interplay of technical competence and non-technical proficiencies. Gamification techniques can offer advantages to both domains. Game-based modalities provide a dynamic, interactive, and highly effective opportunity to learn, practice, and improve both technical and non-technical skills, enriching the overall proficiency of anesthesia professionals. These properties are crucial in a discipline where personal skills, human factors, and the influence of stressors significantly impact daily work activities. Furthermore, gamification can also be embraced for patient education to enhance comfort and compliance, particularly within pediatric settings (game-based distraction), and in pain medicine through stress management techniques. On these bases, the creation of effective gamification tools for anesthesiologists can present a formidable opportunity for users and developers.This narrative review comprehensively examines the intricate aspects of gamification and its potentially transformative influence on the fields of anesthesiology. It delves into theoretical frameworks, potential advantages in education and training, integration with artificial intelligence systems and immersive techniques, and also addresses the challenges that could arise within these contexts.

Continuing Education through the Campus Game: A Sustainable Gamification Project to Improve Doctors' and Nurses' Knowledge of Quality and Clinical Risk Management

The COVID-19 disease has dramatically changed lives worldwide, including education. This is a challenge for traditional learning. In fact, the European Higher Education Area poses the challenge of boosting the quality of teaching through active methodologies supported by digital pedagogy. Gamification is one of these tools and it has considerable attention in the healthcare literature. We aimed to create a game in the Campus Bio-Medico University Hospital Foundation in order to offer continuing education on Quality and Clinical Risk procedures to our staff. The 2021 "Campus Game" (178 players) introduced the "Badge Challenge" (Team Building, Procedures, and Security) and 73 questions. The leaderboard of every single match was posted in some of the hospital's strategic areas and also published online on the company intranet to ensure engagement and competitiveness. Gamification has spontaneously promoted teamworking and a virtuous process of multiprofessional education. We found that, during the Campus Game, there was a 4.9% increase in access to the intranet page containing information on Quality and Patient Safety and an 8% increase in access to the Hospital Policies and Procedures. In the near future, we wish to expand this game, involving hospitals with similar types of activity and levels of attention to quality and safety issues, and also to enhance the network of partners and the principles of Q&S management itself.

The Impact of a Gamified Mobile Mental Health App (eQuoo) on Resilience and Mental Health in a Student Population: Large-Scale Randomized Controlled Trial

BACKGROUND

With many digital mental health interventions failing to engage clients for enough time to demonstrate substantive changes to their well-being and with only 2% of all digital solutions on app stores having undergone randomized controlled trials, the rising demand for mental health prevention and early intervention care is not being met. Young adults in particular struggle to find digital well-being apps that suit their needs.

OBJECTIVE

This study explored the effects of eQuoo, an evidence-based mental health game that teaches psychological skills through gamification, on resilience, depression, anxiety, and attrition in a student population.

METHODS

In total, 1165 students from 180 universities in the United Kingdom participated in a 5-week, 3-armed randomized controlled trial. Participants were randomly allocated into 1 of 3 groups: eQuoo users, users of a treatment-as-usual evidence-based cognitive behavioral health app called Sanvello, and a no-intervention waitlist. The Rugged Resilience Scale, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-8 were administered to all participants at baseline and every 7 days until completion.

RESULTS

A repeated measures-ANOVA revealed statistically significant increases in resilience scores in the test group (P<.001) compared with both control groups (Sanvello: P=.10 and waitlist: P=.82) over 5 weeks. The app also significantly decreased anxiety and depression scores (both P<.001). With 64.5% (251/389) adherence, the eQuoo group retained 42% more participants than the control groups.

CONCLUSIONS

Digital health interventions such as eQuoo are effective, scalable, and low-cost solutions for supporting young adults and are available on all leading mobile platforms. Further investigation could clarify the extent to which specific elements of the eQuoo app (including gamification) led to better outcomes.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS) DRKS00027638; https://drks.de/search/en/trial/DRKS00027638.

Flawless victory! Investigating search and experience qualities as antecedent predictors of video game success

In recent years, video games have been on the rise as entertainment goods, leading to a growing interest by practitioners, researchers, and, of course, consumers alike. While a few unusually successful video games produce overall high revenues, most released games struggle to break even. Hence, there is an urgent need to better understand what distinguishes financially successful games from nonsuccessful video games. Accordingly, several researchers have called for investigations into the drivers of the financial success of video games. However, empirical studies within this respect are still lacking. Based on longitudinal data of 351 video games, the current study strives to fill this research gap by investigating the relative importance of potential success factors for the short-term and long-term financial success of video games. The results of multiple regression analyses confirm that search qualities such as brand popularity, reviews, and awards as well as experience qualities such as graphics, sound, and game duration significantly drive financial success in terms of the total number of sold video games in Europe. Consequently, managers in the video game industry can boost their chances for the production of a successful video game by focusing on these factors.

Biotechnology Data Analysis Training with Jupyter Notebooks

Biotechnology has experienced innovations in analytics and data processing. As the volume of data and its complexity grow, new computational procedures for extracting information are being developed. However, the rate of change outpaces the adaptation of biotechnology curricula, necessitating new teaching methodologies to equip biotechnologists with data analysis abilities. To simulate experimental data, we created a virtual organism simulator (silvio) by combining diverse cellular and subcellular microbial models. With the silvio Python package, we constructed a computer-based instructional workflow to teach growth curve data analysis, promoter sequence design, and expression rate measurement. The instructional workflow is a Jupyter Notebook with background explanations and Python-based experiment simulations combined. The data analysis is conducted either within the Notebook in Python or externally with Excel. This instructional workflow was separately implemented in two distance courses for Master's students in biology and biotechnology with assessment of the pedagogic efficiency. The concept of using virtual organism simulations that generate coherent results across different experiments can be used to construct consistent and motivating case studies for biotechnological data literacy.

Gamifying model-based engineering: the PapyGame experience

Modeling is an essential and challenging activity in any engineering environment. It implies some hard-to-train skills such as abstraction and communication. Teachers, project leaders, and tool vendors have a hard time teaching or training their students, co-workers, or users. Gamification refers to the exploitation of gaming mechanisms for serious purposes, like promoting behavioral changes, soliciting participation and engagement in activities, etc. We investigate the introduction of gaming mechanisms in modeling tasks with the primary goal of supporting learning/training. The result has been the realization of a gamified modeling environment named PapyGame. In this article, we present the approach adopted for PapyGame implementation, the details on the gamification elements involved, and the derived conceptual architecture required for applying gamification in any modeling environment. Moreover, to demonstrate the benefits of using PapyGame for learning/training modeling, a set of user experience evaluations have been conducted. Correspondingly, we report the obtained results together with a set of future challenges we consider as critical to make gamified modeling a more effective education/training approach.

Examining the utility of a photorealistic virtual ear in otologic education

BACKGROUND

Otolaryngology-head and neck surgical (OHNS) trainees' operating exposure is supplemented by a combination of didactic teaching, textbook reading, and cadaveric dissections. Conventional teaching, however, may not adequately equip trainees with an understanding of complex visuospatial relationships of the middle ear. Both face and content validation were assessed of a novel three-dimensional (3D) photorealistic virtual ear simulation tool underwent face and content validation as an educational tool for OHNS trainees.

METHODS

A three-dimensional mesh reconstruction of open access imaging was generated using geometric modeling, which underwent global illumination, subsurface scattering, and texturing to create photorealistic virtual reality (VR) ear models were created from open access imaging and comiled into a educational platform. This was compiled into an educational VR platform which was explored to validate the face and content validity questionnaires in a prospective manner. OHNS post-graduate trainees were recruited from University of Toronto and University of Calgary OHNS programs. Participation was on a voluntary basis.

RESULTS

Total of 23 OHNS post-graduate trainees from the two universities were included in this study. The mean comfort level of otologic anatomy was rated 4.8 (± 2.2) out of 10. Senior residents possessed more otologic surgical experience (P < 0.001) and higher average comfort when compared to junior residents [6.7 (± 0.7) vs. 3.6 (± 1.9); P = 0.001]. Face and content validities were achieved in all respective domains with no significant difference between the two groups. Overall, respondents believed OtoVIS was a useful tool to learn otologic anatomy with a median score of 10.0 (8.3-10.0) and strongly agreed that OtoVIS should be added to OHNS training with a score of 10.0 (9.3-10.0).

CONCLUSIONS

OtoVIS achieved both face and content validity as a photorealistic VR otologic simulator for teaching otologic anatomy in the postgraduate setting. As an immersive learning tool, it may supplement trainees' understanding and residents endorsed its use.

Exploring the Impact of Gamification Elements in Brand Apps on the Purchase Intention of Consumers

The purpose of this manuscript is to understand how the elements of the game apps impact the intention of purchase of a consumer with the mediating effect of perceived enjoyment, hedonic value, and social interaction to derive benefits designed in terms of marketing strategies. Quantitative data obtained from the non-probability sampling via a standardized questionnaire in the design of exploratory analysis was done to examine the effect of gamification on behaviour intention by adopting mechanic-dynamics-aesthetics (MDA) framework. The findings of the research indicated that fun as a sub-element of mobile gamification can significantly affect social interaction, and storytelling has a significant impact on perceived enjoyment. The study identifies perceived enjoyment as an important antecedent of consumer intention to involve gamification. This provides managers and developers to focus on dynamics, mechanics, and proper feedback systems with the emergence of new technologies.

Effectiveness of Game-Based Solutions in Patients with Total Hip and Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials

The aim of this systematic review of randomized controlled trials (RCTs) was to evaluate the effectiveness of game-based solutions in patients with total knee arthroplasty or total hip arthroplasty. The systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies published prior May 2022 were identified from MEDLINE Ovid, Scopus, EBSCO Databases, Web of Science, and PubMed. The Joanna Briggs Institute Critical Appraisal Checklist for RCTs was used to evaluate the quality of the relevant studies published. A narrative synthesis was used to report the results while effect sizes were estimated for different outcomes. A total of 350 records were identified, and 5 RCTs were selected. Most of the game-based solutions were exergames to support rehabilitation. The findings indicate that game-based solutions have potential to induce positive impact on functional and cognitive performance; however, due to the low number of studies and moderate/weak quality of existing research, the area still lacks assertive evidence. Future research should pay attention to the methodological aspects to provide reliable information on the use of game-based solutions in the given context.

An empirical investigation of repeated donations on crowdfunding platforms during COVID-19

The COVID-19 pandemic has impacted the financial well-being of people and the world's economy. Crowdfunding is a prominent contributor to this pandemic's adverse effects. Donations on crowdfunding platforms have received attention; however, repeated donations, especially during COVID-19, need to be studied. This study aims to understand the role of reward-based gamification as a tool for understanding repeated donation behaviour on crowdfunding platforms during COVID-19. The study uses the self-determination theory to propose the conceptual framework and uses cross sectional data from 514 donors using survey based instruments. This study aims to understand the role of social relatedness with donors' intrinsic motivation to make repeated donations. Similarly, it tries to establish the role of social relatedness and engagement with repeated donation behaviour. The study uses reward-based gamification as moderating variables, and the model controls the experience of donating on crowdfunding platforms. The results confirm the relationship between social relatedness impacting a donor's intrinsic motivation and engagement in crowdfunding platform activities leading to repeated donation behaviour. The study further establishes that reward-based gamification moderates the relationship between intrinsic motivation and repeated donation behaviour. The results reveal that the experience of donating impacts the users' repeated donations. The study presents new insights on the role of gamification in inducing repeated donations on crowdfunding platforms during COVID-19.

The impact of applying challenge-based gamification program on students' learning outcomes: Academic achievement, motivation and flow

Despite the growing attention towards gamification in learning context, challenge-based gamification application has rarely been subjected to testing in education. In recognition of this void, and grounded on gamification principles, we developed Educhall web-based program. Drawing on self-determination theory, and flow theory the present study aims to explore how the application of this challenge-based gamified program in to learning process of students can increase students' motivation, flow, and academic success through the generated competition and challenge. The study applied a random experimental research design within distance learning context with 30 university students of control group and 30 students of experimental group who used the Educhall application for one academic semester. In line with self-determination theory, it was statistically evidenced that application of challenge-based gamified learning method increased level of academic performance and overall motivation. Of the motivational sub factors, experimental group reported significantly higher confidence level and satisfaction towards the course. Furthermore, grounded on flow theory, the study showed that challenge-based gamified learning increased flow level of learners but not significantly which warrants further data collection and experimental research in future studies. Implications for research and practice are discussed.

A gamified approach for improving the learning performance of K-6 students using Easter eggs

Gamification is mainly used to increase user engagement and motivation, hence increasing the user base and user activity. Defined by applying game elements to non-gaming contexts, gamification is mostly integrated with software applications in order to provide a gameful experience for users. Education has been one of the areas where gamification studies have focused a lot during the last decade. Young students with the age range of 7-12 years old (K-6) require different teaching methods to use their full potential. However, the methods and principles presented in studies on gamification and its application in education are not dedicated to K-6 students. Furthermore, the evolution of video games has brought new opportunities to develop new gamification elements and principles. In this research, the easter egg element has been implemented as a gamification element. Easter eggs can trigger children's curiosity by encouraging them to find all the Easter eggs, promising special rewards and perks. Additionally, a gamified approach is proposed for implementing a gamified software application for K-6 students. Based on the proposed approach, Science Island is implemented as an online gamified web application for K-6 students. In order to assess the proposed approach, a group of 47 sixth-grade students was selected to use the application for an observation period of 2 months. Feedbacks from students showed that more than 82% of the students agreed with the effectiveness of gamification in their educational performance. Additionally, the results from the data analysis revealed that students' learning performance was improved significantly after applying gamification elements; showing an increase of 0.63 in average quiz score from the second month compared to the first month. Furthermore, the user activity rate at the end of the observation period showed increased motivation among students for using the software application.

Cognitive Dyadic Measurements: A Game-Changer? Construction and First Validation of Three Cognitively Demanding Competitive Tasks

Competition among individuals is a natural mode of determining who is fittest. While in nature, economics, and sports, it is common to infer ability or aptitude from the outcome of competitions, our knowledge on its effects in regard to psychological/educational assessment is scarce. In the present pilot study, we explore a measurement approach for assessing individual differences in interpersonal, face-to-face competitions, based on a set of cognitively demanding, competitive, fast-paced, two-opponent tasks. For initial task evaluation, we conducted comprehensive reliability and construct validation analyses, considering cognitive ability, motivation, and personality measures. Moreover, using structural equation models we conducted a simultaneous factorization of the tasks with the other validation measures. The results suggest that the newly developed tasks measure both cognitive ability (intelligence) as well as a competition-specific component. The competition-specific component was positively associated with experience in competitive gaming and negatively correlated with neuroticism. While the pattern of validities was promising, the measurements’ reliabilities were yet unsatisfactory. Implications for future research as well as the design of competition-based measurements are discussed.

The impact of virtual interaction on consumers' pro-environmental behaviors: the mediating role of platform intimacy and love for nature

Purpose

Companies are increasingly designing pro-environmental games to motivate users to implement pro-environmental behaviors (PEBs). However, how different types of virtual interactions affect PEBs in pro-environmental games is not clear. Thus, the authors propose that two types of virtual interaction, interactions with game objects and interactions with other users, can induce platform intimacy and love for nature and that platform intimacy has a direct effect on love for nature. Simultaneously, the authors examine the moderating effect of network externality on the relationship between the two types of virtual interaction and platform intimacy.

Design/methodology/approach

The authors, respectively, employed data from 92 students and 574 Chinese mobile users to empirically investigate the research framework.

Findings

The findings indicate that participants in interactions with game objects and interactions with other users reported stronger feelings regarding platform intimacy and love for nature, which, in turn, positively influences PEBs. Consumers with stronger perceptions of network externalities were more likely to be affected by the initiation effect of the interaction with game objects.

Originality/value

The authors introduce the notion of love for nature to the pro-environmental behaviors field and discuss the priming effect of two types of interactions on platform intimacy and love for nature. In addition, the authors focus on the important effect of network externality on users' emotions.

Assessing approaches to learning with nonparametric multidimensional scaling

This article reports on a trace-based assessment of approaches to learning used by middle school aged children who interacted with NASA Mars Mission science, technology, engineering and mathematics (STEM) games in Whyville, an online game environment with 8 million registered young learners. The learning objectives of two games included awareness and knowledge of NASA missions, developing knowledge and skills of measurement and scaling, applying measurement for planetary comparisons in the solar system. Trace data from 1361 interactions were analysed with nonparametric multidimensional scaling methods, which permitted visual examination and statistical validation, and provided an example and proof of concept for the multidimensional scaling approach to analysis of time-based behavioural data from a game or simulation. Differences in approach to learning were found illustrating the potential value of the methodology to curriculum and game-based learning designers as well as other creators of online STEM content for pre-college youth. The theoretical framework of the method and analysis makes use of the Epistemic Network Analysis toolkit as a post hoc data exploration platform, and the discussion centres on issues of semantic interpretation of interaction end-states and the application of evidence centred design in post hoc analysis.

Effect and feasibility of gamification interventions for improving physical activity and health-related outcomes in cancer survivors: an early systematic review and meta-analysis

BACKGROUND

Despite the well-documented advantages of regular physical activity (PA), patients with cancer show suboptimal participation. By using game design elements, gamification could be used to motivate individuals to engage in PA. It has been demonstrated that gamification interventions positively affect children, adolescents and older adults in health-related contexts. There are, however, inconsistent findings regarding the impact of gamification interventions on cancer survivors' PA and health-related outcomes, according to the literature.

OBJECTIVES

The aim of this study is to examine the effectiveness and feasibility of gamification interventions for improving PA and health-related outcomes among cancer survivors.

METHODS

A systematic review and meta-analysis were conducted following the Cochrane Handbook and PRISMA guidelines. Eight English databases and three Chinese databases were searched to identify eligible articles from inception to February 2022. Two reviewers independently performed the literature screening and data extraction. The Cochrane Risk of Bias tool was used to assess the risk of bias. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) Working Group levels of evidence was used to evaluate the certainty of the findings.

RESULTS

Ten randomised controlled trials (RCTs) published between 2014 and 2022 were included. The meta-analysis revealed no significant differences in the step counts and for moderate to vigorous PA, and the certainty of the findings was very low, according to GRADE. Meta-analysis for most outcomes could not be performed owing to the fewer included studies and significant heterogeneity. Most studies reported positive effects in improving moderate PA, sedentary behaviour, fatigue and at least one domain of quality of life. This review proved that gamified interactions are associated with low adverse event rates.

CONCLUSION

Gamification interventions could be a feasible way to promote the adoption of mobile health (mHealth) technology in patients with cancer. Individual studies have demonstrated some positive effects of gamification interventions on PA and health-related outcomes. However, limited studies, small sample sizes and methodological heterogeneity weaken the evidence. Larger, well-designed RCTs are required to confirm the impact of gamification interventions on PA and health-related outcomes in cancer survivors.

How gamified cooperation and competition motivate low-carbon actions: An investigation of gamification in a popular online payment platform in China

Climate change caused by excessive carbon emission has become one of the most severe problems facing the world's ecosystems and human society. Promoting low-carbon actions is an effective means of alleviating climate problems. Gamified interactions have recently emerged as a promising and practical idea to promote low-carbon actions; however, research on the effect of gamification design on consumers' pro-environmental behavior is still at a nascent stage. This study tried to explore the impact mechanisms of two common gamified interactions, competition and cooperation, on consumers' low-carbon actions through goal-framing theory. The proposed hypotheses were tested using a structural equation model based on survey data collected from Ant Forest users on Alipay, one of the popular online payment platforms in China. The results show that while both cooperative and competitive interactions could promote users' low-carbon actions, the incentive effect of cooperation was more significant. In addition, cooperative interactions stimulated users' normative, hedonic, and gain motivations to adopt low-carbon actions, whereas competitive interactions only motivated hedonic and gain goals. The study findings provide new insights into the role of gamification in influencing low-carbon behaviors and offer practical guidance for the design of gamification for related green and low-carbon platforms.

Combining physical and virtual worlds for motor-cognitive training interventions: Position paper with guidelines on technology classification in movement-related research

Efficient movements require intact motor and cognitive function. There is a growing literature on motor-cognitive interventions to improve the overall quality of life of healthy or diseased older people. For such interventions, novel technological advances are crucial not only in terms of motivation but also to improve the user experience in a multi-stimuli world, usually offered as a mixture of real and virtual environments. This article provides a classification system for movement-related research dealing with motor-cognitive interventions performed in different extents of a virtual environment. The classification is divided into three categories: (a) type of digital device with the associated degree of immersiveness provided; (b) presence or absence of a human-computer interaction; and (c) activity engagement during training, defined by activity >1.5 Metabolic Equivalent of task. Since virtual reality (VR) often categorizes different technologies under the same term, we propose a taxonomy of digital devices ranging from computer monitors and projectors to head-mounted VR technology. All immersive technologies that have developed rapidly in recent years are grouped under the umbrella term Extended Reality (XR). These include augmented reality (AR), mixed reality (MR), and VR, as well as all technologies that have yet to be developed. This technology has potential not only for gaming and entertainment, but also for research, motor-cognitive training programs, rehabilitation, telemedicine, etc. This position paper provides definitions, recommendations, and guidelines for future movement-related interventions based on digital devices, human-computer interactions, and physical engagement to use terms more consistently and contribute to a clearer understanding of their implications.

Using exergame-based exercise to prevent and postpone the loss of muscle mass, muscle strength, cognition, and functional performance among elders in rural long-term care facilities: A protocol for a randomized controlled trial

Objective

Elderly individuals in long-term care facilities (LTCFs) have a higher prevalence of sarcopenia than those in the community. Exercise is the gold standard for preventing and treating sarcopenia. Regarding exercise, multicomponent exercises, including progressive resistance training (PRT), are beneficial. However, developing routine, structured exercise programs for the elderly in LTCFs is difficult because of a shortage of healthcare providers, particularly in rural regions. Exergame-based exercises can increase a player's motivation and reduce staff time for an intervention. Nintendo Switch RingFit Adventure (RFA) is a novel exergame that combines resistance, aerobic, and balance exercises. In this study, we aim to investigate the clinical effectiveness of RFA on muscle and functional performance parameters among the elderly in LTCFs.

Methods

The EXPPLORE (using EXergame to Prevent and Postpone the LOss of muscle mass, muscle strength, and functional performance in Rural Elders) trial is a single-center randomized controlled trial involving elderly individuals (≥60 years) living in LTCFs in rural southern Taiwan. The participants will be equally randomized to the intervention group (exergame-based exercise plus standard care) or the control group (standard care alone). Both groups will receive standard care except that the intervention group will receive exergame-based exercises at the time previously scheduled for sedentary activities in the LTCFs. The exergame-based exercise will be performed using RFA in the sitting position with a specialized design, including arm fit skills and knee assist mode. Each session of the exercise lasts 30 mins and will be performed two times per week for 12 weeks. The primary outcomes will be the osteoporotic fracture index, appendicular skeletal muscle mass index, dominant handgrip strength, and gait speed. Meanwhile, the secondary outcomes will be the dexterity and agility, muscle strength and thickness, range of motion of the joints of the dominant upper extremity, Kihon checklist, Medical Outcomes Study 36-Item Short-Form Health Survey, and Brain Health Test.

Discussion

This trial will provide valuable knowledge on whether exergames using RFA can counteract physical decline and improve quality of life and cognition among the elderly in LTCFs.

Clinical trial registration

[www.ClinicalTrials.gov], identifier [NCT05360667].