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August 31, 2021
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The Effects of Digital Health Gamification Interventions Among Veterans

The Study

Effect of Gamification With and Without Financial Incentives to Increase Physical Activity Among Veterans Classified as Having Obesity or Overweight (Agarwal AK et al., JAMA Network Open)

The Story

In a new study from JAMA Network Open, a randomized clinical trial evaluated the effects of gamification incorporating social support (with and without loss-framed financial incentives) on physical activity amongst US veterans classified as overweight or obese.

Why it’s Important

Veterans are a high-risk group for developing cardiovascular disease, with more than 80% presenting with at least two risk factors. While it has previously been studied how gamification with social incentives and loss-framed financial incentives can lead to increased physical activity, the effectiveness of these two behavioral economics concepts specifically amongst veterans is unknown.

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The Details‍

This 3-group, randomized clinical trial consisted of 180 veterans who received care at the Corporal Michael J. Crescenz VA Medical Center (USA) and had a BMI greater than or equal to 25. All participants were given a FitBit to set and track daily step count goals, and divided into three groups:

  • Group 1 (Control): participants were instructed to choose step goals based on their baseline assessments (30-50% higher than baseline), or at least 1,500 steps more than baseline. They only received feedback and step count goal-setting from their FitBit.
  • Group 2 (Gamification + Social Support): participants were given access to an automated game with points and levels, which included daily progress notifications for their individual step count goals. Participants were also given a “social support sponsor” who reviewed their weekly activity reports and offered feedback.
  • Group 3 (Gamification + Social Support + Loss-framed Financial Incentives): participants were given access to both the automated game and social support sponsor, as well as a $120 virtual account where $10 was deducted each week if their step count goals weren’t met.

Participants were remotely monitored for 12 weeks, tracking both average daily steps and total number of days when step count goals were achieved, followed by an eight-week follow-up period.

The Outcomes

When compared with the control group, participants in both intervention groups achieved a significantly higher amount of days when they met their step count goals. Furthermore, participants in the loss-framed financial incentive groups had a higher average daily step count. However, the increased step count activity in both incentive groups was not maintained after the study, as documented during the eight-week follow-up period, calling for further studies focusing on how to sustain the activity and motivate long-term activity.

The Takeaway

This study is a step towards a more thorough understanding of the effects of gamification interventions. Nevertheless, further studies are needed, particularly those focused around long-term maintenance of effects seen during those interventions and with more diverse populations.

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