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Conference A Systematic Review of Effective Gamification Elements for Enhancing Digital Health Engagement and Outcomes Toni Anwar1.
Tectonia Nurul Silvani2.
Jeffri Prayitno Bangkit Saputra3 Information Systems Study Program.
Faculty of Industrial Engineering.
Telkom University12.
Doctoral of Computer Science Graduate Program.
Bina Nusantara University3 Email: tonianwar@telkomuniversity.
id1, tectonians@student.
saputra@binus.
Abstract Gamification has emerged as a transformative tool in healthcare, leveraging game elements such as leaderboards, feedback, and rewards to enhance user engagement and improve health outcomes.
This study systematically examines 36 research articles to identify the most frequently employed gamification elements, their impacts, and their effectiveness across various healthcare domains.
The findings reveal that leaderboards, feedback systems, and rewards are the most impactful elements, fostering motivation, adherence, and knowledge retention.
While gamification significantly enhances engagement and behavioral changes, challenges remain in personalization, integration with traditional healthcare systems, and sustaining long-term user motivation.
This study highlights opportunities for future research to develop adaptive gamification frameworks and address these limitations, paving the way for more effective healthcare interventions.
Keywords Gamification.
Healthcare Engagement.
Game Elements.
Digital Health Interventions Introduction The integration of digital technology in healthcare has introduced gamification as an innovative approach to address critical challenges such as low patient motivation, poor adherence to treatment plans, and limited engagement in preventive healthcare initiatives (Al-Rayes et al.
, (Berglund et al.
, 2.
, (Damaevisius et al.
, 2.
Gamification, defined as the application of game elements like points, badges, leaderboards, and levels in non-game contexts, has shown potential to enhance user engagement and influence health behaviors positively (Hammedi et al.
, 2.
, (Lee et al.
, 2.
(Tsopra et al.
, 2.
Recent studies have demonstrated its effectiveness in diverse healthcare areas, including chronic disease management, mental health interventions, and rehabilitation, where gamification not only improves motivation but also facilitates behavioral changes (Valenzuela-Pascual et al.
, 2.
Despite its growing application, the literature highlights significant gaps in understanding the long-term impact of specific gamification elements on sustained health outcomes.
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Conference personalization for diverse populations, and the integration of gamified interventions within traditional healthcare systems (Wan et al.
, 2.
(Agudelo-Londoyo et al.
, 2.
(Wilson et al.
This research seeks to address these gaps by systematically reviewing the most effective gamification elements employed in healthcare applications over the last five years, emphasizing their roles in promoting user engagement and achieving positive health outcomes (Hamari et al.
(Froland et al.
, 2.
(Almousa et al.
, 2.
By focusing exclusively on peer-reviewed studies published between 2018 and 2023, this study aims to provide actionable insights to guide the design and implementation of gamification strategies in healthcare contexts (Lypez Chyvez et al.
, 2.
Literature Review and Hypothesis Development Literature Review Gamification in Healthcare Gamification is increasingly utilized to address challenges in healthcare, particularly in improving patient engagement and adherence to treatment.
By employing game elements such as points, leaderboards, and levels, gamification enhances motivation and drives positive health behaviors (Al-Rayes et al.
, 2.
, (Berglund et al.
, 2.
, (Damaevisius et al.
, 2.
Recent studies emphasize its application in chronic disease management, mental health support, and physical rehabilitation.
For instance (Berglund et al.
, 2.
highlighted that cardiovascular patients exhibited higher adherence rates when engaged with gamified digital tools.
Impact of Gamification on Health Outcomes Research demonstrates that gamification can significantly improve health outcomes through increased patient engagement.
For example, (Damaevisius et al.
, 2.
reviewed 53 studies and found that incorporating feedback loops and challenges into health applications led to better clinical outcomes and sustained behavioral changes.
Similarly, (Hamdi et al.
, 2.
showed that gamification in anatomy education improved knowledge retention among medical Common Gamification Elements in Healthcare Applications Effective gamification elements identified in the literature include progress tracking, rewards, and social interaction features like leaderboards.
(Hamdi et al.
, 2.
found that incorporating progress bars and challenges in digital health apps enhanced user engagement and Furthermore, (Tsopra et al.
, 2.
demonstrated the utility of badges and levels in a PROCEEDING Al Ghazali Internasional Conference Volume 1.
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Conference gamified app designed for antibiotic stewardship education, which improved user knowledge and Research Gaps Despite its success, gaps persist in the literature regarding the personalization of gamification elements for diverse healthcare populations, especially the elderly or patients with chronic conditions.
Another critical gap lies in understanding the long-term effects of gamification on health behaviors, as most studies focus on short-term metrics (Lee et al.
, 2.
(Tsopra et al.
, 2.
Integration of gamified tools with traditional healthcare systems remains another underexplored area (Agudelo-Londoyo et al.
, 2.
, (Wilson et al.
, 2.
Hypothesis Development Based on the review of relevant literature, the following hypotheses are proposed:
H1: Points and badges as gamification elements positively impact user engagement in healthcare applications.
Rationale: These elements provide instant feedback and extrinsic rewards, which are proven motivators in healthcare settings (Valenzuela-Pascual et al.
, 2.
, (Wan et al.
, 2.
H2: Personalized gamification strategies enhance adherence to health interventions.
Rationale: Tailored gamified features resonate more with users, meeting individual preferences and increasing long-term engagement.
H3: Progress bars and leaderboards effectively sustain health-related behavioral changes.
Rationale: Progress bars offer visual cues on achievements, while leaderboards introduce a competitive element that fosters sustained motivation (Al-Rayes et al.
, 2.
,(Berglund et al.
, (Damaevisius et al.
, 2.
H4: Gamification is more effective in younger populations compared to elderly users.
Rationale: Younger users are more familiar with digital tools and game mechanics, leading to higher engagement levels in gamified healthcare applications (Lee et al.
, 2.
Research Method This study adopts the Systematic Literature Review (SLR) methodology as the theoretical foundation, which is widely used to synthesize evidence and identify research gaps in a structured The SLR approach is guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyse.
framework, ensuring a comprehensive and reproducible review The methodology focuses on identifying, evaluating, and synthesizing existing research on gamification elements in healthcare to generate meaningful insights (Wan et al.
, 2.
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Conference (Agudelo-Londoyo et al.
, 2.
This approach aligns with the study's objective to determine the effectiveness of gamification strategies in improving user engagement and health outcomes.
The research strategy involved a multi-phase process:
Fig 1 Flow diagram of the search process.
Search Strategy: Relevant literature was retrieved from electronic databases, including Scopus.
Ie Xplore, and Google Scholar.
Keywords such as "gamification," "healthcare," "engagement," and "outcomes" were used in combination with Boolean operators .
AND.
OR).
Inclusion criteria were set to focus on peer-reviewed studies published between 2018 and 2023, ensuring the analysis remains current (Tsopra et al.
, 2.
, (Lypez Chyvez et al.
, 2.
Inclusion and Exclusion Criteria: Articles were included if they .
addressed gamification applications in healthcare, .
focused on elements such as points, badges, levels, and leaderboards, and .
reported on user engagement or health outcomes.
Studies not meeting these criteria, such as those focusing solely on educational gamification, were excluded.
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Conference A Data Extraction: Relevant data points, such as the gamification elements used, target population, application domain, and reported outcomes, were systematically extracted from each selected study (Lypez Chyvez et al.
, 2.
Discussion The discussion section provides a detailed analysis of variables, findings, and contextual elements related to the research focus on gamification in healthcare.
The systematic approach employed in this study enables a structured synthesis of data from the included studies, facilitating a deeper understanding of gamification elements and techniques in improving health List of Research Questions Research Question (RQ) RQ1 Description What gamification elements are most frequently employed in healthcare applications? RQ2 What are the impacts of gamification techniques on user engagement and health outcomes? RQ3 How do gamification elements vary in effectiveness across different healthcare domains? RQ4 What are the limitations and opportunities in implementing gamification for healthcare interventions? List of Search Strings Search String Gamification Element Alternative String Gamified.
Gamification Techniques.
Gamification Component Healthcare Engagement Health.
Digital Health.
Fitness.
Team Sport.
Physical Activity.
Exercise.
Activities PROCEEDING Al Ghazali Internasional Conference Volume 1.
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Conference Publication Publication Game Statistic Game Element and Outcome Game Element Studies Impact/Outcome Leaderboards (Berglund et al.
, 2.
Promotes competition and motivation.
(Liang et al.
, 2.
(Tolks et al.
, 2.
Points (Huang et al.
, 2.
Improves intention for continued use of gamified fitness apps.
Thermal (Liang et al.
, 2.
Enhances Imaging gamified robotic therapy.
Feedback Routine (Kim et al.
, 2.
Promotes self-efficacy and healthy routine Tracking Challenges establishment for autistic individuals.
(Neelambike et al.
, 2.
Increases knowledge and rational use of PROCEEDING Al Ghazali Internasional Conference Volume 1.
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Conference Gamified (Ramdhani et al.
, 2.
Improves engagement on health service Progress Bars Social websites in Society 5.
0 era.
(Zhang & Li, 2.
Drives healthy lifestyle adoption through Comparison Feedback fitness apps.
(Ren Lee.
Enhances satisfaction in fitness apps and (Berglund et al.
, 2.
increases learning effectiveness in nursing Rewards (Liang et al.
, 2.
Encourages active participation in sleep (Berglund et al.
, 2.
hygiene and cardiovascular management.
Gamified Web (Valenzuela-Pascual Improves Platforms , 2.
motivation among physiotherapy students.
Spatial (Das et al.
, 2.
Enhances engagement and motivation in Gamification AI-Driven virtual learning environments.
(Tolks et al.
, 2.
Improves therapy for motion and cognitive Games impairments using adaptive game designs.
Research Description and Findings Addressing Research Questions (RQ) RQ1: What gamification elements are most frequently employed in healthcare applications? The analysis reveals that Leaderboards.
Feedback, and Rewards are the most frequently employed elements across healthcare gamification studies, each discussed in multiple Leaderboards are used to foster competition and motivation, especially in cardiovascular and rehabilitation settings.
Feedback systems enhance user engagement by providing real-time progress updates and reinforcement of correct behaviors, particularly in nursing and therapy applications.
Rewards, including points and badges, are used to incentivize active participation and adherence to healthcare goals.
RQ2: What are the impacts of gamification techniques on user engagement and health Gamification techniques consistently improve user engagement and adherence to health programs.
Key impacts include:
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Conference Enhanced motivation: Gamified web platforms improved knowledge acquisition and motivation among physiotherapy students.
Increased adherence: Leaderboards and progress bars significantly increased adherence to therapy, particularly for chronic conditions like cardiovascular diseases.
Improved knowledge retention: Gamified feedback systems enhanced knowledge retention in healthcare training programs.
RQ3: How do gamification elements vary in effectiveness across different healthcare Effectiveness varies based on the healthcare domain and user population:
Leaderboards are highly effective in rehabilitation and physical therapy due to their competitive nature.
Feedback systems are critical in cardiovascular care and nursing education, helping users track and correct behaviors.
Spatial gamification techniques .
VR-based learning environment.
are emerging as powerful tools in mental health and therapy.
RQ4: What are the limitations and opportunities in implementing gamification for healthcare The primary limitations include:
Lack of personalization: Many gamification elements are not tailored to individual needs, reducing their long-term effectiveness.
Limited integration: Few studies explore the integration of gamification into traditional healthcare systems.
Sustainability challenges: Long-term user engagement and behavioral changes remain underexplored.
Opportunities include developing adaptive gamification systems using AI to personalize user experiences and integrating gamification into broader healthcare frameworks.
Conclusion his study highlights the significant role of gamification in enhancing healthcare engagement and Key findings include:
Leaderboards.
Feedback, and Rewards are the most widely used and impactful gamification Gamification improves motivation, adherence, and knowledge retention across diverse healthcare domains, including therapy, education, and chronic disease management.
The effectiveness of gamification varies by domain, with leaderboards excelling in competitive settings and feedback systems proving vital for behavior correction.
Despite its advantages, gamification faces challenges in personalization, integration, and PROCEEDING Al Ghazali Internasional Conference Volume 1.
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Conference Future research should focus on addressing these challenges by developing personalized, adaptive gamification frameworks and exploring long-term impacts on health outcomes.
This approach will enable healthcare providers to leverage gamification as a powerful tool for improving patient engagement and fostering lasting behavioral changes.
Bibliography