The use of serious games and gamified design to improve health outcomes in adolescents with chronic disease: A review of recent literature
Aim Poor adherence is commonly cited as a reason for treatment failure in adolescence. The use of game elements, within serious games and gamified applications, has been proposed as a way to improve engagement, adherence and hence the effectiveness of health interventions. This is particularly relevant to chronic diseases, where long term adherence has been shown to influence clinical outcomes. The aim of this study was to explore, by way of a systematic review, (a) the outcomes of serious games and gamified application trials in adolescent chronic disease care, (b) types of interventions that have better outcomes, and (c) game design elements that have the best evidence to support their use. Methods A search of 6 online databases was conducted to identify published articles, describing a primary study where the intervention involved an electronic game or gamified application for adolescents with a chronic disease. Results In total, 12 studies were included in the review. 8 studies were RCTs, 3 prospective cohort studies and 1 used an interrupted time series design. Cancer, Asthma and Type 1 Diabetes were the most common population groups these interventions were trialed with. 5 studies showed a significant improvement in their primary outcome. Only 2 studies had the same primary outcome, and no studies reported using the same game or design elements. Health education interventions (n=5) were the most common intervention type trialed. Surprisingly only 3 studies were gamified applications, and the remaining 9 studies were serious games. Conclusions Although evidence relating to the use of serious games and gamified applications as a way to improve adherence is still weak, our review indicates that research in the field is maturing. In particular, behavioural interventions that promote self care behaviours have evidence supporting improved efficacy when delivered within gamified applications. Despite growing interest in the field, more high quality evidence is needed before healthcare services can justify additional expenditure.