Gamification to enhance engagement in digital smoking cessation interventions: a systematic review using the octalysis framework

BACKGROUND Smoking remains a leading cause of preventable morbidity and mortality worldwide. Digital interventions have shown promise in addressing the limitations of traditional smoking cessation approaches. Integrating gamification into these interventions has been increasingly used to enhance user engagement. However, engagement often declines over time. The Octalysis Framework provides a structured approach for selecting and designing gamification elements that support sustained motivation and long-term engagement. OBJECTIVE This narrative review aimed to identify and describe the gamification elements used in digital smoking cessation interventions by using the Octalysis Framework to provide a foundation for the design of future interventions. METHODS A narrative review was conducted following Ferrari’s approach. Four databases (MEDLINE, PsycInfo, Embase, and Scopus) were searched on June 16, 2025, using keywords related to gamification, digital interventions, and smoking cessation. Study selection and data extraction were performed by two reviewers and verified by a third reviewer. The findings were analyzed using the Octalysis Framework and synthesized narratively. RESULTS Thirteen studies met the inclusion criteria, conducted across the United Kingdom, the United States, and Australia. A total of 67 gamification elements were identified and mapped to the eight Octalysis core drives. Development and Accomplishment was the most frequently activated drive, primarily through rewards and goal setting, while Loss and Avoidance was the least represented. Interventions were predominantly delivered via smartphone apps, with limited adoption of formal gamification frameworks. CONCLUSIONS While our findings reinforce the role of gamification in enhancing engagement, future interventions should adopt structured frameworks and tailor gamification elements to user needs and contexts to maintain long-term engagement and improve smoking cessation outcomes.