An Evaluation of Current Methodological Approaches for Game-Based Health Interventions

In health research, applying game design techniques to create engaging health interventions has become more common, though still met with challenges and criticisms. In this literature review, we evaluate the extent to which recent health-based game intervention studies have improved from past criticisms around the game development process, its theoretical grounding, and its implementation in terms of research design. We reviewed 26 published articles sourced from multiple databases (e.g., PsychInfo) and AI tools (Elicit.org), which met our selection criteria of reporting a game-based intervention task the authors developed and targeting the improvement of a health outcome. We investigated their theoretical grounding, their use of game mechanics, and their methodologies for the development and implementation of game-based interventions. This involved coding for theories from psychology or game design, game mechanics (reinforcement, immersion, performance, social components, and ecological components), and research methods and design approaches used to support intervention development (qualitative/quantitative, user-centered approaches, testing strategies, and iterative approaches). We reasoned that those studies grounded in theory would be more likely to use effective methodologies and provide support for their design choices. All studies in this sample included more than one game mechanic, most studies grounded their interventions in psychological theory, and studies frequently used quantitative methods to determine intervention impact. In line with recommendations, the majority of studies used large sample sizes and applied their interventions in real-world settings. Despite these improvements, we identified areas of growth: future studies still need to utilize interdisciplinary teams, user-centered and iterative approaches, and standardize their reporting of intervention design components. We hope this review helps to inform the future of applied game design in health contexts.