{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T01:41:14Z","timestamp":1781833274339,"version":"3.54.5"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T00:00:00Z","timestamp":1742774400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Digit. Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Applying game design techniques to create engaging health interventions has become more common, though still met with challenges and criticisms. This scoping literature review evaluates the extent to which recent health-based game intervention studies have improved from past criticisms around the process of game development, theoretical grounding, and implementation in terms of research design.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Following a search of relevant databases and an AI tool (<jats:ext-link>Elicit.org<\/jats:ext-link>), 26 published articles met our selection criteria of reporting a game-based health intervention task developed by the article's authors. In each article, the reported theoretical grounding, use of game mechanics, and methodologies for developing and implementing game-based interventions were assessed. Our procedure involved coding for psychological or game design theories, game mechanics, and the research methods and design approaches used for intervention development. We reasoned that articles grounded in theory would be more likely to report effective methodologies and support for their design choices.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Our findings revealed that authors frequently used quantitative methods to determine intervention impact, explicitly referenced psychological (vs. game design) theory more frequently, and used more than one game mechanic in the interventions. In line with recommendations, the majority of studies used large sample sizes and applied their interventions in real-world settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Despite these improvements, we identified areas of growth: utilizing interdisciplinary teams, user-centered and iterative approaches, and standardizing the reporting of intervention design components. This review is intended to inform the future of applied game design in health contexts.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fdgth.2025.1561422","type":"journal-article","created":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T10:46:08Z","timestamp":1742813168000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Advancements and challenges in methodological approaches for game-based health interventions: a scoping review"],"prefix":"10.3389","volume":"7","author":[{"given":"Shaina","family":"Glass","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexia","family":"Galati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,24]]},"reference":[{"key":"B1","first-page":"395","article-title":"Gamification mechanics for behavioral change: a systematic review and proposed taxonomy","author":"Herv\u00e1s","year":"2017"},{"key":"B2","volume-title":"Health Behavior: Theory, Research, and Practice","author":"Galnz","year":"2015"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e13717","DOI":"10.2196\/13717","article-title":"Gamification in apps and technologies for improving mental health and well-being: systematic review","volume":"6","author":"Cheng","year":"2019","journal-title":"JMIR Ment Health"},{"key":"B4","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.invent.2016.10.002","article-title":"Gamification for health and wellbeing: a systematic review of the literature","volume":"6","author":"Johnson","year":"2016","journal-title":"Internet Interv"},{"key":"B5","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1108\/IJILT-02-2017-0009","article-title":"The effect of gamification on motivation and engagement","volume":"35","author":"Alsawaier","year":"2018","journal-title":"Int J Inf Learn Technol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e30390","DOI":"10.2196\/30390","article-title":"Conceptual ambiguity surrounding gamification and serious games in health care: literature review and development of game-based intervention reporting guidelines (GAMING)","volume":"23","author":"Warsinsky","year":"2021","journal-title":"J Med Internet Res"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e42173","DOI":"10.2196\/42173","article-title":"The development of game-based digital mental health interventions: bridging the paradigms of health care and entertainment","volume":"11","author":"Lukka","year":"2023","journal-title":"JMIR Serious Games"},{"key":"B8","volume-title":"The art of Game Design: A Book of Lenses","author":"Schell","year":"2019"},{"key":"B9","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1249\/FIT.0b013e3181916d11","article-title":"The role of motivation in behavior change: how do we encourage our clients to be active?","volume":"13","author":"Rodgers","year":"2009","journal-title":"ACSM\u2019s Health Fitness J"},{"key":"B10","first-page":"1","article-title":"Game mechanic alignment theory","author":"Green","year":"2021"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40561-019-0106-1","article-title":"Analysing gamification elements in educational environments using an existing gamification taxonomy","volume":"6","author":"Toda","year":"2019","journal-title":"Smart Learn Environ"},{"key":"B12","doi-asserted-by":"publisher","first-page":"215","DOI":"10.3389\/fpsyt.2016.00215","article-title":"Serious games and gamification for mental health: current status and promising directions","volume":"7","author":"Fleming","year":"2017","journal-title":"Front Psychiatry"},{"key":"B13","doi-asserted-by":"crossref","DOI":"10.4324\/9781315756516","volume-title":"Clockwork Game Design","author":"Burgun","year":"2015"},{"key":"B14","doi-asserted-by":"crossref","DOI":"10.1201\/9781315208794","volume-title":"Educational Game Design Fundamentals: A Journey to Creating Intrinsically Motivating Learning Experiences","author":"Kalmpourtzis","year":"2018"},{"key":"B15","first-page":"1","article-title":"Goal-setting theory of motivation","volume":"15","author":"Lunenburg","year":"2011","journal-title":"Int J Manag Bus Admin"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e21900","DOI":"10.2196\/21900","article-title":"A gamification framework for cognitive assessment and cognitive training: qualitative study","volume":"9","author":"Khaleghi","year":"2021","journal-title":"JMIR Serious Games"},{"key":"B17","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1089\/g4h.2014.0046","article-title":"Randomized controlled trial of SuperBetter, a smartphone-based\/internet-based self-help tool to reduce depressive symptoms","volume":"4","author":"Roepke","year":"2015","journal-title":"Games Health J"},{"key":"B18","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1177\/2167702614522228","article-title":"Mental health on the go: effects of a gamified attention-bias modification mobile application in trait-anxious adults","volume":"2","author":"Dennis","year":"2014","journal-title":"Clin Psychol Sci"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e28282","DOI":"10.2196\/28282","article-title":"The influence of gamification and information technology identity on postadoption behaviors of health and fitness app users: empirical study in the United States","volume":"9","author":"Esmaeilzadeh","year":"2021","journal-title":"JMIR Serious Games"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e12884","DOI":"10.2196\/12884","article-title":"Engaging users in the behavior change process with digitalized motivational interviewing and gamification: development and feasibility testing of the precious app","volume":"8","author":"Nurmi","year":"2020","journal-title":"JMIR Mhealth Uhealth"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e85092","DOI":"10.1371\/journal.pone.0085092","article-title":"When we should worry more: using cognitive bias modification to drive adaptive health behaviour","volume":"9","author":"Notebaert","year":"2014","journal-title":"PLoS One"},{"key":"B22","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1142\/9789814417358_0006","article-title":"Prospect theory: an analysis of decision under risk","volume-title":"Handbook of the Fundamentals of Financial Decision Making: Part I","author":"Kahneman","year":"2013"},{"key":"B23","doi-asserted-by":"publisher","first-page":"e18644","DOI":"10.2196\/18644","article-title":"The effects of gamification on computerized cognitive training: systematic review and meta-analysis","volume":"8","author":"Vermeir","year":"2020","journal-title":"JMIR Serious Games"},{"key":"B24","doi-asserted-by":"crossref","DOI":"10.24251\/HICSS.2020.155","article-title":"The role of gamification in health behavior change: a review of theory-driven studies","author":"Schmidt-Kraepelin","year":"2020"},{"key":"B25","article-title":"What is behavioral economics? University of Chicago News","author":"Witynski","year":""},{"key":"B26","volume-title":"Flow: The Psychology of Optimal Experience","author":"Csikszentmihalyi","year":"2008"},{"key":"B27","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1089\/g4h.2019.0060","article-title":"Mila blooms: a mobile phone application and behavioral intervention for promoting physical activity and a healthy diet among adolescent survivors of childhood cancer","volume":"9","author":"Fuemmeler","year":"2020","journal-title":"Games Health J"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/15554120231202175","article-title":"The proteus effect: overview, reflection, and recommendations","author":"Liu","year":"2023","journal-title":"Games Cult"},{"key":"B29","first-page":"1","article-title":"Towards agent-based agile approach for game development methodology","author":"Al-Azawi","year":"2014"},{"key":"B30","doi-asserted-by":"publisher","first-page":"565","DOI":"10.4300\/JGME-D-22-00621.1","article-title":"Steps for conducting a scoping review","volume":"14","author":"Mak","year":"2022","journal-title":"J Grad Med Educ"},{"key":"B31","doi-asserted-by":"publisher","first-page":"467","DOI":"10.7326\/M18-0850","article-title":"PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation","volume":"169","author":"Tricco","year":"2018","journal-title":"Ann Intern Med"},{"key":"B32","doi-asserted-by":"publisher","first-page":"2119","DOI":"10.11124\/JBIES-20-00167","article-title":"Updated methodological guidance for the conduct of scoping reviews","volume":"18","author":"Peters","year":"2020","journal-title":"JBI Evid Synth"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1","DOI":"10.62707\/aishej.v9i3.335","article-title":"Doing a thematic analysis: a practical, step-by-step guide for learning and teaching scholars","volume":"9","author":"Maguire","year":"2017","journal-title":"\u00a0Ireland J Higher Educ"},{"key":"B34","doi-asserted-by":"crossref","DOI":"10.31234\/osf.io\/he2m8","article-title":"An Evaluation of Current Methodological Approaches for Game-Based Health Interventions","author":"Glass","year":"2024"},{"key":"B35","doi-asserted-by":"publisher","first-page":"i6795","DOI":"10.1136\/bmj.i6795","article-title":"Standards for reporting implementation studies (StaRI) statement","volume":"356","author":"Pinnock","year":"2017","journal-title":"Br Med J"},{"key":"B36","doi-asserted-by":"crossref","DOI":"10.21203\/rs.3.rs-4489082\/v1","article-title":"Advancing the acceptability of game-based digital mental health interventions: A qualitative study on clinicians\u2019 views. Preprint","author":"Lukka","year":""},{"key":"B37","doi-asserted-by":"publisher","first-page":"719090","DOI":"10.3389\/fneur.2021.719090","article-title":"Mobile attention bias modification training is a digital health solution for managing distress in multiple sclerosis: a pilot study in pediatric onset","volume":"12","author":"Charvet","year":"2021","journal-title":"Front Neurol"}],"container-title":["Frontiers in Digital Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2025.1561422\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T10:46:38Z","timestamp":1742813198000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2025.1561422\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,24]]},"references-count":37,"alternative-id":["10.3389\/fdgth.2025.1561422"],"URL":"https:\/\/doi.org\/10.3389\/fdgth.2025.1561422","relation":{},"ISSN":["2673-253X"],"issn-type":[{"value":"2673-253X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,24]]},"article-number":"1561422"}}