{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T11:19:04Z","timestamp":1787915944950,"version":"build-2784847793"},"reference-count":140,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T00:00:00Z","timestamp":1750723200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union","award":["2021-1-EL01-KA220-SCH-000034496"],"award-info":[{"award-number":["2021-1-EL01-KA220-SCH-000034496"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behavioral Sciences"],"abstract":"<jats:p>This study evaluates design effectiveness in Digital Game-Based Learning (DGBL) for primary health education through systematic teacher assessment of the iLearn4Health platform. Rather than measuring educational transformation, the research investigates how DGBL design principles influence user engagement patterns and platform usability as evaluated by education professionals. The study contributes to design optimization frameworks for primary school digital health education applications by examining the distinction between DGBL and superficial gamification approaches in creating engaging educational interfaces. The iLearn4Health platform underwent comprehensive design evaluation by 337 teachers across 24 schools in five European countries (Greece, Cyprus, Romania, Poland, and Spain). Teachers served as design evaluators rather than end-users, assessing platform engagement mechanisms through systematic interaction analysis. The study employed multiple statistical approaches\u2014descriptive analysis, correlation analysis, ANOVA, regression modeling, and cluster analysis\u2014to identify design engagement patterns and their predictors, tracking completion rates, progress trajectories, and interaction time as indicators of design effectiveness. Design evaluation revealed a distinctive bimodal engagement distribution, with 52.8% of teacher\u2013evaluators showing limited platform exploration (progress ratio 0.0\u20130.2) and 35.3% demonstrating comprehensive design assessment (progress ratio 0.8\u20131.0). A strong positive correlation (r = 0.95, p &lt; 0.001) between time spent and steps completed indicated that design elements successfully sustained evaluator engagement. Multiple regression analysis identified initial design experience as the strongest predictor of continued engagement (\u03b2 = 0.479, p &lt; 0.001), followed by country-specific implementation factors (Romania vs. Cyprus, \u03b2 = 0.183, p = 0.001) and evaluator age (\u03b2 = 0.108, p = 0.049). Cluster analysis revealed three distinct evaluator profiles: comprehensive design assessors (35.3%), early design explorers (52.8%), and selective feature evaluators (11.9%). Cross-national analysis showed significant variations in design engagement, with Romania demonstrating 53% higher average progress ratios than Cyprus (0.460 vs. 0.301, p &lt; 0.01). Teacher evaluation validates effective design implementation in the iLearn4Health platform for creating engaging primary health education experiences. The platform successfully demonstrates DGBL design principles that integrate health concepts into age-appropriate interactive environments, distinct from gamification approaches that merely overlay game elements onto existing content. Identifying initial engagement as the strongest predictor of sustained interaction highlights the critical importance of onboarding design in determining user experience outcomes. While this study establishes design engagement effectiveness through educator assessment, actual educational transformation and student learning outcomes require future implementation studies with primary school populations. The design validation approach provides essential groundwork for subsequent educational effectiveness research while contributing evidence-based design principles for engagement optimization in digital health education contexts.<\/jats:p>","DOI":"10.3390\/bs15070847","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T10:44:41Z","timestamp":1750761881000},"page":"847","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Designing for Engagement in Primary Health Education Through Digital Game-Based Learning: Cross-National Behavioral Evidence from the iLearn4Health Platform"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3197-2019","authenticated-orcid":false,"given":"Evgenia","family":"Gkintoni","sequence":"first","affiliation":[{"name":"Lab of Public Health, Department of Medicine, University of Patras, 26504 Patra, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6517-6857","authenticated-orcid":false,"given":"Emmanuella","family":"Magriplis","sequence":"additional","affiliation":[{"name":"Lab of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, 11855 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fedra","family":"Vantaraki","sequence":"additional","affiliation":[{"name":"Lab of Public Health, Department of Medicine, University of Patras, 26504 Patra, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charitini-Maria","family":"Skoulidi","sequence":"additional","affiliation":[{"name":"p-Consulting, 26442 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Anastassopoulos","sequence":"additional","affiliation":[{"name":"p-Consulting, 26442 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Cornea","sequence":"additional","affiliation":[{"name":"FSLI, 030167 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bego\u00f1a","family":"Inchaurraga","sequence":"additional","affiliation":[{"name":"Centro San Viator, 48190 Sopuerta, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaione","family":"Santurtun","sequence":"additional","affiliation":[{"name":"Centro San Viator, 48190 Sopuerta, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ainhoa de la Cruz","family":"Mancha","sequence":"additional","affiliation":[{"name":"Centro San Viator, 48190 Sopuerta, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Giorgakis","sequence":"additional","affiliation":[{"name":"C.F.C.D.C. Centre for Competence, Development Cyprus Limited, Nicosia 1065, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kleri","family":"Kouppas","sequence":"additional","affiliation":[{"name":"Dimotiko Scholeio Agias Napas-Antoni Tsokkou, Ayia Napa 5330, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0941-0199","authenticated-orcid":false,"given":"Stella","family":"Timotheou","sequence":"additional","affiliation":[{"name":"Dimotiko Scholeio Agias Napas-Antoni Tsokkou, Ayia Napa 5330, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Jose","family":"Moreno Juan","sequence":"additional","affiliation":[{"name":"Errotu Taldea S.L.P., 20160 Donostia-San Sebastian, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miren","family":"Mu\u00f1agorri","sequence":"additional","affiliation":[{"name":"Errotu Taldea S.L.P., 20160 Donostia-San Sebastian, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Harasiuk","sequence":"additional","affiliation":[{"name":"OIC POLAND Foundation, WSEI University, 20-209 Lublin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo Garmendia","family":"Lopez","sequence":"additional","affiliation":[{"name":"p-Consulting, 26442 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Efi","family":"Skoulidi","sequence":"additional","affiliation":[{"name":"p-Consulting, 26442 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4411-3739","authenticated-orcid":false,"given":"Apostolos","family":"Vantarakis","sequence":"additional","affiliation":[{"name":"Lab of Public Health, Department of Medicine, University of Patras, 26504 Patra, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e32898","DOI":"10.1016\/j.heliyon.2024.e32898","article-title":"Faculty and students perspectives towards game-based learning in health sciences higher education","volume":"10","author":"Alharbi","year":"2024","journal-title":"Heliyon"},{"key":"ref_2","first-page":"100290","article-title":"Gamification and deep learning approaches in higher education","volume":"28","year":"2021","journal-title":"Journal of Hospitality, Leisure, Sport & Tourism Education"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Alam, A. (, January March). Leveraging the power of \u2018modeling and computer simulation\u2019 for education: An exploration of its potential for improved learning outcomes and enhanced student engagement. 2023 International Conference on Device Intelligence, Computing and Communication Technologies (DICCT), Dehradun, India.","DOI":"10.1109\/DICCT56244.2023.10110159"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2025108","DOI":"10.31893\/multiscience.2025108","article-title":"Gameful learning: Investigating the impact of game elements, interactivity, and learning style on students\u2019 success","volume":"6","author":"Alamri","year":"2024","journal-title":"Multidisciplinary Science Journal"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"102754","DOI":"10.1016\/j.cose.2022.102754","article-title":"The role of national cybersecurity strategies on the improvement of cybersecurity education","volume":"119","author":"AlDaajeh","year":"2022","journal-title":"Computers & Security"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"104160","DOI":"10.1016\/j.compedu.2021.104160","article-title":"Digital game-based learning effectiveness assessment: Reflections on study design","volume":"167","author":"All","year":"2021","journal-title":"Computers & Education"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"100974","DOI":"10.1016\/j.imu.2022.100974","article-title":"Gaming elements, applications, and challenges of gamification in healthcare","volume":"31","author":"Alfayez","year":"2022","journal-title":"Informatics in Medicine Unlocked"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Andrea Navarro-Espinosa, J., Vaquero-Abell\u00e1n, M., Perea-Moreno, A. J., Pedr\u00f3s-P\u00e9rez, G., del Pilar Mart\u00ednez-Jim\u00e9nez, M., and Aparicio-Mart\u00ednez, P. (2022). Gamification as a promoting tool of motivation for creating sustainable higher education institutions. International Journal of Environmental Research and Public Health, 19, (5).","DOI":"10.3390\/ijerph19052599"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1177\/07439156231165250","article-title":"Helping youth navigate privacy protection: Developing and testing the children\u2019s online privacy scale","volume":"42","author":"Andrews","year":"2023","journal-title":"Journal of Public Policy & Marketing"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"367","DOI":"10.26803\/ijlter.21.5.19","article-title":"Application of gamification tools for identification of neurocognitive and social function in distance learning education","volume":"21","author":"Antonopoulou","year":"2022","journal-title":"International Journal of Learning, Teaching and Educational Research"},{"key":"ref_11","first-page":"820","article-title":"Participants\u2019 experience with gamification elements of a school-based health promotion intervention in Italy: A mixed-methods study","volume":"45","author":"Aresi","year":"2024","journal-title":"Journal of Prevention"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Arora, C., and Razavian, M. (2021). Ethics of gamification in health and fitness tracking. International Journal of Environmental Research and Public Health, 18, (21).","DOI":"10.3390\/ijerph182111052"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.jmir.2020.10.003","article-title":"A scoping review of randomized controlled trials to assess the value of gamification in the higher education of health science students","volume":"52","author":"Arruzza","year":"2021","journal-title":"Journal of Medical Imaging and Radiation Sciences"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"100870","DOI":"10.1016\/j.ssaho.2024.100870","article-title":"Exploring student engagement in technology-based education in relation to gamification, online\/distance learning, and other factors: A systematic literature review","volume":"9","author":"Balalle","year":"2024","journal-title":"Social Sciences & Humanities Open"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1109\/IOTM.001.2300197","article-title":"Navigating privacy challenges in the metaverse: A comprehensive examination of current technologies and platforms","volume":"7","author":"Basyoni","year":"2024","journal-title":"IEEE Internet of Things Magazine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2053951721101730","DOI":"10.1177\/20539517211017308","article-title":"Data as asset? The measurement, governance, and valuation of digital personal data by Big Tech","volume":"8","author":"Birch","year":"2021","journal-title":"Big Data & Society"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/bjet.13004","article-title":"Narrative categorization in digital game-based learning: Engagement, motivation & learning","volume":"52","author":"Breien","year":"2021","journal-title":"British Journal of Educational Technology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e30565","DOI":"10.2196\/30565","article-title":"Developing a web-based app to assess mental health difficulties in secondary school pupils: Qualitative user-centered design study","volume":"6","author":"Burn","year":"2022","journal-title":"JMIR Formative Research"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1177\/01430343211017170","article-title":"The relationship between school-basic psychological need satisfaction and frustration, academic engagement and academic achievement","volume":"42","author":"Buzzai","year":"2021","journal-title":"School Psychology International"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Camacho-S\u00e1nchez, R., Manzano-Le\u00f3n, A., Rodr\u00edguez-Ferrer, J. M., Serna, J., and Lavega-Burgu\u00e9s, P. (2023). Game-based learning and gamification in physical education: A systematic review. Education Sciences, 13, (2).","DOI":"10.3390\/educsci13020183"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Camacho-S\u00e1nchez, R., Rillo-Albert, A., and Lavega-Burgu\u00e9s, P. (2022). Gamified digital game-based learning as a pedagogical strategy: Student academic performance and motivation. Applied Sciences, 12, (21).","DOI":"10.3390\/app122111214"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1007\/s10639-021-10768-w","article-title":"Effects of virtual learning environments: A scoping review of literature","volume":"27","author":"Caprara","year":"2022","journal-title":"Education and Information Technologies"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Castellano-Tejedor, C., and Cencerrado, A. (2024). Gamification for mental health and health psychology: Insights at the first quarter mark of the 21st century. International Journal of Environmental Research and Public Health, 21, (8).","DOI":"10.3390\/ijerph21080990"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12913-022-08441-0","article-title":"ProHealth eCoach: User-centered design and development of an eCoach app to promote healthy lifestyle with personalized activity recommendations","volume":"22","author":"Chatterjee","year":"2022","journal-title":"BMC Health Services Research"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Chen, F. H. (2021). Sustainable education through e-learning: The case study of iLearn2.0. Sustainability, 13, (18).","DOI":"10.3390\/su131810186"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Chen, Y., and Zhao, S. (2022). Chinese EFL learners\u2019 acceptance of gamified vocabulary learning apps: An integration of self-determination theory and technology acceptance model. Sustainability, 14, (18).","DOI":"10.3390\/su141811288"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"107621","DOI":"10.1016\/j.chb.2022.107621","article-title":"A meta-analytic review of gamified interventions in mental health enhancement","volume":"138","author":"Cheng","year":"2023a","journal-title":"Computers in Human Behavior"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1007\/s11920-023-01453-5","article-title":"Gamification: A novel approach to mental health promotion","volume":"25","author":"Cheng","year":"2023b","journal-title":"Current Psychiatry Reports"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1964690","DOI":"10.1080\/2331186X.2021.1964690","article-title":"Integration of educational technology during the COVID-19 pandemic: An analysis of teacher and student receptions","volume":"8","author":"Christopoulos","year":"2021","journal-title":"Cogent Education"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1863","DOI":"10.25300\/MISQ\/2021\/14165","article-title":"Privacy concerns and data sharing in the internet of things: Mixed methods evidence from connected cars","volume":"45","author":"Cichy","year":"2021","journal-title":"MIS Quarterly"},{"key":"ref_31","first-page":"234","article-title":"A systematic review of the limitations and associated opportunities of ChatGPT","volume":"41","author":"Soyoof","year":"2025","journal-title":"International Journal of Human-Computer Interaction"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"103624","DOI":"10.1016\/j.csi.2022.103624","article-title":"Information technologies exposing children to privacy risks: Domains and children-specific technical controls","volume":"82","author":"Crepax","year":"2022","journal-title":"Computer Standards & Interfaces"},{"key":"ref_33","first-page":"456","article-title":"Gamification is not working: Why?","volume":"19","author":"Dah","year":"2024","journal-title":"Games and Culture"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3685","DOI":"10.1007\/s10639-022-11548-w","article-title":"Gamification and game based learning for vocational education and training: A systematic literature review","volume":"29","author":"Dahalan","year":"2024","journal-title":"Education and Information Technologies"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"de Carvalho, C. V., and Coelho, A. (2022). Game-based learning, gamification in education and serious games. Computers, 11, (3).","DOI":"10.3390\/computers11030036"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"del Cura-Gonz\u00e1lez, I., Ariza-Cardiel, G., Polentinos-Castro, E., L\u00f3pez-Rodr\u00edguez, J. A., Sanz-Cuesta, T., Barrio-Cortes, J., Garc\u00eda-Sagredo, P., Hern\u00e1ndez-Santiago, V., Rodr\u00edguez-Barrientos, R., Zabaleta-del-Olmo, E., Garc\u00eda-Agua-Soler, N., Gonz\u00e1lez-Gonz\u00e1lez, A. I., Garc\u00eda-de-Blas-Gonz\u00e1lez, F., de-Dios-del-Valle, R., Escortell-Mayor, E., and Mart\u00edn-Fern\u00e1ndez, J. (2022). Effectiveness of a game-based educational strategy e-EDUCAGUIA for implementing antimicrobial clinical practice guidelines in family medicine residents in Spain: A randomized clinical trial by cluster. BMC Medical Education, 22, (1).","DOI":"10.1186\/s12909-022-03843-4"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1177\/10468781221114160","article-title":"Improving environmental outcomes with games: An exploration of behavioral and technological design and evaluation approaches","volume":"53","author":"Ashbarry","year":"2022","journal-title":"Simulation & Gaming"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1111\/cobi.13708","article-title":"How to address data privacy concerns when using social media data in conservation science","volume":"35","author":"Fink","year":"2021","journal-title":"Conservation Biology"},{"key":"ref_39","first-page":"1032","article-title":"Investigating the different facets of student engagement during augmented reality use in primary school","volume":"53","author":"Wong","year":"2022","journal-title":"British Journal of Educational Technology"},{"key":"ref_40","doi-asserted-by":"crossref","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":"ref_41","doi-asserted-by":"crossref","first-page":"41","DOI":"10.18034\/gdeb.v12i1.774","article-title":"Machine learning-driven gamification: Boosting user engagement in business","volume":"12","author":"Farhan","year":"2023","journal-title":"Global Disclosure of Economics and Business"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1080\/13561820.2020.1850660","article-title":"Strategies for Health: A game-based, interprofessional approach to teaching social determinants of health: A randomized controlled pilot study","volume":"39","author":"Feldhacker","year":"2025","journal-title":"Journal of Interprofessional Care"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"8873997","DOI":"10.1155\/2021\/8873997","article-title":"Teaching method for software measurement process based on gamification or serious games: A systematic review of the literature","volume":"2021","author":"Furtado","year":"2021","journal-title":"International Journal of Computer Games Technology"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"21582440231218834","DOI":"10.1177\/21582440231218834","article-title":"Gamification in health care management: Systematic review of the literature and research agenda","volume":"13","year":"2023","journal-title":"SAGE Open"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1007\/s11528-024-00968-9","article-title":"Advancing gamification research and practice with three underexplored ideas in self-determination theory","volume":"68","author":"Gao","year":"2024","journal-title":"TechTrends"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Ghahramani, A., de Courten, M., and Prokofieva, M. (2022). The potential of social media in health promotion beyond creating awareness: An integrative review. BMC Public Health, 22, (1).","DOI":"10.1186\/s12889-022-14885-0"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2028","DOI":"10.1002\/mar.21752","article-title":"Brands in a game or a game for brands? Comparing the persuasive effectiveness of in-game advertising and advergames","volume":"39","author":"Ghosh","year":"2022","journal-title":"Psychology & Marketing"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Gkintoni, E., Antonopoulou, H., Sortwell, A., and Halkiopoulos, C. (2025a). Challenging cognitive load theory: The role of educational neuroscience and artificial intelligence in redefining learning efficacy. Brain Sciences, 15, (2).","DOI":"10.3390\/brainsci15020203"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"262","DOI":"10.28991\/ESJ-2024-SIED1-016","article-title":"Cognitive insights from emotional intelligence: A systematic review of EI models in educational achievement","volume":"8","author":"Gkintoni","year":"2025b","journal-title":"Emerging Science Journal"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Gkintoni, E., Vantaraki, F., Skoulidi, C., Anastassopoulos, P., and Vantarakis, A. (2024a). Gamified health promotion in schools: The integration of neuropsychological aspects and CBT\u2014A systematic review. Medicina, 60, (12).","DOI":"10.3390\/medicina60122085"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Gkintoni, E., Vantaraki, F., Skoulidi, C., Anastassopoulos, P., and Vantarakis, A. (2024b). Promoting physical and mental health among children and adolescents via gamification\u2014A conceptual systematic review. Behavioral Sciences, 14, (2).","DOI":"10.3390\/bs14020102"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Govender, T., and Arnedo-Moreno, J. (2021). An analysis of game design elements used in digital game-based language learning. Sustainability, 13, (12).","DOI":"10.3390\/su13126679"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1080\/10494820.2022.2091611","article-title":"Applying game-based learning in primary education: A systematic review of journal publications from 2010 to 2020","volume":"32","author":"Guan","year":"2024","journal-title":"Interactive Learning Environments"},{"key":"ref_54","first-page":"456","article-title":"Is game-based pedagogy just a fad? A self-determination theory approach to gamification in higher education","volume":"36","author":"Gupta","year":"2022","journal-title":"International Journal of Educational Management"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Halkiopoulos, C., and Gkintoni, E. (2024). Leveraging AI in E-learning: Personalized learning and adaptive assessment through cognitive neuropsychology\u2014A systematic analysis. Electronics, 13, (18).","DOI":"10.3390\/electronics13183762"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"100417","DOI":"10.1016\/j.entcom.2021.100417","article-title":"Serious games to improve social and emotional intelligence in children with autism","volume":"38","author":"Hassan","year":"2021","journal-title":"Entertainment Computing"},{"key":"ref_57","first-page":"103141","article-title":"Evaluation of game design framework using a gamified browser-based application","volume":"128","year":"2023","journal-title":"Computers & Security"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.intmar.2021.01.001","article-title":"The influence of consumer-brand relationships on the personalized advertising privacy calculus in social media","volume":"55","author":"Hayes","year":"2021","journal-title":"Journal of Interactive Marketing"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s13218-021-00733-7","article-title":"Teaching artificial intelligence to K-12 through a role-playing game questioning the intelligence concept","volume":"35","author":"Henry","year":"2021","journal-title":"KI-K\u00fcnstliche Intelligenz"},{"key":"ref_60","first-page":"104408","article-title":"Encouraging gameful experience in digital game-based learning: A double-mediation model of perceived instructional support, group engagement, and flow","volume":"180","year":"2022","journal-title":"Computers & Education"},{"key":"ref_61","first-page":"4182","article-title":"Investigating the effects of different game-based learning on the health care knowledge and emotions for middle-aged and older adults","volume":"32","author":"Hsiao","year":"2024","journal-title":"Interactive Learning Environments"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"114","DOI":"10.19101\/IJATEE.2020.S1762123","article-title":"Exploring gamification design elements for mental health support","volume":"8","author":"Ibrahim","year":"2021","journal-title":"International Journal of Advanced Technology and Engineering Exploration"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Jingili, N., Oyelere, S. S., Nystr\u00f6m, M. B., and Anyshchenko, L. (2023). A systematic review on the efficacy of virtual reality and gamification interventions for managing anxiety and depression. Frontiers in Digital Health, 5.","DOI":"10.3389\/fdgth.2023.1239435"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1111\/jcpp.13864","article-title":"Annual Research Review: Sex, gender, and internalizing conditions among adolescents in the 21st century\u2014Trends, causes, consequences","volume":"65","author":"Keyes","year":"2024","journal-title":"Journal of Child Psychology and Psychiatry"},{"key":"ref_65","doi-asserted-by":"crossref","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":"ref_66","doi-asserted-by":"crossref","unstructured":"Kim, J., and Castelli, D. M. (2021). Effects of gamification on behavioral change in education: A meta-analysis. International Journal of Environmental Research and Public Health, 18, (7).","DOI":"10.3390\/ijerph18073550"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"100475","DOI":"10.1016\/j.entcom.2021.100475","article-title":"Re-framing engagement for applied games: A conceptual framework","volume":"40","author":"Kniestedt","year":"2022","journal-title":"Entertainment Computing"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/s10734-020-00639-7","article-title":"The future of value in digitalised higher education: Why data privacy should not be our biggest concern","volume":"83","author":"Komljenovic","year":"2022","journal-title":"Higher Education"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"106963","DOI":"10.1016\/j.chb.2021.106963","article-title":"Revealing the theoretical basis of gamification: A systematic review and analysis of theory in research on gamification, serious games, and game-based learning","volume":"125","author":"Krath","year":"2021","journal-title":"Computers in Human Behavior"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1002\/sd.2773","article-title":"Artificial intelligence-driven sustainable development: Examining organizational, technical, and processing approaches to achieving global goals","volume":"32","author":"Kulkov","year":"2024","journal-title":"Sustainable Development"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/ijsa.12376","article-title":"Game-based, gamified, and gamefully designed assessments for employee selection: Definitions, distinctions, design, and validation","volume":"30","author":"Landers","year":"2022","journal-title":"International Journal of Selection and Assessment"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1057\/s41264-022-00154-z","article-title":"Trust and digital privacy: Willingness to disclose personal information to banking chatbot services","volume":"28","author":"Lappeman","year":"2022","journal-title":"Journal of Financial Services Marketing"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"18","DOI":"10.54489\/ijtim.v1i1.12","article-title":"Improving IoT privacy, data protection, and security concerns","volume":"1","author":"Lee","year":"2021","journal-title":"International Journal of Technology, Innovation and Management (IJTIM)"},{"key":"ref_74","first-page":"412","article-title":"Ocean literacy gamified: A systematic evaluation of the effect of game elements on students\u2019 learning experience","volume":"28","author":"Maguire","year":"2022a","journal-title":"Environmental Education Research"},{"key":"ref_75","first-page":"2341","article-title":"A systematic evaluation of game elements effects on students\u2019 motivation","volume":"27","author":"Maguire","year":"2022b","journal-title":"Education and Information Technologies"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s40561-022-00195-w","article-title":"Effect of OSLM features and gamification motivators on motivation in DGBL: Pupils\u2019 viewpoint","volume":"9","author":"Leonardou","year":"2022","journal-title":"Smart Learning Environments"},{"key":"ref_77","first-page":"9321","article-title":"Evaluation of gamification techniques in learning abilities for higher school students using FAHP and EDAS methods","volume":"27","author":"Li","year":"2023","journal-title":"Soft Computing"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1007\/s10639-021-10642-9","article-title":"Gamification for educational purposes: What are the factors contributing to varied effectiveness?","volume":"27","author":"Luo","year":"2022","journal-title":"Education and Information Technologies"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1080\/00131911.2022.2035685","article-title":"Educational technology for learners with disabilities in primary school settings in low-and middle-income countries: A systematic literature review","volume":"76","author":"Lynch","year":"2024","journal-title":"Educational Review"},{"key":"ref_80","first-page":"156","article-title":"Reboot your course\u2014From beta to better","volume":"37","author":"Lynch","year":"2016","journal-title":"Distance Education"},{"key":"ref_81","first-page":"234","article-title":"Examining the commonalities and differences between gamblification and gamification: A theoretical perspective","volume":"41","author":"Macey","year":"2025","journal-title":"International Journal of Human-Computer Interaction"},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Masi, L., Abadie, P., Herba, C., Emond, M., Gingras, M. P., and Amor, L. B. (2021). Video games in ADHD and non-ADHD children: Modalities of use and association with ADHD symptoms. Frontiers in Pediatrics, 9.","DOI":"10.3389\/fped.2021.632272"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"e26779","DOI":"10.2196\/26779","article-title":"Evaluating the effectiveness of gamification on physical activity: Systematic review and meta-analysis of randomized controlled trials","volume":"24","author":"Mazeas","year":"2022","journal-title":"Journal of Medical Internet Research"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1109\/TTS.2024.3453396","article-title":"Mitigating risk and ensuring human flourishing using design standards: IEEE 2089\u20132021 an age appropriate digital services framework for children","volume":"5","author":"Michael","year":"2024","journal-title":"IEEE Transactions on Technology and Society"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1057\/s41599-023-02243-3","article-title":"A bibliometric analysis of the use of the gamification octalysis framework in training: Evidence from web of science","volume":"10","author":"Mohanty","year":"2023","journal-title":"Humanities and Social Sciences Communications"},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Muniandy, N., Kamsin, A., and Sabri, M. I. (, January November). Enhancing children\u2019s health awareness through narrative game-based learning using digital technology: A framework and methodology. 2023 9th International HCI and UX Conference in Indonesia (CHIuXiD), Bali, Indonesia.","DOI":"10.1109\/CHIuXiD59550.2023.10452746"},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Nadeem, M., Oroszlanyova, M., and Farag, W. (2023). Effect of digital game-based learning on student engagement and motivation. Computers, 12, (9).","DOI":"10.3390\/computers12090177"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1108\/INTR-07-2023-0558","article-title":"Gamification as a panacea to workplace cyberloafing: An application of self-determination and social bonding theories","volume":"35","author":"Nivedhitha","year":"2025","journal-title":"Internet Research"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/s42979-023-02579-2","article-title":"System thinking in gamification","volume":"5","author":"Nordby","year":"2024","journal-title":"SN Computer Science"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1111\/bjet.13172","article-title":"Frustration in technology-rich learning environments: A scale for assessing student frustration with e-textbooks","volume":"53","author":"Novak","year":"2022","journal-title":"British Journal of Educational Technology"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1108\/CI-09-2022-0247","article-title":"Application of gamification for sustainable construction: An evaluation of the challenges","volume":"24","author":"Oke","year":"2024","journal-title":"Construction Innovation"},{"key":"ref_92","first-page":"3456","article-title":"Understanding children\u2019s perceptions of game elements in an online gamified intervention: Contributions by the self-determination theory","volume":"40","author":"Oliveira","year":"2024","journal-title":"International Journal of Human-Computer Interaction"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s40561-022-00194-x","article-title":"The effects of personalized gamification on students\u2019 flow experience, motivation, and enjoyment","volume":"9","author":"Oliveira","year":"2022","journal-title":"Smart Learning Environments"},{"key":"ref_94","first-page":"345","article-title":"Digital game-based technology for English language learning in preschools and primary schools: A systematic analysis","volume":"16","author":"Ongoro","year":"2023","journal-title":"IEEE Transactions on Learning Technologies"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1111\/teth.12685","article-title":"Faith in frames: Constructing a digital game-based learning framework for religious education","volume":"27","author":"Papakostas","year":"2024","journal-title":"Teaching Theology & Religion"},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Pel\u00e1ez, C. A., and Solano, A. (2023). A practice for the design of interactive multimedia experiences based on gamification: A case study in elementary education. Sustainability, 15, (3).","DOI":"10.3390\/su15032385"},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Pellas, N., Mystakidis, S., and Christopoulos, A. (2021). A systematic literature review on the user experience design for game-based interventions via 3D virtual worlds in K-12 education. Multimodal Technologies and Interaction, 5, (6).","DOI":"10.3390\/mti5060028"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"100839","DOI":"10.1016\/j.ijme.2023.100839","article-title":"Enhancing students\u2019 engagement through a business simulation game: A qualitative study within a higher education management course","volume":"21","author":"Pitic","year":"2023","journal-title":"The International Journal of Management Education"},{"key":"ref_99","first-page":"107892","article-title":"The role of playfulness in gamification for health behavior motivation","volume":"148","author":"Qiu","year":"2024","journal-title":"Computers in Human Behavior"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1007\/s11747-022-00845-y","article-title":"Digital technologies: Tensions in privacy and data","volume":"50","author":"Quach","year":"2022","journal-title":"Journal of the Academy of Marketing Science"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"102549","DOI":"10.1016\/j.ijinfomgt.2022.102549","article-title":"Gamification of cooperation: A framework, literature review and future research agenda","volume":"65","author":"Riar","year":"2022","journal-title":"International Journal of Information Management"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1080\/23299460.2022.2076985","article-title":"Responsible innovation at work: Gamification, public engagement, and privacy by design","volume":"9","author":"Ruggiu","year":"2022","journal-title":"Journal of Responsible Innovation"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"e3341","DOI":"10.1002\/rev3.3341","article-title":"Knowledge brokering to bridge the research-practice gap in education: Where are we now?","volume":"10","year":"2022","journal-title":"Review of Education"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1007\/s10639-024-12936-0","article-title":"Unveiling the landscape of generative artificial intelligence in education: A comprehensive taxonomy of applications, challenges, and future prospects","volume":"30","author":"Samala","year":"2025","journal-title":"Education and Information Technologies"},{"key":"ref_105","doi-asserted-by":"crossref","unstructured":"S\u00e1iz-Manzanares, M. C., Martin, C. F., Alonso-Mart\u00ednez, L., and Almeida, L. S. (2021). Usefulness of digital game-based learning in nursing and occupational therapy degrees: A comparative study at the University of Burgos. International Journal of Environmental Research and Public Health, 18, (22).","DOI":"10.3390\/ijerph182211757"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1080\/0144929X.2020.1817559","article-title":"Analyzing adaptive gamification design principles for online courses","volume":"41","author":"Sezgin","year":"2022","journal-title":"Behaviour & Information Technology"},{"key":"ref_107","doi-asserted-by":"crossref","unstructured":"Shaheen, A., Ali, S., and Fotaris, P. (2023). Assessing the efficacy of reflective game design: A design-based study in digital game-based learning. Education Sciences, 13, (12).","DOI":"10.3390\/educsci13121204"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"20835","DOI":"10.1038\/s41598-023-48835-6","article-title":"Impact of gamification on green consumption behavior integrating technological awareness, motivation, enjoyment, and virtual CSR","volume":"13","author":"Shahzad","year":"2023","journal-title":"Scientific Reports"},{"key":"ref_109","unstructured":"Shrestha, A. K., Barthwal, A., Campbell, M., Shouli, A., Syed, S., Joshi, S., and Vassileva, J. (2024). Navigating AI to unpack youth privacy concerns: An in-depth exploration and systematic review. arXiv."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"102511","DOI":"10.1016\/j.ijinfomgt.2022.102511","article-title":"Tailoring open government data portals for lay citizens: A gamification theory approach","volume":"65","author":"Simonofski","year":"2022","journal-title":"International Journal of Information Management"},{"key":"ref_111","doi-asserted-by":"crossref","unstructured":"Sinha, N. (2021). Introducing gamification for advancing current mental healthcare and treatment practices. IoT in healthcare and ambient assisted living, Springer.","DOI":"10.1007\/978-981-15-9897-5_11"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"101320","DOI":"10.1016\/j.cosust.2023.101320","article-title":"Serious games and citizen science; from parallel pathways to greater synergies","volume":"62","author":"Speelman","year":"2023","journal-title":"Current Opinion in Environmental Sustainability"},{"key":"ref_113","first-page":"567","article-title":"Pathways to inclusive and equitable quality education for people with disabilities: Cross-context conversations and mutual learning","volume":"29","author":"Singal","year":"2025","journal-title":"International Journal of Inclusive Education"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"2234","DOI":"10.1108\/MD-12-2020-1669","article-title":"Continuous learning at work: The power of gamification","volume":"61","author":"Torresan","year":"2023","journal-title":"Management Decision"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"106644","DOI":"10.1016\/j.chb.2020.106644","article-title":"The perils of gamification: Does engaging with gamified services increase users\u2019 willingness to disclose personal information?","volume":"116","author":"Trang","year":"2021","journal-title":"Computers in Human Behavior"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1145\/3673230","article-title":"Self-determination theory and HCI games research: Unfulfilled promises and unquestioned paradigms","volume":"31","author":"Tyack","year":"2024","journal-title":"ACM Transactions on Computer-Human Interaction"},{"key":"ref_117","doi-asserted-by":"crossref","unstructured":"Tzachrista, M., Gkintoni, E., and Halkiopoulos, C. (2023). Neurocognitive profile of creativity in improving academic performance\u2014A scoping review. Education Sciences, 13, (11).","DOI":"10.3390\/educsci13111127"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"512","DOI":"10.59653\/pancasila.v2i01.512","article-title":"Impact of digital learning platforms on behaviour change communication in public health education","volume":"2","author":"Udoudom","year":"2023","journal-title":"Pancasila International Journal of Applied Social Science"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1080\/0144929X.2020.1849401","article-title":"Gamification of query-driven knowledge sharing systems","volume":"41","author":"Kirshner","year":"2022","journal-title":"Behaviour & Information Technology"},{"key":"ref_120","first-page":"106276","article-title":"Real-world and game-based learning to enhance decision-making","volume":"138","year":"2024","journal-title":"Nurse Education Today"},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"100081","DOI":"10.1016\/j.ijedro.2021.100081","article-title":"Teachers\u2019 perceptions of the impact of technology on children and young people\u2019s emotions and behaviours","volume":"2","author":"Ventouris","year":"2021","journal-title":"International Journal of Educational Research Open"},{"key":"ref_122","doi-asserted-by":"crossref","unstructured":"Vijay, M., and Jayan, J. P. (, January August). Evolution of research on adaptive gamification: A bibliometric study. 2023 International Conference on Circuit Power and Computing Technologies (ICCPCT), Kollam, India.","DOI":"10.1109\/ICCPCT58313.2023.10245165"},{"key":"ref_123","first-page":"1","article-title":"Gameful education: A study of gamifiter application\u2019s role in promoting physical activity and active lifestyle","volume":"11","author":"Prycl","year":"2024","journal-title":"Smart Learning Environments"},{"key":"ref_124","doi-asserted-by":"crossref","unstructured":"Wang, G., Zhao, J., Van Kleek, M., and Shadbolt, N. (5, January April). Informing age-appropriate AI: Examining principles and practices of AI for children. 2022 CHI Conference on Human Factors in Computing Systems, New Orleans, LA, USA.","DOI":"10.1145\/3491102.3502057"},{"key":"ref_125","doi-asserted-by":"crossref","unstructured":"Wang, K., Liu, P., Zhang, J., Zhong, J., Luo, X., Huang, J., and Zheng, Y. (2023). Effects of digital game-based learning on students\u2019 cyber wellness literacy, learning motivations, and engagement. Sustainability, 15, (7).","DOI":"10.3390\/su15075716"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"e30390","DOI":"10.2196\/30390","article-title":"Conceptual ambiguity surrounding gamification and serious games in healthcare: Literature review and development of game-based intervention reporting guidelines (GAMING)","volume":"23","author":"Warsinsky","year":"2021","journal-title":"Journal of Medical Internet Research"},{"key":"ref_127","first-page":"234","article-title":"Digital game-based learning in music education: A systematic review between 2011 and 2023","volume":"46","author":"Weatherly","year":"2024","journal-title":"Research Studies in Music Education"},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"e30364","DOI":"10.2196\/30364","article-title":"The development of an mHealth tool for children with long-term illness to enable person-centered communication: User-centered design approach","volume":"5","author":"Chaplin","year":"2022","journal-title":"JMIR Pediatrics and Parenting"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1080\/10447318.2021.1990517","article-title":"Internet-of-gamification: A review of literature on IoT-enabled gamification for user engagement","volume":"38","author":"Xiao","year":"2022","journal-title":"International Journal of Human-Computer Interaction"},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"104578","DOI":"10.1016\/j.compedu.2022.104578","article-title":"The influence of digital educational games on preschool children\u2019s creative thinking","volume":"189","author":"Xiong","year":"2022","journal-title":"Computers & Education"},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/j.jad.2021.06.070","article-title":"Psychological interventions of virtual gamification within academic intrinsic motivation: A systematic review","volume":"293","author":"Xu","year":"2021","journal-title":"Journal of Affective Disorders"},{"key":"ref_132","doi-asserted-by":"crossref","unstructured":"Xu, M., Luo, Y., Zhang, Y., Xia, R., Qian, H., and Zou, X. (2023). Game-based learning in medical education. Frontiers in Public Health, 11.","DOI":"10.3389\/fpubh.2023.1113682"},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1080\/0144929X.2020.1733088","article-title":"Using gamification elements for competitive crowdsourcing: Exploring the underlying mechanism","volume":"40","author":"Yang","year":"2021","journal-title":"Behaviour & Information Technology"},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1007\/s12528-021-09271-5","article-title":"Gamification in education: A mixed-methods study of gender on computer science students\u2019 academic performance and identity development","volume":"33","author":"Zahedi","year":"2021","journal-title":"Journal of Computing in Higher Education"},{"key":"ref_135","first-page":"1519880","article-title":"Meta-analysis on investigating and comparing the effects on learning achievement and motivation for gamification and game-based learning","volume":"2022","author":"Zhang","year":"2022","journal-title":"Education Research International"},{"key":"ref_136","unstructured":"Zhang, R., Cheng, G., and Zou, D. (2025). Effects of digital game elements on engagement and vocabulary development, University of Hawaii Press."},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1145\/3555608","article-title":"Understanding teenage perceptions and configurations of privacy on Instagram","volume":"6","author":"Zhao","year":"2022","journal-title":"Proceedings of the ACM on Human-Computer Interaction"},{"key":"ref_138","first-page":"164892","article-title":"An innovative multi-layer gamification framework for improved STEM learning experience","volume":"9","author":"Zhao","year":"2021","journal-title":"IEEE Access"},{"key":"ref_139","first-page":"145","article-title":"Comparison of gamification, game-based learning, and serious games in medical education: A scientometrics analysis","volume":"11","author":"Zohari","year":"2023","journal-title":"Journal of Advances in Medical Education & Professionalism"},{"key":"ref_140","doi-asserted-by":"crossref","unstructured":"Zolfaghari, Z., Karimian, Z., Zarifsanaiey, N., and Farahmandi, A. Y. (2025). A scoping review of gamified applications in English language teaching: A comparative discussion with medical education. BMC Medical Education, 25, (1).","DOI":"10.1186\/s12909-025-06822-7"}],"container-title":["Behavioral Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-328X\/15\/7\/847\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:57:28Z","timestamp":1760032648000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-328X\/15\/7\/847"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,24]]},"references-count":140,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["bs15070847"],"URL":"https:\/\/doi.org\/10.3390\/bs15070847","relation":{},"ISSN":["2076-328X"],"issn-type":[{"value":"2076-328X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,24]]}}}