Background: Adherence to effective Web-based interventions for common mental disorders (CMDs) and well-being remains\na critical issue, with clear potential to increase effectiveness. Continued identification and examination of ââ?¬Å?activeââ?¬Â technological\ncomponents within Web-based interventions has been called for. Gamification is the use of game design elements and features\nin nongame contexts. Health and lifestyle interventions have implemented a variety of game features in their design in an effort\nto encourage engagement and increase program adherence. The potential influence of gamification on program adherence has\nnot been examined in the context of Web-based interventions designed to manage CMDs and well-being.\nObjective: This study seeks to review the literature to examine whether gaming features predict or influence reported rates of\nprogram adherence in Web-based interventions designed to manage CMDs and well-being.\nMethods: A systematic review was conducted of peer-reviewed randomized controlled trials (RCTs) designed to manage CMDs\nor well-being and incorporated gamification features. Seven electronic databases were searched.\nResults: A total of 61 RCTs met the inclusion criteria and 47 different intervention programs were identified. The majority were\ndesigned to manage depression using cognitive behavioral therapy. Eight of 10 popular gamification features reviewed were in\nuse. The majority of studies utilized only one gamification feature (n=58) with a maximum of three features. The most commonly\nused feature was story/theme. Levels and game leaders were not used in this context. No studies explicitly examined the role of\ngamification features on program adherence. Usage data were not commonly reported. Interventions intended to be 10 weeks in\nduration had higher mean adherence than those intended to be 6 or 8 weeks in duration.\nConclusions: Gamification features have been incorporated into the design of interventions designed to treat CMD and well-being.\nFurther research is needed to improve understanding of gamification features on adherence and engagement in order to inform\nthe design of future Web-based health interventions in which adherence to treatment is of concern. Conclusions were limited by\nvaried reporting of adherence and usage data.
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