Using Gamified Elements to Increase Daily Step Count in University Students in Taiwan A RCT

Summary

Background: Physical inactivity is a major factor in the onset of non-communicable diseases (NCDs) worldwide. Heart disease, Diabetes mellitus, and hypertensive diseases are among the top 10 leading causes of death in Taiwan in 2021. Although 81.6% of Taiwanese participants in a 2022 nationwide survey responded that they exercised regularly, the Health Promotion Administration stated that 50.3% of the population from 2017-2020 is overweight or obese, up from 32.7% in 1993-1996. The intention-behavior gap in habit formation is difficult to overcome for most, especially when self-motivation is the biggest factor. Gamification, the use of game elements in non-game settings, and game elements can be used to lower the bar necessary for individuals to develop healthier daily habits.

Aim: This study aims to investigate the effects of applying gamified elements on the daily lives of university students in Taiwan to increase their daily step count as compared to their baseline and the control group, along with changes in certain health indicators, overall physical activity, sleep behavior \& quality, and mental health, whether combining gamified elements is more effective than implementing gamified elements individually, and if implicit or explicit gamification is more effective.

Methods: 255 participants were recruited and, after providing informed consent, randomized into four groups: (1) Control, (2) Individual Gamified Elements Group (IGG), (3) Combined Gamified Elements Group (CGG), and (4) Explicit Gamification Group (EGG). Control group participants will add the official LINE account, submit weekly summaries of their DSC and to complete the three questionnaires. IGG, CGG, and EGG participants will be asked to add the official LINE account, download Google Fit onto their smartphone, establish a baseline for the first seven days, then set a Daily Step Count Goal (DSG) of an increase of 25%, 33%, or 50% on Day 7 of the study. IGG and CGG participants will then engage in various interventions, including Nudging (Week Two), and gamified interventions, including Points, Badges, \& Leaderboards (PBLs) (Weeks Three \& Four), Social Aspects (Weeks Five and Six), and Personalized Avatar \& Progression via Explicit Gamification (Weeks Seven \& Eight). IGG participants will engage with the multiple forms of gamified elements separately throughout the experiment, while CGG participants will slowly combine gamified elements as the experiment progresses (i.e. Week 2 Nudging, Week 3 Nudging + Points, Week 4 Nudging + Points + Leaderboard, etc.). EGG Participants will play Pikmin Bloom, which includes various gamified elements, for the duration of the study (8 weeks). Participants will complete the questionnaire at three points: the beginning of the experiment (initial check-in), the end of the experiment (8 weeks), and at follow-up (twelve weeks). The primary aim will be to determine whether or not the implementation of gamified elements will lead to an increase in overall DSC from baseline to 8 and 12 weeks, along with a certain percentage of patient-days that self-set DSGs are met at 8 and 12 weeks, as compared to the control group. Secondary outcomes include: how increasing participants' DSC will affect their health indicators, physical activity, mental health, and sleep behavior \& quality, comparing the effectiveness of combined gamified elements vs. individual gamified elements in increasing participants' DSC, and if implicit or explicit gamification is more effective at increasing DSC.

Conditions

• Physical Activity
• Gamification
• Daily Step Count

Interventions

BEHAVIORAL

Points and Leaderboards

Participants will have the opportunity to gain points if they meet their self-set daily step goal throughout the experiment period. Participants will also compete with others in their own respective groups on a leaderboard in regards to each day's daily step count.

BEHAVIORAL

Social Aspects

Participants will be randomly assigned into groups of three to compete with other groups based on their daily step count. Each day, one participant will be randomly selected to represent the group against their opponent. If they walked more than their randomly selected opponent, the participant's group will receive a positive, encouraging message congratulating them for winning that day. If they did not walk more than their randomly selected opponent, they will receive a motivational message to encourage them to walk more.

BEHAVIORAL

Health Messages

Experiment participants will receive messages that encourage healthy behaviors. These include topics such as: nutrition, sleep, physical activity, and decreased consumption/use of unhealthy products (tobacco, alcohol, etc.).

BEHAVIORAL

Pikmin Bloom

Participants will play the mobile game Pikmin Bloom, which encourages users to increase their daily step count and allows them to utilize various gamified elements to do so. The game has many gamified elements included, such as personalization and avatar, social aspects, competition, collaboration, progression, and many more.

Sponsors & Collaborators

• Taipei Medical University

  lead OTHER

Principal Investigators

• Feng-Jen Tsai, PhD · Taipei Medical University

Study Design

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

35 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2024-04-01

Primary Completion

2025-02-28

Completion

2025-02-28

Countries

• Taiwan

Study Locations