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Original Investigation
October 2, 2017

Effect of a Game-Based Intervention Designed to Enhance Social Incentives to Increase Physical Activity Among FamiliesThe BE FIT Randomized Clinical Trial

Author Affiliations
  • 1Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 2Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia
  • 3Leonard Davis Institute Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
  • 4Department of Medicine, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
  • 5Framingham Heart Study, Framingham, Massachusetts
  • 6Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
  • 7Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
  • 8National Heart, Lung, and Blood Institute Intramural Program, Bethesda, Maryland
  • 9Merck Research Laboratories, Boston, Massachusetts
  • 10Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia
  • 11Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
JAMA Intern Med. Published online October 2, 2017. doi:10.1001/jamainternmed.2017.3458
Key Points

Question  Does gamification, the application of game design elements such as points and levels in nongame contexts, that uses insights from behavioral economics to enhance social incentives increase physical activity among families in the community?

Findings  In this randomized clinical trial of 200 adults comprising 94 families, participants in the gamification arm had significantly greater physical activity during the 12-week intervention than participants in the control arm, including the proportion of days that step goals were achieved and the change in the mean daily steps.

Meaning  Gamification designed to leverage insights from behavioral economics to enhance social incentives could offer a promising approach to improve daily health behaviors.

Abstract

Importance  Gamification, the application of game design elements such as points and levels in nongame contexts, is often used in digital health interventions, but evidence on its effectiveness is limited.

Objective  To test the effectiveness of a gamification intervention designed using insights from behavioral economics to enhance social incentives within families to increase physical activity.

Design, Setting, and Participants  The Behavioral Economics Framingham Incentive Trial (BE FIT) was a randomized clinical trial with a 12-week intervention period and a 12-week follow-up period. The investigation was a community-based study between December 7, 2015, and August 14, 2016. Participants in the modified intent-to-treat analysis were adults enrolled in the Framingham Heart Study, a long-standing cohort of families.

Interventions  All participants tracked daily step counts using a wearable device or a smartphone, established a baseline, selected a step goal increase, and received daily individual feedback on goal performance by text message or email for 24 weeks. Families in the gamification arm could earn points and progress through levels based on physical activity goal achievement during the 12-week intervention. The game design was meant to enhance collaboration, accountability, and peer support.

Main Outcomes and Measures  The primary outcome was the proportion of participant-days that step goals were achieved during the intervention period. Secondary outcomes included the proportion of participant-days that step goals were achieved during the follow-up period and the change in the mean daily steps during the intervention and follow-up periods.

Results  Among 200 adults comprising 94 families, the mean age was 55.4 years, and 56.0% (n = 112) were female. During the intervention period, participants in the gamification arm achieved step goals on a significantly greater proportion of participant-days (0.53 vs 0.32; adjusted difference, 0.27; 95% CI, 0.20-0.33; P < .001) and had a significantly greater increase in the mean daily steps compared with baseline (1661 vs 636; adjusted difference, 953; 95% CI, 505-1401; P < .001) than the control arm. During the follow-up period, physical activity in the gamification arm declined but remained significantly greater than that in the control arm for the proportion of participant-days achieving step goals (0.44 vs 0.33; adjusted difference, 0.12; 95% CI, 0.05-0.19; P < .001) and the mean daily steps compared with baseline (1385 vs 798; adjusted difference, 494; 95% CI, 170-818; P < .01).

Conclusions and Relevance  Gamification designed to leverage insights from behavioral economics to enhance social incentives significantly increased physical activity among families in the community.

Trial Registration  clinicaltrials.gov Identifier: NCT02531763

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