Table 2 Characteristics of included studies
Reference | Study design/ Number and time of follow-ups | Country | Sample1 and drop-outs | Game-based elements | Duration | Intervention |
|---|---|---|---|---|---|---|
Bostock et al. (2019) [15] | RCT / 2 (after 8 weeks, after 9–11 weeks) | United Kingdom | Age: M = 35.5 (23–61 years) Intervention group (n = 128): Female sex: 60.2% Drop-out: 18.0% Control group (n = 110): Female sex: 58.2% Drop-out: 26.4% Handling of drop-outs: Per protocol analysis | - Reward - Progress - Surprise - Sensation2 | 8 weeks | Intervention group: - Participants had 8 weeks to use the app “HeadSpace” with 45 meditation sessions. One session should be completed each day. A weekly reminder was sent from the research team Wait-list group: - The control group was once sent a link to an online advice for work stress from the NHS |
Champion et al. (2018) [23] | RCT / 2 (afterday 10, after day 30) | United Kingdom | Intervention group (n = 38): Age: M = 40.2 Female sex: 44.8% Drop-out: 23.7% Control group (n = 36): Age: M = 38.2 Female sex: 72.7% Drop-out: 8.3% Handling of drop-outs: Intention-to-treat analysis + complete case analysis | - Reward - Progress - Surprise - Sensation2 | 30 days | Intervention group: - Participants had 30 days access to the self-guided mindfulness meditation app and were encouraged to use the app for 10–20 min daily. 3 levels with 10 sessions to be completed each. Further, e-mails were sent with questionnaires and notes to encourage them to continue Wait-list group: - Participants received only the questionnaires and follow-up emails informing them that they would have access to the app after 30 days |
Collins et al. (2019) [24] | Experimental and field study with randomization/ 2 (after presentation of task/after break activity, after 10 min or 5 days past intervention) | United Kingdom | Study 1 (n = 45) Age: 19–36 years Female sex: 57.8% Drop-out: 8.9% (due to technical issue) Study 2 (n = 20) Age: 19–58 years Female sex: 60.0% Drop-out: No information Handling of drop-outs: No information on numbers of participants at intervention and control group Per-protocol analysis | - Reward - Progress - Surprise - Sensation2 | Study 1: 10 min for the intervention Study 2: 5 days | Study 1: Intervention group (Mindfulness app): - Participants used a 10 min mindfulness exercise from HeadSpace during their 10 min break Control group: - Participants played Block! Hexa Puzzle during their 10 min break Control group: - Participants were just sitting in a room and resting, and could use the toy called fidget spinner during their 10 min break Study 2: The same tasks were for the digital games group and the mindfulness app group as in study 1, except that participants had to do their after-work break activity for 10 min every 5 days. A daily email reminder was sent. No other control group was included |
Costa et al. (2018) [25] | RCT / 1 | Portugal | Intervention group (n = 20): Age: M = 73 Female sex: 50.0% Comparison group (n = 20): Age: M = 69 Female sex: 60.0% Control group (n = 20): Age: M = 69 Female sex: 65.0% Handling of drop-outs: No drop-outs | - Challenges - Storytelling - Social sharing - Sensation | 6 weeks | Intervention group: - Participants first tested the Game-Based Learning Program (GBLP) which includes a set of missions related to physical and cognitive activity by travelling to Hizen, 1709. Further, mini-games could be played. In the second part, they used a computer-assisted platform (CAP) with videos on cognitive activity, nutrition, or human security topics. At the end, users could share their progress and daily life missions Comparison group: - Same intervention as in the intervention group, just the other way around Wait-list group: - No intervention |
Deady et al. (2022) [26] | RCT / 3(after 5 weeks, after 3 months, after 12 months) | Australia | Intervention group (n = 1,131): Age: M = 40.2 (18–78 years) Female sex: 27.6% Drop-out: 0.3% Control group (n = 1,144): Age: M = 40.3 (18–68 years) Female sex: 24.0% Drop-out: 0.1% Handling of drop-outs: Intention-to-treat analysis | - Challenges | 30 days | Intervention group: - Participants had 30 days of access to the behavioural activation and mindfulness-based app HeadGear. They needed to complete 5–10 min challenges per day Control group: - Participants used for 30 days an app similar to HeadGear, which includes a risk calculator and mood tracker |
Economides et al. (2018) [27] | RCT / 1 (after 1–2 months) | - | Age: 18–49 years Intervention group (n = 41): Female sex: 63.4% Control group (n = 28): Female sex: 53.6% Handling of drop-outs: No detailed information on drop-outs stratified by intervention vs. control. Overall drop-out 27.5% Per-protocol analysis | - Reward - Progress - Surprise - Sensation2 | 1 month | Intervention group: - Participants had one month of access to the app HeadSpace and needed to complete the first 10 introductory sessions including an introduction to meditation and breath awareness or body scanning techniques Control group: - Participants had one month of access to 10 audiobook sessions from the Headspace Guide to Meditation and Mindfulness through the HeadSpace app |
Firestone et al. (2018) [28] | cRCT / 1 (after 12 weeks) | New Zealand | Age: ≥ 18 years Intervention group (n = 389): Female sex: 65.8% Control group (n = 405): Female sex: 65.2% Handling of drop-outs: No information on drop-outs Per-protocol analysis | - Goal - Reward - Progress - Social sharing | 12 weeks | Intervention group: - Participants had 12 weeks of access to the OL@-OR@ m-Health program Comparison group: - Participants received a control version of the OL@-OR@ tool which was similar in visual design but that only collected baseline and outcome data |
Flett et al. (2019) [29]3 | RCT / 2(t1 = after 10 days, t2 = after 30 days) | New Zealand | Age: M = 20.1 (18–49 years) Intervention group (n = 72) Drop-out at t1: 0% Drop-out at t2: 7.0% Comparison group (n = 63) Drop-out at t1: 0% Drop-out at t2: 8.0% Control group (n = 75) Drop-out at t1: 2.8% Drop-out at t2: 10.7% Handling of drop-outs: Per-protocol analysis | - Reward - Progress - Surprise - Sensation2 | 10 days, up to 40 days | Intervention group (HeadSpace): - Participants needed to complete the introductory level over 10 days. After that, they could continue using the app for 30 more days Comparison group (Smiling Mind): - Participants received the Smiling Mind app with the “For adults” program for 10 min each day over 10 days and could continue using the app for a further 30 days. The program included practices like mindful breathing, body scan, or sitting meditation Control group: - Participants used 40 days the app Evernote while they needed to write down all the things they can remember doing on this day last week for 10 min every day for 10 days |
Howells et al. (2016) [30] | RCT / 1 (after 10 days) | 11 countries (including Australia, USA, Poland, Switzerland, Malta, Sweden, and Singapore; with no information on further countries) | Intervention group (n = 97): Age: M = 39.7 Female sex: 85.6% Drop-out: 41.3% Control group (n = 97): Age: M = 40.9 Female sex: 90.7% Drop-out: 34.1% Handling of drop-outs: Per-protocol analysis | - Reward - Progress - Surprise - Sensation2 | 10 days | Intervention group: - Participants needed to follow the daily mindfulness exercises feature of the ‘‘Take 10’’ (introductory level) program for 10 min a day over 10 days Control group: - Participants used the list-making app Catch notes and needed to use the checklist function to ‘create an outline of what they did on this day last week’ for 10 min a day over 10 days |
Keeman et al. (2017) [31]4 | Experimental study with randomization/ 1 (after 1 week) | New Zealand | Age: M = 21.5 Intervention group (n = 32): Female sex: 75.0% Control group (n = 28): Female sex: 71.4% Handling of drop-outs: No drop-outs, but removal of 10 participants from analysis (5 for intervention and 5 for control group) | - Levels - Rewards - Leaderboard | 1 week | Intervention group: - Participants were required to play the Wellbeing Game every day for seven days. This game contains its own logged activities, primary psychosocial interventions, secondary interventions and different coping strategies Wait-list group: - Participants did not receive any intervention during those 7 days. They just had to complete the survey and an image task at the beginning and after one week (the same as the control condition) |
Kelders et al. (2018) [32]2,5 | RCT / 1 (after 12 weeks) | Nether-lands | Intervention group (n = 39): Age: M = 23.4 Female sex: 71.8% Drop-out: 0% Control group (n = 36): Age: M = 22.2 Female sex: 58.3% Drop-out: 2.8% (due to technical issue) Handling of drop-outs: Per-protocol analysis | - Challenges - Rewards - Progress - Avatar - Storytelling/ Narration - Sensation | 12 weeks | Intervention group: - Participants have 12 weeks of access to the self-guided “This is your life” web-based positive psychology intervention, which included 8 lessons with approximately 5 exercises within 2 challenges Comparison group: - Participants received the same intervention but the layout and wording differed from the intervention group so that it was non-gamified |
Litvin et al. (2020) [33] | RCT / 2 (after 17 days, after 35 days) | United Kingdom | Age: 16 years or older Intervention group (n = 135): Female sex: 44.4% Drop-out: 39.2% Control group (n = 89): Female sex: 29.2% Drop-out: 67.0% Wait-list group (n = 130): Female sex: 41.5% Drop-out: 40.4% Handling of drop-outs: Per-protocol (complete case) analysis | - Challenges - Rewards - Level - Avatar - Storytelling/ Narration | 5 weeks | Intervention group: - Participants used the App “eQuoo” and had to complete 5 levels in 5 weeks. They learned two skills at each level from CBT, positive psychology and systematic therapies Control group: - Participants used the App “CBT Thought Diary”, which is based on CBT and positive psychology. They had to complete a mood diary and do typical CBT exercises Wait-list group: - Participants answered the questionnaires that each group had was required to answer without receiving an intervention |
Myers et al (2017) [34] | RCT / 2 (t1 = after 30 days, t2 = after 60 days) | USA | Intervention group (n = 237): Age: M = 41.58 Female sex: 75.1% Drop-out at t1: 41.0% Drop-out at t2: 46.9% Control group (n = 242): Age: M = 41.93 Female sex: 76.9% Drop-out at t1: 32.6% Drop-out at t2: 33.5% Handling of drop-outs: Intention-to-treat analysis + complier analysis | - Challenges - Progress - Social sharing - Sensation | 30 days | Intervention group: - Participants had access to 152 challenges designed to increase well-being Control group: - Participants had access to a website with numerous links on the topic of well-being |
Przybylko et al. (2021) [35] | RCT / 2 (after 12, after 24 weeks) | Australia | Intervention group (n = 255): Age: M = 49.5 Female sex: 69.8% Drop-out: 37.6% Control group (n = 253): Age: M = 45.4 Female sex: 73.3% Drop-out: 36.0% Handling of drop-outs: Per-protocol analysis | - Challenges - Rewards - Leaderboard - Social sharing - Sensation | 10 weeks | Intervention group: - Participants were given access to “The Live More Project” or “Te Lift Project”. In each weekly session, users viewed 1 out of 10 topic base learning videos and completed daily and weekly challenges Wait-list group: - Participants were placed on a waitlist without access to the intervention |
Routledge et al. (2021) [36] | RCT / 1 (after 4 weeks) | Australia | Intervention group (n = 170): Age: M = 42.6 Female sex: 66.5% Control group (n = 182): Age: M = 42.9 Female sex: 67.0% Handling of drop-outs: No detailed information on drop-outs stratified by intervention vs. control available. Therefore, presented sample sizes refer to the samples being analyzed Overall drop-out 53.8% Intention-to treat analysis + Per-protocol analysis | - Progress | 4 weeks | Intervention group: - Participants were given access to “MyBrainSolutions” which includes online games addressing cognitive and emotional performance. Users needed to play 2–3 times a week for 20–30 min Wait-list group: - Participants were placed on a waitlist without access to the intervention |
Schakel et al. (2020) [37] | RCT / 2 (after 6–7 weeks, after 10 weeks) | Nether-lands | Intervention group (n = 35): Age: M = 22.5 Female sex: 0% Drop-out: 17.2% Control group (n = 34): Age: M = 22.9 Female sex: 0% Drop-out: 8.9% Handling of drop-outs: Per-protocol analysis | - Goals - Storytelling/ Narration | 6 weeks | Intervention group: - Participants received a guided ICBT intervention for 6 weeks, which contained 6 modules guided by a therapist. Additionally, users played a serious game (Ivanovna©) that included comparable modules as the guided intervention Control group: - Participants did not receive any intervention |