Effectiveness of gamified team competition in the context of mHealth intervention for medical interns: a micro-randomized trial

Abstract

Background: Twin revolutions in wearable technologies and smartphone-delivered digital health interventions have significantly expanded the accessibility and uptake of personalized interventions in multiple domains of health sciences. Gamification, the application of gaming elements to increase enjoyment and engagement, has the potential to improve the effectiveness of digital health interventions. However, the effectiveness of competition gamification components remains poorly understood, challenging informed decisions on the potential adoption of these components in future studies and trial designs. We aimed to evaluate the effect of smartphone-based gamified team competition intervention on daily step count and sleep duration via a micro-randomized trial. Methods: We recruited first-year medical residents (interns) in the US, who downloaded the study app, provided consent, wore a wearable device, and completed a baseline survey. Teams were formed based on participating residents' institutions and specialties, and subsequently randomized weekly to the competition or non-competition arms. In the competition arm, opponent teams and competition type (step count or sleep duration) were also randomly selected. Competition participants had access to the current competition scoreboard and competition history via the study app; they also received scheduled competition-related push notifications in a competition week. We estimated the main and moderated causal effects of competition on proximal daily step count and sleep duration. This trial is registered with ClinicalTrials.gov (NCT05106439). Findings: Between April and June 2020, we enrolled 2,286 medical interns from 263 institutions, of whom 1,936 were formed into 191 teams that met the criteria for participation in competitions between July 6 and September 27, 2020. 1,797 participants who had pre-internship baseline information were included in the analysis. Relative to the no competition arm, competition intervention significantly increased the mean daily step count by 111.5 steps (SE 40.4, p=0.01), while competition did not significantly affect the mean daily sleep minutes (p=0.69). Secondary moderator analyses indicated that, for each additional week-in-study, the causal effects of competition on daily step count and sleep minutes decreased by 9.1 (11.6) steps (p=0.43) and 1.9 (0.6) minutes (p=0.003), respectively. Intra-institutional competition negatively moderated the causal effect of competition upon daily step count by -114.9 (93.7) steps (p=0.22). Interpretation: Gamified competition delivered via mobile app significantly increased daily physical activity which suggests that team competition can function as a mobile health intervention tool to increase short-term physical activity level.

Participant Engagement in Microrandomized Trials of mHealth Interventions: Scoping Review

“…Sensor data were the second most common measure of engagement. Overall, 35% (7/20) of the studies that explicitly measured engagement included at least 1 measure of this category [ 24 , 27 , 28 , 31 , 33 , 34 , 41 ]. Wang et al [ 34 ], for example, measured the proportion of days in a week that participants wore the study’s FitBit smartwatch to track their step counts and sleep duration.…”

Participant Engagement in Microrandomized Trials of mHealth Interventions: Scoping Review

“…and for studies involving wearable sensor technology the (3) usage of wearable sensors [19,22,23,26,28,29,36].…”

“…Interestingly, the measurement of engagement as participant retention was unique to studies that were designed to evaluate the effect of intervention components on health outcomes. For engagement as usage of wearable sensors, time spent wearing the sensors was the only indicator of engagement [19,22,23,26,28,29,36]. Wang et al [29] for example, measured the proportion of days in a week that participants wore the study's…”

“…For engagement as usage of wearable sensors, time spent wearing the sensors was the only indicator of engagement [19,22,23,26,28,29,36]. Wang et al [29] for example, measured the proportion of days in a week that participants wore the study's…”

“…The remaining two studies were designed to evaluate the effect of intervention components on health outcomes or to describe engagement. The former study assessed a time-based variable as its variable of interestthe causal effect of being in an intervention week on participant engagement [29]. The latter study assessed task-related variables (lapses in self-monitoring and behavioral goal attainment) and an anthropometric variable (weight change) as determinants of participant engagement [38].…”