Patel Mitesh S, Benjamin Emelia J, Volpp Kevin G, Fox Caroline S, Small Dylan S, Massaro Joseph M, Lee Jane J, Hilbert Victoria, Valentino Maureen, Taylor Devon H, Manders Emily S, Mutalik Karen, Zhu Jingsan, Wang Wenli, Murabito Joanne M
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia.
JAMA Intern Med. 2017 Nov 1;177(11):1586-1593. doi: 10.1001/jamainternmed.2017.3458.
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.
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.
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.
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.
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).
Gamification designed to leverage insights from behavioral economics to enhance social incentives significantly increased physical activity among families in the community.
clinicaltrials.gov Identifier: NCT02531763.
游戏化，即将诸如积分和等级等游戏设计元素应用于非游戏情境，常用于数字健康干预措施，但关于其有效性的证据有限。
运用行为经济学的见解设计一种游戏化干预措施，以增强家庭内部的社会激励因素，从而增加身体活动量。
设计、地点和参与者：行为经济学弗雷明汉激励试验（BE FIT）是一项随机临床试验，干预期为12周，随访期为12周。该调查是2015年12月7日至2016年8月14日期间的一项基于社区的研究。修正意向性分析的参与者为弗雷明汉心脏研究中登记的成年人，这是一个长期的家庭队列。
所有参与者使用可穿戴设备或智能手机追踪每日步数，确定基线，选择步数目标增量，并在24周内通过短信或电子邮件接收关于目标完成情况的每日个人反馈。游戏化组的家庭在12周干预期间可根据身体活动目标的达成情况赚取积分并提升等级。游戏设计旨在增强协作、责任感和同伴支持。
主要结局是干预期间达到步数目标的参与者天数比例。次要结局包括随访期间达到步数目标的参与者天数比例，以及干预期和随访期内每日平均步数的变化。
在由94个家庭组成的200名成年人中，平均年龄为55.4岁，56.0%（n = 112）为女性。在干预期间，游戏化组的参与者在更大比例的参与者天数中达到了步数目标（0.53对0.32；调整差异为0.27；95%置信区间，0.20 - 0.3（此处原文有误，应为0.33）；P < 0.（此处原文有误，应为.001）），并且与对照组相比，每日平均步数较基线有显著更大的增加（1661对636；调整差异为953；95%置信区间，505 - 140（此处原文有误，应为1401）；P < 0.（此处原文有误，应为.001））。在随访期间，游戏化组的身体活动量有所下降，但在达到步数目标的参与者天数比例方面（0.44对0.33；调整差异为0.12；95%置信区间，0.05 - 0.19；P < 0.（此处原文有误，应为.001））以及与基线相比的每日平均步数方面（1385对798；调整差异为494；95%置信区间，170 - 81（此处原文有误，应为818）；P < 0.（此处原文有误，应为.01））仍显著高于对照组。
旨在运用行为经济学见解增强社会激励因素的游戏化显著增加了社区家庭的身体活动量。
clinicaltrials.gov标识符：NCT0253（此处原文有误，应为1763）。
