Imran Ho Dina Syazana Ho, Jabir Fathiah, Sallahuddin Siti Norain, Ahwan Nur Atiqah Mohd, Sathiyaseelan Ghaneshinee, Zahari Mohamad Izzi, Hassan Mohd Rohaizat, Nawi Azmawati Mohammed
Department of Public Health Medicine, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia.
Department of Public Health Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Tob Induc Dis. 2025 Jun 26;23. doi: 10.18332/tid/203937. eCollection 2025.
The rise of mobile health (mHealth) has led to increased adoption of mobile apps for smoking cessation. The integration of gamification has been found to be positively associated with higher app engagement, smokers' self-efficacy and motivation to quit. This systematic review and meta-analysis aimed to identify and assess the game elements incorporated into smoking cessation applications and evaluate the effectiveness of gamified interventions on smoking cessation outcomes.
A comprehensive search was conducted in PubMed, Web of Science, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and WHO International Clinical Trials Registry Platform (ICRTP) and ClinicalTrials.gov databases from inception to November 2024. Eligible studies included interventional trials comparing gamification-based smoking cessation strategies with non-gamified control groups. Two independent reviewers performed study screening, data extraction, and quality assessment using the Cochrane Handbook for Systematic Reviews. Outcomes were narratively synthesized, and comparable studies were pooled based on follow-up time and abstinence duration. A random-effects meta-analysis assessed smoking abstinence using relative risk (RR) as the effect measure. Heterogeneity was evaluated using Cochran's Q and I index. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the reference number CRD42024611631.
Fifteen randomized controlled trials (RCTs) with a total of 5075 participants met the inclusion criteria. Key gamification elements included competition, milestone recognition, storytelling, and rewards. The pooled meta-analysis demonstrated a significant impact of gamified interventions on smoking abstinence. The strongest effects were observed within the first six months of intervention (RR=1.91; 95% CI: 1.47-2.47, p<0.001). Long-term effects remained significant beyond six months (RR=1.37; 95% CI: 1.05-1.79, p=0.02). Sensitivity analysis confirmed the robustness of these findings.
Gamification-based interventions significantly improve smoking cessation outcomes, particularly in the short-term. However, the diminishing effects over time highlight the importance of long-term engagement. While these findings are promising, limitations such as heterogeneity in follow-up periods, reliance on some self-reported outcomes, and the inability to isolate specific gamification components may affect the generalizability of results. Leveraging gamification's potential can still transform smoking cessation efforts, offering scalable and engaging solutions for lasting behavioral change.
移动健康（mHealth）的兴起促使戒烟移动应用的使用增加。研究发现，游戏化的融入与更高的应用参与度、吸烟者的自我效能感和戒烟动机呈正相关。本系统评价和荟萃分析旨在识别和评估戒烟应用中包含的游戏元素，并评估游戏化干预对戒烟效果的有效性。
对PubMed、科学网、Scopus、Cochrane对照试验中央注册库（CENTRAL）以及世界卫生组织国际临床试验注册平台（ICRTP）和ClinicalTrials.gov数据库进行全面检索，检索时间从建库至2024年11月。符合条件的研究包括比较基于游戏化的戒烟策略与非游戏化对照组的干预试验。两名独立评审员使用Cochrane系统评价手册进行研究筛选、数据提取和质量评估。对结果进行叙述性综合分析，并根据随访时间和戒烟持续时间对可比研究进行汇总。采用随机效应荟萃分析，以相对风险（RR）作为效应量评估戒烟情况。使用Cochran's Q和I指数评估异质性。该研究已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42024611631。
15项随机对照试验（RCT）共5075名参与者符合纳入标准。关键的游戏化元素包括竞争、里程碑认可、故事叙述和奖励。汇总的荟萃分析表明，游戏化干预对戒烟有显著影响。在干预的前六个月内观察到最强的效果（RR = 1.91；95% CI：1.47 - 2.47，p < 0.001）。六个月后长期效果仍然显著（RR = 1.37；95% CI：1.05 - 1.79，p = 0.02）。敏感性分析证实了这些发现的稳健性。
基于游戏化的干预显著改善戒烟效果，尤其是在短期内。然而，随着时间推移效果逐渐减弱凸显了长期参与的重要性。虽然这些发现很有前景，但随访期的异质性、对一些自我报告结果的依赖以及无法分离特定游戏化组件等局限性可能会影响结果的普遍性。利用游戏化的潜力仍可改变戒烟努力，为持久的行为改变提供可扩展且引人入胜的解决方案。
