Be Fit

Gamification designed to leverage insights from behavioral economics offers a promising approach to improve daily health behaviors at low cost

Mitesh Patel, MD, MBA, MS
Principal Investigator
Tori Hilbert, MPH, RD
Operations Manager
Devon Taylor, MPH
Implementation Lead

Aim and key question

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.

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? The objective of the study was to test the effectiveness of a gamification intervention designed using insights from behavioral economics to enhance social incentives within families to increase physical activity.

Intervention and design

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.

Way to Health use

  • Study Enrollment: Enroll and randomize participants across the study arms

  • Device Integration: Collect data from the devices by patient

  • Rules Engine: Set and monitor activity and achievement vs targets

  • Gamification: Award points and levels

Findings and conclusions

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.

This study is important in that it shows that gamification designed to leverage insights from behavioral economics to enhance social incentives could offer a promising approach to improve daily health behaviors.