Researchers examine the impact of gamification on the effectiveness of digital health interventions

An adequate amount of sleep and physical activity helps alleviate several health conditions, such as obesity, depression and cardiovascular disease. However, the recommended amount of sleep and physical activity is not achieved in most cases.

An earlier US-based report indicates that more than a third of American adults fail to sleep the recommended seven hours each night. In addition, only one in four achieves the recommended 150 minutes of moderate physical activity each week.

She studies: Effectiveness of gamified team competition as an mHealth intervention for medical interns: a micro-randomized cluster study. Image Credit: BlurryMe/


Medical Internships provide intensive training for physicians for one year. During this time, interns are typically sleep deprived and have less physical activity, which affects their health and mental condition.

Often, medical interns are overwhelmed with constantly working in a highly stressful environment during their residency. However, time-intensive intervention strategies to monitor and alleviate these effects in medical trainees are non-existent.

Recent technological advances in wearable devices and smartphones offer the opportunity to deliver user-friendly interventions with minimal expense. Additionally, these devices obtain real-time measurements of the user’s physical activity and record geographic locations to deliver just-in-time (JITAI) personalized adaptive interventions offering temporal and spatial flexibility.

The effectiveness of smartphones and wearable-based interventions in analyzing health outcomes has been evaluated in many studies. Additionally, these studios introduced gamification, a strategy used to increase user enjoyment and engagement through game mechanics in a non-gaming environment.

Gamification strategies have advanced self-monitoring including progress tracking and performance feedback. Furthermore, a social comparison has been found to inspire an individual to change certain behaviors.

When designing mHealth-related apps, eight gamification archetypes were developed, including team competition. The effectiveness of this program on residents has not been evaluated. However, gamified competition was hypothesized to be effective in physician groups, which are a highly competitive population with respect to other competitors.

About the studio

In a recent npj Digital Medicine study, micro-randomized trials (MRTs) were conducted to evaluate the effectiveness of JITAI components based on the principles of health behavior change and gamification. More specifically, the mHealth intervention was evaluated to determine its impact on an individual’s sleep duration and physical activity, particularly among first-year medical interns.

A total of 2,286 interns enrolled in this study, 84.7% of whom were grouped into a team of at least five interns, with 191 teams formed. All interns represented 12 specialties.

The mean age of the participants was 27.6 years, with both genders almost equally represented. The interns underwent the competition arm for 5.8 weeks.

The effectiveness of the mHealth intervention on medical interns was assessed based on self-reported mood scores. Previous studies have indicated that an individual’s mood score improves with more sleep and better physical activity.

Study results

Smartphone-administered gamified team competition by US-based medical interns significantly improved daily step count by approximately 106 steps per day. Furthermore, a positive effect of the competition on the participants’ sleep duration and mood score was observed.

The contest was found to be a beneficial component of the mHealth intervention. However, the moderator’s analysis indicated a decline in the effect of competition over time.

Intrainstitutional competition may have reduced the effectiveness of competition. This indicates the need for improved strategies in allocating opposing teams to improve the effectiveness of team competition.

Due to constant work in very intense and stressful work environments, medical trainees were less responsive than people exposed to less stressful working conditions. A previous study using obese participants indicated a greater willingness to use mobile-based gamification to promote physical activity than the current cohort, which included healthier participants.

More studies are needed to improve the effect of the mHealth intervention. For example, new competition-related elements, such as the scoreboard, levels and awards, could be introduced to improve interns’ motivation to use the mHealth app more consistently.

The strategy around matching opponents to achieve maximum health benefits also needs to be improved. A negative impact of intra-institutional competition was observed in this study, as participants saw themselves as colleagues and, therefore, were less competitive.

The effectiveness of introducing short-term breaks between match assignments to decrease fatigue should also be evaluated.


Potential smartphone-based/wearable MRT on medical interns revealed a positive causal effect of team competition on proximal step count. Thus, the efficacy of incorporating gamified competition into the mHealth intervention was confirmed in this study.

In the future, more strategies will need to be established to optimize the benefits of mHealth. However, the current study provided a benchmark for future trials to determine the effectiveness of other competitor-related app features.

Magazine reference:

  • Wang, J., Fang, Y., Frank, E., et al. (2023) Effectiveness of gamified team competition as an mHealth intervention for medical interns: a micro-randomized cluster study. npj Digital Medicine 6(4). doi:10.1038/s41746-022-00746-e

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