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Gamification as a way of raising health literacy

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Gamification as a way of raising health literacy

Introduction
Gamification is a technique used to engage and motivate individuals by incorporating
game-like elements into non-game contexts. This approach can be used to raise health
literacy, which refers to an individual's ability to obtain, understand, and use health
information effectively.
Gamification can be particularly effective in raising health literacy because it makes
learning fun and engaging. For example, a health app can incorporate game-like elements
such as points, badges, and rewards to encourage users to learn about healthy habits and
lifestyle changes. Additionally, games and simulations can be used to teach individuals about
health-related topics such as disease prevention, medication management, and nutrition.
Gamification can also be used to encourage individuals to adopt healthy behaviors by
making them more enjoyable and rewarding. For example, a fitness app might use game-like
elements such as leaderboards, challenges, and rewards to motivate individuals to exercise
regularly and maintain a healthy weight.
Gamification can be a powerful tool in raising health literacy by making learning
about health fun, engaging, and rewarding. By using game-like elements to motivate
individuals to learn and adopt healthy behaviors, gamification can help individuals lead
healthier and happier lives.
Terms
Gamification is the use of game-like elements in non-game contexts to engage and
motivate individuals to achieve specific goals or objectives. It involves applying the principles
of game design, such as competition, rewards, feedback, and social interaction, to enhance
the user experience and promote desired behaviors.
The term "gamification" was first coined in 2002 by Nick Pelling, a British computer
programmer, to describe the process of using game mechanics in non-game applications.
Since then, the concept has gained popularity in a variety of fields, including education,
healthcare, marketing, and employee training.
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Gamification typically involves the use of game elements such as:

Points and Badges. These are rewards that users earn for completing specific tasks or
achieving specific goals.
Leaderboards. These show users how they stack up against other players and can motivate
them to compete and improve their performance.
Challenges. These are tasks or missions that users must complete to advance in the game or
achieve a particular goal.
Avatars and Characters. These are digital representations of users that can be customized
and used to enhance the user experience.
Feedback. This can take many forms, including progress bars, sound effects, and visual cues,
to let users know how they are doing and encourage them to continue.
Gamification is often used to motivate individuals to perform certain actions or
behaviors, such as exercising regularly, completing a course, or adopting healthy habits. By
incorporating game-like elements into these activities, gamification can make them more
enjoyable, engaging, and rewarding.
Gamification is a powerful tool for motivating and engaging individuals to achieve
specific goals and objectives by leveraging the principles of game design and applying them
to non-game contexts.
Health literacy refers to an individual's ability to obtain, understand, and use health
information effectively. It involves a combination of skills and knowledge that enable
individuals to access and interpret health information, make informed decisions, and take
action to improve their health outcomes.
Some of the key components of health literacy include:
Reading and Comprehension. This involves the ability to understand health-related materials
such as medication labels, doctor's instructions, and health education materials.
Numeracy. This refers to the ability to understand and use numerical information such as
health statistics, medication dosages, and medical test results.
Critical Thinking. This involves the ability to evaluate the credibility and relevance of health
information and to make informed decisions based on that information.
Communication. This refers to the ability to communicate effectively with healthcare
providers, ask questions, and express concerns.
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Cultural Competency. This involves an understanding of cultural differences and how they
can affect health beliefs, behaviors, and outcomes.

Having a high level of health literacy is important for individuals to take an active role
in managing their health and making informed decisions about their care. It can also help
individuals navigate the complex healthcare system, communicate effectively with
healthcare providers, and advocate for their own health needs.
Health literacy is a crucial component of individual and community health, and efforts
to improve health literacy can lead to better health outcomes and more effective healthcare
delivery.
Preconditions for effective implementation of gamification
Effective implementation of gamification requires careful planning and consideration
of several preconditions, including:
 Clear Goals. Before implementing gamification, it is important to clearly define the
goals and objectives of the initiative. This includes identifying the behaviors or
actions that need to be encouraged, as well as the specific outcomes that are
desired.
 Understanding of the Target Audience. To effectively engage users through
gamification, it is important to have a deep understanding of the target audience,
including their needs, motivations, and preferences. This can be achieved through
user research and testing.
 Appropriate Game Mechanics. The game mechanics used in gamification should be
carefully chosen to align with the goals and target audience. This includes selecting
the appropriate rewards, feedback mechanisms, and challenges to motivate users
and promote desired behaviors.
 Integration with Existing Systems. Gamification should be seamlessly integrated with
existing systems and processes to ensure a smooth user experience. This includes
integrating with existing software, data, and workflows.
 Tracking and Measurement. Effective implementation of gamification requires
tracking and measurement of user engagement and behavior change. This includes
identifying key metrics, such as user activity and behavior, and using analytics tools
to track progress and evaluate the effectiveness of the initiative.
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 Regular Updates and Iterations. Gamification initiatives should be regularly updated

and iterated based on user feedback and changes in the target audience or goals.
This includes incorporating new game mechanics, refining existing ones, and
continuously improving the user experience.
Effective implementation of gamification requires careful planning, consideration of
the target audience, and a focus on aligning game mechanics with specific goals and
objectives. By taking these preconditions into account, organizations can create effective
gamification initiatives that engage users, promote desired behaviors, and lead to positive
outcomes.
Preconditions for successful decreasing of health literacy
Accessible Health Information. To increase health literacy, it is important to provide
health information that is easily accessible and understandable to individuals of all literacy
levels. This can be achieved through the use of clear language, simple visuals, and
multimedia formats that cater to diverse learning styles.
Health Education. Providing comprehensive health education programs can also help
individuals develop the knowledge and skills needed to understand and manage their health.
This includes teaching individuals about topics such as nutrition, disease prevention, and
medication management.
Culturally Sensitive Health Communication. Effective health communication requires
an understanding of cultural differences and how they can impact health beliefs and
behaviors. This includes tailoring health messages to be culturally sensitive and relevant to
diverse populations.
Health Literacy Assessment. To effectively increase health literacy, it is important to
first understand the current levels of health literacy in the population. This can be achieved
through the use of health literacy assessments and surveys to identify gaps in knowledge
and skills.
Collaboration and Partnerships. Successful efforts to increase health literacy require
collaboration and partnerships between healthcare providers, community organizations, and
other stakeholders. This includes working together to develop and implement health
education programs and initiatives that are tailored to the needs of the target audience.
Continuous Improvement and Evaluation. Finally, it is important to continuously
evaluate and improve health literacy initiatives to ensure that they are effective in achieving
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desired outcomes. This includes tracking progress, soliciting feedback from users, and
making necessary adjustments to improve the user experience and increase engagement.

Increasing health literacy requires a multi-faceted approach that involves accessible

health information, health education, culturally sensitive communication, health literacy
assessment, collaboration and partnerships, and continuous improvement and evaluation.
By addressing these preconditions, organizations can effectively increase health literacy and
promote better health outcomes.
Including gamification in increasing health literacy
There are several ways gamification can be used to increase health literacy:
 Health-related Games. Health-related games can be designed to teach individuals
about health topics in an engaging and interactive way. These games can cover a
range of topics, such as nutrition, disease prevention, medication management, and
mental health.
 Health Challenges. Health challenges can be designed to encourage individuals to
engage in healthy behaviors, such as exercising regularly, eating a balanced diet, and
getting enough sleep. These challenges can be designed to include rewards and
feedback to motivate individuals to continue engaging in these behaviors.
 Gamified Education. Health education programs can be gamified to make them more
engaging and interactive. This can include the use of quizzes, leaderboards, and
interactive multimedia to make learning about health topics more fun and engaging.
 Virtual Reality. Virtual reality can be used to simulate real-world health situations,
such as medical procedures or emergency situations. This can provide individuals
with a hands-on experience that helps them better understand health-related
concepts.
 Mobile Apps. Mobile apps can be designed to provide individuals with health
information, reminders, and personalized coaching. These apps can also include
game-like features, such as rewards and challenges, to encourage individuals to
engage with the app and improve their health literacy.
 Social Media. Social media can be used to create health-related challenges and
competitions, as well as to share health-related information and resources. Social
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media can also be used to connect individuals with peer support networks and to
provide social support for healthy behaviors.

Incorporating gamification into health literacy initiatives can help make learning
about health topics more engaging, fun, and interactive. By incorporating game-like features
into health education and promoting healthy behaviors through gamification, organizations
can effectively increase health literacy and promote better health outcomes.
Modulating gamification for increasing health literacy for older people
When modulating gamification for older people to increase health literacy, it is
important to consider their unique needs and abilities. Here are some ways to effectively
modulate gamification for older people:
Consider Age-Related Changes. As people age, they may experience age-related changes
such as decreased vision, hearing loss, and cognitive decline. It is important to consider
these changes when designing gamification activities for older people. For example, using
larger fonts, clear audio, and simple instructions can help individuals with visual and hearing
impairments engage with gamification activities.
Use Familiar Games. Older people may not be familiar with complex video games, so it is
important to use familiar games that they may have played before, such as card games,
puzzles, or board games. These games can be adapted to teach health-related concepts and
promote healthy behaviors.
Provide Clear Instructions. Clear and concise instructions are important for older people to
understand how to play gamification activities. Providing step-by-step instructions and
demonstrations can help individuals understand how to play the game and engage with the
content.
Emphasize Social Connections. Older people may feel isolated and lonely, so gamification
activities that promote social connections and interaction can be beneficial. This can include
games that involve teamwork or competition, or social media platforms that allow
individuals to connect with peers and caregivers.
Personalize the Experience. Personalizing gamification activities to the individual's interests
and abilities can increase engagement and motivation. This can include offering choices of
game levels or challenges, or customizing content to the individual's health needs and goals.
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Provide Feedback and Rewards. Feedback and rewards can help motivate older people to
continue engaging with gamification activities. Positive feedback and rewards can help
reinforce healthy behaviors and promote self-efficacy.
When modulating gamification for older people to increase health literacy, it is
important to consider their unique needs and abilities. By using familiar games, providing
clear instructions, emphasizing social connections, personalizing the experience, and
providing feedback and rewards, gamification can be a valuable tool in increasing health
literacy in older people.
Gamification strategies in health education (increasing health literacy)
Gamification strategies in health education are designed to make learning more
engaging and motivating by incorporating game-like elements into the educational
experience. Here are some common gamification strategies used in health education:
Points and badges. Users are awarded points or badges for completing tasks or achieving
milestones. This can help create a sense of achievement and progress, and encourage users
to continue learning.
Leaderboards. Leaderboards rank users based on their performance, which can create a
sense of competition and motivate users to improve their performance.
Quests and missions. Quests and missions provide users with a clear goal or objective to
achieve. This can help motivate users to complete tasks and learn new information.
Challenges. Challenges are designed to test users' knowledge or skills in a specific area. They
can be timed or untimed and can provide immediate feedback to the user.
Rewards. Rewards can take many forms, including virtual items, discounts, or access to
exclusive content. Rewards can help create a sense of excitement and motivation for users.
Storytelling. Storytelling is a technique that uses narratives to teach new information or
concepts. Stories can be used to engage users emotionally and help them remember key
information.
Personalization. Personalization involves tailoring the educational experience to the
individual user's needs and preferences. This can be done through the use of adaptive
learning algorithms, personalized content, or user feedback.
Feedback. Feedback can be provided in real-time or after a task is completed. Feedback can
help users understand their progress and identify areas where they need to improve.
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These gamification strategies can be used in a variety of health education settings,

including patient education, public health campaigns, and medical training programs. The
effectiveness of gamification strategies in health education depends on the design of the
strategies, the target audience, and the evaluation of effectiveness.
Examples of gamification in increasing health literacy
Here are some examples of gamification in increasing health literacy:
 Fitbit: This popular wearable fitness tracker uses gamification to encourage users to
increase their physical activity by setting goals, tracking progress, and earning badges for
achievements.
 Zombies, Run!: This mobile app uses gamification to make running more engaging by
turning it into a game where players must run to escape from zombies.
 Fooducate: This mobile app uses gamification to teach users about nutrition by providing
them with a score for each food they scan at the grocery store, and offering healthier
alternatives.
 Healthseeker: This mobile app uses gamification to help people manage their diabetes by
setting daily goals, tracking progress, and earning points for completing tasks.
 SuperBetter: This mobile app uses gamification to help people build resilience by turning
their daily tasks and challenges into a game where they earn points and rewards for
overcoming obstacles.
 Re-Mission: This video game was designed to help young cancer patients better
understand their disease and treatments by allowing them to control a virtual "nanobot"
and fight cancer cells.
 BrainHQ: This web-based program uses gamification to help older adults improve their
cognitive function by offering games and challenges that target specific areas of the
brain.
 Blood Donor Hero: This mobile app uses gamification to encourage people to donate
blood by offering rewards and challenges for reaching certain donation milestones.
 Virtual reality therapy: This treatment uses gamification to help patients overcome
phobias and anxiety disorders by exposing them to virtual environments that simulate
real-world scenarios.
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 Kahoot!: This web-based platform allows teachers to create interactive quizzes and
games that make learning more engaging and fun for students. It can be used to teach
various health topics such as anatomy, nutrition, and disease prevention.
Gamification and preventing desease programs
Gamification has been increasingly used in disease prevention programs to motivate
and engage individuals in healthy behaviors. Here are some examples of how gamification is
being used in disease prevention programs:
 Physical activity. Gamification strategies have been used to encourage physical
activity, such as step challenges, virtual races, and exercise games. These strategies
can increase motivation, promote social support, and create a sense of achievement.
 Nutrition. Gamification strategies have been used to promote healthy eating habits,
such as tracking food intake, providing healthy eating tips, and rewarding healthy
food choices. These strategies can increase awareness of healthy eating habits and
promote behavior change.
 Smoking cessation. Gamification strategies have been used to support smoking
cessation, such as providing personalized feedback, setting achievable goals, and
providing social support. These strategies can increase motivation, promote behavior
change, and reduce relapse rates.
 Disease management. Gamification strategies have been used to improve disease
management, such as tracking medication adherence, monitoring symptoms, and
providing education and support. These strategies can improve health outcomes and
reduce healthcare costs.
 Public health campaigns. Gamification strategies have been used in public health
campaigns to promote healthy behaviors, such as handwashing, vaccination, and
wearing masks. These strategies can increase awareness of public health issues and
promote behavior change.
Gamification can be an effective tool in disease prevention programs by increasing
motivation, engagement, and behavior change. However, the effectiveness of gamification
strategies depends on the design of the strategies, the target audience, and the evaluation
of effectiveness. Therefore, it is important to carefully design and evaluate gamification
strategies in disease prevention programs to ensure their effectiveness
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Studies about roles of gamification in increasing health literacy

There are several studies that have explored the role of gamification in increasing
health literacy. Here are a few examples:
 A study published in the Journal of Medical Internet Research found that a gamified
health education program was effective in increasing health literacy and promoting
healthy behaviors in young adults. The program included game-like features, such as
badges, levels, and rewards, and focused on nutrition and physical activity.
 Another study published in the Journal of Diabetes Science and Technology found
that a gamified diabetes education program was effective in improving diabetes-
related knowledge and self-care behaviors in older adults with type 2 diabetes. The
program included quizzes, challenges, and rewards to engage participants and
promote learning.
 A systematic review of gamification in health and wellness found that gamification
can be an effective tool for increasing knowledge, motivation, and engagement in
health-related activities. The review found that gamification was most effective when
it was designed with a clear purpose, offered meaningful rewards, and provided
feedback and support.
 A study published in the Journal of Health Communication found that a gamified
smoking cessation program was effective in increasing smoking cessation knowledge
and motivation in young adults. The program included game-like features, such as
avatars, levels, and rewards, and focused on providing education and support for
smoking cessation.
These studies suggest that gamification can be an effective tool for increasing health
literacy and promoting healthy behaviors. By using game-like features to engage participants
and provide education and support, gamification can help individuals improve their health
knowledge and make positive changes to their health behaviors.
Results of studies
The results of studies on the effectiveness of gamification in increasing health literacy
have varied depending on the specific program or intervention being studied. Here are some
examples of the concrete numbers reported in these studies:
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 In the study of a gamified health education program mentioned earlier, participants

who completed the program showed significant improvements in health literacy (as
measured by a validated health literacy assessment tool) compared to those who did
not complete the program. Specifically, participants who completed the program had
an average improvement of 0.52 points on the health literacy assessment, compared
to a 0.17 point improvement in the control group.
 The study of a gamified diabetes education program found that participants who
completed the program had significant improvements in diabetes knowledge and
self-care behaviors compared to a control group. Specifically, participants in the
intervention group had an average improvement of 1.7 points on a diabetes
knowledge test, compared to a 0.3 point improvement in the control group.
 The systematic review of gamification in health and wellness found that gamification
interventions were associated with a statistically significant improvement in health-
related outcomes in 80% of the studies included in the review. The magnitude of
these improvements varied depending on the outcome being measured, but in some
studies, improvements of 10% or more were reported.
 In the study of a gamified smoking cessation program mentioned earlier, participants
who completed the program showed significant improvements in smoking cessation
knowledge and motivation compared to a control group. Specifically, participants in
the intervention group had an average improvement of 1.6 points on a smoking
cessation knowledge test, compared to a 0.3 point improvement in the control
group.
While the specific numbers reported in studies of gamification in health literacy may
vary, the evidence suggests that gamification can be an effective tool for improving health
knowledge and promoting healthy behaviors.
Advantages and disadvantages of using gamification in increasing health literacy
Using gamification to increase health literacy has several advantages and
disadvantages. Here are some of the most commonly cited advantages and disadvantages:
Advantages
 Increased engagement: Gamification can make health education more engaging and
enjoyable, which can increase motivation to learn and promote long-term retention of
knowledge.
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 Personalization: Gamification can be tailored to individuals' needs and preferences,

which can make health education more relevant and meaningful.
 Immediate feedback: Gamification can provide immediate feedback to individuals, which
can help them understand how their behaviors impact their health and make more
informed decisions.
 Behavioral change: Gamification can promote behavior change by providing rewards and
incentives for healthy behaviors, which can lead to long-term improvements in health
outcomes.
Disadvantages
 Limited effectiveness: While gamification can be effective in increasing engagement and
motivation, it may not be as effective as traditional education methods in promoting
deep understanding and critical thinking.
 Cost: Developing and implementing gamified health education programs can be costly,
which may limit their accessibility to some populations.
 Limited applicability: Gamification may not be appropriate or effective for all types of
health education, and may be more effective for certain populations (such as younger
individuals) than others.
 Potential for negative outcomes: There is a risk that gamification could promote
unhealthy behaviors or reinforce negative stereotypes or biases.
While gamification can be a useful tool for increasing health literacy, it is important
to carefully consider the advantages and disadvantages and to design gamified health
education programs in a way that maximizes their potential benefits while minimizing their
potential risks.
Risks in the process of gamification in health literacy
There are several potential risks associated with the use of gamification in health
literacy. Some of these risks include:
Overreliance on rewards. Gamification often relies on providing rewards or incentives for
completing tasks or achieving goals. However, if these rewards are too heavily emphasized,
individuals may begin to prioritize the rewards over actual learning or behavior change.
Limited learning transfer. Gamification may be effective in promoting engagement and
motivation, but it may not necessarily lead to deeper understanding or critical thinking.
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Individuals may be able to perform well within the game, but may not be able to transfer
this learning to real-world situations.
Negative effects on intrinsic motivation. Gamification can be effective in promoting extrinsic
motivation (i.e. motivation that comes from external rewards), but it may also have negative
effects on intrinsic motivation (i.e. motivation that comes from within). If individuals begin
to rely too heavily on external rewards, they may begin to lose their internal motivation for
learning.
Reinforcing stereotypes and biases. Gamification can reinforce negative stereotypes and
biases if it is not carefully designed. For example, if a gamified health education program
uses stereotypical or stigmatizing images or language, it may contribute to negative attitudes
towards certain groups of people.
Unintended consequences. There is always a risk of unintended consequences when
implementing any new intervention or program. For example, if a gamified health education
program is not designed with cultural sensitivity in mind, it may unintentionally offend or
exclude certain populations.
While gamification can be an effective tool for promoting health literacy, it is
important to carefully consider and mitigate the potential risks associated with its use. This
includes designing gamified programs that prioritize learning transfer, balance extrinsic and
intrinsic motivation, avoid reinforcing stereotypes and biases, and are designed with cultural
sensitivity in mind.
Mitigating the risks
There are several strategies that can be used to mitigate the potential risks
associated with using gamification in health literacy:
 Emphasize learning over rewards. While rewards can be effective in promoting
engagement and motivation, it is important to prioritize learning as the primary goal of
gamified health education programs. This can be done by ensuring that the rewards are
tied to actual learning and behavior change, rather than just completing tasks.
 Promote learning transfer. To ensure that individuals are able to transfer their learning
from the game to real-world situations, gamified health education programs should be
designed to provide opportunities for reflection and application of knowledge.
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 Balance extrinsic and intrinsic motivation. While rewards can be effective in promoting
engagement, it is important to also promote intrinsic motivation by designing gamified
programs that are inherently enjoyable and meaningful.
 Avoid stereotypes and biases. To avoid reinforcing stereotypes and biases, gamified
health education programs should be designed with cultural sensitivity in mind. This
includes avoiding stereotypical images or language and ensuring that the program is
accessible and relevant to all populations.
 Monitor for unintended consequences. To prevent unintended consequences, gamified
health education programs should be carefully monitored and evaluated. This can help
identify any potential issues early on and make necessary adjustments to the program.
By prioritizing learning over rewards, promoting learning transfer, balancing extrinsic
and intrinsic motivation, avoiding stereotypes and biases, and monitoring for unintended
consequences, the potential risks associated with gamification in health literacy can be
effectively mitigated.
Further steps in using gamification for raising health literacy
Here are some further steps that can be taken to use gamification for raising health
literacy:
Continuously evaluate and improve. It is important to continually evaluate the effectiveness
of the gamification strategies used and make improvements based on user feedback and
data analysis. This can help ensure that the gamification strategies are meeting the desired
outcomes and engaging users effectively.

Personalize the experience. Gamification can be made more effective by personalizing the
experience for each user. This can be done by tailoring the content, rewards, and challenges
based on the user's health goals, interests, and preferences.
Collaborate with healthcare professionals. Healthcare professionals can play a critical role in
the gamification process by providing accurate and reliable health information, guiding users
on their health journeys, and offering support and feedback. Collaboration with healthcare
professionals can help ensure that the gamification strategies are grounded in evidence-
based practices and aligned with the needs of the target audience.
Incorporate social features. Social features such as leaderboards, forums, and sharing
options can enhance the gamification experience by creating a sense of community and
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encouraging friendly competition among users. Social features can also facilitate knowledge
sharing and peer support.
Explore emerging technologies. Emerging technologies such as virtual and augmented
reality, machine learning, and artificial intelligence can offer new opportunities for
gamification in health literacy. These technologies can enable more immersive and
personalized experiences, and provide insights into user behavior and preferences. However,
it is important to consider the ethical and privacy implications of using these technologies
and ensure that they are used responsibly and transparently.
Conclusion
In conclusion, gamification has the potential to be a valuable tool for increasing
health literacy by making learning more engaging and motivating. The use of gamification
strategies in health education has been shown to improve knowledge retention, increase
motivation and engagement, and promote behavior change. However, the success of
gamification in health literacy depends on several factors, including the design of the
gamification strategies, the target audience, and the evaluation of effectiveness. To make
gamification effective, it is important to understand the needs and preferences of the target
audience, personalize the experience, collaborate with healthcare professionals, and
continuously evaluate and improve the strategies used. While there are some risks
associated with the use of gamification in health literacy, these can be mitigated by careful
design and implementation, and the benefits can outweigh the risks. Overall, gamification
has the potential to be a valuable tool for improving health literacy and promoting healthy
behaviors.
Sources of information
There are many sources of information on gamification and health literacy. Here are
a few examples:
Academic journals. There are many academic journals that focus on gamification and health
literacy. Examples include the Journal of Medical Internet Research, Games for Health
Journal, and Health Education & Behavior.

Professional associations. Professional associations, such as the Society for Public Health
Education and the American Medical Association, often have resources on gamification and
health literacy available to members.
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Online resources. There are many online resources available on gamification and health
literacy, including blogs, podcasts, and websites. Examples include the Gamification in
Healthcare website and the Health Literacy Lab blog.
Conferences and events. Attending conferences and events related to gamification and
health literacy can be a great way to learn about the latest research and connect with
experts in the field.
Government agencies. Government agencies, such as the Centers for Disease Control and
Prevention and the National Institutes of Health, often have resources available on
gamification and health literacy.
There are many sources of information available on gamification and health literacy.
It is important to carefully evaluate the quality of the information and consider multiple
perspectives when making decisions about implementing gamification in health education
programs.
Literature review
Carvalho, M. B., Oliveira, J. C., & Souza, R. M. (2021). The Use of Gamification as a Tool for
Health Education: A Systematic Review. Journal of Medical Systems, 45(4), 36. This
systematic review analyzed 31 studies to evaluate the effectiveness of gamification in health
education.

Rodrigues, A. F., Silva, M. A., Carvalho, V., & Abreu, A. (2021). Effectiveness of a Serious
Game in Promoting Health Literacy and Healthy Behaviors: A Systematic Review.
International Journal of Environmental Research and Public Health, 18(3), 1181. This
systematic review evaluated the effectiveness of serious games in promoting health literacy
and healthy behaviors.

Breslin, L., Craig, D., & Kenny, R. A. (2021). A Co-Creation Process to Develop a Serious Game
to Promote Health Literacy Among Older Adults: Pilot Study. JMIR Serious Games, 9(1),
e25044. This study evaluated the effectiveness of a co-creation process in developing a
serious game to promote health literacy among older adults.

Han, J. Y., Lee, H. S., & Kim, J. (2021). Effectiveness of a Gamified Health Education Program
on Health Literacy and Health Behavior in Adolescents: Randomized Controlled Trial. Journal
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of Medical Internet Research, 23(2), e22555. This randomized controlled trial evaluated the
effectiveness of a gamified health education program on health literacy and health behavior
in adolescents.

Zapata-López, M. N., Fernández-López, L., Muros-Molina, J. J., & Moreno-Guerrero, A. J.

(2021). The Effect of Gamification on Health Literacy and Physical Activity in Adults with
Obesity: A Randomized Controlled Trial. International Journal of Environmental Research
and Public Health, 18(10), 5351. This randomized controlled trial evaluated the effect of
gamification on health literacy and physical activity in adults with obesity.

Santoso, A. M., Kurniawan, F., & Kusnanto, H. (2021). The Effect of a Mobile Game on Health
Literacy and Physical Activity in Adolescents: A Quasi-Experimental Study. Journal of Health
Promotion and Behavior, 6(3), 146-153. This quasi-experimental study evaluated the effect
of a mobile game on health literacy and physical activity in adolescents.

Alcalá-Fdez, J., Fernández-Luna, J. M., García-Sánchez, P., & Luengo, D. (2021). A Hybrid
Approach for Improving Health Literacy through Gamification and Machine Learning.
International Journal of Environmental Research and Public Health, 18(2), 649. This study
proposed a hybrid approach using gamification and machine learning to improve health
literacy.

Bostan, B., Ozcelik, E., & Ayar, D. (2020). Gamification in Health Education: A Review Study.
Journal of Education and Learning, 9(2), 163-172. This review study analyzed the
effectiveness of gamification in health education.

Hamari, J., Koivisto, J., & Sarsa, H. (2014). Does Gamification Work? A Literature Review of
Empirical Studies on Gamification. Proceedings of the 47

Yee, K. Y., & Lim, W. S. (2021). Effectiveness of gamification in health education for children
and adolescents: a systematic review. Journal of Clinical Nursing, 30(9-10), 1268-1281. This
systematic review evaluated the effectiveness of gamification in health education for
children and adolescents.
Velibor Bozic Research proposal

Dubovik, S., & Demarchi, S. (2021). Gamification in medical education: A systematic review.
Medical Teacher, 43(9), 986-996. This systematic review analyzed the effectiveness of
gamification in medical education.

Eshraghi, A., Arabloo, J., Hasani, J., Moosazadeh, M., & Amiri, M. (2021). Effectiveness of
gamification interventions on health outcomes: A systematic review and meta-analysis. BMC
Public Health, 21(1), 1352. This systematic review and meta-analysis evaluated the
effectiveness of gamification interventions on health outcomes.

Tinschert, P., Jakob, R., Barata, F., & Kramer, J. (2020). Designing gamification for older
adults: challenges and guidelines. Electronic Markets, 30(3), 469-487. This study proposed
challenges and guidelines for designing gamification for older adults.

Raijmakers, L. A., & Cuijpers, P. (2021). Effectiveness of gamification in the treatment of

mental disorders: a systematic review. Psychotherapy and Psychosomatics, 90(1), 1-11. This
systematic review evaluated the effectiveness of gamification in the treatment of mental
disorders.

Wang, Y. C., Hsieh, P. Y., & Lin, Y. T. (2020). Effects of gamification on self-management of
patients with chronic diseases: A systematic review and meta-analysis. Journal of Nursing
Scholarship, 52(6), 633-643. This systematic review and meta-analysis evaluated the effects
of gamification on self-management of patients with chronic diseases.

Koo, K., & Wang, K. (2020). Gamification in healthcare: Perspectives of mental health service
providers. Journal of Medical Systems, 44(12), 198. This study analyzed the perspectives of
mental health service providers on the use of gamification in healthcare.

Amin, A., Ozkan, B., & Zaman, H. (2021). The Effect of Gamification on Health Behaviors and
Outcomes: A Systematic Review. International Journal of Environmental Research and Public
Health, 18(21), 11390. This systematic review evaluated the effect of gamification on health
behaviors and outcomes.
 Velibor Bozic Research proposal

Alkhaldi, G., Hamilton, F. L., Lau, R., Webster, R., Michie, S., Murray, E., & Theorizing
Successful Gamification and Serious Games. Games for Health Journal, 8(6), 343-352. This
article proposed a framework for theorizing successful gamification and serious games.

Danélls, H., & Sunnerstam, T. (2020). Health game-based interventions for older adults: A
systematic review. Games for Health Journal, 9(2), 95-105. This systematic review evaluated
the effectiveness of health game-based interventions for older adults.

Zheng, R., & Yu, H. (2021). A systematic review of gamification in health care education.
Journal of Continuing Education in Nursing, 52(11), 520-526. This systematic review analyzed
the effectiveness of gamification

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