JMIR Serious Games

Cognitive Function Assessment Using a Virtual Reality Serious Game System in Patients With Stable Schizophrenia: Prospective Cohort Study

2026-05-08T12:30:04-04:00

Background: Cognitive impairment is a core and enduring deficit in schizophrenia, severely affecting social functioning and quality of life. Traditional assessments such as the MATRICS Consensus Cognitive Battery face limitations in validity and engagement. Virtual reality (VR) serious games may offer an immersive alternative, and machine learning (ML) can uncover complex behavioral patterns. However, integrating VR-based assessment with ML for discriminating stable-phase schizophrenia remains unexplored. Objective: This prospective cohort study aimed to examine whether a VR serious game (“Fruit Pioneer”) can effectively assess cognitive function in stable schizophrenia, verify its correlation with the standard Brief Cognitive Assessment Tool for Schizophrenia (B-CATS), and test the discriminative capacity using ML models. We hypothesize that (1) patients with schizophrenia will show poorer VR game performance than healthy controls (HCs), (2) VR metrics will correlate with B-CATS scores, and (3) ML models will help classify patients with schizophrenia and HCs using VR data. Methods: A total of 42 patients with stable schizophrenia and 65 HCs (aged 18-40 years) were enrolled. Exclusion criteria included color blindness, visual impairment, substance abuse, and comorbid chronic physical diseases. Finally, 39 patients with schizophrenia and 64 HCs were included. Materials included the VR serious game “Fruit Pioneer,” B-CATS (Digital Symbol Substitution Test, Trail Making Test Part A, Trail Making Test Part B, and Animal Fluency), Simulator Sickness Questionnaire, and Game Experience Questionnaire. Data were collected via standardized VR gameplay and paper-based assessments. Logistic regression and a support vector machine (SVM) model were built using VR metrics. Results: Patients with schizophrenia performed worse on all B-CATS subtests (all P<.001). They also showed lower VR total scores (median 467, IQR 376-544 vs median 683, IQR 616-753; P<.001), longer reaction times (median 1.11, IQR 0.995-1.23 vs median 1.03, IQR 0.96-1.1; P=.006), lower gaze hit rates (median 0.515, IQR 0.442-0.554 vs median 0.552, IQR 0.497-0.592; P=.01), and higher bomb penalty scores (median 150, IQR 95-170 vs median 108, IQR 85-131; P=.002). In the schizophrenia group, VR metrics correlated with B-CATS results, whereas this relationship was minimal in HCs. Classification performance of the SVM (average area under the curve [AUC]=0.874, 95% CI 0.860-0.888) was comparable to logistic regression (average AUC=0.854, 95% CI 0.838-0.870). Conclusions: This study demonstrates the innovative integration of a VR serious game with ML to assess cognitive function in stable schizophrenia. Unlike prior VR studies focused mainly on validation, our approach combines behavioral metrics with an SVM model, achieving effective classification. The findings support the potential of a scalable digital assessment correlated with standard tests. In clinical practice, this system may serve as an engaging alternative to traditional methods, facilitating long-term cognitive monitoring and personalized rehabilitation strategies.

Brain Structural Covariance Networks in Long-Term First-Person Shooter and Multiplayer Online Battle Arena Players: Cross-Sectional Study

2026-05-04T16:30:18-04:00

Background: The relationship between video game experience and cognitive plasticity remains a central focus of research, particularly given its potential applications in clinical rehabilitation. Although both first-person shooter (FPS) and multiplayer online battle arena (MOBA) games have been shown to enhance cognitive functions, the specific associations between the cognitive effects of different game genres and brain network structure remain unclear. Objective: This study aimed to examine whether long-term experience with FPS and MOBA games is associated with genre-specific patterns of cortical thickness covariation across brain regions. Methods: A total of 116 male participants (mean age 21.2, SD 1.9 y) were recruited via online advertisements for this cross-sectional study. On the basis of strict inclusion criteria (gaming experience >5 years, gaming frequency >5 hours per week, and ranking within the top 15%), participants were categorized into FPS players (n=39, 33.6%) and MOBA players (n=40, 34.5%). An additional group of healthy controls (n=37, 31.9%) with no gaming experience in the past 2 years was also included. High-resolution structural magnetic resonance imaging data were acquired using a 3-T scanner. Individualized differential structural covariance networks were constructed based on the cortical thickness values extracted from 68 brain regions using the Desikan-Killiany atlas. Statistical analysis included one-way ANOVA to identify significant structural covariance edges (SCEs), network-based statistic prediction analysis for weekly gaming hours, and support vector machine analysis for group classification. Results: One-way ANOVA identified 30 significant SCEs across the 3 groups (<.001, false discovery rate corrected). Post hoc analysis (<.02, Bonferroni corrected) revealed that, compared to the MOBA and control groups, the FPS group exhibited 2 dominant networks: a temporo-fronto-parietal network anchored in auditory regions and a visuo-sensorimotor network. Both gaming groups showed enhanced SCEs in visual-attentional networks compared to the control group. The network-based statistic–predict analysis demonstrated that structural covariance matrices could effectively predict weekly gaming hours in FPS players (=0.34, 95% CI 0.26‐0.42). The positive edges primarily formed a temporo-fronto-parietal-occipital network, whereas the negative edges were centered on the entorhinal cortex. The support vector machine classifier successfully differentiated FPS players from controls (area under the curve=82.95%) and from MOBA players (area under the curve=72.37%). Conclusions: Long-term FPS and MOBA gaming experiences are associated with different brain structural network architectures. The uniqueness of FPS gaming lies in the extensive structural covariance between the primary auditory cortex and regions supporting visual attention and sensorimotor processing, which may reflect higher demands on cognitive skills. This suggests potential utility in auditory-visual rehabilitation and provides a theoretical basis for the assessment and selection of professional electronic sports players. However, the negative edges involving the entorhinal cortex in FPS players indicate that an overreliance on response learning strategies may come at the expense of the spatial memory system. Consequently, caution is warranted when applying such games to ameliorate age-related memory decline.

Gamified Feedback-Based Training System for Pediatric Asthma Inhaler Use: Mixed Methods Randomized Crossover Study

2026-05-04T15:15:15-04:00

Background: Asthma is a prevalent chronic respiratory condition among children worldwide. Inhalation therapy is the primary treatment method, but children often make errors in its use and exhibit poor adherence, which impacts treatment effectiveness. Therefore, interventions to improve inhalation techniques and enhance adherence are urgently needed. Objective: This study aimed to develop and evaluate BreatheBuddy, developed by Haoyu Zhang, a training system incorporating gamified feedback designed to enhance inhalation skills and treatment adherence in children with asthma. Methods: This study used a single-factor repeated-measures design and recruited 20 children aged 6 to 8 years (10 boys and 10 girls), all of whom had prior experience with inhalers. The experimental group used the BreatheBuddy system, which combines a physical inhaler with an interactive game-based software. The system provides real-time animated feedback based on data from inhalation, breath-holding, and exhalation to guide the rhythm and depth of inhalation. The control group used a conventional inhaler method without a gamified system. Inhalation accuracy, adherence, and satisfaction were assessed using the respiration sensor, the Player Experience of Need Satisfaction scale, the Game User Experience Satisfaction Scale (GUESS), and the System Usability Scale (SUS) scales. Statistical comparisons between the groups were conducted using paired tests and Mann-Whitney tests to analyze differences. Results: The experimental group demonstrated significant improvements in inhalation accuracy, with longer breath-holding times and more stable breathing patterns compared to the control group (<.001). The experimental group also exhibited significantly higher engagement and motivation, with Player Experience of Need Satisfaction (standardized score=93.83) and GUESS (median 87.92, IQR 86.54-88.46) scores markedly higher than those of the control group. Usability scores for the experimental group were also superior, with an SUS score of 88.96 (<.001). Additionally, children in the experimental group showed reduced anxiety and improved focus during training. Conclusions: BreatheBuddy effectively optimized children’s inhalation skills, boosted treatment adherence, and relieved inhalation-related anxiety. Different from conventional non-gamified training or simple game-based distraction, this study integrated breathing behaviors into core game interaction. With dynamic respiratory rhythm feedback, the system unifies skill training, motivation promotion, and emotional regulation. Combined with standard inhaler operation and immersive gamified interaction, it presents a novel behavior-oriented design paradigm. This work provides empirical evidence for gamified intervention in pediatric respiratory treatment and offers a practical auxiliary tool for clinical daily training to strengthen children’s self-management. Further research will focus on personalized adjustment and wider clinical application of the system.

Socially Prescribed Perfectionism, Resilience, and Internet Gaming Disorder in Adolescents: 3-Wave Longitudinal Study

2026-04-30T17:00:25-04:00

Background: Internet gaming disorder (IGD) is increasingly prevalent among adolescents. Although socially prescribed perfectionism (SPP) and resilience are both related to IGD, longitudinal evidence on their temporal relationships and underlying mechanisms remains limited. Objective: This study aimed to examine the longitudinal associations among SPP, resilience, and IGD in Chinese adolescents; test the mediating role of resilience; and explore potential sex differences. Methods: A 3-wave prospective longitudinal study was conducted among students from 4 middle schools in Zhejiang Province, China. Adolescents who had played online games in the past 12 months were recruited using convenience sampling. Data were collected at 6-month intervals: time 1 (T1; March 2024), time 2 (T2; September 2024), and time 3 (T3; March 2025). A total of 1332 Chinese adolescents (875/1332, 65.7% male; mean age 13.61, SD 0.70 years) participated in the baseline survey. SPP, resilience, and IGD were assessed using the Hewitt-Flett Multidimensional Perfectionism Scale-Short Form, the 10-item Connor-Davidson Resilience Scale, and the 9-item (Fifth Edition) IGD Checklist, respectively. Cross-lagged panel model (CLPM) and multigroup analyses across sex were conducted. Results: All statistical tests were 2-tailed with =.05. The CLPM demonstrated good fit to the data (χ²=163.34; comparative fit index [CFI]=0.945; Tucker-Lewis index [TLI]=0.932; root mean square error of approximation [RMSEA]=0.054; standardized root mean square residual [SRMR]=0.047). Higher SPP predicted later IGD (T1→T2: =0.10, 95% CI 0.04 to 0.16, <.001; T2→T3: =0.09, 95% CI 0.03 to 0.15, =.004) and lower resilience (T1→T2: =−0.09, 95% CI −0.16 to −0.02, =.007; T2→T3: =−0.12, 95% CI −0.18 to −0.06, <.001). In contrast, SPP was not significantly predicted by prior IGD nor resilience. Higher resilience predicted lower subsequent IGD (T1→T2: β=−0.09, 95% CI −0.15 to −0.03, =.001; T2→T3: =−0.09, 95% CI −0.15 to −0.03, =.001), whereas higher IGD predicted lower subsequent resilience (T1→T2: =−0.19, 95% CI −0.27 to −0.11, <.001; T2→T3: =−0.09, 95% CI −0.15 to −0.03, =.003). Bootstrapped mediation analysis showed a significant indirect effect of SPP at T1 on IGD at T3 via resilience at T2 (=0.008, 95% CI 0.004 to 0.012, =.005). However, multigroup analyses revealed no significant sex differences. Conclusions: This study provides novel insights into the longitudinal associations among SPP, resilience, and IGD in adolescents. Unlike previous research based mainly on cross-sectional data, this 3-wave CLPM study clarifies the temporal relationships among these variables and shows that resilience mediates the association between SPP and subsequent IGD. These findings advance the field by identifying a temporal psychological pathway underlying adolescent IGD. They also have practical implications for early screening and for developing resilience-focused interventions for adolescents at risk of IGD.

Associations Between Parental Gaming Behaviors and Conversion From Internet Gaming Disorder Noncases to Cases Among Adolescents: Prospective Longitudinal Cohort Study

2026-04-30T13:00:20-04:00

Background: Parental factors are known determinants of internet gaming disorder (IGD) among adolescents. However, the associations between gaming-specific parental factors (eg, parental gaming frequency and parental invitations for cogaming) and IGD have been less investigated, and relevant longitudinal evidence is lacking to inform effective IGD interventions. Objective: This study aimed to investigate (1) the prevalence of IGD conversion (from a noncase at baseline to a case at follow-up) and (2) the prospective associations between two parental gaming behaviors and IGD conversion as well as their mediation mechanisms via parental supportive attitude toward adolescents’ gaming behaviors and behavioral intention of increasing gaming time. Methods: A 12-month prospective longitudinal study, with the baseline survey in December 2018 (T1) and the follow-up survey in December 2019 (T2), was conducted among students from 6 convenience-selection junior middle schools in Chengdu and Guangzhou, China. All grade 7 and 8 students of these schools were invited for participation; students self-administered the structured questionnaire on paper and pencil, in classroom settings, and in the absence of schoolteachers. The 9-item DSM-5 Internet Gaming Disorder Symptoms Checklist was used to assess IGD (Cronbach α=0.73). Those with IGD at T1 were excluded, and the final sample size was 2172 (mean age 12.56, SD 0.02, 95% CI 12.52-12.60 years; n=1102, 50.7%, 95% CI 48.7%-52.8% female). The prevalence of IGD conversion was 5.2% (113/2172; 95% CI 4.4%-6.1%). Results: Adjusted for background factors and respective mediator and outcome scores at T1, two path analysis models showed satisfactory model fit indices (ie, root mean square error approximation=0.02 and 0.03, comparative fit index=0.97 for both models, and standardized root mean square residual=0.02 for both models). The prospective associations between perceived parental gaming frequency and perceived parental invitations for cogaming and IGD conversion were significantly and fully mediated by the 1-mediator indirect path via parental supportive attitude (β=0.02, 95% CI 0.01-0.04 and β=0.02, 95% CI 0.01-0.04) and the 2-mediator indirect path first via parental supportive attitude and then via behavioral intention of increasing gaming time (β=0.006, 95% CI 0.002-0.009 and β=0.005, 95% CI 0.001-0.009) but not the 1-mediator indirect path via the behavioral intention (β=0.01, 95% CI −0.01 to 0.03 and β=0.01, 95% CI −0.01 to 0.03), respectively. Conclusions: This longitudinal study revealed the prospective associations between 2 parental gaming behaviors and adolescent IGD conversion, as well as the mediation mechanisms, addressing inconsistencies in previous cross-sectional studies and filling in the knowledge gap in longitudinal studies that overlooked parental gaming behaviors. It suggests that parental gaming behaviors may form important family environments shaping adolescents’ perceptions and behaviors related to internet gaming. Family-based prevention and intervention programs on IGD conversion may hence take into account these findings.

User Experience of a Virtual Reality–Based Treadmill for Children With a Chronic Disease Affecting Physical Health: Cross-Sectional Feasibility Study

2026-04-29T14:31:21-04:00

Background: For children with chronic conditions affecting physical health and who require long-term care, the use of a connected treadmill for gait training as part of a home program can be a way to promote motivation in rehabilitation. Furthermore, the device must be evaluated by all user groups to ensure that its development best meets the rehabilitation needs of children. Objective: The study aimed to assess the user experience of a connected treadmill called Amy—with both immersive and nonimmersive virtual reality—among children with a chronic disease impacting physical health, as well as their parents and therapists, to explore the feasibility and potential of such a device for home-based rehabilitation in this population. Methods: Children with cerebral palsy, neuromuscular diseases, or obesity, along with one of their parents and rehabilitation therapists, were recruited. The study involved evaluating preexisting Amy solutions and collecting user experience feedback from participants with questionnaires. Amy solutions consisted of immersive virtual reality (using a virtual reality headset) and nonimmersive (tablet-based) games, both controlled through body movements on a treadmill conceived to train walking and balance. Questionnaires were the short version of the User Experience Questionnaire; the Usability Metric for User Experience; the Virtual Reality Sickness Questionnaire; a customized questionnaire evaluating comfort, fun, sense of presence and immersion; and a customized questionnaire evaluating parent’s perception. Results: Twenty-eight children, 28 parents, and 18 therapists participated in the study. Compared with User Experience Questionnaire benchmark data, the overall results with immersive and nonimmersive virtual reality in all participants were in the range of 10% best results or in the “excellent” category. The mean (95% CI) scores for each group of participants, with nonimmersive and immersive virtual reality, were as follows: 1.9 (1.6-2.2) and 2.1 (1.6-2.5) for children, 2.0 (1.7-2.2) and 2.3 (2.0-2.5) for parents, and 1.4 (1.1-1.7) and 1.4 (1.1-1.7) for therapists, respectively. User experience was significantly better for children and parents than for therapists (P adjusted .001). From the Usability Metric for User Experience, participants rated the Amy treadmill’s usability as “good to excellent” on the System Usability Scale, regardless of whether immersive virtual reality was used. Immersive virtual reality was well tolerated by children. Children experienced immersive virtual reality positively in terms of comfort, immersion, presence, and fun. Parents’ acceptability of the connected treadmill was positively assessed. Conclusions: This study is, to our knowledge, the first to assess the user experience of a playful treadmill-based virtual environment controller in children with chronic conditions affecting physical health in a user-centered and multidisciplinary team-based approach. This initial test demonstrates promising potential for using the connected treadmill as a rehabilitation tool. Therapists may need improvements to better meet their expectations, highlighting the importance of further iterations to align technological features and practical clinical context. Trial Registration:

Reciprocal Within-Person Dynamics Between Internet Gaming Disorder Symptoms, Physical Activity, and Loneliness Among Chinese Adolescent Gamers: Three-Wave Prospective Cohort Study

2026-04-27T16:30:05-04:00

Background: Problematic gaming and internet gaming disorder (IGD) symptoms are prevalent in adolescence, yet the longitudinal interplay between physical activity (PA), loneliness, and IGD symptoms, as well as potential sexual differences, remains unclear. Objective: This study aimed to examine reciprocal within-person associations between PA, loneliness, and IGD symptoms among Chinese adolescent gamers and test sexual differences in these associations. Methods: We conducted a three-wave prospective cohort study among 1332 Chinese adolescents selected using convenience sampling from five middle schools in central China who had engaged in online gaming during the previous year (n=441, 33.1%, females; mean age 3.64, SD 0.76, years). PA, loneliness, and IGD symptoms were assessed using the Physical Activity Rating Scale-3, the three-item short form of the University of California, Los Angeles Loneliness Scale, and the nine-item Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition IGD Checklist, respectively, at three 6-month intervals: wave 1 (baseline, T1), wave 2 (T2), and wave 3 (T3). A random intercept (RI) cross-lagged panel model (CLPM) and multigroup analyses were conducted. Results: RI-CLPM indicated that at the within-person level, higher PA predicted decreased subsequent loneliness (T1→T2: β=–0.12, 95% CI −0.16 to −0.08; T2→T3: β=–0.13, 95% CI −0.17 to −0.08) and IGD symptoms (T1→T2: β=–0.10, 95% CI −0.16 to −0.04, P=.009; T2→T3: β=–0.10, 95% CI −0.16 to −0.04). Increased loneliness (β=–0.22, 95% CI −0.26 to −0.18) and increased IGD symptoms (β=–0.08, 95% CI −0.12 to −0.04) each predicted later reductions in PA, indicating a mutually reinforcing cycle. Increased loneliness also predicted an increase in subsequent IGD symptoms (T1→T2: β=0.14, 95% CI 0.11-0.17), and increased IGD symptoms, in turn, predicted greater loneliness in the next wave (T1→T2: β=0.18, 95% CI 0.14-0.22). Multigroup models indicated that the protective effect of PA on later loneliness and the prospective effect of loneliness on subsequent IGD symptoms were stronger among girls than boys. In males, PA significantly predicted loneliness (β=–0.08 to –0.09, 95% CI −0.15 to −0.01), and loneliness significantly predicted IGD symptoms (β=0.09, 95% CI 0.03-0.15). In females, the cross-lagged effects from PA to loneliness were significant but stronger (β=–0.17, 95% CI −0.23 to −0.11), and the paths from loneliness to later IGD symptoms were also significant (β=0.16, 95% CI 0.11-0.21). Conclusions: PA, loneliness, and IGD symptoms are reciprocally linked in adolescent gamers. By using RI-CLPM to distinguish within-person changes from stable between-person differences, this study extends prior research based mainly on cross-sectional designs or traditional CLPMs and provides a clearer understanding of the dynamic interplay among behavioral, emotional, and gaming-related factors. The findings highlight that interventions aiming to prevent IGD symptoms should simultaneously promote PA and reduce loneliness, with particular attention to sex-specific patterns, especially in girls.

Mental Health Professionals’ Views on Gaming to Inform Game-Based Interventions: Qualitative Cross-Sectional Study

2026-04-20T13:00:04-04:00

Background: Few game-based digital mental health interventions have been adopted in clinical practice, where mental health professionals (MHPs) play a critical role in the uptake of new technologies. Existing evidence suggests that MHPs’ views on game-based interventions and entertainment video games are mixed, reflecting broader tensions surrounding video games, which are perceived as both harmful and beneficial. However, the underlying reasons for these perceptions have remained unclear, even though they may substantially influence MHPs’ willingness to adopt or refuse new clinical solutions. Objective: This qualitative cross-sectional study investigates how MHPs view entertainment video games and gaming in clinical contexts. By examining these perceptions, the study aims to inform the implementation of game-based digital mental health interventions in health care. Methods: This study combined 3 qualitative interview datasets (n=19, n=16, and n=6) capturing Finnish MHPs’ views on video games and gaming, resulting in a combined sample of 41 participants, of whom 56% (n=23) were women and 59% (n=24) reported playing games. The interview data were analyzed using reflexive thematic analysis. Additionally, 2 post hoc analyses were conducted with complementary qualitative questionnaire data (n=80) collected alongside the first dataset. Results: In total, 3 themes were generated to reflect the MHPs’ views. First, personal recreation, clinically harmful: MHPs demonstrated a self-client attitude asymmetry, describing their own gaming primarily as positive and recreational, while associating clients’ gaming with problems. Second, adverse technology and meaningful culture: MHPs expressed attitudinal ambivalence, making sense of gaming through conflicting frames as both potentially harmful technology and meaningful culture. Third, holistic exploration of clients’ gaming: MHPs evaluated their clients’ gaming within the broader context of the clients’ lives. The first post hoc analysis reinforced the observed self-client attitude asymmetry, showing that MHPs associated their own gaming experiences with more positive and fewer negative meanings compared to their clients’ gaming. The second post hoc analysis suggested that MHPs expected game-based interventions to be approachable, motivating, and complementary to other treatments, and particularly suited for children and youth, people with strong digital competencies, and clients who were withdrawn. Conclusions: Existing qualitative research on MHPs’ perceptions of video games remains limited and has not examined clinicians’ broader sense-making of gaming to inform the implementation of game-based interventions. This study identifies how clinician education can build on MHPs’ existing perceptions while addressing potential misconceptions by clearly differentiating game-based interventions from entertainment games, clarifying their clinical aims and mechanisms of action, situating them within clients’ broader care and recovery processes, and challenging narrow assumptions about their target audience. Together, these contributions address a critical gap in the literature and inform strategies to improve clinician education, communication, and the adoption of game-based interventions in mental health care.

Balance Assessment Using Gamified Digital Technology in Community-Dwelling Older Adults: Mixed Methods Validation Study and Randomized Controlled Trial

2026-04-15T15:45:09-04:00

Background: Falls cause injury and mortality among older adults, necessitating reliable, scalable, engaging balance assessment tools to use in community settings. Traditional clinician-administered assessments like the Brief Balance Evaluation Systems Test (Brief-BESTest) are limited by subjectivity and accessibility constraints. Computer vision–based digitalization combined with gamification may address these limitations; yet, validation evidence remains limited. Objective: We (1) digitalized and validated a computer vision–based Brief-BESTest against clinician scoring and (2) investigated whether a gamified interface improves older adults’ user experience during balance assessment, without compromising assessment performance. Methods: This mixed methods study comprised (1) a concurrent validity substudy in a convenience subsample (n=10) and (2) a parallel-group randomized controlled trial (RCT; n=30) with 1:1 allocation. Participants were community-dwelling older adults aged ≥60 years recruited from Hongqi Community, Shanghai, through community announcements and health care worker referrals. Phase 1 (n=10; mean age 64.9, SD 2.76 years) evaluated concurrent validity of a computer vision-based digitalized Brief-BESTest using OpenPose skeletal tracking (Carnegie Mellon University Perceptual Computing Lab; Logitech Brio 4K webcam, 27-inch touchscreen) against the clinician-administered version. Phase 2 (n=30; mean age 66.7, SD 3.93 years) used a parallel-group RCT with 1:1 coin-flip allocation. Primary outcome measures include perceived exertion (Borg Rating of Perceived Exertion scale 6‐20), intrinsic motivation (Intrinsic Motivation Inventory 7-point Likert, including interest and enjoyment, perceived competence, and pressure and tension subscales), and intention to continue use (7-point Likert scale). Semistructured interviews (mean 4.8 minutes) assessed engagement factors. Data collection occurred in a controlled indoor setting with safety railings. Results: Phase 1 demonstrated excellent intrasession reliability (intraclass correlation coefficient=0.89‐0.92) and strong concurrent validity (Spearman ρ=0.91; 95% CI 0.68‐0.98; <.01), with no significant mean difference (MD; paired test: MD 0.23; =.77; =−0.07). In phase 2, Gamified Digital Balance Assessment (GDBA) users reported significantly lower perceived exertion (Mann-Whitney : MD −2.67; 95% CI −4.60 to −0.74; =.01; =−1.08), higher enjoyment (MD 1.53; =.009; =1.17), higher perceived competence (MD 1.14; =.02; =0.89), and higher intention to continue use (MD 1.66; =.001; =1.25). Pressure and tension (=.09; =0.63) showed no significant difference. Thematic analysis (Cohen κ=0.68) identified 2 themes: motivational rewards (80% cited real-time feedback) and perceived usability (87% emphasized avatar demonstrations). Conclusions: This study validated a computer vision–based digital Brief-BESTest and experimentally tested a gamified interface for balance assessment in community-dwelling older adults. Unlike prior work focused largely on single-task digital tests or nongamified interfaces, the GDBA integrates comprehensive, clinically grounded balance assessment with evidence-based gamification tailored to older users. These findings advance digital geriatric assessment by demonstrating that gamified designs can enhance motivation, perceived competence, and tolerability of testing without sacrificing measurement quality. If replicated in longitudinal and real-world settings, such systems could provide scalable, low-cost tools for routine fall-risk screening, self-monitoring, and targeted preventive interventions in community and primary-care environments. Trial Registration: ClinicalTrials.gov NCT06958653; https://clinicaltrials.gov/study/NCT06958653

Is Gamification the New Panacea for Health Behavioral Changes? Implications for the Health and Life Insurance Industry

2026-04-13T13:45:09-04:00

Chronic health conditions impose substantial financial and operational burdens on the public health sector and insurance providers in the United Kingdom. While gamification demonstrates the potential for enhancing health behavior, a structured analysis linking to established behavioral frameworks is missing. We provide a viewpoint on whether, as health and life insurers transition from traditional risk assessment toward proactive risk reduction strategies, gamification offers an innovative mechanism to strengthen their prevention initiatives and insurer-insured relationships. We examine how gamification aligns with key theoretical models, including the Behavior Change Wheel and Behavior Change Techniques, and how gamification elements can be mapped onto them. This enables combining multiple Behavior Change Techniques into effective interventions, which provide engaging user experiences and promote intrinsic motivation. We distinguish gamification from mere incentivization, highlighting its potential for sustained health outcomes. We also explore the ethical and practical considerations of gamification in the insurance sector. We highlight the need for a robust ethical framework that preserves an individual’s ability to make free and informed decisions, while ensuring inclusivity and absence of discrimination based on personal characteristics that may affect their capacity to engage in healthy behaviors. Similarly, we highlight how privacy, transparency, and accountability need to be prioritized in the governance structure of gamification programs in the sector. Our analysis emphasizes that gamification has the potential to represent the new panacea for the insurance sector, if effective gamified interventions incorporate inclusive design principles, theoretical grounding, ethical accountability, and continuous refinement to ensure alignment with long-term public and individual health objectives. This viewpoint is the first to map gamification and behavioral change frameworks into a unified model for insurer-led health behavior interventions and encourage greater investment in gamified wellness products and the use of theory-driven behavioral science in insurance-led digital health tools.