Search Results (354)

Background/Objectives: Dietary behaviors among young adults in Japan have become increasingly polarized, highlighting the limitations of traditional knowledge-based health education. Behavioral science-based approaches such as nudging and gamification may offer alternative strategies. This study aimed to develop and examine a Theory of Planned Behavior (TPB)-based path model of healthy dietary choice behavior among young Japanese adults and to examine patterns associated with a star-rating gamification feature embedded in a nutrition management mobile application. Methods: A total of 188 participants aged 18–39 years completed an online survey assessing TPB constructs and normative factors. Participants used either a star-rating or non-rating version of the FoodLog Athl application. Composite-score-based path analysis and conditional process analyses were conducted to examine relational patterns among constructs. Results: Intention and self-efficacy jointly explained 48% of the variance in dietary behavior, with self-efficacy emerging as the strongest predictor. Several moderation patterns were observed, including those of gender, university year, diet app use, awareness of consequences, and ascription of responsibility. Compared with users of the non-rating version, star-rating users were observed to show higher nutrient scores but lower self-efficacy and dietary behavior scores, along with greater awareness of dietary consequences. These post-intervention findings are exploratory. Conclusions: Self-efficacy plays a central role in healthy dietary choice behavior among young adults, and its association with behavior appears to be shaped by perceived consequences and responsibility. By applying a composite-score-based path analysis within an SEM framework, this study clarifies the structural relationships among TPB components in everyday dietary choice behavior among Japanese young adults. Star-rating feedback may enhance reflective awareness and shows potential as a gamified nudging tool but further research is needed to clarify its effects. Full article

Virtual reality (VR) is increasingly integrated into the rehabilitation of children with cerebral palsy (CP). However, evidence to substantiate its potential as part of standard care remains limited. This Phase 1 study aimed to evaluate a VR-based immersive gamification technology system (ImGTS) for use in CP rehabilitation based on its safety, acceptability, and usability in healthy children. The system included software and hardware designs informed by discussions with CP rehabilitation and VR development experts (e.g., developmental pediatricians, physical therapists) and tailored to the local context, tested with two setups: the head-mounted display (HMD) and the semi-cave automatic virtual environment (semi-CAVE). We describe the experience of 30 healthy children aged 6–12 years using the ImGTS (Mission to Planet Axel version 1.0) using either the HMD (n = 15) or semi-CAVE (n = 15) setup. Descriptive and thematic analyses of data from semi-structured interviews based on questionnaires for safety and acceptability, as well as observations of behaviors for the usability dimensions of effectiveness, efficiency, and satisfaction, indicated that participants were engaged and motivated with the ImGTS, with low incidence and severity of VR-related symptoms for both setups and high acceptance of the ImGTS, based on perceptions of the environment and feelings of presence. Usability was also high. These findings suggest that the ImGTS is safe, acceptable, and usable for healthy children. This trial provides initial evidence to guide the methods of subsequent trials testing the safety, acceptability, usability, and clinical effectiveness of the ImGTS in children with cerebral palsy, and, eventually, to guide its deployment. Full article

Background/Objectives: Population ageing is accelerating, and adults aged ≥75 years (the “very old”) have distinct functional, cognitive, and social needs. Game-based digital interventions—including exergames, serious/digital games, and gamification—may promote multidimensional well-being; however, findings are often reported for broad “older adult” samples without age-disaggregated results. This scoping review mapped the use and effects of game-based digital interventions in adults aged ≥75 years and assessed how frequently studies reported age-specific outcomes. Methods: The review was conducted in accordance with JBI guidance. PubMed, CINAHL, PsycINFO, Scopus, and Web of Science were searched. Records were screened in Rayyan by two reviewers. Data were extracted using a standardized charting form, and outcomes were classified into predefined outcome domains and implementation-related categories. Results: Nineteen studies were included, predominantly European and largely conducted in supervised institutional settings. Exergames were the most common intervention type. Physical outcomes were reported most frequently, whereas cognitive, emotional, social, and quality-of-life outcomes were assessed less consistently. Conclusions: In adults aged ≥75 years, evidence on game-based digital interventions is mainly based on supervised exergame programmes and emphasizes physical-function outcomes, while age-disaggregated reporting and person-centred outcomes remain limited. Future research should routinely report results specific to participants aged ≥75 and broaden outcome assessment to better inform intervention design for the very old. Full article

Vocabulary learning has been a challenge for second language (L2) learners, often due to its repetitive nature and the massive time investment it requires. To address these challenges, digital gamification features have been introduced to L2 learners and educators in higher education contexts to enhance the learning experience and foster learner grit. This study examined the impact of a mobile collaborative gamification feature, the learning-pal activity, on L2 vocabulary acquisition, focusing on learners’ vocabulary learning grit and perceived social presence. Using a quasi-experimental design, 100 L2 students from a Chinese university were divided into two groups: an experimental group (N = 62), which used the learning-pal feature within the Shanbay Danci (SBDC) app, and a control group (N = 38), which used the app without the collaborative feature. Employing a mixed-methods approach, the study found that participation in the learning-pal activity significantly improved learners’ vocabulary learning grit. However, the activity did not significantly enhance perceived social presence; notably, the experimental group reported lower levels of perceived social presence than the control group. These findings suggest that mobile collaborative gamification can effectively foster sustained vocabulary learning efforts but provide limited opportunities for social interaction during the vocabulary learning process. Full article

Digital Mental Health Interventions (DMHIs) offer a scalable solution to the global mental health crisis, yet their real-world impact is often hampered by low user engagement. Gamification has been widely adopted as a strategy to enhance adherence, but its implementation creates a complex and often unacknowledged “Engagement–Efficacy–Ethics Trilemma”. This systematic review synthesises the current literature to deconstruct this trilemma, arguing that an uncritical focus on maximising engagement can fail to improve—or may even undermine—clinical efficacy, while simultaneously introducing significant ethical risks. Our analysis reveals a persistent “Engagement–Efficacy Gap”, where increased usage of mobile health applications (mHealth apps) does not consistently translate to better therapeutic outcomes. Furthermore, we map the ethical landscape, identifying potential harms such as manipulation, psychological distress, and privacy violations that arise from persuasive design. The roles of Artificial Intelligence (AI) in personalising these experiences and Human–Computer Interaction (HCI) in mediating user responses are critically examined as key factors that both amplify and potentially mitigate the tensions of the trilemma. The findings indicate a pressing need for a paradigm shift toward an integrated approach that concurrently evaluates engagement, efficacy, and ethical integrity. We conclude by proposing a framework for responsible innovation, emphasising theory-driven design, co-design with users, and prioritising intrinsic motivation to harness the potential of gamified DMHIs safely and effectively. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was conducted across Scopus, Web of Science, MEDLINE, and PsycINFO for studies published between 2015 and 2025. Full article

Background/Objectives: Vaccination coverage among adolescents remains below the recommended target, highlighting the need for effective educational strategies to improve vaccine knowledge. This study aimed to assess baseline knowledge of vaccines and immune mechanisms among adolescents and to evaluate whether a school-based educational intervention can improve knowledge related to vaccination. Methods: A prospective quasi-experimental pre–post study was conducted between 1 February 2025 and 1 June 2025 among adolescents aged 14–19 years attending high schools in Southern Italy. The intervention was based on the e-Bug educational module and delivered by trained nurses through interactive lessons, gamification, and guided discussions. Vaccine-related knowledge was assessed using a questionnaire administered before and after the intervention. Changes in knowledge scores were analyzed using paired statistical tests, and the effect size was estimated. A stepwise multivariate linear regression model was employed to identify factors associated with post-intervention test scores, with statistical significance set as p ≤ 0.05. Results: Among 386 participants, the majority were female (74.2%), the average age was 15.8, and 15% reported a chronic medical condition. Knowledge gaps were observed at baseline, particularly regarding the items on recommended adolescent vaccinations (37.4%), the definition of innate immunity (25.6%), and the mechanism of vaccines’ action (51%). After the intervention, all the items showed an improvement in correct answers, statistically significant for 5 of the 7 analyzed items (r = 0.364, p < 0.001). The most pronounced improvement was in the awareness of age-specific recommended vaccines (61.2%). The multivariate linear regression analysis showed that those with higher pre-intervention test scores, those who had parents with chronic medical conditions, those whose fathers worked, and those willing to participate in similar future interventions were more likely to achieve higher post-intervention test scores. Conclusions: School-based interventions may represent an effective strategy for enhancing adolescents’ knowledge related to vaccination, but further studies with control groups and long-term follow-up are needed to confirm effectiveness. Full article

As part of our technology-enhanced learning (TEL) strategy, we developed a field-based augmented reality (AR) learning system for biodiversity education among senior elementary school students. Using a 2D illustration style to present the appearance of the species and a situational interactive design, the AR app focused on common wild animals in Taiwan. They also gained insight into wild animal species in outdoor settings, gained knowledge about the phenomenon of roadkill and the rescue of wild animals, and promoted their awareness of ecological conservation. Using the design-based research (DBR) method, we integrated user-oriented design processes and iteratively modified the system functions and interface through expert review and field usability testing. During this activity, 26 senior elementary school students were recruited to participate in an interactive AR game designed for a single player. As part of the learning content, students must collect images of species, recognize roadkill, and learn about wildlife rescue. To evaluate the effect of the activity on knowledge learning and the app’s usability, data were collected through pre- and post-test paper tests, questionnaires, and so on. Based on the research results, this system can significantly enhance students’ learning interests and contextual understanding of biodiversity topics as an effective technology-assisted learning tool. Students reported high levels of immersion and learning motivation, and the teachers agreed that it promoted inquiry-based and independent learning. The results of this study contribute to the field of educational and environmental education. Consequently, context-aware AR tools may enhance students’ situational learning experience and environmental literacy. In addition, it provides a practical design reference for future AR educational applications, demonstrating that gamification and outdoor learning can enhance the learning outcomes of traditional science education. Full article

This exploratory mixed-methods study examined whether a narrative-driven digital gamification platform, FantasyClass, grounded in the MDA (Mechanics–Dynamics–Aesthetics) framework and Bartle’s player typology (used as a cohort-level design input), was associated with science attitudinal change in preservice primary teachers. The quantitative component employed a one-group pretest–posttest (pre-experimental) within-participant design using a validated 22-item attitudes questionnaire (N = 23), structured across three temporal dimensions: past (retrospective experiences), present (current perceptions), and future (teaching expectations). Significant improvements were observed across all attitudinal dimensions with large effect sizes, most notably in students’ future expectations and confidence to teach science. Exploratory correlation analyses indicated that participants’ perceived motivational value of narrative and immersion elements was moderately associated with Future-dimension attitudinal gains. Qualitative thematic analysis of open-ended responses (n = 15) revealed enhanced motivation, reduced science anxiety, more positive perceptions of physics and chemistry, and strong intentions to adopt game-based and gamified strategies in future teaching practice. Convergence across quantitative and qualitative strands suggests that structurally coherent, player-type-informed narrative gamification may be associated with attitudinal transformation and early professional identity development in STEM teacher education, while recognizing that the design does not permit causal attribution. Full article

Background: Gamification is a promising approach to support rehabilitation, but implementing new devices after hand surgery (HS) faces challenges, especially in patient motivation and compliance. Technology-based, personalized solutions may encourage patients to perform gamified exercises consistently. This study investigated the impact of a tablet-based gamified hand-mobilization system on functional outcomes after HS compared to standard finger-expander training. Methods: Forty inpatients at BG Klinikum Duisburg were randomly assigned to a gamified or control group. Both groups underwent four weeks of stationary rehabilitation. Outcomes were assessed using the Disabilities of Arm, Shoulder, and Hand questionnaire (DASH), SF-36 health-related quality of life, and a visual analog scale (VAS) at pre- (T0) and post-training (T1). Tablet use frequency and duration were recorded. Results: DASH scores improved significantly over time (F(1.55, 58.85) = 16.36, p < 0.001, partial η² = 0.137) with no Group or Time × Group effects (p > 0.40), exceeding the MCID in both groups. SF-36 MCS, PCS, and VAS pain also improved over time (all p < 0.05) with no between-group differences (p > 0.40). Exercise duration differed (p = 0.007), but training frequency did not. Conclusions: Both gamified and conventional rehabilitation programs led to clinically meaningful improvements in hand function after hand surgery. No significant differences were observed between groups, indicating that the tablet-based system was feasible and well-accepted but not superior to standard training. Full article

Most of the existing Virtual World (VW)-based curriculum-related educational systems use conventional non-player characters (NPCs) to interact with users, represented as avatars, to guide and help them to accomplish learning activities. Also, a few of them use some kind of gamification and keep data for user interactions and activities, and even fewer allow for real-time tutor intervention. In this paper, we present the design, implementation, and evaluation of an educational system based on VW technology, which employs gamification features; two types of NPCs, one conventional and another LLM-based; and a database that stores, apart from educational information, information about the interactions users have with NPCs. Furthermore, we designed and implemented a learning management unit for online-tutor tracing and for supporting the learning progress of users. The evaluation of the system, via experimental use and questionnaires, shows that both types of NPCs were useful for different reasons, although there was a preference for the LLM-based NPC. LLM-based NPCs made dialogues more interesting and were perceived as more friendly and helpful, but conventional ones provided more targeted help. However, both were less interesting than the two gamification features: a scoring system and quizzes. Additionally, the effectiveness of the tutoring system was confirmed in terms of learning outcomes and overall experience, although in a subjective manner. Finally, online-tutor support was recognized as a very positive capability. Full article

Fall-compliant flooring represents a passive fall preventative approach that has emerged as an effective intervention for reducing fall-related injuries, yet its adoption remains limited due to insufficient understanding among end-users and key stakeholders. To address this knowledge gap, this perspective article provides a proof-of-concept for an interactive pedagogical tool designed to use gamification principles to improve understanding of the mechanical behavior of fall-compliant flooring. This two-part perspective article first establishes the scientific foundation through controlled ball drop experiments comparing energy dissipation between fall-compliant and standard flooring. Through video-based tracking analysis, the experiments quantified kinetic energy and force dissipation across spatial and temporal dimensions. Results revealed that fall-compliant flooring exhibits significantly superior spatiotemporal energy dissipation capabilities compared to standard flooring across both force and kinetic energy metrics. Building on these findings, the second part proposes a conceptual framework for a pedagogical tool that translates these experimental insights into an interactive learning experience that could, in future implementations, allow users to conduct hands-on ball drop activities supported by real-time scientific explanations. This approach transforms complex biomechanical concepts into accessible, engaging learning experiences. By combining experiential learning with gamified elements, this tool, termed “Fallville”, has the potential to increase fall-injury prevention awareness, deepen understanding of fall-compliant flooring mechanisms, and ultimately accelerate adoption of this proven safety intervention in healthcare and residential settings. Full article

Background: Gamification is an innovative pedagogical strategy for improving learning outcomes, motivation, engagement, and knowledge retention. Nevertheless, evidence on the effectiveness of gamification remains heterogeneous. Methods: A systematic review was conducted. Searches were performed across PubMed/MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, Google Scholar, and grey literature (2010–2025). Eligible studies included quantitative, qualitative, and mixed-methods research involving undergraduate nursing students exposed to gamification interventions. Data extraction and quality assessment were independently performed using RoB-2, ROBINS-I, and JBI tools. Narrative synthesis was adopted due to the heterogeneity of interventions and outcome measures. Results: A total of 48 studies were included. Gamification strategies varied widely and included interactive quizzes, gamified flipped classroom models, serious games with explicit game elements, escape rooms, digital badges, and audience-response systems. For learning outcomes, most studies reported improvements in knowledge or performance, particularly when gamification included immediate feedback and repeated practice. While the knowledge retention was evaluated less frequently (12%), it was generally maintained or improved up to 2–4 weeks and across semester assessments. Strong positive trends of motivation and engagement were found across most studies, especially with competitive quizzes, missions, and narrative-based activities. Self-efficacy and satisfaction frequently improved, particularly in gamified simulations and team-based activities. Risk of bias was variable, with many quasi-experimental and descriptive studies limiting causal inference. Evidence certainty ranged from low to moderate according to GRADE criteria. Conclusions: Gamification is a promising educational approach in undergraduate nursing programs. Effects on long-term retention and practical skills remain less clear due to methodological variability and limited follow-up data. Future research focused on standardized outcome measures and longer follow-up intervals is required to consolidate evidence and guide educational policy. Protocol registered on PROSPERO (CRD420251117719). Full article

Background: Mild cognitive impairment (MCI) is a high-risk prodromal stage of dementia. While tablet/computer-based computerized cognitive training (CCT) is widely used, its efficacy and gamification’s role need clarification. Objective: This study aimed to evaluate the effect of tablet/computer-based CCT on global cognition in older adults with MCI and explore the impact of gamification. Methods: We systematically searched five databases for RCTs (through October 2025) involving individuals aged ≥55 with MCI. The intervention was task-based CCT via tablets/computers. Primary outcome was global cognition. We used random-effects meta-analysis and subgroup analyses. Results: Nineteen RCTs (1013 participants) were included. CCT demonstrated a significant, moderate positive effect on global cognition (Hedges’ g = 0.57, 95% CI [0.36, 0.78]). A trend suggesting greater benefits with higher gamification was observed: high (g = 0.71), medium (g = 0.46), and low (g = 0.45) degrees. However, subgroup differences were not statistically significant (p = 0.4333). Results were robust in sensitivity analyses. Conclusions: Tablet/computer-based CCT effectively improves global cognition in MCI. The potential additive value of gamification highlights its promise for enhancing engagement and effects, warranting further investigation in larger trials. This systematic review was registered with PROSPERO (CRD420251231618). Full article

This paper presents Greenopoli, an innovative framework for sustainability and waste management education that has engaged over 600 schools and 90,000 students since 2014. Greenopoli is founded on the idea that children and youth can grasp environmental issues as well as adults and act as agents of change within their families and communities. The Greenopoli approach combines scientific accuracy with playful, creative pedagogy to simplify complex topics and stimulate peer-to-peer learning. It includes storytelling, games, field visits, and “green raps” (original environmental songs co-created with students). The framework is adaptive, with content and activities tailored to education stages from kindergarten through university. Educators adopt the role of moderators or facilitators, encouraging students to discuss and discover concepts collaboratively. Greenopoli’s participatory method has been implemented across all age groups, yielding enthusiastic engagement and tangible outcomes in waste sorting and recycling behaviors. The program’s reach has extended beyond schools through collaborations with national recycling consortia, NGOs, municipalities, and media (TV programs, social media, TEDx talks). Numerous awards and recognitions (2017–2025) have highlighted its impact. A comparative analysis shows that Greenopoli’s use of peer-led learning, gamification, and creative communication aligns with global best practices while offering a unique blend of tools. Greenopoli is a novel best-practice model in environmental education, bridging theory and practice and contributing to the goals of Education for Sustainable Development and a circular economy. It demonstrates the effectiveness of engaging youth as change-makers through interactive and creative learning, and it can inspire similar initiatives globally. Full article

Despite the growing interest in physiological stress monitoring, an objective measure of stress is currently lacking, especially in clinical and rehabilitation contexts. With the emerging integration of artificial intelligence (AI) in data analytics, heart rate variability (HRV) has gained attention as an effective biomarker; however, the literature remains fragmented across disciplines, stress types, and methodological approaches. This scoping review aims to investigate how AI techniques are applied to HRV analysis for stress detection and prediction in adult populations. Although this review does not focus on a specific subtype of stress, its primary objective is to explore the current methodological state of the art as reported in the literature, without restrictions on stress typology. Following PRISMA-ScR guidelines, a systematic search was conducted across PubMed, Scopus, and Google Scholar for studies published between 2005 and 2025, using MeSH terms including “HRV”, “Rehabilitation”, “SCI” (for Spinal Cord Injury), “Stress”, “Sympathetic”, “Parasympathetic”, “Non-linear”, “Gamification”, “AI” and “Machine Learning”. Inclusion criteria targeted adult human populations and studies employing HRV features as input for AI and machine learning techniques for psychophysical stress assessment. Of the 566 records identified, 15 studies met the eligibility criteria. The reviewed studies exhibit substantial heterogeneity in terms of settings, populations, sensors, and algorithms with most employing supervised methods (e.g., random forest, support vector machine), alongside several applications of deep learning and explainable AI. Only one study focused specifically on physiological stress, none focused on SCI populations, and rehabilitation-related research was scarce, thereby underscoring important gaps in the current literature. Overall, HR variability analysis, especially when combined with artificial intelligence techniques, represents a promising approach for stress assessment; however, the field is methodologically fragmented and clinically underdeveloped in critical areas, underscoring the need for a multidisciplinary methodological framework. Full article