Digital Gamification Tools to Enhance Vaccine Uptake: A Scoping Review and An Environmental Scan (Preprint)

BACKGROUND Gamification has been used successfully to promote various desired health behaviours. Previous studies have used gamification to achieve desired health behaviours or facilitate their learning about health. OBJECTIVE In this scoping review and environmental scan, we aimed to describe gamified digital tools that have been implemented and or evaluated across various populations to encourage vaccination uptake, as well as any reported effects of identified tools. METHODS For the scoping review component, we searched Medline, Embase, CINAHL, Web of Science Core Collection, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Academic Search Premier, PsycInfo, Global Health and ERIC for peer-reviewed articles describing gamified digital tools with or without evaluations. For the environmental scan component, we conducted web searches with Google to identify gamified digital tools lacking associated publications. We also consulted 12 experts in the field of gamification and health behaviour to identify any articles or tools we might have missed. We extracted data about the target population of the tool, the interventions themselves (e.g., type of gamified digital tool platforms, type of disease/vaccine, type and design of the study), any effects of evaluated tools, and synthesized data narratively. RESULTS Of 1402 records, we included 28 peer-reviewed articles and 10 gamified digital tools lacking associated publications. Experts added one gamified digital tool that met the inclusion criteria. Our final data set therefore included 28 peer-reviewed articles and 11 gamified digital tools. Out of 28 peer-reviewed articles, 7 studies explained the development of the tool, 16 studies described evaluation, and 2 reported both development and evaluation of the tool. The 28 peer-reviewed articles reported on 25 different tools. Of these 25 gamified digital tools, 11 were web-based, 8 mobile (native mobile applications or mobile web applications), and 6 virtual reality. Overall, tools that were evaluated showed increases in knowledge and intentions to receive vaccines, mixed effects on attitudes, and positive effects on beliefs. We did not observe discernible advantages of one type of gamified digital tool (web-based, mobile, virtual reality) over the others. However, few studies were randomized controlled trials, and publication bias may have led to such positive effects having a higher likelihood of appearing in the peer-reviewed literature. CONCLUSIONS This review demonstrates that gamified digital tools appear to have potential for improving vaccine uptake by promoting vaccine-favourable beliefs and increasing knowledge about vaccines and intentions to receive vaccines. Comparative studies of different features or different types of gamified digital tools could advance the field by identifying features or types of tools that yield more positive effects across populations and contexts.