Practical applications of gamification in patient-centered outcomes research and digital health, and its acceptance in clinical trials

BackgroundThe application of game elements to engage participants and improve data collection for clinical trials is relatively novel, with limited research around the impact of gamification in clinical research. This article explores published literature and surveys from patients and clinical sites.MethodsA targeted literature review was completed in November 2025 to identify published articles (≤10 years) on the application of gamification in clinical trials. Synthesized findings informed the design of two surveys of US adults (n = 1,044 from UserTesting.com) and clinical trial sites (n = 311) on their perceptions of gamification and acceptance in clinical trials. Both were ∼5-minute online surveys utilizing five open- and closed-ended questions.ResultsTwenty-four articles were focused on the application of gaming design and mechanics to non-gaming activities. Three primary areas identified were education (n = 3), health outcomes measures (n = 7), and patient engagement (n = 14). Eighteen studies reported an advantage of gamification, including positive impacts on health outcomes measures (n = 5) and patient engagement (n = 11). Survey respondents (adults) were most familiar with computer games (62%), stating a preference for participating in trials that included gamified cell phone applications, with the ability to customize application elements as the most important. From a thematic analysis of respondents’ comments, potential impacts on human behavior and performance (33%) were the most prevalent concerns. Data (26%; including concerns about privacy, integrity, and security), and software (22%; including adaptability to account for ability and skill variation, satisfaction, user experience, controls, customization, and personalization) were also key areas of concern for patients. Key perceived benefits included improvements in experience (31%) and engagement (24%). Site respondents were most familiar with managing gamified clinical trials with gamified cell phone applications (30%) and would prefer to manage trials that included these elements vs. traditional trials. Notifications, education, and training were the most important gamification elements for site respondents.ConclusionsPotential advantages of gamification include increased engagement, trial education, adherence to protocols, and enjoyment of the clinical trial experience, which may increase retention and data completeness. Further research is required to better understand the potential impact of gamification on scores of how patients feel or function.