Do forums and game features make a health website work better?
For people with rheumatoid arthritis, adding online social support or game-like rewards to an information website increased use and empowerment and was linked to better self-reported health behaviour, while information alone did no better than no website.
Source
The effect of social support features and gamification on a Web-based intervention for rheumatoid arthritis patients: randomized controlled trial
Study at a glance
- Design
- RCT — Single-blinded parallel RCT with four website arms (information only, plus social support, plus gamification, or all features) and a no-website control; outcomes at baseline, 2 and 4 months analysed with multilevel growth models.
- N
- N=155 · 155 randomised patients who completed the baseline questionnaire, analysed by intention to treat (information 30, social support 29, gaming 28, social support plus gaming 28, control 40).
- Population
- Adults with doctor-diagnosed rheumatoid arthritis in Ticino, the Italian-speaking part of Switzerland, with internet access and no other major chronic illness
- Outcome
- Primary: self-reported physical activity, health care utilisation and prescription medication overuse; secondary: empowerment and RA knowledge; side outcome: website visits
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What they did
The researchers randomly assigned 155 Swiss patients with rheumatoid arthritis to four versions of a self-management website or a control group: a website with information only, information plus social support (patient videos, a forum and chats with doctors), information plus gamification (points, badges, a leaderboard and prizes), all features, or no website at all. Patients completed questionnaires at the start, after 2 months and after 4 months. Multilevel growth-curve models compared how each group's outcomes changed over time relative to the no-website control group, adjusting for demographics.
What they found
Patients offered the gamified version visited the site far more often (a mean of 66.81 versus 26.15 visits). Compared with controls, the full-feature group increased exercise time over the study, and both the social support group and the full-feature group reduced their health care visits; medication overuse fell only marginally in the social support group. Empowerment rose more in the social support group and the gaming group than in controls, while knowledge about the disease did not change in any group, and the information-only group never differed from controls.
The limits
What it doesn't show
All health outcomes were self-reported, including physical activity, which studies using activity monitors have sometimes failed to confirm. Each arm had only about 30 patients, many group-by-time effects were tested with P values near 0.05 and no correction for multiple comparisons, so some findings may be chance. The control group completed paper questionnaires and was told a different study purpose, follow-up lasted only 4 months, and the sample came from one Swiss canton of long-diagnosed patients, which limits generalisation.
Key terms
- Gamification
- Adding game design elements such as points, badges, leaderboards and prizes to a non-game setting to motivate participation.
- Online social support
- Emotional, practical and informational help exchanged through features like forums, chat rooms and patient testimonies.
- Patient empowerment
- A patient's sense of meaning, competence, self-determination and impact in managing their own illness.
- Multilevel growth-curve model
- A regression approach for repeated measures that models each person's trajectory over time and tests whether trajectories differ between groups.
- Intention-to-treat analysis
- Analysing all randomised participants in the group they were assigned to, regardless of how much they used the intervention.
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Quiz yourself
What was the clearest effect of adding gamification to the website?
Common questions
Why did the study use several website versions instead of just website versus no website?
A factorial-style design lets the researchers separate the effect of social support features from the effect of gamification, and check whether plain information adds anything on its own.
Did gamification make patients healthier or just make them use the site more?
It clearly increased site use; the health effects were smaller, self-reported and mostly seen when gaming was combined with social support, so its direct health benefit is less certain.
Why did knowledge not improve?
Participants had been diagnosed for 11.89 years on average, so they probably already knew most of the content; newly diagnosed patients might show a different pattern.
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