Perspectives of Australian healthcare professionals towards gamification in practice

Abstract

Aim

Gamification may be an effective tool in motivating sustained behaviour change. This study aimed to explore perspectives of Australian‐based healthcare professionals, including dietitians, towards gamification in their practice when assisting patients/clients to achieve health‐related goals.

Methods

Semi‐structured online interviews were conducted with healthcare professionals. Data was audio‐recorded, transcribed verbatim, de‐identified and thematically analysed to identify key themes and inform the creation of personas.

Results

Six dietitians, two psychologists, two exercise physiologists, one medical specialist, with 1–24 years of work experience, participated. Most participants (n = 7, 64%) were unable to articulate a definition of gamification, however, when offered more context, they could identify examples. Overall, participants were positive towards gamification, regardless of prior experience/exposure. Three themes emerged; (1) Variable familiarity with gamification, (2) Context matters, (3) Barriers hinder engagement/adoption. Stage of career rather than profession influenced participants' views of gamification, as reflected in three characterising personas; ‘Joel: Early‐Career, Progressive’, ‘Bella: Mid‐Career, Stable’ and ‘Sam: Advanced‐Career, Expert’.

Conclusions

Findings suggest that gamification is not widely used in health practice in Australia. Concerns about participation costs and data privacy are adoption barriers. Promotion of the effectiveness of gamification as a valuable adjunct tool to encourage behaviour change needs support from peak bodies. Embedding gamification in university curricula could better prepare graduates to engage with gamification in future practice. Further research capturing more diverse healthcare professionals' perspectives is required to fully understand the potential of gamification to change health behaviours, and to design feasible gamified solutions.

1. INTRODUCTION

Gamification is the application of game design elements and mechanics to non‐game contexts, ¹ such as motivating health behaviours, including positive changes to eating and exercise. Gamification can be applied in both non‐digital game formats, like sticker awards and community challenges, and digital formats. Common examples of digital gamification include the bidding process in e‐Bay, the earning of reward points in supermarkets, hotels and airlines, and the achievement of new levels of difficulty in online learning platforms such as Duolingo. Gamification constitutes games in various forms, the majority of which incorporate a goal that players try to achieve, rules that define how to achieve the goal, a feedback system informing players of their progress towards the goal, and voluntary player participation. ² Enhanced user engagement can be achieved by game elements such as user boards, badges, points, timers and feedback that also encourage desired behaviour changes. According to a 2017 systematic literature review, gamification has the potential to be an effective motivational tool to assist people to engage in healthy behaviours by making them more enjoyable and rewarding. ³

Management of lifestyle‐related diseases often includes motivating people to adopt healthier lifestyle behaviours over sustained periods of time, typically under the guidance of a healthcare professional. ⁴ , ⁵ , ⁶ , ⁷ , ⁸ , ⁹ , ¹⁰ , ¹¹ , ¹² , ¹³ However, making lifestyle‐related behaviour changes is often challenging, ¹⁴ whether for attainment of healthy eating, increased physical activity, ¹⁵ or smoking cessation. ¹⁶ Attaining long‐term behaviour change is complex and may take around 66 days on average, though the timeline varies as it depends on the individual, the specific behaviour, and other extrinsic factors. ¹⁷ According to the transtheoretical model of change, ¹⁸ also referred to as the stages of change model, behaviour change is a staged process with varying durations for each stage: precontemplation, contemplation, preparation, action and maintenance. The goal of healthcare professionals, within their scope of practice, is often to motivate people to replace potentially negative habits with health‐enhancing ones via behaviour change strategies that are underpinned by the theory of planned behaviour. ¹⁹ The theory of planned behaviour considers an individual's attitudes, social norms and perceived control. ¹⁹ Insights from this perspective can help health professionals better understand their clients or patients, predict their behavioural intentions more accurately, and design effective and individualised interventions. ²⁰ More recently, the ‘COM‐B model’ has been adopted to help design health interventions that address important factors necessary for achieving sustainable Behaviour change, including an individual's Capability, Opportunity and Motivation. ²¹

Healthcare professionals such as dietitians, nutritionists, exercise physiologists and psychologists, play an important role in motivating health behaviour changes, like healthy eating and increased physical activity. Dietary and physical activity guidance documents (Australian Dietary Guidelines ²² and Australian Physical Activity Guidelines ²³ ) offer recommendations on the types/amounts of foods to eat, and how much to exercise, however, they lack motivational strategies critical for achieving and sustaining the benefits that behaviour change has to offer. Effective strategies to motivate people are therefore paramount for optimal patient/client management. Traditionally, healthcare professionals have used the transtheoretical model of change ²⁴ and motivational interviewing ²⁵ to facilitate change. In more recent years, gamification applications on smartphones, tablets and other portable digital devices have emerged as an option for healthcare professionals to help support and motivate behaviour changes in their patients/clients, including diet‐related behaviour modifications. ²⁶ The effectiveness of gamification in promoting healthy eating has been studied in both adults and children, with gamification shown to influence greater vegetable intake in adults, ²⁷ and greater fruit and vegetable consumption in children. ²⁸

To understand whether healthcare professionals are inclined to embrace current or future gamified interventions as an adjunct motivational tool in practice, it is essential to understand their attitudes towards gamification in the first instance. To date, there has been limited research elucidating healthcare professionals' familiarity with and perspectives on gamified interventions aimed at promoting dietary and/or lifestyle behaviour modifications. ²⁹ Therefore, this study aimed to explore healthcare professionals' familiarity with gamification, its current applications within healthcare practice, especially in digital formats, and its potential future use in clinical practice. An exploration of healthcare professionals' perceived barriers and enablers to adoption across different disciplines and workplace settings was a key secondary aim of the study.

2. METHODS

Semi‐structured interviews were used as part of this qualitative exploratory study. Grounded in interpretivism, ³⁰ the research aimed to draw upon the individual experiences of the participants. This methodology is commonly used in health‐related research and was selected to allow a meaningful exploration of a topic that has not yet been comprehensively examined. ³¹ Findings were reported according to the guidelines outlined in the Consolidated Criteria for Reporting Qualitative Research (COREQ). ³²

Purposive sampling was used to recruit eligible healthcare professionals, including dietitians, nutritionists, exercise physiologists and psychologists, working in various public and private health settings, as well as industry. Participants were required to be aged 18 years and over, hold a relevant qualification in their respective field and be currently practising, with an interest in motivating consumer/patient health behaviours. To recruit accredited practising dietitians (APDs) and nutritionists, a social media‐based advertisement was created and shared with the respective platforms of Dietitians Australia and the Nutrition Society of Australia. To recruit accredited exercise psychologists and psychologists, the same advertisement was posted on the exercise and sports science Australia and the Australian Association of Psychologists websites, respectively. Using snowball sampling to extend and diversify the sample, the lead researcher emailed the study advertisement to their relevant contacts. Recruitment spanned a 6‐week period, from the 19th of June to the 28th of July, 2023. Prior to the commencement of the study, ethics approval was granted by the University of Wollongong Human Research Ethics Committee.

Data was collected through semi‐structured interviews using a purpose‐built question guide comprising closed‐ and open‐ended questions (Supporting Information 1). Questions were developed through a preliminary search of the literature and discussions by the researchers to ensure that all relevant lines of enquiry were adequately explored in the interview process. Content validity of the question guide was conducted with two academic researchers not involved in the present study to ensure relevancy and understanding. These subject matter experts provided written and verbal feedback, which was used to refine the question guide. Written consent was obtained from participants prior to their involvement in interviews.

Most of the interviews were completed by one researcher with dietetic qualifications, under the supervision of an experienced qualitative researcher who also holds dietetic qualifications and has over 25 years of experience in interview conduction and observation. All interviews were conducted online using Zoom (2023 Zoom Video Communications, Inc.) and were approximately 30–45 min in duration. Data were audio‐recorded and transcribed verbatim using an automated transcription program (Otter.ai, 2023 Feb). Transcripts were reviewed against the audio recordings for accuracy. All data were de‐identified, remained confidential and were securely stored on a password‐protected server only accessible to the researchers.

A team‐based approach towards thematic analysis was undertaken to interpret the collected interview data. Braun and Clarke's six‐step approach to thematic analysis was utilised to guide coding and analysis of the data. ³³ The initial step was familiarisation, which included re‐reading the transcripts. Interview transcripts were first inductively coded line‐by‐line by the two researchers independently, collaborating afterwards to compare descriptions and determine the coding framework. Data were then grouped, analysed and categorised into key themes in Microsoft Excel (Microsoft Office, 2021). Illustrative quotations were extracted from the transcripts to represent key themes. The researchers employed reflexivity to critically reflect on their personal biases and perspectives that could influence the research process and data analysis. ³⁴ By maintaining ongoing awareness of their position, the researchers could enhance the rigour and trustworthiness of the study, in accordance with criteria proposed by Lincoln and Guba. ³⁵

During data analysis, the research team identified similar responses emerging from certain ‘types’ of interviewees. A total of three types of interviewees were categorised and described in the form of personas. A persona is a fictional character that represents a broader group of users who share similar experiences, backgrounds, needs and goals. ³⁶ , ³⁷ They are a useful way to embed empathy and to create an improved understanding of group or user perspectives. ³⁶ , ³⁷ Commonly employed in the design of new products or services, personas are utilised to craft reliable and realistic representations of a key audience or target group, ³⁸ and are increasingly being used in qualitative research. ³⁹ In this study, the personas were utilised as a way of grouping or characterising the participants to understand their differing perceptions of gamification in healthcare practice.

3. RESULTS

Eleven healthcare professionals participated, including six APDs, two Accredited Exercise Physiologists, two psychologists and one medical specialist. Although the medical specialist initially did not meet the eligibility criteria, their data were included to offer an additional perspective. No participants refused to participate or dropped out.

Participants were eight females and three males, aged 24–53 years (mean age 42 years). Of these, six were dietitians working in various settings, including hospitals, private practice, and a major Fast‐Moving‐Consumer‐Goods company. Two exercise physiologists were affiliated with tertiary education institutions and involved in academic research. The two psychologists and the medical specialist worked in private clinical practice. The majority of the healthcare professionals (64%) had between 11 and 24 years of work experience within their respective fields (Participants' 1, 2, 4, 5, 8, 9 and 11). Two participants had up to 3 years of experience [Participants 3 and 10], and two had between seven and 10 years [Participants 6 and 7]. Ten participants were employed within NSW. All consenting participants were interviewed.

Analysis of the data yielded three key themes: (1) Variable familiarity with gamification, (2) Context matters, and (3) Barriers hinder engagement/adoption. The key themes are summarised alongside characterising statements in Table 1. The first theme was ‘variable familiarity with gamification’. Five out of eleven participants initially stated that they had never heard of the term gamification, whilst two out of the remaining five participants were aware of the word but could not articulate the meaning adequately. Most participants with eleven or more years of work experience expressed limited familiarity with the term ‘gamification’, except for two participants. Despite this, many of them recalled prior engagement with a gamified digital application. For example:

'I'd never heard that word before in my life. Sounds like a very modern word,’ but then continued, ‘I did an entire course of Duolingo and it absolutely motivated me all the way through to the end.' [Participant 1, medical specialist]

'I've got absolutely no experience with it,’ but then added, ‘It just came to mind that there is an app called mySugr that we always look at for fasting glucose level trends.' [Participant 5, hospital‐based dietitian]

I can't really think of any examples [but] we do ‘STEPtember’ every year and it becomes so competitive … It's one of those things where we have leaderboards, and we do it in teams. There's also a little prize at the end [Participant 7, hospital‐based dietitian]

The healthcare professionals with previous exposure to gamification demonstrated a clearer understanding of its meaning and application in practice. They had commonly encountered gamification in educational and research settings, such as university curricula and testing gamified interventions in university‐led studies. These healthcare professionals were more adept at recognising gamified experiences in their daily lives:

We're working with children and adolescents so it's certainly something that we can use as a tool for exercise … we use fitness trackers, have them compete against each other or themselves and receive rewards [to gain more] intrinsic and extrinsic motivation. [Participant 6, Accredited Exercise Physiologist, > 7 years' experience]

My keen area of interest is innovation and regulatory affairs…[we have developed many experiences] to get children to interact with our brand, including spot the differences on cereal boxes, and virtual reality such as the ‘Gut Bacteria Reef Experience’, ‘Gut Bacteria Zoo’ and ‘Game of Thrones Run’. [Participant 9, dietitian for a major Fast‐Moving‐Consumer‐Goods company, > 20 years' experience]

I know last year at university, we did a topic on gamification … Apple watches are a form of gamification, encouraging people to move more so that they can ‘close their rings’. [Participant 10, new graduate hospital‐based dietitian]

Numerous examples of gamification were recognised by the healthcare professionals (Table 2), with mobile applications being the most common. Notably, MyFitnessPal, Fitbits/Apple watches and virtual reality experiences were frequently identified as examples of gamification. These are underpinned by collaboration, competition and physical/virtual reward elements.

TABLE 1.

Key themes and characterising statements.

Themes	Characterising statements for each theme
Variable familiarity with gamification	The majority of healthcare professionals only recognise gamification approaches in everyday life when given examples
	Healthcare professionals with previous experience found it easier to make connections with gamification, and many are currently engaged with some form of gamification, either knowingly or inadvertently
	Limited exposure and opportunities within workplaces to integrate gamification in practice
Context matters	The perceived applicability and value of gamification is dependent on healthcare professionals' profession and job role
	Attitudes towards the potential use of gamification depends on a healthcare professional's field of work, stage of career development, and their level of technology literacy a
	A gamified experience is unlikely to modify behaviour unless it is applicable to clients'/patients' contexts
Barriers hinder engagement	Resistance to change is likely to be encountered from healthcare professionals who embody ‘Persona C' a . This group is influential and must be brought along in any adoption journey
	Poor accessibility to a gamified solution will be a key barrier to uptake by clients/patients
	Healthcare professionals require time and resources to collaborate with solution providers in the development and testing of gamified interventions

^a Differing perceptions are reflected in the three personas shown in Figure 1.

TABLE 2.

Gamification examples identified by healthcare professionals during interviews.

App/experience	Frequency	Purpose	Game elements	Mode
Health insurance services	1	Encourages PA	Point system and rewards	Online program
Strava	2	Encourages PA	Leaderboards and medals	Mobile application
Couch to 5k	1	Encourages PA	Avatars	Mobile application
Nintendo Wii Fit	2	Encourages PA	Avatars and levels	Online platform
Dance Dance Revolution	1	Improves strength and balance	Avatars and scores	Online platform
Fitbits/Apple watches	4	Encourages PA	Points, levels and rewards	Digital gadgets
MyFitnessPal	3	Encourages PA and healthy dietary patterns	Competition and collaboration	Mobile application
STEPtember	1	Encourages PA and donation to charities	Collaboration, leaderboards, rewards	Online program
Wordle	1	Encourages enhanced vocabulary	Competition, feedback and rewards	Mobile application
mySugr	1	Encouraged disease management	Progress tracking	Mobile application
Spot the differences + VR experiences	5	Encourage healthy eating and nutrition knowledge	Role play, immersion and avatars	Paper‐based game, online platforms

Several healthcare professionals expressed that they have been unable to integrate gamification into their practice to date due to limited exposure and opportunities within their workplaces:

Nobody's ever approached me with any new gamification type technology, so it doesn't exist in my world. [Participant 1, medical specialist]

You have piqued my interest and perhaps I should look what's out there as it's not something that has landed in my lap yet. [Participant 2, private practice psychologist]

Some hospital‐based participants were uncertain about key decision makers within their organisation who were responsible for identifying and implementing targeted health‐based gamification or any other innovations, which might limit their ability to embrace it. For example:

I don't think there's anyone really responsible for coming up with it. If there was a dedicated person to do it, I think it would be doable. Most people just don't think about it on a day‐to‐day basis. [Participant 7, hospital‐based dietitian]

In general, most participants displayed a positive attitude towards gamification, regardless of whether they had previous experience with it, as exemplified by the following quotation:

…. it could be a tool in the tool kit to consider when you are promoting behaviour change, whether it be an improved diet, or physical activity, [because] it is really hard to sustainably change their lifestyle. [Participant 6, accredited exercise physiologist]

Overall, it appeared that most participants across all disciplines were unable to articulate a definition of gamification initially, however, when offered more context, they could identify examples in their work and daily lives. Regardless of their prior exposure, participants were positive towards gamification generally.

The second theme, ‘context matters,’ reveals varying perspectives among healthcare professionals regarding the potential role of gamification within their field. For example:

I don't have the motivation to go use games. [Participant 1, medical specialist]

My particular area of interest is working with a couple of technology companies to develop a robotic system that involves gamification to engage patients to do more exercises, particularly patients with neurological injuries. [Participant 11, Accredited Exercise Physiologist in academia]

Healthcare professionals practising in the public sector perceived that gamification could provide more significant advantages to individuals working in private practice:

I am not sure whether it would be useful for me. I could probably speculate that it would be useful for a dietitian working with paediatric patients or a private practising dietitian seeing patients in the long‐term. [Participant 5, hospital‐based dietitian]

Healthcare professionals believed that misjudging the purpose or suitability of different gamified interventions could impede participation and interest for both the patient/client and the healthcare professionals. To address this concern, some healthcare professionals recommended adopting a tailored and individualised approach for long‐term behavioural adherence and success. For example:

When you suggest something to someone, you have to think about it [and] whether it is realistic for them, otherwise you can end up setting people up for failure … What I am saying is that there is a time and place for things. [Participant 2, private practice psychologist]

Several participants emphasised the importance of pinpointing the optimal use case and tailoring the game experience to meet user needs. A hospital‐based dietitian [Participant 7] proposed that gamified interventions may be more effective when applied to ‘long stay, mental health rehab, and hospital spinal wards.’ This perspective was supported by a private practise dietitian [Participant 3] with 3 years of experience working within the mental health space, ‘I'm working with a university medical student to develop an app for our service … we want to have game elements so that our young clients want to engage with it over the long term.'

The third theme, ‘barriers hinder engagement/adoption’, underscores the presence of obstacles and enablers that must be addressed to validate a market opportunity for gamification. These factors are applicable to both healthcare professionals and the patients/clients under their care. Elements such as prior education, current job status and opportunity for workplace innovation significantly influenced the healthcare professionals' perceptions of the potential of gamification, as exemplified here:

Working for New South Wales Health, there's obviously a lot of red tape involved in terms of what we can give patients. [Participant 5, hospital‐based dietitian]

I think some of the problem is like we don't want another app…we're having an issue at the moment with too much screen time. [Participant 6, Accredited Exercise Physiologist]

Hospitals are still recovering from COVID financially. This type of intervention would be considered an addition so I am not sure how many would be looking to pay extra to embed them. [Participant 6, Accredited Exercise Physiologist]

I definitely think the universities need to keep up‐to‐date with what's going on and prepare and plan for the future workforce. [Participant 9, dietitian in a major Fast‐Moving‐Consumer‐Goods company]

I don't think my manager with 40 years of experience would know what gamification is so with her being in charge of the quality improvement activities, I don't know if gamification would actually come up as one of them. [Participant 10, new graduate hospital‐based dietitian]

Most of the healthcare professionals believed that their patients or clients would be receptive to using different forms of gamification, however, they identified several potential barriers for their patients/clients. The primary barrier identified was accessibility, which included challenges like low technology literacy and the associated costs of engaging with gamified experiences. For example:

Some older generations are just not tech savvy. [Participant 4, private practice dietitian]

I work in the area of mental health, meaning you can have quite a large proportion of low socio‐economic consumers. They may not have a phone or any internet connection to access a gamified mobile phone application. [Participant 3, private practice dietitian]

Concerns about unintentional breaches of confidentiality caused by engagement with online or digital gamified experiences were also raised: 'Patients need to be able to make up their own minds as to where their data goes.' [Participant 1, medical specialist] and 'A lot of my patients are quite elderly, and they get quite taken aback when you ask to send out personal information about them.' [Participant 10, newly graduated hospital‐based dietitian].

Some participants proposed solutions to the identified barriers. For example, a psychologist in private practice [Participant 8] stated, 'there is definitely the lack of knowledge that current healthcare professionals have of the topic … I don't see how I could integrate it without it taking too much of my time and resources.' This highlights the inherent dilemma for healthcare professionals who aspire to implement innovative methods of practice, but lack the requisite skills to do so. A dietitian working for a Fast‐Moving‐Consumer‐Goods company [Participant 9] stated 'the hard part will be game developers that have no scientific or nutritional knowledge', underscoring the significance of collaborative and inter‐professional efforts to ensure that gamified interventions remain evidence‐based and expert‐informed.

Participants' interview responses appeared to be significantly influenced by the stage of career development and/or age, and the level of technology literacy, rather than solely by their job title. This is illustrated through three representative personas (Figure 1). Persona 1; Joel: early career progressive (a young healthcare enthusiast with <5 years of work experience, who is tech‐savvy, recognises the high potential of gamification but also acknowledges some obstacles), Persona 2; Bella: mid‐career stable (healthcare professional in their early 30s with 5–15 years of work experience, who is slightly sceptical of new technologies and shares a willingness to explore new approaches to improve patient outcomes), and Persona 3; Sam: advanced career expert (healthcare professional in their mid‐50s with >15 years of work experience, who is time poor, holds a position of influence in the private or public sector, has low awareness of gamification and considers it may be more aligned with other healthcare contexts).

FIGURE 1.

The three characterising personas that emerged during data analysis.

4. DISCUSSION

In this study, the current perspectives of Australian healthcare professionals towards gamification were explored through semi‐structured interviews with dietitians, exercise physiologists, psychologists and a medical specialist. Three key themes emerged from the data: (1) Variable familiarity with gamification, (2) Context matters and (3) Barriers hinder engagement/adoption. The design of three distinct fictional interviewee personas helped researchers improve the understanding of the types of healthcare professionals interviewed in this study, as well as elucidating their differing perceptions of gamification in healthcare practice.

The healthcare professionals' familiarity with the term ‘gamification’ was variable in this study, although most were able to recognise gamified experiences that they had engaged with in their daily lives, but generally not in their day‐to‐day work practices. The early career progressive (Joel—Persona 1) was most familiar with the term ‘gamification’ and could often provide a detailed definition and practical examples of everyday use. In contrast, the advanced career expert (Sam—Persona 3) was least likely to be familiar with the term or its use. This lack of recognition was also evident in a recent survey of internal medicine and psychiatry healthcare workers in Switzerland, although only a small proportion (10%) of participants had prior experience with gamification. ⁴⁰ The researchers postulated that people may not recognise gamification as a serious intervention since it often involves playful elements. ⁴⁰ In the present study, most participants characterised by the mid‐career stable (Bella—Persona 2) and the advanced career expert (Sam—Persona 3) recalled examples of gamification after being offered additional contextual information, such as a basic definition and examples of common gamified experiences (virtual and non‐virtual).

The participants characterised by the early career progressive persona (Joel—Persona 1) had prior experience with gamification either through formal university studies or involvement in digital game playing or game development, and readily shared examples and knowledge during interviews without further context. Previous research has shown that when people have a mental reference point, it makes it easier to identify and recall similar instances in the future. ⁴¹ , ⁴² In the present study, the early career progressive persona was more likely to recognise game elements, strategies or gamified interventions. Their familiarity with the concept enabled them to apply this knowledge and also explore the possible benefits more readily than the possible barriers. ‘Experiential blindness’ lends itself to the idea that people may find it difficult to understand how a certain skill, technology or experience could be meaningful if they have not personally endured it. ⁴³ All interviewees recognised that their engagement with gamification‐based innovations in practice would be dependent on the type of organisations in which they work (e.g., health districts, large hospitals, sole practice, and fast growing private health practice).

The advanced career expert (Sam—Persona 3) expressed the barriers to adoption within their organisation more readily than the early career progressive. Prior knowledge of fiscal constraints and the approach to the adoption of novel practice‐based innovations within a workplace can also influence attitudes towards gamified solutions. In the present study, the advanced career expert was more likely to have budgetary or management responsibilities and to be more experienced in organisational innovation policies than the early career progressive. This may result in low interest and engagement in gamification, and novel innovations in general, among key healthcare decision makers within the workplace. This could potentially diminish opportunities to enhance practices and improve patient/client outcomes in some healthcare workplaces. ⁴⁴ , ⁴⁵

The context and motivation of both the service provider and user play a crucial role in the successful application of novel interventions. ⁴⁶ Multiple studies have shown the effectiveness of gamified educational experiences in enhancing different healthcare professionals' knowledge acquisition, motivation and delivery of care/practice, especially within the field of nursing. ⁴⁷ , ⁴⁸ , ⁴⁹ , ⁵⁰ The age of healthcare professionals influences their familiarity with serious games, with younger generations expressing higher motivation when considering the future use of game elements in practice. ⁵¹ The early career (Joel—Persona 1) and mid‐career stable personas (Bella—Persona 2) represent individuals who may possess the requisite motivation to trial gamified solutions with clients or seek to promote use more broadly within their workplace.

Participants in the present study acknowledged the need to assess the clients/patients' motivation, intent and readiness for change. This evaluation is crucial in determining whether a gamified intervention is suitable for their clients'/patients' needs. The ‘Stages of Change Model’ by Prochaska ⁵² provides a framework that aligns with this holistic assessment approach, encompassing pre‐contemplation, contemplation, preparation, action and maintenance. It encourages healthcare professionals to tailor gamified interventions to the individuals' current state of readiness and provide more effective support throughout the entire journey towards healthier behaviours. ⁵² Moreover, healthcare professionals in this study revealed that fostering a sense of community can function as a valuable motivational tool for patients/clients when adopting healthy behaviours. Social support is a key feature of numerous gamified interventions, showcasing its potential as a valuable motivational tool and adjunct to traditional motivational practices across diverse healthcare settings. ⁵⁰

Past studies indicate that an individual's capability and willingness to access gamified interventions can act as barriers to engagement and adoption. ⁵³ , ⁵⁴ In the present study, accessibility emerged as a major obstacle to the trial and ongoing use of gamification in healthcare practice. A scoping review from 2022 investigating the barriers and enablers of technological adoption for the care of older adults with chronic diseases suggests that older individuals may encounter use challenges, such as slow internet connectivity and knowledge gaps. ⁵⁵

Confidentiality emerged as a notable concern among participants in the current study. A two‐year exploration by Wangler et al. ⁵⁶ delved into the perspectives and experiences of general practitioners in Germany regarding digital health applications, revealing that GPs believed that gamified interventions could have been more effectively integrated into patient care. In the current study, participants expressed concerns about the credibility of gamified interventions in terms of safety, efficacy and the underlying evidence base. Many healthcare professionals reported a hesitancy to adopt gamified experiences without evidence of favourable effects and safety. This scepticism is mirrored at the institutional level, as evidenced by the Australian Government Department of Education's reluctance to incorporate gamification into science, technology, engineering and mathematics curricula due to mixed results on the effectiveness in enhancing students' engagement. ⁵⁷

A study commissioned by Ford Australia, in collaboration with Deakin and Griffith Universities, identified the top 100 jobs anticipated for the future Australian workforce. ⁵⁸ Among these, the role of ‘The Health Shaper’ was recognised, aligning with the traditional role of a dietitian/nutritionist. However, the report emphasised the need for more specialised digital and data literacy skills to access health data, monitor environments, and track behaviours for designing personalised interventions. Expanding knowledge of gamification aligns well with these requirements. An effective starting point is embedding gamification into university education curricula. Early exposure to gamification for students could enhance their awareness and confidence, preparing them to engage with it as graduate healthcare professionals. This approach has the potential to foster innovation in the workplace and encourage advocacy for the adoption of gamification in the future.

Supporting this, a 2022 intervention study demonstrated that gamified simulations targeting knowledge, skills and behaviours improved professional competencies among pharmacology students, leading to enhanced grades and positive pre‐post change scores for seven of the 26 pharmacological competency standards. ⁵⁹ Additionally, another 2022 study utilised a gamified website to augment knowledge and motivation among physiotherapy students, resulting in increased enthusiasm. ⁶⁰

For the successful adoption of gamification in health practice by healthcare professionals, multidisciplinary collaboration is important. Consideration of the contextual and motivational factors influencing users' motivation for adoption and engagement is essential. Utilising the COM‐B model may be useful in this regard as it considers elements that influence behaviour change, such as individuals' physical and psychological capability, opportunities within their social and physical environments, and their level of motivation. ²¹ A framework for designing a healthy eating intervention through the COM‐B lens is presented in Supporting Information 2, alongside recommendations for the broader adoption of gamification in dietetic practice. These collective approaches and recommendations would allow for the development of personalised gamified experiences, applicable to various healthcare fields. Underpinned by domain expertise and evidence, these interventions are more likely to achieve favourable outcomes for clients/patients. Researchers and healthcare professionals interested in gamification are well positioned to lead discussions with peak bodies, such as Dietitians Australia, and share emerging evidence supporting the potential benefits of gamification to enhance practice. Dietitians Australia, with its broad reach to almost 7000 dietitians, plays an integral role in promoting gamification for dietetics practice. This could involve sharing an article in newsletters, publishing editorials in the Dietitians Australia journal or conducting workshops at the national conference on gamification facilitated by dietitians and gamification designers. The latter not only generates new knowledge for dietitians, but also helps develop their design skills, adaptability and interdisciplinary engagement.

This study has a number of strengths and limitations. To our knowledge, this research is the first to capture insights from a diverse group of healthcare professionals' perceptions towards gamification in practice in Australia. While the study targeted a diverse group of healthcare professionals, including those less familiar with gamified experiences, key informants (stakeholders with domain expertise and deep understanding) were not involved. ⁶¹ Targeting key informants may be valuable for future research. The semi‐structured interviews were particularly effective with a small sample size, given the opportunity to clarify questions, probe for deeper insights, and to establish context, though the lines of inquiry may have inadvertently influenced participants to discuss topics they may not have otherwise considered. The researchers' commitment to reflexivity ³⁴ throughout the study increased their awareness of potential biases during interviews, thereby enhancing the study's overall rigour and trustworthiness. ³⁵

Recruitment challenges resulted in a small sample, and uneven gender and profession representation, as well as the nature of voluntary participation, may have been sources of bias. The perspectives of non‐participating practitioners were not represented, and the findings may have been influenced by subjective participant responses with a stronger interest in the topic of gamification, potentially introducing self‐selection bias. ⁶² Furthermore, all but one of the participants were based in NSW, limiting the documentation of perspectives from individuals in other states and regions with different socio‐cultural contexts and experiences of gamification. The degree to which the outcomes can therefore be generalised to other health disciplines is limited, and a larger sample size would have potentially allowed the creation of more representative personas. These limitations, as well as the nature of qualitative research, may limit the generalisability of our fundings beyond this specific study context.

The use of gamified interventions in practice among healthcare professionals appears uncommon across various health disciplines in Australia, including dietetics. However, healthcare professionals recognise potential benefits in areas such as paediatrics, mental health, long‐stay hospital patient care and private clinical practice. Interest in gamification varies based on context, with younger, more technologically literate healthcare professionals showing greater interest. Barriers to adoption include accessibility and confidentiality concerns. Healthcare professionals express a reluctance to use gamified solutions unless specifically designed for patients/clients based on evidence of effectiveness. Research to identify effective gamification solutions and address barriers is therefore a priority. Embedding gamification in university curricula is recommended to increase adoption in healthcare practices and better equip future healthcare professionals, with implications for the broader healthcare workforce. Further research is needed to explore perspectives of a wider diversity of healthcare professionals in different disciplines to support key findings.

AUTHOR CONTRIBUTIONS

ASN: conceptualisation; ethics application; research design; data analysis; original manuscript draft; review and editing; academic supervision. ALG: data collection; data analysis; writing initial results under the academic guidance of ASN. All authors contributed to the final manuscript.

CONFLICT OF INTEREST STATEMENT

There are no conflicts of interest to declare.

ETHICS STATEMENT

Ethics approval was received from the University of Wollongong Human Research Ethics Committee (HREC 2023/142).

Supporting information

Supporting Information 1. Purpose‐built question guide.

Supporting Information 2.Supporting Information.

Stefoska‐Needham A, Goldman AL. Perspectives of Australian healthcare professionals towards gamification in practice. Nutrition & Dietetics. 2025;82(2):206‐217. doi: 10.1111/1747-0080.12911

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.