Participants' Experience with Gamification Elements of a School-Based Health Promotion Intervention in Italy: A Mixed Methods Study.

Gamified interventions consist of a combination of game elements designed to motivate and engage users, thus addressing issues of participant low participation and enthusiasm in interventions. Gamification does not work well in all situations and its success depends on the context and target users. However, there is a lack of research on analog health interventions. Qualitative and quantitative data were collected in parallel to examine participants' experiences with Food Game, an analog gamified intervention designed to promote healthier and more sustainable food choices among high school students. Teams of students compete to complete peer-led thematic challenges. Sixty-four students from the 2022/23 edition participated in focus group interviews (N = 11), and 119 completed a survey (56.1% response rate) with indicators of responsiveness and perceived motivational impact of the program's five game elements. Results indicate a relatively high level of engagement with the program. Students valued Food Game because it gave them the opportunity to demonstrate their sense of agency and autonomy and to work in a group with their peers, thus addressing basic needs for competence, relatedness, and autonomy as described by Self-Determination Theory and providing an empowering experience. The least motivating game element in the Food Game was the leaderboard and inter-team competition. Focus group data confirmed students' ambivalence about the competition embedded in the program and pointed to potential unintended consequences, including inter-team conflict, stress, and reduced intrinsic motivation to play. The strengths and weaknesses of Food Game approach to gamification are discussed, along with implications for prevention research and practice.