Evidence map›Paper›PMID 40380122›Full record

Trial reportBMC public health2025

What motivates participants: a qualitative analysis of gamification and financial incentives to increase physical activity.

Eric Ryu, David Farraday, Alexander C Fanaroff, Samantha Coratti, Neel P Chokshi, Jingsan Zhu, Julia E Szymczak, Louise B Russell, Laurie Norton, Dylan Small and 2 more

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03911141 (Behavioral Economic Approaches to Increase Physical Activity Among Patients With Elevated Risk for Cardiovascular Disease), which is not on this map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03911141 nacompletednot on this map

Behavioral Economic Approaches to Increase Physical Activity Among Patients With Elevated Risk for Cardiovascular Disease

TypeinterventionalSponsorUniversity of PennsylvaniaRan2019 to 2024Enrolled1,062ConditionsAtherosclerotic Cardiovascular DiseaseArmsGamification, Financial
3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Eric RyuDepartment of Medical Ethics and Health Policy, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.
David FarradayDepartment of Medical Ethics and Health Policy, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.
Alexander C FanaroffDepartment of Medical Ethics and Health Policy, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.
Samantha CorattiDepartment of Medical Ethics and Health Policy, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.
Neel P ChokshiDepartment of Medical Ethics and Health Policy, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.
Jingsan ZhuDepartment of Medical Ethics and Health Policy, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.
Julia E SzymczakDivision of Epidemiology, Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA.
Louise B RussellDepartment of Medical Ethics and Health Policy, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.
Laurie NortonDepartment of Medical Ethics and Health Policy, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.
Dylan SmallDepartment of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Kevin G VolppDepartment of Medical Ethics and Health Policy, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.
Tamar KlaimanDepartment of Medical Ethics and Health Policy, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA. tamar.klaiman@pennmedicine.upenn.edu.

Funding

Behavioral Economic Approaches to Increase Physical Activity among Patients with Elevated Risk for Cardiovascular DiseaseR33HL141440 · NHLBI · UNIVERSITY OF PENNSYLVANIA · PI FANAROFF, ALEXANDER CRAIG, VOLPP, KEVIN G · 2019 to 2022
$3.3M
NHLBI NIH HHS R33 HL141440NIH HHS R61/R33HL141440
6 · The paper itself

Abstract

backgroundPhysical activity reduces the risk of major cardiovascular events, but many people who are most at-risk do not get enough exercise. In the BE ACTIVE randomized controlled trial, - a study in which text messages were used to communicate with participants- game playing (gamification), financial incentives, and the combination of gamification plus financial incentives increased physical activity from baseline more than control over a 12-month intervention period. Participants randomized to gamification plus financial incentives maintained a significantly greater increase than control over the 6-month post-intervention follow-up. To understand the impact of the interventions on motivation and performance we conducted semi-structured interviews with a subset of participants.

methodsUsing extreme case sampling, interviewees were selected from participants who were randomized to an intervention arm and were identified as either high or low performers based on their change from baseline to the end of the trial in mean daily step count. During semi-structured telephone interviews, participants were asked their thoughts and feelings about the trial, motivations for participation, and about specific aspects of the intervention. Interviews were conducted within 6 months after the participant completed participation in the trial. Thematic analysis was conducted inductively and deductively, and identified themes were mapped onto the COM-B Framework to understand the interaction between different themes.

resultsWe achieved saturation after conducting interviews with 55 participants (30 high performers and 25 low performers); 19 in the gamification arm, 19 in the financial incentives arm, and 17 in the gamification plus financial incentives arm. Based on qualitative interviews, the importance of individual accountability via goal setting and feedback appears to be a primary factor in behavior change in this trial; however, the combination of accountability with the opportunity of access to the intervention had additional impact on the results.

conclusionGamification and financial incentives both increased physical activity in the BE ACTIVE study, but results may be improved by tailoring interventions based on participants' personal traits and level of social support to optimize motivation. (328 words)

trial registrationNCT03911141 Registration date: 04/09/2019.

Indexed as

ExerciseGamificationHealth PromotionMotivationAdultFemaleHumansInterviews as TopicMaleMiddle AgedQualitative ResearchText MessagingASCVDBehavioral economicsFinancial incentivesGamification

Identifiers

PMID40380122
PMCPMC12083105

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.