Huvudbild för Vitalis 2021
Profilbild för Gamification and nudging: Improving user engagement in mental health apps for young people

Gamification and nudging: Improving user engagement in mental health apps for young people

Föreläsare: Hassan Auf, Jessica Dagman, John Chaplin, Sara Renström

Spår: Digital psykologi

Mental health disorders among young people (adolescents and young adults) is a steadily growing source of global burden of disease in the last decade. Data from the Institute for Health Metrics and Evaluation (IHME 2019) shows that in 2018 mental health disorders participated in 25% of overall disability-adjusted life years (DALYs) for individuals aged between 10 and 24 living in Sweden.

To address this problem thousands of mobile applications were developed to promote mental wellbeing, and reduce stress, but engagement data for these interventions shows that users engagement is quite low, as the mean of retention rate at the 7th day is only 7% (i.e: only 7% of users that downloaded the app continue use it at the 7th day).

Both gamification and nudging seem to be promising techniques for improving user engagement within mental health app. Gamification has been defined by Zichermann and Cunningham (2011) as “The process of game-thinking and game mechanics to engage users and solve problems”. While nudging or nudge theory is based on behavioral economics which combines the rational nature of human behavior from economics theory perspective, and the human cognitive biases from psychological one which participate in influencing personal decision making (Thaler and Sunstein 2009). A nudge could be defined as an indirect positive reinforcement toward specific planned behavior based on a choice architecture with a predictable effect, using human features like cognitive biases, heuristics, non-rational, and non-conscious features according to (Thaler and Sunstein 2009; Hagman 2018).

This presentation will discuss the finding of the our study which answers the following questions: 

What are the most potential gamification and nudging techniques in mental health apps that could be used to improve onboarding engagement (i.e.: retention in the first 1-2 weeks after installing the app), user retention (continuous use of the app on the long term after the onboarding), daily duration (time of use per day), and frequency of use (number of sessions per day)?


IHME (2019) The Institute for Health Metrics and Evaluation - Global Burden Of Disease Compare | Viz Hub, available: [accessed 10 December 2020].

Zichermann, G. and Cunningham, C. (2011) Gamification by design: Implementing game mechanics in web and mobile apps, " O'Reilly Media, Inc.".

Thaler, R.H. and Sunstein, C.R. (2009) Nudge: Improving decisions about health, wealth, and happiness, Penguin.

Hagman, W. (2018) When are nudges acceptable?: Influences of beneficiaries, techniques, alternatives and choice architects, unpublished thesis, Linköping University Electronic Press.

Moore, A.W., Gruber, T., Derose, J. and Malinowski, P. (2012) 'Regular, brief mindfulness meditation practice improves electrophysiological markers of attentional control', Frontiers in human neuroscience, 6, 18.

Baumel, A., Muench, F., Edan, S. and Kane, J.M. (2019) 'Objective user engagement with mental health apps: systematic search and panel-based usage analysis', Journal of medical Internet research, 21(9), e14567.




Mental health


Tools for implementation




Management/decision makers
Patient/user organizations




Profilbild för Hassan Auf

Hassan Auf Föreläsare

Extern, MSc, DDs
RISE Research Institutes of Sweden

Research oriented | Health practitioner | Designer
Just finished my masters in public health with health economics at the University of Gothenburg.

I worked in the health sector as a health care provider, and within the design industry as a web and game designer.

Fields that describes my interests are: eHealth, eLearning, Research and Design..

The lecture I am participating with via Vitalis conference is based on my thesis work during my externship at RISE (Research Institutes of Sweden), and it combines my interests in eHealth and design (heart and soul).

I am amazed by the potential positive viral effect of online technologies, which I witnessed through my projects that I founded, for example:
• Dentora: App for dental radiographic diagnostics (with over 20,000 installs on Google play store), and cited in two studies.
• A self-learning platform for dentists providing them with clinical and academic knowledge (with over 57,000 follower on Facebook).

My main academic interest is in eHealth and diagnostics research field and design for both patient-centered and clinician-centered care. As I am pumped for the great potential social impact of technology in improving health, communication and education.

Jessica Dagman Föreläsare

RISE Research Institutes of Sweden

Profilbild för John Chaplin

John Chaplin Föreläsare

Assoc. Professor
Sahlgrenska Academy at University of Gothenburg

John Chaplin is an Assoc. Professor, psychologist working with development of computer adapted systems for the measurement of patient reported outcomes and patient experience. Member of the Steering Committee of Patient Reported Outcome Measurement System (PROMIS) and the Swedish representative of PROMIS. Closely working on the validation of PROMIS measures for use in Quality Registries and healthcare in Sweden. Chair of the International Committee for the translation and implementation of PROMIS. He recently orgainsed a seminar on Computer Adapted Testing of children at the 2020 International Conferenece on Quality of Life.

Sara Renström Föreläsare

Senior Researcher
RISE Research Institutes of Sweden