Patient engagement and adherence to long-term therapies: the role of gamification

In the healthcare system, non-adherence to treatment for chronic diseases is a prevalent issue with a high incidence rate, generating substantial clinical and economic costs. Some earlier studies suggested that gamification could solve this problem; however, other researchers have noted that this approach may not always succeed. This study contributes to this debate by incorporating the concept of patient engagement, arguing that it is the underlying mechanism that explains when and why gamification translates into sustained adherence. Using a qualitative case study approach based on interviews with patients and physicians in the hepatology ward of an Italian hospital, we have developed a conceptual model linking gamification, patient engagement, and adherence. Findings show that specific gamification elements activate distinct dimensions of patient engagement, achievement-related elements driving cognitive and behavioural engagement and immersion-related elements addressing the emotional dimension, and that this activation pattern shifts across the stages of the patient’s care journey. Our main contribution is reconciling the inconsistent findings reported in the gamification-adherence literature by showing that effective gamification design requires matching specific elements to patients’ evolving engagement needs throughout their care trajectory, rather than applying a uniform configuration