Table 4 Synthesis of evidence from selected studies.

Alsaleh & Alnanih (2020)

Favourite food

EG > CG (50% healthy eating, 40% fruits and vegetables, 10% juice vs. 30% cake and sweets, 20% chocolate, 20% fruits, 20% healthy eating, 10% juice)

Performance: Maximum number of collected points

EG > CG (91.1% vs. 63.6%)

Effectiveness: Highest number of badges

EG > CG (8.5 vs. 7.9)

Efficiency: Maximum number of minutes consumed in the game

EG > CG (17.9 vs. 12.6)

Cates et al. (2020)

Knowledge Scale: 5 items scale

EG > CG^a (2.56 ± 0.34 vs. 2.28 ± 0.41) (p = 0.03)

Self-efficacy and intentions to vaccinate: Vaccination self-efficacy and decisional balance Scales

Vaccination self-efficacy

CG > EG^a (1.65 ± 0.35 vs. 1.45 ± 0.35) (p = 0.05)

Decisional Balance

Pros: EG > CG (2.44 ± 0.39 vs. 2.31 ± 0.42) (p = 0.29)

Cons: EG > CG (1.38 ± 0.31 vs. 1.47 ± 0.43) (p = 0.39)

Preteen´s immersion in the story: Physical/Emotional/Narrative Presence Scale–PENS-

>50% preteens called the game boring and not affected emotionally

>50% positive scores on game autonomy, ease, and freedom

Gameplay: Self-reported opinions

86% (n = 18) EG participants played the game

HPV immunisation records

Initiation rate: EG > CG (22% vs. 15%) (p = 0.31)

Completion rate: EG > CG (9% vs. 2%) (p = 0.10)

González et al. (2016)

Medical area

- Weight: Balance

- Height: Stadiometer

- Skin folds: Calipers

- Bone diameters: Compass

- Muscle and body perimeters: Tape measure

- BMI

- Physiological measurements: Heart rate sensor

Weight (kg)

EG < CG_Pretest (45.26 ± 7.65 vs. 48.12 ± 9.25, d = 0.11)

EG < CG_Postest (45.85 ± 7.62 vs. 49.10 ± 8.88, d = 0.13)

BMI

EG > CG_Pretest (23.22 ± 1.97 vs. 23.16 ± 1.59, d = 0.01)

EG < CG_Postest (23.08 ± 2.11 vs. 23.32 ± 1.62, d = 0.04)

Interactivity and User experience: Adaptation of the questionnaire on use and attitudes toward video games

Person and structure of activity (50%)

Person (15%)

Structure of activity and context (21%)

Context (9%)

Person and context (2%)

Person, structure of activity and context (2%)

Structure of activity (1%)

Psychology and pedagogy

Interpersonal relationships, relationships with parents, self-esteem, self-confidence: Behaviour assessment system for children and adolescents (BASC)

Knowledge: Mediterranean Diet adherence questionnaire (KIDMED)

EG > CG^b_Postest (8.73 ± 1.48 vs. 6.33 ± 1.41; t = 3.65, p = 0.002)

Goyal et al. (2017)

HbA_1c

HbA1c (12 months):

CG = EG (8.96 ± 1.2 vs. 8.96 ± 1.3, p = 0.99)

Hypoglycaemic events: Frequency of mild and severe hypoglycaemic events was self-reported by participants or their guardians

Hypoglycaemic events (12 months):

CG < EG_Mild (7.54 ± 7.7 vs. 11.52 ± 10.7, p = 0.04)

CG > EG_Severe (0.48 ± 1.2 vs. 0.16 ± 0.4, p = 0.13)

Self-monitoring of blood glucose (SMGB): 50-day blood glucose metre and/or insulin pump printout

CG < EG (3.39 ± 1.5 vs. 3.49 ± 1.8, p = 0.42)

Self-initiated adjustments: Changes made to the prescribed treatment regimen

CG < EG (1.10 ± 1.3 vs. 1.77 ± 2.7, p = 0.25)

Adherence: Self Care Inventory (SCI)

CG > EG (35.57 ± 6.4 vs. 35.42 ± 5, p = 0.81)

Quality of life: Diabetes Quality of Life for Youth (DQOLY)

Impact of symptoms

CG < EG (3.16 ± 1.6 vs. 3.33 ± 1.7, p = 0.15)

Impact of treatment

CG < EG (2.28 ± 2.2 vs. 2.53 ± 2.1, p = 0.51)

Impact on activities

CG > EG (3.42 ± 3 vs. 2.96 ± 3, p = 0.72)

Parental issues

CG < EG (4.67 ± 3.6 vs. 5.2 ± 3.6, p = 0.75)

Worries about diabetes

CG < EG (4.81 ± 5 vs. 6.84 ± 5.8, p = 0.17)

Health perception

CG > EG (2.10 ± 0.6 vs. 1.96 ± 0.7, p = 0.50)

Diabetes Family Responsibility Questionnaire (DFRQ)

CG < EG (36.79 ± 5.7 vs. 37.16 ± 4.3, p = 0.78)

Satisfaction with Bant app

Engagement level

- Very low: 17 (37%)

- Low: 13 (28%)

- Moderate: 12 (26%)

- High: 4 (9%)

Satisfaction

Satisfied and very satisfied = 76%

Usefulness = trending feature (45%); logbook (14%); and the app home page (11%)

Haruna et al. (2018)

Knowledge: Adolescent Sexual Health Literacy Test—ASHLT-

EG_{(GM, GBL)}> CG_TT^b:

F (2,117) = 54.75, p = 0.001

EG_(GM) > CG_TT^b: p = 0.001

EG_(GBL)> CG_TT^b: p = 0.001

EG_(GM) = EG_(GBL): p = 0.970

MAKE Framework:

Motivation:

- Attention

- Relevance

- Confidence

- Satisfaction

Attitude:

- Affective

- Cognitive

Knowledge:

- Importance

- Effectiveness

- Application

Engagement:

- Emotional

- Cognitive

Motivation

Attention

EG_(GM) > CG_TT^b: 4.40 ± 0.4 vs. 2.55 ± 1.16 (p = 0.001)

EG_(GBL) > CG_TT^b: 4.43 ± 0.37 vs. 2.55 ± 1.16 (p = 0.001)

EG_(GM) < EG_(GBL): 4.40 ± 0.4 vs. 4.43 ± 0.37 (p = 1.000)

Relevance

EG_(GM)> CG_TT^b: 4.55 ± 0.41 vs. 2.76 ± 0.73 (p = 0.001)

EG_(GBL) > CG_TT^b: 4.47 ± 0.32 vs. 2.76 ± 0.73 (p = 0.001)

EG_(GM) > EG_(GBL): 4.55 ± 0.41 vs. 4.47 ± 0.32 (p > 0.05)

Confidence

EG_(GM) > CG_TT^a: 4.42 ± 0.52 vs. 3.65 ± 1.12 (p = 0.004)

EG_(GBL) > CG_TT^b: 4.63 ± 0.32 vs. 3.65 ± 1.12 (p = 0.001)

EG_(GM) < EG_(GBL): 4.42 ± 0.52 vs. 4.63 ± 0.32 (p > 0.05)

Satisfaction

EG_(GM) > CG_TT^b: 4.56 ± 0.3 vs. 3.67 ± 0.82 (p = 0.001)

EG_(GBL)> CG_TT^b: 4.53 ± 0.38 vs. 3.67 ± 0.82 (p = 0.001)

EG_(GM) > EG_(GBL): 4.56 ± 0.3 vs. 4.53 ± 0.38 (p > 0.05)

Attitude

Affective

EG_(GM) > CG_TT^b: 4.84 ± 0.19 vs. 3.64 ± 1.03 (p = 0.001)

EG_(GBL) > CG_TT^b: 4.69 ± 0.35 vs. 3.64 ± 1.03 (p = 0.001)

EG_(GM) > EG_(GBL): 4.84 ± 0.19 vs. 4.69 ± 0.35 (p = 0.351)

Cognitive

EG_(GM)> CG_TT^b: 4.77 ± 0.22 vs. 3.51 ± 0.94 (p = 0.001)

EG_(GBL)> CG_TT^b: 4.76 ± 0.25 vs. 3.51 ± 0.94 (p = 0.001)

EG_(GM) > EG_(GBL): 4.77 ± 0.22 vs. 4.76 ± 0.25 (p > 0.05)

Knowledge

Importance

EG_(GM) > CG_TT^b: 4.84 ± 0.2 vs. 3.13 ± 1.13 (p = 0.001)

EG_(GBL) > CG_TT^b: 4.79 ± 0.23 vs. 3.13 ± 1.13 (p = 0.001)

EG_(GM) > EG_(GBL): 4.84 ± 0.2 vs. 4.79 ± 0.23 (p = 1.000)

Effectiveness

EG_(GM) > CG_TT^b: 4.88 ± 0.26 vs. 2.85 ± 0.95 (p = 0.001)

EG_(GBL)> CG_TT^b: 4.76 ± 0.34 vs. 2.85 ± 0.95 (p = 0.001)

EG_(GM) > EG_(GBL): 4.88 ± 0.26 vs. 4.76 ± 0.34 (p > 0.05)

Application

EG_(GM) > CG_TT^b: 4.84 ± 0.28 vs. 3.97 ± 0.85 (p = 0.001)

EG_(GBL) > CG_TT^b: 4.78 ± 0.35 vs. 3.97 ± 0.85 (p = 0.001)

EG_(GM) > EG_(GBL): 4.84 ± 0.28 vs. 4.78 ± 0.35 (p > 0.05)

Engagement

Emotional

EG_(GM)> CG_TT^b: 4.67 ± 0.28 vs. 2.77 ± 0.96 (p = 0.001)

EG_(GBL) > CG_TT^b: 4.63 ± 0.33 vs. 2.77 ± 0.96 (p = 0.001)

EG_(GM) > EG_(GBL): 4.67 ± 0.28 vs. 4.63 ± 0.33 (p > 0.05)

Cognitive

EG_(GM) > CG_TT^b: 4.64 ± 0.37 vs. 2.98 ± 0.79 (p = 0.001)

EG_(GBL) > CG_TT^b: 4.67 ± 0.4 vs. 2.98 ± 0.79 (p = 0.001)

EG_(GM) < EG_(GBL): 4.64 ± 0.37 vs. 4.67 ± 0.4 (p > 0.05)

Feedback on experience: Focus group

CG: “We are not free during learning as we feel shy and fear to ask questions in the class. As a result, the learning becomes unappealing and boring” (TT-13) and “The way we were taught this subject is too personal and teacher centred and but it is supposed to be more engaging, involving, and attractive” (TT-18)

EG: “I enjoyed learning, I think even my fellow students felt the same way” (GBL-21). “I wanted to spend more time when the training ended” (GBL-30). In the gamification condition, students reported, “I always am the last students to leave the computer lab and sometimes I was reluctant to shut off my computer” (GM-5)

Jia et al. (2020)

Percent Accuracy score: Game logs

EG > CG^b (74.2 ± 12.1 vs. 63.5 ± 12.1, p < 0.001)

Confidence Perceived score: Game logs

EG > CG (46.1 ± 22.6 vs. 42.4 ± 20.9, p = 0.2)

Melero-Cañas et al. (2021)

Lifestyle Habits:

Youth Activity Profile Spain (YAP-S)

PA in school

- Pre-test and Post-test CG^a: 2.9 ± 0.73 vs. 3.24 ± 0.86 (p = 0.005)

- Pre-test and Post-test EG^a: 2.86 ± 0.88 vs. 3.04 ± 0.78 (p = 0.011)

Afterschool PA (weekday)

- Pre-test and Post-test CG: 3.17 ± 0.79 vs. 3.16 ± 0.85 (p = 0.912)

- Pre-test and Post-test EG^b: 2.71 ± 0.87 vs. 3.04 ± 0.91 (p = 0.001)

Afterschool PA (weekend)

- Pre-test and Post-test CG^a: 2.95 ± 0.97 vs. 2.65 ± 0.82 (p = 0.020)

- Pre-test and Post-test EG^b: 2.35 ± 0.87 vs. 3.02 ± 1.01 (p < 0.001)

- GE > CG^a (p = 0.004)

Afterschool PA (week)

- Pre-test and Post-test CG: 3.08 ± 0.71 vs. 2.96 ± 0.71 (p = 0.223)

- Pre-test and Post-test EG^b: 2.57 ± 0.77 vs. 3.03 ± 0.82 (p < 0.001)

Sedentary time

- Pre-test and Post-test CG: 2.46 ± 0.51 vs. 2.64 ± 0.58 (p = 0.203)

- Pre-test and Post-test EG^b: 2.72 ± 0.57 vs. 2.47 ± 0.54 (p < 0.001)

Physical Fitness (PF):

- Cardiorespiratory fitness: 20 min shuttle run test

- Speed-Agility: 4 × 10 m speed-agility test

- Strength: Standing broad jump

- Flexibility: Back sabre sit-and-reach test

- Agility: Hexagon test

Cardiorespiratory fitness

- Pre-test and Post-test CG: 5.08 ± 2.11 vs. 4.70 ± 2.19 (p = 0.066)

- Pre-test and Post-test EG^b: 3.99 ± 2.27 vs. 5.04 ± 2.2 (p < 0.001)

Speed-agility

- Pre-test and Post-test CG^a: 12.78 ± 1.1 vs. 12.38 ± 1.21 (p = 0.043)

- Pre-test and Post-test EG^b: 13.27 ± 1.29 vs. 11.63 ± 1.53 (p < 0.001)

- EG < CG^a (p = 0.005)

Strength

- Pre-test and Post-test CG: 1.57 ± 0.34 vs. 1.61 ± 0.38 (p = 0.268)

- Pre-test and Post-test EG^b: 1.50 ± 0.37 vs. 1.64 ± 0.38 (p < 0.001)

Flexibility

- Pre-test and Post-test CG^b: 4.38 ± 7.6 vs. 6.03 ± 8.22 (p < 0.001)

- Pre-test and Post-test EG^b: 3.51 ± 7.63 vs. 5.82 ± 7.51 (p < 0.001)

Agility

- Pre-test and Post-test CG: 13.69 ± 2.17 vs. 13.30 ± 2.6 (p = 0.203)

- Pre-test and Post-test EG^b: 14.93 ± 2.18 vs. 12.30 ± 1.93 (p < 0.001)

- EG < CG^a (p = 0.008)

Body Mass Index (BMI)

- Pre-test and Post-test CG^b: 21.04 ± 4.05 vs. 21.94 ± 3.44 (p < 0.001)

- Pre-Postest EG: 21.46 ± 4.11 vs. 21.50 ± 4.05 (p = 0.521)

Patricio et al. (2020)

Abdominal circumference:

Measuring tape

Initial (p = 0.081)

EG < CG_elevated (8.1% vs. 25.9%)

EG > CG_normal (91.9% vs. 74.1%)

Final (p = 0,488)

EG < CG_elevated (17.2% vs. 25.0%)

EG > CG_normal (82.8% vs. 75.0%)

BMI: Tanita digital scale

Stadiometer

Initial (p = 0.013)

EG < CG^b_obesity (33.3% vs. 66.7%)

EG < CG^b_overweight (67.4% vs. 32.6%)

Final (p = 0,488)

EG < CG_obesity (20.7% vs. 33.3%)

EG > CG_overweight (72.4% vs. 56.7%)

EG > CG_eutrophic (6.9% vs. 0%)

Frequency of physical activity: Questionnaire

Final (p = 0.048)

EG < CG^b_≤25% (8.1% vs. 25.9%)

EG < CG^b_{>30% <75%} (35.1% vs. 44.4%)

EG >CG^b_≥75% (56.8% vs. 29.6%)

Putnam et al. (2018)

Free recall of healthy and unhealthy items from the app (condition): 2-item questionnaire about healthy and unhealthy foods

Free recall of healthy and unhealthy items from the app recall (condition)

Healthy items (p < 0.017)

RAE > SAE^b (3.09 vs. 1.85 compared to NAE)

SAE > NAE^b (2.08 ± 1.55 vs. 1.12 ± 1.42; p = 0.001)

RAE > NAE^b (3.47 ± 2.35 vs. 1.12 ± 1.42; p < 0.001)

Unhealthy items (p < 0.017)

RAE > SAE^b (7.69 vs. 3.79 compared to NAE)

SAE > NAE^b (1.11 ± 1.07 vs. 0.29 ± 0.46; p < 0.001)

RAE > NAE^b (2.25 ± 1.57 vs. 0.29 ± 0.46; p < 0.001)

Children´s liking of the character

Liking:

RAE > NAE^b (3.58 ± 1.44 vs. 2.73 ± 1.58; t = −2.41; p < 0.018)

Pyky et al. (2017)

Life satisfaction (LS): Self-reported four-item scale

- Pre-test and Post-test CG^b: 7.0 vs. 7.5 (p < 0.001)

- Pre-test and Post-test EG^b: 7.1 vs. 7.9 (p < 0.001)

- EG > CG (p = 0.215)

Self-rated health: Good, pretty good, average, pretty poor or poor

- Pre-test and Post-test CG: 141 vs. 181 (p = 1.000)

- Pre-test and Post-test EG: 153 vs. 175 (p = 0.383)

- EG < CG (p = 0.654)

Physical activity and sitting

- Pre-test and Post-test CG: 9.4 vs. 8.8 (p = 0.106)

- Pre-test and Post-test EG: 8.9 vs. 9.2 (p = 0.307)

- EG > CG (p > 0.05)

Weight

- Pre-test and Post-test CG^b: 72.9 vs. 74.5 (p < 0.001)

- Pre-test and Post-test EG^b: 73.4 vs. 74.9 (p < 0.001)

- EG > CG (p = 0.421)

BMI

- Pre-test and Post-test CG: 23.0 vs. 23.5 (p > 0.05)

- Pre-test and Post-test EG^b: 23.2 vs. 23.6 (p < 0.001)

- EG > CG (p > 0.05)

Ryu et al. (2018)

Anxiety: Yale Preoperative Anxiety Scale

m-YPAS

Baseline: EG > CG (51.7 [46.7–67.5] vs. 50 [43.3–65]) (p = 0.389)

Preanaesthesia: EG < CG^b (28.3 [23.3–36.7] vs. 46.7 [31.7–51.7]) (p < 0.001)

Compliance of patient during induction of anaesthesia: Induction Compliance Checklist–ICC-

EG < CG^a (p = 0.038)

Perfect (0): CG = 19 (54), EG = 27 (79)

Moderate (1–3): CG = 13 (37), EG = 7 (21)

Poor (>4): CG = 3 (9), EG = 0 (0)

Behaviour in a stressful medical procedure: Procedural Behaviour Rating Scale–PBRS-

EG < CG (p = 0.092)

Parent/guardian´s satisfaction: 101 NRS

EG = CG (p = 0.268)

Stapinski et al. (2018)

Knowledge: 26-item quiz about drug effects, prevalence, risks and harm-minimisation information

EG < CG_Pretest (21.9 ± 8.8 vs. 23.0 ± 7.0)

EG > CG_Postest (28.8 ± 7.3 vs. 28.2 ± 7.1)

Intentions to use: Life Skills Training Questionnaire (adapted)

EG < CG_Pretest (0.6 ± 1.6 vs. 0.8 ± 2.3)

EG = CG_Postest (1.0 ± 2.6 vs. 1.0 ± 2.4)

Lesson engagement: Adapted version of the motivation survey developed and validated based on Keller’s Model of Motivation

EG < CG_Postest (22.5 ± 6.2 vs. 23.4 ± 6.0)

Enjoyment of the game: Pure rash feedback

EG_pretest < EG_Posttest^b (21.9 ± 8.8 vs. 28.8 ± 7.3; p < 0.001)

CG_pretest < CG_Posttest^b (23.0 ± 7.0 vs. 28.2 ± 7.1; p < 0.001)

Vepsäläinen et al. (2022)

FV acceptance: Range 0–125

Pre-test and Post-test CG = 70.2 ± 25 vs. 72.4 ± 26.2

Pre-test and Post-test EG = 70.6 ± 25.5 vs. 78.5 ± 30.6

EG > CG (78.5 vs. 72.4)

FV relative acceptance score: Range 0–5

Pre-test and Post-test CG = 3.77 ± 1.1 vs. 3.75 ± 1.1

Pre-test and Post-test EG = 3.84 ± 1.1 vs. 3.97 ± 1

EG > CG (3.97 vs. 3.75)

Wengreen et al. (2021)

Vegetable consumption

EG > CG (26.61 ± 3.94 vs. 17.38 ± 3.92, p = 0.096)

EG > CG_3m (21.36 ± 3.94 vs. 13.73 ± 3.92, p = 0.169)

Fruit consumption

EG > CG^a (58.57 ± 5.37 vs. 42.24 ± 5.34, p = 0.031)

EG > CG^a_3m (45.85 ± 5.37 vs. 30.82 ± 5.34, p = 0.047)

Combined FV consumption

EG > CG (86.93 ± 11.39 vs. 60.22 ± 11.36, p = 0.097)

EG > CG_3m (66.01 ± 11.38 vs. 43.74 ± 11.35, p = 0.166)

Skin carotenoid concentration

EG > CG^a (35,168 ± 596 vs. 31,628 ± 543, p = 0.007)

EG > CG^a_3m (34,012 ± 600 vs. 30,912 ± 550, p = 0.015)

Zolfaghari et al. (2021)

Oral Health Knowledge of mothers: 18 items questionnaire

Pre-test and Post-test CG^b = 10.5 ± 2.1 vs. 13.1 ± 1.6 (p < 0.001)

Pre-test and Post-test EG^b = 11.3 ± 1.9 vs. 14.3 ± 2.0 (p < 0.001)

Self-reported oral health practice of children: 5 items questionnaire

Pre-test and Post-test CG^b = 4.4 ± 2.4 vs. 8.5 ± 1.7 (p < 0.001)

Pre-test and Post-test EG^b = 4.8 ± 3.2 vs. 8.0 ± 2.2 (p < 0.001)

Plaque Index (PI): Leo & Silness modified dental plaque index

Pre-test and Post-test CG^a = 0.8 ± 0.4 vs. 0.5 ± 0.3 (p = 0.006)

Pre-test and Post-test EG^b = 1 ± 0.3 vs. 0.5 ± 0.3 (p < 0.001)