Gamification to Motivate the Unmotivated Smoker: The "Take a Break" Digital Health Intervention

UMMS Affiliation

Department of Population and Quantitative Health Sciences

Publication Date


Document Type



Behavioral Medicine | Health Psychology | Preventive Medicine | Psychiatry and Psychology | Substance Abuse and Addiction | Telemedicine | Translational Medical Research


Objective: Digital health technologies most often reach only those more motivated to engage, particularly when preventive health is targeted. To test whether gamification could be used to engage low-motivation smokers, we conceptualized "Take a Break"-a 3-week technology-assisted challenge for smokers to compete in setting and achieving brief abstinence goals.

Materials and Methods: In the feasibility study of the multi-technology Take a Break challenge, low-motivation smokers were given (1) daily motivational messages, (2) brief "challenge quizzes" related to smoking behaviors, (3) a telehealth call to personalize their abstinence goal for the challenge, (4) "coping minigames" to help manage cravings while attempting to achieve their brief abstinence goals, and (5) a leaderboard "webApp," providing comparative feedback on smokers' participation, and allowing for competition. Heterogeneity of engagement was tracked.

Results: All 41 smokers initially reported that they were not actively quitting. Over half were employed less than full time (51%), completed less than a 4-year college education (76%), and experienced financial stress (54%). No smokers opted out of the motivational messages, and mean proportion of response to the challenge quizzes was 0.88 (SD = 0.19). Half of the smokers reported using the "coping minigames." Almost all set abstinence goals (78%), with over half lasting 1-2 days (51%); median = 1 day (IQR 1-7). Leaderboard points ranged widely.

Conclusions: Rates of smoking in the developed world have declined, and those who remain smokers are complex and have lower motivation to quit. Using a game-inspired challenge, we achieved high levels of engagement from low-motivation smokers.


UMCCTS funding, Digital technology, Game design theory, Motivational intervention, Tobacco cessation, Usability and feasibility testing, eHealth

DOI of Published Version



Games Health J. 2019 Aug;8(4):275-284. doi: 10.1089/g4h.2018.0076. Epub 2019 Jun 20. Link to article on publisher's site

Journal/Book/Conference Title

Games for health journal

Related Resources

Link to Article in PubMed

PubMed ID