Leveling up immunization: a systematic review of gamification interventions to improve Human Papillomavirus (HPV) vaccine uptake

Background: HPV vaccine is effective in preventing cervical cancer in adolescents and young adults. Despite its proven effectiveness, vaccination rates remain suboptimal due to several barriers, such as insufficient knowledge and vaccine hesitancy. Gamification has emerged as an effective strategy for getting people involved and altering their health-related behaviors. To date, there are no literature-based systematic reviews on the effectiveness of gamification in leveling up HPV immunization and knowledge among adolescents or young adults. This systematic review seeks to evaluate the impact of gamification interventions on HPV vaccine knowledge, intentions, and attitudes in adolescents and young adults. Method: This systematic review was conducted using PRISMA guidelines and PI(E)COS model. The study protocol was registered in PROSPERO: CRD42024557308. Peer-reviewed scientific articles regarding gamification interventions in the context of promoting HPV were included. The database search encompassed PubMed, Scopus, Cochrane Central, PsycINFO, as well as manual searches from Google Scholar. Results: This systematic review identified 216 records, of which nine studies met the full inclusion criteria. These studies focused on adolescents and young adults between the ages of 11 and 26 across different geographical locations. The reviewed studies indicate that gamification interventions, particularly those delivered through digital platforms, can effectively enhance knowledge, positively influence attitudes, and improve intentions to receive the HPV vaccine among adolescents. Customization features and interactive elements in the gamified intervention played a crucial role in engaging participants and driving vaccine-related behaviors. However, the findings were not universally consistent, with some studies reporting no significant impact. Conclusion: The evidence from this review supports the potential of gamification interventions to positively influence adolescent health, particularly in the context of HPV vaccination. Nonetheless, the review is limited by the small number of quantitative studies. Consequently, larger-scale studies are necessary to validate the effectiveness of these interventions robustly. Prospero registration: CRD42024557308.