The use of gamification in promoting physical and mental health in children is an innovative approach that requires a careful consideration of the technological prerequisites and disparities in digital device access. Ensuring device compatibility across smartphones, tablets, and computers is essential for broad accessibility [1]. Additionally, reliable internet access is a critical factor, particularly in regions with limited connectivity, as noted in a report by the World Health Organization. The design of these gamified applications must be user-friendly and appropriate for children, allowing for easy navigation and engagement. However, economic, and geographical disparities pose significant challenges. Children from different socioeconomic backgrounds may not have equal access to digital devices, and those in rural or remote areas might face additional hurdles due to less advanced technology and internet availability. Furthermore, the level of digital literacy, often tied to available educational resources, can influence children’s ability to engage with digital health tools [2] effectively.

To mitigate these disparities, the inclusive design of gamified health applications is vital, ensuring they can operate on primary devices. Establishing community centers or schools as access points can provide opportunities for children without personal devices, a strategy recommended by UNICEF. Additionally, providing digital literacy training can help children use these tools more effectively [3]. Regular feedback and assessment mechanisms are crucial for evaluating gamified tools’ effectiveness and engagement levels. Moreover, collecting data on usage patterns and health outcomes is essential for assessing the impact on children’s health, as emphasized in [4]. Collaborations with educational institutions and support from government and NGOs can enhance accessibility, providing the necessary resources and infrastructure for a broader reach, as seen in the initiatives described by the Centers for Disease Control and Prevention (CDC) (2022) [5]. These steps are crucial in maximizing the impact and reach of gamification in improving children’s physical and mental health. Overall, ensuring accessibility and addressing disparities in digital access, literacy, and socioeconomic factors are crucial for maximizing the impact of gamified health applications on children’s health and well-being, particularly in underprivileged communities.

In conclusion, while gamified health applications can potentially improve children’s health and well-being, it is essential to address disparities in digital access and ensure inclusive designs to maximize their impact on all children, regardless of socioeconomic background or geographical location [6]. Thus, it is crucial to provide necessary resources and infrastructure, promote digital literacy, and establish collaborations with educational institutions, government, and NGOs [7].

Children and adolescents’ well-being relies heavily on health promotion. Thanks to the increasing use of digital technology, gamification has emerged as a promising strategy for engaging and motivating young people in health-related behaviors. Several studies have investigated the efficacy of gamified interventions in promoting behavior modification and health in children and adolescents and have found that gamified interventions can effectively promote behavior change and improve health outcomes [8]. These interventions can leverage intrinsic motivation, making them more engaging and pleasurable for young people. A study on gamified sexual health education among adolescents in low-tech settings, for instance, found that gamified learning promoted sexual well-being more effectively and engagingly [9].

Likewise, a study on gamified learning for sexual health education revealed that gamification enhanced students’ attitudes, knowledge, and motivation to learn [10]. In addition, gamified scenarios can promote healthier lifestyles among children and teenagers. Another study [11] found that gamification can effectively enhance this population’s diet, physical activity, and sedentary behavior. A systematic review and meta-analysis found, for instance, that gamification interventions effectively improved diet, nutritional practices, and body composition in children and adolescents [12]. In addition, gamification has been utilized to promote active school transportation, encouraging children and adolescents to engage in physical activity [13]. Gamified scenarios can motivate young individuals to adopt and maintain healthful behaviors by incorporating game elements such as rewards, challenges, and goal setting.

Additionally, gamified scenarios can be tailored to address health concerns among children and adolescents. For instance, gamification has been utilized to promote adherence to national food-based dietary guidelines and increase knowledge of healthier nutritional practices [14]. It has also been investigated as a tool for assessing and intervening in behavioral problems such as conduct disorder, self-harming tendencies, and attention-deficit/hyperactivity disorder (ADHD) [15]. Gamified scenarios can help young people develop skills, knowledge, and behaviors that contribute to their overall health and well-being by providing interactive and engaging experiences.

The results highlight the numerous ways in which engaging and motivating learners is a well-known challenge in health education [68]. Even though healthy nutrition is essential for physical well-being, it can often appear complicated and dull to children and adolescents. Gamification is an innovative solution due to its capacity to capture and maintain interest. By making learning about healthy eating in a fun, interactive experience, children and adolescents are more likely to retain the information. One of the assets of gamified platforms is their capacity to employ a variety of learning -promoting game mechanics. Elements such as quests or challenges can be mapped to nutrition-related objectives, such as eating a certain number of fruits and vegetables daily or preparing a balanced meal. Reward systems, such as points, badges, and levels, can provide positive reinforcement, encouraging the repetition of healthy eating behaviors.

Additionally, leaderboards can cultivate a sense of healthy competition and community, thereby increasing motivation. In addition, the results of the focus groups presented in one paper [69] suggest that gamification of nutrition can improve adolescents’ dietary habits. Four themes emerged from the analyses: enhanced eating behavior, increased physical activity, increased nutrition knowledge, and influencing others. Researchers also observed that after playing the game, the participants had improved nutrition knowledge and they reported influencing the eating habits of their parents, siblings, and acquaintances. Nonetheless, remarks made by participants during the focus group discussions highlighted nutrition-related misinformation. In addition, in one paper [70], the challenge was to create highly user-friendly and motivating programs to promote adherence and efficacy. This usability study aimed to evaluate and improve the usability and engagement of an unguided online intervention program to promote a healthy lifestyle and reduce the risk of eating disorders and obesity among adolescents.

Gamification could be effective [71] in enhancing nutritional knowledge regarding healthier dietary practices. To avoid and prevent chronic diseases, it is necessary to promote the development of practical educational instruments to support learning about nutrition. Also, according to a shared perspective [72], the newly developed gamified “Snack Track School” app attempts to address some of the issues identified in earlier prevention programs, which were unsuccessful in altering nutrition behaviors and anthropometrics. According to the research protocol [73], the results indicate that the app’s core features should include individualized meal recommendations and assistance with meal planning, social networking for peer support, customized and convenient tracking, remote access to health care providers, features to support mental health, and an engaging user interface.

In addition, according to other research [74], the challenge of gamification is creating extremely user-friendly and motivating programs to promote adherence and efficacy. This study intended to evaluate and improve the usability and engagement of an unguided online intervention program designed to promote a healthy lifestyle and reduce the risk of eating disorders and obesity among adolescents. A mobile application employing gamification techniques was utilized to prevent obesity in the at-risk group. Gamification techniques applied to the game experience without adequate support from the design discipline may compromise the user’s understanding of the actual benefits of serious games. Behind entertainment and therapy, it is mandatory to involve all stakeholders in the design process when working in this field to produce a genuine contribution to promoting healthy habits among adolescents.

Based on [75], an intervention program was conducted to determine whether the hybridization of teaching personal and social responsibility and gamification could be enhanced. The results indicate that hybridization of teaching personal and social responsibility and gamification strategies improved cognitive performance but not academic achievement. These findings emphasize the significance of promoting and empowering cognitive processes for improved academic performance. According to the qualitative findings of the paper [76], students reported increased self-confidence and empowerment in their school community and family environment. Increasing pupil engagement is essential to the success of an intervention. Lastly, in [77], the intervention, which incorporated gamification strategies and recruitment methods employing parental opt-out procedures, was acceptable to both participants and instructors. Innovative gamified interventions may be one strategy for engaging and motivating health behavior modification. All articles extracted are listed in Table below (Table 1).