Gamification in Health Behaviour Change: A Narrative Review with Implications for the Health and Life Insurance Industry (Preprint)

UNSTRUCTURED Chronic health conditions, exacerbated by physical inactivity, impose substantial financial and operational burdens on the public health sector and insurance providers in the UK. While gamification demonstrates the potential for enhancing health behaviour, a structured analysis of how it relates to established behavioural frameworks is missing. This review examines how gamification aligns with key theoretical models, including the Behaviour Change Wheel (BCW), Behaviour Change Techniques (BCTs), and self-efficacy theory. We provide a mapping of gamification elements onto these frameworks, illustrating how gamified interventions can enhance effectiveness by synthesising multiple BCTs into engaging, cohesive user experiences that activate intrinsic motivation. As insurers transition from traditional risk assessment toward proactive risk reduction strategies, gamification offers an innovative mechanism to strengthen their prevention initiatives. Strategic implementation of gamification can increase customer engagement and motivation within wellness programmes, reduce claim costs, and strengthen insurer-insured relationships. Drawing on evidence from digital health applications and theoretical foundations, we distinguish gamification from conventional approaches that rely primarily on incentivisation, highlighting gamification's distinctive capacity for achieving sustained health outcomes. Our analysis emphasises that effective gamified interventions must incorporate inclusive design principles, theoretical grounding, ethical accountability, and continuous refinement through rigorous evaluation. We advocate for strategic, theory-informed investment in gamification by insurers, coupled with ongoing assessment of health outcomes and return on investment to ensure alignment with long-term public and individual health objectives.