The rapid growth in digital technology usage among children and adolescents has highlighted the need for novel approaches to promote their physical and mental health. This paper investigates the viability of gamification—the application of game mechanics to non-gaming contexts—as a potent instrument for health promotion and mental health support. This conceptual systematic review seeks to examine the various published articles promoting children and adolescents’ physical and mental health through gamified techniques. These interventions can provide an interactive and engaging platform for encouraging physical activity, promoting healthy nutrition, enhancing emotional regulation, and promoting mental health. The significance of this topic stems from the pervasive use of electronic games, beginning at a young age, which makes them popular educational tools. For the review to be systematic and reproducible, the PsycINFO, Scopus, PubMed, and Elsevier databases were searched and the PRISMA method was utilized for the analysis. After analyzing the research data, empirical studies assessing the use of gamification in promoting adolescents’ physical and mental health are discussed. In conclusion, gamification has demonstrated promise for promoting children’s and adolescents’ physical and mental health. It improves motivation, commitment, and adherence to healthy behaviors. However, additional research is required to evaluate gamification interventions’ long-term effectiveness and sustainability in promoting health behaviors among this population.

Background and Objectives: This systematic review examines the integration of gamified health promotion strategies in school settings, with a focus on their potential to positively influence health behaviors and promote well-being among adolescents. This study explores the incorporation of cognitive behavioral therapy (CBT), artificial intelligence, and neuropsychological principles in gamified interventions, aiming to enhance engagement and effectiveness. Materials and Methods: A narrative synthesis of 56 studies, following PRISMA guidelines, underscores the significant impact of these gamified interventions on mental health outcomes, emphasizing reductions in anxiety, depression, and burnout while improving coping skills and lifestyle habits. The focus of key areas in mental health outcomes, emotional regulation, cognitive flexibility, and adherence mechanisms is explored through quantitative and qualitative syntheses to underscore intervention effectiveness and design principles. Results: This review highlights the high-quality evidence supporting the use of gamification in educational settings and calls for further research to optimize design elements and address implementation barriers. The findings propose that well-designed gamified health interventions can effectively engage students, promote healthy behaviors, and improve mental well-being while acknowledging the need for further studies to explore underlying mechanisms and long-term effects. Conclusions: Gamified health interventions that embed CBT and neuropsychological principles are promising for promoting the mental well-being of schoolchildren. Although the evidence indicates that they are effective in improving psychological and behavioral outcomes, further research is needed to optimize design features and overcome implementation challenges to ensure wider and more sustainable application.

This study evaluates design effectiveness in Digital Game-Based Learning (DGBL) for primary health education through systematic teacher assessment of the iLearn4Health platform. Rather than measuring educational transformation, the research investigates how DGBL design principles influence user engagement patterns and platform usability as evaluated by education professionals. The study contributes to design optimization frameworks for primary school digital health education applications by examining the distinction between DGBL and superficial gamification approaches in creating engaging educational interfaces. The iLearn4Health platform underwent comprehensive design evaluation by 337 teachers across 24 schools in five European countries (Greece, Cyprus, Romania, Poland, and Spain). Teachers served as design evaluators rather than end-users, assessing platform engagement mechanisms through systematic interaction analysis. The study employed multiple statistical approaches—descriptive analysis, correlation analysis, ANOVA, regression modeling, and cluster analysis—to identify design engagement patterns and their predictors, tracking completion rates, progress trajectories, and interaction time as indicators of design effectiveness. Design evaluation revealed a distinctive bimodal engagement distribution, with 52.8% of teacher–evaluators showing limited platform exploration (progress ratio 0.0–0.2) and 35.3% demonstrating comprehensive design assessment (progress ratio 0.8–1.0). A strong positive correlation (r = 0.95, p < 0.001) between time spent and steps completed indicated that design elements successfully sustained evaluator engagement. Multiple regression analysis identified initial design experience as the strongest predictor of continued engagement (β = 0.479, p < 0.001), followed by country-specific implementation factors (Romania vs. Cyprus, β = 0.183, p = 0.001) and evaluator age (β = 0.108, p = 0.049). Cluster analysis revealed three distinct evaluator profiles: comprehensive design assessors (35.3%), early design explorers (52.8%), and selective feature evaluators (11.9%). Cross-national analysis showed significant variations in design engagement, with Romania demonstrating 53% higher average progress ratios than Cyprus (0.460 vs. 0.301, p < 0.01). Teacher evaluation validates effective design implementation in the iLearn4Health platform for creating engaging primary health education experiences. The platform successfully demonstrates DGBL design principles that integrate health concepts into age-appropriate interactive environments, distinct from gamification approaches that merely overlay game elements onto existing content. Identifying initial engagement as the strongest predictor of sustained interaction highlights the critical importance of onboarding design in determining user experience outcomes. While this study establishes design engagement effectiveness through educator assessment, actual educational transformation and student learning outcomes require future implementation studies with primary school populations. The design validation approach provides essential groundwork for subsequent educational effectiveness research while contributing evidence-based design principles for engagement optimization in digital health education contexts.

Background and Objectives: This study examines the distinction between gamification and Digital Game-Based Learning (DGBL) in health education, introducing the iLearn4Health platform designed to enhance health literacy among primary school students aged 6-12. The research investigates how DGBL's integration of educational content into gameplay mechanics affects user engagement and learning outcomes compared to superficial gami-fication approaches. Materials and Methods: Developed through international collaboration across five European countries, the iLearn4Health platform features six health-focused modules with age-appropriate content and multilingual support. The study analyzed platform usage data from 337 teachers across 24 schools, tracking engagement metrics, including complete steps, progress ratios, and time spent. Multiple statistical approach-es—descriptive analysis, correlation analysis, ANOVA, regression modeling, and cluster analysis—were employed to identify engagement patterns and their predictors. Results: Analysis revealed a distinctive bimodal distribution of user progress, with 52.8% showing low engagement (progress ratio 0.0-0.2) and 35.3% demonstrating high engagement (pro-gress ratio 0.8-1.0). A strong positive correlation (r=.95, p< .001) between time spent and steps completed indicated that sustained engagement predicted educational progression. Multiple regression analysis identified initial engagement as the strongest predictor of overall progress (β=0.479, p< .001), followed by country effects (Romania vs. Cyprus, β=0.183, p=.001) and age (β=0.108, p=.049). Cluster analysis revealed three distinct user profiles: high engagers (35.3%, n=119), early dropouts (52.8%, n=178), and selective en-gagers (11.9%, n=40). Cross-country analysis showed significant variations in platform engagement, with Romania demonstrating 53% higher average progress ratios than Cy-prus (0.460 vs. 0.301, p< .01). Conclusions: The iLearn4Health platform reflects the effec-tiveness of DGBL—distinct from gamification—for health education in primary schools. The platform supports knowledge acquisition and behavioral change by integrating health concepts directly into age-appropriate game environments rather than merely adding game elements to existing content. Identifying initial engagement as the strongest predictor of overall progress highlights the critical importance of early user experience in determining educational outcomes. The platform's comprehensive approach to DGBL in primary health education establishes a framework for creating effective digital interven-tions that recognize the unique developmental needs of primary school children while adapting to diverse educational contexts.