From Evidence to Innovation: Developing a Reward-Based mHealth Business Model for Video- Game-Playing Children and Adolescents

Abstract

Background: Physical inactivity is a leading global health challenge, contributing to 4-5 million preventable deaths annually. This issue often begins in youth, as activity patterns established during adolescence can persist throughout life; currently, 81% of adolescents fail to meet WHO recommendations, justifying early intervention. While mobile health interventions show promise, existing standalone reward-based approaches have demonstrated limited effectiveness in rigorous trials. The HealthGrind concept proposes embedding physical activity rewards into established video-game ecosystems to leverage youth motivations. This thesis evaluates the evidence for such mHealth interventions and develops a business model for this gaming-integrated approach in the German health market. Methods: A systematic review searched PubMed for reward-based mHealth interventions promoting physical activity in children/adolescents (6-18 years) from January 2019 - March 2025. Risk of bias was assessed (RoB-2, ROBINS-I). Business model development used the Business Model Development Framework by Osterwalder and Pigneur (2013), supported by an environmental analysis of German market forces, industry dynamics, regulation, and macroeconomic conditions. Results: Nine studies (n=7,747) applied virtual, social, financial, or altruistic rewards. Effectiveness inversely correlated with methodological quality: three large, low-bias RCTs reported null effects, while high-bias studies reported positive outcomes. All interventions used standalone applications, and none integrated rewards into gaming platforms. Business model analysis identified §140a SGB V Special Care Contracts as a potential viable pathway. The model relies on publisher partnerships and tiered B2C/B2B revenue streams, navigating a cost structure where platform fees and VAT absorb ~30% of gross revenue. Conclusion: Rigorous trials show standalone reward-based mHealth apps are ineffective for youth. This thesis identifies a critical gap, as the potential of rewards integrated directly into gaming ecosystems remains empirically untested. The proposed business model's success hinges on securing game publisher partnerships, staged funding, and future RCT evidence to validate the approach within Germany's §140a SGB V framework