The study, led by Ayla Schwarz of Wageningen University together with Maarten van Bottenburg of Utrecht University and Monique Simons of Wageningen University, combined exploratory interviews with municipalities that had prior gamification experience with a series of workshops and follow-up interviews involving municipalities new to the field. The researchers anchored their analysis in two complementary frameworks: the Exploration, Adoption/Preparation, Implementation, and Sustainment (EPIS) model from implementation science, and the Validated Scaling Instrument, which distinguishes between emergence, institutionalization, and stabilization phases and between three scaling strategies: scaling in, scaling out, and scaling up. This dual lens allowed the team to trace how early interest either matures into routine practice or evaporates once an enthusiastic champion moves on.

Adoption, the first phase, turned out to be driven almost entirely by informal processes. Enthusiastic policymakers, aldermen, and neighborhood sport coaches were repeatedly the decisive factor in whether a gamified app got a foothold at all. Trust in product reliability and peer recommendations from other municipalities carried far more weight than any systematic evaluation. Perhaps most strikingly, generic outreach from companies, such as standardized promotional emails sent to many municipalities at once, was simply ignored. Personalized approaches that explicitly addressed a municipality’s specific policy goals, or recommendations from trusted colleagues, proved decisive. As one company representative observed, every municipality had a different policy and was looking for something completely different in such an app, making it difficult to navigate the patchwork of local priorities.

The absence of a national approval framework for non-medical health apps in the Netherlands compounds this informality. Platforms like the Dutch ‘GGD App Store’ offer some quality evaluation support, but policymakers otherwise lack standardized criteria for judging whether a gamified intervention is credible, effective, or worth public money. The study notes that this reflects a broader international tension: commercially available health apps are proliferating faster than scientific evaluation can keep pace, with new products often lacking rigorous testing. Estimates cited in the paper suggest that moving from development to widespread adoption can take anywhere from roughly five years to as long as 14 to 17 years, a timeline that sits awkwardly with the rapid iteration cycles of the tech industry and the slower bureaucratic rhythms of municipal government.

Implementation, the second phase, depended less on the quality of the intervention than on municipal readiness. The municipalities that succeeded had invested early in preparatory capacity: designated coordinators, marketing plans, communication toolkits, and timely app updates. Continuous marketing to end users emerged as essential, and the study found that smaller-scale, neighborhood-focused promotion outperformed large city-wide campaigns. One municipality that ran paid advertisements targeting parents, built a dedicated website, and produced a promotional video reported higher awareness and participation. Conversely, where no starter pack or communication plan existed, implementers had to improvise, and the workload of updating content, troubleshooting technical issues, and keeping children engaged often exceeded available skills and staffing.

Monitoring and evidence collection proved to be a double-edged sword during implementation. Municipalities combined quantitative usage statistics, such as downloads and completed missions, with qualitative feedback from children, gym teachers, and colleagues to demonstrate value. Reported outcomes included improved motor skills, exposure to new sports, and the engagement of previously inactive target groups. Yet policymakers consistently demanded proven outcomes before committing to long-term budgets, and the lack of long-term evidence became a self-reinforcing barrier: without sustained funding, robust evaluation was impossible, and without robust evaluation, sustained funding was withheld. Political support, often tied to temporary subsidy schemes, added further fragility, and a change of alderman could sideline an entire initiative overnight.

Scaling, the third and most elusive phase, was rarely achieved. Most municipalities described themselves as still working toward it, uncertain how to secure gamification structurally within their policy and organizational systems. Only two of the six municipalities studied had explicitly embedded gamification in their policy plans, whether as part of a multi-year strategy or an innovation agenda. The rest treated it as a flexible tool for short-term goals. The researchers distinguished three scaling pathways: scaling in, integrating the intervention within the sport organizations where health professionals work; scaling out, replicating the app across multiple municipalities, which is the company’s ambition; and scaling up, embedding gamification within municipal policy frameworks for systemic change. Each pathway faced distinct obstacles, from unclear responsibilities between policymakers and implementers to financial constraints imposed by short-term funding.

Cross-domain alignment emerged as a promising route toward scaling up. Municipalities that positioned gamification within education, health, well-being, and economic strategies found it easier to mobilize support and resources. The Dutch Gezond en Actief Leven Akkoord, or Healthy and Active Living Agreement, a national framework encouraging integrated collaboration across health, youth, and sport domains, was regarded as a promising vehicle for structurally positioning gamification, since a single app can simultaneously serve sport participation goals, public health prevention goals, and youth engagement goals. Short communication lines between policymakers and field-level professionals also facilitated progress, allowing practice-based insights to flow back into policy decisions quickly.

The study’s practical outputs include a decision guide outlining the questions health professionals and policymakers actually consider when evaluating a company’s gamification proposal, from product credibility and peer municipality experiences to fit with local policy and target population needs. The authors argue that such transparency benefits companies as much as municipalities: when health systems clarify how innovations will be assessed and valued, developers can align product development with policy needs instead of repeatedly reinventing the wheel. Their recommendations progress from first actions, including pilots with visible outcomes, designated coordinators, and supportive leadership, to next actions such as cross-domain integration, network exchange, early-stage co-development with companies, and structured evaluation that captures policy integration rather than just usage statistics.

The authors are careful to note the study’s limitations. The sample was small, comprising six municipalities of varying size and experience and a single company, and the findings are rooted in the specific Dutch policy context, so the identified barriers and facilitators may not generalize to all municipalities or countries. The project was also confined to the early experimental phase of scaling, and the innovation capacity questionnaire proved difficult for health professionals with limited knowledge of municipal processes, highlighting the subjectivity of such self-assessments. Raw qualitative data cannot be shared publicly for ethical and re-identification reasons. Even so, the core message stands: gamified physical activity interventions remain in their infancy within municipal policy, and whether they ever escape the pilot trap will depend less on the next clever app than on transparent decision frameworks, structured early preparation, and durable collaboration between the public officials, frontline professionals, and private developers who must ultimately sustain them.

Subject of Research: Decision-making pathways for adopting, implementing, and scaling gamified physical activity interventions in Dutch municipal policy

Article Title: Decision-making pathways for adopting, implementing, and scaling gamified physical activity interventions in municipal policy and practice in the Netherlands

Article References: Schwarz, A., van Bottenburg, M., & Simons, M. (2026). Decision-making pathways for adopting, implementing, and scaling gamified physical activity interventions in municipal policy and practice in the Netherlands. PLOS Digital Health, 5(10), e0001792. https://doi.org/10.1371/journal.pdig.0001792

Image Credits: AI Generated

DOI: 10.1371/journal.pdig.0001792

Keywords: gamification, physical activity, municipal policy, implementation science, scaling, public health, Netherlands, digital health interventions, Missie Master, health professionals, pilot projects, EPIS framework