{
  "abstract": "Municipalities increasingly pilot gamified physical activity (PA) interventions, yet few progress beyond pilots. This qualitative study examined decision-making pathways through which Dutch municipalities adopt, implement, and scale digital gamified PA interventions, using the case of ‘Missie Master’. A two-phase design was applied, combining exploratory interviews with policymakers, health professionals, and a company (phase 1), followed by two multi-stakeholder workshops and follow-up interviews with municipalities new to gamification (phase 2). Thematic analysis showed that adoption was driven by informal processes, enthusiastic individuals, trust in product reliability, and peer recommendations, while generic company outreach was ignored. Implementation relied on early preparatory capacity, such as designated coordinators, marketing plans, and timely app updates. Scaling was rare and cyclical, dependent on political support, cross-domain alignment, and short communication lines. The study offers a practical decision guide and highlights monitoring needs. Policy implications include transparent evaluation pathways, structured early implementation, and strengthened public-private co-development. Author summary: Municipalities increasingly experiment with digital tools that use game elements to encourage, especially children, to be more physically active. While many of these initiatives show promise, most remain small pilot projects and do not become part of long-term local policy or everyday practice. In this study, we wanted to understand why this happens and what helps municipalities move beyond experimentation. We studied how Dutch municipalities decided whether to adopt, use, and continue a gamified physical activity app. By talking with policymakers, health professionals, and an app developer, we explored how decisions were made in practice. We found that adoption often depended on enthusiastic individuals and informal recommendations rather than formal evaluation procedures. Successful implementation required early preparation, such as clear coordination, communication, and ongoing support. Scaling initiatives beyond pilots proved difficult and usually depended on political support, cooperation across policy domains, and close collaboration between those making policy and those delivering activities. Our findings show that moving from pilots to sustained policy requires clearer decision pathways, better preparation, and stronger collaboration between public and private partners. These insights can help municipalities make more effective use of digital health innovations in the future.",
  "abstract_shown": true,
  "affiliations": [
    "Consumption & Healthy Lifestyles, Wageningen University, Wageningen, the Netherlands.",
    "Utrecht School of Governance, Utrecht University, Utrecht, the Netherlands."
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Ayla Schwarz",
      "orcid": "0000-0002-8851-7316"
    },
    {
      "affs": [
        1
      ],
      "name": "Maarten van Bottenburg",
      "orcid": "0000-0001-5764-2459"
    },
    {
      "affs": [
        0
      ],
      "name": "Monique Simons"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/2sf3c9d35dybh.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pdig.0001792",
  "fulltext_url": "https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001792",
  "id": "2sf3c9d35dybh",
  "issns": [
    "2767-3170"
  ],
  "landing_url": "https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001792",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "3204|Educational Games and Gamification"
    ],
    [
      "plos",
      "/Biology and life sciences/Neuroscience/Cognitive science/Cognition/Decision making"
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      "plos",
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      "/Biology and life sciences/Psychology/Cognitive psychology/Decision making"
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      "/Medicine and health sciences/Health care/Communication in health care"
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      "plos",
      "/Medicine and health sciences/Health care/Health care policy"
    ],
    [
      "plos",
      "/Medicine and health sciences/Public and occupational health/Physical activity"
    ],
    [
      "plos",
      "/People and places/Population groupings/Age groups/Children"
    ],
    [
      "plos",
      "/People and places/Population groupings/Families/Children"
    ],
    [
      "plos",
      "/Research and analysis methods/Research design/Pilot studies"
    ],
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      "plos",
      "/Social sciences/Psychology/Cognitive psychology/Decision making"
    ],
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      "plos",
      "/Social sciences/Sociology/Communications/Marketing"
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  "openalex": "W7223684997",
  "pdf_url": "https://journals.plos.org/digitalhealth/article/file?id=10.1371/journal.pdig.0001792&type=printable",
  "pmcid": "PMC13704860",
  "pmid": "42932264",
  "published": "2026-10-26",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/2sf3c9d35dybh.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:17Z",
      "native_id": "10.1371/journal.pdig.0001792",
      "source": "plos",
      "url": "https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001792"
    },
    {
      "first_seen": "2026-10-30T12:22:01Z",
      "native_id": "MED:42932264",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42932264"
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  "subjects": [
    {
      "field": "biology",
      "origin": "plos:neuroscience",
      "subfield": "neuroscience"
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    {
      "field": "medicine",
      "origin": "plos:public and occupational health",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Decision-making pathways for adopting, implementing, and scaling gamified physical activity interventions in municipal policy and practice in the Netherlands",
  "title_text": "Decision-making pathways for adopting, implementing, and scaling gamified physical activity interventions in municipal policy and practice in the Netherlands",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:22:01Z",
  "url": "https://research.draconitic.com/paper/2sf3c9d35dybh",
  "venue": "PLOS Digital Health",
  "versions": []
}