Boosting cancer screening with mobile games: The success of Norway's FightHPV app

Norway has been exploring digital health innovation with the FightHPV mobile game, developed by the researchers at the Cancer Registry of Norway. The game app increased cervical cancer screening participation among women who played through educating with engaging puzzles, reinforced text explanations, interactive features, and prize draws. By using behavioural nudging techniques, the app effectively encourages women to participate in life-saving screenings.

Engaging education through play

FightHPV is a game designed to educate users about HPV infection, its associated risks, and preventive measures. By turning learning into a game, the app makes complex health information accessible and engaging.

A prospective follow up study revealed that women who used the app were significantly more likely to book and attend their cervical cancer screenings compared to those who received traditional reminder letters. The study demonstrated that gamification could effectively reduce anxiety and increase motivation, leading to higher participation in screening programmes.

The app’s playful features, such as creating personalised characters and participating in interactive quizzes, helped demystify how infection is transmitted, HPV vaccination and the screening process. Many users reported feeling more informed and empowered, transforming a traditionally clinical experience into something approachable and even fun.

Development and evaluation

The app was developed using an iterative design process, involving computer scientists, graphic designers, and medical professionals. Initial testing included 40 employees and two focus groups: women aged 40-60 and high school students aged 16-18. Feedback from these groups played a crucial role in refining the app’s usability and effectiveness in disseminating health information.

Figure 1 from the article FightHPV: a game to raise HPV awareness https://www.hpvworld.com/articles/fighthpv-a-game-to-raise-hpv-awareness-and-nudge-people-to-take-action-against-cervical-cancer/

How FightHPV works

The app delivers health education through six structured episodes, each containing ten levels:

– Episode 1: Explains what properties of epithelial cells are, the only type of cells that HPV can infect.
– Episodes 2 & 3: Cover low-risk and high-risk HPV types.
– Episodes 4, 5 & 6: Provide information on contraception, vaccination, and cervical cancer screening.

Each level begins with a short informational text, followed by progressively challenging tasks. To maintain engagement, the app integrates gaming features like leaderboards and achievements, making learning both interactive and rewarding.

Figure 2 from the article FightHPV: a game to raise HPV awareness https://www.hpvworld.com/articles/fighthpv-a-game-to-raise-hpv-awareness-and-nudge-people-to-take-action-against-cervical-cancer/

Impact on screening attendance

The use of FightHPV has led to a measurable increase in cervical cancer screening attendance in the cohort study: DOI: 10.2196/36197

– Women who used the app were more than twice as likely to attend screenings compared to those who did not, meaning that attendance for cervical exams potentially rose by 230%.
– 13 times more cases of high-grade abnormalities were detected among those who used Fight HPV, leading to earlier intervention and treatment indicate that the game-based intervention influenced how users understood and interpreted the relevance and value of the screening test.

Broader implications for public health

The success of FightHPV underscores the potential of mobile health interventions to improve healthcare outcomes. It highlights key strategies that could be applied to other health initiatives, including:

Gamification: Making medical information engaging and interactive.
Behavioural nudging: Encouraging proactive health behaviours.
Personalised education: Delivering targeted content to different demographics.
Seamless healthcare integration: Connecting users to screening resources and healthcare providers.
Data-driven improvement: Using user feedback and analytics to refine digital health tools.

Expanding the FightHPV concept for broader impact

While FightHPV has proven successful among women who played the game, a significant challenge remains: Only a small portion of the population engages with this type of intervention. There is no one-size-fits-all approach to cancer screening communication, and a multi-faceted strategy is needed to reach different groups effectively.

The FightHPV concept could be adapted by other countries to fit their specific communication strategies. Tailoring gamified health interventions to local cultural and linguistic contexts may enhance their impact. Additionally, considering different age groups in future versions of the app could further increase its reach. For example, while the current app engages younger users effectively, alternative formats might be needed for older populations who may not play mobile games as frequently.

FightHPV is just one of many communication tactics in the effort to boost cancer screening participation. A comprehensive approach that includes mobile games, traditional media campaigns, direct reminders, and community outreach can ensure that all segments of the population receive the necessary information and encouragement to participate in life-saving screenings.

Use the QR-code to download FightHPV

Watch our video to learn more about the app: https://www.youtube.com/watch?v=_rOi7z5WE4s

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Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or European Health and Digital Executive Agency (HADEA). Neither the European Union nor HADEA can be held responsible for them.

The general objective of EUCanScreen is to assure sustainable implementation of high-quality screening for breast, cervical and colorectal cancers, as well as implementation of the recently recommended screening programs – for lung, prostate and gastric cancers. EUCanScreen will facilitate the reduction of cancer burden and achieving equity across the EU.

This project has received funding from the European Union’s EU4HEALTH Programme under the Grant Agreement no 101162959