A Smartphone Serious Game for Adolescents (Grow It! App): Development, Feasibility, and Acceptance Study

Evelien Dietvorst, Michelle A. Aukes, Jeroen S. Legerstee, Annabel Vreeker, Micah M. Hrehovcsik, Loes Keijsers, Manon H.J. Hillegers*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

8 Citations (Scopus)
49 Downloads (Pure)


Background: Anxiety and mood problems in adolescents often go unnoticed and may therefore remain untreated. Identifying and preventing the development of emotional problems requires monitoring and effective tools to strengthen adolescents' resilience, for example, by enhancing coping skills. Objective: This study describes the developmental process, feasibility, and acceptance of Grow It!, a multiplayer serious game app for adolescents aged 12-25 years. The app consists of the experience sampling method (ESM) to monitor thoughts, behaviors, and emotions in daily life to enhance self-insight and daily cognitive behavioral therapy-based challenges to promote adaptive coping. Methods: Our approach entails an iterative game design process combined with an agile method to develop the smartphone app. The incorporated game features (ie, challenges, chat functionality, and visual representation) in the Grow It! app were co-designed with adolescent end users to increase participant engagement and adherence. Results: The Grow It! app was delivered for Android and iOS in May 2020. Grow It! was offered to adolescents during the COVID-19 crisis between May and December 2020. Participants of the Grow It! COVID-19 study (sample 1: N=685; mean age 16.19, SD 3.11 years; 193/685, 28.2% boys; sample 2: N=1035; mean age 18.78, SD 3.51 years; 193/1035, 18.64% boys) completed 31.5% (13.2/42) to 49.5% (10.4/21) of challenges. Compliance of ESM was suboptimal (35.1/210, 16.7% to 32.5/105, 30.9%). Follow-up questionnaires indicated an overall score of the app of 7.1 out of 10. Moreover, 72.6% (278/383) to 75.6% (487/644) would recommend the app to friends. Conclusions: To our knowledge, Grow It! is the first gamified ESM app that both measures individual differences in emotional dynamics and offers an integrated cognitive behavioral therapy-based intervention. Our findings support the feasibility and acceptance, and therefore applicability, of the Grow It! app in adolescents. Further iterations of this serious game app will focus on the increase of compliance and on providing participants feedback through their personal mood profiles.

Original languageEnglish
Article numbere29832
JournalJMIR Formative Research
Issue number3
Publication statusPublished - 3 Mar 2022

Bibliographical note

Funding Information:
This research was funded by the Netherlands Organization for Health Research and Development Juiste Zorg Op De Juiste Plek

Publisher Copyright: © 2022 JMIR Publications Inc.. All Rights Reserved.


Dive into the research topics of 'A Smartphone Serious Game for Adolescents (Grow It! App): Development, Feasibility, and Acceptance Study'. Together they form a unique fingerprint.

Cite this