Stéphanie Carlier, Femke De Backere, Filip De Turck
Serious games and gamification (SGG) have shown to have positive effects on health outcomes of eHealth applications. However, research has shown that a shift towards a personalized approach is needed, considering the diversity of users. This introduces new challenges to the domain of SGG as research is needed on how such personalization is achieved. A literature search was conducted to provide an overview of personalization strategies. In total, 50 articles were identified, 35 reported on a serious game and 15 focused on gamification. We introduce a three-tiered classification model, including a model level, a personalization paradigm level, and algorithmic framework level to synthesize how personalization is implemented. Data-driven approaches are most common overall (22/50), with knowledge-driven and hybrid methods more prevalent in rehabilitation, reflecting safety and explainability requirements. Popular modeling choices include Hexad-based player modeling and ontologies for expert knowledge integration. Despite encouraging results, reusability remains limited, impeding comparison and knowledge transfer. This review outlines opportunities for progress:shareable knowledge assets, swap-friendly personalization engines, and clinically bounded hybrid approaches, alongside cautious use of generative AI to accelerate design while maintaining safety and explainability. This classification framework and synthesis aims to guide more modular, comparable, and clinically aligned personalized SGG.