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

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.