Abstract
BACKGROUND: Exergaming, which combines physical exercise with video gaming, has shown benefits for individuals with chronic conditions. Implementation occurs at different levels and phases and influenced by various factors. To address the factors that influence the implementation of exergaming in healthcare, we aimed to explore stakeholder's experiences of strengths, weaknesses, opportunities and threats to the implementation of exergaming (in preparation, execution and continuation) for individuals with chronic conditions, in healthcare at the micro, meso and macro level. METHODS: A qualitative study with deductive content analysis was performed to explore stakeholder's experiences regarding the strengths, weaknesses, opportunities and threats (SWOTs) of implementing exergaming in healthcare. Data were collected through semi-structured interviews with 24 stakeholders, including patient representatives, researchers, healthcare professionals, game developers and individuals involved in healthcare regulations. RESULTS: At the micro level assessing patient's needs and involving stakeholders in the development and evaluation phases were described as strengths in implementing exergaming in healthcare. Weaknesses included patient's lack of digital literacy and healthcare professional's concerns about the safety and quality of exergames. The involvement of healthcare professionals and family support were described as opportunities, whereas threats included the challenge of tailoring exergames to patient's needs and healthcare professional's fear of losing control over the technology. At the meso level, strengths involved collaboration between healthcare professionals and technicians, whereas weaknesses included the high cost and time required for designing exergames. Opportunities were found the use of existing exergames, and threats involved competition for research grants and staff turnover. At the macro level, strengths included supportive regulations and collaboration among policy-makers, whereas weaknesses involved defining intended use and fragmented responsibilities. Opportunities were identified in governmental funding programs and international collaborations, whereas threats included challenges in data storage and sharing. CONCLUSIONS: The effective implementation of exergaming in healthcare requires coordinated efforts. Stakeholder's involvement, supportive leadership and digital readiness are crucial for successful implementation, while inconsistent implementation of the policies and limited evidence on patient safety pose significant barriers. These insights can inform future strategies for integrating exergaming into healthcare settings.