The last decade witnessed an emergence of the prevalent use of smartphones. Such devices have become a vital component of daily life, and their integration has been facilitated by their low cost and technological advances. Smartphones with sophisticated mobile operating systems have characteristics similar to those of handheld personal computer systems (1). In Hong Kong (HK), the demographic that mostly uses and owns smartphones involves young people, with nearly 92% over the age of 10 (2). Internet services, online entertainment, games, telecommunications, and social connections are all possible via multifunctional smartphone devices (3–8). The psychological and physical health of smartphone users who play online games remains an active area of public health research (9–15).

Location-based games (LBGs), a mobile technology enabling people to experience immersive game environments, provides augmented reality environments in which digital images are layered onto reality (16, 17). Pokémon GO is an augmented reality game with an LBG component (4, 18, 19). Players participate in a virtual environment through their smartphones, in which they hunt for and catch digitally animated characters. Real geographical locations, tied to virtual environments, are a distinctive characteristic of LBGs. Various animated characters are displayed in real-world locations via augmented reality, which draws in young users. After downloading the game or application, users search for the animated characters in the physical environment that is familiar to them, that is, their neighborhood. Thus, physical exercise in the form of walking around one’s neighborhood is stimulated and encouraged, as many people are drawn into the game and its mechanics. However, the physical and mental health of an individual might also be negatively impacted by the excessive time spent playing LBGs (3, 12, 17, 19).

Consequently, it is crucial to explore how the physical and mental wellbeing of young people are impacted by LBG engagement. In terms of the social, psychological, and physical impacts of gaming addiction, multiple effects on health are noted in the literature (7, 9, 12, 17, 19–23). On the one hand, depression can be alleviated by such engagement, and the benefits of physical exercise can mitigate Type 2 diabetes and reduce the issues caused by obesity (9, 24–29).

On the other hand, players may become addicted to games (30–35). When enthusiasm gives way to addiction, studies have shown that the health consequences may become decidedly negative (16, 36, 37). Nonetheless, individual health can be beneficially affected by games that encourage healthy lifestyles (38). Patients suffering from pain have reported the utility of LBGs in distracting them from their discomfort (4, 39). Depression, social anxiety, and other psychological disorders experienced by players can also be alleviated through game engagement (40, 41). Furthermore, the reduction of sedentary behavior and elevated physical activity are direct outcomes for anyone who engages with Pokémon GO, regardless of age (42–44). This is exemplified by the approximately 2,500 steps taken daily by LBG players, per statistics provided by location-based technology (45, 46).

Following a thorough literature review, we found that the health-related implications associated with the continual engagement in LBGs have not been studied extensively among young adults. Thus, this qualitative study aims to explore the insights of their experiences with Pokémon GO as a well-known LBG and their motivations for playing, in order to investigate their perspectives on the game’s implications on the public health of their communities. In alignment with the above-mentioned aims, the research objectives of this qualitative study are as follows: 1) to explore the underlying factors that constitute the primary driving force for young adults to develop continual engagement with LBGs—in our case, Pokémon GO, and 2) to examine the implications of the continual engagement of LBGs for the young adults in terms of their social, psychological, and physical wellbeing, and in relation to the public health of their communities at large.

Focus groups (FG) were used to collect data from group interactions and discussions providing diverse explanations and outlooks concerning the central topics (47). This study was approved by the Committee on the Use of Human and Animal Subjects in Teaching and Research at the Tung Wah College (Ref. no. RESC2017003). Participants provided written consent for their participation in this study and were assured that their experiences and interview content would be reported anonymously in an international journal. The details of the methodological considerations were provided in Table 1.

As Table 3 illustrates, the Pokémon GO trainer level of the participants was as follows: two were between trainer levels 16–20; four between trainer levels 21–25; nine between trainer levels 26–30; nine between trainer levels 31–35; 25 between trainer levels 36–40; and 11 above trainer level 41. Table 3 also illustrates the amounts of money the participants spent on Pokémon GO as at the interview day: nine spent no money; three spent between 1 and 12 USD; nine spent between 13 and 64 USD; 27 spent between 65 and 130 USD, and 12 spent over 130 USD. The average playing time, per day, was 4.9 h and the average duration spent playing was 5.3 months.

The cognitive, psychological, and physical health of Pokémon GO players may be positively affected in their day-to-day lives by playing the LBG (56). For positive outcomes to occur in these aspects of health, the level of players’ engagement in a particular LBG over time is an important question for researchers who intend to apply LBG as a health promotion tool at a population level. Though the nature of this study as a qualitative inquiry may limit our ability to answer that important question, our study revealed that the extent of the players’ engagement and motivation to play the game is largely determined by their childhood memories (as Pokémon in this case). This finding implicates that, if a LBG is to be constructed for the purposes of health promotion, a careful selection of games (and/or the characters in games) may be required; these games and/or characters should be able to stimulate players’ memories and thereby internally motivating the players to engage in the gaming activities over time. To confirm this argument, the comments from 51 participants in our study may be relevant. They noted repeatedly in the interviews that the “mental connection [that is, how a player of LBG perceives and experiences the game]” plays a major role in maintaining the engagement in the gaming activities through time. Our study found that the gaming design of Pokémon GO enables players to feel the experiences and sentiments of an adventurous and interactive journey via augmented reality technology. As the participants experienced the sensation of becoming a Pokémon trainer in real life, specific memories are generated. These memories serve as a driving force to keep them engaging in the game, leading to alterations in cognitive behaviors through time (for example, an increase in the player’s social interactions with individuals in their neighborhood). Our study confirms the findings from similar research that the positive influence on mental and physical health appeared to take effect through various engaging features of LBG, namely, human interaction, community integration, and physical participation (38).

Our study findings suggested that walking more than usual was incentivized, the formation of exercising habits was stimulated, and prolonged game engagement can lead to high levels of daily physical exercise. For example, the physical activities such as walking, and running are the core of the treasure-hunt tasks required by the players in Pokémon GO. In the game, encountering other characters or stimulating the hatching of eggs, is more likely when walking than when using various forms of transportation, which led to some participants increasing the amount they walked (57). Similar to our findings, research in other countries also pointed out that, after playing the game, an average increase of between 1,000 and 2,000 steps was observed by the players (58, 59). To support the notion that exercising habits were stimulated through gaming experiences, a majority of the participants in our study mentioned that when searching for a Pokémon that was only available for a limited time, they would run toward the target. They also observed that many players develop this habit of running in their rapid pursuit of rare Pokémon characters. As pointed out in the literature (60), the increases in physical activity of an engaging player may range from moderate to substantial. However, as a word of caution, our research team also noted the drawbacks of excessive engagement of LBG using smartphones (38, 61), and these findings should be considered when LBG is used for the purposes of health promotion.

An important finding of this paper is that the application of an LBG may help integrate a community, which may have implications when LBG is used to promote health at a population level. The design and objective of LBG technology is in part conveyed through the treasure-hunt mechanic, which led the players (and the participants in our study) to explore novel locations within their communities (4, 60, 62, 63). Specifically, owing to the game requirement to search for Pokémon characters in multiple locations, participants reported an increased desire to visit places that they never or rarely would have. Increased knowledge and familiarity with one’s neighborhood or city are encouraged via the repeated walks through the community. As a result, approximately 80% of our participants noted that, because of their perceived closeness with the community, they are more aware of the health promotional campaigns in their cities. Other studies also indicate the effects of LBG in terms of community integration (4, 64).

Pokémon GO enables the possibility of fortifying and building human relationships, implicating that positive effects on the population health may not solely at the physical level, but also at a psychosocial level. Our study confirms that rather than electronic communication via text, in-person social interactions are incentivized via the gameplay mode (3, 4, 65). Similar to other studies (3, 66), our study found that participants engage with a common goal without social anxiety when they are virtually battling in gyms in the same geolocation. In pursuit of this common goal, players unknown to one another can communicate with each other if they are in the same vicinity.

The recent surge in Pokémon popularity has led to multiple age groups engaging with the free-to-play game (67–69). Our study reveals that players are stimulated to develop positive relationships with not only other players, but also their parents through game engagement within a family. According to the participants, common issues like generation gaps, were bridged and relationships were developed. This positive benefit on family health may be explained by that the participants’ childhood memories of Pokémon resurfaced through playing the game. Such recaptured memories are not merely enjoyed again but are lived out and reflected through playing among people of different generations, leading to the closing of communication gaps between generations (70–72).

Nonetheless, our study also highlighted one possible drawback of the application of LBG in promoting activity levels. Social disturbance and other risks within the community have been caused by the significant influx of players pouring into the streets, while being focused on the gameplay on their smartphones. Thus, players blindly crossing the street, colliding with objects in the street, and running into people, are among the physical drawbacks that other studies have identified as a result of distracted players (4).