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Studies have shown that digital media and digital games can enhance students' learning experience. However, few teachers appear to use digital game-based learning (DGBL) regularly. The purpose of this qualitative study was to understand how middle school teachers use DGBL in the classroom and the factors that positively and negatively influenced their choices to use DGBL. Rogers's diffusion of innovations theory framed the study. Research questions examined how middle school teachers use DGBL in the classroom, what they view as positively and negatively influencing decisions to integrate DGBL, and differences based upon the point in their teaching career when they began using DGBL. Eight purposively selected middle school teachers who have integrated DGBL were interviewed. In vivo and pattern coding were used in analysis. Findings indicated that teachers use DGBL to engage students in content, support skill building, promote teamwork, individualize learning, and for feedback and classroom management. Factors that positively influenced adoption included teachers' own gaming experiences and perceptions of positive influence on lesson planning, classroom management, and students. Negative influences included technical difficulties, lack of self-efficacy, perceptions of students being distracted, time constraints, and the need for back up plans. There were some differences between number of years participants had been using DGBL. By better understanding how and why teachers use DGBL, policy makers, administrators, and preservice and professional development providers can develop strategies to better support DGBL use, which will benefit students' learning.