BACKGROUND
Emerging healthcare strategies to address medication adherence include the use of direct-to-patient incentives or elements adapted from computer games. However, there is currently no published evidence synthesis on the use of gamification and/or financial incentives in mobile applications (apps) to improve medication adherence.
OBJECTIVE
The aim of this scoping review is to synthesise and appraise the literature pertaining to the use of mobile apps containing gamification and/or financial incentives for medication adherence. There were two objectives: 1) to explore the reported effectiveness of these features 2) describe and appraise the design and development process(es), including patient involvement.
METHODS
The following databases were searched for relevant articles published in English from database inception to 24th September 2020: Embase, MEDLINE, PsycINFO, CINAHL and Web of Science. Arksey and O’Malley’s framework and the PRISMA-ScR checklist guided this scoping review. Using a systematic screening process, studies were included if incentives and/or game features were used within mobile apps to specifically address medication adherence. An appraisal using risk of bias tools were also applied to their respective study design.
RESULTS
An initial 691 potentially relevant articles were retrieved. A total of 11 studies were included in this review. Across the studies, gamification alone (n=9) was used more than financial incentives (n=1) alone or a combination of the two (n=1). A majority of studies were conducted after 2016. The studies generally reported improved or sustained optimal medication adherence outcomes with gamification and financial incentives; however, there were significant heterogeneity in the patient population, methodology such as outcome measures and reporting of these studies. There was considerable variability in the development process and evaluation of the apps, with authors opting for either the waterfall or agile methodology. App development was often guided by a theory and across the reviewed studies there were no common theories used. Patient involvement and contributions were not commonly evident in predevelopment phases but were generally reserved for evaluations of feasibility, acceptance and effectiveness. Patient perspectives on gamified app features indicated a potential to motivate positive health behaviours such as medication adherence along with critical themes of repetitiveness and irrelevance of certain features. The appraisal indicated a low risk of bias in most studies whilst concerns were identified in potential confounding.
CONCLUSIONS
To effectively address medication adherence via gamified and incentivised mobile apps, an evidence-based co-design approach and agile methodology should be used. This review indicates some adoption of an agile approach in app development however patient involvement is lacking in earlier stages. Further research in a generalised cohort of patients living with chronic conditions would facilitate the identification of barriers and potential opportunities and justification for the use of gamification and financial incentives in mobile apps for medication adherence.
CLINICALTRIAL