BACKGROUND
Amblyopia is the leading cause of visual impairment in children worldwide. The predominant clinical treatment, occlusion therapy, is marred by poor adherence, often attributed to the physical discomfort and social stigma associated with eye patching. Adjunct digital visual trainings have not consistently sustained patient engagement due to their repetitive nature, thereby compromising their efficacy.
OBJECTIVE
This study aimed to evaluate the effectiveness of a gamified mobile application designed to increase treatment adherence among children with amblyopia by making the therapeutic process more engaging and accessible within home settings.
METHODS
An exploratory study was conducted, commencing with qualitative interviews and questionnaires to explore the barriers to traditional treatment adherence. This formative research informed the development of a gamified mobile application, which was shaped by cognitive appraisal theory to address identified emotional and psychological needs, potentially impacting adherence. The subsequent quantitative phase utilized a randomized controlled trial involving 34 amblyopic children aged 7-10, recruited from a local primary school. These participants were randomly assigned to either the intervention group, which used a novel gamified mobile application developed by our team, or the control group, which utilized another commercially available mobile application. Both groups engaged with their respective applications in a home environment. The Morisky Medication Adherence Scale (MMAS-8) was adapted to measure treatment adherence.
RESULTS
Over the four-week trial, 34 children aged 7-10 with amblyopia were enrolled and randomized into two groups: intervention (n=18) and control (n=16). Children in both the intervention and control groups engaged daily for 20 minutes at home, using mobile applications designed for visual rehabilitation. The intervention group (n=18) achieved a significantly higher mean adherence rate (Mean = 6.56, SD = 1.06) on the Morisky Medication Adherence Scale (MMAS-8) compared to the control group (n=16, Mean = 5.01, SD = 1.22), with a P-value of 0.001. Thematic analysis of the design process revealed that integrating cognitive appraisal theory effectively enhanced emotional engagement and adherence.
CONCLUSIONS
The integration of cognitive appraisal theory into the design of a gamified mobile application for amblyopia treatment has shown to significantly improve adherence among children.
CLINICALTRIAL
ClinicalTrials.gov NCT06372548