Understanding patient perspectives on the use of gamification and incentives in mHealth applications to improve medication adherence: Qualitative Study (Preprint)

Abstract

Medication non-adherence remains a significant health and economic burden in many developed countries. Emerging smartphone interventions have started to utilize features such as gamification and financial incentives with varying degrees of effectiveness on medication adherence and health outcomes. A more consistent approach to applying these features, informed by patient perspectives, may result in more predictable and beneficial results from this type of intervention.

This qualitative study aims to identify patient perspectives on the use of gamification and financial incentives in mHealth apps for medication adherence, in Australian patients taking medication for chronic conditions.

A total of 19 participants were included in iterative semi-structured online focus groups conducted between May and December 2022. The facilitator used exploratory prompts relating to mHealth apps, gamification, and financial incentives, along with concepts raised from previous focus groups. Transcriptions were independently coded to develop a set of themes.

Three themes were identified: (1) purpose-driven design, (2) trust-based standards, and (3) personal choice. All participants acknowledged gamification and financial incentives as potentially effective features in mHealth apps for medication adherence. However, they also indicated that the effectiveness heavily depended on implementation and execution. Main concerns relating to gamification and financial incentives were perceived trivialization and potential for abuse, respectively.

The study’s findings provide a foundation for developers seeking to apply these novel features in an app intervention for a general cohort of patients. However, the study highlights the need for standards for mHealth apps for medication adherence, with particular attention to the use of gamification and financial incentives. Future research with patients and stakeholders across the mHealth app ecosystem should be explored to formalize and validate a set of standards or framework.