The Design of a Persuasive Game to Motivate People with Asthma in Adherence to Their Maintenance Medication

Charlotte C Poot; Jasmijn de Boer; Lyè Goto; Susanne J van de Hei; Niels H Chavannes; Valentijn T Visch; Eline Meijer

doi:10.2147/PPA.S423161

The Design of a Persuasive Game to Motivate People with Asthma in Adherence to Their Maintenance Medication

Patient Prefer Adherence. 2023 Nov 1:17:2719-2736. doi: 10.2147/PPA.S423161. eCollection 2023.

Authors

Charlotte C Poot^{1

2}, Jasmijn de Boer³, Lyè Goto³, Susanne J van de Hei^{4

5}, Niels H Chavannes^{1

2}, Valentijn T Visch³, Eline Meijer^{1

2}

Affiliations

¹ Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.
² National eHealth Living Lab (NeLL), Leiden University Medical Centre, Leiden, The Netherlands.
³ Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands.
⁴ Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁵ General Practitioners Research Institute, Groningen, The Netherlands.

Abstract

Objective: This study aimed to design a persuasive game, using objective adherence data, to motivate people with asthma to adhere to their medication regimen.

Methods: A participatory user-centered design approach was employed, involving end-users and other stakeholders throughout the study. The approach consisted of four phases. Semi-structured interviews and a survey were conducted to understand user needs and reasons for poor adherence (Phase 1: define). Key themes were identified, leading to the formulation of behavior change strategies and design and game requirements. Several design directions were ideated, resulting in a concept for a serious game (Phase 2: ideate). Two rounds of user-tests were performed to evaluate a prototype of the serious game in terms of usability, perceived impact on medication adherence and motivation (Phase 3: prototype and Phase 4: evaluate).

Results: Findings from semi-structured interviews (n = 6) and the online survey (n = 20) revealed that people's non-adherence was often attributed to the perception of asthma as an episodic condition, the delayed experienced effect of maintenance inhalers, and lack of knowledge regarding difference of effect between maintenance and reliever inhalers. The study used behavior change strategies to translate these insights into design requirements for the development of the narrative-based persuasive game Ademgenoot. This six-week challenge-based game combines various behavior change strategies, including personal goal setting and continuous visual feedback, as well as persuasive game design elements, such as a narrative and rewards, with the aim of enhancing motivation to adhere to their medication regimen. User-testing (n = 8; round 1 and 2) showed that Ademgenoot is feasible in clinical practice and has the potential to support people with mild asthma in adherence to their maintenance medication.

Discussion: Future efforts should be directed towards a larger evaluation to assess the impact on motivation and inhaler use behaviour.

Keywords: adherence monitoring; behavior change; medication adherence; participatory design; serious game design.

Grants and funding

The study is funded by AstraZeneca following a research collaboration agreement. The funding body was not involved in designing the study, data collection, study management nor the analysis and interpretation of data and writing the manuscript. AstraZeneca was provided the opportunity to review the manuscript and full editorial control remained with the authors.