A Gamified Real-time Video Observed Therapies (GRVOTS) Mobile App via the Modified Nominal Group Technique: Development and Validation Study (Preprint)

Abstract

BACKGROUND The number of Tuberculosis (TB) patient increases everyday and according to a model projection by (Ismail N. et al.,2013), the observed and projected TB cases in Malaysia, will reach up to 300,000 cases in 2030. In Malaysia, Direct Observed Therapy Short Course (DOTS) has been implemented since 1994 however the treatment success rate still remains at, below the recommended WHO target of 90%. With the increasing trend of TB Defaulter in Malaysia despite DOTS implementation, exploring another method to improve TB treatment adherence is vital. Therefore, the use gamification- reality elements via Video Observed Therapy (VOTS) in the mobile apps is expected to induce motivation toward TB treatment adherence. OBJECTIVE This study aims to document the process of designing, developing, and validating the gamification-motivation-reality element in the GRVOTS mobile apps. METHODS According to the literature review, gamification elements can motivate TB patients. The modified nominal group technique (NGT) via expert panel of 14 people were used to validate the presence of gamification-motivation element inside the apps. The participants of the serial NGT session were divided into three main groups, including the IT expert team, the TB administrator team, and the on-site healthcare worker. They were asked to assess the gamification-motivation element in the apps based on the percentage value of agreement, where a value of more than 70% is interpreted as acceptable and confirming to the element's existence. RESULTS The GRVOTS mobile apps, that can be used by three different users — patients, supervisors, and administrators — was successfully developed. For the validation study purpose, this apps have also been verified as the gamification-motivation features inside it have been rated over 70% through the agreement results via the NGT study. For the gamification element, the fun received the lowest values maybe due to many factors including perception of fun vary by different personalities as well as the nature of serious game which do not prioritize the fun element. As for the motivation factors, the least voted element is relatedness which usually associated with feature of leader boards or chat which is not favoured in this apps as majority our tuberculosis patients refuse to disclose their condition and communicate with other patient due to the stigma associated with the tuberculosis itself. CONCLUSIONS It has been validated that the GRVOTS mobile apps contain a gamification-motivation element, which is intended to encourage medication adherence for DOTS amongst the TB patients

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“…This is the direction that can be considered. Indeed, the current application of gami cation primarily focuses on enhancing motivation for engagement in interventions or behavior change [51][52][53] , without considering how gami cation could serve other behavior change drivers, such as capability and opportunity. This oversight may lead to the inability to maximize its effectiveness [15] .…”