Developing a Game (Inner Dragon) Within a Leading Smartphone App for Smoking Cessation: Design and Feasibility Evaluation Study (Preprint)

Abstract

BACKGROUND Several stand-alone smartphone apps have used serious games to provide an engaging approach to quitting smoking. To date, the uptake of these games has been modest, and the evidence base for their efficacy in promoting smoking cessation is still evolving. The feasibility of integrating a game into a popular smoking cessation app is unclear. OBJECTIVE The aim of this paper is to describe the design and iterative development of the Inner Dragon game within Smoke Free, a smartphone app with proven efficacy, and the results of a single-arm feasibility trial as part of a broader program that seeks to assess the effectiveness of the gamified app for smoking cessation. METHODS In Phase 1, the study team undertook an multi-step process to design and develop the game, including virtual focus group discussions with end users (N=15). In Phase 2, a single-arm study of Smoke Free users who were trying to quit (N=30) was conducted to assess the feasibility and acceptability of the integrated game and to establish the feasibility of the planned procedures for a randomized pilot trial. RESULTS Phase 1 led to the final design of Inner Dragon, informed by principles from psychology and behavioral economics and incorporating several game mechanics designed to increase user engagement and retention. Inner Dragon users maintain an evolving pet dragon that serves as a virtual avatar for the users’ progress in quitting. The Phase 2 study established the feasibility of the study methods. The mean number of app sessions completed per user was 13.8 (median 8.0, range 1.0 to 46.0), with a mean duration per session of 5.8 minutes (median 1.1, range 0.0 to 81.1). Three-quarters of participants entered the Inner Dragon game at least once, and had a mean of 2.2 ± 2.2 sessions of game use. Use of Inner Dragon was positively associated with total number of app sessions (correlation 0.57). The mean satisfaction score of participants who provided ratings (n=11) was 4.2 on a 5-point scale, although satisfaction ratings for Inner Dragon were only completed by 3 participants. CONCLUSIONS Evidence supported further development and evaluation of Inner Dragon as a beneficial feature of Smoke Free. The next step of this research is to conduct a randomized pilot trial to determine whether the gamified version of the app increases user engagement over a standard version of the app.