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Randomized Controlled Trial
. 2019 Jan 3;21(1):e11683.
doi: 10.2196/11683.

Use of In-Game Rewards to Motivate Daily Self-Report Compliance: Randomized Controlled Trial

Sara Taylor  1 , Craig Ferguson  1 , Fengjiao Peng  1 , Magdalena Schoeneich  2 , Rosalind W Picard  1
Affiliations
Randomized Controlled Trial

Use of In-Game Rewards to Motivate Daily Self-Report Compliance: Randomized Controlled Trial

Sara Taylor et al. J Med Internet Res. .

Abstract

Background: Encouraging individuals to report daily information such as unpleasant disease symptoms, daily activities and behaviors, or aspects of their physical and emotional state is difficult but necessary for many studies and clinical trials that rely on patient-reported data as primary outcomes. Use of paper diaries is the traditional method of completing daily diaries, but digital surveys are becoming the new standard because of their increased compliance; however, they still fall short of desired compliance levels.

Objective: Mobile games using in-game rewards offer the opportunity to increase compliance above the rates of digital diaries and paper diaries. We conducted a 5-week randomized control trial to compare the completion rates of a daily diary across 3 conditions: a paper-based participant-reported outcome diary (Paper PRO), an electronic-based participant-reported outcome diary (ePRO), and a novel ePRO diary with in-game rewards (Game-Motivated ePRO).

Methods: We developed a novel mobile game that is a combination of the idle and pet collection genres to reward individuals who complete a daily diary with an in-game reward. Overall, 197 individuals aged 6 to 24 years (male: 100 and female: 97) were enrolled in a 5-week study after being randomized into 1 of the 3 methods of daily diary completion. Moreover, 157 participants (male: 84 and female: 69) completed at least one diary and were subsequently included in analysis of compliance rates.

Results: We observed a significant difference (F2,124=6.341; P=.002) in compliance to filling out daily diaries, with the Game-Motivated ePRO group having the highest compliance (mean completion 86.4%, SD 19.6%), followed by the ePRO group (mean completion 77.7%, SD 24.1%), and finally, the Paper PRO group (mean completion 70.6%, SD 23.4%). The Game-Motivated ePRO (P=.002) significantly improved compliance rates above the Paper PRO. In addition, the Game-Motivated ePRO resulted in higher compliance rates than the rates of ePRO alone (P=.09). Equally important, even though we observed significant differences in completion of daily diaries between groups, we did not observe any statistically significant differences in association between the responses to a daily mood question and study group, the average diary completion time (P=.52), or the System Usability Scale score (P=.88).

Conclusions: The Game-Motivated ePRO system encouraged individuals to complete the daily diaries above the compliance rates of the Paper PRO and ePRO without altering the participants' responses.

Trial registration: ClinicalTrials.gov NCT03738254; http://clinicaltrials.gov/ct2/show/NCT03738254 (Archived by WebCite at http://www.webcitation.org/74T1p8u52).

Keywords: protocol compliance; recreational games; self-reports.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Screenshots of The Guardians while the player completes a daily diary. Players collect pets by filling out a daily diary. The pets are needed to complete quests and gather Light to awaken the guardian.
Figure 2
Figure 2
Screenshots of leveling menu and housing placement puzzle.
Figure 3
Figure 3
Flow of participants through the study. ePRO: electronic-based participant-reported outcome; PRO: participant-reported outcome.
Figure 4
Figure 4
Distribution of participants who filled out the prestudy survey by age and daily diary condition. ePRO: electronic-based participant-reported outcome; PRO: participant-reported outcome.
Figure 5
Figure 5
Game-motivated electronic participant-reported outcome participants’ engagement with various components of the game and the corresponding diary completion.
Figure 6
Figure 6
Average daily diary completion rate for each study arm. The error bars show the 95% CI and P values are from the Tukey posthoc test and are adjusted for multiple comparisons. ePRO: electronic-based participant-reported outcome; PRO: participant-reported outcome.
Figure 7
Figure 7
Kaplan-Meier curves of survival (ie, missing 3 or fewer diaries) for each study group. ePRO: electronic-based participant-reported outcome; PRO: participant-reported outcome.
Figure 8
Figure 8
Percentage of participants who completed at least 90% of the daily diaries (ie, 32 out of 35 diaries) in each study arm. The 95% CI and P values are shown. ePRO: electronic-based participant-reported outcome; PRO: participant-reported outcomes.
See this image and copyright information in PMC

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