Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov 1:17:2719-2736.
doi: 10.2147/PPA.S423161. eCollection 2023.

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

Charlotte C Poot  1   2 , Jasmijn de Boer  3 , Lyè Goto  3 , Susanne J van de Hei  4   5 , Niels H Chavannes  1   2 , Valentijn T Visch  3 , Eline Meijer  1   2
Affiliations

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

Charlotte C Poot et al. Patient Prefer Adherence. .

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.

PubMed Disclaimer

Conflict of interest statement

All authors declare no competing interests in this work.

Figures

Figure 1
Figure 1
Schematic overview study design and design phases.
Figure 2
Figure 2
Visual representation of the core elements of the persuasive game “Ademgenoot”.
Figure 3
Figure 3
Paper prototype testing of the serious game Ademgenoot with a participant.
See this image and copyright information in PMC

References

    1. Price D, Fletcher M, van der Molen T. Asthma control and management in 8000 European patients: the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey. NPJ Prim Care Respir Med. 2014;24:14009. doi: 10.1038/npjpcrm.2014.9 - DOI - PMC - PubMed
    1. Van Boven J, Lavorini F, Richard Dekhuijzen N. Urging Europe to put non-adherence to inhaled respiratory medication higher on the policy agenda: a report from the First European Congress on Adherence to Therapy. Eur Respir J. 2017;49:1700076. - PubMed
    1. Engelkes M, Janssens HM, de Jongste JC, Sturkenboom MC, Verhamme KM. Medication adherence and the risk of severe asthma exacerbations: a systematic review. Eur Respir J. 2015;45(2):396–407. doi: 10.1183/09031936.00075614 - DOI - PubMed
    1. Williams LK, Peterson EL, Wells K, et al. Quantifying the proportion of severe asthma exacerbations attributable to inhaled corticosteroid nonadherence. J Allergy Clin Immunol. 2011;128(6):1185–1191.e2. doi: 10.1016/j.jaci.2011.09.011 - DOI - PMC - PubMed
    1. Ebmeier S, Thayabaran D, Braithwaite I, Bénamara C, Weatherall M, Beasley R. Trends in international asthma mortality: analysis of data from the WHO Mortality Database from 46 countries (1993–2012). Lancet. 2017;390(10098):935–945. - PubMed