Multiplatform web app (My Way Up) plus motivational interviewing for improving treatment retention in patients with onset of alcohol-related liver disease and alcohol use disorder - an example of participatory research

Abstract

Background: With the aim of improving treatment retention in patients with the onset of alcohol-related liver disease (ArLD), we designed a blended intervention (brief motivational intervention + 'serious game' (SG)). We present the participatory design methodology and outcomes and the usability assessment of the intervention.

Methods: (1) The design of the SG was based on the outcomes of two 3-h co-creation sessions with 37 participants (healthcare and technology professionals, patients, and patients' relatives). The brief face-to-face motivational intervention was based on the 5 As Model and adapted to the ArLD population. (2) Usability pilot study: 20 participants (10 ArLD patients + 10 healthcare professionals) received the intervention. System Usability Scale (SUS) and Post-Study System Usability Questionnaire (PSSUQ) were applied to assess the SG usability and patients' satisfaction with it. Weekly semi-structured interviews on the phone were conducted to identify the preferred elements in the SG and those aspects that should be improved.

Results: (1) Design: an SG in the form of a gamified web app, consisting of a daily activity for six weeks and adapted brief motivational interviewing. (2) Usability pilot study: usability results were excellent for both patients and healthcare professionals (SUS median score = 85). The general usability, the quality of the information provided by the SG and the quality of the interface were very positively rated in the PSSUQ (overall median score = 2, IQR = 1-2). The best-rated aspects were the provision of feedback, the use of metaphors and the application of audiovisual material. Changes in the design, response mechanics and content were applied after the study.

Conclusions: The usability and acceptability of an intervention for increasing retention to treatment in patients with recent onset of ArLD and AUD were excellent for patients and healthcare professionals. A randomized-controlled trial is required to test the efficacy of this approach.

Keywords: Digital health; MI; adherence; alcohol liver disease; alcohol use disorder; retention to treatment; serious games.

Figure 1.

Screenshots from the ‘My Way Up’ serious game. At the top, from left to right: layout of the six weeks; activity consisting of a crossword; points and medal received after completing the seven activities of the week. At the bottom, from left to right: positive reinforcement message after successfully completing the activity. At the bottom of the screen, the compass drawing signalling the easter egg is visible; the activity consisting of ranking how true each statement is for the patient; log-in screen and logo.