Medication non-adherence refers to the failure to take medications reasonably and as closely as prescribed by health care providers [1]. In the United States (US), 50% of patients who use prescription medication to manage their chronic diseases are not adherent to their medication efforts [2, 3]. It is a prevalent healthcare problem with poor health outcomes and added healthcare costs. It is also well documented that medication non-adherence is associated with increased healthcare costs [2, 4].
Patient education is the most frequent medication adherence intervention type [5], where the focus is on educating patients on why and how to take the medication. For patient education, Patient Package Inserts (PPIs) play a key role in alerting patients on important drug information, including warnings, side effects, and drug interactions [6]. While patients claim to read PPIs, research shows that they are only taking a cursory glance at the information [7]. One likely explanation is that the format of PPIs places a lot more cognitive demands on the mental faculties of an average patient and lacks patient engagement [8]. Thus, patients are often unable to identify crucial warnings in PPI, a partial reason for the growing number of ADR (Adverse Drug Reactions)-related hospitalizations [9].
Mobile health (mHealth) apps may improve patient engagement with the medication information presented in PPIs. There is a growing body of evidence to support the use of mHealth apps in addressing behavioral interventions to significantly reduce medication non-adherence [10]. The literature suggests that interactive information presentation can improve a person’s ability to remember and recall information [11, 12]. In a recent study, Roosan et al. developed a mHealth prototype app to deliver medication information through interactive visualization [8]. The users from their study suggested a gamification-based approach to enhance their learning engagement.
Gamification is a relatively new trend in mHealth, although it has been widely adopted in domains such as education, industry training, and business [13]. In health care, gamification has mostly been studied in areas of chronic disease management, physical activities, nutrition, and mental health [13]. A recent study attempted to design a gamification app to improve medication adherence for people with epilepsy [14]. However, their study focused on motivating people with a specific disease to adhere to medication regimens. To the best of our knowledge, no study has applied gamification towards medication information education for a general population.
MedScrab[i], a gamified mHealth app, was designed to address this literature gap. It provides a fun and iterative process for users to learn about crucial medication information, shifting them from passive information recipients to active information seekers. The benefits of MedScrab can only be realized by its effective use, which requires the assessment of MedScrab quality as perceived by the users [15].
The goal of this study is to evaluate the usability of MedScrab. More specifically, the paper presents (1) the development of MedScrab, (2) a mixed-method approach for evaluating and improving the usability of MedScrab, and (3) the assessment of MedScrab usability using a modified mHealth App Usability Questionnaire (MAUQ). The contributions of our study are twofold. First, we adapt and validate the widely used MAUQ [16] for evaluating gamification-based mHealth apps. We demonstrate that MAUQ should be used with adaptation based on the app characteristics. Second, we present a mixed-method approach for studying usability. It can serve as a methodological guide for designing, evaluating, and improving mHealth apps.
[i] https://www.medscrab.com/