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Published in: BMC Public Health 1/2024

Open Access 01-12-2024 | Tuberculosis | Research

Enhancing tuberculosis treatment adherence and motivation through gamified real-time mobile app utilization: a single-arm intervention study

Authors: Siti Aishah Abas, Nurhuda Ismail, Yuslina Zakaria, Siti Munira Yasin, Khalid Ibrahim, Ismassabah Ismail, Asmah Razali, Mas Ahmad Sherzkawi, Norliza Ahmad

Published in: BMC Public Health | Issue 1/2024

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Abstract

Background

Finding innovative methods to enhance Tuberculosis treatment adherence in Malaysia is imperative, given the rising trend of non-adhere TB patients. Direct Observed Therapy (DOTS) has been used to ensure Tuberculosis (TB) drug compliance worldwide. However, due to its inconvenience, digitalizing this system into a virtual monitoring system via a mobile app can help deliver a more efficient tuberculosis management system. A gamified video-observed therapy is developed that connects three users the patient, supervisor, and administrator, allowing drug monitoring and patient loss to follow up with the patient tracking system. Thus, the objective of this study is to determine the impact of Gamified Real-time Video Observed Therapy (GRVOTS) mobile apps on patient medication adherence rates and motivation.

Methods

71 patients from 18 facilities participated in the 8-week single-arm intervention study. GRVOTS mobile apps were installed in their mobile apps, and patients were expected to fulfill tasks such as providing Video Direct Observe Therapy (VDOTS) daily as well as side effect reporting. At 3-time intervals of baseline,1-month, and 2-month intervals, the number of VDOT taken, the Malaysian Medication Adherence Assessment Tool (MyMAAT), and the Intrinsic Motivation Inventory (IMI) questionnaire were collected. One-sample t-test was conducted comparing the VDOT video adherence to the standard rate of 80%. RM ANOVA was used to analyze any significant differences in MyMAAT and IMI scores across three-time intervals.

Results

This study involved 71 numbers of patients from 18 healthcare facilities who showed a significantly higher treatment adherence score of 90.87% than a standard score of 80% with a mean difference of 10.87(95% CI: 7.29,14.46; p < 0.001). The participants’ MyMAAT and IMI scores significantly increased over 3-time intervals with the IMI Interest domain showing the highest mean difference 19.76 (95% CI: 16.37, 21.152: p < 0.001).

Conclusions

By utilizing GRVOTS, a mobile application based on gamification and real-time features, we can enhance motivation and medication adherence among TB patients, while also addressing the limitations of physical DOTS.

Trial registration

IRCT20230308057657N1, Registered on (15/03/23).
Literature
1.
go back to reference WHO. GLOBAL TUBERCULOSIS REPORT 2020. 2020. WHO. GLOBAL TUBERCULOSIS REPORT 2020. 2020.
2.
go back to reference Ismail N. Mathematical modelling of Tuberculosis transmission and impact of isoniazid preventive therapy in Malaysia. /Nurhuda Ismail: University of Malaya; 2017. Ismail N. Mathematical modelling of Tuberculosis transmission and impact of isoniazid preventive therapy in Malaysia. /Nurhuda Ismail: University of Malaya; 2017.
3.
go back to reference Tok PSK, Liew SM, Wong LP, Razali A, Loganathan T, Chinna K, et al. Determinants of unsuccessful treatment outcomes and mortality among Tuberculosis patients in Malaysia: a registry-based cohort study. PLoS ONE. 2020;15(4):e0231986.CrossRefPubMedPubMedCentral Tok PSK, Liew SM, Wong LP, Razali A, Loganathan T, Chinna K, et al. Determinants of unsuccessful treatment outcomes and mortality among Tuberculosis patients in Malaysia: a registry-based cohort study. PLoS ONE. 2020;15(4):e0231986.CrossRefPubMedPubMedCentral
4.
go back to reference Mehraeen E, Reza Safdari, Alinaghi SAS, Zahed NM, Arji G. Identifying and Validating Requirements of a Mobile-Based Self-Management System for People Living ith HIV. 2018. Mehraeen E, Reza Safdari, Alinaghi SAS, Zahed NM, Arji G. Identifying and Validating Requirements of a Mobile-Based Self-Management System for People Living ith HIV. 2018.
5.
go back to reference Mehraeen E, Noori T, Nazeri Z, Heydari M, Mehranfar A, Moghaddam HR et al. Identifying features of a mobile-based application for self-care of people living with T2DM. Diabetes Res Clin Pract. 2021;171. Mehraeen E, Noori T, Nazeri Z, Heydari M, Mehranfar A, Moghaddam HR et al. Identifying features of a mobile-based application for self-care of people living with T2DM. Diabetes Res Clin Pract. 2021;171.
6.
go back to reference Mehraeen E, Safdari R, SeyedAlinaghi S, Noori T, Kahouei M, Soltani-Kermanshahi M. A mobile-based self-management application- usability evaluation from the perspective of HIV-positive people. Health Policy and Technology. 2020;9(3):294–301.CrossRef Mehraeen E, Safdari R, SeyedAlinaghi S, Noori T, Kahouei M, Soltani-Kermanshahi M. A mobile-based self-management application- usability evaluation from the perspective of HIV-positive people. Health Policy and Technology. 2020;9(3):294–301.CrossRef
7.
go back to reference WHO. Handbook for the use of Digital technologies to Support Tuberculosis Medication Adherence. 2017. WHO. Handbook for the use of Digital technologies to Support Tuberculosis Medication Adherence. 2017.
8.
go back to reference Yejin Lee MCR, Antoine Flahault. The Use of Digital Technology to Enhance Tuberculosis Control: Scoping Review. 2019. Yejin Lee MCR, Antoine Flahault. The Use of Digital Technology to Enhance Tuberculosis Control: Scoping Review. 2019.
9.
go back to reference Sarah Iribarren R, PhDa, Rebecca Schnall, RN, MPH, PhDa. Call for Increased Patient Support Focus- Review and Evaluation. 2016. Sarah Iribarren R, PhDa, Rebecca Schnall, RN, MPH, PhDa. Call for Increased Patient Support Focus- Review and Evaluation. 2016.
10.
go back to reference Abdul Rahim MI, Thomas RH. Gamification of Medication Adherence in Epilepsy. Seizure.2017;52:11– 4. Abdul Rahim MI, Thomas RH. Gamification of Medication Adherence in Epilepsy. Seizure.2017;52:11– 4.
11.
go back to reference Alsawaier RS. The effect of gamification on motivation and engagement. The International Journal of Information and Learning Technology. 2018;35(1):56–79. Alsawaier RS. The effect of gamification on motivation and engagement. The International Journal of Information and Learning Technology. 2018;35(1):56–79.
12.
go back to reference Treiblmaier H, Putz L-M. Gamification as a moderator for the impact of intrinsic motivation: Findings from a multigroup field experiment. Learning and Motivation.2020;71. Treiblmaier H, Putz L-M. Gamification as a moderator for the impact of intrinsic motivation: Findings from a multigroup field experiment. Learning and Motivation.2020;71.
13.
go back to reference Abas SA, Ismail N, Zakaria Y, Ismail I, Mat Zain NH, Yasin SM, et al. A Gamified Real-time Video Observed Therapies (GRVOTS) Mobile App via the Modified Nominal Group Technique: Development and Validation Study. JMIR Serious Games. 2023;11:e43047. Abas SA, Ismail N, Zakaria Y, Ismail I, Mat Zain NH, Yasin SM, et al. A Gamified Real-time Video Observed Therapies (GRVOTS) Mobile App via the Modified Nominal Group Technique: Development and Validation Study. JMIR Serious Games. 2023;11:e43047.
14.
go back to reference Holzman SB, Atre S, Sahasrabudhe T, Ambike S, Jagtap D, Sayyad Y, et al. Use of Smartphone-Based Video Directly Observed Therapy (vDOT) in Tuberculosis Care: Single-Arm,Prospective Feasibility Study. JMIR Form Res. 2019;3(3):e13411. Holzman SB, Atre S, Sahasrabudhe T, Ambike S, Jagtap D, Sayyad Y, et al. Use of Smartphone-Based Video Directly Observed Therapy (vDOT) in Tuberculosis Care: Single-Arm,Prospective Feasibility Study. JMIR Form Res. 2019;3(3):e13411.
15.
go back to reference Rowland AA, Knekta E, Eddy S, Corwin LA. Defining and Measuring Students’ Interest in Biology: An Analysis of the Biology Education Literature. CBE Life Sci Educ. 2019;18(3):ar34. Rowland AA, Knekta E, Eddy S, Corwin LA. Defining and Measuring Students’ Interest in Biology: An Analysis of the Biology Education Literature. CBE Life Sci Educ. 2019;18(3):ar34.
16.
go back to reference Sharani ZZ, Ismail N, Yasin SM, Zakaria Y, Razali A, Demong NAR, et al. Characteristics and determinants of loss to follow-up among tuberculosis (TB) patients who smoke in an industrial state of Malaysia: a registry-based study of the years 2013–2017. BMC Public Health. 2022;22(1):638. Sharani ZZ, Ismail N, Yasin SM, Zakaria Y, Razali A, Demong NAR, et al. Characteristics and determinants of loss to follow-up among tuberculosis (TB) patients who smoke in an industrial state of Malaysia: a registry-based study of the years 2013–2017. BMC Public Health. 2022;22(1):638.
17.
go back to reference Story A, Aldridge RW, Smith CM, Garber E, Hall J, Ferenando G, et al. Smartphone-enabled video-observed versus directly observed treatment for tuberculosis: a multicentre,analyst-blinded, randomised, controlled superiority trial. Lancet. 2019;393(10177):1216-24. Story A, Aldridge RW, Smith CM, Garber E, Hall J, Ferenando G, et al. Smartphone-enabled video-observed versus directly observed treatment for tuberculosis: a multicentre,analyst-blinded, randomised, controlled superiority trial. Lancet. 2019;393(10177):1216-24.
18.
go back to reference Kuo M-S, Chuang T-Y. How gamification motivates visits and engagement for online academic dissemination– An empirical study. Computers in Human Behavior. 2016;55:16–27. Kuo M-S, Chuang T-Y. How gamification motivates visits and engagement for online academic dissemination– An empirical study. Computers in Human Behavior. 2016;55:16–27.
19.
go back to reference Kai Huotari JH. Defining Gamification - A Service Marketing Perspective. 2012. Kai Huotari JH. Defining Gamification - A Service Marketing Perspective. 2012.
20.
go back to reference Koivisto J, Hamari J. Demographic differences in perceived benefits from gamification.Computers in Human Behavior. 2014;35:179– 88. Koivisto J, Hamari J. Demographic differences in perceived benefits from gamification.Computers in Human Behavior. 2014;35:179– 88.
21.
go back to reference Foong Li Law ZMK, Chun Kiat Gan. Gamification towards Sustainable Mobile Application.2011. Foong Li Law ZMK, Chun Kiat Gan. Gamification towards Sustainable Mobile Application.2011.
22.
go back to reference Sarkar U, Gourley GI, Lyles CR, Tieu L, Clarity C, Newmark L, et al. Usability of Commercially Available Mobile Applications for Diverse Patients. J Gen Intern Med.2016;31(12):1417-26. Sarkar U, Gourley GI, Lyles CR, Tieu L, Clarity C, Newmark L, et al. Usability of Commercially Available Mobile Applications for Diverse Patients. J Gen Intern Med.2016;31(12):1417-26.
23.
go back to reference Nahid P, Dorman SE, Alipanah N, Barry PM, Brozek JL, Cattamanchi A, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis.Clin Infect Dis. 2016;63(7):e147-e95. Nahid P, Dorman SE, Alipanah N, Barry PM, Brozek JL, Cattamanchi A, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis.Clin Infect Dis. 2016;63(7):e147-e95.
24.
go back to reference Ravenscroft L, Kettle S, Persian R, Ruda S, Severin L, Doltu S, et al. Video-observed therapy and medication adherence for tuberculosis patients: randomised controlled trial in Moldova. Eur Respir J. 2020;56(2). Ravenscroft L, Kettle S, Persian R, Ruda S, Severin L, Doltu S, et al. Video-observed therapy and medication adherence for tuberculosis patients: randomised controlled trial in Moldova. Eur Respir J. 2020;56(2).
25.
go back to reference James DeMaio LS, Peggy Cooley,Alan Tice. The Application of Telemedicine Technology to a Directly Observed Therapy Program for Tuberculosis: A Pilot Project. 2014. James DeMaio LS, Peggy Cooley,Alan Tice. The Application of Telemedicine Technology to a Directly Observed Therapy Program for Tuberculosis: A Pilot Project. 2014.
26.
go back to reference Lam CK, McGinnis Pilote K, Haque A, Burzynski J, Chuck C, Macaraig M. Using Video Technology to Increase Treatment Completion for Patients With Latent Tuberculosis Infection on 3-Month Isoniazid and Rifapentine: An Implementation Study. J Med Internet Res. 2018;20(11):e287. Lam CK, McGinnis Pilote K, Haque A, Burzynski J, Chuck C, Macaraig M. Using Video Technology to Increase Treatment Completion for Patients With Latent Tuberculosis Infection on 3-Month Isoniazid and Rifapentine: An Implementation Study. J Med Internet Res. 2018;20(11):e287.
27.
go back to reference Chuck C, Robinson E, Macaraig M, Alexander M, Burzynski J. Enhancing management of tuberculosis treatment with video directly observed therapy in New York City. Int J Tuberc Lung Dis. 2016;20(5):588– 93. Chuck C, Robinson E, Macaraig M, Alexander M, Burzynski J. Enhancing management of tuberculosis treatment with video directly observed therapy in New York City. Int J Tuberc Lung Dis. 2016;20(5):588– 93.
28.
go back to reference Garfein RS, Liu L, Cuevas-Mota J, Collins K, Munoz F, Catanzaro DG, et al. Tuberculosis Treatment Monitoring by Video Directly Observed Therapy in 5 Health Districts, California,USA. Emerg Infect Dis. 2018;24(10):1806-15. Garfein RS, Liu L, Cuevas-Mota J, Collins K, Munoz F, Catanzaro DG, et al. Tuberculosis Treatment Monitoring by Video Directly Observed Therapy in 5 Health Districts, California,USA. Emerg Infect Dis. 2018;24(10):1806-15.
29.
go back to reference Hoffman JA, Cunningham JR, Suleh AJ, Sundsmo A, Dekker D, Vago F, et al. Mobile direct observation treatment for tuberculosis patients: a technical feasibility pilot using mobile phones in Nairobi, Kenya. Am J Prev Med. 2010;39(1):78–80. Hoffman JA, Cunningham JR, Suleh AJ, Sundsmo A, Dekker D, Vago F, et al. Mobile direct observation treatment for tuberculosis patients: a technical feasibility pilot using mobile phones in Nairobi, Kenya. Am J Prev Med. 2010;39(1):78–80.
30.
go back to reference Nguyen TA, Pham MT, Nguyen TL, Nguyen VN, Pham DC, Nguyen BH, et al. Video Directly Observed Therapy to support adherence with treatment for tuberculosis in Vietnam:A prospective cohort study. Int J Infect Dis. 2017;65:85– 9. Nguyen TA, Pham MT, Nguyen TL, Nguyen VN, Pham DC, Nguyen BH, et al. Video Directly Observed Therapy to support adherence with treatment for tuberculosis in Vietnam:A prospective cohort study. Int J Infect Dis. 2017;65:85– 9.
31.
go back to reference Sekandi JN, Kasiita V, Onuoha NA, Zalwango S, Nakkonde D, Kaawa-Mafigiri D, et al. Stakeholders’ Perceptions of Benefits of and Barriers to Using Video-Observed Treatment for Monitoring Patients With Tuberculosis in Uganda: Exploratory Qualitative Study. JMIR Mhealth Uhealth. 2021;9(10):e27131. Sekandi JN, Kasiita V, Onuoha NA, Zalwango S, Nakkonde D, Kaawa-Mafigiri D, et al. Stakeholders’ Perceptions of Benefits of and Barriers to Using Video-Observed Treatment for Monitoring Patients With Tuberculosis in Uganda: Exploratory Qualitative Study. JMIR Mhealth Uhealth. 2021;9(10):e27131.
32.
go back to reference MOH. The National Strategic Plan for TB Control (2016–2020). 2016. MOH. The National Strategic Plan for TB Control (2016–2020). 2016.
33.
go back to reference Wiecek E, Torres-Robles A, Cutler RL, Benrimoj SI, Garcia-Cardenas V. Impact of a Multicomponent Digital Therapeutic Mobile App on Medication Adherence in Patients with Chronic Conditions: Retrospective Analysis. J Med Internet Res. 2020;22(8):e17834. Wiecek E, Torres-Robles A, Cutler RL, Benrimoj SI, Garcia-Cardenas V. Impact of a Multicomponent Digital Therapeutic Mobile App on Medication Adherence in Patients with Chronic Conditions: Retrospective Analysis. J Med Internet Res. 2020;22(8):e17834.
34.
go back to reference Tran S, Smith L, El-Den S, Carter S. The Use of Gamification and Incentives in Mobile Health Apps to Improve Medication Adherence: Scoping Review. JMIR Mhealth Uhealth.2022;10(2):e30671. Tran S, Smith L, El-Den S, Carter S. The Use of Gamification and Incentives in Mobile Health Apps to Improve Medication Adherence: Scoping Review. JMIR Mhealth Uhealth.2022;10(2):e30671.
35.
go back to reference Badawy SM, Shah R, Beg U, Heneghan MB. Habit Strength, Medication Adherence, and Habit-Based Mobile Health Interventions Across Chronic Medical Conditions: Systematic Review. J Med Internet Res. 2020;22(4):e17883. Badawy SM, Shah R, Beg U, Heneghan MB. Habit Strength, Medication Adherence, and Habit-Based Mobile Health Interventions Across Chronic Medical Conditions: Systematic Review. J Med Internet Res. 2020;22(4):e17883.
36.
go back to reference Lucas M. Jeno G, JA, Vandvik, V. The effect of a mobile-application tool on intrinsic motivation,perceived competence and achievement. 2016. Lucas M. Jeno G, JA, Vandvik, V. The effect of a mobile-application tool on intrinsic motivation,perceived competence and achievement. 2016.
37.
go back to reference Florian Brühlmann. Gamification From the Perspective of Self-Determination Theory and Flow. 2013. Florian Brühlmann. Gamification From the Perspective of Self-Determination Theory and Flow. 2013.
38.
go back to reference Bitrián P, Buil I, Catalán S. Enhancing user engagement: The role of gamification in mobile apps. Journal of Business Research. 2021;132:170– 85. Bitrián P, Buil I, Catalán S. Enhancing user engagement: The role of gamification in mobile apps. Journal of Business Research. 2021;132:170– 85.
39.
go back to reference Fan J, Wang Z. The impact of gamified interaction on mobile learning APP users’learning performance: the moderating effect of users’ learning style. Behaviour &Information Technology. 2020:1–14. Fan J, Wang Z. The impact of gamified interaction on mobile learning APP users’learning performance: the moderating effect of users’ learning style. Behaviour &Information Technology. 2020:1–14.
40.
go back to reference Wood LC, Reiners T. Gamification. Encyclopedia of Information Science and Technology,Third Edition. Advances in Information Quality and Management2014. p. 3039-47. Wood LC, Reiners T. Gamification. Encyclopedia of Information Science and Technology,Third Edition. Advances in Information Quality and Management2014. p. 3039-47.
41.
go back to reference Burgers C, Eden A, van Engelenburg MD, Buningh S. How feedback boosts motivation and play in a brain-training game. Computers in Human Behavior. 2015;48:94–103. Burgers C, Eden A, van Engelenburg MD, Buningh S. How feedback boosts motivation and play in a brain-training game. Computers in Human Behavior. 2015;48:94–103.
42.
go back to reference Choi KH, Saperstein AM, Medalia A. The relationship of trait to state motivation:the role of self-competency beliefs. Schizophr Res. 2012;139(1–3):73– 7. Choi KH, Saperstein AM, Medalia A. The relationship of trait to state motivation:the role of self-competency beliefs. Schizophr Res. 2012;139(1–3):73– 7.
43.
go back to reference Josef Buchner JZ. Promoting intrinsic motivation with a mobile augmented reality learning environment. 2018. Josef Buchner JZ. Promoting intrinsic motivation with a mobile augmented reality learning environment. 2018.
44.
go back to reference Orsini C, Evans P, Jerez O. How to encourage intrinsic motivation in the clinical teaching environment?: a systematic review from the self-determination theory. J Educ Eval Health Prof. 2015;12:8. Orsini C, Evans P, Jerez O. How to encourage intrinsic motivation in the clinical teaching environment?: a systematic review from the self-determination theory. J Educ Eval Health Prof. 2015;12:8.
45.
go back to reference Tola HH, Shojaeizadeh D, Tol A, Garmaroudi G, Yekaninejad MS, Kebede A, et al.Psychological and Educational Intervention to Improve Tuberculosis Treatment Adherence in Ethiopia Based on Health Belief Model: A Cluster Randomized Control Trial. PLoS One. 2016;11(5):e0155147. Tola HH, Shojaeizadeh D, Tol A, Garmaroudi G, Yekaninejad MS, Kebede A, et al.Psychological and Educational Intervention to Improve Tuberculosis Treatment Adherence in Ethiopia Based on Health Belief Model: A Cluster Randomized Control Trial. PLoS One. 2016;11(5):e0155147.
46.
go back to reference Lee S, Khan OF, Seo JH, Kim DY, Park KH, Jung SI, et al. Impact of Physician’s Education on Adherence to Tuberculosis Treatment for Patients of Low Socioeconomic Status in Bangladesh. Chonnam Med J. 2013;49(1):27–30. Lee S, Khan OF, Seo JH, Kim DY, Park KH, Jung SI, et al. Impact of Physician’s Education on Adherence to Tuberculosis Treatment for Patients of Low Socioeconomic Status in Bangladesh. Chonnam Med J. 2013;49(1):27–30.
47.
go back to reference Chen SH, Wang I, Hsu HL, Huang CC, Liu YJ, Putri DU, et al. Advantage in privacy protection by using synchronous video observed treatment enhances treatment adherence among patients with latent tuberculosis infection. J Infect Public Health. 2020;13(9):1354-9. Chen SH, Wang I, Hsu HL, Huang CC, Liu YJ, Putri DU, et al. Advantage in privacy protection by using synchronous video observed treatment enhances treatment adherence among patients with latent tuberculosis infection. J Infect Public Health. 2020;13(9):1354-9.
48.
go back to reference Holzman SB, Zenilman A, Shah M. Advancing Patient-Centered Care in Tuberculosis Management: A Mixed-Methods Appraisal of Video Directly Observed Therapy. Open Forum Infect Dis. 2018;5(4):ofy046. Holzman SB, Zenilman A, Shah M. Advancing Patient-Centered Care in Tuberculosis Management: A Mixed-Methods Appraisal of Video Directly Observed Therapy. Open Forum Infect Dis. 2018;5(4):ofy046.
Metadata
Title
Enhancing tuberculosis treatment adherence and motivation through gamified real-time mobile app utilization: a single-arm intervention study
Authors
Siti Aishah Abas
Nurhuda Ismail
Yuslina Zakaria
Siti Munira Yasin
Khalid Ibrahim
Ismassabah Ismail
Asmah Razali
Mas Ahmad Sherzkawi
Norliza Ahmad
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-023-17561-z

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