Epic Allies: A Gamified Mobile App to Improve Engagement in HIV Care and Antiretroviral Adherence among Young Men Who have Sex with Men

Hightow-Weidman, Lisa; Muessig, Kathryn E.; Egger, Joseph; Vecchio, Alyssa; Platt, Alyssa

doi:10.1007/s10461-021-03222-y

Cited by 19 publications

(13 citation statements)

References 40 publications

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“…In addition, a secondary reference search was performed, yielding 1 more relevant record. Consequently, a total of 26 articles were included in the qualitative analysis [ 13 24-48 undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined ]. Furthermore, of the 26 articles, 6 RCTs were chosen for the meta-analysis [ 24 29 30 32 33 39 ].…”

Section: Resultsmentioning

confidence: 99%

“…An overview of the different risks of bias in each study is presented in Tables S4-1 and S4-2 in Multimedia Appendix 3 [ 13 24 25 28-30 32-36 39 42 43 45 48 undefined undefined undefined undefined undefined undefined ]. The weighted Cohen κ coefficient was 0.88, suggesting good agreement between raters [ 53 ].…”

Section: Resultsmentioning

confidence: 99%

“…Authors of the initial publications were contacted when additional information was needed. Because of multiple classifications proposed for the term gamification, the components in each digital gamified intervention were analyzed through the lens of the Octalysis gamification framework [ 23 ], which comprises 8 core drives into which various gamification elements can be placed, namely, epic meaning and calling, development and accomplishment, empowerment creativity and feedback, ownership and possession, social influence and relatedness, scarcity and impatience, unpredictability and curiosity, and loss and avoidance (Table S3-2 in Multimedia Appendix 2 [ 13 24-48 undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined undefined ]). Laine et al [ 49 ] mapped their interview results from schoolchildren to the Octalysis framework to better establish a digital gamification-based intervention for promoting active school transport.…”

Section: Methodsmentioning

confidence: 99%

“…Unlike serious games, which refer to full-fledged video games for health purposes, gamification is relatively open to varying situational engagement models [ 12 ]. Previous studies have been widely conducted on the use of gamification as a means to increase the initiation of desired health behaviors [ 13 14 ]. Given its increasing use in public health, gamification might also be useful for interventions to promote HIV prevention and control services.…”

Section: Introductionmentioning

confidence: 99%

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mHealth-Based Gamification Interventions Among Men Who Have Sex With Men in the HIV Prevention and Care Continuum: Systematic Review and Meta-Analysis

Luo,

Zhang,

Wang

et al. 2024

JMIR Mhealth Uhealth

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Background In the past few years, a burgeoning interest has emerged in applying gamification to promote desired health behaviors. However, little is known about the effectiveness of such applications in the HIV prevention and care continuum among men who have sex with men (MSM). Objective This study aims to summarize and evaluate research on the effectiveness of gamification on the HIV prevention and care continuum, including HIV-testing promotion; condomless anal sex (CAS) reduction; and uptake of and adherence to pre-exposure prophylaxis (PrEP), postexposure prophylaxis (PEP), and antiretroviral therapy (ART). Methods We comprehensively searched PubMed, Embase, the Cochrane Library, Web of Science, Scopus, and the Journal of Medical Internet Research and its sister journals for studies published in English and Chinese from inception to January 2024. Eligible studies were included when they used gamified interventions with an active or inactive control group and assessed at least one of the following outcomes: HIV testing; CAS; and uptake of and adherence to PrEP, PEP, and ART. During the meta-analysis, a random-effects model was applied. Two reviewers independently assessed the quality and risk of bias of each included study. Results The systematic review identified 26 studies, including 10 randomized controlled trials (RCTs). The results indicated that gamified digital interventions had been applied to various HIV outcomes, such as HIV testing, CAS, PrEP uptake and adherence, PEP uptake, and ART adherence. Most of the studies were conducted in the United States (n=19, 73%). The most frequently used game component was gaining points, followed by challenges. The meta-analysis showed gamification interventions could reduce the number of CAS acts at the 3-month follow-up (n=2 RCTs; incidence rate ratio 0.62, 95% CI 0.44-0.88). The meta-analysis also suggested an effective but nonstatistically significant effect of PrEP adherence at the 3-month follow-up (n=3 RCTs; risk ratio 1.16, 95% CI 0.96-1.38) and 6-month follow-up (n=4 RCTs; risk ratio 1.28, 95% CI 0.89-1.84). Only 1 pilot RCT was designed to evaluate the effectiveness of a gamified app in promoting HIV testing and PrEP uptake. No RCT was conducted to evaluate the effect of the gamified digital intervention on PEP uptake and adherence, and ART initiation among MSM. Conclusions Our findings suggest the short-term effect of gamified digital interventions on lowering the number of CAS acts in MSM. Further well-powered studies are still needed to evaluate the effect of the gamified digital intervention on HIV testing, PrEP uptake, PEP initiation and adherence, and ART initiation in MSM.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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mHealth-Based Gamification Interventions Among Men Who Have Sex With Men in the HIV Prevention and Care Continuum: Systematic Review and Meta-Analysis

Luo,

Zhang,

Wang

et al. 2024

JMIR Mhealth Uhealth

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show abstract

“…A previous study found that a gamified mobile app could improve HIV knowledge and confidence in adherence to HIV medications among these individuals [ 11 ]. The positive effect of gamification was markedly higher in regular users [ 12 ]. With rewards like badges, credit points, and actual prizes, and social elements, such as leader boards, the elements in the gamified experience were not just acceptable to MSM, but could also motivate them to engage in promotional activities [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

User Experience and Usability of Neumorphism and Gamification User Interface Designs in an HIV Self-Test Referral Program for Men Who Have Sex With Men: Prospective Open-Label Parallel-Group Randomized Controlled Trial

Kwan¹,

Chan²,

Lee³

2022

JMIR Serious Games

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Background Digital interventions have been applied for promoting HIV prevention and care among men who have sex with men (MSM). As user interface (UI) design plays a role in determining usability and user experience (UX), the intervention outcome could be affected. Objective In this study, we hypothesized that 2 UI design styles, namely gamification and neumorphism, could impact usability and be differentially preferred by distinct groups of MSM. Methods A prospective parallel-group open-label randomized controlled trial was conducted in Hong Kong. Eligible participants were adult MSM recruited by the research team or referred by enrolled participants, who followed instructions for performing an HIV self-test and promoted its use within their social network. Participants were randomized in a 1:1 ratio into either a gamification or neumorphism arm, with primarily visual differences in the UI only. The primary outcome was usability measured by the System Usability Scale (SUS) between the 2 arms. Distinct characteristics of promoters in the 2 arms who gave an SUS score of 80 or above were identified. Results Of 463 MSM registered in the study, 232 and 231 were randomized to the gamification and neumorphism arms, respectively. Excluding those who did not request a self-test kit, data from 218 and 216 participants in the gamification and neumorphism arms, respectively, were analyzed (totally 434 participants). With a median SUS score of 80 overall, participants in the neumorphism arm gave a higher score (P<.001), with a higher proportion giving a promoter-level SUS score (P=.002). Promoters used social media for sex networking (P=.02), used pre-exposure prophylaxis in the preceding year (P=.006), had higher satisfaction in UI design (P<.001), and had made a self-test referral (P=.04). In general, higher usability was recorded among participants who were confident in performing the HIV self-test (P<.001), and this was associated with a promoter-level SUS score in both arms. While no other personal characteristics were associated with promoters in the neumorphism arm, those in the gamification arm had higher HIV-related knowledge (P=.01), preferred a specific partner body image type (P=.03), and progressed toward peer referral by completing online training (P=.04). Conclusions Both gamified and neumorphic UI designs were well-accepted by MSM. UX and satisfaction of UI were both crucial in influencing the willingness of MSM to promote the application by referring their peers in the community to participate. The simplistic visual design of neumorphism conferred a more general acceptance in the community, whereas gamification was preferred in certain MSM subcommunities. Appropriate UI/UX design should be considered when developing digital interventions targeting the MSM community. Trial Registration ClinicalTrials.gov NCT04379206; https://clinicaltrials.gov/ct2/show/NCT04379206

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Preferences for a Game-Based SMS Adherence Intervention Among Young People Living with HIV in Ghana: A Qualitative Study

et al. 2022

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Epic Allies: A Gamified Mobile App to Improve Engagement in HIV Care and Antiretroviral Adherence among Young Men Who have Sex with Men

Cited by 19 publications

References 40 publications

mHealth-Based Gamification Interventions Among Men Who Have Sex With Men in the HIV Prevention and Care Continuum: Systematic Review and Meta-Analysis

mHealth-Based Gamification Interventions Among Men Who Have Sex With Men in the HIV Prevention and Care Continuum: Systematic Review and Meta-Analysis

User Experience and Usability of Neumorphism and Gamification User Interface Designs in an HIV Self-Test Referral Program for Men Who Have Sex With Men: Prospective Open-Label Parallel-Group Randomized Controlled Trial

Preferences for a Game-Based SMS Adherence Intervention Among Young People Living with HIV in Ghana: A Qualitative Study

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