Auditory Training, Gamification and mHealth for Children with Cochlear Implants and Hearing Aids: Systematic Review of the App Store (Preprint)

BACKGROUND Gamification in mHealth may be especially useful for engaging children who use hearing devices in interventions, however it is not known if gamification impacts app quality in this field OBJECTIVE The present study aimed to evaluate app quality and the impact of gamification on currently available free to download apps that utilised auditory training to improve speech perception outcomes for children with hearing aids and/or cochlear implants. METHODS A systematic review of the iOS and Android app store was conducted. Two raters assessed the apps using the user version of the Mobile App Rating Scale (uMARS; Stoyanov et al., 2015) to obtain an overall score of App Quality, and on subscales of Functionality, Information, Aesthetics, and Engagement. RESULTS There were 2431 auditory training apps identified and 38 apps met inclusion criteria. Fifty-five percent of apps included gamification; the most prevalent gamification element was achieving higher ‘levels’. Fifty percent of apps rated as poor quality. Functionality was the highest scoring subscale and Information was rated lowest. Mann-Whitney testing found that apps with gamification rated higher (Mdn = 3.30) on Engagement compared to apps with no gamification (Mdn = 2.80) (p = 0.01). CONCLUSIONS Study findings highlighted the need for clinicians to carefully evaluate apps before recommending them to parents or utilising them in clinical scenarios as many are of poor quality. Results suggested that inclusion of gamification elements was associated with Engagement, with no relationship found between gamification and Functionality. Future studies may consider conducting a user-based study to examine the effect of gamification on intervention efficacy.