Gamification to improve medication adherence: a mixed-method usability study for MedScrab

Abstract MedScrab, a gamification-based mHealth app, is a first attempt to deliver crucial life-saving medication information to patients and increase their medication adherence. The paper presents the development of MedScrab and a two-phase mixed-method usability evaluation of MedScrab. Phase I qualitatively evaluated MedScrab using a think-aloud protocol for its usability. With 51 participants, qualitative data analysis of Phase I revealed two themes: positive functionality of the app and four areas of improvement. The improvement recommendations were incorporated into MedScrab’s design. Phase I also validated a widely used mHealth App Usability Questionnaire (MAUQ). Quantitative data analysis of Phase I reduced the original 18-item MAUQ scale to a 15-item scale with two factors: ease of use (4 items) and usefulness and satisfaction (11 items). Phase II surveyed 83 participants from mTurk using a modified MAUQ. The modified MAUQ scale showed strong internal consistency and high loadings. Data analysis results showed that MedScrab was perceived as ease of use (6.24 out of 7) with high usefulness and satisfaction (5.72 out of 7). The results support the use of the modified MAUQ as a valid instrument for mHealth usability evaluation. However, the instrument should be used with adaptation based on the app's characteristics. This study can serve as a methodological guide for designing, evaluating, and improving mHealth apps.