JMIR Publications

ABSTRACT

Background:

Medication nonadherence remains a major global health challenge, contributing to preventable disease, hospitalizations, and healthcare costs. Mobile health (mHealth) applications incorporating gamification and financial incentives have shown potential to improve adherence; however, most research has focused on patient perspectives, with limited understanding of how non-patient stakeholders perceive their feasibility, risks, and implementation. Understanding non-patient stakeholder perspectives in relation to patient viewpoints is essential for informing future policy development and establishing practical, industry-supported safeguards that protect consumers while enabling innovation.

Objective:

This study aimed to explore non-patient stakeholder perspectives on the use of gamification and financial incentives in mHealth apps for medication adherence and to integrate these with previously reported patient perspectives to inform consensus-based design and policy considerations.

Methods:

A mixed-methods study was conducted using a modified virtual Nominal Group Technique (vNGT). Non-patient stakeholders across healthcare, industry, and policy sectors in Australia were recruited. Data collection involved a pre-session survey followed by online focus groups. Qualitative responses were analyzed using thematic analysis supported by AI-assisted coding. Consensus statements derived from themes were rated during the focus groups. Additional prompts were used to elicit further discussion where consensus was not immediately achieved.

Results:

A total of 20 participants were included in the study. Six key themes were identified: tailored gamification for adherence, financial incentives as a contested motivator, designing for diversity and inclusion, usability barriers to engagement, trust through data governance, and validated and sustainable innovation. These informed 24 consensus statements, of which 54% (13/24) achieved unanimous agreement. Stakeholders strongly endorsed personalization, simplicity, and transparent data practices, while expressing nuanced concerns regarding the ethical use, sustainability, and potential unintended consequences of financial incentives. Compared with prior patient findings, the participants demonstrated substantial alignment on core design principles but contributed additional system-level considerations related to feasibility, scalability, and regulation.

Conclusions:

Non-patient stakeholders largely reinforce patient priorities while extending them with critical perspectives on implementation, governance, and sustainability. Gamification and financial incentives are viewed as potentially effective but require careful, ethically grounded design to balance engagement with long-term motivation and trust. These findings support the development of stakeholder-informed guidelines for responsible mHealth innovation and highlight the importance of integrating patient and system-level perspectives in digital health design. Future research should prioritize co-designed longitudinal studies utilizing apps with gamification and a range of incentive offers with clear redemption processes to evaluate the long-term impact on medication adherence across diverse patient populations.