JMIR Publications

ABSTRACT

Background:

With an extensive number of Americans living with multiple chronic conditions, the opportunity for medication misuse and its severe consequences has never been greater. The US spends over $100 billion annually on the impact of medication misuse, which demonstrates that many patients struggle with safe and appropriate use of medicines. Medication misuse includes nonadherence, dosing errors, improper storage, handling, and disposal. Many studies have found that serious games are effective and innovative digital tools for educating patients about positive health behaviors. However, there are limited systematic reviews that examined the prevalence of serious games that incorporate medication use.

Objective:

This systematic review explores serious games for patients with components of medication adherence, education, and safety. We also assess the methodology (specifically theoretical frameworks and sampling frames) for developing and evaluating serious games for medication use.

Methods:

PubMed, Scopus, and Web of Science databases were searched for literature about medication based serious games for patients. PRISMA guidelines were followed for article selection.

Results:

Using PRISMA guidelines, 953 publications and 749 unique titles were identified from PubMed, Scopus, and Web of Science. A total of 16 studies featuring 12 unique serious games were included with components of medication adherence, education, and safety which were published from 2003 to 2019. Of the 12 games included, eight serious games were tested in adolescents, three in young adults, and a single game tested solely with adults. Most studies (11) used small sample sizes to test the usability of the serious games. Theoretical frameworks identified in the 12 serious games included information, motivation and behavior theory (IMB theory), social cognitive theory, PRECEDE-PROCEED model, middle-range theory of chronic illness, adult learning theory, experiential learning theory, and the theory of reasoned action. Existing systematic reviews explore serious games focused on the management of specific disease states such as HIV, diabetes, and asthma, and the positive impact of serious game education in each respective disease state. While other reviews target broad topics such as health care gamification and serious games to educate healthcare workers, no reviews focus solely on medication use. Additionally, there were limited studies on serious games for health that incorporated medication use. Serious games identified which incorporated the use of medicines were mainly focused on improving adherence, while medication safety was not widely explored. There is a lack of research on the efficacy and usability of medication-focused serious games often due to small and non-representative sample sizes which limit the generalizability of existing studies.

Conclusions:

Serious game utilization has the potential to successfully teach patients about medication use and patient safety. In the future, serious game effectiveness could be improved by increasing study sample size and diversity of study participats, so results are generalizable to broader populations. Serious games should describe extent of theoretical framework incorporated into game design and evaluate success through testing player’s retention of learning objectives.