Accepted for/Published in: JMIR Serious Games
Date Submitted: Jun 30, 2021
Date Accepted: Nov 6, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
A serious puzzle game to enhance adherence to anti-rheumatic drugs in rheumatoid arthritis patients: systematic development using Intervention Mapping
ABSTRACT
Background:
Patients’ implicit attitudes towards medication need and concerns may influence their adherence. Targeting these implicit attitudes by combining game-entertainment with medication-related triggers might improve medication adherence in rheumatoid arthritis (RA) patients.
Objective:
To describe the systematic development of a serious game to enhance adherence to anti-rheumatic drugs using Intervention Mapping.
Methods:
A serious game was developed using the Intervention Mapping framework guided by a multidisciplinary expert group which proceeded along six steps: (1) exploring the problem by assessing the relationship between medication adherence and implicit attitudes, (2) defining change objectives, (3) selecting evidence-based behaviour change techniques that focussed on adjusting implicit attitudes, (4) designing the intervention, (5) guaranteeing implementation by focussing on intrinsic motivation and (6) planning a scientific evaluation.
Results:
Based on the problem assessment and guided by the Dual-Attitude Model, implicit negative and illness related attitudes of RA patients were defined as the main target for the intervention. Consequently the change objective was: ‘After the intervention, participants have a more positive attitude towards anti-rheumatic drugs’. Attention bias modification, evaluative conditioning and goal priming were the techniques chosen to implicitly target medication needs. These techniques were redesigned into medication-related triggers and built in the serious puzzle game. Thirty-seven RA patients tested the game at several stages. Intrinsic motivation was led by the self-determination theory and addressed the three needs competence, autonomy and relatedness. The intervention will be evaluated in a randomised clinical trial that assessed the effect of playing the serious game on anti-rheumatic drug adherence.
Conclusions:
We systematically developed a serious game application to enhance adherence to anti-rheumatic drugs among RA patients using the Intervention Mapping framework. This protocol could serve as a guideline for other healthcare providers when developing similar interventions.
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