JMIR Publications

ABSTRACT

Background:

Digital interventions have been applied in promoting human immunodeficiency virus (HIV) prevention and care among men who have sex with men (MSM). As user interface (UI) design plays a role in determining usability and user experience (UX), the intervention outcome could be affected.

Objective:

In this study, we hypothesised that the two UI design styles, namely gamification and neumorphism, could impact usability and be differentially preferred by distinct groups of MSM.

Methods:

A prospective parallel-group open-label randomised controlled trial was conducted in Hong Kong. Eligible participants were adult MSM recruited by the Research Team or referred by enrolled participants, who followed instructions for performing HIV self-test and promoted its use within one’s social network. Participants were randomised in a 1:1 ratio into either Gamification or Neumorphism arm with primarily visual differences in the UI only. The primary outcome was the usability measured by the System Usability Scale (SUS) between two arms. Distinct characteristics of promoters in the two arms who gave an SUS score of 80 or above were identified.

Results:

Of 463 MSM registered in the study, 232 and 231 were randomised to the Gamification and Neumorphism arm, respectively. Excluding participants who did not request a self-test kit, data from 218 and 216 in the respective arm, totalling 434, were analysed. With a median SUS score of 80 overall, participants in the Neumorphism arm gave a higher score (p=.00021), with a higher proportion giving a promoter-level SUS score (p=.0023). Promoters featured using social media for sex networking (p=.019), using pre-exposure prophylaxis in the preceding year (p=.0063), had higher satisfaction in UI design (p<.0001), and had made a self-test referral (p=.041). In general, higher usability was recorded in participants who were confident in performing HIV self-test (p<.01) and this was associated with a promoter-level SUS score in both arms. While no other personal characteristics were associated with promoters in the Neumorphism arm, those in the Gamification arm had a higher HIV-related knowledge (p<.01), preferred specific partner body image type (p<.05), and progressed towards peer referral by completing the online training (p=.039).

Conclusions:

Both gamified and neumorphic UI designs were well-accepted by MSM. UX and satisfaction of UI were both crucial in influencing one’s willingness to promote the application by referring their peers in the community to participate. The simplistic visual design of neumorphism conferred a more general acceptance in the community, whereas gamification was preferred in certain MSM sub-communities. Appropriate UI/UX design should be considered when developing digital interventions targeting MSM community. Clinical Trial: ClinicalTrials.gov (ID: NCT04379206)