Previously submitted to: JMIR Serious Games (no longer under consideration since Jul 16, 2026)
Date Submitted: Jan 18, 2026
Warning: This is an author submission that is not peer-reviewed or edited.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.
Gamified Real-Time Video Observed Therapy (GRVOTS) Mobile Application Usability Study
ABSTRACT
Background:
Direct Observed Therapy Short-course (DOTS) has been used to ensure Tuberculosis (TB) drug compliance worldwide. However, due to its inconvenience, digitalizing this system into a virtual monitoring system via a mobile app can help deliver a more efficient tuberculosis management system. A gamified video-observed therapy system has been developed that connects three key users: the patient, supervisor, and administrator. This system enables drug monitoring and prevents patient loss to follow-up through an integrated patient tracking feature.
Objective:
Thus, the objective of our study is to assess the usability evaluation of the Gamified Real-Time Video Observed Therapy (GRVOTS) mobile apps, a mobile app specifically designed by having a combination of gamification elements in Video Direct Observed Therapy (VDOTS) to induce motivation from the perspective of the end user, both the patient and supervisor.
Methods:
11 supervisors with 54 patients participated in the 4-week usability study. GRVOTS mobile apps were installed, and patients were asked to complete tasks such as sending VOTS with supervisors to approve it daily. After one month, participants were asked to assess the usability of the app using the validated Malay version of the System Usability Scale Questionnaire (SUSQ). The one-sample t test was used to assess the usability score with a cutoff value of 68 for the usable mobile app. An independent t test was also performed to see if there is any difference between the usability marks of patients and supervisors.
Results:
The mean usability score was 74.73 (SD 14.64), which indicates that GRVOTS is a usable mobile app that can be used as a tool to replace physical DOTS. There are no significant differences between supervisors and patients (p<0.05).
Conclusions:
The GRVOTS mobile app can be used as a user-friendly tool for DOTS monitoring. A considerable amount of feedback and possibilities for improvement were also collected, which needs to be considered in future app development. There is potential for a commercially available app to be used in large-scale studies; thus, a single-arm intervention study is needed to measure the impact of the apps in the future. Clinical Trial: IRCT20230308057657NI, registered in March 2023
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