A Gamified Mobile Health Framework for Pediatric Tuberculosis Treatment Adherence

Abstract : Tuberculosis (TB) treatment in children requires long-term adherence to anti-tuberculosis drug therapy (OTD), which often leads to boredom and refusal to take medication. Non-adherence to treatment can increase the risk of treatment failure, relapse, and drug resistance. This study proposes a mobile health-based gamification framework designed to improve treatment adherence in pediatric TB patients by integrating game elements into the therapy monitoring process. The gamification framework was developed using a user-centered approach by identifying factors influencing adherence through interviews with pediatric patients, medication supervisors (PMOs), and healthcare professionals. Aspects of medication adherence were mapped using the Morisky Medication Adherence Scale (MMAS-8) and classified into dimensions of behavior, motivation, knowledge, and memory. User characteristics were analyzed using the HEXAD gamification user types questionnaire to determine the dominant user type. The analysis showed that the dominant user type in pediatric TB patients was the player type, followed by the socializer type and the free spirit type. Based on these findings, a gamification framework was designed that includes points, rewards, challenges, reminders, and progress visualization mechanisms. Expert evaluation using the After-Scenario Questionnaire (ASQ) demonstrated high levels of satisfaction and confidence that the proposed framework has the potential to improve treatment adherence. This study demonstrates that mobile health-based gamification design has strong potential as a behavior change strategy to support long-term pediatric TB treatment.