Growing Well with Grow It!: Acceptability of a Gamified mHealth App for Adolescents With a Chronic Somatic Illness – A Mixed Methods Study

Background: Over 17% of children live with a chronic somatic illness and are at increased risk of experiencing psychological problems, such as anxiety and depression. Grow It! is a transdiagnostic mobile health (mHealth) intervention that combines experience sampling and personalised mood feedback with daily coping challenges to promote reflection, emotional insight and adaptive coping. The app fosters a collaborative team experience in which participants contribute to growing a shared virtual tree and communicate through a chat function with predesigned stickers. Objective: This study aimed to evaluate the acceptability of the Grow It! app among adolescents with a chronic somatic illness and to identify key lessons the development of other gamified mHealth apps designed to promote well-being.Methods: This preregistered study is part of a randomised waitlist controlled trial. Adolescents with a chronic somatic illness aged 10-18 years old were recruited from a university medical children’s hospital. Upon inclusion, adolescents were randomised to an intervention group that used the Grow It! app or a waitlist control group. Follow up questionnaires were completed immediately after the four week intervention period and three months later. Consecutively, the waitlist control group was also offered the Grow It! app and completed questionnaires immediately after use and three months later. Participants completed user experience survey comprising open ended and closed questions after playing the app. Responses were analysed using qualitative content analysis and descriptive statistics.Results: Between August 2021 and September 2023, 208 adolescents were included in the study. Due to participant attrition, the user experience survey was distributed to 183 participants and completed by 150 (Mage=13.95, 39.33% male, 59.33% female, 1.33% other). The app received a mean overall rating of 7.32 out of 10, and a mean look-and-feel rating of 7.98 out of 10; 84% would recommend the app to a friend. Participants reported that the app helped them recognise their emotions and gain greater self-insight. They also described its design as colourful and visually appealing. Suggested improvements included adjusting the timing and frequency of the momentary assessments, and expanding the chat function to allow free-text messages or a wider selection of stickers. Conclusions: The Grow It! app is well-accepted by adolescents aged 10 to 18 with a chronic somatic illness, although optimising the chat function and reducing questionnaire burden may further improve user experience. Combined with evidence of effectiveness, these findings on acceptability and user experience support the implementation of the Grow It! app in paediatric healthcare.