Willingness to Use Gamified mHealth Apps Among Preadmission Patients With Pituitary Adenoma: Exploratory Sequential Mixed Methods Study

Abstract Background Patients with pituitary adenoma (PA) must complete preparation tasks during the preadmission stage and may experience information asymmetry and anxiety. Gamified mobile health (mHealth) apps may support motivation and engagement; however, research has examined isolated predictors, and the combinations of app-related factors associated with willingness to use these tools remain unclear. Objective This study aimed to identify factors associated with willingness to use gamified mHealth apps among preadmission patients with PA and to examine configurations associated with high and low willingness. Methods We conducted an exploratory sequential mixed methods study comprising a qualitative phase followed by a cross-sectional quantitative phase, guided by the stimulus-organism-response framework. Participants were recruited using criterion-based purposive sampling from the Department of Neurosurgery at the Affiliated Hospital of Zunyi Medical University between August and November 2024. In the qualitative phase, 10 patients completed semistructured interviews after viewing a standardized description and slide presentation of a hypothetical gamified mHealth app. Interview data were analyzed through inductive open coding followed by deductive framework-guided categorization. The findings informed a 27-item checklist covering 6 antecedent conditions and willingness to use, refined through multidisciplinary expert consultation. In the quantitative phase, 120 patients completed a cross-sectional survey. Variables were directly calibrated as fuzzy sets, and fuzzy-set qualitative comparative analysis was used to assess necessity and identify configurations associated with high and low willingness. Results The qualitative analysis identified reward mechanisms, interactivity, enjoyment, privacy protection, usability, and authority background as app-related conditions. No single condition met the prespecified necessity threshold. Four configurations were associated with high willingness: reward-driven engagement (H1), interactive enjoyment with privacy protection (H2), privacy- and usability-supported enjoyment (H3), and authority-supported functional assurance (H4). Configuration consistency ranged from 0.960 to 0.997; overall solution consistency and coverage were 0.964 and 0.510, respectively. Five configurations were associated with low willingness: broad feature deficit (L1), authority with engagement and usability deficits (L2), enjoyment and privacy deficit (L3), enjoyment and privacy deficit despite reward and authority support (L4), and authority-background deficit (L5). Their consistency ranged from 0.994 to 1.000; overall solution consistency and coverage were 0.993 and 0.645, respectively. Conclusions By integrating patients’ qualitative accounts with configurational analysis, this study extends single-factor research and provides disease- and stage-specific evidence for preadmission care in PA. The configurations offer a preliminary basis for modular prototypes: rewards, progress indicators, and interactive checklists could support preparation tasks; interactive education could be combined with visible privacy controls; simplified navigation could improve access to examination and hospitalization instructions; and hospital endorsement and clinician-reviewed content could strengthen information credibility. Because participants evaluated a hypothetical rather than functioning app, these findings concern stated willingness, not actual adoption or clinical effectiveness. Prospective studies using deployed apps, objective task-completion measures, and app-log data are required.