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Sustained Gamification in Medication Adherence: Strategies and Conceptual Framework

by Rose Oluwaseun Adetunji, Adele Botha, Marlien Herselman
International Journal of Computer Applications
Foundation of Computer Science (FCS), NY, USA
Volume 186 - Number 74
Year of Publication: 2025
Authors: Rose Oluwaseun Adetunji, Adele Botha, Marlien Herselman
10.5120/ijca2025924610

Rose Oluwaseun Adetunji, Adele Botha, Marlien Herselman . Sustained Gamification in Medication Adherence: Strategies and Conceptual Framework. International Journal of Computer Applications. 186, 74 ( Mar 2025), 54-69. DOI=10.5120/ijca2025924610

@article{ 10.5120/ijca2025924610,
author = { Rose Oluwaseun Adetunji, Adele Botha, Marlien Herselman },
title = { Sustained Gamification in Medication Adherence: Strategies and Conceptual Framework },
journal = { International Journal of Computer Applications },
issue_date = { Mar 2025 },
volume = { 186 },
number = { 74 },
month = { Mar },
year = { 2025 },
issn = { 0975-8887 },
pages = { 54-69 },
numpages = {9},
url = { https://ijcaonline.org/archives/volume186/number74/sustained-gamification-in-medication-adherence-strategies-and-conceptual-framework/ },
doi = { 10.5120/ijca2025924610 },
publisher = {Foundation of Computer Science (FCS), NY, USA},
address = {New York, USA}
}
%0 Journal Article
%1 2025-03-25T22:41:41.149533+05:30
%A Rose Oluwaseun Adetunji
%A Adele Botha
%A Marlien Herselman
%T Sustained Gamification in Medication Adherence: Strategies and Conceptual Framework
%J International Journal of Computer Applications
%@ 0975-8887
%V 186
%N 74
%P 54-69
%D 2025
%I Foundation of Computer Science (FCS), NY, USA
Abstract

This paper examines the current body of literature on medication adherence using sustained gaming strategies and approaches. The objective is to investigate the concepts of sustained gaming, gaming strategies, and gaming approaches in relation to medication adherence. The goal is to identify the elements that contribute to a conceptual framework for understanding medication adherence behavior in patients, as part of a broader study. A comprehensive literature review was performed on four scholarly databases: MEDLINE, BMC, Global health, and Embase. The study examined the strategies and methodologies employed by the Pokémon Go game as a location-based game (LBG), and its impact on patients' adherence to medication. The study has identified several components, namely physical activities, social connections, exploration, enhanced emotional expression, and individual/self-treatment. The study conducted a qualitative examination on Pokemon Go players to understand their experiences and what kept them playing the games for a longer period. Therefore, the findings from the study and data analysis helped in the development of conceptual framework for promoting medication adherence using sustained gaming strategies and approaches is hereby presented. The results of this study have the potential to contribute to a shared comprehension among practitioners, professionals, and academics in the field of digital health and serious games. Additionally, these findings can serve as a foundation for future research on the long-term viability of digital health through gaming.

References
  1. Akkaya, B. and S. Üstgörül, Sustainability of SMEs and health sector in a dynamic capabilities perspective, in Challenges and opportunities for SMEs in Industry 4.0. 2020, IGI Global. p. 43-64.
  2. Allen, J.P. and J. Kim. Digital Gaming: Organizing for Sustainable Innovation. in IFIP Working Conference on IT Innovation for Adaptability and Competitiveness. 2004. Springer.
  3. Mills, D.J. and J.J. Allen, Self-determination theory, internet gaming disorder, and the mediating role of self-control. Computers in Human Behavior, 2020. 105: p. 106209.
  4. Knight, J.F., et al., Serious gaming technology in major incident triage training: a pragmatic controlled trial. Resuscitation, 2010. 81(9): p. 1175-1179.
  5. Kassutto, S.M., C. Baston, and C. Clancy, Virtual, augmented, and alternate reality in medical education: socially distanced but fully immersed. ATS scholar, 2021. 2(4): p. 651-664.
  6. Sanner, T.A. and J.I. Sæbø, Paying per diems for ICT4D project participation: a sustainability challenge. Information Technologies & International Development, 2014. 10(2): p. pp. 33-47.
  7. Molero, A., et al., Sustainability in healthcare: perspectives and reflections regarding laboratory medicine. Annals of laboratory medicine, 2021. 41(2): p. 139-144.
  8. Molero-Aranda, T., J.L. Lázaro Cantabrana, and M. Gisbert Cervera, Safety, inclusion and technology: a technological solution for emergency situations. Siglo Cero, 2023. 54(2): p. 11-28.
  9. Kamanga, R. and P.M. Alexander, Contradictions and strengths in activity systems: Enhancing insights into human activity in IS adoption research. The Electronic Journal of Information Systems in Developing Countries, 2021. 87(1): p. e12149.
  10. Motheeram, P., A. Botha, and M. Herselman, A scoping review of digital open badge ecosystems in relation to resource-constrained environments. TD: The Journal for Transdisciplinary Research in Southern Africa, 2018. 14(1): p. 1-10.
  11. Marais, ICT4D and Sustainability in: International Encyclopedia of Digital Communication and Society (in press). 2014, London: Wiley-Blackwell.
  12. Sanner, T.A., T.D. Manda, and P. Nielsen, Grafting: balancing control and cultivation in information infrastructure innovation. Journal of the Association for Information Systems, 2014. 15(4): p. 1.
  13. Petticrew, M. and H. Roberts, Systematic reviews in the social sciences: A practical guide. 2008: John Wiley & Sons.
  14. Adetunji, et al., Augmented reality technology: A systematic review on gaming strategy for medication adherence. Recent Innovations in Artificial Intelligence and Smart Applications, 2022: p. 47-66.
  15. Okoli, C., A guide to conducting a standalone systematic literature review. Communications of the Association for Information Systems, 2015. 37.
  16. Caxaj, C.S., A.M. Weiler, and J. Martyniuk, Housing conditions and health implications for migrant agricultural workers in Canada: A scoping review. Canadian Journal of Nursing Research, 2024. 56(1): p. 16-28.
  17. Peterson, J., et al., Understanding scoping reviews: Definition, purpose, and process. Journal of the American Association of Nurse Practitioners, 2017. 29(1): p. 12-16.
  18. Hosseini, L.J., H. Rafiemanesh, and S. Bahrami, Levels of motivation and basic psychological need satisfaction in nursing students: In perspective of self-determination theory. Nurse Education Today, 2022. 119: p. 105538.
  19. Altuwayrib, S.A., K.T. Win, and M. Freeman. Gamified medication adherence applications for chronic health conditions: scoping review. in International Conference on Persuasive Technology. 2023. Springer.
  20. Riar, M., et al., Gamification of cooperation: A framework, literature review and future research agenda. International Journal of Information Management, 2022. 67: p. 102549.
  21. Hong, Y., N. Saab, and W. Admiraal, Approaches and game elements used to tailor digital gamification for learning: A systematic literature review. Computers & Education, 2024: p. 105000.
  22. Aldabbas, H., et al., Extrinsic rewards for employee creativity? The role of perceived organisational support, work engagement and intrinsic motivation. International Journal of Innovation Science, 2023.
  23. Manjarres-Posada, N., D.J. Onofre-Rodríguez, and R.A. Benavides-Torres, Social cognitive theory and health care: Analysis and evaluation. Int'l J. Soc. Sci. Stud., 2020. 8: p. 132.
  24. Nurmi, J., et al., Engaging users in the behavior change process with digitalized motivational interviewing and gamification: development and feasibility testing of the precious app. JMIR mHealth and uHealth, 2020. 8(1): p. e12884.
  25. Bandhu, D., et al., Theories of motivation: A comprehensive analysis of human behavior drivers. Acta Psychologica, 2024. 244: p. 104177.
  26. Asbjørnsen, R.A., et al., Identifying persuasive design principles and behavior change techniques supporting end user values and needs in eHealth interventions for long-term weight loss maintenance: qualitative study. Journal of medical Internet research, 2020. 22(11): p. e22598.
  27. Silic, M. and P.B. Lowry, Using design-science based gamification to improve organizational security training and compliance. Journal of management information systems, 2020. 37(1): p. 129-161.
  28. Cervone, D., The role of self-referent cognitions in goal setting, motivation, and performance, in Cognitive science foundations of instruction. 2020, Routledge. p. 57-96.
  29. Tran, S., et al., The use of gamification and incentives in mobile health apps to improve medication adherence: scoping review. JMIR mHealth and uHealth, 2022. 10(2): p. e30671.
  30. Adetunji, O., et al. Medication Nonadherence in TB Patients: Innovative Technology Use and Related Legal Framework: Health Informatics And Medical Systems (CSCI-RTHI). in 2022 International Conference on Computational Science and Computational Intelligence (CSCI). 2022. IEEE.
  31. Adetunji, R.O., et al. Scoping review: Adherence in TB journey, its challenges and sustainability. in International Conference on Emerging Technology and Interdisciplinary Sciences. 2021.
  32. Passalacqua, M., et al., Should gamification be personalized? A self-deterministic approach. AIS Transactions on Human-Computer Interaction, 2021. 13(3): p. 265-286.
  33. Ajana, B., Personal metrics: Users’ experiences and perceptions of self-tracking practices and data. Social Science Information, 2020. 59(4): p. 654-678.
  34. Porter, M.E. and T.H. Lee, Why strategy matters now. N Engl J Med, 2015. 372(18): p. 1681-1684.
  35. Collis, D.J. and M.G. Rukstad, Can you say what your strategy is? Harvard business review, 2008. 86(4): p. 82-90.
  36. Sheth, A. and J.V. Sinfield, An analytical framework to compare innovation strategies and identify simple rules. Technovation, 2022. 115: p. 102534.
  37. Wang, Systematic literature review on health effects of playing Pokémon Go. Entertainment Computing, 2021. 38: p. 100411.
  38. Meschtscherjakov, A., et al. Pokémon WALK: Persuasive effects of Pokémon GO game-design elements. in International Conference on Persuasive Technology. 2017. Springer.
  39. Shiau, W.-L. and L.-C. Huang, Scale development for analyzing the fit of real and virtual world integration: an example of Pokémon Go. Information Technology & People, 2023. 36(2): p. 500-531.
  40. Fang, F., et al., Introduction to game theory. Game Theory and Machine Learning for Cyber Security, 2021: p. 21-46.
  41. Fang, I.-Y., et al., Does Pokémon GO increase leisure-time physical activity according to World Health Organization physical activity guidelines? Sport Sciences for Health, 2023. 19(1): p. 167-175.
  42. Khamzina, M., et al., Impact of Pokémon Go on physical activity: a systematic review and meta-analysis. American Journal of Preventive Medicine, 2020. 58(2): p. 270-282.
  43. Althoff, T., R.W. White, and E. Horvitz, Influence of Pokémon Go on physical activity: study and implications. Journal of medical Internet research, 2016. 18(12): p. e315.
  44. Broom, D.R. and S.W. Flint, Gotta catch ‘em all: Impact of Pokémon Go on physical activity, sitting time, and perceptions of physical activity and health at baseline and three-month follow-up. Games for health journal, 2018. 7(6): p. 401-408.
  45. Martínez-López, E.J., et al., Effects of the augmented reality game Pokémon GO on fitness and fatness in secondary school students. Health Education Journal, 2022. 81(1): p. 54-68.
  46. Kim, et al., Replacing self-efficacy in physical activity: Unconscious intervention of the AR game, Pokémon GO. Sustainability, 2018. 10(6): p. 1971.
  47. Liu and A. Ligmann-Zielinska, A pilot study of Pokémon Go and players' physical activity. Games for health journal, 2017. 6(6): p. 343-350.
  48. Ma, B.D., et al., Pokémon GO and physical activity in Asia: multilevel study. Journal of medical Internet research, 2018. 20(6): p. e9670.
  49. Alloway, T.P. and R. Carpenter, Gotta catch ‘em all: Exploring the use of Pokémon Go to enhance cognition and affect. Psychology of Popular Media, 2021. 10(2): p. 178.
  50. Wang and A. Skjervold, Health and social impacts of playing Pokémon Go on various player groups. Entertainment Computing, 2021. 39: p. 100443.
  51. Kim, et al. " It Should Be a Game for Fun, Not Exercise": Tensions in Designing Health-Related Features for Pokémon GO. in Proceedings of the 2020 CHI Conference on Human Factors in Computing Systems. 2020.
  52. Hamari, J., et al., Uses and gratifications of pokémon go: Why do people play mobile location-based augmented reality games? International Journal of Human–Computer Interaction, 2019. 35(9): p. 804-819.
  53. Lee, et al., Effects of Pokémon GO on physical activity and psychological and social outcomes: A systematic review. Journal of Clinical Medicine, 2021. 10(9): p. 1860.
  54. Mattheiss, E., et al., User-centred design with visually impaired pupils: A case study of a game editor for orientation and mobility training. International Journal of Child-Computer Interaction, 2017. 11: p. 12-18.
  55. Bonus, J.A., et al., Look on the bright side (of media effects): Pokémon Go as a catalyst for positive life experiences. Media Psychology, 2018. 21(2): p. 263-287.
  56. Evans, L. and M. Saker, The playeur and Pokémon Go: Examining the effects of locative play on spatiality and sociability. Mobile Media & Communication, 2019. 7(2): p. 232-247.
  57. Militello, L.K., N. Hanna, and C.R. Nigg, Pokémon GO within the context of family health: retrospective study. JMIR Pediatrics and Parenting, 2018. 1(2): p. e10679.
  58. Barkley, J.E., A. Lepp, and E.L. Glickman, “Pokémon Go!” may promote walking, discourage sedentary behavior in college students. Games for health journal, 2017. 6(3): p. 165-170.
  59. Chamary, J., Why ‘Pokémon GO’is the world’s most important game. Forbes, 2018.
  60. Kerdvibulvech, C. Location-Based Augmented Reality Games Through Immersive Experiences. in International Conference on Human-Computer Interaction. 2021. Springer.
  61. Kari, T., J. Arjoranta, and M. Salo. Behavior change types with Pokémon GO. in Proceedings of the 12th International Conference on the Foundations of digital Games. 2017.
  62. Ruiz-Ariza, A., et al., Effect of augmented reality game Pokémon GO on cognitive performance and emotional intelligence in adolescent young. Computers & Education, 2018. 116: p. 49-63.
  63. Rasche, P., A. Schlomann, and A. Mertens, Who is still playing Pokémon Go? A web-based survey. JMIR serious games, 2017. 5(2): p. e7197.
  64. Zach, F.J. and I.P. Tussyadiah, To catch them all—the (un) intended consequences of Pokémon GO on mobility, consumption, and wellbeing, in Information and communication technologies in tourism 2017. 2017, Springer. p. 217-227.
  65. Harborth, D. and S. Pape, How nostalgic feelings impact Pokémon Go players–integrating childhood brand nostalgia into the technology acceptance theory. Behaviour & Information Technology, 2020. 39(12): p. 1276-1296.
  66. Kaczmarek, L.D., et al., The Pikachu effect: Social and health gaming motivations lead to greater benefits of Pokémon GO use. Computers in Human Behavior, 2017. 75: p. 356-363.
  67. Kogan, L., et al., A pilot investigation of the physical and psychological benefits of playing Pokémon GO for dog owners. Computers in Human Behavior, 2017. 76: p. 431-437.
  68. Sung, H.-t., L. Sigerson, and C. Cheng, Social capital accumulation in location-based mobile game playing: A multiple-process approach. Cyberpsychology, Behavior, and Social Networking, 2017. 20(8): p. 486-493.
  69. Das, P., et al., Augmented reality video games: new possibilities and implications for children and adolescents. Multimodal Technologies and Interaction, 2017. 1(2): p. 8.
  70. Pilkington, G., et al., The effectiveness of community engagement and participation approaches in low and middle income countries: a review of systematic reviews with particular reference to the countries of South Asia. 2018.
  71. Schiavo, R., What is true community engagement and why it matters (now more than ever). Journal of Communication in Healthcare, 2021. 14(2): p. 91-92.
  72. Johnson. Audience engagement is NOT community engagement. 2019 [cited 2022 June 23]; Available from: https://blog.americansforthearts.org/2019/03/29/audience-engagement-is-not-community-engagement.
  73. Ndaguba, E.A. and B. Hanyane, Stakeholder model for community economic development in alleviating poverty in municipalities in South Africa. Journal of Public Affairs, 2019. 19(1): p. e1858.
  74. Mlambo, D.N., M.A. Mubecua, and M.W. Mbatha, Examining the Socio-economic Milieu of South Africa's Marginalised Population Post-1994: A Need for a Community-based Development Approach. Journal of Nation-Building and Policy Studies, 2023. 7(1): p. 5.
  75. Torjman, S., Community-based poverty reduction. 1998: Citeseer.
  76. Eftekhari, M.B., et al., The main advantages of community based participatory health programs: an experience from the Islamic Republic of Iran. Global journal of health science, 2013. 5(3): p. 28.
  77. Wang and X. Peng, How to Develop Sustainably after Poverty Alleviation in Poverty-Stricken Areas under Paired Assistance: A Quantitative Assessment Framework Based on System Dynamics Model. Sustainability, 2023. 15(6): p. 4764.
  78. Yan, Z., K. Finn, and K. Breton, Does it Promote Physical Activity? College Students' Perceptions of Pokémon Go. Montenegrin Journal of Sports Science and Medicine, 2020. 9(1): p. 5.
  79. Martínez-López, E.J., et al., Effects of the augmented reality game Pokémon GO on fitness and fatness in secondary school students. Health Education Journal, 2021: p. 00178969211047800.
  80. Winand, M., A. Ng, and T. Byers, Pokémon “Go” but for how long?: a qualitative analysis of motivation to play and sustainability of physical activity behaviour in young adults using mobile augmented reality. Managing Sport and Leisure, 2020: p. 1-18.
  81. Caci, B., et al., The reciprocal influences among motivation, personality traits, and game habits for playing Pokémon GO. International Journal of Human–Computer Interaction, 2019. 35(14): p. 1303-1311.
  82. Zsila, Á. and G. Orosz, Motives for playing Pokémon GO and their associations with problematic and health behaviors, in Augmented Reality Games I. 2019, Springer. p. 71-93.
  83. Vella, K., et al., A sense of belonging: Pokémon GO and social connectedness. Games and Culture, 2019. 14(6): p. 583-603.
  84. Olsson, T., et al., Technologies for enhancing collocated social interaction: review of design solutions and approaches. Computer Supported Cooperative Work (CSCW), 2020. 29(1): p. 29-83.
  85. Vaterlaus, J.M., K. Frantz, and T. Robecker, “Reliving my childhood dream of being a Pokémon Trainer”: An exploratory study of college student uses and gratifications related to Pokémon Go. International Journal of Human–Computer Interaction, 2019. 35(7): p. 596-604.
  86. Wong, et al., Improving patients’ medication adherence and outcomes in nonhospital settings through eHealth: systematic review of randomized controlled trials. Journal of medical Internet research, 2020. 22(8): p. e17015.
  87. Alha, K., et al., Why do people play location-based augmented reality games: a study on Pokémon GO. Computers in Human Behavior, 2019. 93: p. 114-122.
  88. Ghazali, E.M., D.S. Mutum, and M.Y. Woon, Multiple sequential mediation in an extended uses and gratifications model of augmented reality game Pokémon Go. Internet Research, 2019.
  89. Marquet, O., C. Alberico, and A.J. Hipp, Pokémon GO and physical activity among college students. A study using Ecological Momentary Assessment. Computers in Human Behavior, 2018. 81: p. 215-222.
  90. Schiavo, R., K.M. Hilyard, and E.C. Skinner, Community-based risk communication in epidemics and emerging disease settings. 2016: Jossey-Bass, an imprint of Wiley San Francisco, CA.
  91. Dudhia, R. and A. Kagee, Experiences of participating in an antiretroviral treatment adherence club. Psychology, Health & Medicine, 2015. 20(4): p. 488-494.
  92. Mukumbang, F.C., et al., Towards developing an initial Programme theory: Programme designers and managers assumptions on the antiretroviral treatment adherence Club Programme in primary health care facilities in the metropolitan area of Western Cape Province, South Africa. PLoS One, 2016. 11(8): p. e0161790.
  93. Grimsrud, A., et al., Implementation of community‐based adherence clubs for stable antiretroviral therapy patients in Cape Town, South Africa. Journal of the International AIDS Society, 2015. 18(1): p. 19984.
  94. Christiaensen, Down to earth: agriculture and poverty reduction in Africa. 2007: World Bank Publications.
  95. Christiaensen, L. Demery, and J. Kuhl, The (evolving) role of agriculture in poverty reduction—An empirical perspective. Journal of development economics, 2011. 96(2): p. 239-254.
  96. Navarrete Moreno, C. and N. Agapitova, Emerging Social Enterprise Ecosystems is East and South African Countries. 2017.
  97. Ndaguba, E.A., Community economic development strategic framework for poverty alleviation in local government in a rural South Africa. 2019, North-West University (South Africa).
  98. LandMark, U., Land Governance in South Africa. 2013.
  99. Gachassin, M., B. Najman, and G. Raballand, The Impact of Roads on Poverty Reduction. A Case Study of Cameroon‖, World Bank Policy Research Working Paper, 2010. 5209.
  100. Creswell and Poth, Qualitative inquiry and research design: Choosing among five approaches. 2016: Sage publications.
  101. Alonso, A.D., et al., Overcoming the unprecedented: Micro, small and medium hospitality enterprises under COVID-19. International Journal of Hospitality Management, 2022. 103: p. 103201.
  102. Dearden, A. and D. Kleine. Ethical standards for the ICTD/ICT4D community: A participatory process and a co-created document. in Proceedings of the Tenth international conference on information and Communication technologies and development. 2019.
  103. Wagner-Greene, V.R., et al., Pokémon GO: Healthy or Harmful? Am J Public Health, 2017. 107(1): p. 35-36.
  104. Lindqvist, A.-K., et al., The Praise and Price of Pokémon GO: A Qualitative Study of Children’s and Parents’ Experiences. JMIR Serious Games, 2018. 6(1): p. e1.
Index Terms

Computer Science
Information Sciences

Keywords

Medication adherence sustained gaming strategies AR games behavior and lifestyle changes