Abstract:

In Malaysia, Tuberculosis (TB) has a high incidence and causes most deaths among all infectious diseases reported for the last thirty years. Studies had reported that the highest age category of TB patients that contributes to the majority TB caseloads are among the working aged group, 20-50 years old. Despite the implementation of DOTS that was suggested by WHO as the control strategy tool, TB caseloads keep on arising. TB-patients’ adherence has been reported to be one of the crucial reasons that caused the increment of TB cases. The needs of increasing the effectiveness of adherence interventions must be further studied for its greater impact on the health of the population than any improvement in specific medical treatments. This study aims to investigate whether gamified interventions are effective in persuading behavior change among TB patients and its possibilities of driving better engagement of patients throughout self-management TB treatment in Malaysia. This study will involve three main phases, EXPLORATORY PHASE, DEVELOPMENT PHASE and INTERVENTION PHASE. In-depth literature reviews together with interviews with ex-TB patients and TB expert panels will be conducted in Exploratory Phase in order to identify the motivation factors and barriers towards treatment adherence and the possibilities of using gamification to improve it. Then, in-depth interviews with mobile game experts will be conducted, and the latter output, together with the former will then be used to model the gamification mobile apps theoretical framework. The output of this phase will be a Treatment Adherence Motivation Gamification Framework (TAMGF) that can be used as a tool to aid in the design and development of architecture for treatment adherence using gamification approach. In the Development Phase, TAMGF will be used to develop an architecture for gamified mobile apps to improve adherence which will be validated by the Game Experts and ex-TB patients. The output of this phase will be the Architecture of Treatment Adherence Gamification (ATAG), a design and analysis tool to help designers design and develop gamified apps for promoting treatment adherence. The final phase, Intervention Phase will adopt a Randomized Control Trial (RCT), which will involve 146 new TB patients, divided equally into 2 arms. The gamified mobile apps developed in the Development Phase (TB-GDOTS mobile apps) will be used in the study group, while the control group will adopt the traditional DOTS. The output of this phase will be the treatment adherence rates between gamified intervention group and face-to-face control group as well as the relationship between personal motivation and gamification elements with TB treatment adherence. This study is in line with the strategic thrust of Malaysian health sector, which is to transform the health sector towards an efficient and effective health system in order to ensure universal access to healthcare and to empower individuals to be responsible for their own health.