Considering Theory-Based Gamification in the Co-Design and Development of a Virtual Reality Cognitive Remediation...

Area of Science:

• Digital health interventions
• Virtual reality therapeutics
• Cognitive remediation

Background:

• Developing digital interventions like immersive virtual reality (VR) cognitive remediation for major depressive disorder (MDD) requires understanding effective components and clinical relevance.
• Low uptake and noncompliance challenge digital intervention delivery; gamification can improve adherence but needs careful design for intrinsic motivation.
• This study addresses these challenges through co-design and behavior change theories, following international guidelines for VR therapy development.

Purpose of the Study:

• To iteratively develop and refine a VR cognitive remediation program (bWell-D) for MDD.
• To integrate user-centered design and gamification strategies informed by behavior change theories.
• To enhance intrinsic user motivation and engagement in digital mental health interventions.

Main Methods:

• Collected qualitative data from patients and care providers on VR use for cognitive remediation and behavior change drivers.
• Translated qualitative insights into software features, evaluating gamification elements against behavioral theories for intrinsic engagement.
• Formally evaluated implemented changes through user trials to assess tolerability and engagement.

Main Results:

• End-user feedback emphasized gamification for artificial challenges, personalization, and assistance, focusing on capability as a driver.
• The need for competence was the most frequently cited factor for promoting intrinsic engagement.
• bWell-D demonstrated good tolerability, with preliminary results showing increased user experience and high engagement over a 4-week program.

Conclusions:

• A process for applying gamification in digital mental health interventions is presented, characterizing applied elements and targeted mechanisms.
• End-user feedback led to incorporating less common gamification elements focused on individual ability, moving beyond extrinsic motivators like points and rewards.
• Incorporating user feedback allows for broader application of gamification, identifying elements potentially better suited for mental health domains.