Journal Article

Effect of Gamification on Improved Adherence to Inhaled Medications in Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial

Wu, Wenxiao, Dai, Yifan, Jiang, Zhili, Huang, Lihua, Liu, Yang, Huang, Xiting, Dai, Ziying, Wang, Jing, Chen, Liping, Wang, Zhiqian

2025

Overview

Inhaled medication is the preferred route of administration for patients with chronic obstructive pulmonary disease (COPD). The compliance rate of inhaled medication in patients with COPD is <50%, which increases the risk of acute exacerbations. Considering the complex steps of inhaled medication, improving inhaled medication compliance not only requires consistent medication frequency and medical advice but also an evaluation of whether the patient has mastered the inhaler technique to achieve the correct dose. This study aimed to explore the effectiveness of an inhaled medication education program (Inhaling-Health website) based on the Fogg Behavior Model and gamification design on inhaled medication compliance and other health-related outcomes in patients with COPD. In a randomized, 2-arm, concurrent parallel design, we enrolled 102 patients with COPD from respiratory medicine clinics at 2 hospitals in Zhejiang Province, China, between April and May 2023. Participants were randomly assigned to either the control group (51/102, 50%) or the experimental group (51/102, 50%). All participants completed the intervention, with 94 participants completing 6 months of follow-up. Two independent-sample 2-tailed t tests and the Mann-Whitney U test were used to analyze group differences, and generalized estimating equations were used to analyze repeated measurements. After the intervention, all outcome measures improved compared to baseline. The generalized estimating equation showed that, compared to the control group, the Inhaling-Health website led to a gradual improvement in total adherence-to-inhaler scores starting from 2 months after the intervention (median 51.00, IQR 49.00-52.25 vs median 50.00, IQR 47.00-51.00; Z=-2.014; P=.04). It had a separate positive effect on inhaler technique. In addition, the website was more effective in reducing the modified Medical Research Council score than routine inhaled medication education, starting from 4 months after intervention (median 1.00, IQR 1.00-2.00 vs median 1.00, IQR 0.00-2.00; Z=-2.260; P=.02). The website was also more effective than the conventional intervention in improving Chronic Obstructive Pulmonary Disease Knowledge Questionnaire scores, beginning at the end of the intervention (mean 6.14, SD 1.83 vs mean 7.06, SD 1.82; t =-2.551; P=.01). The gamified inhaled medication education program based on the Fogg Behavior Model can improve inhaled medication adherence, inhaler technique accuracy, health literacy, lung function, and health-related quality of life; help reduce the severity of dyspnea and COPD physical symptoms; and reduce the risk of acute exacerbations in patients with COPD. This study can provide a reference for inhaled medication education in patients with COPD. China Clinical Trials Registry (ChiCTR) ChiCTR2300070213; https://www.chictr.org.cn/showprojEN.html?proj=194829.

• Publisher: Journal of Medical Internet Research,Gunther Eysenbach MD MPH, Associate Professor,JMIR Publications
• Subject: Academic achievement / Adherence / Administration, Inhalation / Aged / China / Chronic illnesses / Chronic obstructive pulmonary disease / Clinical research / Clinical trials / Clinics / Compliance / Disease / Dosage and administration / Drug therapy / Drugs / Dyspnea / Education / Educational aspects / Educational programs / Female / Gamification / Groups / Health behavior / Health education / Health literacy / Health status / Hospitals / Humans / Inhaled medication / Intervention / Literacy / Lung diseases / Lung diseases, Obstructive / Male / Medical research / Medical schools / Medication Adherence / Medicine / Methods / Middle Aged / Original Paper / Patient compliance / Patient education / Patient Education as Topic / Patients / Physical symptoms / Pulmonary Disease, Chronic Obstructive - drug therapy / Quality of life / Registration / Risk reduction / Technology application / Websites