"DiscoverU": Formative Development and Mixed-Methods Evaluation of an Afterschool Health and Well-Being Mentoring Program for Adolescents.

Individuals undergoing cancer treatment often experience persistent physical and emotional distress that can interfere with daily life, impede treatment, and worsen clinical outcomes. To address patients’ symptom-related needs efficiently and effectively, many have called for a transformation within oncology care to routinely monitor symptoms through patient-reported outcome (PRO) assessments [,]. These calls are reinforced by an accumulation of clinical trials demonstrating that PRO monitoring can improve health-related quality of life, health care resource use, and in some cases, survival [-]. PRO monitoring interventions are most effective when assessments are completed frequently over several months during cancer treatment []. However, maintaining regular engagement with remote PRO monitoring can be a challenge for patients. For example, studies of system-wide implementation of PRO monitoring programs in oncology have found that only about 40%‐50% of eligible patients completed at least one PRO survey [,]. Furthermore, another study found that on average, patients complete only about 50% of the survey invitations they receive []. Therefore, developing and implementing strategies to improve patient uptake and maintenance of PRO monitoring should improve patient outcomes. Although PRO use is multifactorial, one barrier is patients’ motivation to use (and continue using) available assessment platforms. Decades of research on behavior change theory emphasize the use of rewards to motivate individuals to maintain health behaviors [], with autonomous motivations leading to long-lasting health behavior changes []. As technology has advanced, many mobile health (mHealth) interventions now target reward pathways by using “gamification” to incentivize specific behaviors. Past research suggests that health interventions using video game components (eg, personal avatars, points, badges, and leaderboards) facilitate participation and engagement [,]. Moreover, a recent scoping review found that gamified interventions for cancer self-management are growing and can increase adherence to clinically relevant health behaviors, such as medication taking, physical activity, and postchemotherapy fluid intake []. However, to our knowledge, there are no existing gamified interventions available that aim to increase patient adherence to PRO monitoring. Given that remote PRO monitoring interventions already rely on health information technologies, gamification is a logical strategy for enhancing user engagement. The aim of this study was to conduct a multistage, mixed methods user-centered design process to design a gamified application for collecting PROs among individuals undergoing cancer treatment. Previous gamified interventions for cancer survivors have included multiple gamification elements, such as personal avatars, progress, levels, and aesthetically pleasing graphics and visuals inspired by video games []. However, there is a paucity of research highlighting older adult users’ preferences for gamified cancer and other health-focused apps []. Therefore, in Phase 1 of our multistage user-centered design process [], we conducted an online survey of older adults with a chronic disease that asked about their technology use and comfort, preferences for various gamification elements, and associated background characteristics. Phase 2 engaged feedback from a user interface designer and patients, and Phase 3 engaged oncologists and patients to iteratively develop a gamified application for PRO monitoring.