Gamification to improve engagement in a self-monitoring application for long-term care prevention: a retrospective follow-up study.

Abstract

We have developed a self-monitoring health promotion application for the purpose of preventing long-term care. However, as with many health care applications, there have been challenges with user retention rates. Therefore, gamification was introduced as one means to improve the retention rate. Although previous studies have demonstrated that gamification can enhance user engagement, its effectiveness in healthcare applications targeting older adults remains unclear. To retrospectively examine the impact of gamification on user retention rates for a healthcare application. A retrospective analysis was conducted using data from the "Online Kayoinoba App" user database. The study included 1,392 participants who downloaded the application within 3 months before and after the introduction of gamification. Propensity score matching was applied to balance age and sex between application versions. We defined dropout as cases where the application was not launched for more than 7 consecutive days after initial download within 30 days after installation. User retention was assessed using Kaplan-Meier curves and the log-rank test, and hazard ratios (HRs) associated with retention were calculated using Cox proportional hazards models. The analysis revealed that the median user retention period increased from 4 (interquartile range, 1-13) days before the introduction of gamification to 7 (interquartile range, 1-18) days after the introduction (p = 0.001). Furthermore, the Cox proportional hazards model showed that gamification implementation was associated with longer retention times (HR: 0.86, 95% confidence interval: 0.77-0.97). The introduction of gamification elements significantly increased the retention rate of the "Online Kayoinoba App." These results suggest that gamification is also useful for increasing the retention rates among older adults using healthcare applications. Future studies are needed to examine the long-term retention rates, changes in step counts, and health outcomes as a result of application retention.