MoviPill: Improving Medication Compliance for Elders Using a Mobile Persuasive Social Game

✨ Summary

Overview

The paper presents MoviPill, a mobile persuasive social game designed to improve medication-taking behavior among older adults. Unlike reminder-only systems, MoviPill frames medication intake as a competitive activity: participants earn more points when they take a prescribed dose close to the target time and can compare their performance with other players. The system used a smartphone interface, a sensor-equipped electronic pillbox, a remote server, weekly rankings, and privacy-preserving compliance indicators such as emoticons.

Study design

The authors conducted a six-week field study with 18 elders, whose median age was 67.5 years. Participants used two conditions for three weeks each in a randomized crossover design:

• Button condition: participants recorded each intake using a simple smartphone button and relied on their usual memory strategies.
• Game condition: participants used the same intake function but also received access to the social ranking and a delayed alarm that sounded 15 minutes after a missed target time.

The study focused on one non-life-threatening medication taken twice daily. Medication behavior was measured primarily with electronic pillbox logs, although application logs were used for six participants when the pillbox was not used consistently outside the home.

Findings

The game condition improved both outcome measures examined by the authors:

• Prescription adherence: participants missed six doses during the Game condition compared with 15 during the Button condition, a 60% reduction in missed doses. The difference was statistically significant.
• Regimen adherence: the median deviation from the prescribed intake time improved by 43%, from 420 seconds in the Button condition to 240 seconds in the Game condition. Among participants who expressed interest in games, the improvement increased to 56%.

The study also found that age was negatively associated with prescription adherence in the Button condition but not in the Game condition, which the authors interpret cautiously as possible evidence that the game mitigated some age-related memory difficulties. Participants generally found the application easy to use, and social competition motivated some participants even though most did not know the other players personally.

The delayed alarm did not explain the improvement in regimen adherence: doses taken while the alarm was active were not more frequent in the Game condition than in the corresponding time window of the Button condition, and most participants reported that the alarm rarely or never helped them. This supports the authors’ interpretation that the social-game component, rather than the reminder alone, was the principal mechanism associated with the observed behavioral change, although the design did not include a reminder-only control condition.

Design implications

The paper emphasizes that persuasive healthcare systems for older adults should be personalized and designed for variation in vision, motor ability, technological experience, and motivational preferences. The authors recommend multimodal interaction, usability evaluation through walkthrough and think-aloud methods, strong consistency with users’ existing expectations, explicit attention to cheating or gaming the measurement mechanism, careful selection of competitors, involvement of caregivers as observers, reciprocal privacy practices, and consideration of users’ existing routines and technologies. The results also indicate that games are not universally attractive: participants who were uninterested in games showed less benefit, highlighting the need for multiple persuasive strategies and reward types.

Limitations

The sample was small, recruited from elders who were already relatively compliant, and limited to participants who owned mobile phones and took a suitable twice-daily medication. The experiment did not include a reminder-only condition, did not evaluate multiple medications or medications tied to meals, and allowed participants to report intake through the smartphone independently of the pillbox, creating opportunities for cheating. Consequently, the results demonstrate short-term associations in a controlled field trial rather than establishing long-term clinical effectiveness.

Subsequent influence

A targeted literature search found that later medication-adherence research continues to cite MoviPill as an early example of gamification and social competition in mobile health. A 2022 scoping review on gamification and incentives in mobile health apps lists MoviPill among the foundational studies in this area, while a 2020 feasibility randomized controlled trial on medication adherence among older adults also cites it when discussing technology-supported adherence interventions. These citations indicate continued use of MoviPill as a reference point for the design history of gamified and socially persuasive medication-support systems, but the search did not establish that MoviPill itself became a deployed commercial product or directly produced a specific industry system. (ic.unicamp.br)