TLDR:
- We tested the effects of eQuoo on well-being -IT WORKS!
- We tested the following well-being metrics: Psychological Well-Being (Ryff's Scale) - Positive Relationships with others, Resilience (ARS), Personal Growth (PGIS), a One Item Anxiety Likert Scale
- It was a 5-week, 3-arm randomized controlled trial with 358 participants
Background
Young adults 18 - 28 years old are the most vulnerable population to mental health issues of which 29% are living with a diagnosed mental illness. With less than 35% having access to therapy and psychological care, it is pressing to develop therapeutic tools that are cost-efficient, effective and 'sticky'. The broad distribution of smartphones offers a compelling platform in the form of applications, but evidence-based apps struggle with high attrition. Additionally, prevention programs have attrition rates of up to 99%, making them difficult to implement. Research suggests gamification to be a valid strategy to intrinsically motivate patients to adhere to prevention and early-stage mobile interventions.
Methods
A game named eQuoo, teaching psychological concepts such as emotional bids, generalization, and reciprocity through psychoeducation, storytelling, and gamification was developed and published on all application platforms. A hypothesis was postulated that using the app over a period of 5 weeks would significantly boost Resilience, Personal Growth.
Psychological well-being: Positive Relations With Others and Anxiety as well as heighten adherence. 358 participants partook in a 5-week, 3-armed randomized controlled trial, of which a third used eQuoo, a third used a 'Treatment as Usual' CBT Journal app and a third was on a waitlist with no intervention. All 3 groups filled out the following questionnaires at 3 time-points: The Adult Resilience Scale, The Personal Growth Inventory Scale, the Psychological well-being: Positive Relations With Others Scale by Ryff and a 1 Item Anxiety Likert scale.
Results
Results of repeated measures of ANOVAs showed statistically significant increases in the well-being metrics and a significant decrease in anxiety when using the app over a timeframe of 5 weeks. The app significantly increased resilience as measured with the ARS by d .37, personal growth as measured by PGIS by d .67, positive relations with others as measured by Ryff's PWB by d .42 and anxiety as measured with a 1 Item Ankiety Likert Scale lowered by d .20. With 90% adherence, eQuoo was able to retain 21% more participants than the control or waitlist group.
Conclusion
eQuoo is a mental health game that significantly raises mental well-being and lowers anxiety as well as maintains high adherence. This allows a deduction that smartphones are a valuable and effective platform - for those who adhere to the intended therapy process - to offer mental health interventions within an app. Using gamification could be the key to achieving the attention and motivation needed to generate higher retention rates and reduce attrition for a certain age group. Future research would benefit from measuring eQuoo's effect on anxiety with a more sensitive tool GAD 7 as well as other widespread mental illness like depression.
