Development and usability evaluation of the mHealth Tool for Lung Cancer (mHealth TLC): A virtual world health game for lung cancer patients

• Eight users confirmed mHealth TLC to be believable, clinic-appropriate and helpful.
• Emotionally charged content created concerns about use clinic settings.
• mHealth TLC users benefited from and were engaged with virtual world role-play.
• Users provided useful usability feedback, despite being non-patients.
• Best practice for health game development includes using expert game developers.

ObjectiveTo test the feasibility and usability of mHealth TLC, an interactive, immersive 3-dimensional iPad health game that coaches lung cancer patients toward assertive communication strategies during first-person virtual clinics visits.MethodWe observed players and conducted semi-structured interviews. Research questions focused on scenario believability, the impact of technical issues, transparency of game goals, and potential of mHealth TLC to decrease lung cancer stigma (LCS) and improve patient–clinician communication.ResultsEight users confirmed mHealth TLC to be: (1) believable, (2) clinic-appropriate, and (3) helpful in support of informed healthcare consumers. Concerns were expressed about emotionally charged content and plans to use mHealth TLC in clinic settings as opposed to at home.ConclusionsAlthough the dialog and interactions addressed emotionally charged issues, players were able to engage, learn, and benefit from role-play in a virtual world. Health games have the potential to improve patient–clinician communication, and mHealth TLC specifically may decrease LCS, and promote optimal self-management.Practice implicationsProcess reflection revealed the need for health games to be created by experienced game developers in collaboration with health care experts. To prepare for this best practice, research institutions and game developers interested in health games should proactively seek out networking and collaboration opportunities.