Table 2.

Changes to Epic Allies for Phase Three

Phase One and Two components	Phase Three components	Phase Three component description	Rationale for change
–	Superhero theme, app storyline, virtual guide	An app storyline was developed to explain the superhero theme, provide a backstory for the app and to introduce users to their role in the game (Textbox 1). A virtual guide, Walter, was created to present the storyline to users and provide a tour of the app.	The storyline and superhero theme were added in response to focus group participants’ request for an engaging and interactive user experience that would motivate regular app use.
–	The Battle	The objective of the Battle is to collect virtual cards used to defeat the monsters in the city of Medopolis. Each day, players fight a new battle to defeat a monster; success or failure depends on the set of three cards they have in their hand. Players can buy and upgrade their cards using points earned by engaging in other parts of the app. Within the Battle, a new social component called the “Spotlight” was created. Using the spotlight, participants can call on their Allies to help defeat difficult monsters.	The Battle feature was introduced to increase app engagement, motivate participants to complete activities within the app, and encourage interactions with Allies.
Customizable avatars	Profile	The avatar concept was expanded to include more detailed information about users such as interests, hobbies, and current ART use.	Focus group participants emphasized the need for social support for adherence. The profile was changed to create a stronger sense of community among users.
Dashboard	Dashboard	The Dashboard feature expanded to include additional tracking options such as exercise, smoking, drug and alcohol use, and mood.	This change responded to focus group participants’ request for customization within the app.
Reminder messages and tailored feedback	Reminder messages and tailored feedback	Reminder messages were made optional. Tailored feedback was expanded to include messages on new tracking options (ie, exercise, smoking).	Focus group participants noted that reminders are an important feature to include in an adherence app. However, those who already have strategies for remembering to take their medications may not need them. The change allows users to customize the app to their needs. Expansion of tailored feedback was designed to provide additional customized feedback on factors related to adherence.
Friends	Allies	The name was changed from “Friends” to “Allies”. The feature was expanded to include the “Spotlight” feature described in the Battle section above.	The name was changed to align with the storyline and superhero theme. The “Spotlight” feature enhanced the ability for users to interact with their Allies in an interactive and fun way.
Information modules	Daily Dose	The information modules were replaced with the Daily Dose, an app newspaper that follows a curriculum of daily short articles and tips to address HIV and ART knowledge and promote disease management. Reading an article earns users points that can be used to buy new cards for the Battle.	The Daily Dose replaced the educational modules so that informational needs could be addressed in an engaging and interactive manner (ie, proper dosing guidelines, common medication side effects, coping with side effects, HIV acceptance process, identifying sources of social support). Users are encouraged to log into the app daily to get a new article. Awarding points increases motivation for reading articles and app engagement.
Gamification	Gamification	The gamification principles were expanded so that users earned points for each completed activity in the app. A “leveling up” feature was added so that users could unlock new battles.	The additional gamification features were added to increase motivation for behavior change and app use.