Table 2.

Summary of findings in relation to the research question.

Theme	Facilitators	Barriers	Needs
Congruence with hobbies	Initiate and maintain interest over time to allow repeated play Concentrate on being educational and enjoyable	Limitations in terms of the number of preprogrammed scenarios catering to all hobbies	Relate to common enjoyable hobbies for the intended user groups
Life gets in the way	Promote usage of the app during unavoidable daily tasks, for example, commuting	Incorporating the app into busy daily lives Reliance on passive health care models	App to send notifications and reminders when the user is overdue for a training session. Allow offline play, for example, when commuting
Motivational challenge	Promote altruism to contribute to research	App not offering the right level or type of challenge leading to lack of repeated playing and training.	Level of difficulty to be challenging enough to entice repeated play Multiple scenarios relevant to difficult hearing situations
Accessibility	Design considerations, for example, use of colors, font sizes, and images	Smaller screens on smartphones Inappropriate screen resolution for each device	Accessible to all ages Available on multiple platforms and devices, including PCs
Addictive competition	Option to share progress with family and friends to encourage competition	Not a driver for playing for people who are not of a competitive nature	Include daily high scores that are comparable with friends or self across time
Realism	Skills honed in the app would be more transferable More likely to recommend to friends	May prefer more realistic graphics rather than taking a gamified approach	Relatable to real-life environments where hearing is difficult