Tonal Auditory Discrimination Training in Youths: Design, Implementation, and Evaluation of Game-Based Versus Non-Game-Based Systems in a Cross-Sectional Study.

Background: Auditory discrimination training is widely used to supplement aural habilitation and rehabilitation in individuals with hearing or auditory challenges. Recently, gamification has been introduced as a strategy to enhance attention, motivation, and engagement during training. However, the relationship between user experience (UX) and auditory discrimination performance remains unclear. In addition, maintaining long-term interest in auditory training is still a challenge, particularly in younger populations, highlighting the need for more engaging and user-centered approaches. Objective: The objective of our study was to develop and compare 2 pure-tone auditory discrimination training systems: a game-based system with dual-task gamified activities and a non-game-based control system with identical auditory tasks but without gamified elements. We further aimed to evaluate differences in UX, engagement, usability, and behavioral auditory discrimination performance between the two systems. Methods: A 3-stage process (design, implementation, and evaluation) yielded beta versions of both systems. Both platforms were developed using identical auditory stimuli, task logic, and performance metrics to isolate the effect of gamification, differing only in the interface and game elements. In the evaluation stage, a cross-sectional study with 11 young adults (aged 18-30 y) was conducted, where participants completed usability, UX, and engagement questionnaires after using each system. Behavioral performance was assessed through mean response time, proportion of correct responses, the Balanced Integration Score, and a novel Auditory Discrimination Performance Index integrating the Weber fraction and response time. UX was measured using the User Experience Questionnaire, the Post-Study System Usability Questionnaire, and the User Engagement Scale-Short Form. Statistical analyses included Shapiro-Wilk tests, paired t tests, and Wilcoxon signed rank tests. Results: The game-based system produced significantly higher scores in 6 of 11 evaluated questionnaire dimensions, including focused attention, aesthetic appeal, reward, attractiveness, stimulation, and novelty, while no significant differences were found in most auditory discrimination performance metrics. Specifically, measures such as response time, accuracy, and Balanced Integration Score showed comparable results between systems. Usability-related outcomes showed a slight advantage for the non-game-based system, whereas all engagement-related domains consistently favored the game-based system, indicating improved user involvement and overall engagement without compromising performance. Conclusions: These findings suggest that gamification can substantially improve UX and engagement without degrading short-term discrimination performance. This indicates that gamified auditory training systems may enhance user adherence without compromising task effectiveness. This study is innovative in that it directly compares game-based and non-game-based auditory training systems under controlled conditions, isolating the effect of gamification. Unlike other studies that primarily evaluate gamified systems without a control condition, this work clarifies the specific contribution of game elements to UX and performance. These findings contribute to the development of more effective, user-centered auditory training technologies and highlight the need for future longitudinal studies to determine whether these advantages translate into sustained auditory benefits across tasks.