The methodology for both systems’ design, implementation, and evaluation was adapted from [16,19] and consisted of (1) problem definition and initial design, (2) creation of a prototype and testing, and (3) UX, usability, and engagement evaluation of the beta version, as described in Figure 1.

This study was conducted in accordance with the principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the Ethical Committee of the Instituto Tecnológico y de Estudios Superiores de Monterrey Engineering School with ID EHE-2023‐11 and was registered in the International Standard Randomized Controlled Trial Number registry (ISRCTN43661994).

Participants were given informed consent prior to study enrollment. The consent stated the procedure and described the materials, ensuring voluntary participation. Participants’ data were anonymized prior to analysis to protect participants’ privacy and confidentiality. No identification of individual participants or users is included in this study. No monetary compensation was given to the participants.

Measurement quality was supported using a controlled laboratory environment, standardized hardware (headphones and computer setup), and consistent task instructions across participants. All sessions and procedures were supervised from informed consent until the last task was completed by each participant. No missing data were reported. Prior to performing statistical tests, data were first inspected for normality (Shapiro-Wilk tests) to select an appropriate analysis strategy.

Analyses were conducted to evaluate differences between systems across behavioral and questionnaire-based outcomes. For the in-game key performance indicators (KPIs), Python 3.12.12 was used to perform all statistical computations with the SciPy Stats library. The tests were carried out by comparing NGBS and GBS conditions paired by training feature (pitch or duration). Data were first inspected for normality using Shapiro-Wilk tests. The parametric paired t test was used when normality conditions were met. Otherwise, the nonparametric alternative, Wilcoxon signed rank test, was applied. Statistical significance was set at P<.05 for all tests conducted.

For questionnaire assessment, the Wilcoxon signed rank test using MATLAB 2025a and the Statistics and Machine Learning Toolbox was used to determine statistically significant differences between both systems across all questionnaire dimensions, considering the ordinal nature of the data. Mean scores, SD, P values, and effect sizes (r) values were calculated for each dimension per user, per questionnaire, and per system.

All participants reported no hearing or visual impairment, no attentional or neurological disorders, and no current use of medication at the time of the experiment. As general information for the study, participants self-reported information regarding their sleep, eating, and hydration habits, as well as their average weekly time spent in hours playing video games. A participant flow diagram adapted from JARS guidelines is presented in Figure 5.

Regarding gaming exposure, 9 participants reported playing video games less than 4 hours per week, 1 participant reported between 4 and 8 hours, and 1 participant reported between 8 and 12 hours. This variable was included as a proxy for prior familiarity with interactive and gamified environments, which can influence both usability and engagement outcomes.

Due to limited variability in gaming exposure, no clear exploratory relationship was found between demographics and average weekly hours spent playing video games.

For all 3 questionnaires, participants recorded their answers across every dimension and system. For comparison between the GBS and NGBS, bar plots were generated to represent results and highlight differences in UX and overall performance patterns, as shown in Figure 6. Questionnaire responses showed significant differences and greater results in focused attention, aesthetic appeal, reward factor, attractiveness, stimulation, and novelty domains when using the gamified version.

Although the PSSUQ domains and the perceived usability domain of the UES-SF scored slightly higher in the NGBS than in the GBS, this resulted in a significant difference in only 1 of the 4 domains.

Afterward, a comprehensive statistical analysis was performed, which included the calculation of metrics such as mean score, SD, P value, and r coefficient, as presented in Tables 2-4.

During auditory discrimination tasks, background noise was recorded when both systems were used. Background noise for the GBS had a mean equivalent continuous A-weighted sound pressure level of 43.21 (SD 3.39), and for the NGBS, it had a mean equivalent continuous A-weighted sound pressure level of 37.79 (SD 2.08), which means that for both systems, the background noise was very low during training and may not affect discrimination performance.

This study aimed to design a game-based auditory discrimination training system and compare it with an equivalent non–game-based version through UEQs and behavioral performance. Main findings of this work suggest that in terms of UX, the game-based system significantly improved engagement-related and hedonic dimensions while maintaining comparable auditory discrimination performance across most metrics. In contrast, the non–game-based system showed a slight advantage in perceived usability, suggesting a trade-off between simplicity and engaging elements [38]. Behavioral results showed that the non–game-based system tended toward slower but slightly more accurate responses. Despite added cognitive load, the game-based system maintained similar efficiency and no degradation of auditory discrimination, suggesting that gamification enhanced engagement without impairing performance [39].

Our study has revealed that UEQ dimensions such as attractiveness, stimulation, and novelty were consistently higher in the GBS, indicating a more engaging and appealing UX. In contrast, usability dimensions such as clarity, efficiency, and dependability showed no relevant differences between systems. These results imply that the design of game-based auditory training did not compromise usability aspects as recommended [40]. This is important since if the system is insufficiently easy to use, the user may choose to avoid the system or use it improperly even if other aspects, such as functionality, are well thought out [41], and this can drastically impact the UX and training outcomes [42]. PSSUQ results indicated no significant differences between systems in perceived usability, suggesting that both interfaces were functionally comparable. These findings suggest that the NGBS design may be more straightforward in terms of usability, which may not be the case in more interactive systems [40]. Similarly, engagement-related dimensions in the UES-SF consistently favored the GBS, particularly in terms of focused attention, aesthetic appeal, and perceived reward. Overall, these findings indicate that gamification may enhance user engagement while not differing in levels of usability.

A factor that could be relevant and influential to interpreting UX outcomes is the rate of exposure to video games. Most participants reported “low” gaming activity (<4 h/wk), indicating limited familiarity with gamified environments. Repetitive gaming experience (replay value) can influence how users perceive and interact with gamified systems [43]. Users who regularly play video games are accustomed to dynamic interfaces, reward structures, and multitasking demands, which may reduce cognitive load, in contrast with users with limited gaming experience, who may initially perceive gamified environments as more complex and less intuitive, potentially contributing to the slightly higher usability ratings observed for the non–game-based system [44]. Still, out of the 11 participants, only 2 reported higher use of video games (4‐8 h and 8-12 h), and no exploratory trend was found.

Interestingly, most of the KPIs showed nonsignificant differences between systems, with the exception of MRT (duration), MRT of JND (pitch and duration), PC (pitch), and ADPI (pitch), suggesting comparable auditory performance across systems. KPIs related to BIS showed slightly higher MRT values for the NGBS when compared to the GBS across both training features, indicating an overall slower response that could be attributed to the absence of dynamic elements in the NGBS, as supported by studies comparing tasks with and without game elements [45]. NGBS also exhibited slightly higher PC results, supported by the traditional speed-accuracy trade-off, where reaction time correlates with accuracy [46,47]. However, when comparing training features, BIS shows a clear trend: both systems exhibit positive values in the pitch feature, indicating fast and accurate performance, whereas the negative values in duration training reflect slower and inaccurate performance. Regarding MRT of JND, related to ADPI, NGBS showed longer reaction times than GBS, while Weber fraction had no variation in pitch but a larger value for GBS duration, possibly indicating lower sensibility. However, significant differences were only found for MRT of JND in both pitch and duration, as well as for ADPI pitch. Additionally, since participants in the NGBS achieved higher MRTs but lower Weber fraction values, slightly higher ADPI results were obtained. This enhances the efficiency compensation of the speed-accuracy trade-off [31].

The dual-task element introduced in the game-based system did not lead to a decline in performance, as shown by BIS and ADPI results. Conversely, participants in the GBS maintained similar BIS values to the NGBS and even showed an improvement in ADPI. Similar results were found in a study involving an auditory discrimination gamified system [48], where the enhancement of learning was attributed to the reward signals playing a reinforcement role. In the present study, this may suggest that the different aspects of the game-based system (eg, animated success/error, points, lives, visual stimuli, background music) served to mitigate the monotony of the primary task—repetitive auditory discrimination—rather than acting as a source of distraction, thereby enhancing engagement and maintaining performance despite the additional cognitive load [49]. This finding also highlights the potential benefits of the infinite runner game genre in these tasks, suggesting recommended levels of cognitive load to mediate task difficulty and user performance [50].

Studying the relationships between engagement and outcomes has been suggested in game-assisted learning, as motivation may play a crucial role in effectiveness [51]. This is supported by other studies that suggest that user-perceived experience and cognitive load may be good predictors of cognitive training performance [52]. Thus, players’ interactions with the systems’ mechanics (dynamics) and aesthetics (feelings of players during those interactions) [53] may enhance user-perceived experience while balancing cognitive load to optimize performance.

This study has several limitations that should be considered. First, the sample size was modestly small and limited to young adults. This may bias behavioral performance significance and restrict the generalizability of the findings to other populations but may serve as a pilot study for treating auditory processing disorders [54] or hearing device users [55]. The sample size is considered enough for addressing usability-related measurements; however, the significance of differences in behavioral performance should be interpreted with caution. Second, the sample presented a slightly unbalanced gender distribution with a male-to-female ratio of 1.75:1. Although acceptable for initial studies, it can introduce bias in UX perceptions. Future studies should aim for a more balanced sample in gender distribution to ensure broader generalizability of the findings. Moreover, the evaluation focused on short-term performance and UX and therefore does not allow conclusions about long-term training effects, as auditory processing is subject to different time courses of plasticity [56]. Although the systems were carefully controlled to isolate the effect of gamification, other factors such as individual familiarity with video games and personal preferences may have influenced engagement outcomes [57].

The usability-engagement tradeoff seen in the results between both systems could be addressed through adaptive, user-centered interface design. Interface complexity may adapt to user performance and familiarity, offering simpler layouts for novices and more dynamic environments for experienced users [58]. Additionally, progressive disclosure can introduce game mechanics, scoring, and feedback incrementally, maintaining clarity while leveraging motivational benefits [59]. Over time, neuroplasticity-related adaptation may further enhance usability, as repeated exposure to gamified environments improves users’ efficiency and perception of the interface [49]. Consequently, although non–game-based systems may provide immediate usability advantages, game-based systems could match or surpass them as familiarity increases and cognitive load decreases [59].

Taken together, the present findings highlight the value of incorporating gamification into auditory discrimination training, particularly as a strategy to enhance engagement and sustained attention without negatively affecting performance [52]. A key contribution of this study lies in directly comparing game-based and non–game-based systems under controlled conditions, which offers a more nuanced perspective on how specific game elements may influence UX and behavioral outcomes, although game elements may vary across conditions and other outcomes [60]. From an applied standpoint, the observed improvements in engagement-related domains suggest that such approaches may support greater adherence to auditory training protocols, which is critical for compliance in the real-world aural rehabilitation process [61]. Future research should further explore these effects over longer periods to determine the systems’ efficiency in longitudinal studies, as it is suggested that gamification may perform more efficiently compared to control groups [62].

This study compared the use of gamification in auditory discrimination tasks. The introduction of gamified dual tasks favors a better qualitative perception of UX, particularly those related to engagement- and attention-related domains but may complicate interface understanding in a first approach, since more elements are displayed that require higher attention and cognitive workload when starting with system interaction. This is supported by qualitative feedback items suggesting longer tutorials. The introduction of a dual task did not significantly affect performance in auditory discrimination tasks for duration and pitch features in the GBS compared to the NGBS, as shown by BIS and ADPI, even presenting slightly better scores for the GBS, although not significant except for ADPI in pitch. This also suggests that gamified discrimination tasks tend to decrease reaction time as part of the game mechanics, yielding focused attention and faster responses.

The current research also analyzes some key gamification elements that impact user perception. Findings suggest that the infinite runner game genre is flexible with auditory tasks and enhances engagement and attentional resources, supported by both questionnaire and discrimination performance results, providing important insights into genre selection for training compatibility. Additionally, longer exposure time is something to consider, as only one training session was evaluated and could yield slower responses due to first impressions. This may guide further research on the long-term impact of gamification on user evaluation and performance in auditory tasks, where improvements can be measured to compare both systems based on users’ responses. More research is still needed in game-based training and user-centered design for auditory technology development to deliver better experiences to youths and children in aural habilitation and rehabilitation processes that enhance attention, fun, and lead to better auditory discrimination. Overall, our findings support the use of gamified, dual-task paradigms as a promising strategy to enhance UX and engagement in auditory discrimination training without compromising short-term performance. Future longitudinal studies should examine whether these experiential benefits translate into sustained improvements in auditory performance and clinical outcomes.