Community Health Workers (CHWs) play a critical role in delivering primary healthcare services in low-resource settings, yet sustaining their training and performance remains a persistent challenge. Prior research has explored digital and game-based approaches for CHW training. However, limited work has synthesized longitudinal design insights into generalizable guidelines for interactive health interventions. Building on a four-year design-based research program involving multiple game-based refresher training systems, including quiz-based mobile apps, physical and augmented reality games, card-based games, and location-based games, we examine which design guidelines support sustained engagement, learning transfer, and contextual appropriateness in CHW training. We conducted a mixed-methods analysis across deployments with Accredited Social Health Activists and Anganwadi Workers in India, including interviews, field observations, and usage logs. Through thematic synthesis, we derive eight design guidelines addressing contextual realism, adaptive learning, hybrid interaction, social motivation, explainability, professional identity, and ethical considerations. Our findings contribute actionable design knowledge for researchers and practitioners developing interactive health interventions in low-resource healthcare contexts.

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