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Deniz HA, Polat Balkan E, İncebeyaz B, Kamburoğlu K. Effect of gamification applications on success of dentistry students. World J Methodol 2025; 15:97374. [PMID: 40115397 PMCID: PMC11525888 DOI: 10.5662/wjm.v15.i1.97374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/03/2024] [Accepted: 08/05/2024] [Indexed: 09/29/2024] Open
Abstract
BACKGROUND Gamification, the use of game materials in education, has been used in several scientific fields, and studies have demonstrated its effectiveness in student comprehension. AIM To evaluate whether the success of 4th- and 5th-grade dentistry students increases when using the gamification applications Kahoot! and Mentimeter. METHODS An experimental design was used to measure the effect of gamification applications on students who were taught using the traditional method. For this purpose, Mentimeter and Kahoot! applications were used in this experimental study. Three groups of 4th- and 5th-grade students were formed: Mentimeter, Kahoot!, and control groups. The effect of gamification applications on achievement was evaluated by administering a post-test to these groups after the instructional process. One-way analysis of variance and t-tests were used for statistical analyses. RESULTS A total of 35.5% of the students were in the Mentimeter group, 29.8% in the Kahoot! group, and 34.6% in the control group. Of the total number of students, 54.8% were female and 45.2% were male, while 52.2% were 5th-grade students and 47.8% were 4th-grade students. The overall grade point average was found to be 66.65 (range, 24-100). There was a statistically significant difference in average success scores between students of different groups (P = 0.003 < 0.05) and grades (P = 0.036 < 0.05). The average success score was the highest in the Mentimeter group (71.64) and the lowest in the Kahoot! group (62.15). In the control group, this score was 65.41. The average success score was higher for students in the 5th-grade (68.16) and for female students (68.84). CONCLUSION Gamification has a great potential in the education of dentomaxillofacial radiology students. Mentimeter outperformed both the Kahoot! and the traditional method in terms of average student success rates.
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Affiliation(s)
- Hatice Ahsen Deniz
- Department of Dentomaxillofacial Radiology, Ankara University Faculty of Dentistry, Ankara 06500, Türkiye
| | - Elif Polat Balkan
- Department of Dentomaxillofacial Radiology, Ankara University Faculty of Dentistry, Ankara 06500, Türkiye
| | - Burak İncebeyaz
- Department of Dentomaxillofacial Radiology, Ankara University Faculty of Dentistry, Ankara 06500, Türkiye
| | - Kıvanç Kamburoğlu
- Department of Dentomaxillofacial Radiology, Ankara University Faculty of Dentistry, Ankara 06500, Türkiye
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Hansen K. From Surviving to Thriving: A Roadmap for Reinventing Cardiac Rehabilitation in Pediatric Congenital Heart Disease. Can J Cardiol 2025; 41:375-385. [PMID: 39603342 DOI: 10.1016/j.cjca.2024.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 11/11/2024] [Accepted: 11/12/2024] [Indexed: 11/29/2024] Open
Abstract
Exercise is an essential component of the cardiac care of children with congenital heart disease (CHD), and safe and effective exercise counselling by the medical team is important early in life to develop positive physical activity and exercise habits. Without it, children are at risk for sedentariness and related comorbidities in childhood and adulthood. Pediatric cardiologists can guide patients to a cycle of positive fitness through exercise counselling, promotion, prescription, and/or supervised exercise training similar to adult cardiac rehabilitation (ACR). ACR has improved exercise capacity, mortality, and quality of life in adults with acquired heart disease. Similar outcomes have been shown in exercise training for adult and pediatric CHD. Exercise training specific to pediatric CHD is not widely available but is expanding in response to growing need and increasing demand. Although ACR provides a framework for structured exercise training, approaches to pediatric exercise training must be individualized and innovated upon to be successful for children. I propose that the ACR model must be reinvented for children with CHD by integrating 6 missing pieces. First, the underlying goal should be to optimize fitness, not rehabilitate to a previous state of health. Second and third are training mental skills and motor skills. Fourth, play-based exercise training is needed to foster a positive relationship with exercise. Fifth, family-focused exercise interventions can address root causes of sedentariness. Finally, building communities in which positive fitness is a priority will be essential to long-term sustainability.
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Affiliation(s)
- Katherine Hansen
- Division of Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA.
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Shakoor A, Mohansingh C, van der Boon RMA, Brugts JJ, Schaap J. Gamification and its Potential for Better Engagement in the Management of Heart Failure or Quality of Care Registries: A Viewpoint. Curr Heart Fail Rep 2024; 22:4. [PMID: 39636506 DOI: 10.1007/s11897-024-00692-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2024] [Indexed: 12/07/2024]
Abstract
Over the past decade, gamification, an umbrella term that refers to tools that engage and motivate participants through the use of game design elements (e.g., challenges and rewards) in a non-gaming context, has emerged as a promising approach in the management of chronic diseases. Specifically, it has been demonstrated to be effective in the education of both patients as well as healthcare professionals on medication adherence, risk reduction, patient self-care, and rehabilitation. There is some evidence suggesting that gamification might have similar benefits for heart failure (HF) patients and their health care professionals. This is of specific interest since HF is a chronic disease associated with a severely compromised long-term prognosis and subsequent high health care resource utilization. However, more robust research is needed to confirm these findings and determine the optimal method, as well as barriers, to the implementation of gamification in the working process of health care professionals or treatment adherence to patients specifically in the setting of HF. This viewpoint explores the literature concerning HF and gamification and aims to identify its various potentials in the management of HF patients.
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Affiliation(s)
- Abdul Shakoor
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, The Netherlands
| | - Chanu Mohansingh
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, The Netherlands
| | - Robert M A van der Boon
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, The Netherlands
| | - Jeroen Schaap
- Department of Cardiology, Amphia Hospital, Molengracht 21, Breda, 4818 CK, The Netherlands.
- Dutch Network for Cardiovascular Research (WCN), Utrecht, The Netherlands.
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Gallagher R, Neubeck L, Davis A, Redfern J, Parker HM, Hyun K, Chow C, Celermajer DS, Buckley T, Schumacher T, Tofler G, Figtree G. A Self-Administered Gamified Mobile Application for Secondary Prevention of Heart Disease in Patients Following a Cardiac Event (MyHeartMate): Process Evaluation from a Randomized Controlled Trial. Games Health J 2024. [PMID: 39585749 DOI: 10.1089/g4h.2024.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2024] Open
Abstract
Objective: This study reports the process evaluation of a randomized controlled trial of the MyHeartMate app for patients with coronary heart disease (CHD). Materials and Methods: Data were collected on engagement in the intervention group from the app platform logs and self-reported usage and via interviews for perspectives of usefulness and acceptability. Participants' (n = 194) data logs showed 80.4% entered baseline data. Tracking (≥30 days) occurred for body mass index (23.2%), blood pressure (BP) (21.1%), and exercise (23.7%). Missions completed on ≥4 days were 47.5% for healthy eating and 30.9% for exercise; 50.5% used the word game. One quarter (26.8%) was classified as "engaged" (tracked exercise and/or BP ≥5 times and completed ≥18 missions in the first 30 days). There were no differences between participants who were "engaged" or not in baseline characteristics or 6-month outcomes, although engaged users were more likely to meet 4/5 recommended risk factor guideline levels (30.8% vs. 17.6%, P = 0.03). Results: Participants perceived tracking, prompts, and rewards as useful for recovery and risk factor-related lifestyle change, and games were enjoyed. Engagement decreased with time. Acceptability was limited when app processes were difficult to understand, not personalized enough and/or the overall game concept was disliked. Conclusions: Insight into user's perceptions and use of gamified app components is essential to address barriers to uptake and optimize potential health benefits. The target audience for a serious game app for CHD remains uncertain.
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Affiliation(s)
- Robyn Gallagher
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lis Neubeck
- The Centre for Cardiovascular Health, Edinburgh Napier University, Sighthill, United Kingdom
| | - Angus Davis
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Julie Redfern
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
| | - Helen M Parker
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Clara Chow
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - David S Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Thomas Buckley
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tracy Schumacher
- College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, New South Wales, Australia
| | - Geoffrey Tofler
- Department of Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Gemma Figtree
- Department of Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Homem F, Reveles A, Amaral A, Coutinho V, Gonçalves L. Improving transitional care after acute myocardial infarction: A scoping review. HEALTH CARE SCIENCE 2024; 3:312-328. [PMID: 39479273 PMCID: PMC11520247 DOI: 10.1002/hcs2.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/18/2024] [Accepted: 08/05/2024] [Indexed: 11/02/2024]
Abstract
Cardiovascular disease remains the leading cause of morbidity and mortality, posing a significant challenge to healthcare systems worldwide. Transitional care interventions, which ensure coordination and continuity of care as patients move between different levels of healthcare, have been shown to reduce unnecessary healthcare utilization and improve patient outcomes. While much attention has been given to transitional care in heart failure, this review aims to map the interventions implemented for patients following an acute myocardial infarction (AMI). A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology, with literature searches performed in the Cochrane, CINAHL, MEDLINE, JBI, and SciELO databases, focusing on publications from 2013 onwards in both Portuguese and English. Seventy-five studies were included, with most combining multiple interventions that contributed to improved cardiovascular health outcomes, including increased adherence to healthy lifestyle behaviors, enhanced medication compliance, and better healthcare self-management. These interventions were effective in reducing cardiovascular-related Emergency Department visits, unplanned 30-day readmissions, and mortality following a first-time myocardial infarction. Key strategies identified included discharge planning, digital health solutions, outpatient care, and healthcare coordination. The findings of this review underscore the need for developing methodologies that enhance the transition of care from hospital to primary care following an AMI. There is an urgent need to design and implement new healthcare programs that integrate discharge interventions, digital health, outpatient care, and healthcare coordination to ensure continuity of care and optimize patient outcomes post-discharge.
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Affiliation(s)
- Filipa Homem
- ULS Coimbra, Cardiologia CHUCCoimbraPortugal
- UICISA:E/ESEnfCCoimbra UniversityCoimbraPortugal
| | - Anaísa Reveles
- ULS Baixo Mondego, UIDRua HospitalFigueira da FozPortugal
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Shakoor A, Mohansingh C, El Osrouti A, Borleffs JWC, van Houwelingen GK, van de Swaluw JEC, van Kimmenade R, den Besten M, Pisters R, van Ofwegen-Hanekamp CEE, Koudstaal S, Handoko LM, Asselbergs FW, van Veghel D, van Wijk SS, van der Boon RMA, Brugts JJ, Schaap J. Design and rationale of the Engage-HF study: the impact of a gamified engagement toolkit on participation and engagement in a heart failure registry. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:643-650. [PMID: 39318682 PMCID: PMC11417485 DOI: 10.1093/ehjdh/ztae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/24/2024] [Accepted: 07/01/2024] [Indexed: 09/26/2024]
Abstract
Aims Heart failure (HF) registries provide valuable insights into patient management and quality of care. However, healthcare professionals face challenges due to the administrative burden of participation in registries. This study aims to evaluate the impact of education through an engagement toolkit on HF nurse practitioners' participation rate and data completeness in a national registry: the Netherlands Heart Registration-Heart Failure (NHR-HF) registry. Methods and results Engage-HF is an observational study (intervention at the HF nurse level) with a pretest-posttest design within the participating hospitals. Between December 2022 and April 2024, 28 HF nurse practitioners from 12 hospitals will participate in a 24-week educational programme using the Engage-HF engagement toolkit. The main interaction platform in this toolkit is a gamified smartphone-based educational application called BrightBirds. The complete toolkit includes this educational application with weekly challenges, interactive posters, pop-ups, and alert messages, and a follow-up call at Week 4. The primary endpoints are the NHR-HF participation rates and data completeness at 1 and 6 months after using the toolkit. Additionally, we will analyse the experience of participants with the toolkit concerning their HF registry and knowledge of ESC 2021 HF guidelines. Conclusion The Engage-HF study is the first to explore the impact of education through a gamified engagement toolkit to boost participation rates in a HF registry (NHR-HF) and test participant knowledge of the ESC 2021 HF guidelines. This innovative approach addresses challenges in the rollout of healthcare registries and the implementation of guidelines by providing a contemporary support base and a time-efficient method for education.
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Affiliation(s)
- Abdul Shakoor
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, The Netherlands
| | - Chanu Mohansingh
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, The Netherlands
| | - Azzeddine El Osrouti
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, The Netherlands
| | - Jan Willem C Borleffs
- Department of Cardiology, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 AA The Hague, The Netherlands
| | - Gert K van Houwelingen
- Department of Cardiology, Medisch Spectrum Twente, Koningstraat 1, 7512 Enschede, The Netherlands
| | | | - Roland van Kimmenade
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Marjolein den Besten
- Department of Cardiology, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands
| | - Ron Pisters
- Department of Cardiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands
| | | | - Stefan Koudstaal
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, The Netherlands
- Department of Cardiology, Groene Hart Hospital, Bleulandweg 10, 2803 HH Gouda, The Netherlands
| | - Louis M Handoko
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Dennis van Veghel
- Netherlands Heart Registration, Moreelsepark 1, 3511 EP Utrecht, The Netherlands
| | - Sandra S van Wijk
- Department of Cardiology, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands
| | - Robert M A van der Boon
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, The Netherlands
| | - Jeroen Schaap
- Department of Cardiology, Amphia Hospital, Molengracht 21, 4818 CK Breda, The Netherlands
- Dutch Network for Cardiovascular Research (WCN), Moreelsepark 1, 3511 EPUtrecht, The Netherlands
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Huang X, Xiang X, Liu Y, Wang Z, Jiang Z, Huang L. The Use of Gamification in the Self-Management of Patients With Chronic Diseases: Scoping Review. JMIR Serious Games 2023; 11:e39019. [PMID: 38133907 PMCID: PMC10770795 DOI: 10.2196/39019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 02/26/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Chronic disease self-management is a public health issue of worldwide concern, and gamification is an emerging strategy to improve patients' participation in chronic disease self-management. Some studies have summarized designs for the gamification of chronic disease self-management from the perspective of eHealth technology, but they have not mentioned differences in design methods, functions, and evaluation methods of gamified designs for self-management in different chronic diseases. OBJECTIVE This scoping review aims to synthesize the characteristics of realization forms, functions, and evaluation methods in chronic disease self-management gamification to improve self-management among the chronic disease population. METHODS We applied a methodological framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. As of January 7, 2023, we systematically searched 9 databases for relevant studies from January 2012 to December 2022. Related data were extracted based on the research questions. We calculated the frequencies, charted the quantitative data, and coded the extracted material for qualitative content analysis. RESULTS We retrieved 16,221 records, of which 70 (0.43%) met the eligibility criteria. In the included research, the target populations for gamified designs for self-management of chronic diseases included patients with stroke, cancer, diabetes, chronic obstructive pulmonary disease, coronary heart disease, obesity, and hypertension. Almost all studies mentioned technical support for gamification (68/70, 97%), mainly in the form of active video games (58/70, 83%); however, less than half of the studies mentioned the theoretical basis for gamification (31/70, 44%). There were 37 concepts or theories relevant to gamification design, most of which were in the field of psychology or were cross-disciplinary (n=33, 89%). Gamification for the self-management of chronic diseases has been widely recognized, including for promoting physical exercise and rehabilitation training (48/99, 48%), increasing initiative for symptom management (18/99, 18%), providing psychological support (14/99, 14%), improving cognitive function (12/99, 12%), and improving medication adherence (7/99, 7%). A total of 39 studies mentioned the gamification effect; however, we did not find a unified evaluation standard. CONCLUSIONS This scoping review focuses on gamification designs for chronic disease self-management and summarizes the realization forms and functions of gamification in self-management for different patient populations. With practice in a gamified internet-based environment, patients can not only master the knowledge and skills of self-management in fascinating scenarios but also benefit from gaming experience and make better health-related decisions in real life. It is worth noting that a comprehensive evaluation of the users as well as a personalized and targeted intervention should be developed before gamification.
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Affiliation(s)
- Xiting Huang
- Nursing Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinyue Xiang
- Department of Respiratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yang Liu
- Nursing Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhiqian Wang
- Nursing Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhili Jiang
- Nursing Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lihua Huang
- Nursing Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Stephen BUA, Uzoewulu BC, Asuquo PM, Ozuomba S. Diabetes and hypertension MobileHealth systems: a review of general challenges and advancements. JOURNAL OF ENGINEERING AND APPLIED SCIENCE 2023; 70:78. [DOI: 10.1186/s44147-023-00240-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/14/2023] [Indexed: 01/06/2025]
Abstract
AbstractMobile health (mHealth) systems are sipping into more and more healthcare functions with self-management being the foremost modus operandi. However, there has been challenges. This study explores challenges with mHealth self-management of diabetes and hypertension, two of the most comorbid chronic diseases. Existing literature present the challenges in fragments, certain subsets of the challenges at a time. Nevertheless, feedback from patient/users in extant literature depict very variegated concerns that are also interdependent. This work pursues provision of an encyclopedic, but not redundant, view of the challenges with mHealth systems for self-management of diabetes and hypertension.Furthermore, the work identifies machine learning (ML) and self-management approaches as potential drivers of potency of diabetes and hypertension mobile health systems. The nexus between ML and diabetes and hypertension mHealth systems was found to be under-explored. For ML contributions to management of diabetes, we found that machine learning has been applied most to diabetes prediction followed by diagnosis, with therapy in distant third. For diabetes therapy research, only physical and dietary therapy were emphasized in reviewed literature. The four most considered performance metrics were accuracy, ROC-AUC, sensitivity, and specificity. Random forest was the best performing algorithm across all metrics, for all purposes covered in the literature. For hypertension, in descending order, hypertension prediction, prediction of risk factors, and prediction of prehypertension were most considered areas of hypertension management witnessing application of machine learning. SVM averaged best ML algorithm in accuracy and sensitivity, while random forest averaged best performing in specificity and ROC-AUC.
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Lukey A, Mackay M, Hasan K, Rush KL. A Pre-Post, Mixed-Methods Study to Pilot Test a Gamified Heart Failure Self-Care Education Intervention. Games Health J 2023; 12:385-396. [PMID: 37582271 DOI: 10.1089/g4h.2022.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Objective: Self-care is essential to improving heart failure patient outcomes. However, the knowledge and behaviours necessary for self-care decision making, such as symptom perception and management, are complex and require patient education. The objective of this study was to test the feasibility, acceptability, and potential effectiveness of a web-based, gamified heart failure patient education solution, Heart Self-Care Patient Education (HeartSCaPE), that used narrative and virtual reward gamification techniques. Materials and Methods: This mixed-methods study used a pre-post-test design with an embedded explanatory qualitative phase. Patients completed the Self-Care of Heart Failure Index, that measured self-care behaviour change and the Dutch Heart Failure Knowledge Scale, used to measure heart failure knowledge. Usability measures of HeartSCaPE were tracked using Google Analytics and the System Usability Scale. Results: Nineteen patients completed the study, with a subset of six participating in semi-structured interviews. We found increases in HF knowledge despite high baseline knowledge scores. Post-intervention self-reported HF self-care behaviours (maintenance, management and confidence), as measured by the Self-Care of Heart Failure Index, were also improved. Knowledge and self-care scores were not correlated. Participants also scored HeartSCaPE as highly usable. In interviews, participants described valuing the opportunity to practice self-care decision-making. There were mixed opinions regarding the use of virtual rewards. Conclusion: We found that a gamified web-based solution that uses narrative and reward-based gamification techniques has the potential to improve HF patient knowledge and self-care. Further research is needed to confirm the study's clinical benefits and address technology literacy inequities.
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Affiliation(s)
- Alexandra Lukey
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Martha Mackay
- School of Nursing, University of British Columbia, Vancouver, Canada
- Center for Health Evaluation and Outcomes Sciences, Vancouver, Canada
| | - Khalad Hasan
- Computer Science, University of British Columbia Okanagan, Kelowna, Canada
| | - Kathy L Rush
- School of Nursing, University of British Columbia Okanagan, Kelowna, Canada
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Velez M, Lugo-Agudelo LH, Patiño Lugo DF, Glenton C, Posada AM, Mesa Franco LF, Negrini S, Kiekens C, Spir Brunal MA, Roberg ASB, Cruz Sarmiento KM. Factors that influence the provision of home-based rehabilitation services for people needing rehabilitation: a qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 2:CD014823. [PMID: 36780267 PMCID: PMC9918343 DOI: 10.1002/14651858.cd014823] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND To increase people's access to rehabilitation services, particularly in the context of the COVID-19 pandemic, we need to explore how the delivery of these services can be adapted. This includes the use of home-based rehabilitation and telerehabilitation. Home-based rehabilitation services may become frequently used options in the recovery process of patients, not only as a solution to accessibility barriers, but as a complement to the usual in-person inpatient rehabilitation provision. Telerehabilitation is also becoming more viable as the usability and availability of communication technologies improve. OBJECTIVES To identify factors that influence the organisation and delivery of in-person home-based rehabilitation and home-based telerehabilitation for people needing rehabilitation. SEARCH METHODS We searched PubMed, Global Health, the VHL Regional Portal, Epistemonikos, Health Systems Evidence, and EBM Reviews as well as preprints, regional repositories, and rehabilitation organisations websites for eligible studies, from database inception to search date in June 2022. SELECTION CRITERIA: We included studies that used qualitative methods for data collection and analysis; and that explored patients, caregivers, healthcare providers and other stakeholders' experiences, perceptions and behaviours about the provision of in-person home-based rehabilitation and home-based telerehabilitation services responding to patients' needs in different phases of their health conditions. DATA COLLECTION AND ANALYSIS: We used a purposive sampling approach and applied maximum variation sampling in a four-step sampling frame. We conducted a framework thematic analysis using the CFIR (Consolidated Framework for Implementation Research) framework as our starting point. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. MAIN RESULTS: We included 223 studies in the review and sampled 53 of these for our analysis. Forty-five studies were conducted in high-income countries, and eight in low-and middle-income countries. Twenty studies addressed in-person home-based rehabilitation, 28 studies addressed home-based telerehabilitation services, and five studies addressed both modes of delivery. The studies mainly explored the perspectives of healthcare providers, patients with a range of different health conditions, and their informal caregivers and family members. Based on our GRADE-CERQual assessments, we had high confidence in eight of the findings, and moderate confidence in five, indicating that it is highly likely or likely respectively that these findings are a reasonable representation of the phenomenon of interest. There were two findings with low confidence. High and moderate confidence findings Home-based rehabilitation services delivered in-person or through telerehabilitation Patients experience home-based services as convenient and less disruptive of their everyday activities. Patients and providers also suggest that these services can encourage patients' self-management and can make them feel empowered about the rehabilitation process. But patients, family members, and providers describe privacy and confidentiality issues when services are provided at home. These include the increased privacy of being able to exercise at home but also the loss of privacy when one's home life is visible to others. Patients and providers also describe other factors that can affect the success of home-based rehabilitation services. These include support from providers and family members, good communication with providers, the requirements made of patients and their surroundings, and the transition from hospital to home-based services. Telerehabilitation specifically Patients, family members and providers see telerehabilitation as an opportunity to make services more available. But providers point to practical problems when assessing whether patients are performing their exercises correctly. Providers and patients also describe interruptions from family members. In addition, providers complain of a lack of equipment, infrastructure and maintenance and patients refer to usability issues and frustration with digital technology. Providers have different opinions about whether telerehabilitation is cost-efficient for them. But many patients see telerehabilitation as affordable and cost-saving if the equipment and infrastructure have been provided. Patients and providers suggest that telerehabilitation can change the nature of their relationship. For instance, some patients describe how telerehabilitation leads to easier and more relaxed communication. Other patients describe feeling abandoned when receiving telerehabilitation services. Patients, family members and providers call for easy-to-use technologies and more training and support. They also suggest that at least some in-person sessions with the provider are necessary. They feel that telerehabilitation services alone can make it difficult to make meaningful connections. They also explain that some services need the provider's hands. Providers highlight the importance of personalising the services to each person's needs and circumstances. AUTHORS' CONCLUSIONS This synthesis identified several factors that can influence the successful implementation of in-person home-based rehabilitation and telerehabilitation services. These included factors that facilitate implementation, but also factors that can challenge this process. Healthcare providers, program planners and policymakers might benefit from considering these factors when designing and implementing programmes.
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Affiliation(s)
- Marcela Velez
- Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | | | | | - Claire Glenton
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ana M Posada
- Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University La Statale , Milano, Italy
- Laboratory of Evidence Based Rehabilitation, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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11
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Sivakumar B, Lemonde M, Stein M, Goldstein S, Mak S, Arcand J. Evaluating Health Care Provider Perspectives on the Use of Mobile Apps to Support Patients With Heart Failure Management: Qualitative Descriptive Study. JMIR Cardio 2022; 6:e40546. [PMID: 36287588 PMCID: PMC9647459 DOI: 10.2196/40546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nonadherence to diet and medical therapies in heart failure (HF) contributes to poor HF outcomes. Mobile apps may be a promising way to improve adherence because they increase knowledge and behavior change via education and monitoring. Well-designed apps with input from health care providers (HCPs) can lead to successful adoption of such apps in practice. However, little is known about HCPs' perspectives on the use of mobile apps to support HF management. OBJECTIVE The aim of this study is to determine HCPs' perspectives (needs, motivations, and challenges) on the use of mobile apps to support patients with HF management. METHODS A qualitative descriptive study using one-on-one semistructured interviews, informed by the diffusion of innovation theory, was conducted among HF HCPs, including cardiologists, nurses, and nurse practitioners. Transcripts were independently coded by 2 researchers and analyzed using content analysis. RESULTS The 21 HCPs (cardiologists: n=8, 38%; nurses: n=6, 29%; and nurse practitioners: n=7, 33%) identified challenges and opportunities for app adoption across 5 themes: participant-perceived factors that affect app adoption-these include patient age, technology savviness, technology access, and ease of use; improved delivery of care-apps can support remote care; collect, share, and assess health information; identify adverse events; prevent hospitalizations; and limit clinic visits; facilitating patient engagement in care-apps can provide feedback and reinforcement, facilitate connection and communication between patients and their HCPs, support monitoring, and track self-care; providing patient support through education-apps can provide HF-related information (ie, diet and medications); and participant views on app features for their patients-HCPs felt that useful apps would have reminders and alarms and participative elements (gamification, food scanner, and quizzes). CONCLUSIONS HCPs had positive views on the use of mobile apps to support patients with HF management. These findings can inform effective development and implementation strategies of HF management apps in clinical practice.
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Affiliation(s)
- Bridve Sivakumar
- Faculty of Health Science, Ontario Tech University, Oshawa, ON, Canada
| | - Manon Lemonde
- Faculty of Health Science, Ontario Tech University, Oshawa, ON, Canada
| | - Matthew Stein
- Social Research Centre, Ontario Tech University, Oshawa, ON, Canada
| | - Sarah Goldstein
- School of Nutrition, Faculty of Community Services, Toronto Metropolitan University, Toronto, ON, Canada
| | - Susanna Mak
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sinai Health, Toronto, ON, Canada
| | - JoAnne Arcand
- Faculty of Health Science, Ontario Tech University, Oshawa, ON, Canada
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12
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Radhakrishnan K, DeMain AS, Julien C, Leggio K, O'Hair M, Hebért Arsers ET, Lee G, Baranowski T. A Sensor-Controlled Digital Game for Heart Failure Self-Care Based on Behavioral Change Frameworks. SEGAH ... IEEE ... INTERNATIONAL CONFERENCE ON SERIOUS GAMES AND APPLICATIONS FOR HEALTH : BOOK OF PROCEEDINGS. IEEE INTERNATIONAL CONFERENCE ON SERIOUS GAMES AND APPLICATIONS FOR HEALTH 2022; 2022:10.1109/segah54908.2022.9978594. [PMID: 37817860 PMCID: PMC10564567 DOI: 10.1109/segah54908.2022.9978594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
Self-care behaviors are critical to manage the adverse impact of heart failure disease. However, engaging in self-care behaviors such as physical activity or daily weight-monitoring can be difficult due to lack of knowledge or motivation. Digital games can serve as an alternative to traditional patient education to provide information and motivate engagement in critical self-care behaviors. In this paper, we describe a sensor-controlled digital game (SCDG) in which game play is driven by the player's real life self-care behaviors. We also present the design and development of the next iteration of the SCDG based on playtesting results and behavioral theoretical frameworks.
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Affiliation(s)
| | | | - Christine Julien
- Cockrell School of Engineering, The University of Texas-Austin, Austin, USA
| | - Katelyn Leggio
- School of Nursing, The University of Texas-Austin, Austin, USA
| | | | | | - Grace Lee
- Cockrell School of Engineering, The University of Texas-Austin, Austin, USA
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13
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Berglund A, Jaarsma T, Berglund E, Strömberg A, Klompstra L. Understanding and assessing gamification in digital healthcare interventions for patients with cardiovascular disease. Eur J Cardiovasc Nurs 2022; 21:630-638. [PMID: 35709297 DOI: 10.1093/eurjcn/zvac048] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 11/14/2022]
Abstract
Gamification is defined as the use of game design elements in contexts other than gaming to increase user engagement and experience. Gamification in cardiovascular care can contribute to positively change health behaviour with possible effects and benefits on physical health and mental well-being. Based on previous literature, in this article we describe: the conceptualization of gamification, the five gamification principles for gamified digital health programmes or applications, the six most common game elements used to impact health behaviour applied in gamified digital health interventions and finally scientifically validated instruments to use for assessment of gamification in terms of self-reported psychological outcomes.
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Affiliation(s)
- Aseel Berglund
- Department of Computer and Information Science, Linköping University, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Erik Berglund
- Department of Computer and Information Science, Linköping University, Linköping, Sweden
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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14
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Mahrer-Imhof R, Østergaard B, Brødsgaard A, Konradsen H, Svavarsdóttir EK, Dieperink KB, Imhof L, García-Vivar C, Luttik ML. Healthcare practices and interventions in Europe towards families of older patients with cardiovascular disease: A scoping review. Scand J Caring Sci 2022; 36:320-345. [PMID: 34786754 DOI: 10.1111/scs.13045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 10/19/2021] [Accepted: 10/24/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND In Europe, cardiovascular disease is one of the predominant causes of mortality and morbidity among older people over 65 years. The occurrence of cardiovascular disease can have a negative impact on the quality of life of older patients and their families and family health overall. Assuming that illness is a family affair shaped by culture and health care systems, we explored European health care practices and interventions toward families of older patients with cardiovascular disease and heart failure. AIMS This paper aimed to determine the extent, range, and variety of practices and interventions in Europe directed to families of older patients and to identify knowledge gaps. MATERIALS & METHODS A scoping review was conducted including studies published in Medline, CINHAL, or Cochrane library between 2009 and mid-2020. RESULTS A total of 22 articles from 17 studies were included, showing diverse practices and interventions. The interventions targeted the family as a unit (six studies), dyads (five studies), patients alone, but assessed family members' reactions (five studies) or the family member primarily, but assessed the reaction of the patient (one study). Target outcomes were family caregiver burden; health-related QoL; and perceived control in patients; and family functioning and changes in health behavior or knowledge in both, family members and patients. Most studies did not include an integral view of the family as the unit of care but rather had a disease-centered approach. DISCUSSION This scoping review provides insight into a variety of healthcare practices towards families of older patients with cardiovascular disease in Europe. Clarifying underlying assumptions to involve families is needed. More studies with family-focused approaches as integral models could lead to practices that improve families' well-being. Exploring integral models for their acceptance in health care and family systems appears pertinent to develop European policy to support and add to family health.
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Affiliation(s)
- Romy Mahrer-Imhof
- Family-Centred and Community-Based Care, Nursing Science & Care Ltd, Basel, Switzerland
| | - Birte Østergaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne Brødsgaard
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Amager Hvidovre, Copenhagen, Denmark
- Section for Nursing, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Hanne Konradsen
- Department of Gastroenterology, Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurobiology, Care Sciences and Society, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Erla Kolbrun Svavarsdóttir
- School of Health Sciences, Faculty of Nursing, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Karin B Dieperink
- Family Focused Healthcare Research Center (FaCe), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Lorenz Imhof
- Family-Centred and Community-Based Care, Nursing Science & Care Ltd, Basel, Switzerland
| | | | - Marie-Louise Luttik
- Family Care, Hanze University of Applied Sciences, Groningen, The Netherlands
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15
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CardioVR-ReTone—Robotic Exoskeleton for Upper Limb Rehabilitation following Open Heart Surgery: Design, Modelling, and Control. Symmetry (Basel) 2022. [DOI: 10.3390/sym14010081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Following cardiac surgery, patients experience difficulties with the rehabilitation process, often finding it difficult, and therefore lack the motivation for rehabilitation activities. As the number of people aged 65 and over will rise by 207 percent globally by 2050, the need for cardiac rehabilitation will significantly increase, as this is the main population to experience heart problems. To address this challenge, this paper proposes a new robotic exoskeleton concept with 12 DoFs (6 DoFs on each arm), with a symmetrical structure for the upper limbs, to be used in the early rehabilitation of cardiac patients after open-heart surgery. The electromechanical design (geometric, kinematic, and dynamic model), the control architecture, and the VR-based operating module of the robotic exoskeleton are presented. To solve the problem of the high degree of complexity regarding the CardioVR-ReTone kinematic and dynamic model, the iterative algorithm, kinetic energy, and generalized forces were used. The results serve as a complete model of the exoskeleton, from a kinematic and dynamic point of view as well as to the selection of the electric motors, control system, and VR motivation model. The validation of the concept was achieved by evaluating the exoskeleton structure from an ergonomic point of view, emphasizing the movements that will be part of the cardiac rehabilitation.
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16
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Cestari VRF, Florêncio RS, Garces TS, Souza LCD, Pessoa VLMDP, Moreira TMM. MOBILE APP MAPPING FOR HEART FAILURE CARE: A SCOPING REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2021-0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to map mobile apps for care in heart failure. Method: this is a scoping review based on the method proposed by the Joanna Briggs Institute. The following research question was used: which mobile apps on heart failure are used by health professionals, people with heart failure and their family/caregivers? Health bases and portals were analyzed through the search with the descriptors “Heart Failure”, “Mobile Applications”, “Patients”, “Health Personnel”, “Family” and “Caregivers” and the keyword “Applications”. Forty-seven studies were selected for analysis. Results: a total of 47 published studies were analyzed, which allowed mapping 39 mobile applications from four continents, among which 20 (51.3%) were intended for co-management and 19 (48.7%) had as target population patients and health professionals; 23 (58.9%) applications did not use theoretical framework for its construction. The prevalent theme and resources involved daily care (36; 92.3%) and data management (37; 94.9%), respectively. Conclusion: the themes and resources of the applications assisted patients, family members and professionals in heart failure management. However, a gap was identified in several themes involving individuals and their surroundings, essential for comprehensive care.
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17
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Effects of Supervised Cardiac Rehabilitation Programmes on Quality of Life among Myocardial Infarction Patients: A Systematic Review and Meta-Analysis. J Cardiovasc Dev Dis 2021; 8:jcdd8120166. [PMID: 34940521 PMCID: PMC8703932 DOI: 10.3390/jcdd8120166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/11/2021] [Accepted: 11/25/2021] [Indexed: 12/13/2022] Open
Abstract
Coronary heart disease is the leading cause of death and disability worldwide. Traditionally, cardiac rehabilitation programmes are offered after cardiac events to aid recovery, improve quality of life, and reduce adverse events. The objective of this review was to assess the health-related quality of life, after a supervised cardiac rehabilitation programme, of patients who suffered a myocardial infarction. A systematic review was carried out in the CINAHL, Cochrane, LILACS, Medline, Scopus, and SciELO databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Randomised controlled trials were selected. Meta-analyses were performed for the Short Form Health Survey SF-36, Myocardial Infarction Dimensional Assessment Scale (MIDAS), MacNew Heart Disease-Health-Related Quality of Life (HRQL) questionnaire, and European Quality of Life-Visual Analogue Scale (EuroQol-VAS) with the software Cochrane RevMan Web. Ten articles were found covering a total of 3577 patients. In the meta-analysis, the effect size of the cardiac rehabilitation programme was statistically significant in the intervention group for physical activity, emotional reaction, and dependency dimensions of the MIDAS questionnaire. For the control group, the score improved for SF-36 physical functioning, and body pain dimensions. The mean difference between the control and intervention group was not significant for the remaining dimensions, and neither for the MacNew Heart Disease-HRQL and EuroQol-VAS questionnaires. Supervised cardiac rehabilitation programmes were effective in improving health-related quality of life, however, there was a potential variability in the interventions; therefore, the results should be interpreted with caution. This study supports the importance of providing care and evaluating interventions via the supervision of trained health professionals, and further randomised clinical trials are needed to analyse the positive changes in mental and physical health outcomes.
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18
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Radhakrishnan K, Julien C, Baranowski T, O'Hair M, Lee G, Sagna De Main A, Allen C, Viswanathan B, Thomaz E, Kim M. Feasibility of a Sensor-Controlled Digital Game for Heart Failure Self-management: Randomized Controlled Trial. JMIR Serious Games 2021; 9:e29044. [PMID: 34747701 PMCID: PMC8663490 DOI: 10.2196/29044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/03/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Poor self-management of heart failure (HF) contributes to devastating health consequences. Our innovative sensor-controlled digital game (SCDG) integrates data from sensors to trigger game rewards, progress, and feedback based on the real-time behaviors of individuals with HF. OBJECTIVE The aim of this study is to compare daily weight monitoring and physical activity behavior adherence by older adults using an SCDG intervention versus a sensors-only intervention in a feasibility randomized controlled trial. METHODS English-speaking adults with HF aged 55 years or older who owned a smartphone and could walk unassisted were recruited from Texas and Oklahoma from November 2019 to August 2020. Both groups were given activity trackers and smart weighing scales to track behaviors for 12 weeks. The feasibility outcomes of recruitment, retention, intervention engagement, and satisfaction were assessed. In addition to daily weight monitoring and physical activity adherence, the participants' knowledge, functional status, quality of life, self-reported HF behaviors, motivation to engage in behaviors, and HF-related hospitalization were also compared between the groups at baseline and at 6, 12, and 24 weeks. RESULTS A total of 38 participants with HF-intervention group (IG; 19/38, 50%) and control group (CG; 19/38, 50%)-were enrolled in the study. Of the 38 participants, 18 (47%) were women, 18 (47%) were aged 65 years or older, 21 (55%) had been hospitalized with HF in the past 6 months, and 29 (76%) were White. Furthermore, of these 38 participants, 31 (82%)-IG (15/19, 79%) and CG (16/19, 84%)-had both weight monitoring and physical activity data at the end of 12 weeks, and 27 (71%)-IG (14/19, 74%) and CG (13/19, 68%)-participated in follow-up assessments at 24 weeks. For the IG participants who installed the SCDG app (15/19, 79%), the number of days each player opened the game app was strongly associated with the number of days the player engaged in weight monitoring (r=0.72; P=.04) and the number of days with physical activity step data (r=0.9; P<.001). The IG participants who completed the satisfaction survey (13/19, 68%) reported that the SCDG was easy to use. Trends of improvement in daily weight monitoring and physical activity in the IG, as well as within-group improvements in HF functional status, quality of life, knowledge, self-efficacy, and HF hospitalization in both groups, were observed in this feasibility trial. CONCLUSIONS Playing an SCDG on smartphones was feasible and acceptable for older adults with HF for motivating daily weight monitoring and physical activity. A larger efficacy trial of the SCDG intervention will be needed to validate trends of improvement in daily weight monitoring and physical activity behaviors. TRIAL REGISTRATION ClinicalTrials.gov NCT03947983; https://clinicaltrials.gov/ct2/show/NCT03947983.
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Affiliation(s)
| | - Christine Julien
- Department of Electrical and Computer Engineering, Cockrell School of Engineering, The University of Texas Austin, Austin, TX, United States
| | | | | | - Grace Lee
- Department of Electrical and Computer Engineering, Cockrell School of Engineering, The University of Texas Austin, Austin, TX, United States
| | - Atami Sagna De Main
- School of Nursing, The University of Texas Austin, Austin, TX, United States
| | - Catherine Allen
- School of Nursing, The University of Texas Austin, Austin, TX, United States
| | - Bindu Viswanathan
- Department of Statistics and Data Sciences, The University of Texas Austin, Austin, TX, United States
| | - Edison Thomaz
- Department of Electrical and Computer Engineering, Cockrell School of Engineering, The University of Texas Austin, Austin, TX, United States
| | - Miyong Kim
- School of Nursing, The University of Texas Austin, Austin, TX, United States
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19
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Arora C, Razavian M. Ethics of Gamification in Health and Fitness-Tracking. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111052. [PMID: 34769570 PMCID: PMC8583052 DOI: 10.3390/ijerph182111052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/10/2021] [Accepted: 10/13/2021] [Indexed: 11/23/2022]
Abstract
The use of game-like elements is become increasingly popular in the context of fitness and health apps. While such “gamified” apps hold great potential in motivating people to improve their health, they also come with a “darker side”. Recent work suggests that these gamified health apps raise a number of ethical challenges that, if left unaddressed, are not only morally problematic but also have adverse effects on user health and engagement with the apps. However, studies highlighting the ethical challenges of gamification have also met with criticism, indicating that they fall short of providing guidance to practitioners. In avoiding this mistake, this paper seeks to advance the goal of facilitating a practice-relevant guide for designers of gamified health apps to address ethical issues raised by use of such apps. More specifically, the paper seeks to achieve two major aims: (a) to propose a revised practice-relevant theoretical framework that outlines the responsibilities of the designers of gamified health apps, and (b) to provide a landscape of the various ethical issues related to gamified health apps based on a systematic literature review of the empirical literature investigating adverse effects of such apps.
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Affiliation(s)
- Chirag Arora
- Philosophy and Ethics Section, Eindhoven University of Technology, 5612AE Eindhoven, The Netherlands
- Correspondence:
| | - Maryam Razavian
- Information Systems Group, Eindhoven University of Technology, 5612AE Eindhoven, The Netherlands;
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20
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AlSaad FM, Durugbo CM. Gamification-as-Innovation: A Review. INTERNATIONAL JOURNAL OF INNOVATION AND TECHNOLOGY MANAGEMENT 2021. [DOI: 10.1142/s0219877021300020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Gamification is a paradigm and process innovation premised on applying game mechanics to non-game settings with benefits of creative games designs and disruptive effects challenging conventional learning approaches. The purpose of this study is to review the literature on gamification-as-innovation. Applying the systematic review methodology, this study examines 96 articles and identifies developments in gamification-as-innovation in literature. Insights from the review suggests three main perspectives on gamification-as innovation in processes that reveal problems (investigation), stimulate novel behavior (induction) or transform processes (intervention) for improved effectiveness and engagement. The review also captures the state-of-the-art in gamification research underscoring advances in multi-level models, strategic initiatives and digital platforms. The review concludes by highlighting future research directions that advance gamification scholarship and practice.
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Affiliation(s)
- Fatemah M. AlSaad
- Department of Innovation and Technology Management, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Christopher M. Durugbo
- Department of Innovation and Technology Management, Arabian Gulf University, Manama, Kingdom of Bahrain
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21
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Development of a Digital Lifestyle Modification Intervention for Use after Transient Ischaemic Attack or Minor Stroke: A Person-Based Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094861. [PMID: 34063298 PMCID: PMC8124154 DOI: 10.3390/ijerph18094861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 12/18/2022]
Abstract
This paper describes the development of the ‘Brain-Fit’ app, a digital secondary prevention intervention designed for use in the early phase after transient ischaemic attack (TIA) or minor stroke. The aim of the study was to explore perceptions on usability and relevance of the app in order to maximise user engagement and sustainability. Using the theory- and evidence-informed person-based approach, initial planning included a scoping review of qualitative evidence to identify barriers and facilitators to use of digital interventions in people with cardiovascular conditions and two focus groups exploring experiences and support needs of people (N = 32) with a history of TIA or minor stroke. The scoping review and focus group data were analysed thematically and findings were used to produce guiding principles, a behavioural analysis and explanatory logic model for the intervention. Optimisation included an additional focus group (N = 12) and individual think-aloud interviews (N = 8) to explore perspectives on content and usability of a prototype app. Overall, thematic analysis highlighted uncertainty about increasing physical activity and concerns that fatigue might limit participation. Realistic goals and progressive increases in activity were seen as important to improving self-confidence and personal control. The app was seen as a useful and flexible resource. Participant feedback from the optimisation phase was used to make modifications to the app to maximise engagement, including simplification of the goal setting and daily data entry sections. Further studies are required to examine efficacy and cost-effectiveness of this novel digital intervention.
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22
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Davis AJ, Parker HM, Gallagher R. Gamified applications for secondary prevention in patients with high cardiovascular disease risk: A systematic review of effectiveness and acceptability. J Clin Nurs 2021; 30:3001-3010. [PMID: 33872436 DOI: 10.1111/jocn.15808] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 02/26/2021] [Accepted: 03/16/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Gamified health mobile applications (apps) are promoted as innovative approaches to self-management and risk factor reduction. However, information is lacking on effectiveness or feasibility in older patients at high risk for cardiovascular diseases (CVD), which limits uptake and recommendations by nurses. This study aimed to evaluate the effectiveness and acceptability of gamified apps for CVD secondary prevention. METHODS EQUATOR PRISMA checklist was used to guide the systematic review. PubMed, Embase and SCOPUS were searched from inception to January 2020 for studies evaluating app interventions incorporating ≥2 game tactics and targeting secondary prevention in patients diagnosed with heart disease, hypertension, stroke or type 2 diabetes. Narrative summaries of results were used as meta-analysis were not possible. The PROSPERO ID number was CRD42020209791. RESULTS Seven studies involving 657 patients were included. Gamified apps resulted in more improvement in physical activity, HbA1C and diabetes self-management empowerment compared to multiple different comparators, and more physical activity motivation compared to a neutral content control app. Heart failure knowledge also improved significantly. However, no benefits above usual care were evident for blood pressure or body mass index, or from app use for heart failure self-management, medication adherence or atrial fibrillation knowledge. App acceptability in terms of usage declined with time but was high for the game components of challenges, medication monitoring, viewing of leader boards and badges and walking training participation. Enjoyment was highest for elements that featured surprise/novelty, having teammates, challenges, good graphic design and clarity. CONCLUSIONS Gamified mobile apps show the potential to improve secondary prevention in high CVD risk patients. Indications for acceptability were evident, with higher adherence than clinic-based secondary prevention programmes. However, further well-designed randomised controlled trials, which track app usage are needed to confirm this potential and encourage nurses to recommend these types of apps.
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Affiliation(s)
- Angus J Davis
- Sydney School of Nursing, University of Sydney, Sydney, Australia
| | - Helen M Parker
- Charles Perkins Centre, University of Sydney, Sydney, Australia.,School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Robyn Gallagher
- Sydney School of Nursing, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia
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Sotirakos S, Fouda B, Mohamed Razif NA, Cribben N, Mulhall C, O'Byrne A, Moran B, Connolly R. Harnessing artificial intelligence in cardiac rehabilitation, a systematic review. Future Cardiol 2021; 18:154-164. [PMID: 33860679 DOI: 10.2217/fca-2021-0010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This systematic review aims to evaluate the current body of research surrounding the efficacy of artificial intelligence (AI) in cardiac rehabilitation. Presently, AI can be incorporated into personal devices such as smart watches and smartphones, in diagnostic and home monitoring devices, as well as in certain inpatient care settings. Materials & methods: The PRISMA guidelines were followed in this review. Inclusion and exclusion criteria were set using the Population, Intervention, Comparison and Outcomes (PICO) tool. Results: Eight studies meeting the inclusion criteria were found. Conclusion: Incorporation of AI into healthcare, cardiac rehabilitation delivery, and monitoring holds great potential for early detection of cardiac events, allowing for home-based monitoring, and improved clinician decision making.
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Affiliation(s)
- Sara Sotirakos
- Trinity College Dublin, School of Medicine, Dublin 2, Ireland
| | - Basem Fouda
- Trinity College Dublin, School of Medicine, Dublin 2, Ireland
| | | | | | - Cormac Mulhall
- Trinity College Dublin, School of Medicine, Dublin 2, Ireland
| | - Aisling O'Byrne
- Trinity College Dublin, School of Medicine, Dublin 2, Ireland
| | - Bridget Moran
- Trinity College Dublin, School of Medicine, Dublin 2, Ireland
| | - Ruairi Connolly
- Trinity College Dublin, School of Medicine, Dublin 2, Ireland.,National Rehabilitation Hospital, Dublin, Ireland
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24
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Eckardt I, Buschhaus C, Nickenig G, Jansen F. Smartphone-guided secondary prevention for patients with coronary artery disease. J Rehabil Assist Technol Eng 2021; 8:2055668321996572. [PMID: 33796334 PMCID: PMC7970225 DOI: 10.1177/2055668321996572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/04/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Coronary artery disease (CAD) is the leading cause of death worldwide.
Lifestyle change is a crucial part of secondary prevention. Only 30% of CAD
patients follow the corresponding guideline recommendations. The widespread
adoption of smartphones offers the opportunity to integrate secondary
prevention into the daily routine of CAD patients. Methods We developed an app to integrate secondary prevention into CAD patients’
everyday life (smartphone-guided secondary prevention, SGSP). The app
provided a daily 15-minute program that included video-guided exercises,
video sessions with background information about CAD, and a tool to record
blood pressure and heart rate once a day. The SGSP app was tested with the
primary outcome of 28-day adherence. The secondary outcome was a composite
of (1) self-reported behavioral changes, (2) gain of knowledge about
cardiovascular risk factors, and (3) an increase in quality of life. Results Of the 66 patients screened, 43 (65%) were included into the study and, of
those, 17 (40%) used the app continuously for 28 days. From this group, 14
(82%) were physically more active and ten (59%) improved their dietary
habits. Usage of the SGSP app was also associated with a gain of knowledge
about cardiovascular risk factors (70% physical activity, 59% healthy
diet). Conclusion The regular use of a SGSP app appears to support lifestyle changes in
patients with CAD.
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Affiliation(s)
- Irina Eckardt
- Heart Center, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany Both authors contributed equally
| | - Clara Buschhaus
- Heart Center, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany Both authors contributed equally
| | - Georg Nickenig
- Heart Center, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany Both authors contributed equally
| | - Felix Jansen
- Heart Center, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany Both authors contributed equally
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A Survey on Gamification for Health Rehabilitation Care: Applications, Opportunities, and Open Challenges. INFORMATION 2021. [DOI: 10.3390/info12020091] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Research trends in gamification have shown a significant diversity in various areas of e-health, particularly in addressing the issues of rehabilitation and physical activity. Rehabilitation requires better engaging tools that help to increase the patient’s motivation and engagement in particular forms of rehabilitation training. Adopting gamification in rehabilitation offers different treatment and care environments when implementing rehabilitation training. As gamification is increasingly being explored in rehabilitation, one might not realize that using various techniques in gamified applications yields a different effect on gameplay. To date, varied gamification techniques have been utilized to provide useful experiences from the perspective of health applications. However, a limited number of surveys have investigated the gamification of rehabilitation and the use of suitable game techniques for rehabilitation in the literature. The objective of this paper is to examine and analyze the existing gamification techniques for rehabilitation applications. A classification of rehabilitation gamification is developed based on the rehabilitation gamifying requirements and the gamification characteristics that are commonly applied in rehabilitation applications. This classification is the main contribution of this paper. It provides insight for researchers and practitioners into suitable techniques to design and apply gamification with increased motivation and sustainable engagement for rehabilitation treatment and care. In addition, different game elements, selection blocks, and gamification techniques are identified for application in rehabilitation. In conclusion, several challenges and research opportunities are discussed to improve gamification deployment in rehabilitation in the future.
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A group-based real-time videoconferencing telerehabilitation programme in recently discharged geriatric patients: a feasibility study. Eur Geriatr Med 2021; 12:801-808. [PMID: 33544388 PMCID: PMC7863611 DOI: 10.1007/s41999-020-00444-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/17/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Exercise at home and improvement in the ability to undertake daily tasks are highly valued by older people after hospitalisation. New telerehabilitation (TR) technologies make it possible to supervise and communicate with exercising participants through videoconferencing equipment. This technology has been shown to be both feasible and effective in Danish chronic obstructive pulmonary disease patients in terms of basic mobility, safety, social interactions and patient perception. This study sought to examine whether it was feasible to carry out TR through home exercises in groups. METHODS Both medical and hip-fracture home-dwelling patients aged 65 years and older admitted to the Emergency Department (ED) and Department of Geriatrics for acute reasons were asked to participate in the study just before their discharge. The inclusion criteria were normal cognitive function, being dependent on a walking aid and computer users before hospitalisation. RESULTS At discharge, 333 patients were consecutively screened for participation. Of those, 300 patients were excluded. Thirty-three patients met the inclusion criteria. They had a mean age of 82.3 years (± 7.8) and 76% were women. Nine patients agreed to participate, but seven withdrew. The most frequent explanation was exhaustion in the continuation of hospitalisation. CONCLUSION It was not possible to conduct a videoconference TR study in a geriatric population, as many were excluded and those who were eligible withdrew after inclusion. During the COVID-19 pandemic, TR may be an important tool for isolated older persons to hinder functional decline. Aspects such as recruitment procedures and IT solutions designed for older people must be considered.
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Tadas S, Coyle D. Barriers to and Facilitators of Technology in Cardiac Rehabilitation and Self-Management: Systematic Qualitative Grounded Theory Review. J Med Internet Res 2020; 22:e18025. [PMID: 33174847 PMCID: PMC7688378 DOI: 10.2196/18025] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022] Open
Abstract
Background Dealing with cardiovascular disease is challenging, and people often struggle to follow rehabilitation and self-management programs. Several systematic reviews have explored quantitative evidence on the potential of digital interventions to support cardiac rehabilitation (CR) and self-management. However, although promising, evidence regarding the effectiveness and uptake of existing interventions is mixed. This paper takes a different but complementary approach, focusing on qualitative data related to people’s experiences of technology in this space. Objective Through a qualitative approach, this review aims to engage more directly with people’s experiences of technology that supports CR and self-management. The primary objective of this paper is to provide answers to the following research question: What are the primary barriers to and facilitators and trends of digital interventions to support CR and self-management? This question is addressed by synthesizing evidence from both medical and computer science literature. Given the strong evidence from the field of human-computer interaction that user-centered and iterative design methods increase the success of digital health interventions, we also assess the degree to which user-centered and iterative methods have been applied in previous work. Methods A grounded theory literature review of articles from the following major electronic databases was conducted: ACM Digital Library, PsycINFO, Scopus, and PubMed. Papers published in the last 10 years, 2009 to 2019, were considered, and a systematic search with predefined keywords was conducted. Papers were screened against predefined inclusion and exclusion criteria. Comparative and in-depth analysis of the extracted qualitative data was carried out through 3 levels of iterative coding and concept development. Results A total of 4282 articles were identified in the initial search. After screening, 61 articles remained, which were both qualitative and quantitative studies and met our inclusion criteria for technology use and health condition. Of the 61 articles, 16 qualitative articles were included in the final analysis. Key factors that acted as barriers and facilitators were background knowledge and in-the-moment understanding, personal responsibility and social connectedness, and the need to support engagement while avoiding overburdening people. Although some studies applied user-centered methods, only 6 involved users throughout the design process. There was limited evidence of studies applying iterative approaches. Conclusions The use of technology is acceptable to many people undergoing CR and self-management. Although background knowledge is an important facilitator, technology should also support greater ongoing and in-the-moment understanding. Connectedness is valuable, but to avoid becoming a barrier, technology must also respect and enable individual responsibility. Personalization and gamification can also act as facilitators of engagement, but care must be taken to avoid overburdening people. Further application of user-centered and iterative methods represents a significant opportunity in this space.
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Barak Ventura R, Nakayama S, Raghavan P, Nov O, Porfiri M. The Role of Social Interactions in Motor Performance: Feasibility Study Toward Enhanced Motivation in Telerehabilitation. J Med Internet Res 2019; 21:e12708. [PMID: 31094338 PMCID: PMC6540723 DOI: 10.2196/12708] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/12/2019] [Accepted: 02/17/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Robot-mediated telerehabilitation has the potential to provide patient-tailored cost-effective rehabilitation. However, compliance with therapy can be a problem that undermines the prospective advantages of telerehabilitation technologies. Lack of motivation has been identified as a major factor that hampers compliance. Exploring various motivational interventions, the integration of citizen science activities in robotics-based rehabilitation has been shown to increase patients' motivation to engage in otherwise tedious exercises by tapping into a vast array of intrinsic motivational drivers. Patient engagement can be further enhanced by the incorporation of social interactions. OBJECTIVE Herein, we explored the possibility of bolstering engagement in physical therapy by leveraging cooperation among users in an environmental citizen science project. Specifically, we studied how the integration of cooperation into citizen science influences user engagement, enjoyment, and motor performance. Furthermore, we investigated how the degree of interdependence among users, such that is imposed through independent or joint termination (JT), affects participation in citizen science-based telerehabilitation. METHODS We developed a Web-based citizen science platform in which users work in pairs to classify images collected by an aquatic robot in a polluted water canal. The classification was carried out by labeling objects that appear in the images and trashing irrelevant labels. The system was interfaced by a haptic device for fine motor rehabilitation. We recruited 120 healthy volunteers to operate the platform. Of these volunteers, 98 were cooperating in pairs, with 1 user tagging images and the other trashing labels. The other 22 volunteers performed both tasks alone. To vary the degree of interdependence within cooperation, we implemented independent and JTs. RESULTS We found that users' engagement and motor performance are modulated by their assigned task and the degree of interdependence. Motor performance increased when users were subjected to independent termination (P=.02), yet enjoyment decreased when users were subjected to JT (P=.005). A significant interaction between the type of termination and the task was found to influence productivity (P<.001) as well as mean speed, peak speed, and path length of the controller (P=.01, P=.006, and P<.001, respectively). CONCLUSIONS Depending on the type of termination, cooperation was not always positively associated with engagement, enjoyment, and motor performance. Therefore, enhancing user engagement, satisfaction, and motor performance through cooperative citizen science tasks relies on both the degree of interdependence among users and the perceived nature of the task. Cooperative citizen science may enhance motivation in robotics-based telerehabilitation, if designed attentively.
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Affiliation(s)
- Roni Barak Ventura
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Shinnosuke Nakayama
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Preeti Raghavan
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, United States
| | - Oded Nov
- Department of Technology Management and Innovation, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Maurizio Porfiri
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States.,Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
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Gallagher R, Chow C, Parker H, Neubeck L, Celermajer D, Redfern J, Tofler G, Buckley T, Schumacher T, Ferry C, Whitley A, Chen L, Figtree G. Design and rationale of the MyHeartMate study: a randomised controlled trial of a game-based app to promote behaviour change in patients with cardiovascular disease. BMJ Open 2019; 9:e024269. [PMID: 31092643 PMCID: PMC6530325 DOI: 10.1136/bmjopen-2018-024269] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 11/29/2018] [Accepted: 01/30/2019] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Recurrence of cardiac events is common after a first event, leading to hospitalisations and increased health burden. Patients have difficulties achieving the lifestyle changes required for secondary prevention and access to secondary prevention programs is limited. This study aims to evaluate the impact of a game-based mobile app, MyHeartMate, which is designed to motivate engagement in secondary prevention behaviours for cardiovascular risk factors. METHODS AND ANALYSIS The MyHeartMate study is a randomised controlled trial with 6-month follow-up and blinded assessment of the primary outcome. Participants (n=394) with coronary heart disease will be recruited from hospitals in metropolitan Sydney and randomly allocated to standard care or the MyHeartMate app intervention. The intervention group will receive the app, which uses game techniques to promote engagement and lifestyle behaviour change for secondary prevention. The primary outcome is difference between the groups in physical activity (metabolic equivalent of task minutes/week) at 6 months. Secondary outcomes include change in low-density lipoprotein cholesterol, systolic blood pressure, medication adherence, body mass index, waist circumference, mood and dietary changes at 6 months. Data on app engagement, and patient perspectives of usability and acceptability, will also be analysed. ETHICS AND DISSEMINATION The study has received ethics approval from Northern Sydney Local Health District Human Research Ethics Committee. The study findings will be disseminated via peer-reviewed publications and presentation at international scientific meetings/conferences. TRIAL REGISTRATION NUMBER ACTRN12617000869370; Pre-results.
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Affiliation(s)
- Robyn Gallagher
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
| | - Clara Chow
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Helen Parker
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Lis Neubeck
- Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - David Celermajer
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Julie Redfern
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Geoffrey Tofler
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Thomas Buckley
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
| | - Tracy Schumacher
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Cate Ferry
- Clinical Programs, Heart Foundation, Deakin, Australian Capital Territory, Australia
| | - Alexandra Whitley
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Lily Chen
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Gemma Figtree
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Cardiothoracic and Vascular Health, Kolling Institute of Medical Research, Saint Leonards, New South Wales, Australia
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Radhakrishnan K, Baranowski T, Julien C, Thomaz E, Kim M. Role of Digital Games in Self-Management of Cardiovascular Diseases: A Scoping Review. Games Health J 2019; 8:65-73. [PMID: 30199275 PMCID: PMC6909707 DOI: 10.1089/g4h.2018.0011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Examine research on the use of digital games to improve self-management (SM) behaviors in patients diagnosed with cardiovascular diagnoses of hypertension, coronary artery disease, heart failure, or myocardial infarction. MATERIALS AND METHODS For this scoping review, the CINAHL, PubMed, and Web of Science databases were searched for studies published from January 1, 2008 to December 20, 2017 using terms relevant to digital games and cardiovascular diseases (CVDs). RESULTS Eight articles met the inclusion/exclusion criteria, seven of which presented studies with participants 50 years or older. Five of the eight studies assessed physical activity. Only two studies included a control group. Digital games significantly improved exercise capacity and energy expenditure but did not affect quality of life, self-efficacy, anxiety, or depression. Digital games were found enjoyable by 79%-93% of participants, including those with lower education or age; however, barriers to game use included being tired or bored, lack of interest in digital games, poor perception of fitness through games, sensor limitations, conflicts with daily life routine, and preferences for group exercise. Average adherence ranged from 70% to 100% over 2 weeks to 6 months of study duration, with higher adherence rates in studies that included human contact through supervision or social support. CONCLUSION Paucity of studies about digital games for CVD SM behaviors precludes the need to undertake a full systematic review. Future studies examining digital games should include larger sample sizes, longer durations, game-design guided by behavioral change theoretical frameworks, and CVD SM behaviors in addition to physical activity behaviors.
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Affiliation(s)
| | - Thomas Baranowski
- Department of Pediatrics-Nutrition, Baylor College of Medicine, Houston, Texas
| | - Christine Julien
- Mobile and Pervasive Computing Laboratory, Department of Electrical and Computer Engineering, The University of Texas–Austin, Austin, Texas
| | - Edison Thomaz
- Department of Electrical and Computer Engineering, School of Information, The University of Texas–Austin, Austin, Texas
| | - Miyong Kim
- School of Nursing, The University of Texas–Austin, Austin, Texas
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García-Martínez E, Soler-González J, Rubí-Carnacea F, García-Martínez B, Climent-Sanz C, Blanco-Blanco J, Valenzuela-Pascual F. The influence of an educational internet-based intervention in the beliefs and attitudes of primary care professionals on non-specific chronic low back pain: study protocol of a mixed methods approach. BMC FAMILY PRACTICE 2019; 20:31. [PMID: 30791879 PMCID: PMC6383219 DOI: 10.1186/s12875-019-0919-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 02/13/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Personal convictions in referral to pain cause misbeliefs in health professionals, which can influence patients who suffer from non-specific chronic low back pain. Likewise, health professionals' beliefs affect their advice and attitudes towards patients' treatment, becoming a possible cause of greater disability. The development of educational interventions based on the best scientific evidence in neurophysiology of pain could be a way to provide information and advice to primary care health professionals to change their cognition towards chronic non-specific low back pain. The use of Information and Communication Technologies allows the development of web sites, which might be one of the effective resources to modify misbeliefs and attitudes, in relation to the origin and meaning of non-specific chronic low back pain, of primary care professionals and that may modify their attitudes in patients' treatment. METHODS The aim of this project is to identify misbeliefs and attitudes of primary care physicians and nurses about chronic non-specific low back pain to develop a web-based educational tool using different educational formats and gamification techniques. This study has a mixed-method sequential exploratory design. The participants are medical and nursing staff working in primary care centers in the city of Lleida, Spain. For the qualitative phase of this study, the authors will use personal semi-structured interviews. For the quantitative phase the authors will use an experimental study design. Subjects will be randomly allocated using a simple random sample technique. The intervention group will have access to the web site where they will find information related to non-specific chronic low back pain, based on the information obtained in the qualitative phase. The control group will have access to a video explaining the clinical practice guidelines on low back pain. DISCUSSION This study has been designed to explore and modify the beliefs and attitudes about chronic low back pain of physicians and nurses working in primary care settings, using a web-based educational tool with different educational formats and gamification techniques. The aim of the educational intervention is to change their knowledge about the origin and meaning of pain, with the result of reducing their misbeliefs and attitudes of fear avoidance. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02962817 . Date of registration: 11/09/2016.
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Affiliation(s)
| | - Jorge Soler-González
- Grup d’Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain
- Faculty of Medicine, University of Lleida, Lleida, Spain
- Institut Català de la Salut, Lleida, Spain
| | - Francesc Rubí-Carnacea
- Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup d’Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, Institut de Recerca Biomèdica, Lleida, Spain
| | | | - Carolina Climent-Sanz
- Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup d’Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, Institut de Recerca Biomèdica, Lleida, Spain
| | - Joan Blanco-Blanco
- Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup d’Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, Institut de Recerca Biomèdica, Lleida, Spain
| | - Fran Valenzuela-Pascual
- Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup d’Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, Institut de Recerca Biomèdica, Lleida, Spain
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Abstract
To determine the effects of gamification on student education, researchers implemented "Kaizen," a software-based knowledge competition, among a first-year class of undergraduate nursing students. Multiple-choice questions were released weekly or biweekly during two rounds of play. Participation was voluntary, and students could play the game using any Web-enabled device. Analyses of data generated from the game included (1) descriptive, (2) logistic regression modeling of factors associated with user attrition, (3) generalized linear mixed model for retention of knowledge, and (4) analysis of variance of final examination performance by play styles. Researchers found a statistically significant increase in the odds of a correct response (odds ratio, 1.8; 95% confidence interval, 1.0-3.4) for a round 1 question repeated in round 2, suggesting retention of knowledge. They also found statistically significant differences in final examination performance among different play styles.To maximize the benefits of gamification, researchers must use the resulting data both to power educational analytics and to inform nurse educators how to enhance student engagement, knowledge retention, and academic performance.
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Zhang L, Ding D, Neubeck L, Gallagher P, Paull G, Gao Y, Gallagher R. Mobile Technology Utilization Among Patients From Diverse Cultural and Linguistic Backgrounds Attending Cardiac Rehabilitation in Australia: Descriptive, Case-Matched Comparative Study. JMIR Cardio 2018; 2:e13. [PMID: 31758767 PMCID: PMC6858003 DOI: 10.2196/cardio.9424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/25/2018] [Accepted: 05/13/2018] [Indexed: 01/26/2023] Open
Abstract
Background Barriers to attending cardiac rehabilitation (CR), including cultural and linguistic differences, may be addressed by recent technological developments. However, the feasibility of using these approaches in culturally and linguistically diverse patients is yet to be determined. Objective This study aims to assess the use of mobile technologies and features, as well as confidence in utilization across patients speaking different languages at home (ie, English, Mandarin Chinese, and a language other than English and Mandarin [other]) and are both eligible and physically suitable for CR. In addition, the study aims to determine the sociodemographic correlates of the mobile technology/feature use, including language spoken at home in the three groups mentioned above. Methods This is a descriptive, case matched, comparative study. Age and gender-matched patients speaking English, Mandarin and other languages (n=30/group) eligible for CR were surveyed for their mobile technology and mobile feature use. Results ‘Participants had a mean age of 66.7 years (SD 13, n=90, range 46-95), with 53.3% (48/90) male. The majority (82/90, 91.1%) used at least one technology device, with 87.8% (79/90) using mobile devices, the most common being smartphones (57/90, 63.3%), tablets (28/90, 31.1%), and text/voice-only phones (24/90, 26.7%). More English-speaking participants used computers than Mandarin or “other” language speaking participants (P=.003 and .02) and were more confident in doing so compared to Mandarin-speaking participants (P=.003). More Mandarin-speaking participants used smartphones compared with “other” language speaking participants (P=.03). Most commonly used mobile features were voice calls (77/82, 93.9%), text message (54/82, 65.9%), the internet (39/82, 47.6%), email (36/82, 43.9%), and videoconferencing (Skype or FaceTime [WeChat or QQ] 35/82, 42.7%). Less Mandarin-speaking participants used emails (P=.001) and social media (P=.007) than English-speaking participants. Speaking Mandarin was independently associated with using smartphone, emails, and accessing the web-based medication information (OR 7.238, 95% CI 1.262-41.522; P=.03, OR 0.089, 95% CI 0.016-0.490; P=.006 and OR 0.191, 95% CI 0.037-0.984; P=.05). Conclusions This study reveals a high usage of mobile technology among CR patients and provides further insights into differences in the technology use across CALD patients in Australia. The findings of this study may inform the design and implementation of future technology-based CR.
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Affiliation(s)
- Ling Zhang
- Sydney Nursing School, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Ding Ding
- Charles Perkins Centre, University of Sydney, Sydney, Australia.,Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Lis Neubeck
- Sydney Nursing School, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia.,School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Patrick Gallagher
- Sydney Nursing School, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Glenn Paull
- Cardiology Department, St George Hospital, Kogarah, Australia
| | - Yan Gao
- Cardiology Department, St George Hospital, Kogarah, Australia
| | - Robyn Gallagher
- Sydney Nursing School, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia
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Coorey GM, Neubeck L, Mulley J, Redfern J. Effectiveness, acceptability and usefulness of mobile applications for cardiovascular disease self-management: Systematic review with meta-synthesis of quantitative and qualitative data. Eur J Prev Cardiol 2018; 25:505-521. [PMID: 29313363 DOI: 10.1177/2047487317750913] [Citation(s) in RCA: 174] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2024]
Abstract
Background Mobile technologies are innovative, scalable approaches to reducing risk of cardiovascular disease but evidence related to effectiveness and acceptability remains limited. We aimed to explore the effectiveness, acceptability and usefulness of mobile applications (apps) for cardiovascular disease self-management and risk factor control. Design Systematic review with meta-synthesis of quantitative and qualitative data. Methods Comprehensive search of multiple databases (Medline, Embase, CINAHL, SCOPUS and Cochrane CENTRAL) and grey literature. Studies were included if the intervention was primarily an app aimed at improving at least two lifestyle behaviours in adults with cardiovascular disease. Meta-synthesis of quantitative and qualitative data was performed to review and evaluate findings. Results Ten studies of varying designs including 607 patients from five countries were included. Interventions targeted hypertension, heart failure, stroke and cardiac rehabilitation populations. Factors that improved among app users were rehospitalisation rates, disease-specific knowledge, quality of life, psychosocial well-being, blood pressure, body mass index, waist circumference, cholesterol and exercise capacity. Improved physical activity, medication adherence and smoking cessation were also characteristic of app users. Appealing app features included tracking healthy behaviours, self-monitoring, disease education and personalised, customisable content. Small samples, short duration and selection bias were noted limitations across some studies, as was the relatively low overall scientific quality of evidence. Conclusions Multiple behaviours and cardiovascular disease risk factors appear modifiable in the shorter term with use of mobile apps. Evidence for effectiveness requires larger, controlled studies of longer duration, with emphasis on process evaluation data to better understand important system- and patient-level characteristics.
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Affiliation(s)
- Genevieve M Coorey
- 1 The George Institute for Global Health Australia, Sydney, Australia
- 2 Sydney Medical School, University of Sydney, Australia
| | - Lis Neubeck
- 3 School of Health and Social Care, Edinburgh Napier University, UK
- 4 Sydney Nursing School, University of Sydney, Australia
| | - John Mulley
- 1 The George Institute for Global Health Australia, Sydney, Australia
| | - Julie Redfern
- 1 The George Institute for Global Health Australia, Sydney, Australia
- 2 Sydney Medical School, University of Sydney, Australia
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Kaczmarek LD, Misiak M, Behnke M, Dziekan M, Guzik P. The Pikachu effect: Social and health gaming motivations lead to greater benefits of Pokémon GO use. COMPUTERS IN HUMAN BEHAVIOR 2017. [DOI: 10.1016/j.chb.2017.05.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Young HM, Nesbitt TS. Increasing the Capacity of Primary Care Through Enabling Technology. J Gen Intern Med 2017; 32:398-403. [PMID: 28243871 PMCID: PMC5377889 DOI: 10.1007/s11606-016-3952-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/13/2016] [Accepted: 11/28/2016] [Indexed: 01/17/2023]
Abstract
Primary care is the foundation of effective and high-quality health care. The role of primary care clinicians has expanded to encompass coordination of care across multiple providers and management of more patients with complex conditions. Enabling technology has the potential to expand the capacity for primary care clinicians to provide integrated, accessible care that channels expertise to the patient and brings specialty consultations into the primary care clinic. Furthermore, technology offers opportunities to engage patients in advancing their health through improved communication and enhanced self-management of chronic conditions. This paper describes enabling technologies in four domains (the body, the home, the community, and the primary care clinic) that can support the critical role primary care clinicians play in the health care system. It also identifies challenges to incorporating these technologies into primary care clinics, care processes, and workflow.
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Affiliation(s)
- Heather M Young
- Betty Irene Moore School of Nursing, UC Davis Health System, Sacramento, CA, 95817, USA.
| | - Thomas S Nesbitt
- UC Davis Health System, Davis, CA, USA
- Family and Community Medicine, UC Davis, Davis, CA, USA
- Center for Information Technology Research in the Interest of Society, University of California, Davis, CA, USA
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Radhakrishnan K, Toprac P, O'Hair M, Bias R, Kim MT, Bradley P, Mackert M. Interactive Digital e-Health Game for Heart Failure Self-Management: A Feasibility Study. Games Health J 2016; 5:366-374. [PMID: 27976955 PMCID: PMC5180075 DOI: 10.1089/g4h.2016.0038] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To develop and test the prototype of a serious digital game for improving community-dwelling older adults' heart failure (HF) knowledge and self-management behaviors. The serious game innovatively incorporates evidence-based HF guidelines with contemporary game technology. MATERIALS AND METHODS The study included three phases: development of the game prototype, its usability assessment, and evaluation of the game's functionality. Usability testing included researchers' usability assessment, followed by research personnel's observations of participants playing the game, and participants' completion of a usability survey. Next, in a pretest-post-test design, validated instruments-the Atlanta Heart Failure Knowledge Test and the Self Care for Heart Failure Index-were used to measure improvement in HF self-management knowledge and behaviors related to HF self-maintenance, self-management, and self-efficacy, respectively. A postgame survey assessed participants' perceptions of the game. RESULTS During usability testing, with seven participants, 100%, 100%, and 86% found the game easy to play, enjoyable, and helpful for learning about HF, respectively. In the subsequent functionality testing, with 19 participants, 89% found the game interesting, enjoyable, and easy to play. Playing the game resulted in a significant improvement in HF self-management knowledge, a nonsignificant improvement in self-reported behaviors related to HF self-maintenance, and no difference in HF self-efficacy scores. Participants with lower education level and age preferred games to any other medium for receiving information. CONCLUSION It is feasible to develop a serious digital game that community-dwelling older adults with HF find both satisfying and acceptable and that can improve their self-management knowledge.
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Affiliation(s)
| | - Paul Toprac
- Simulation and Game Applications Laboratory, University of Texas–Austin, Austin, Texas
- Topcat Productions, L.L.C., Austin, Texas
| | - Matt O'Hair
- Simulation and Game Applications Laboratory, University of Texas–Austin, Austin, Texas
| | - Randolph Bias
- School of Information, Information eXperience Lab (IX Lab), University of Texas–Austin, Austin, Texas
- The Usability Team, Austin, Texas
| | - Miyong T. Kim
- School of Nursing, University of Texas–Austin, Austin, Texas
| | - Paul Bradley
- School of Nursing, University of Texas–Austin, Austin, Texas
| | - Michael Mackert
- Moody School of Communication, University of Texas–Austin, Austin, Texas
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