101
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McCann L, McMillan KA, Pugh G. Digital Interventions to Support Adolescents and Young Adults With Cancer: Systematic Review. JMIR Cancer 2019; 5:e12071. [PMID: 31368438 PMCID: PMC6693302 DOI: 10.2196/12071] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/16/2019] [Accepted: 06/28/2019] [Indexed: 01/30/2023] Open
Abstract
Background The last decade has seen an increase in the number of digital health interventions designed to support adolescents and young adults (AYAs) with cancer. Objective The objective of this review was to identify, characterize, and fully assess the quality, feasibility, and efficacy of existing digital health interventions developed specifically for AYAs, aged between 13 and 39 years, living with or beyond a cancer diagnosis. Methods Searches were performed in PubMed, EMBASE, and Web of Science to identify digital health interventions designed specifically for AYA living with or beyond a cancer diagnosis. Data on the characteristics and outcomes of each intervention were synthesized. Results A total of 4731 intervention studies were identified through the searches; 38 interventions (43 research papers) met the inclusion criteria. Most (20/38, 53%) were website-based interventions. Most studies focused on symptom management and medication adherence (15, 39%), behavior change (15, 39%), self-care (8, 21%), and emotional health (7, 18%). Most digital health interventions included multiple automated and communicative functions such as enriched information environments, automated follow-up messages, and access to peer support. Where reported (20, 53% of studies), AYAs’ subjective experience of using the digital platform was typically positive. The overall quality of the studies was found to be good (mean Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields scores >68%). Some studies reported feasibility outcomes (uptake, acceptability, and attrition) but were not sufficiently powered to comment on intervention effects. Conclusions Numerous digital interventions have been developed and designed to support young people living with and beyond a diagnosis of cancer. However, many of these interventions have yet to be deployed, implemented, and evaluated at scale.
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Affiliation(s)
- Lisa McCann
- Digital Health and Wellness Group, Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Kathryn Anne McMillan
- Digital Health and Wellness Group, Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Gemma Pugh
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
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102
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Hieftje K, Duncan L, Florsheim O, Sawyer B, Fiellin LE. One Night Stan: Feasibility Study of an HIV Prevention and Sexual Risk Reduction Social Card Game for Young Black Women. Games Health J 2019; 8:112-120. [PMID: 30964717 DOI: 10.1089/g4h.2017.0106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To develop and test the feasibility and preliminary impact of the social card game prototype, One Night Stan, a theory-driven and evidence-based human immunodeficiency virus (HIV) prevention intervention for young black women. MATERIALS AND METHODS The study included the enrollment of 21 young, heterosexual black women (mean age 19) to test the feasibility and preliminary impact of the card game, using a pre/postdesign. Participant satisfaction and gameplay experience were assessed using quantitative and qualitative measures. Knowledge, self-efficacy, and intentions regarding condom use and HIV/sexually transmitted infection partner testing were assessed using standardized assessments. Effect sizes for the change in these outcome variables were calculated to determine the preliminary efficacy of the game. RESULTS One hundred percent of participants reported that that they would play the game again, 95% liked the way the game looked, 100% enjoyed playing the game, and 100% reported that they would tell their friends to play. Effect sizes were large (ranged from 0.21 to 0.51) for all variables except perceived susceptibility (0.07) and suggest that playing the game can lead to increased self-efficacy and intentions to use condoms and insist that their partners get tested for HIV across time. CONCLUSIONS One Night Stan is a feasible intervention approach and may be efficacious in helping players develop a pattern of cognitions and motivation that can protect them against the risk of HIV.
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Affiliation(s)
- Kimberly Hieftje
- 1 Department of General Medicine, Yale Center for Health and Learning Games, New Haven, Connecticut.,2 play2PREVENT Lab at Yale, New Haven, Connecticut
| | - Lindsay Duncan
- 1 Department of General Medicine, Yale Center for Health and Learning Games, New Haven, Connecticut.,2 play2PREVENT Lab at Yale, New Haven, Connecticut.,3 McGill University, Montreal, Quebec
| | - Orli Florsheim
- 4 Department of Kinesiology and Physical Education, Irvine School of Medicine, University of California, Irvine, California
| | - Ben Sawyer
- 1 Department of General Medicine, Yale Center for Health and Learning Games, New Haven, Connecticut.,2 play2PREVENT Lab at Yale, New Haven, Connecticut.,5 Digitalmill, Inc., Freeport, Maine
| | - Lynn E Fiellin
- 1 Department of General Medicine, Yale Center for Health and Learning Games, New Haven, Connecticut.,2 play2PREVENT Lab at Yale, New Haven, Connecticut.,6 Yale Child Study Center, New Haven, Connecticut
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103
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Cabras C, Cubadda ML, Sechi C. Relationships Among Violent and Non-Violent Video Games, Anxiety, Self-Esteem, and Aggression in Female and Male Gamers. INTERNATIONAL JOURNAL OF GAMING AND COMPUTER-MEDIATED SIMULATIONS 2019. [DOI: 10.4018/ijgcms.2019070102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study examines the differences in anxiety, self-esteem, and aggression levels between players of violent and non-violent video game and its connection to gender and age. This survey-based research utilizes survey data from 851 video gamers. The study included 61% men and 39% women. The ages of the participants ranged from 18 to 45. Participants were administered an anonymous survey including demographics, a questionnaire for video game habits, Rosenberg's self-esteem scale, a state anxiety inventory (STAI-S), and the Buss-Perry Aggression Questionnaire (BPAQ). The results revealed significant differences between males and females, as well as between younger and older gamers. Despite the majority of research showing a positive relationship between violent video game exposure and aggression levels, the results suggest that of the preference for a violent video game over a non-violent one is not, in itself, a cause for increased anxiety, self-esteem, and aggression levels.
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104
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Verschueren S, van Aalst J, Bangels AM, Toelen J, Allegaert K, Buffel C, Vander Stichele G. Development of CliniPup, a Serious Game Aimed at Reducing Perioperative Anxiety and Pain in Children: Mixed Methods Study. JMIR Serious Games 2019; 7:e12429. [PMID: 31199333 PMCID: PMC6592492 DOI: 10.2196/12429] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/20/2019] [Accepted: 04/05/2019] [Indexed: 12/15/2022] Open
Abstract
Background An increasing number of children undergo ambulatory surgery each year, and a significant proportion experience substantial preoperative anxiety and postoperative pain. The management of perioperative anxiety and pain remains challenging in children and is inadequate, which negatively impacts the physical, psychosocial, and economic outcomes. Existing nonpharmacological interventions are costly, time consuming, vary in availability, and lack benefits. Therefore, there is a need for an evidence-based, accessible, nonpharmacological intervention as an adjunct to existing pharmacological alternatives to reduce perioperative anxiety and pain in children undergoing ambulatory surgery. Technology-enabled interventions have been proposed as a method to address the unmet need in this setting. In particular, serious games hold a unique potential to change health beliefs and behaviors in children. Objective The objective of this research was to describe the rationale, scientific evidence, design aspects, and features of CliniPup, a serious game aimed at reducing perioperative anxiety and pain in children undergoing ambulatory surgery. Methods The SERES Framework for serious game development was used to create the serious game, CliniPup. In particular, we used a mixed methods approach that consisted of a structured literature review supplemented with ethnographic research, such as expert interviews and a time-motion exercise. The resulting scientific evidence base was leveraged to ensure that the resulting serious game was relevant, realistic, and theory driven. A participatory design approach was applied, wherein clinical experts qualitatively reviewed several versions of the serious game, and an iterative creative process was used to integrate the applicable feedback. Results CliniPup, a serious game, was developed to incorporate a scientific evidence base from a structured literature review, realistic content collected during ethnographic research such as expert interviews, explicit pedagogical objectives from scientific literature, and game mechanics and user interface design that address key aspects of the evidence. Conclusions This report details the systematic development of CliniPup, a serious game aimed at reducing perioperative anxiety and pain in children undergoing ambulatory surgery. Clinical experts validated CliniPup’s underlying scientific evidence base and design foundations, suggesting that it was well designed for preliminary evaluation in the target population. An evaluation plan is proposed and briefly described.
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Affiliation(s)
| | - June van Aalst
- Division of Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | | | - Jaan Toelen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
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105
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Buffel C, van Aalst J, Bangels AM, Toelen J, Allegaert K, Verschueren S, Vander Stichele G. A Web-Based Serious Game for Health to Reduce Perioperative Anxiety and Pain in Children (CliniPup): Pilot Randomized Controlled Trial. JMIR Serious Games 2019; 7:e12431. [PMID: 31199324 PMCID: PMC6592396 DOI: 10.2196/12431] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/29/2019] [Accepted: 04/15/2019] [Indexed: 12/21/2022] Open
Abstract
Background As pediatric ambulatory surgeries are rising and existing methods to reduce perioperative anxiety and pain are lacking in this population, a serious game for health (SGH), CliniPup, was developed to address this unmet need. CliniPup was generated using the SERES framework for serious game development. Objective The goal of the research was to clinically evaluate CliniPup as an adjunct therapy to existing pharmacological interventions aimed at reducing perioperative anxiety and pain in children undergoing ambulatory surgery. Methods CliniPup was evaluated in a prospective randomized controlled pilot trial in 20 children aged 6 to 10 years who underwent elective surgery and their parents. Study participants were randomly assigned to the test (n=12) or control group (n=8). Children in the test group played CliniPup 2 days prior to surgery, and children in the control group received standard of care. On the day of surgery, pediatric anxiety was measured with the modified Yale Preoperative Anxiety Scale and parental anxiety was assessed with the State-Trait Anxiety Inventory. Pediatric postoperative pain was assessed by the Wong-Baker Faces Pain Rating Scale. Child and parent user experience and satisfaction were also evaluated in the test group using structured questionnaires. Results Despite the small sample, preoperative anxiety scores were significantly lower (P=.01) in children who played CliniPup prior to surgery compared to controls. Parental preoperative anxiety scores were also lower in the test group (P=.10) but did not reach significance. No significant differences were observed in postoperative pain scores between groups (P=.54). The evaluation of user experience and satisfaction revealed that both children and parents were satisfied with CliniPup and would recommend the game to peers. Conclusions Results of the pilot trial introduce CliniPup as a potentially effective and attractive adjunct therapy to reduce preoperative anxiety in children undergoing ambulatory surgery with a trend toward positive impact on parental preoperative anxiety. These results support the use of the SERES framework to generate an evidence-based SGH that results in positive health outcomes for patients. Based on these preliminary findings, we propose a research agenda to further develop and investigate this tool. Trial Registration ClinicalTrials.gov NCT03874442; https://clinicaltrials.gov/ct2/show/NCT03874442 (Archived by WebCite at http://www.webcitation.org/78KZab8qc)
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Affiliation(s)
| | - June van Aalst
- Division of Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | | | - Jaan Toelen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
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106
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Sabben G, Mudhune V, Ondeng'e K, Odero I, Ndivo R, Akelo V, Winskell K. A Smartphone Game to Prevent HIV Among Young Africans (Tumaini): Assessing Intervention and Study Acceptability Among Adolescents and Their Parents in a Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e13049. [PMID: 31115348 PMCID: PMC6547768 DOI: 10.2196/13049] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 02/06/2023] Open
Abstract
Background Young people aged 15 to 24 years account for one-third of new adult HIV infections. Controlling the HIV epidemic requires effective interventions targeted toward young people and their needs. Smartphone games offer a promising avenue for reaching this population with evidence-based HIV prevention interventions. It is crucial to the effectiveness of these interventions that they be acceptable and intrinsically motivating to adolescents as well as acceptable to their parents. Objective Tumaini is a narrative-based smartphone game designed to help prevent HIV among young Africans aged 11 to 14 years by delaying first sex and increasing condom use at first sex. Following a 16-day feasibility study of Tumaini, we assessed the acceptability (1) of the intervention, where acceptability was operationalized as appeal, relevance, value, usability, and understandability, and (2) of this study and a planned future randomized controlled efficacy trial. Methods During the randomized feasibility study (n=60) of Tumaini in western Kenya in spring 2017, 30 participants used the intervention on a study-provided smartphone. The app automatically logged participant interaction with the game in time-stamped log files. All 30 participants completed an Audio Computer-Assisted Self-Interview–based game experience survey, and 27 took part in 4 focus group discussions (FGDs) about the game’s appeal, relevance, value, usability, and understandability. Their parents (n=22) also participated in 4 FGDs about the acceptability of the intervention, of this study, and of a planned efficacy trial. Survey data were analyzed using SAS software (SAS Institute Inc); FGD transcripts were coded and analyzed in MAXQDA 12 (Verbi GmbH); and gameplay log files were analyzed using Microsoft Excel. Results Adolescent participants’ survey responses indicated that Tumaini scored well with players on all indicators of acceptability (appeal, relevance, value, usability, and understandability). Focus group analyses aligned with these findings and emphasized a high degree of player engagement with the game, which was supported by log file analysis. Adolescent participants were eager for additional content, and parents were receptive to a longer study involving biomarkers, based on their positive experiences with this study. There is scope to improve communication with parents about their role in the intervention. As the game was tested in beta version, there is also scope to fine-tune some of the game mechanics to increase usability. Conclusions This study shows the strong acceptability of an interactive smartphone-based game both to adolescents and their parents in western Kenya and that of the study methods used to pilot-test the intervention. It also suggests that longitudinal efficacy studies of this type of intervention, including those using biomarkers, have the potential to be acceptable among parents. Trial Registration ClinicalTrials.gov NCT03054051; https://clinicaltrials.gov/ct2/show/NCT03054051 (Archived by WebCite at http://www.webcitation.org/70U2gCNtW)
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Affiliation(s)
- Gaëlle Sabben
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Victor Mudhune
- Centre for Global Health Research, HIV Research Branch, Kenya Medical Research Institute, Kisumu, Kenya
| | - Ken Ondeng'e
- Centre for Global Health Research, HIV Research Branch, Kenya Medical Research Institute, Kisumu, Kenya
| | - Isdorah Odero
- Centre for Global Health Research, HIV Research Branch, Kenya Medical Research Institute, Kisumu, Kenya
| | - Richard Ndivo
- Centre for Global Health Research, HIV Research Branch, Kenya Medical Research Institute, Kisumu, Kenya
| | - Victor Akelo
- Centre for Global Health Research, HIV Research Branch, Kenya Medical Research Institute, Kisumu, Kenya
| | - Kate Winskell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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107
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Teaching HCI Skills in Higher Education through Game Design: A Study of Students’ Perceptions. INFORMATICS 2019. [DOI: 10.3390/informatics6020022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Human-computer interaction (HCI) is an area with a wide range of concepts and knowledge. Therefore, a need to innovate in the teaching-learning processes to achieve an effective education arises. This article describes a proposal for teaching HCI through the development of projects that allow students to acquire higher education competencies through the design and evaluation of computer games. Finally, an empirical validation (questionnaires and case study) with 40 undergraduate students (studying their fifth semester of software engineering) was applied at the end of the semester. The results indicated that this teaching method provides the students with the HCI skills (psychology of everyday things, involving users, task-centered system design, models of human behavior, creativity and metaphors, and graphical screen design) and, more importantly, they have a positive perception on the efficacy of the use of videogame design in a higher education course.
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108
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McGrady ME, Pai ALH. A Systematic Review of Rates, Outcomes, and Predictors of Medication Non-Adherence Among Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2019; 8:485-494. [PMID: 31038372 DOI: 10.1089/jayao.2018.0160] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Nonadherence to medications in cancer treatment protocols may be a particular concern among adolescents and young adults (AYAs) with cancer and predictive of poor health outcomes, but data supporting this claim remain limited. The purpose of this article was to systematically review the rates, outcomes, and predictors of oral medication nonadherence among AYAs with cancer. PubMed (i.e., MEDLINE), CINAHL, and PsycINFO databases were searched in 2018 using terms related to medication adherence and cancer. A total of 37,884 records representing 34,006 unique articles were identified and reviewed. Thirteen articles representing 12 studies met inclusion criteria and examined medication adherence among AYAs with cancer. Results of these studies suggest that 21%-60% of AYAs are nonadherent to oral medications, likely placing them at increased risk for poor health outcomes (i.e., relapse, infection/fever, and death). Psychosocial factors (i.e., knowledge, beliefs about capabilities, beliefs about consequences, environmental context and resources, and emotion) were related to nonadherence and warrant future study. Of note, demographic, disease, and family composition variables did not predict nonadherence. Clinical implications as well as limitations and resulting future directions are discussed.
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Affiliation(s)
- Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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109
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Kuhn S, Frankenhauser S, Tolks D. [Digital learning and teaching in medical education : Already there or still at the beginning?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:201-209. [PMID: 29234823 DOI: 10.1007/s00103-017-2673-z] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The current choice of digital teaching and learning formats in medicine is very heterogeneous. In addition to the widely used classical static formats, social communication tools, audio/video-based media, interactive formats, and electronic testing systems enrich the learning environment.For medical students, the private use of digital media is not necessarily linked to their meaningful use in the study. Many gain their experience of digital learning in the sense of "assessment drives learning", especially by taking online exams in a passive, consuming role. About half of all medical students can be referred to as "e-examinees" whose handling of digital learning is primarily focused on online exam preparation. Essentially, they do not actively influence their digital environment. Only a quarter can be identified as a "digital all-rounder", who compiles their individual learning portfolio from the broad range of digital media.At present, the use of digital media is not yet an integral and comprehensive component of the teaching framework of medical studies in Germany, but is rather used in the sense of a punctual teaching enrichment. Current trends in digital teaching and learning offerings are mobile, interactive, and personalized platforms as well as increasing the relevance of learning platforms. Furthermore, didactical concepts targeting the changed learning habits of the students are more successful regarding the acceptance and learning outcomes. In addition, digitalization is currently gaining importance as a component in the medical school curricula.
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Affiliation(s)
- Sebastian Kuhn
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland.
| | - Susanne Frankenhauser
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Daniel Tolks
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der Universität München, München, Deutschland
- Zentrum für Angewandte Gesundheitswissenschaften, Leuphana Universität Lüneburg, Lüneburg, Deutschland
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110
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Coyne KD, Trimble KA, Lloyd A, Petrando L, Pentz J, Van Namen K, Fawcett A, Laing CM. Interventions to Promote Oral Medication Adherence in the Pediatric Chronic Illness Population: A Systematic Review From the Children's Oncology Group. J Pediatr Oncol Nurs 2019; 36:219-235. [PMID: 30943831 PMCID: PMC6487845 DOI: 10.1177/1043454219835451] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Pediatric oncology protocols frequently include multiple oral medications administered at varied dosing schedules, often for prolonged periods of time. Nonadherence to protocol-directed oral medications may place patients at increased risk for morbidity and mortality. The purpose of this systematic review was to evaluate the existing body of evidence to determine best-practice recommendations regarding interventions for oral medication adherence in children and adolescents with cancer. Twenty-four articles were systematically reviewed and evaluated according to the Grading of Recommendations, Assessment, Development, and Evaluation criteria; 2 studies focused on the pediatric oncology population, and the remaining 22 studies focused on other chronic illnesses of childhood. A variety of interventions to increase oral medication adherence in children were identified, including pill swallowing, technology, incentivization, education-based intervention, psychosocial support-based intervention, and combination intervention. Most interventions were shown to have some benefit in pediatrics, most in the non-oncology setting. The overall synthesis of the literature indicates that nonadherence to oral medications is a prevalent problem in pediatrics, and much work is needed to address this problem, particularly in pediatric oncology.
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Affiliation(s)
- Kelly D. Coyne
- Ann & Robert H. Lurie Children’s
Hospital of Chicago, Chicago, IL, USA
| | | | - Ashley Lloyd
- Northwestern Medicine Central DuPage
Hospital, Winfield, IL, USA
| | - Laura Petrando
- Northwestern Medicine Central DuPage
Hospital, Winfield, IL, USA
| | - Jennie Pentz
- Northwestern Medicine Central DuPage
Hospital, Winfield, IL, USA
| | - Kari Van Namen
- Northwestern Medicine Chicago Proton
Center, Warrenville, IL, USA
| | - Andrea Fawcett
- Ann & Robert H. Lurie Children’s
Hospital of Chicago, Chicago, IL, USA
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111
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Aubin S, Rosberger Z, Hafez N, Noory MR, Perez S, Lehmann S, Batist G, Kavan P. Cancer!? I Don't Have Time for That: Impact of a Psychosocial Intervention for Young Adults with Cancer. J Adolesc Young Adult Oncol 2019; 8:172-189. [DOI: 10.1089/jayao.2017.0101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
| | | | - Nada Hafez
- Jewish General Hospital, Montreal, Canada
| | | | | | | | | | - Petr Kavan
- Jewish General Hospital, Montreal, Canada
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112
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Patel AD, Glynn P, Falke AM, Reynolds M, Hoyt R, Hoynes A, Moore-Clingenpeel M, Salvator A, Moreland JJ. Impact of a Make-A-Wish experience on healthcare utilization. Pediatr Res 2019; 85:634-638. [PMID: 30385853 DOI: 10.1038/s41390-018-0207-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/22/2018] [Accepted: 10/03/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate the impact of receiving a wish from the Make-A-WishR Foundation on (1) patient healthcare utilization and (2) savings benefit measures. STUDY DESIGN Make-A-WishR arranges experiences, or "wishes," to children with progressive, life-threatening, or life-limiting illness. A retrospective, case-control analysis was performed comparing patients who received or did not receive a wish and associated impact on healthcare utilization and costs across 2 years. Healthcare utilization was defined as visits to primary, urgent, emergent care, and planned/unplanned inpatient hospitalizations. We defined wish savings benefit as a decline in the cost of care from years 1 to 2, which exceeded the average cost of a wish in 2016, $10,130. RESULTS From 2011 to 2016, 496 Nationwide Children's Hospital patients received a wish. We matched these patients to 496 controls based on age, gender, disease category, and disease complexity. Patients who received a wish were 2.5 and 1.9 times more likely to have fewer unplanned hospital admissions and emergency department visits, respectively. These decreases were associated with a higher likelihood (2.3-fold and 2.2-fold greater odds) of the wish achieving a savings benefit compared to hospital charges. CONCLUSIONS Participation in the Make-A-WishR program may provide children quality of life relief while reducing hospital visits and healthcare expenditures.
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Affiliation(s)
- Anup D Patel
- Department of Pediatrics and Neurology, Nationwide Children's Hospital, FOB 41.55, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Peter Glynn
- Department of Pediatrics and Neurology, Nationwide Children's Hospital, FOB 41.55, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Ashley M Falke
- Department of Pediatrics and Neurology, Nationwide Children's Hospital, FOB 41.55, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Megan Reynolds
- Department of Pediatrics and Neurology, Nationwide Children's Hospital, FOB 41.55, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Richard Hoyt
- Department of Pediatrics and Neurology, Nationwide Children's Hospital, FOB 41.55, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Allison Hoynes
- Department of Pediatrics and Neurology, Nationwide Children's Hospital, FOB 41.55, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Melissa Moore-Clingenpeel
- Department of Pediatrics and Neurology, Nationwide Children's Hospital, FOB 41.55, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Ann Salvator
- Department of Pediatrics and Neurology, Nationwide Children's Hospital, FOB 41.55, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Jennifer J Moreland
- Department of Pediatrics and Neurology, Nationwide Children's Hospital, FOB 41.55, 700 Children's Drive, Columbus, OH, 43205, USA
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113
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Whiteley L, Mena L, Craker LK, Healy MG, Brown LK. Creating a Theoretically Grounded Gaming App to Increase Adherence to Pre-Exposure Prophylaxis: Lessons From the Development of the Viral Combat Mobile Phone Game. JMIR Serious Games 2019; 7:e11861. [PMID: 30916652 PMCID: PMC6456850 DOI: 10.2196/11861] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/05/2018] [Accepted: 12/09/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In the United States, young minority men who have sex with men (MSM) are most likely to become infected with HIV. The use of antiretroviral medications to reduce the risk of acquiring HIV infection (pre-exposure prophylaxis, PrEP) is an efficacious and promising prevention strategy. There have been significant advances regarding PrEP, including the definitive demonstration that PrEP reduces HIV acquisition and the development of clinical prescribing guidelines. Despite these promising events, the practical implementation of PrEP can be challenging. Data show that PrEP's safety and effectiveness could be greatly compromised by suboptimal adherence to treatment, and there is concern about the potential for an increase in HIV risk behavior among PrEP users. Due to these challenges, the prescribing of PrEP should be accompanied by behavioral interventions to promote adherence. OBJECTIVE This study aimed to develop an immersive, action-oriented iPhone gaming intervention to improve motivation for adherence to PrEP. METHODS Game development was guided by social learning theory, taking into consideration the perspectives of young adult MSM who are taking PrEP. A total of 20 young men who have sex with men (YMSM; aged 18-35 years) were recruited from a sexually transmitted infection (STI), HIV testing, and PrEP care clinic in Jackson, Mississippi, between October 2016 and June 2017. They participated in qualitative interviews guided by the information-motivation-behavioral skills (IMB) model of behavior change. The mean age of participants was 26 years, and all the participants identified as male. Acceptability of the game was assessed with the Client Service Questionnaire and session evaluation form. RESULTS A number of themes emerged that informed game development. YMSM taking PrEP desired informational game content that included new and comprehensive details about the effectiveness of PrEP, details about PrEP as it relates to doctors' visits, and general information about STIs other than HIV. Motivational themes that emerged were the desire for enhancement of future orientation; reinforcement of positive influences from partners, parents, and friends; collaboration with health care providers; decreasing stigma; and a focus on personal relevance of PrEP-related medical care. Behavioral skills themes centered around self-efficacy and strategies for adherence to PrEP and self-care. CONCLUSIONS We utilized youth feedback, IMB, and agile software development to create a multilevel, immersive, action-oriented iPhone gaming intervention to improve motivation for adherence to PrEP. There is a dearth of gaming interventions for persons on PrEP. This study is a significant step in working toward the development and testing of an iPhone gaming intervention to decrease HIV risk and promote adherence to PrEP for YMSM.
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Affiliation(s)
- Laura Whiteley
- Department of Psychiatry, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Leandro Mena
- University of Mississippi Medical Center, University of Mississippi, Jackson, MS, United States
| | - Lacey K Craker
- Young Adult Behavioral Health, Department of Psychiatry and Human Behavior, Rhode Island Hospital, Providence, RI, United States
| | - Meredith Garver Healy
- Young Adult Behavioral Health, Department of Psychiatry and Human Behavior, Rhode Island Hospital, Providence, RI, United States
| | - Larry K Brown
- Department of Psychiatry, Warren Alpert Medical School, Brown University, Providence, RI, United States
- Young Adult Behavioral Health, Department of Psychiatry and Human Behavior, Rhode Island Hospital, Providence, RI, United States
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114
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Lim NLY, Shorey S. Effectiveness of technology-based educational interventions on the empowerment related outcomes of children and young adults with cancer: A quantitative systematic review. J Adv Nurs 2019; 75:2072-2084. [PMID: 30740758 DOI: 10.1111/jan.13974] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/10/2018] [Accepted: 12/03/2018] [Indexed: 01/28/2023]
Abstract
AIM To determine the effectiveness of technological-based educational interventions on the empowerment-related outcomes of children and young adults with cancer. DESIGN Quantitative systematic review. DATA SOURCES Six electronic databases, including PubMed, Cochrane Library, EMBASE, CINAHL, Scopus, and PsycINFO, were searched to identify eligible randomized controlled trials from each database's point of inception to December 2017. Grey literature was also searched from ProQuest and MedNar. REVIEW METHODS A narrative summary of the results was undertaken owing to the small number of eligible studies and high heterogeneity across the studies. RESULTS Five studies were included in the review. Five empowerment-related outcomes under the domain "patient states" were identified at differing time points of 3-month postintervention, immediate postintervention, and during treatment: (a) self-efficacy; (b) cancer knowledge; (c) health locus of control; (d) emotional well-being; and (e) quality of life. At 3-month postintervention, health locus of control was found to be significant in two studies and self-efficacy and cancer knowledge were found to be significant in one study. No difference in quality of life was found. At immediate postintervention, a beneficial indication was observed. During treatment, no statistical significance was found regarding the effectiveness of a technological-based cognitive behavioural package. CONCLUSION Weak evidences led to inconclusive findings on the effectiveness of technological-based educational interventions on the empowerment-related outcomes of children and young adults with cancer. Future research will benefit from well-designed clinical trials that use a common outcome measurement to provide more information regarding the effectiveness of such interventions.
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Affiliation(s)
- Natalie L Y Lim
- Nursing Division, KK Women's and Children's Hospital, Singapore, Singapore
| | - Shefaly Shorey
- Yong Loo Lin School of Medicine, Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore.,National University Health System, Singapore, Singapore
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115
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Sparapani VDC, Fels S, Kamal N, Nascimento LC. Conceptual framework for designing video games for children with type 1 diabetes. Rev Lat Am Enfermagem 2019; 27:e3090. [PMID: 30916223 PMCID: PMC6432989 DOI: 10.1590/1518-8345.2764.3090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 09/17/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE to present a theoretically based conceptual framework for designing video games for children with type 1 diabetes mellitus. METHODS this was a methodological study that developed a conceptual framework with nine steps in view of health behavior change theories and the user-centered design approach as theoretical and methodological frameworks, respectively. Twenty-one children, aged 7 to 12 years, participated by expressing their needs and preferences related to diabetes and video games. Data were analysed following content analysis guidelines. Then, a choice of appropriate health behavioral change theories and their determinants that should be capable of influencing children's behaviors and preferences. RESULTS the conceptual framework proposes a video game that consists of six phases, each addressing one stage of behavioral change and specific determinants, aligned with the needs and preferences identified by the participating children. This study shows the applicability of this framework in view of each proposed phase presenting examples and the children's ideas. CONCLUSION the results of this study contribute to advance the discussion on how behavioral theories and their determinants should be related to the design of creative and funny video games considering the profile of the target population as well as its needs and preferences.
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Affiliation(s)
| | - Sidney Fels
- University if British Columbia, Department of Electrical and Computer Engineering, Vancouver, BC, Canada
| | - Noreen Kamal
- University of Calgary, Department of Clinical Neurosciences, Calgary, AB, Canada
| | - Lucila Castanheira Nascimento
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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116
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Tuijnman A, Kleinjan M, Hoogendoorn E, Granic I, Engels RC. A Game-Based School Program for Mental Health Literacy and Stigma Regarding Depression (Moving Stories): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e11255. [PMID: 30869652 PMCID: PMC6437615 DOI: 10.2196/11255] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/31/2018] [Accepted: 11/10/2018] [Indexed: 12/19/2022] Open
Abstract
Background The prevalence of elevated depressive symptoms among youth in most western societies is high. Yet, most adolescents who are experiencing depressive symptoms do not seek help. Low mental health literacy, high stigma, and low social support have been shown to hinder help-seeking. A small number of interventions has been developed to target mental health literacy and stigma, but few focus on actual help-seeking and first aid behavior. We have developed a game-based school program called Moving Stories that targets mental health literacy, including knowledge and behavior, and stigma among adolescents, in regard to depression specifically. Objective Our aim is to describe the protocol for a study that will test the effectiveness of the program Moving Stories in a Dutch adolescent sample. We hypothesize that adolescents who participate in the program Moving Stories will have better mental health literacy and less stigma regarding depression compared to adolescents in the nonintervention control group at posttest and at 3- and 6-months follow-up. We also expect a positive change in actual help-seeking and first aid behavior at 3- and 6-months follow-up. Methods Moving Stories has been developed by a professional game design company in collaboration with researchers and relevant stakeholders. The effectiveness of Moving Stories will be tested through a randomized controlled trial with two conditions: Moving Stories versus control. Participants will fill in questionnaires at pretest, posttest, and 3- and 6-months follow-up. Our power analysis showed a required sample size of 180 adolescents. Results Four high schools have agreed to participate with a total of 10 classes. A total of 185 adolescents filled in the pretest questionnaire. The last of the follow-up data was collected in December 2018. Conclusions If Moving Stories proves to be effective, it could be implemented as a school-based program to target mental health literacy and stigma regarding depression; this could, in turn, improve early help-seeking in adolescents suffering from depression. Trial Registration Nederlands Trial Register NTR7033; https://www.trialregister.nl/trial/6855 International Registered Report Identifier (IRRID) DERR1-10.2196/11255
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Affiliation(s)
- Anouk Tuijnman
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands.,Trimbos Institute, Utrecht, Netherlands
| | - Marloes Kleinjan
- Trimbos Institute, Utrecht, Netherlands.,Department of Interdisciplinary Social Sciences, Utrecht University, Utrecht, Netherlands
| | | | - Isabela Granic
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Rutger Cme Engels
- Erasmus School of Social and Behavioural Sciences, Erasmus University, Rotterdam, Netherlands
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117
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Kuipers DA, Terlouw G, Wartena BO, Prins JT, Pierie JPEN. Maximizing Authentic Learning and Real-World Problem-solving in Health Curricula Through Psychological Fidelity in a Game-Like Intervention: Development, Feasibility, and Pilot Studies. MEDICAL SCIENCE EDUCATOR 2019; 29:205-214. [PMID: 34457469 PMCID: PMC8368371 DOI: 10.1007/s40670-018-00670-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
High fidelity is regarded as a hallmark of educational games and simulations for health education. Mainly physical and functional fidelity are associated with authenticity, resulting in the pursuit of a true-to-life simulation and suggesting the imposition of a generally accepted and often unintentional design rationale that assumes that the greater the fidelity of a game or simulation to the real world, the more authentic the intervention is perceived as. Psychological fidelity receives significantly less attention, although it correlates strongly to credibility, suspension of disbelief, and engagement. The BABLR simulator reduces physical and functional fidelity to a minimum and explores the use of psychological fidelity as the main carrier of an authentic learning experience. BABLR was assessed using 26 participants with varying backgrounds in health innovation and social work. In several pilot studies, we collected data on perceived realisticness and real-world relevance. Results show that experts, as well as participants, attest to BABLR's engagement, immersiveness, and motivational qualities. Practical implications of these findings for future research into developing low-fidelity simulations with high psychological fidelity will be discussed.
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Affiliation(s)
- Derek A. Kuipers
- NHL Stenden University of Applied Sciences, Rengerslaan 10, 8917 DD Leeuwarden, Netherlands
- Medical Faculty LEARN, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Gijs Terlouw
- NHL Stenden University of Applied Sciences, Rengerslaan 10, 8917 DD Leeuwarden, Netherlands
| | - Bard O. Wartena
- NHL Stenden University of Applied Sciences, Rengerslaan 10, 8917 DD Leeuwarden, Netherlands
- Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Jelle T. Prins
- MCL Academy, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Jean Pierre E. N. Pierie
- Surgery Department, Medical Center Leeuwarden, Leeuwarden, Netherlands
- Post Graduate School of Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Abraham O, Feathers A, Grieve L, Babichenko D. Developing and piloting a serious game to educate children about over‐the‐counter medication safety. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2019. [DOI: 10.1111/jphs.12292] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Olufunmilola Abraham
- Social & Administrative Sciences University of Wisconsin‐Madison School of Pharmacy Madison Wisconsin USA
| | - Alison Feathers
- Department of Pharmacy and Therapeutics University of Pittsburgh School of Pharmacy Pittsburgh Pennsylvania USA
| | - Lorin Grieve
- Department of Pharmacy and Therapeutics University of Pittsburgh School of Pharmacy Pittsburgh Pennsylvania USA
| | - Dmitriy Babichenko
- University of Pittsburgh School of Computing and Information Pittsburgh Pennsylvania USA
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119
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Thomas TH, McLaughlin M, Hayden M, Shumaker E, Trybus J, Myers E, Zabiegalski A, Cohen SM. Teaching Patients with Advanced Cancer to Self-Advocate: Development and Acceptability of the Strong Together™ Serious Game. Games Health J 2019; 8:55-63. [DOI: 10.1089/g4h.2018.0021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Teresa Hagan Thomas
- Department of Health Promotion & Development, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
| | - Mary McLaughlin
- University of Pittsburgh Medical Center Passavant, Pittsburgh, Pennsylvania
| | - Margaret Hayden
- University of Pittsburgh Medical Center Passavant, Pittsburgh, Pennsylvania
| | - Elizabeth Shumaker
- University of Pittsburgh Medical Center Passavant, Pittsburgh, Pennsylvania
| | - Jessica Trybus
- Simcoach Games, Pittsburgh, Pennsylvania
- Entertainment Technology Center, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Eben Myers
- Simcoach Games, Pittsburgh, Pennsylvania
| | | | - Susan M. Cohen
- Department of Health Promotion & Development, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
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120
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Greenspoon T, Charow R, Papadakos J, Samadi M, Maloney AM, Paulo C, Forcina V, Chen L, Thavaratnam A, Mitchell L, Lorenzo A, Gupta AA. Evaluation of an Educational Whiteboard Video to Introduce Fertility Preservation to Female Adolescents and Young Adults With Cancer. JCO Oncol Pract 2019; 16:e488-e497. [PMID: 32048948 DOI: 10.1200/op.19.00365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Fertility is an important issue for adolescents and young adults with cancer facing potential infertility. Egg cryopreservation options exist, but information is sometimes overwhelming. We evaluated a fertility preservation educational video and assessed patient and family knowledge and impressions at pre- and post-video timepoints. METHODS We developed a whiteboard video to explain egg cryopreservation to patients and families. The video was evaluated on the basis of patient education best practices (readability, understandability, actionability). Participants were recruited using convenience sampling in oncology clinics. They completed questionnaires before and after watching to assess knowledge and interest. Inclusion criteria were patients age 13-39 years and minimum 1 month from diagnosis. Descriptive statistics, correlation analyses, and mean comparisons were conducted. RESULTS The video script read at a grade 8 reading level. Average understandability and actionability scores were below the acceptable standard. We recruited 108 patients (mean age, 27 years) and 39 caregivers/partners. Patients' knowledge about fertility preservation increased after viewing the video. Interest was high before and after, and satisfaction was high for both patients and caregivers. Participants appreciated information on process, procedure, and delivery but desired more information on logistics, including cost. CONCLUSION A targeted patient education video about fertility preservation options can build knowledge and encourage discussions about infertility. The video can be used as a model for videos on related topics to provide accurate information in a youth-friendly medium; however, following patient education best practices for readability, understandability, and actionability may increase video effectiveness. Future research should assess how audiovisual patient education material affects patient behavior.
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Affiliation(s)
- Talia Greenspoon
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Charow
- Cancer Health Literacy Research Centre, Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Janet Papadakos
- Cancer Health Literacy Research Centre, Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Patient Education, Cancer Care Ontario; University of Toronto, Institute of Health Policy, Management & Evaluation, Toronto, Ontario, Canada
| | - Mahsa Samadi
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Anne Marie Maloney
- Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Chelsea Paulo
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Victoria Forcina
- Adolescent & Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Li Chen
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adrian Thavaratnam
- Adolescent & Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Laura Mitchell
- Adolescent & Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Armando Lorenzo
- Division of Pediatric Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Abha A Gupta
- Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Adolescent & Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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121
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Whiteley L, Brown LK, Mena L, Craker L, Arnold T. Enhancing health among youth living with HIV using an iPhone game. AIDS Care 2019; 30:21-33. [PMID: 30626196 DOI: 10.1080/09540121.2018.1503224] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Despite promising outcomes of antiretroviral therapy (ART), challenges to improving adherence among youth living with HIV (YLWH) exist. Mobile games are popular among youth and may improve skills related to resilience, coping, and ART adherence. This study examines the preliminary effects of an iPhone game/app on ART adherence, viral load, and relevant knowledge and attitudes among YLWH in Jackson, MS. METHODS A RCT with 61 YLWH tested the impact of BattleViro, an ART-related iPhone game, over 16 weeks. Participants, ages 14-26, were recruited from HIV clinics and randomly assigned to receive BattleViro or a non-HIV-related game. All participants received a medication monitoring device. Chi-square and t-test analyses examined baseline differences between conditions. Continuous outcomes were examined using analyses of covariance (ANCOVAs) controlling for baseline scores. Cohen's d effect size differences (ESD) between groups were calculated. RESULTS The sample was 79% male, 97% Black, and 74% non-heterosexual, with a mean age of 22 years. A third had started ART in the past 3 months. There were no demographic differences between conditions. Examination of ESDs revealed that BattleViro demonstrated promising, but nonsignificant, improvements in HIV knowledge (ESD = 0.50), ART knowledge (ESD = 0.42) and social support (ESD = 0.62). Exploratory moderation analyses revealed interactions between BattleViro and newly starting ART. Those newly starting ART in the BattleViro condition, compared to those in the control, experienced a 0.96 log greater decrease in viral load (ESD=-2.21, F = 4.33, p = 0.04), better adherence (71% vs. 48%; ESD = 1.15, F = 3.90, p = 0.05), more HIV knowledge (ESD = 0.90), and more ART knowledge (ESD = 0.72). CONCLUSION BattleViro showed promising improvements in HIV knowledge, ART knowledge and social support. Also, there was improved adherence and viral load outcomes specifically among those newly starting ART. ART initiation may be an opportunity to empower and motivate YLWH to build healthy skills.
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Affiliation(s)
- Laura Whiteley
- a Department of Psychiatry and Human Behavior , Alpert Medical School of Brown University , Providence , RI , USA
| | - Larry K Brown
- a Department of Psychiatry and Human Behavior , Alpert Medical School of Brown University , Providence , RI , USA.,b Rhode Island Hospital , Providence , RI , USA
| | - Leandro Mena
- c University for Mississippi Medical Center , Jackson , MS , USA
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Stergiopoulos S, Michaels DL, Kunz BL, Getz KA. Measuring the Impact of Patient Engagement and Patient Centricity in Clinical Research and Development. Ther Innov Regul Sci 2019. [DOI: 10.1177/2168479018817517] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Stella Stergiopoulos
- Tufts Center for the Study of Drug Development, Tufts University School of Medicine, Boston, MA, USA
| | - Debra L. Michaels
- Drug Information Association, DIA Global Center, Washington, DC, USA
| | | | - Kenneth A. Getz
- Tufts Center for the Study of Drug Development, Tufts University School of Medicine, Boston, MA, USA
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123
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Arbi Care application increases preschool children's hand-washing self-efficacy among preschool children. ENFERMERIA CLINICA 2019. [PMID: 29650200 DOI: 10.1016/s1130-8621(18)30031-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This research aimed to examine the effectiveness of an Android mobile game application called Arbi Care as a means to prevent diarrhea and build self-efficacy in hand washing among preschool children. METHOD This research used a pre- and post-test control group and time series design approach. Respondents were chosen randomly from a group of four to six years children. The intervention group (n = 60) received Arbi Care intervention for 25 minutes, twice a week, for five weeks while the control group (n = 60) received standard education. Self-efficacy was measured by using questionnaire and observation. Measurement was carried out three times in the sixth, eight, and tenth week post-intervention. The data was analyzed using the GLMRM test. RESULTS There was a significant increase in the average score of self-efficacy in hand washing for the intervention group versus the control group. Moreover, there were significant differences in the results of average scores in which the intervention group showed much better self-efficacy improvement over the control group during the first, second, and final post-test after the intervention was given (p < 0.001). CONCLUSIONS An Android-based educational game can be an effective medium to improve hand washing self-efficacy among preschool children, thus helping to prevent diarrhea.
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Nijhof SL, Vinkers CH, van Geelen SM, Duijff SN, Achterberg EM, van der Net J, Veltkamp RC, Grootenhuis MA, van de Putte EM, Hillegers MH, van der Brug AW, Wierenga CJ, Benders MJ, Engels RC, van der Ent CK, Vanderschuren LJ, Lesscher HM. Healthy play, better coping: The importance of play for the development of children in health and disease. Neurosci Biobehav Rev 2018; 95:421-429. [DOI: 10.1016/j.neubiorev.2018.09.024] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/27/2018] [Accepted: 09/26/2018] [Indexed: 12/20/2022]
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Kim SM, Kim HJ, Hwang HC, Hong JS, Bae S, Min KJ, Han DH. The Effects of a Serious Game on Depressive Symptoms and Anxiety in Breast Cancer Patients with Depression: A Pilot Study Using Functional Magnetic Resonance Imaging. Games Health J 2018; 7:409-417. [PMID: 30383458 DOI: 10.1089/g4h.2017.0183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Depression is common in cancer patients. We investigated the effects of playing a serious game in breast cancer patients with mild to moderate depression using functional neuroimaging. Materials and Methods: Thirty-five participants were randomly assigned to the Game group and the Nongame group, and fifteen participants in each group completed the study protocol. Participants in the Game group were asked to play a serious game, "Hit the Cancer" (RAW HAND, Seoul, Korea), for at least 30 minutes/day, 5 days/week, for 3 weeks. Participants in the Nongame group received usual care. At baseline and follow-up, all participants were assessed with the Beck Depression Inventory (BDI), Beck Anxiety Inventory, Stress Response Inventory (SRI), and 3-Tesla resting-state functional magnetic resonance imaging. Changes in functional connectivity (FC) between the brain regions in the default mode network (DMN) and salience network (SN) were analyzed. Results: After the intervention, BDI and SRI scores in the Game group greatly decreased compared with those in the Nongame group. In addition, compared with the Nongame group, the Game group showed decreased postintervention FC between the right posterior cingulate cortex (PCC) of the DMN and right insula of the SN. The improvement in BDI and SRI scores correlated with the decrease in FC between the right PCC and right insula. Conclusion: Selective attention training and repetitive stimulation of the insula by serious game play might cause normalization of the FC between the SN and DMN, thus improving depressive mood.
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Affiliation(s)
- Sun Mi Kim
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hee-Jun Kim
- Division of Hemato-oncology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Chan Hwang
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ji Sun Hong
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sujin Bae
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyoung Joon Min
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Korea
| | - Doug Hyun Han
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Korea
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Precision gaming for health: Computer games as digital medicine. Methods 2018; 151:28-33. [PMID: 30273711 DOI: 10.1016/j.ymeth.2018.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/14/2018] [Accepted: 09/27/2018] [Indexed: 11/22/2022] Open
Abstract
Health based games have significant potential as therapeutic interventions due to the inherent mechanisms associated with social and individual game play and their capacity for sensor integration, data capture analysis and patient feedback. Moreover, they are low cost and they can be deployed at the point of care across an evolving digital ecosystem. However, a robust evidence base to support their wider adoption as a clinical intervention for chronic diseases is lacking and significant methodological barriers exist for health games developers creating efficacious 'digital medicines'. Game design is complex and it must utilise validated game mechanics balanced with a creative and engaging game design. The aim of this review is therefore to outline the fundamental steps of game development for health professionals and to critically appraise the methodology for assessing health games as medical interventions. This requires (1) The adoption of clearly defined global language for health games development based on a targeted function as therapeutic agents. (2) The development of multidisciplinary teams with a broad portfolio of development and clinical skill sets. (3) The creation of health game engines specifically built to facilitate clinical game development. (4) Robust trial design and assessment of translational impact: If games are to be prescribed, their efficacy and toxicity must be based on a rigorous assessment of their use within a real world clinical environment. Trials for precision health games have specific challenges around blinding, learning curves, bias and confounding that are particularly problematic. We propose the adoption of the IDEAL-GAMES framework for game development that systematically assess and validates games through open registries. In conclusion we propose a new framework for assessing the robustness and clinical efficacy of games for health as clinical interventions in the clinical environment.
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Thomsen EK, Hemingway C, South A, Duda KA, Dormann C, Farmer R, Coleman M, Coleman M. ResistanceSim: development and acceptability study of a serious game to improve understanding of insecticide resistance management in vector control programmes. Malar J 2018; 17:422. [PMID: 30424788 PMCID: PMC6234623 DOI: 10.1186/s12936-018-2572-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 11/09/2018] [Indexed: 11/13/2022] Open
Abstract
The use of insecticides is the cornerstone of effective malaria vector control. However, the last two decades has seen the ubiquitous use of insecticides, predominantly pyrethroids, causing widespread insecticide resistance and compromising the effectiveness of vector control. Considerable efforts to develop new active ingredients and interventions are underway. However, it is essential to deploy strategies to mitigate the impact of insecticide resistance now, both to maintain the efficacy of currently available tools as well as to ensure the sustainability of new tools as they come to market. Although the World Health Organization disseminated best practice guidelines for insecticide resistance management (IRM), Rollback Malaria's Vector Control Working Group identified the lack of practical knowledge of IRM as the primary gap in the translation of evidence into policy. ResistanceSim is a capacity strengthening tool designed to address this gap. The development process involved frequent stakeholder consultation, including two separate workshops. These workshops defined the learning objectives, target audience, and the role of mathematical models in the game. Software development phases were interspersed with frequent user testing, resulting in an iterative design process. User feedback was evaluated via questionnaires with Likert-scale and open-ended questions. The game was regularly evaluated by subject-area experts through meetings of an external advisory panel. Through these processes, a series of learning domains were identified and a set of specific learning objectives for each domain were defined to be communicated to vector control programme personnel. A simple "game model" was proposed that produces realistic outputs based on player strategy and also runs in real-time. Early testing sessions revealed numerous usability issues that prevented adequate player engagement. After extensive revisions, later testing sessions indicated that the tool would be a valuable addition to IRM training.
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Affiliation(s)
- Edward K Thomsen
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Charlotte Hemingway
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Andy South
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Kirsten A Duda
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Claire Dormann
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Robert Farmer
- Extra Mile Studios, 142 West Nile St, Glasgow, G1 2RQ, UK
| | - Michael Coleman
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Marlize Coleman
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
- IVCC, Pembroke Pl, Liverpool, L3 5QA, UK
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129
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Kim HJ, Kim SM, Shin H, Jang JS, Kim YI, Han DH. A Mobile Game for Patients With Breast Cancer for Chemotherapy Self-Management and Quality-of-Life Improvement: Randomized Controlled Trial. J Med Internet Res 2018; 20:e273. [PMID: 30578205 PMCID: PMC6305659 DOI: 10.2196/jmir.9559] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 06/23/2018] [Accepted: 07/10/2018] [Indexed: 12/20/2022] Open
Abstract
Background The application of game-based learning in clinical practice has shown potential advantages in previous studies. However, there have been little efforts to use smartphone-based mobile games in the management of adult patients with cancer. Objective The objective of our study was to evaluate if patient education using a mobile game may increase drug compliance, decrease physical side effects of chemotherapy, and improve psychological status in breast cancer patients. Methods A total of 76 patients with metastatic breast cancer who were planned to receive cytotoxic chemotherapy were enrolled in this trial. Study participants were randomly assigned to a mobile game play group (game group, n=36) or a conventional education group (control group, n=40) in a ratio of 1:1. The patients were unblinded and followed prospectively for 3 weeks. Outcome measures included time spent for education, compliance to medication, physical side effects, and psychological side effects including quality of life (QoL). Results Overall, 72 out of 76 patients completed the study after 3 weeks (95%). The subjects in the game group showed high levels of satisfaction with the app. The time spent playing the mobile game in the game group was longer than that spent for self-education in the control group (mean 22.2, SD 6.1 vs mean 5.5, SD 4.0 minutes a day; P<.001). The mobile game group showed better drug adherence (Korean version of the Medication Adherence Rating Scale; mean 7.6, SD 0.7 vs mean 6.5, SD 0.5; P<.001). The use of the mobile game was associated with lower rates of chemotherapy-related side effects, such as nausea, fatigue, numbness of hand or foot, and hair loss, than the control group. The game group exhibited better QoL during chemotherapy (mean 74.9, SD 3.5 vs mean 72.2, SD 5.3; P=.01). However, there were no significant differences in terms of depression and anxiety scales. Conclusions This study suggests the feasibility and potentiality of the use of smartphone mobile games for patients with breast cancer receiving chemotherapy. Education using a mobile game led to better patient education, improved drug compliance, decreased side effects, and better QoL compared with conventional education. Mobile games can be used as easy, fun, and effective measures for patient education and have the potential to improve treatment outcomes. Trial Registration ClinicalTrials.gov NCT03205969; http://clinicaltrials.gov/ct2/show/NCT03205969 (Archived by WebCite at http://www.webcitation.org/71jfSBOq9).
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Affiliation(s)
- Hee Jun Kim
- Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Republic Of Korea
| | - Sun Mi Kim
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic Of Korea
| | - Heechul Shin
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul, Republic Of Korea
| | - Joung-Soon Jang
- Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Republic Of Korea
| | - Young In Kim
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic Of Korea
| | - Doug Hyun Han
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic Of Korea
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Castel AD, Qasmieh S, Greenberg D, Ellenberger N, Howell TH, Griffith C, Wilbourn BC, Ganesan K, Hussein N, Ralte G, Rakhmanina N. Digital Gaming to Improve Adherence Among Adolescents and Young Adults Living With HIV: Mixed-Methods Study to Test Feasibility and Acceptability. JMIR Serious Games 2018; 6:e10213. [PMID: 30322838 PMCID: PMC6231793 DOI: 10.2196/10213] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/27/2018] [Accepted: 07/17/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND An estimated 50% of adolescents and young adults (AYA) living with HIV are failing to adhere to prescribed antiretroviral treatment (ART). Digital games are effective in chronic disease management; however, research on gaming to improve ART adherence among AYA is limited. OBJECTIVE We assessed the feasibility and acceptability of video gaming to improve AYA ART adherence. METHODS Focus group discussions and surveys were administered to health care providers and AYA aged 13 to 24 years living with HIV at a pediatric HIV program in Washington, DC. During focus group discussions, AYA viewed demonstrations of 3 game prototypes linked to portable Wisepill medication dispensers. Content analysis strategies and thematic coding were used to identify adherence themes and gaming acceptance and feasibility. Likert scale and descriptive statistics were used to summarize response frequencies. RESULTS Providers (n=10) identified common adherence barriers and strategies, including use of gaming analogies to improve AYA ART adherence. Providers supported exploration of digital gaming as an adherence intervention. In 6 focus group discussions, 12 AYA participants identified disclosure of HIV status and irregular daily schedules as major barriers to ART and use of alarms and pillboxes as reminders. Most AYA were very or somewhat likely to use the demonstrated game prototypes to help with ART adherence and desired challenging, individually tailored, user-friendly games with in-game incentives. Game prototypes were modified accordingly. CONCLUSIONS AYA and their providers supported the use of digital games for ART adherence support. Individualization and in-game incentives were preferable and informed the design of an interactive technology-based adherence intervention among AYA living with HIV.
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Affiliation(s)
- Amanda D Castel
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Saba Qasmieh
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | | | | | - Tyriesa Howard Howell
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
- Center for Prevention Science, School of Social Work, Rutgers University, New Brunswick, NJ, United States
| | - Caleb Griffith
- Children's National Health System, Washington, DC, United States
| | - Brittany C Wilbourn
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Kavitha Ganesan
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
- Walter Reed Army Institute of Research, United States Military HIV Research Program, Silver Spring, MD, United States
| | - Nadia Hussein
- Children's National Health System, Washington, DC, United States
| | | | - Natella Rakhmanina
- Children's National Health System, Washington, DC, United States
- Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC, United States
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States
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Einführung in die Vergangenheit, Gegenwart und Zukunft von Serious Games (for Health). PRAVENTION UND GESUNDHEITSFORDERUNG 2018. [DOI: 10.1007/s11553-018-0667-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wu YP, Linder LA, Kanokvimankul P, Fowler B, Parsons BG, Macpherson CF, Johnson RH. Use of a Smartphone Application for Prompting Oral Medication Adherence Among Adolescents and Young Adults With Cancer. Oncol Nurs Forum 2018; 45:69-76. [PMID: 29251285 DOI: 10.1188/18.onf.69-76] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To explore the feasibility and acceptability of use of a smartphone medication reminder application to promote adherence to oral medications among adolescents and young adults (AYAs) with cancer.
. SAMPLE & SETTING 23 AYAs with cancer from a Children's Oncology Group-affiliated children's hospital and a National Cancer Institute-designated comprehensive cancer center in Salt Lake City, UT.
. METHODS & VARIABLES Participants were asked to use the application for eight weeks. Data on application usage were obtained from a cloud-based server hosted by the application developers. Weekly self-report questionnaires were completed. Feasibility was assessed through participants' usage and responses. Acceptability was assessed through participants' perceived ease of use and usefulness.
. RESULTS Almost all participants used the application at least once. More than half reported that they took their medications immediately when they received reminders. Participants also reported that the application was easy to set up and use, and that it was useful for prompting medication taking.
. IMPLICATIONS FOR NURSING Nurses could continue to test the efficacy of integrating e-health modalities, such as smartphone applications, into efforts to promote medication adherence.
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Affiliation(s)
| | | | | | | | | | | | - Rebecca H Johnson
- Mary Bridge Children's Hospital and Health Center/MultiCare Health System
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Winskell K, Sabben G, Akelo V, Ondeng'e K, Obong'o C, Stephenson R, Warhol D, Mudhune V. A Smartphone Game-Based Intervention (Tumaini) to Prevent HIV Among Young Africans: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e10482. [PMID: 30068501 PMCID: PMC6094086 DOI: 10.2196/10482] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/01/2018] [Accepted: 06/19/2018] [Indexed: 12/05/2022] Open
Abstract
Background There is a pressing need to ensure that youth in high HIV prevalence settings are prepared for a safer sexual debut. Smartphone ownership is increasing dramatically in low-income and middle-income countries. Smartphone games that are appropriately grounded in behavioral theory and evidence-based practice have the potential to become valuable tools in youth HIV prevention efforts in Sub-Saharan Africa. Objective To pilot-test a theory-based, empirically grounded smartphone game for young Kenyans designed to increase age and condom use at first sex, aiming to establish directionality of effects on behavior change. Methods Tumaini (“hope for the future” in Swahili) is an interactive, narrative-based game grounded in social cognitive theory. A randomized controlled pilot study was conducted in Kisumu, Western Kenya, from April to June 2017 with 60 participants aged 11-14 (mean 12.7) years. Intervention arm participants (n=30) were provided with an Android smartphone with Tumaini installed on it and were instructed to play the game for at least 1 hour a day for 16 days; control arm participants (n=30) received no intervention. All participants completed a survey on behavioral mediators, delivered via an audio computer-assisted self-interview system at baseline (T1), post intervention (T2), and at 6 weeks postintervention (T3). The postintervention survey for intervention arm participants included questions eliciting feedback on the game. Intervention arm participants and their parents participated in 8 postintervention focus group discussions. Game log files were analyzed to calculate the length of exposure to the game. Behavioral survey data were analyzed using two-sample t tests to compare mean change from T1 to T2 and to T3 for intervention versus control arm participants. Descriptive statistics on game feedback questions were computed. Focus group transcripts were uploaded to MAXQDA software, where they were labeled with deductive and inductive codes. Data were analyzed thematically and compared across demographics. Results Intervention arm participants played Tumaini for a mean of approximately 27 hours. The intervention arm showed significant gains in sexual health-related knowledge and self-efficacy (both P<.001), behavioral intention for risk-avoidance strategies and sexual risk communication (P=.006), and overall survey scores (P<.001) compared with the control arm at T3. The postintervention survey revealed high subjective measures of the game’s value, relevance, and appeal. Focus groups identified a wide range of knowledge and skills the participants had gained, including setting goals and planning how to achieve them, which was perceived as a key motivator for avoiding or reducing risk. Conclusions The study supports the need for further research to assess the efficacy of the game-based intervention. If proven efficacious, smartphone games have the potential to dramatically increase the reach of culturally adapted behavioral interventions while ensuring fidelity to intervention design. Trial Registration ClinicalTrials.gov NCT03054051; http://clinicaltrials.gov/ct2/show/NCT03054051 (Archived by WebCite at http://www.webcitation.org/70U2gCNtW)
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Affiliation(s)
- Kate Winskell
- Rollins School of Public Health, Hubert Department of Global Health, Emory University, Atlanta, GA, United States
| | - Gaëlle Sabben
- Rollins School of Public Health, Hubert Department of Global Health, Emory University, Atlanta, GA, United States
| | - Victor Akelo
- Kenya Medical Research Institute- Centre for Global Health Research, HIV Research Branch, Kisumu, Kenya
| | - Ken Ondeng'e
- Kenya Medical Research Institute- Centre for Global Health Research, HIV Research Branch, Kisumu, Kenya
| | | | - Rob Stephenson
- School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - David Warhol
- Realtime Associates, El Segundo, CA, United States
| | - Victor Mudhune
- Kenya Medical Research Institute- Centre for Global Health Research, HIV Research Branch, Kisumu, Kenya
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134
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McGrady ME, Eckman MH, O'Brien MM, Pai ALH. Cost-Effectiveness Analysis of an Adherence-Promotion Intervention for Children With Leukemia: A Markov Model-Based Simulation. J Pediatr Psychol 2018; 43:758-768. [PMID: 29771338 DOI: 10.1093/jpepsy/jsy022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/28/2018] [Indexed: 12/22/2022] Open
Abstract
Objective Improving medication adherence among children with B-cell precursor acute lymphoblastic leukemia (B-ALL) has the potential to reduce relapse rates but requires an investment in resources. An economic evaluation is needed to understand the potential costs and benefits of delivering adherence-promotion interventions (APIs) as part of standard clinical care. Methods A Markov decision analytic model was used to simulate the potential incremental cost-effectiveness per quality-adjusted life year (QALY) to be gained from an API for children with B-ALL in first continuous remission compared with treatment as usual (TAU, no intervention). Model parameter estimates were informed by previously published studies. The primary outcome was incremental cost (2015 US$) per QALY gained for API compared with TAU. Results The model predicts the API to result in superior health outcomes (4.87 vs. 4.86 QALYs) and cost savings ($43,540.73 vs. $46,675.71) as compared with TAU, and simulations indicate that, across a range of plausible parameter estimates, there is a 95% chance that the API is more effective and less costly than TAU. The API was estimated to remain more effective and less costly than TAU in situations where the prevalence of nonadherence exceeds 32% and when API improves baseline adherence in at least 3% of patients. Conclusions Providing APIs to children with B-ALL may improve health outcomes and save costs over a 6-year period.
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Affiliation(s)
- Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology, Patient and Family Wellness Center
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | - Mark H Eckman
- Department of Internal Medicine, University of Cincinnati
| | - Maureen M O'Brien
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center
| | - Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology, Patient and Family Wellness Center
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
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135
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Wonggom P, Du H, Clark RA. Evaluation of the effectiveness of an interactive avatar-based education application for improving heart failure patients' knowledge and self-care behaviours: A pragmatic randomized controlled trial protocol. J Adv Nurs 2018; 74:2667-2676. [PMID: 29920745 DOI: 10.1111/jan.13768] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/09/2018] [Indexed: 12/19/2022]
Abstract
AIM The aim of this study was to evaluate the effectiveness of an avatar-based education application for improving knowledge and self-care behaviour in patients with heart failure (HF). BACKGROUND Avatar-based technologies for supporting education are an innovative approach for patients with low literacy, low health literacy and English as a second language. The use of avatar technologies for patient education has shown benefits in improving knowledge, self-care behaviours and quality of life in chronic diseases such as cancer, diabetes and depression. Research has demonstrated positive outcomes in clinical practice. However, the effectiveness of this technology has not been evaluated among patients with HF. DESIGN A multi-centred, non-blinded randomized, two-armed parallel pragmatic, controlled trial. METHOD Eighty-eight participants will be recruited from the HF clinics at three public hospitals and randomized into either control or intervention groups. The intervention group will receive the avatar-based education plus usual care. The control group will receive usual care. The primary outcome is HF knowledge, secondary outcomes include; improved self-care behaviours, readmission and satisfaction. Data will be collected at the baseline and at 1- and 3-month follow-ups. DISCUSSION This study will measure the effectiveness of avatar-based education on patients' knowledge and self-care behaviours following HF. The evidence will be evaluated in terms of the reduction in patients' readmission.
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Affiliation(s)
- Parichat Wonggom
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Huiyun Du
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Robyn A Clark
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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136
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Hoffmann S, Wilson S. The role of serious games in the iManageCancer project. Ecancermedicalscience 2018; 12:850. [PMID: 30079112 PMCID: PMC6057654 DOI: 10.3332/ecancer.2018.850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Indexed: 11/06/2022] Open
Abstract
Within the iManageCancer project, two serious games were developed, one for adults and one for children and adolescents. The adult's game was developed by the University of Bedfordshire (UK), the kid's game by Promotion Software GmbH (Germany). The aim was to support adult and young cancer patients with serious games to manage the impact of the disease on their psychological status, such as negative emotions, anxiety or depression, and motivate them to stay positive and to participate in social life [Patterson and Garwick (1994) Ann Behav Med16 131-142; Brennan et al. (2002) J Consul Clin Psychol70 1075-1085; Robinson et al. (2007) J Pediatr Psychol32 400-410]. Early demonstrators showed how important it is that players understand the meaning behind the game design. Improvements in the design of the games addressed that issue. Also, technical and use case issues were found that had a significant impact on the outcome. Both games interact with the iManageCancer platform, record game results and make them available for research. Two pilots are on the way and another evaluation cycle will follow.
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Affiliation(s)
| | - Stephen Wilson
- University of Bedfordshire, Bedfordshire, Luton LU1 3JU, UK
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137
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Holtz BE, Murray K, Park T. Serious Games for Children with Chronic Diseases: A Systematic Review. Games Health J 2018; 7:291-301. [PMID: 29957082 DOI: 10.1089/g4h.2018.0024] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE The purpose of this study was to systematically review the literature to assess if serious games impact health outcomes for children less than 18 years of age with chronic diseases. Additionally, the impact of self-efficacy, adherence, knowledge, use of theory, parent involvement, and study quality was also examined. MATERIALS AND METHODS Searches were conducted in databases EBSCO, PubMed, and Web of Science between June and August 2016. Randomized controlled trials using a serious game as an intervention, for participants under 18 years of age, to improve their chronic disease were included. RESULTS Data were extracted by two independent researchers, including: Title, author, and publication year; chronic disease; game description; number and age of participants; intervention duration; significant findings; parent involvement; theory; and study quality. Any disagreements were tackled and consensus was achieved. Eighteen studies were included in the review. The areas of health addressed included cerebral palsy, asthma, diabetes, developmental coordination disorders, and vision disorders. In these articles, eight health outcome variables were measured, including: lung function, glycemic control, hospital visits, motor proficiency, and visual acuity. Psychosocial variables that were assessed included self-efficacy and knowledge. Two articles included parents in the intervention, and three articles used theory. Six studies had significant health outcome finding, and four studies found a significant change in one psychosocial variable. CONCLUSION This review demonstrates the potential for games to improve health outcomes of young individuals. However, the mixed results suggest that more serious game interventions need to be better designed and rigorously tested to support their impact on improving health outcomes.
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Affiliation(s)
- Bree E Holtz
- 1 Department of Advertising and Public Relations, Michigan State University , East Lansing, Michigan
| | - Katharine Murray
- 1 Department of Advertising and Public Relations, Michigan State University , East Lansing, Michigan
| | - Taiwoo Park
- 2 Department of Media and Information, Michigan State University , East Lansing, Michigan
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Dawson EW, Clark K, Obenchain R, Loscalzo MJ, Folbrecht J. Biopsychosocial Distress in Young Adult Oncology Patients: Examining Sex Differences in Sources of High Distress and Requests for Assistance. J Adolesc Young Adult Oncol 2018; 7:367-373. [DOI: 10.1089/jayao.2017.0081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elaine Wheat Dawson
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California
| | - Karen Clark
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California
| | - Richard Obenchain
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California
| | - Matthew J. Loscalzo
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California
| | - Jeanelle Folbrecht
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California
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139
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Hughes N, Stark D. The management of adolescents and young adults with cancer. Cancer Treat Rev 2018; 67:45-53. [PMID: 29753962 DOI: 10.1016/j.ctrv.2018.05.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 12/11/2022]
Abstract
Adolescents and Young Adults (AYA) with cancer are young people developing serious illness when at the interface between the responsibilities of paediatric and adult cancer services. Personally, they are in a period of transition both biologically and in major social roles (Sawyer et al., 2018) [1]. For these and other reasons they present a unique set of clinical challenges in their management. Over the last 20 years the requirement for specific services to address their needs has been identified and this has become a growing field of research. Despite this survival rates still lag behind those of children and older adults with cancer (Gatta et al., 2009) [2]. Why do AYA patients have worse outcomes? The observation is that the reason is multifactorial with path to diagnosis, unique cancer biology, uncertainty of treatment protocol, compliance issues and poor recruitment to clinical trials all playing a part. In this review we will discuss the unique challenges faced by healthcare professionals when managing AYA patients who are commonly and accurately described as being in an 'interface' position.
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Affiliation(s)
- Nicola Hughes
- Leeds Institute of Cardiovascular and Molecular Medicine, University of Leeds, UK.
| | - Dan Stark
- Leeds Institute of Cancer and Pathology, St James's Institute of Oncology, Beckett Street, Leeds, UK
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Whiteley L, Brown L, Lally M, Heck N, van den Berg JJ. A Mobile Gaming Intervention to Increase Adherence to Antiretroviral Treatment for Youth Living With HIV: Development Guided by the Information, Motivation, and Behavioral Skills Model. JMIR Mhealth Uhealth 2018; 6:e96. [PMID: 29685863 PMCID: PMC5993532 DOI: 10.2196/mhealth.8155] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 10/23/2017] [Accepted: 11/28/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Highly active combination antiretroviral treatment has been shown to markedly improve the health of HIV-infected adolescents and young adults. Adherence to antiretroviral treatment leads to decreased morbidity and mortality and decreases the number of hospitalizations. However, these clinical achievements can only occur when young persons with HIV are adherent to care. Unfortunately, adolescents and young adults have poorer rates of adherence to antiretroviral medications and poorer rates of retention in care than older adults. Novel and engaging digital approaches are needed to help adolescents and young adults living with HIV be adherent to treatment. OBJECTIVE The aim of this study was to develop an immersive, action-oriented iPhone gaming intervention to improve adherence to antiretroviral medication and treatment. METHODS Game development was guided by social learning theory, taking into consideration the perspectives of adolescents and young adults living with HIV. A total of 20 adolescents and young adults were recruited from an HIV care clinic in Rhode Island, and they participated in qualitative interviews guided by the information-motivation-behavioral skills model of behavior change. The mean age of participants was 22 years, 60% (12/20) of the participants identified as male, and 60% (12/20) of the sample reported missing a dose of antiretroviral medication in the previous week. Acceptability of the game was assessed with client service questionnaire and session evaluation form. RESULTS A number of themes emerged that informed game development. Adolescents and young adults living with HIV desired informational game content that included new and comprehensive details about HIV, details about HIV as it relates to doctors' visits, and general health information. Motivational themes that emerged were the desire for enhancement of future orientation; reinforcement of positive influences from partners, parents, and friends; collaboration with health care providers; decreasing stigma; and increasing personal relevance of HIV care. Behavioral skills themes centered on self-efficacy and strategies for medical adherence and self-care. On the client service questionnaire, 10 out of the 11 participants indicated they were "satisfied with the game activities," and 9 out of 11 "would recommend it to a friend." On the session evaluation form, 9 out of 11 agreed that they "learned a lot from the game." CONCLUSIONS We utilized youth feedback, social learning theory (information-motivation-behavioral skills), and agile software development to create a multilevel, immersive, action-oriented iPhone gaming intervention to measure and improve treatment adherence for adolescents and young adults living with HIV. There is a dearth of gaming interventions for this population, and this study is a significant step in working toward the development and testing of an iPhone gaming app intervention to promote adherence to antiretroviral treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT01887210; http://clinicaltrials.gov/ct2/show/NCT01887210 (Archived by WebCite at http://www.webcitation.org/6xHMW0NI1).
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Affiliation(s)
- Laura Whiteley
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Larry Brown
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Michelle Lally
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States
- Division of Infectious Disease, Veterans Administration Medical Center, Providence, RI, United States
| | - Nicholas Heck
- Department of Psychology, Marquette University, Milwaukee, WI, United States
| | - Jacob J van den Berg
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
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LeGrand S, Muessig KE, Platt A, Soni K, Egger JR, Nwoko N, McNulty T, Hightow-Weidman LB. Epic Allies, a Gamified Mobile Phone App to Improve Engagement in Care, Antiretroviral Uptake, and Adherence Among Young Men Who Have Sex With Men and Young Transgender Women Who Have Sex With Men: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e94. [PMID: 29622527 PMCID: PMC5909052 DOI: 10.2196/resprot.8811] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 03/02/2018] [Accepted: 03/14/2018] [Indexed: 11/17/2022] Open
Abstract
Background In the United States, young men who have sex with men (YMSM) and transgender women who have sex with men (YTWSM) bear a disproportionate burden of prevalent and incident HIV infections. Once diagnosed, many YMSM and YTWSM struggle to engage in HIV care, adhere to antiretroviral therapy (ART), and achieve viral suppression. Computer-based interventions, including those focused on behavior change, are recognized as effective tools for engaging youth. Objective The purpose of the study described in this protocol is to evaluate the efficacy of Epic Allies, a theory-based mobile phone app that utilizes game mechanics and social networking features to improve engagement in HIV care, ART uptake, ART adherence, and viral suppression among HIV-positive YMSM and YTWSM. The study also qualitatively assesses intervention acceptability, perceived impact, and sustainability. Methods This is a two-group, active-control randomized controlled trial of the Epic Allies app. YMSM and YTWSM aged 16 to 24 inclusive, with detectable HIV viral load are randomized 1:1 within strata of new to care (newly entered HIV medical care ≤12 months of baseline visit) or ART-nonadherent (first entered HIV medical care >12 months before baseline visit) to intervention or control conditions. The intervention condition addresses ART adherence barriers through medication reminders and adherence monitoring, tracking of select adherence-related behaviors (eg, alcohol and marijuana use), an interactive dashboard that displays the participant’s adherence-related behaviors and provides tailored feedback, encouragement messages from other users, daily HIV/ART educational articles, and gamification features (eg, mini-games, points, badges) to increase motivation for behavior change and app engagement. The control condition features weekly phone-based notifications to encourage participants to view educational information in the control app. Follow-up assessments are administered at 13, 26, and 39 weeks for each arm. The primary outcome measure is viral suppression. Secondary outcome measures include engagement in care, ART uptake, ART adherence, and psychosocial barriers to engagement in care and ART adherence, including psychological distress, stigma, and social support. Results Baseline enrollment began in September 2015 and was completed in September 2016 (n=146), and assessment of intervention outcomes continued through August 2017. Results for primary and secondary outcome measures are expected to be reported in ClinicalTrials.gov by April 30, 2018. Conclusions If successful, Epic Allies will represent a novel adherence intervention for a group disproportionately impacted by HIV in the United States. Adherent patients would require less frequent clinic visits and experience fewer HIV-related secondary infections, thereby reducing health care costs and HIV transmission. Epic Allies could easily be expanded and adopted for use among larger populations of YMSM and YTWSM, other HIV-positive populations, and for those diagnosed with other chronic diseases such as diabetes and hypertension. Trial Registration ClinicalTrials.gov NCT02782130; https://clinicaltrials.gov/ct2/show/NCT02782130 (Archived by Webcite at http://www.webcitation.org/6yGODyerk)
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Affiliation(s)
- Sara LeGrand
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Kathryn E Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Alyssa Platt
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Karina Soni
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Joseph R Egger
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | | | | | - Lisa B Hightow-Weidman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Daugherty J, Miles I, Sarmiento K, Sansone C, Kroshus E, Bethea B. A Description and Evaluation of the Concussion Education Application HEADS UP Rocket Blades. Health Promot Pract 2018; 20:22-30. [PMID: 29597872 DOI: 10.1177/1524839918764670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Concussions are responsible for numerous emergency department visits and hospitalizations among children annually. However, there remains a great deal of confusion about how to prevent and manage concussions in youth. To teach children aged 6 to 8 years about concussion safety, the Centers for Disease Control and Prevention (CDC) created a mobile gaming application called HEADS UP Rocket Blades. This report introduces the game and presents findings on its evaluation. METHODS The aim of the game is to teach children what a concussion is, its commons signs and symptoms, how to prevent one, and what to do if one occurs. An early version of the game went through two rounds of usability testing with children and parents to obtain initial impressions and make improvements. RESULTS The first round of usability testing focused on the mechanics of the game. Based on feedback from this session, CDC and the developers simplified the messaging and adjusted the game's level of difficulty. The second round focused on the gaming experience. The children indicated that they enjoyed playing, and nearly all were able to relay at least one learning objective. CONCLUSIONS Parents and children rated Rocket Blades as a good learning tool and indicated that they would download it for personal use.
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Affiliation(s)
- Jill Daugherty
- 1 Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Isa Miles
- 2 Banyan Communications, Atlanta, GA, USA
| | - Kelly Sarmiento
- 1 Centers for Disease Control and Prevention, Atlanta, GA, USA
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Coughtrey A, Millington A, Bennett S, Christie D, Hough R, Su MT, Constantinou MP, Shafran R. The Effectiveness of Psychosocial Interventions for Psychological Outcomes in Pediatric Oncology: A Systematic Review. J Pain Symptom Manage 2018; 55:1004-1017. [PMID: 28962919 DOI: 10.1016/j.jpainsymman.2017.09.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 11/18/2022]
Abstract
CONTEXT This review summarizes the current randomized controlled trials literature on psychological and physical outcomes of psychosocial interventions in pediatric oncology. OBJECTIVES The objective of this study was to evaluate the effectiveness and impact of psychosocial interventions in children with cancer. METHODS A search of the literature resulted in a total of 12 randomized clinical trials and these have evaluated psychosocial interventions in children younger than 18 years with current and previous diagnoses of cancer. Outcome measures were both psychological (e.g., symptoms of anxiety, depression, quality of life, and self-esteem) and physical (e.g., cancer symptoms, treatment adherence, and pain). Interventions identified included cognitive behavioral therapy (CBT; n = 4), joint CBT and physical exercise therapy (n = 1), family therapy (n = 2), therapeutic music video (n = 2), self-coping strategies (n = 1), a wish fulfillment intervention (n = 1), and joint family therapy and CBT (n = 1). RESULTS Nine studies reported statistically significant improvements on psychological outcomes. These findings suggest that psychosocial interventions are effective at reducing anxiety and depressive symptoms as well as improving quality of life. Additionally, six studies found psychosocial interventions to have a positive impact on physical symptoms and well-being, including a reduction in procedural pain and symptom distress. CONCLUSION These findings suggest that mental health needs in pediatric oncology patients can and should be addressed, potentially which will lead to better mental and physical health outcomes.
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Affiliation(s)
- Anna Coughtrey
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Amy Millington
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sophie Bennett
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Deborah Christie
- Child and Adolescent Psychological Services, University College London Hospital, NHS Foundation Trust, London, UK
| | - Rachael Hough
- Department of Adolescent Haematology, University College London Hospital, NHS Foundation Trust, London, UK
| | - Merina T Su
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, London, UK.
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Abstract
As the field of games for health continues to gain momentum, it is crucial to document the field's scale of growth, identify design patterns, and to address potential design issues for future health game development. Few studies have explored the attributes and usability features of games for health as a whole over time. We offer the first comprehensive systematic content analysis of digital games for health by examining 1743 health games released between 1983 and 2016 in 23 countries extracted from nine international English health game databases and directories. The majority of these games were developed in the United States (67.18%) and France (18.59%). The most popular platforms included web browsers (72.38%) and Windows (14.41%). Approximately four out of five (79.12%) of the games were available at no cost. We coded 1553 accessible games for an in-depth analysis and further assessed 1303 for usability. Popular health topics represented included: cognitive training (37.41%), indirect health education (13.33%), and medical care provision (9.98%). Most games (75.66%) could be completed within 60 minutes. The main game usability problems identified included a lack of customization, nonskippable contents, and a lack of feedback and instruction to the players. While most of the usability problems have improved as did the software and hardware technology, the players' ability to skip nonplayable contents has become slightly more restricted overtime. Comparison with game efficacy publications suggested that a further understanding of the scope for games for health is needed on a global level.
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Affiliation(s)
- Amy Shirong Lu
- Health Technology Laboratory, Department of Communication Studies, College of Arts, Media & Design, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Hadi Kharrazi
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Urech C, Grossert A, Alder J, Scherer S, Handschin B, Kasenda B, Borislavova B, Degen S, Erb J, Faessler A, Gattlen L, Schibli S, Werndli C, Gaab J, Berger T, Zumbrunn T, Hess V. Web-Based Stress Management for Newly Diagnosed Patients With Cancer (STREAM): A Randomized, Wait-List Controlled Intervention Study. J Clin Oncol 2018; 36:780-788. [PMID: 29369731 PMCID: PMC5844668 DOI: 10.1200/jco.2017.74.8491] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Being diagnosed with cancer causes major psychological distress; however, a majority of patients lack psychological support during this critical period. Internet interventions help patients overcome many barriers to seeking face-to-face support and may thus close this gap. We assessed feasibility and efficacy of Web-based stress management (STREAM [Stress-Aktiv-Mindern]) for newly diagnosed patients with cancer. Patients and Methods In a randomized controlled trial, patients with cancer who had started first-line treatment within the previous 12 weeks were randomly assigned to a therapist-guided Web-based intervention or a wait-list (control), stratified according to distress level (≥ 5 v < 5 on scale of 0 to 10). Primary efficacy end point was quality of life after the intervention (Functional Assessment of Chronic Illness Therapy–Fatigue). Secondary end points included distress (Distress Thermometer) and anxiety or depression (Hospital Anxiety and Depression Scale). Treatment effect was assessed with analyses of covariance, adjusted for baseline distress. Results A total of 222 of 229 screened patients applied online for participation. Between September 2014 and November 2016, 129 newly diagnosed patients with cancer, including 92 women treated for breast cancer, were randomly assigned to the intervention (n = 65) or control (n = 64) group. Adherence was good, with 80.0% of patients using ≥ six of eight modules. Psychologists spent 13.3 minutes per week (interquartile range, 9.5-17.9 minutes per week) per patient for online guidance. After the intervention, quality of life was significantly higher (Functional Assessment of Chronic Illness Therapy–Fatigue: mean, 8.59 points; 95% CI, 2.45 to 14.73 points; P = .007) and distress significantly lower (Distress Thermometer: mean, −0.85; 95% CI, −1.60 to −0.10; P = .03) in the intervention group as compared with the control. Changes in anxiety or depression were not significant in the intention-to-treat population (Hospital Anxiety and Depression Scale: mean, −1.28; 95% CI, −3.02 to 0.45; P = .15). Quality of life increased in the control group with the delayed intervention. Conclusion The Web-based stress management program STREAM is feasible and effective in improving quality of life.
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Affiliation(s)
- Corinne Urech
- Corinne Urech, Astrid Grossert, Sandra Scherer, Barbara Handschin, Benjamin Kasenda, and Viviane Hess, University Hospital Basel; Astrid Grossert, Judith Alder, Barbara Handschin, Benjamin Kasenda, Borislava Borislavova, Sven Degen, Jennifer Erb, Alexandra Faessler, Laura Gattlen, Sarah Schibli, Celine Werndli, Jens Gaab, Thomas Zumbrunn, and Viviane Hess, University of Basel, Basel; and Thomas Berger, University of Bern, Bern, Switzerland
| | - Astrid Grossert
- Corinne Urech, Astrid Grossert, Sandra Scherer, Barbara Handschin, Benjamin Kasenda, and Viviane Hess, University Hospital Basel; Astrid Grossert, Judith Alder, Barbara Handschin, Benjamin Kasenda, Borislava Borislavova, Sven Degen, Jennifer Erb, Alexandra Faessler, Laura Gattlen, Sarah Schibli, Celine Werndli, Jens Gaab, Thomas Zumbrunn, and Viviane Hess, University of Basel, Basel; and Thomas Berger, University of Bern, Bern, Switzerland
| | - Judith Alder
- Corinne Urech, Astrid Grossert, Sandra Scherer, Barbara Handschin, Benjamin Kasenda, and Viviane Hess, University Hospital Basel; Astrid Grossert, Judith Alder, Barbara Handschin, Benjamin Kasenda, Borislava Borislavova, Sven Degen, Jennifer Erb, Alexandra Faessler, Laura Gattlen, Sarah Schibli, Celine Werndli, Jens Gaab, Thomas Zumbrunn, and Viviane Hess, University of Basel, Basel; and Thomas Berger, University of Bern, Bern, Switzerland
| | - Sandra Scherer
- Corinne Urech, Astrid Grossert, Sandra Scherer, Barbara Handschin, Benjamin Kasenda, and Viviane Hess, University Hospital Basel; Astrid Grossert, Judith Alder, Barbara Handschin, Benjamin Kasenda, Borislava Borislavova, Sven Degen, Jennifer Erb, Alexandra Faessler, Laura Gattlen, Sarah Schibli, Celine Werndli, Jens Gaab, Thomas Zumbrunn, and Viviane Hess, University of Basel, Basel; and Thomas Berger, University of Bern, Bern, Switzerland
| | - Barbara Handschin
- Corinne Urech, Astrid Grossert, Sandra Scherer, Barbara Handschin, Benjamin Kasenda, and Viviane Hess, University Hospital Basel; Astrid Grossert, Judith Alder, Barbara Handschin, Benjamin Kasenda, Borislava Borislavova, Sven Degen, Jennifer Erb, Alexandra Faessler, Laura Gattlen, Sarah Schibli, Celine Werndli, Jens Gaab, Thomas Zumbrunn, and Viviane Hess, University of Basel, Basel; and Thomas Berger, University of Bern, Bern, Switzerland
| | - Benjamin Kasenda
- Corinne Urech, Astrid Grossert, Sandra Scherer, Barbara Handschin, Benjamin Kasenda, and Viviane Hess, University Hospital Basel; Astrid Grossert, Judith Alder, Barbara Handschin, Benjamin Kasenda, Borislava Borislavova, Sven Degen, Jennifer Erb, Alexandra Faessler, Laura Gattlen, Sarah Schibli, Celine Werndli, Jens Gaab, Thomas Zumbrunn, and Viviane Hess, University of Basel, Basel; and Thomas Berger, University of Bern, Bern, Switzerland
| | - Borislava Borislavova
- Corinne Urech, Astrid Grossert, Sandra Scherer, Barbara Handschin, Benjamin Kasenda, and Viviane Hess, University Hospital Basel; Astrid Grossert, Judith Alder, Barbara Handschin, Benjamin Kasenda, Borislava Borislavova, Sven Degen, Jennifer Erb, Alexandra Faessler, Laura Gattlen, Sarah Schibli, Celine Werndli, Jens Gaab, Thomas Zumbrunn, and Viviane Hess, University of Basel, Basel; and Thomas Berger, University of Bern, Bern, Switzerland
| | - Sven Degen
- Corinne Urech, Astrid Grossert, Sandra Scherer, Barbara Handschin, Benjamin Kasenda, and Viviane Hess, University Hospital Basel; Astrid Grossert, Judith Alder, Barbara Handschin, Benjamin Kasenda, Borislava Borislavova, Sven Degen, Jennifer Erb, Alexandra Faessler, Laura Gattlen, Sarah Schibli, Celine Werndli, Jens Gaab, Thomas Zumbrunn, and Viviane Hess, University of Basel, Basel; and Thomas Berger, University of Bern, Bern, Switzerland
| | - Jennifer Erb
- Corinne Urech, Astrid Grossert, Sandra Scherer, Barbara Handschin, Benjamin Kasenda, and Viviane Hess, University Hospital Basel; Astrid Grossert, Judith Alder, Barbara Handschin, Benjamin Kasenda, Borislava Borislavova, Sven Degen, Jennifer Erb, Alexandra Faessler, Laura Gattlen, Sarah Schibli, Celine Werndli, Jens Gaab, Thomas Zumbrunn, and Viviane Hess, University of Basel, Basel; and Thomas Berger, University of Bern, Bern, Switzerland
| | - Alexandra Faessler
- Corinne Urech, Astrid Grossert, Sandra Scherer, Barbara Handschin, Benjamin Kasenda, and Viviane Hess, University Hospital Basel; Astrid Grossert, Judith Alder, Barbara Handschin, Benjamin Kasenda, Borislava Borislavova, Sven Degen, Jennifer Erb, Alexandra Faessler, Laura Gattlen, Sarah Schibli, Celine Werndli, Jens Gaab, Thomas Zumbrunn, and Viviane Hess, University of Basel, Basel; and Thomas Berger, University of Bern, Bern, Switzerland
| | - Laura Gattlen
- Corinne Urech, Astrid Grossert, Sandra Scherer, Barbara Handschin, Benjamin Kasenda, and Viviane Hess, University Hospital Basel; Astrid Grossert, Judith Alder, Barbara Handschin, Benjamin Kasenda, Borislava Borislavova, Sven Degen, Jennifer Erb, Alexandra Faessler, Laura Gattlen, Sarah Schibli, Celine Werndli, Jens Gaab, Thomas Zumbrunn, and Viviane Hess, University of Basel, Basel; and Thomas Berger, University of Bern, Bern, Switzerland
| | - Sarah Schibli
- Corinne Urech, Astrid Grossert, Sandra Scherer, Barbara Handschin, Benjamin Kasenda, and Viviane Hess, University Hospital Basel; Astrid Grossert, Judith Alder, Barbara Handschin, Benjamin Kasenda, Borislava Borislavova, Sven Degen, Jennifer Erb, Alexandra Faessler, Laura Gattlen, Sarah Schibli, Celine Werndli, Jens Gaab, Thomas Zumbrunn, and Viviane Hess, University of Basel, Basel; and Thomas Berger, University of Bern, Bern, Switzerland
| | - Celine Werndli
- Corinne Urech, Astrid Grossert, Sandra Scherer, Barbara Handschin, Benjamin Kasenda, and Viviane Hess, University Hospital Basel; Astrid Grossert, Judith Alder, Barbara Handschin, Benjamin Kasenda, Borislava Borislavova, Sven Degen, Jennifer Erb, Alexandra Faessler, Laura Gattlen, Sarah Schibli, Celine Werndli, Jens Gaab, Thomas Zumbrunn, and Viviane Hess, University of Basel, Basel; and Thomas Berger, University of Bern, Bern, Switzerland
| | - Jens Gaab
- Corinne Urech, Astrid Grossert, Sandra Scherer, Barbara Handschin, Benjamin Kasenda, and Viviane Hess, University Hospital Basel; Astrid Grossert, Judith Alder, Barbara Handschin, Benjamin Kasenda, Borislava Borislavova, Sven Degen, Jennifer Erb, Alexandra Faessler, Laura Gattlen, Sarah Schibli, Celine Werndli, Jens Gaab, Thomas Zumbrunn, and Viviane Hess, University of Basel, Basel; and Thomas Berger, University of Bern, Bern, Switzerland
| | - Thomas Berger
- Corinne Urech, Astrid Grossert, Sandra Scherer, Barbara Handschin, Benjamin Kasenda, and Viviane Hess, University Hospital Basel; Astrid Grossert, Judith Alder, Barbara Handschin, Benjamin Kasenda, Borislava Borislavova, Sven Degen, Jennifer Erb, Alexandra Faessler, Laura Gattlen, Sarah Schibli, Celine Werndli, Jens Gaab, Thomas Zumbrunn, and Viviane Hess, University of Basel, Basel; and Thomas Berger, University of Bern, Bern, Switzerland
| | - Thomas Zumbrunn
- Corinne Urech, Astrid Grossert, Sandra Scherer, Barbara Handschin, Benjamin Kasenda, and Viviane Hess, University Hospital Basel; Astrid Grossert, Judith Alder, Barbara Handschin, Benjamin Kasenda, Borislava Borislavova, Sven Degen, Jennifer Erb, Alexandra Faessler, Laura Gattlen, Sarah Schibli, Celine Werndli, Jens Gaab, Thomas Zumbrunn, and Viviane Hess, University of Basel, Basel; and Thomas Berger, University of Bern, Bern, Switzerland
| | - Viviane Hess
- Corinne Urech, Astrid Grossert, Sandra Scherer, Barbara Handschin, Benjamin Kasenda, and Viviane Hess, University Hospital Basel; Astrid Grossert, Judith Alder, Barbara Handschin, Benjamin Kasenda, Borislava Borislavova, Sven Degen, Jennifer Erb, Alexandra Faessler, Laura Gattlen, Sarah Schibli, Celine Werndli, Jens Gaab, Thomas Zumbrunn, and Viviane Hess, University of Basel, Basel; and Thomas Berger, University of Bern, Bern, Switzerland
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Carolan K, Verran J, Crossley M, Redfern J, Whitton N, Amos M. Impact of educational interventions on adolescent attitudes and knowledge regarding vaccination: A pilot study. PLoS One 2018; 13:e0190984. [PMID: 29351325 PMCID: PMC5774691 DOI: 10.1371/journal.pone.0190984] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/22/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Current immunisation levels in England currently fall slightly below the threshold recommended by the World Health Organization, and the three-year trend for vaccination uptake is downwards. Attitudes towards vaccination can affect future decisions on whether or not to vaccinate, and this can have significant public health implications. Interventions can impact future vaccination decisions, and these interventions can take several forms. Relatively little work has been reported on the use of vaccination interventions in young people, who form the next generation of individuals likely to make vaccination decisions. METHOD We investigated the impact of two different types of educational intervention on attitudes towards vaccination in young people in England. A cohort of young people (n = 63) was recruited via a local school. This group was divided into three sub-groups; one (n = 21) received a presentation-based intervention, one (n = 26) received an interactive simulation-based intervention, and the third (n = 16) received no intervention. Participants supplied information on (1) their attitudes towards vaccination, and (2) their information needs and views on personal choice concerning vaccination, at three time points: immediately before and after the intervention, and after six months. RESULTS Neither intervention had a significant effect on participants' attitudes towards vaccination. However, the group receiving the presentation-based intervention saw a sustained uplift in confidence about information needs, which was not observed in the simulation-based intervention group. DISCUSSION Our findings with young people are consistent with previous work on vaccination interventions aimed at adults, which have shown limited effectiveness, and which can actually reduce intention to vaccinate. Our findings on the most effective mode of delivery for the intervention should inform future discussion in the growing "games for health" domain, which proposes the use of interactive digital resources in healthcare education.
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Affiliation(s)
- Kate Carolan
- School of Computing, Mathematics and Digital Technology, Manchester Metropolitan University, Manchester, United Kingdom
| | - Joanna Verran
- School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom
| | - Matthew Crossley
- School of Computing, Mathematics and Digital Technology, Manchester Metropolitan University, Manchester, United Kingdom
| | - James Redfern
- School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom
| | - Nicola Whitton
- Faculty of Education, Manchester Metropolitan University, Manchester, United Kingdom
| | - Martyn Amos
- School of Computing, Mathematics and Digital Technology, Manchester Metropolitan University, Manchester, United Kingdom
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Bruggers CS, Baranowski S, Beseris M, Leonard R, Long D, Schulte E, Shorter A, Stigner R, Mason CC, Bedrov A, Pascual I, Bulaj G. A Prototype Exercise-Empowerment Mobile Video Game for Children With Cancer, and Its Usability Assessment: Developing Digital Empowerment Interventions for Pediatric Diseases. Front Pediatr 2018; 6:69. [PMID: 29686977 PMCID: PMC5900044 DOI: 10.3389/fped.2018.00069] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/08/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Medical advances continue to improve morbidity and mortality of serious pediatric diseases, including cancer, driving research addressing diminished physical and psychological quality of life in children with these chronic conditions. Empowerment enhances resilience and positively influences health, disease, and therapy understanding. We describe the development and usability assessment of a prototype Empower Stars! mobile video game grounded in behavioral and exercise theories with the purpose of coupling physical exercise with empowerment over disease in children with cancer. METHODS Academic faculty, health-care providers, and community video game developers collaborated in this project. The iPadAir was selected as a delivery platform for its accelerometer and gyroscope features facilitating exercise design. Unity multiplatform technology provided animation and audiovisual features for immediate player feedback. Javascript, C#, Photoshop, Flash, and SketchUp were used for coding, creating graphical assets, Sprite sheets, and printing files, respectively. 3D-printed handles and case backing were used to adapt the iPad for physical exercise. Game usability, engagement, and enjoyment were assessed via a multilevel study of children undergoing cancer chemotherapy, their parents, and pediatric cancer health-care providers. Feedback crucial for ongoing game development was analyzed. RESULTS A prototype Empower Stars! mobile video game was developed for children 7-14 years old with cancer. Active, sedentary, educational, and empowerment-centered elements intermix for 20 min of exercise within a 30 min "one-day treatment" gameplay session involving superheroes, space exploration, metaphorical cancer challenges, life restoration on a barren planet, and innumerable star rewards. No player "dies." Usability assessment data analyses showed widespread enthusiasm for integrating exercise with empowerment over cancer and the game itself. Favorite elements included collecting star rewards and planet terraforming. Traveling in space and the Healthy Food Choice game were least liked. The need for improved gameplay instructions was expressed by all groups. The usability study provided essential feedback for converting the prototype into alpha version of Empower Stars! CONCLUSION Adapting exercise empowerment-promoting video game technology to mobile platforms facilitates usability and widespread dissemination for children with cancer. We discuss broader therapeutic applicability in diverse chronic pediatric diseases, including obesity, asthma, cystic fibrosis, diabetes, and juvenile idiopathic arthritis.
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Affiliation(s)
- Carol S Bruggers
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States.,Primary Children's Hospital, Salt Lake City, UT, United States
| | | | | | | | - Derek Long
- Spy Hop Youth Media, Salt Lake City, UT, United States
| | | | | | - Rowan Stigner
- Spy Hop Youth Media, Salt Lake City, UT, United States
| | - Clinton C Mason
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Alisa Bedrov
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States.,Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Ian Pascual
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States.,Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States.,Juan Diego Catholic High School, Draper, UT, United States
| | - Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
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148
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[Serious video games in pediatrics]. Arch Pediatr 2017; 25:48-54. [PMID: 29269184 DOI: 10.1016/j.arcped.2017.10.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 08/04/2017] [Accepted: 10/26/2017] [Indexed: 11/23/2022]
Abstract
Playing video games has been associated with several negative effects in children. However, serious games, which are video games designed for a primary purpose other than pure entertainment, should not be neglected by pediatricians. In the field of public health, some serious games are a means to decrease drug consumption and improve sexual health behavior in adolescents. In schools, serious games can be used to change students' perception of the disease of one of their classmates, or to train students on basic life support. Serious games are also used with patients: they can distract them from a painful procedure, increase their compliance to treatments, or participate in their rehabilitation. Finally, serious games allow healthcare professionals to train on the management of various medical situations without risk. For every field of application, this review presents the rationale of the use of video games, followed by concrete examples of video games and the results of their scientific evaluation.
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149
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Pereira-Salgado A, Westwood JA, Russell L, Ugalde A, Ortlepp B, Seymour JF, Butow P, Cavedon L, Ong K, Aranda S, Breen S, Kirsa S, Dunlevie A, Schofield P. Mobile Health Intervention to Increase Oral Cancer Therapy Adherence in Patients With Chronic Myeloid Leukemia (The REMIND System): Clinical Feasibility and Acceptability Assessment. JMIR Mhealth Uhealth 2017; 5:e184. [PMID: 29212628 PMCID: PMC5738545 DOI: 10.2196/mhealth.8349] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/04/2017] [Indexed: 01/01/2023] Open
Abstract
Background Optimal dosing of oral tyrosine kinase inhibitor therapy is critical to treatment success and survival of patients with chronic myeloid leukemia (CML). Drug intolerance secondary to toxicities and nonadherence are significant factors in treatment failure. Objective The objective of this study was to develop and pilot-test the clinical feasibility and acceptability of a mobile health system (REMIND) to increase oral drug adherence and patient symptom self-management among people with CML (chronic phase). Methods A multifaceted intervention was iteratively developed using the intervention development framework by Schofield and Chambers, consisting of defining the patient problem and iteratively refining the intervention. The clinical feasibility and acceptability were examined via patient and intervention nurse interviews, which were audiotaped, transcribed, and deductively content analyzed. Results The intervention comprised 2 synergistically operating elements: (1) daily medication reminders and routine assessment of side effects with evidence-based self-care advice delivered in real time and (2) question prompt list (QPL) questions and routinely collected individual patient adherence and side effect profile data used to shape nurses’ consultations, which employed motivational interviewing to support adoption of self-management behaviors. A total of 4 consultations and daily alerts and advice were delivered over 10 weeks. In total, 58% (10/17) of patients and 2 nurses participated in the pilot study. Patients reported several benefits of the intervention: help in establishing medication routines, resolution of symptom uncertainty, increased awareness of self-care, and informed decision making. Nurses also endorsed the intervention: it assisted in establishing pill-taking routines and patients developing effective solutions to adherence challenges. Conclusions The REMIND system with nurse support was usable and acceptable to both patients and nurses. It has the potential to improve adherence and side-effect management and should be further evaluated.
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Affiliation(s)
- Amanda Pereira-Salgado
- Centre for Nursing Research, Cabrini Institute, Malvern, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Jennifer A Westwood
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Lahiru Russell
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Anna Ugalde
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Bronwen Ortlepp
- Department of Haematology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - John F Seymour
- Department of Haematology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Phyllis Butow
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Lawrence Cavedon
- School of Science, RMIT University, Melbourne, Victoria, Australia
| | - Kevin Ong
- School of Science, RMIT University, Melbourne, Victoria, Australia
| | - Sanchia Aranda
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.,Cancer Council Australia, Sydney, New South Wales, Australia
| | - Sibilah Breen
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.,Public Health Group, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg , Victoria, Australia
| | - Suzanne Kirsa
- Pharmacy Department, Monash Health, Clayton, Victoria, Australia.,Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Andrew Dunlevie
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Penelope Schofield
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Department of Psychology, School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
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150
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Wu YP, Stenehjem DD, Linder LA, Yu B, Parsons BG, Mooney R, Fluchel MN. Adherence to Oral Medications During Maintenance Therapy Among Children and Adolescents With Acute Lymphoblastic Leukemia: A Medication Refill Analysis. J Pediatr Oncol Nurs 2017; 35:86-93. [PMID: 29188741 DOI: 10.1177/1043454217741877] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Adherence to oral medications during maintenance therapy is essential for pediatric patients with acute lymphoblastic leukemia. Self-reported or electronic monitoring of adherence indicate suboptimal adherence, particularly among particular sociodemographic groups. This study used medication refill records to examine adherence among a national sample of pediatric patients with acute lymphoblastic leukemia. Patients in a national claims database, aged 0 to 21 years with a diagnosis of acute lymphoblastic leukemia and in the maintenance phase of treatment, were included. Medication possession ratios were used as measures of adherence. Overall adherence and adherence by sociodemographic groups were examined. Adherence rates were 85% for 6-mercaptopurine and 81% for methotrexate. Adherence was poorer among patients 12 years and older. Oral medication adherence rates were suboptimal and similar to or lower than previously documented rates using other methods of assessing adherence. Refill records offer a promising avenue for monitoring adherence. Additional work to identify groups most at-risk for poor adherence is needed. Nurses are well positioned to routinely monitor for medication adherence and to collaborate with the multidisciplinary team to address barriers to adherence.
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Affiliation(s)
- Yelena P Wu
- 1 University of Utah, Salt Lake City, UT, USA
| | - David D Stenehjem
- 1 University of Utah, Salt Lake City, UT, USA.,3 Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, College of Pharmacy, Duluth, MN, USA
| | - Lauri A Linder
- 1 University of Utah, Salt Lake City, UT, USA.,2 Primary Children's Hospital, Salt Lake City, UT, USA
| | - Bin Yu
- 1 University of Utah, Salt Lake City, UT, USA
| | | | - Ryan Mooney
- 1 University of Utah, Salt Lake City, UT, USA
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