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Alahäivälä T, Oinas-Kukkonen H. Understanding persuasion contexts in health gamification: A systematic analysis of gamified health behavior change support systems literature. Int J Med Inform 2016; 96:62-70. [PMID: 26944611 DOI: 10.1016/j.ijmedinf.2016.02.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 01/20/2016] [Accepted: 02/15/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Gamification is increasingly used as a design strategy when developing behavior change support systems in the healthcare domain. It is commonly agreed that understanding the contextual factors is critical for successful gamification, but systematic analyses of the persuasive contexts have been lacking so far within gamified health intervention studies. OBJECTIVES AND METHODS Through a persuasion context analysis of the gamified health behavior change support systems (hBCSSs) literature, we inspect how the contextual factors have been addressed in the prior gamified health BCSS studies. The implications of this study are to provide the practitioners and researchers examples of how to conduct a systematic analysis to help guide the design and research on gamified health BCSSs. The ideas derived from the analysis of the included studies will help identify potential pitfalls and shortcomings in both the research and implementations of gamified health behavior change support systems. RESULTS We systematically analyzed the persuasion contexts of 15 gamified health intervention studies. According to our results, gamified hBCSSs are implemented under different facets of lifestyle change and treatments compliance, and use a multitude of technologies and methods. We present a set of ideas and concepts to help improve endeavors in studying gamified health intervention through comprehensive understanding of the persuasive contextual factors. CONCLUSIONS Future research on gamified hBCSSs should systematically compare the different combinations of contextual factors, related theories, chosen gamification strategies, and the study of outcomes to help understand how to achieve the most efficient use of gamification on the different aspects of healthcare. Analyzing the persuasion context is essential to achieve this. With the attained knowledge, those planning health interventions can choose the 'tried-and-tested' approaches for each particular situation, rather than develop solutions in an ad-hoc manner.
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102
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Myneni S, Cobb N, Cohen T. In Pursuit of Theoretical Ground in Behavior Change Support Systems: Analysis of Peer-to-Peer Communication in a Health-Related Online Community. J Med Internet Res 2016; 18:e28. [PMID: 26839162 PMCID: PMC4756252 DOI: 10.2196/jmir.4671] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 10/24/2015] [Accepted: 11/09/2015] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Research studies involving health-related online communities have focused on examining network structure to understand mechanisms underlying behavior change. Content analysis of the messages exchanged in these communities has been limited to the "social support" perspective. However, existing behavior change theories suggest that message content plays a prominent role reflecting several sociocognitive factors that affect an individual's efforts to make a lifestyle change. An understanding of these factors is imperative to identify and harness the mechanisms of behavior change in the Health 2.0 era. OBJECTIVE The objective of this work is two-fold: (1) to harness digital communication data to capture essential meaning of communication and factors affecting a desired behavior change, and (2) to understand the applicability of existing behavior change theories to characterize peer-to-peer communication in online platforms. METHODS In this paper, we describe grounded theory-based qualitative analysis of digital communication in QuitNet, an online community promoting smoking cessation. A database of 16,492 de-identified public messages from 1456 users from March 1-April 30, 2007, was used in our study. We analyzed 795 messages using grounded theory techniques to ensure thematic saturation. This analysis enabled identification of key concepts contained in the messages exchanged by QuitNet members, allowing us to understand the sociobehavioral intricacies underlying an individual's efforts to cease smoking in a group setting. We further ascertained the relevance of the identified themes to theoretical constructs in existing behavior change theories (eg, Health Belief Model) and theoretically linked techniques of behavior change taxonomy. RESULTS We identified 43 different concepts, which were then grouped under 12 themes based on analysis of 795 messages. Examples of concepts include "sleepiness," "pledge," "patch," "spouse," and "slip." Examples of themes include "traditions," "social support," "obstacles," "relapse," and "cravings." Results indicate that themes consisting of member-generated strategies such as "virtual bonfires" and "pledges" were related to the highest number of theoretical constructs from the existing behavior change theories. In addition, results indicate that the member-generated communication content supports sociocognitive constructs from more than one behavior change model, unlike the majority of the existing theory-driven interventions. CONCLUSIONS With the onset of mobile phones and ubiquitous Internet connectivity, online social network data reflect the intricacies of human health behavior as experienced by health consumers in real time. This study offers methodological insights for qualitative investigations that examine the various kinds of behavioral constructs prevalent in the messages exchanged among users of online communities. Theoretically, this study establishes the manifestation of existing behavior change theories in QuitNet-like online health communities. Pragmatically, it sets the stage for real-time, data-driven sociobehavioral interventions promoting healthy lifestyle modifications by allowing us to understand the emergent user needs to sustain a desired behavior change.
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Affiliation(s)
- Sahiti Myneni
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, United States.
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103
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Lewis ZH, Swartz MC, Lyons EJ. What's the Point?: A Review of Reward Systems Implemented in Gamification Interventions. Games Health J 2016; 5:93-9. [PMID: 26812253 DOI: 10.1089/g4h.2015.0078] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Rewards are commonly used in interventions to change behavior, but they can inhibit development of intrinsic motivation, which is associated with long-term behavior maintenance. Gamification is a novel intervention strategy that may target intrinsic motivation through fun and enjoyment. Before the effects of gamified interventions on motivation can be determined, there must be an understanding of how gamified interventions operationalize rewards, such as point systems. The purpose of this review is to determine the prevalence of different reward types, specifically point systems, within gamified interventions. Electronic databases were searched for relevant articles. Data sources included Medline OVID, Medline PubMed, Web of Science, CINAHL, Cochrane Central, and PsycINFO. Out of the 21 articles retrieved, 18 studies described a reward system and were included in this review. Gamified interventions were designed to target a myriad of clinical outcomes across diverse populations. Rewards included points (n = 14), achievements/badges/medals (n = 7), tangible rewards (n = 7), currency (n = 4), other unspecified rewards (n = 3), likes (n = 2), animated feedback (n = 1), and kudos (n = 1). Rewards, and points in particular, appear to be a foundational component of gamified interventions. Despite their prevalence, authors seldom described the use of noncontingent rewards or how the rewards interacted with other game features. The reward systems relying on tangible rewards and currency may have been limited by inhibited intrinsic motivation. As gamification proliferates, future research should explicitly describe how rewards were operationalized in the intervention and evaluate the effects of gamified rewards on motivation across populations and research outcomes.
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Affiliation(s)
- Zakkoyya H Lewis
- 1 Division of Rehabilitation Sciences, University of Texas Medical Branch , Galveston, Texas
| | - Maria C Swartz
- 1 Division of Rehabilitation Sciences, University of Texas Medical Branch , Galveston, Texas
| | - Elizabeth J Lyons
- 1 Division of Rehabilitation Sciences, University of Texas Medical Branch , Galveston, Texas.,2 Department of Nutrition and Metabolism, University of Texas Medical Branch , Galveston, Texas.,3 Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch , Galveston, Texas
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104
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Kuang J, Argo L, Stoddard G, Bray BE, Zeng-Treitler Q. Assessing Pictograph Recognition: A Comparison of Crowdsourcing and Traditional Survey Approaches. J Med Internet Res 2015; 17:e281. [PMID: 26678085 PMCID: PMC4704927 DOI: 10.2196/jmir.4582] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 10/16/2015] [Accepted: 11/05/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Compared to traditional methods of participant recruitment, online crowdsourcing platforms provide a fast and low-cost alternative. Amazon Mechanical Turk (MTurk) is a large and well-known crowdsourcing service. It has developed into the leading platform for crowdsourcing recruitment. OBJECTIVE To explore the application of online crowdsourcing for health informatics research, specifically the testing of medical pictographs. METHODS A set of pictographs created for cardiovascular hospital discharge instructions was tested for recognition. This set of illustrations (n=486) was first tested through an in-person survey in a hospital setting (n=150) and then using online MTurk participants (n=150). We analyzed these survey results to determine their comparability. RESULTS Both the demographics and the pictograph recognition rates of online participants were different from those of the in-person participants. In the multivariable linear regression model comparing the 2 groups, the MTurk group scored significantly higher than the hospital sample after adjusting for potential demographic characteristics (adjusted mean difference 0.18, 95% CI 0.08-0.28, P<.001). The adjusted mean ratings were 2.95 (95% CI 2.89-3.02) for the in-person hospital sample and 3.14 (95% CI 3.07-3.20) for the online MTurk sample on a 4-point Likert scale (1=totally incorrect, 4=totally correct). CONCLUSIONS The findings suggest that crowdsourcing is a viable complement to traditional in-person surveys, but it cannot replace them.
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Affiliation(s)
- Jinqiu Kuang
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States.
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105
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Valenzuela-Pascual F, Molina F, Corbi F, Blanco-Blanco J, Gil RM, Soler-Gonzalez J. The influence of a biopsychosocial educational internet-based intervention on pain, dysfunction, quality of life, and pain cognition in chronic low back pain patients in primary care: a mixed methods approach. BMC Med Inform Decis Mak 2015; 15:97. [PMID: 26597937 PMCID: PMC4657202 DOI: 10.1186/s12911-015-0220-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 11/20/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Low back pain is the highest reported musculoskeletal problem worldwide. Up to 90 % of patients with low back pain have no clear explanation for the source and origin of their pain. These individuals commonly receive a diagnosis of non-specific low back pain. Patient education is a way to provide information and advice aimed at changing patients' cognition and knowledge about their chronic state through the reduction of fear of anticipatory outcomes and the resumption of normal activities. Information technology and the expedited communication processes associated with this technology can be used to deliver health care information to patients. Hence, this technology and its ability to deliver life-changing information has grown as a powerful and alternative health promotion tool. Several studies have demonstrated that websites can change and improve chronic patients' knowledge and have a positive impact on patients' attitudes and behaviors. The aim of this project is to identify chronic low back pain patients' beliefs about the origin and meaning of pain to develop a web-based educational tool using different educational formats and gamification techniques. METHODS/DESIGN This study has a mixed-method sequential exploratory design. The participants are chronic low back pain patients between 18-65 years of age who are attending a primary care setting. For the qualitative phase, subjects will be contacted by their family physician and invited to participate in a personal semi-structured interview. The quantitative phase will be a randomized controlled trial. Subjects will be randomly allocated using a simple random sample technique. The intervention group will be provided access to the web site where they will find information related to their chronic low back pain. This information will be provided in different formats. All of this material will be based on the information obtained in the qualitative phase. The control group will follow conventional treatment provided by their family physician. DISCUSSION The main outcome of this project is to identify chronic low back pain patients' beliefs about the origin and meaning of pain to develop a web-based educational tool using different educational formats and gamification techniques. TRIAL REGISTRATION ClinicalTrials.gov NCT02369120 Date: 02/20/2015.
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Affiliation(s)
- Fran Valenzuela-Pascual
- Universidad de Lleida, Facultad de Enfermería y Fisioterapia, Montserrat Roig 2, Lleida, 25198, Spain. .,Grupo de Estudios Sociedad, Salud, Educación y Cultura, Universidad de Lleida, Pl. de Víctor Siurana 1, Lleida, 25003, Spain. .,Grup de Recerca de Cures de Salut, Institut de Recerca Biomèdica, Avda Alcalde Rovira Roure 80, Lleida, 25198, Spain.
| | - Fidel Molina
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, Universidad de Lleida, Pl. de Víctor Siurana 1, Lleida, 25003, Spain.,Universidad de Lleida, Facultad de Educación, Psicología y Trabajo Social, Av. Estudi General 4, Lleida, 25001, Spain
| | - Francisco Corbi
- Universidad de Lleida, Institut Nacional d'Educació Física de Catalunya, Centro de Lleida, Partida Caparrella s/n, Lleida, 25192, Spain
| | - Joan Blanco-Blanco
- Universidad de Lleida, Facultad de Enfermería y Fisioterapia, Montserrat Roig 2, Lleida, 25198, Spain.,Grupo de Estudios Sociedad, Salud, Educación y Cultura, Universidad de Lleida, Pl. de Víctor Siurana 1, Lleida, 25003, Spain.,Grup de Recerca de Cures de Salut, Institut de Recerca Biomèdica, Avda Alcalde Rovira Roure 80, Lleida, 25198, Spain
| | - Rosa M Gil
- Departamento de Informática e Ingeniería Industrial, Universidad de Lleida, Jaume II 69, Lleida, 25001, Spain
| | - Jorge Soler-Gonzalez
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, Universidad de Lleida, Pl. de Víctor Siurana 1, Lleida, 25003, Spain.,Universidad de Lleida, Facultad de Medicina, Montserrat Roig 2, Lleida, 25198, Spain.,Institut Català de la Salut, Rambla de Ferran 44, Lleida, 25007, Spain
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107
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Kostova Z, Caiata-Zufferey M, Schulz PJ. Can social support work virtually? Evaluation of rheumatoid arthritis patients' experiences with an interactive online tool. Pain Res Manag 2015; 20:199-209. [PMID: 26252664 PMCID: PMC4532206 DOI: 10.1155/2015/497512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is strong empirical evidence that the support that chronic patients receive from their environment is fundamental for the way they cope with physical and psychological suffering. Nevertheless, in the case of rheumatoid arthritis (RA), providing the appropriate social support is still a challenge, and such support has often proven to be elusive and unreliable in helping patients to manage the disease. OBJECTIVES To explore whether and how social support for RA patients can be provided online, and to assess the conditions under which such support is effective. An online support tool was designed to provide patients with both tailored information and opportunities to interact online with health professionals and fellow sufferers. The general purpose was to identify where the support provided did - or did not - help patients, and to judge whether the determinants of success lay more within patients - their engagement and willingness to participate - or within the design of the website itself. METHODS The present study reports qualitative interviews with 19 users of the tool. A more specific purpose was to elaborate qualitatively on results from a quantitative survey of users, which indicated that any positive impact was confined to practical matters of pain management rather than extending to more fundamental psychological outcomes such as acceptance. RESULTS AND CONCLUSIONS Overall, online learning and interaction can do much to help patients with the everyday stresses of their disease; however, its potential for more durable positive impact depends on various individual characteristics such as personality traits, existing social networks, and the severity and longevity of the disease.
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Affiliation(s)
- Zlatina Kostova
- Institute of Communication and Health, University of Lugano, Lugano, Switzerland
| | | | - Peter J Schulz
- Institute of Communication and Health, University of Lugano, Lugano, Switzerland
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