Spielerische Ansätze in Prävention und Gesundheitsförderung: Serious Games und Gamification

The regulatory status of health apps that employ gamification

Smartphone applications are one of the main delivery modalities in digital health. Many of these mHealth apps use gamification to engage users, improve user experience, and achieve better health outcomes. Yet, it remains unclear whether gamified approaches help to deliver effective, safe, and clinically beneficial products to users. This study examines the compliance of 69 gamified mHealth apps with the EU Medical Device Regulation and assesses the specific risks arising from the gamified nature of these apps. Of the identified apps, 32 (46.4%) were considered non-medical devices; seven (10.1%) were already cleared/approved by the regulatory authorities, and 31 (44.9%) apps were assessed as likely non-compliant or potentially non-compliant with regulatory requirements. These applications and one approved application were assessed as on the market without the required regulatory approvals. According to our analysis, a higher proportion of these apps would be classified as medical devices in the US. The level of risk posed by gamification remains ambiguous. While most apps showed only a weak link between the degree of gamification and potential risks, this link was stronger for those apps with a high degree of gamification or an immersive game experience.

[Is the use of virtual reality in otorhinolaryngology teaching automatically positively rated by students? : A questionnaire-based evaluation among students]

BACKGROUND

Analogous to the situation in other disciplines, digital ENT teaching made significant progress during the pandemic. Most ENT clinics nationwide were able to offer a complete virtual teaching program in time. Innovative teaching methods were also used early on. This was recognized in student teaching evaluations. Due to the expansion of virtual reality (VR) in medical teaching, even greater satisfaction should be expected through improved teaching quality.

MATERIALS AND METHODS

Surveys were performed with students (n = 180) of the ENT block internship in the summer semester of 2023. The aim of the evaluation was to determine the students' satisfaction with and subjective effectiveness of the newly implemented VR digital teaching method for teaching ear anatomy and coniotomy. A survey was also carried out among resident physicians.

RESULTS

The ENT teaching was perceived favorably by the students, with an average rating of 11.7 out of 15. The learning effectiveness and the value of VR in the ENT learning portfolio was evaluated varyingly by the students. The physicians' assessment was different, with a more positive perception.

CONCLUSION

Virtual reality represents an innovative component in the teaching portfolio of otolaryngology. This new teaching method is viewed and accepted as a future-oriented tool. Remarkably, the physicians involved voted consistently positively, while the students gave more critical assessments and pointed out limitations in the individual and subjective areas. These findings are in contrast to the further development of innovative teaching methods demanded by student interest groups.

Digital Educational Game "O Jardim do Ferro": A Tool for the Prevention of Iron Deficiency Anemia in Childhood

Objective: To create and evaluate a digital educational game (DEG) for preschool children for the prevention of iron deficiency and iron deficiency anemia. Methodology: The DEG software was developed by a multidisciplinary team, according to Chandler's methodology, in Engine Unity. The game is a 2D platformer, for Android, with three different phases. A quiz was developed for parents/caregivers about iron absorption and anemia. The quiz content was evaluated by experts. The evaluation of the game was carried out through a questionnaire applied in the school for children from 4 to 6 years of age. Results: For the construction of the game, programming, team planning, art, and soundtrack were necessary. The game was registered at the National Institute of Industrial Property. The quiz was evaluated by 14 experts and all questions had more than 80% agreement. The questionnaire was answered by 32 children with a mean age of 5.0 ± 0.7 years, and ∼70% evaluated the game positively. Thus, the acceptability of the software was favored by most players. Conclusion: The "O Jardim do Ferro" software, from its conception to evaluation, proved to be a promising tool to contribute to food and nutrition education actions, providing opportunities for the construction of knowledge about iron-rich foods for the prevention of iron deficiency and iron deficiency anemia in childhood.

The Role of AI in Serious Games and Gamification for Health: Scoping Review

BACKGROUND

Artificial intelligence (AI) and game-based methods such as serious games or gamification are both emerging technologies and methodologies in health care. The merging of the two could provide greater advantages, particularly in the field of therapeutic interventions in medicine.

OBJECTIVE

This scoping review sought to generate an overview of the currently existing literature on the connection of AI and game-based approaches in health care. The primary objectives were to cluster studies by disease and health topic addressed, level of care, and AI or games technology.

METHODS

For this scoping review, the databases PubMed, Scopus, IEEE Xplore, Cochrane Library, and PubPsych were comprehensively searched on February 2, 2022. Two independent authors conducted the screening process using Rayyan software (Rayyan Systems Inc). Only original studies published in English since 1992 were eligible for inclusion. The studies had to involve aspects of therapy or education in medicine and the use of AI in combination with game-based approaches. Each publication was coded for basic characteristics, including the population, intervention, comparison, and outcomes (PICO) criteria; the level of evidence; the disease and health issue; the level of care; the game variant; the AI technology; and the function type. Inductive coding was used to identify the patterns, themes, and categories in the data. Individual codings were analyzed and summarized narratively.

RESULTS

A total of 16 papers met all inclusion criteria. Most of the studies (10/16, 63%) were conducted in disease rehabilitation, tackling motion impairment (eg, after stroke or trauma). Another cluster of studies (3/16, 19%) was found in the detection and rehabilitation of cognitive impairment. Machine learning was the main AI technology applied and serious games the main game-based approach used. However, direct interaction between the technologies occurred only in 3 (19%) of the 16 studies. The included studies all show very limited quality evidence. From the patients' and healthy individuals' perspective, generally high usability, motivation, and satisfaction were found.

CONCLUSIONS

The review shows limited quality of evidence for the combination of AI and games in health care. Most of the included studies were nonrandomized pilot studies with few participants (14/16, 88%). This leads to a high risk for a range of biases and limits overall conclusions. However, the first results present a broad scope of possible applications, especially in motion and cognitive impairment, as well as positive perceptions by patients. In future, the development of adaptive game designs with direct interaction between AI and games seems promising and should be a topic for future reviews.

Psychodynamic-based virtual reality cognitive training system with personalized emotional arousal elements for mild cognitive impairment patients

BACKGROUND AND OBJECTIVE

Mild cognitive impairment (MCI) is a serious threat to the physical health and quality of life of the elderly, as well as a heavy burden on families and society. The current computer-based rehabilitation training ignores the role of emotions in cognitive impairment rehabilitation, making it difficult to improve patient engagement and efficiency. To address this, a psychodynamics-based cognitive rehabilitation training method with personalized emotional arousal elements was proposed using virtual reality technology.

METHODS

Our proposed method contains four training tasks, which cover (audiovisual memory, attention & processing, working memory, abstract & Logic, spatial pathfinding) and six positive emotional arousal elements (sensory feedback, achievement system, multiplayer interaction, score comparison, relaxation scenarios, and peaceful videos) to motivate participants to persist during cognitive training continuously and maintain a positive mental attitude toward training. The six emotional arousal elements were divided into two personalized combinations-full combination and half combination-based on the results of the pre-assessment and were dynamically distributed throughout both the training tasks and post-training.

RESULTS

Fifteen participants with MCI were recruited to complete the proposed experiment and validate the effectiveness of the system. They were first asked to complete two assessments (e.g., the big five scale and the positive and negative affect scale) to investigate their personalities. Based on the results of the assessments, they were provided with a full or half combination of arousal elements in the training tasks and post-training. Finally, the acceptability of the system and task experience were assessed using questionnaires. Notably, there was a significant increase in training scores for participants who completed a six-week training period (66.7%, 33.4%, and 25.0% for attention and processing, working memory, and abstraction and logic, respectively). The results show that positive emotional arousal had a positive effect on the MCI participants. The training tasks and arousal elements can improve cognitive function and enhance the confidence and engagement of participants. There were no significant differences in cognitive domain training scores between the two groups.

CONCLUSIONS

This personalized cognitive training system has the potential to serve as a convenient solution for complementary treatment of MCI.

Konzeption einer App mit der Technik des „Entschleunigten Atmens“ zur Selbstregulation für Jugendliche während der Corona-Pandemie

Zusammenfassung. Theoretischer Hintergrund: Belastungen und Stress nahmen bei den Jugendlichen während der COVID-19-Pandemie zu. Das Entschleunigte Atmen (EA) wirkt kurz- wie langfristig stressreduzierend und stabilisierend. Mithilfe einer App, die diese Technik vermittelt, haben Schüler_innen auch während des pandemiebedingten Distanz-Lernens die Möglichkeit, an einem schulbasierten Training teilzunehmen. Fragestellung: Wie hoch ist die Erreichbarkeit und wie werden inhaltliche und nicht-inhaltliche Aspekte der App bewertet? Methode: Eine mehrmodulige App, die das EA erklärt, zum Anwenden und Üben dieser Technik anleitet, wurde konzipiert und entwickelt. Während eines Pilotprojekts in der zweiten Welle der COVID-19-Pandemie wurde das vierwöchige Training von 6. bis 8. Klässler_innen erprobt. Das gesamte Training bewerteten 31 Schüler_innen, das EA sieben. Ergebnisse: Erste Ergebnisse deuten auf eine zufriedenstellende nicht-inhaltliche und eine gute inhaltliche Akzeptanz hin. Die Erreichbarkeit hingegen war gering. Alle Ergebnisse werden deskriptiv vorgestellt. Diskussion und Schlussfolgerung: Die App-Revision soll Präsenzmodule beinhalten, die motivationalen Anreize erhöhen und an einer größeren Stichprobe durchgeführt werden.

RESET-APP: ein App-basiertes Angebot zur Selbstregulation für Schüler*innen der Sekundarstufe I – Akzeptanz und Nutzungsverhalten

Hintergrund

Die COVID-19-Pandemie („coronavirus disease 2019“) hat immense Auswirkungen auf die psychische Gesundheit. Kinder und Jugendliche gelten hierbei als besonders vulnerabel. Deshalb sind gerade für sie Angebote zur Gesundheitsförderung und Prävention wichtig. Gesundheitsförderung sollte motivierend gestaltet werden, um für diese Altersgruppe attraktiv zu sein. Ziel dieser Arbeit war zu untersuchen, ob Jugendliche mithilfe von innovativen digitalen Formaten erreicht werden können.

Methodik

Es wurde ein App-basiertes Training zur Förderung der Selbstregulation für die Sekundarstufe I konzipiert und Jugendlichen der Sekundarstufe I im Herbst 2020 angeboten. Hier wurde u. a. die Art der Motivation zur Teilnahme am Training abgefragt. Zudem konnten die Schüler*innen die Attraktivität des Trainings abschließend bewerten.

Ergebnis

Von den registrierten Schüler*innen (n = 91) absolvierten 39,56 % das komplette Training. 40,91 % der Schüler*innen, die das Training vollständig absolviert haben, gaben an, dass das Training „sehr“ hilfreich war, 36,36 % bewerteten es als „ziemlich“ hilfreich. 50 % der Befragten fand das App-basierte Training „modern und motivierend“, die andere Hälfte hätte sich jedoch mehr persönliche Betreuung gewünscht.

Schlussfolgerung

Die Ergebnisse decken sich mit den Ergebnissen bereits veröffentlichter Studien: Heranwachsende sind zwar prinzipiell offen für digitale Formate, jene werden aber kaum verbindlich und kontinuierlich genutzt.

Modification in the Motor Skills of Seniors in Care Homes Using Serious Games and the Impact of COVID-19: Field Study

BACKGROUND

The pandemic has highlighted the importance of low-threshold opportunities for exercise and physical activity. At the beginning of 2020, the COVID-19 pandemic led to many restrictions, which affected seniors in care facilities in the form of severe isolation. The isolation led, among other things, to a lack of exercise, which has led to a multitude of negative effects for this target group. Serious games can potentially help by being used anywhere at any time to strengthen skills with few resources.

OBJECTIVE

The aim of this study is to evaluate the effectiveness of a serious game to strengthen motor skills (study 1) and the influence of pandemic restrictions (study 2) on seniors in care facilities.

METHODS

The data on motor skills (measured by the Tinetti test) originated from an intervention study with repeated measurements that was interrupted by the pandemic conditions. Data were collected 4 times every 3 months with an intervention group (IG, training 3 times for 1 hour per week) and a control group (CG, no intervention). There were 2 substudies. The first considered the first 6 months until the pandemic restrictions, while the second considered the influence of the restrictions on motor skills.

RESULTS

The sample size was 70. The IG comprised 31 (44%) participants, with 22 (71%) female and 9 (29%) male seniors with an average age of 85 years. The CG comprised 39 (56%) participants, with 31 (79%) female and 8 (21%) male seniors with an average age of 87 years. In study 1, mixed-design ANOVA showed no significant interaction between measurement times and group membership for the first measurements (F2.136=1.414, P<.25, partial η2=.044), but there was a significant difference between the CG (mean 16.23, SD 1.1) and the IG (mean 19.81, SD 1.2) at the third time of measurement (P=.02). In study 2 the mixed-design ANOVA (used to investigate motor skills before and after the pandemic conditions between the 2 groups) couldn't reveal any significant interaction between measurement times and group membership: F1.67=2.997, P<.09, partial η2=.043. However, there was a significant main effect of the time of measurement: F1.67=5.44, P<.02, partial η²=.075.

CONCLUSIONS

During the first 6 months, the IG showed increased motor skills, whereas the motor skills of the CG slightly deteriorated and showed a statistically significant difference after 6 months. The pandemic restrictions leveled the difference and showed a significant negative effect on motor skills over 3 months. As our results show, digital games have the potential to break down access barriers and promote necessary maintenance for important skills. The pandemic has highlighted the importance of low-threshold opportunities for exercise and physical activity. This potentially great benefit for the challenges of tomorrow shows the relevance of the topic and demonstrates the urgent need for action and research.

TRIAL REGISTRATION

Deutsches Register klinischer Studien DRKS00016633; https://tinyurl.com/yckmj4px.

Digitale Hochschullehre im ersten COVID-19-Semester. Ergebnisse einer Befragung von Lehrenden in Public Health, Medizin und Pflege

Hintergrund

Die COVID-19(„coronavirus disease 2019“)-Pandemie hat die Ad-hoc-Digitalisierung an Hochschulen vorangetrieben. Zugleich stand die digitale Hochschullehre vor der Herausforderung der Ausgestaltung der Lehre im Zusammenhang mit den vorbestehenden Ressourcen, der digitalen und didaktischen Kompetenzen sowie der zur Verfügung stehenden technischen Infrastruktur.

Ziel der Arbeit/Fragestellung

Das Ziel der Umfrage war die Einschätzung der digitalen Lehre, die die Präsenzlehre infolge der COVID-19-Pandemie zum großen Teil bzw. gänzlich ersetzt hat, aus der Perspektive der Lehrenden in Public Health, Medizin und Pflege.

Material und Methode

Die Querschnitterhebung fand online von Juni bis August 2020 statt und die Daten wurden über www.soscisurvey.de erhoben. Die schriftliche Befragung wurde unter Mitgliedern der Deutschen Gesellschaft für Public Health (DGPH) und des Ausschusses Digitalisierung der Gesellschaft für medizinische Ausbildung (GMA) und der Sektionen Bildung und Beratung der Deutschen Gesellschaft für Pflegewissenschaft (DGP) sowie der Arbeitsgruppe Lehre der Deutschen Gesellschaft für Medizinische Soziologie (DGMS) durchgeführt (n = 100).

Ergebnisse

Bei der Nutzung der digitalen Technologien in den Veranstaltungen rangieren auf der obersten Stelle Präsentationstools, gefolgt von Lernmanagementsystemen, Videoangeboten sowie digitalen Texten. Die Teilnehmenden geben hinsichtlich der Nutzung unterschiedliche (Konferenz‑)Tools an. Das Erstellen von Lehrvideos bejahen 53 % der Befragten, Abstimmungstools) werden bis > 50 % als unbekannt genannt. Als Herausforderungen werden digitale Infrastruktur der Hochschulen, fehlende didaktische Beratung/Unterstützung sowie rechtliche Fragen (Nutzungsrechte, Datenschutz) angegeben.

Schlussfolgerung

Neue Technologie werden vorwiegend für Wissenserwerb, Wissensvermittlung genutzt, selten zur Aktivierung von Studierenden und zur Gestaltung kollaborativer Lehr- und Lernarrangements sowie Neugestaltung von Lernaufgaben und Lernprozessen (individualisiertes Lernen). Welche der aktuell erprobten digitalen Lehr- und Lernformate zukünftig in der Hochschullehre zunehmend eingesetzt werden, hängt von vielen Faktoren ab, u. a. von digitaler Kompetenz sowie der Bereitschaft der Lehrenden und Lernenden die digitale Lernkultur mitzugestalten.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s11553-022-00937-1) enthalten.

Exploring the experience of nursing undergraduates in using gamification teaching mode based on the flow theory in nursing research: A qualitative study

BACKGROUND

With the development of evidence-based nursing practice, nursing research courses are important in undergraduate programs. However, nursing research courses are highly theoretical, which is difficult for students to understand. Improving the teaching quality of nursing research courses is a challenge for educators.

OBJECTIVES

To understand the learning experience and the effect of gamification teaching on nursing undergraduates, and to provide new ideas for nurse educators.

DESIGN

A qualitative research design using individual semi-structured interviews.

SETTINGS

Gamification teaching was applied in an undergraduate nursing research course over one semester at a university in Central China.

PARTICIPANTS

Purposive sampling was adopted to select nine undergraduate nursing students who had recently completed gamification teaching in a nursing research course.

METHODS

Data were collected through semi-structured interviews and analyzed using Colaizzi's phenomenological method.

RESULTS

Three major themes and seven subthemes emerged from the interviewees' experience: (1) positive attitude (e.g., acceptance with pleasure and flow experience); (2) self-perceived competence improvement (e.g., creative thinking, collaboration, and knowledge internalization and application); and (3) challenges of gamification teaching (e.g., learning pressure and rationality of game design).

CONCLUSIONS

The gamification teaching mode based on the flow theory had a positive effect on the students' learning experience in the nursing research course. It is recommended to improve the game design model and to enhance its effectiveness for classrooms in the future.

Gamification in E-Learning and Sustainability: A Theoretical Framework

Progress in communication technologies and social isolation caused by the COVID-19 pandemic have supported the acceptance of e-learning. In the e-learning context, gamification has been identified as one of the most promising trends. Many researchers believe in the game elements’ capacity to drive learning, skills acquisition, and changes for more sustainable behavior. However, the literature on the subject is dispersed, addressing behavioral attitudes and elements in an isolated and fragmented way. This study aims to present a framework relating game elements to behavioral attitudes to promote sustainability and ensure quality of learning. The methodology is based on a systematic literature review using the PRISMA protocol, covering the content analysis of 130 articles indexed in the Web of Science database. For the framework construction, the following were identified: behavioral attitudes stimulated by gamification; main game elements and how they relate to each other. Based on this, a framework called 7GOALS (Gamification-Oriented Active Learning Steps) associated with the PDCA (Plan, Do, Check, Act) was established. The proposed structure is multidisciplinary and can be used in any knowledge field that uses gamification. With this, themes such as sustainability can be widely disseminated and leverage changes towards more sustainable behaviors that adhere to the real world.

["Health promotion: Is it worth it?" A discussion game for training and practice]

In order to strengthen health promotion spreading knowledge is as essential as tackling typical problems of its implementation. Both aspects can be adressed by using game-based learning approaches. To this end, we specifically developed a discussion game divided into four phases of play. Our aim is to (1) spread facts, (2) raise awareness of the topic and (3) promote well-informed political opinion-forming at individual as well as group levels. Experience shows that these objectives can be achieved with this game. The game as a whole or parts of it can easily be integrated into university teaching in different ways. In addition, there is major potential for using the game in lifelong learning settings and health promotion projects. In the next step the game will be adapted to enable its implementation in the workplace as a special setting for health promotion.

Virtual bedside teaching for pharmacy students during their final term at LMU Munich

At Ludwig-Maximilians-Universität (LMU) bedside teaching (BT) for pharmacy students has been in place since 2014. To continue offering BT during the contact restrictions imposed by the authorities in 2020, the course was digitalised, and virtual bedside teaching implemented. Using Moodle, the original concept was divided into smaller sections and presented, e.g. in the form of video sequences. All sections of the course were accessed asynchronously by the students. Tasks were individually processed and evaluated. Virtual awards were used to increase the students' motivation. Contact with each other was possible via posting in available forums or the weekly online chat consultation. A total of 70 students successfully completed the course. The evaluation of the course was very positive, with mainly technical difficulties that were criticized. The students' feedback will be implemented in the course concept for the winter term.

The use of the online Inverted Classroom Model for digital teaching with gamification in medical studies

Introduction: In 2014, a newly designed, case-based seminar was successfully implemented in the subjects of health systems, health economics and public health care (GGG). The seminar "The Lonely Patient" is based on a real patient case and deals with the German health care system from the perspective of a patient. In order to create more space for discussion and exchange among students, the seminar was redesigned on the basis of the Inverted Classroom Method (ICM). Project description: Due to the COVID-19 pandemic, new, purely digital teaching formats had to be developed quickly in the sense of Emergency Remote Teaching. Therefore, the Inverted Classroom concept of the seminar was transformed into an online ICM. In order to promote active learning based on the ICAP model (Interactive, Constructive, Active, Passive), the online face-to-face part was designed as a synchronous interactive learner-centered course using the gamified audience response system Kahoot! Results: Evaluation results to date and feedback rounds with students indicate that the online ICM-version of the seminar leads to at least as good evaluation results as the previous face-to-face course. In particular, the students positively emphasize the use of Kahoot! as an activating digital medium. Discussion: Through the use of the ICM and the gamified audience response system Kahoot!, students could be activated in meaningful ways. The resulting discussions about the patient case and teaching content of the quiz questions in the synchronous online course could be implemented just as well as in the classroom-based course of previous semesters. Conclusion: The application of the online ICM, along with the consideration of the ICAP Model, has led to the successful implementation of a digital course within the context of the increased difficulty surrounding the emergency remote teaching. Additionally, students' learning success has remained at a similar level as during traditional classroom-based courses of previous semesters.