Using the new board game SeCZ TaLK to stimulate the communication on sexual health for adolescents with chronic conditions

Game-Based Learning for Learners With Disabilities-What Is Next? A Systematic Literature Review From the Activity Theory Perspective

The design, implementation, and outcome of game-based learning for learners with disabilities have not been sufficiently examined systematically. Particularly, learner-based and contextual factors, as well as the essential roles played by various stakeholders, have not been addressed when game-based learning applications are used in special education. Therefore, a systematic literature review using the Activity Theory (AT) was conducted to analyse studies about game-based learning for learners with disabilities. Content analysis of 96 studies reported relevant information with respect to each activity component-(a) subject (learners with disabilities), (b) technology (game-based learning applications), (c) object (target skills or behaviours), (d) rules (implementation procedure and performance measures), (e) community (learners with disabilities, special education professionals, and parents), (f) division of labour (among learners, professionals, and parents) and (g) outcome (performance of target skills or behaviours). Furthermore, this study identified existing gaps from the reviewed studies, including occasional lack of parental engagement, difficulty of standardising performance measures due to the heterogeneity of learner profiles and contradictions (e.g., opposing views among experts on the role of educational games in social interactions). Finally, recommendations were made under each activity component. The study concluded that both general and domain-specific guidelines should be created for each disability category proposed in this review to assist practitioners who wish to use game-based learning with learners with disabilities.

An Exploratory Digital Board Game Approach to the Review and Reinforcement of Complex Medical Subjects Like Anatomical Education: Cross-sectional and Mixed Methods Study

Background

Serious games have the potential to resolve educational problems faced by medical students, such as insufficient rehearsal due to boredom and lack of motivation. However, serious games’ relatively novel concepts in science and many genres of games that are common in recreation remain underresearched in the literature. Board games are one such genre that, despite their potential, affordability, and flexibility, are rarely designed for medical students, and little is known about student perceptions of them and their compatibility with rehearsal.

Objective

In this cross-sectional study, we sought to elicit, via an exploratory mixed methods approach, student perceptions of a digital serious board game specifically designed for the gamified rehearsal of complex medical subjects, with the chosen topic of anatomy.

Methods

A digital serious board game, based on self-determination theory (SDT), was first designed and developed to facilitate the rehearsal of anatomy information. Students were then voluntarily recruited to partake in the intervention and were randomly split into three teams of 2 players per game session, after which they were administered the Flow Short Scale (FSS), which is a 13-item measure where items were rated on a 7-point Likert scale ranging from 1 (“not at all”) to 7 (“very much”). Students then participated in a focus group discussion to elicit their perceptions of the game. Findings from the FSS were subject to descriptive analysis, and the focus group discussion was subject to inductive thematic analysis.

Results

A total of 12 undergraduate, second-year medical students from the Lee Kong Chian School of Medicine in Singapore participated in the study. FSS results indicated a moderate level of overall flow (mean score 4.94, SD 1.07) via the subdomains of fluency (mean score 4.77, SD 1.13) and absorption (mean score 5.21, SD 1.1). Students perceived the game as fun, enjoyable, engaging, and appropriate as a rehearsal tool that alleviated the monotony of traditional methods of rehearsal.

Conclusions

Our digital board game–based rehearsal tool, when based on SDT, appeared to be suitable for gamified rehearsal in a fun and enjoyable environment due to its facilitation of intrinsic motivation in its players.

Tabletop Board Game Elements and Gamification Interventions for Health Behavior Change: Realist Review and Proposal of a Game Design Framework

Background

Games, when used as interventional tools, can influence behavior change by incentivizing, reinforcing, educating, providing feedback loops, prompting, persuading, or providing meaning, fun, and community. However, not all game elements will appeal to all consumers equally, and different elements might work for different people and in different contexts.

Objective

The aim of this study was to conduct a realist review of tabletop games targeting behavior change and to propose a framework for designing effective behavior change games.

Methods

A realist review was conducted to inform program theory in the development of tabletop games for health behavior change. The context, mechanisms used to change behavior, and outcomes of included studies were reviewed through a realist lens.

Results

Thirty-one papers met the eligibility criteria and were included in the review. Several design methods were identified that enhanced the efficacy of the games to change behavior. These included design by local teams, pilot testing, clearly defined targets of behavior change, conscious attention to all aspects of game design, including game mechanics, dynamics, aesthetics, and the elicitation of emotions. Delivery with other mediums, leveraging behavioral insights, prior training for delivery, and repeated play were also important. Some design elements that were found to reduce efficacy included limited replayability or lack of fun for immersive engagement.

Conclusions

Game designers need to consider all aspects of the context and the mechanisms to achieve the desired behavior change outcomes. Careful design thinking should include consideration of the game mechanics, dynamics, aesthetics, emotions, and contexts of the game and the players. People who know the players and the contexts well should design the games or have significant input. Testing in real-world settings is likely to lead to better outcomes. Careful selection and purposeful design of the behavior change mechanisms at play is essential. Fun and enjoyment of the player should be considered, as without engagement, there will be no desired intervention effect.

Healthcare providers' perspectives with addressing sex-related issues and sexual identity within pediatric rehabilitation: A qualitative study

BACKGROUND

Although having a sexual and reproductive life is a fundamental human right, people with disabilities, especially youth, often have many unaddressed needs. Healthcare providers commonly report lacking knowledge and training in how to address sexual-related topics with youth.

PURPOSE

The purpose of this study was to explore the perspectives of pediatric rehabilitation care providers in addressing sex and sexuality among youth with disabilities.

METHOD

This qualitative study involved a secondary analysis of interviews with 21 participants (18 women, 2 men, 1 trans man) from a range of pediatric rehabilitation disciplines. An open-coding thematic analysis of the transcripts was performed.

FINDINGS

The results highlighted the following themes regarding healthcare providers' perspective of addressing sex-related issues within pediatric rehabilitation: (1) lack of attention to sex-related issues (i.e., taboo topic); (2) coping with clients disclosing sexual identity (i.e., unpreparedness, addressing discrimination and mental health issues, creating a safe space); and (3) navigating parental concerns (i.e., resistance to sex-related issues, privacy and confidentiality, youth's reliance on parents for managing menstruation).

CONCLUSIONS

Pediatric rehabilitation healthcare providers encounter challenges in providing health services and advice to youth with disabilities regarding sex-related issues and may need further training.

Empowering Patients and Health Professionals to Address Sexual Health in the Context of Anorectal Malformations and Hirschsprung's Disease

The aim of this study is to develop a tool that is aligned with patients' and health professionals' needs to address sexual health in the context of anorectal malformations and Hirschsprung's disease. A multiphased participatory action-research was conducted. First, an inventory of needs was made through interviews (11 patients, 11 professionals), three online focus groups (4 patients, 20 professionals), and a questionnaire (38 patients). Subsequently, four cocreation sessions with in total four patients and nine professionals were organized to translate the needs into a tool (in the form of a website). The websites' functionality was assessed via a questionnaire (n = 34). The website, directed to patients, their parents, and professionals, stimulates awareness, fills knowledge gaps, and shows possibilities for support. The website is expected to change restrictive attitudes toward sexual health and improve the legitimization of the topic needed for the allocation of resources and sexologists' involvement in current care pathways.

Development and evaluation of an educational game to support pharmacy students

INTRODUCTION

United Kingdom pharmacy students need to efficiently navigate the British National Formulary (BNF), a standard medicines reference source. "Pharmacy Challenge" is a web-based prototype game based on the BNF. This research aimed to evaluate the game in terms of design, content, and impact on students' performance and confidence.

METHODS

Evaluation was comprised of three phases: implementation, perception, and impact. Game design and evaluation methods were modelled using adapted elements of the Relevance Embedding Translation Adaption Immersion and Naturalisation framework. Qualitative and quantitative questionnaires were utilised to assess students' perceptions of the game and its role in their education and to evaluate changes in confidence and performance after playing the game. Quizzes were developed to determine changes in performance.

RESULTS

The questionnaire evaluation (n = 152) found students' confidence increased significantly (p < .05) in speed of using, knowledge of BNF sections, extracting information, and knowing where to look for the answer. Most students (88%) felt they had learnt something new and 86% felt that it reinforced their learning. A significant (p < .05) increase in pre- and post- BNF quiz marks was observed.

CONCLUSIONS

Statistically significant improvement in students' perceived confidence was noted. The study identified design elements such as the need for a simple interface to encourage engagement. The prototype has undergone a design transformation based on the feedback provided and is now released under the name "DOSE" with a bank of 300 questions, improved graphics, a leadership board, and medals.

Sexual Health Communication Between Healthcare Professionals and Adolescents with Chronic Conditions in Western Countries: An Integrative Review

Adolescent patients and healthcare professionals find it difficult to initiate the discussion on sexual health in consultations. The aim of this integrative review is to give an overview of determinants in the communication about sexual health between adolescents with chronic conditions, their parents, and their healthcare professionals. A systematic literature search for the period of January 2000 to October 2018 was conducted in four databases (Cinahl, Cochrane, PsycINFO, and Pubmed) and resulted in fifteen included studies. Four determinants were found in these studies: attitude, beliefs, knowledge, and self-efficacy. Patients, parents, and healthcare professionals experienced sexual health as a taboo topic and felt not comfortable talking about it. Both patients and professionals expressed a need to discuss sexual health, however personal and practical barriers withhold them from initiating the discussion. This in-depth overview suggests that all four determinants should be targeted to improve communication about sexual health in healthcare settings. Future research should be conducted to give more insight in the experiences and support needs of adolescent patients. On the long term, the discussion about sexual health should become normalized by improving knowledge, training, and support for healthcare professionals and integrating sexual health in education and hospital policies.

Pace and determinants of implementation of the self-management of well-being group intervention: a multilevel observational study

Background

When implementing an empirically supported intervention (ESI) arrays of influencing factors operate on the professional and organizational level, but so far dependency between these levels has often been ignored. The aim of this study is to describe the pace and identify determinants of implementation of the Self-Management of Well-being (SMW) group intervention while taking the dependency between professionals and organizations into account.

Methods

Pace of implementation was measured as the time between training of professionals and first use of the SMW intervention in months. Determinants of first use were derived from the Fleuren framework and assessed using web-based questionnaires and telephone interviews. First, univariate analyses, Fisher’s exact tests and t-tests, were performed to identify determinants of first use of the SMW intervention on the individual professional and the organizational level independently. Second, multilevel analyses were performed to correct for the dependency between professionals and organizations. Simple multilevel logistic regression analyses were performed with determinants found significant in the univariate analyses as independent variables, first use as dependent variable, professionals entered in the first level, and organizations in the second level.

Results

Forty-eight professionals from 18 organizations were trained to execute the SMW intervention. Thirty-two professionals achieved first use, at a mean pace of 7.5 months ± 4.2. Determinants on the professional level were ‘ownership’, ‘relative advantage’, ‘support from colleagues’ and ‘compatibility’. Determinants on the organizational level were ‘organizational size’ and ‘innovation-task orientation fit’. Multilevel analysis showed that ‘compatibility’, a factor on the professional level, was the only significant determinant contributing to first use in the multilevel model.

Conclusions

This implementation study revealed a strong dependency between professionals and organizations. Results showed that a majority of professionals used the SMW intervention in about 8 months. When the dependency between professionals and organization was taken into account, the professionals’ perception of compatibility was the only remaining determinant of implementation on the professional level. Organizational size and managers’ perception of ‘innovation-task orientation fit’ were determinants of implementation on the organizational level. It is advisable to discuss the compatibility between new and current tasks among managers and professionals before adopting a new intervention.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-3891-x) contains supplementary material, which is available to authorized users.

Non-disease Specific Health Promotion Interventions for Chronically Ill Adolescents in Medical Settings: A Systematic Review

Adolescents with chronic conditions are highly likely to encounter physical, social and psychological difficulties that can threaten their overall wellbeing and health. As any other adolescent, they need to be helped to tackle the non-medical determinants of their health. This is the aim of primary prevention and general health promotion interventions. The present paper aims to review any hospital-based intervention that strives to promote general health in chronically ill teenagers. A systematic process of search and screening revealed four articles that presented and evaluated non-disease specific interventions that explicitly aimed to promote the overall health of chronically ill teenagers in clinical settings. Congruently with health promotion principles and values, the interventions described in our selection of articles targeted positive health determinants, in terms of personal skills and attitudes that contribute to psychosocial resiliency. The clinical relevance and feasibility of developing non-disease specific health promotion interventions in clinical settings was confirmed. However, the lack of relevant reported details did not allow us to highlight the key factors and mechanisms associated with successful interventions for health promotion targeted at chronically ill adolescents attending health care settings. Moreover, the design of the included studies varied in quality: number of participants, presence of a post-test and a follow-up, use of validated questionnaires, etc. Well-conducted non-disease specific clinical health promotion interventions still remain an under-investigated area of research, and maybe even of practice.

Game-Based Health Education: The Case of Hexacago Health Academy

It is a well-documented fact that women and minorities are currently underrepresented in STEM higher education degree programs and careers. As an outreach measure to these populations, we established the Hexacago Health Academy (HHA), an ongoing summer program. Structured as an informal learning environment with a strong youth initiated mentoring component, HHA uses game-based learning as both a means of health education and stimulating interest in careers in medicine among adolescents from underrepresented minority populations. In this article, we describe the 2015 session of the Hexacago Health Academy, which focused on the topic of sexual and reproductive health (SRH). The overall structure of HHA, with its dual focus on game design and enabling youth interaction with science and health professionals, is discussed. Qualitative data from the 24 youths that participated in the 2015 summer session was collected. Results indicated that the initial session of HHA succeeded in its goals of developing critical thinking skills among participants, encouraging teamwork, broadening understanding of the health sciences, and encouraging risk-taking in education. The overall potential efficacy of informal learning environments that use game design as a core component to stimulate interest in STEM fields is discussed.

Don't Push Your Luck! Educational Family Board (Not Bored) Game for School-Age Children Living with Chronic Conditions

PURPOSE

Children who are living with chronic conditions may be supported in self-care through enjoyable active learning and family social processes. This research focused on development and evaluation of "Don't Push Your Luck!", an educational board game designed to inspire family discussion about chronic conditions, and help affected children learn about self-care choices and consequences.

DESIGN AND METHODS

Mixed-method research was conducted with families from one outpatient Cystic Fibrosis Clinic and four Hemophilia Treatment Centres in Canada and United States (N=72). In phase I, board game prototype and questionnaires were refined with affected boys, siblings, and parents living with hemophilia (n=11), compared with families living with cystic fibrosis (n=11). In phase II, final board game was evaluated with families living with hemophilia (n=50). Data collection included pre-post-game questionnaires on decision-making and Haemo-QoL Index©, and post-game enjoyment. Analysis included descriptive statistics, inferential statistics (non-parametric), and qualitative themes.

RESULTS

Findings revealed this game was an enjoyable and effective resource to engage families in self-care discussions. Key themes included communication, being involved, knowing, decisions and consequences, and being connected. Qualitative and quantitative findings aligned. Statistical significance suggests the game enhanced family engagement to support decision-making skills, as parents identified that the game helped them talk about important topics, and children gained insight regarding family supports and self-care responsibility.

CONCLUSIONS

This board game was an effective, developmentally appropriate family resource to facilitate engagement and conversation about everyday life experiences in preparation for self-care.

PRACTICE IMPLICATIONS

There is promising potential to extend this educational family board game intervention with a greater range of school-age children and families living with chronic conditions.

Evaluating 'FREDA Challenge': a coproduced human rights board game in services for people with intellectual disabilities

BACKGROUND

A serious board game called 'FREDA Challenge' was co-produced with people with intellectual disabilities (PWID) as a tool for human rights (HR) education and increase positive attitudes towards HR in healthcare settings. The current study evaluated 'FREDA Challenge' with PWID and their carers.

METHOD

Eighteen PWID and 13 carers participated in a repeated measures design whereby changes in attitudes and knowledge of HR were measured.

RESULTS

Analysis revealed statistically significant differences (P = 0.02) between PWID and carers in their knowledge of HR. The same was not evident for attitudes towards HR. The positive attitudes and knowledge in the PWID group significantly increased after playing the game (P ≤ 0.02), but not for the carers/professionals group.

CONCLUSIONS

Findings suggest that playing the board game can positively change the attitudes and knowledge of PWID towards HR. The board game seems to elicit positive interpersonal dynamics between PWID and carers/professionals.

Lagging behind or not? Four distinctive social participation patterns among young adults with chronic conditions

PURPOSE

Typical childhood and adolescent development and acquiring self-management skills are crucial for a satisfying adult life and autonomy in social participation. The aims of this study were to identify patterns of autonomy in social participation and to explore differences between these patterns.

METHODS

Adolescents with various chronic conditions participating in a survey in 2006 (T0) were re-invited for a follow-up study (T1) in 2012. The young adults (18-25 years of age) assessed self-management skills, their condition's impact on school or work, health-related quality of life (HRQoL), and social participation in various domains. Patterns were identified through cluster analysis. Differences between patterns were analyzed in bivariate and multivariate analyses.

RESULTS

Compared with healthy age-mates, our sample (n = 483) generally lagged behind in social participation. Four patterns emerged: typical developers, financially secure laggers, slow developers, and outgoing laggers. The patterns differed regarding gender, educational level, attending special education, having disability benefits, and degree of physical limitations. Groups with a higher level of autonomy in social participation did not necessarily have higher HRQoL but did report higher self-efficacy and independence at both measurements.

CONCLUSIONS

Autonomy in some participation domains can coincide with a lack of autonomy in others. In addition, better social participation does not necessarily correlate with higher HRQoL, or vice versa. Yet, more social participation was associated with more self-efficacy and independence. Our results emphasize that there is no standardized approach. Clinicians should take care to address all life areas in clinical practice to screen patients' lived experiences and the need for social and self-management support.