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Sivakumar B, Lemonde M, Stein M, Goldstein S, Mak S, Arcand J. Evaluating Health Care Provider Perspectives on the Use of Mobile Apps to Support Patients With Heart Failure Management: Qualitative Descriptive Study. JMIR Cardio 2022; 6:e40546. [DOI: 10.2196/40546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Nonadherence to diet and medical therapies in heart failure (HF) contributes to poor HF outcomes. Mobile apps may be a promising way to improve adherence because they increase knowledge and behavior change via education and monitoring. Well-designed apps with input from health care providers (HCPs) can lead to successful adoption of such apps in practice. However, little is known about HCPs’ perspectives on the use of mobile apps to support HF management.
Objective
The aim of this study is to determine HCPs’ perspectives (needs, motivations, and challenges) on the use of mobile apps to support patients with HF management.
Methods
A qualitative descriptive study using one-on-one semistructured interviews, informed by the diffusion of innovation theory, was conducted among HF HCPs, including cardiologists, nurses, and nurse practitioners. Transcripts were independently coded by 2 researchers and analyzed using content analysis.
Results
The 21 HCPs (cardiologists: n=8, 38%; nurses: n=6, 29%; and nurse practitioners: n=7, 33%) identified challenges and opportunities for app adoption across 5 themes: participant-perceived factors that affect app adoption—these include patient age, technology savviness, technology access, and ease of use; improved delivery of care—apps can support remote care; collect, share, and assess health information; identify adverse events; prevent hospitalizations; and limit clinic visits; facilitating patient engagement in care—apps can provide feedback and reinforcement, facilitate connection and communication between patients and their HCPs, support monitoring, and track self-care; providing patient support through education—apps can provide HF-related information (ie, diet and medications); and participant views on app features for their patients—HCPs felt that useful apps would have reminders and alarms and participative elements (gamification, food scanner, and quizzes).
Conclusions
HCPs had positive views on the use of mobile apps to support patients with HF management. These findings can inform effective development and implementation strategies of HF management apps in clinical practice.
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Hammer Y, Shaul AA, Ben‐Avraham B, Zadok OIB, Barac YD, Rubchevsky V, Yaari V, Gutrov E, Strömberg A, Klompstra L, Jaarsma T, Ben‐Gal T. Exergaming in patients with a left ventricular assist device: a feasibility study. ESC Heart Fail 2022; 10:738-741. [PMID: 36251532 PMCID: PMC9871679 DOI: 10.1002/ehf2.14203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/08/2022] [Accepted: 09/29/2022] [Indexed: 01/27/2023] Open
Abstract
AIMS Exercise games (exergames) have been recently proposed as a mode of facilitating physical activity in patients with chronic diseases. Although patients supported with left ventricular assist devices (LVADs) benefit from physical activity, specific LVAD-related issues hinder their ability to exercise properly. The objective of this study was to assess the feasibility and safety of exergaming in LVAD-supported patients. METHODS AND RESULTS Eleven LVAD-supported patients were enrolled in a 4 week exergaming programme using Nintendo Wii console with five sport games. Patients were instructed to play for 30 min a day, 5 days a week. Data on exercise capacity and exergaming were collected by using the 6 min walk test (6MWT) and a daily self-report diary, respectively. Feasibility of using the console and its safety was assessed by a semi-structured patient interview. Quality of life was assessed by the Minnesota Living with Heart failure Questionnaire (MLHFQ) and the Cantril's Ladder of Life. Safety was assessed by patient's report in interview and diary. The study group consisted of 10 male patients and 1 female patient, mean age of 67 ± 7 years, of whom 10 were supported with the HeartMate 3 LVAD for a median of 10 (interquartile range 3, 21) months. Baseline exercise capacity assessed by the 6MWT ranged from 240 to 570 m (mean 448 ± 112). After 4 weeks of exergaming, 6MWT distance increased from a mean of 448 ± 112 (evaluated in six patients) to 472 ± 113 m (P = 0.023). Patients' Cantril's Ladder of Life score improved numerically from an average of 6.13 to 7.67, as did their MLHFQ score from 45.9 ± 27 to 38.7 ± 18, with higher and lower scores, respectively, reflecting higher quality of life. No specific LVAD-related safety issues regarding exergaming were reported. CONCLUSIONS Exergaming was found to be a safe and feasible mode for encouraging physical activity in LVAD-supported patients and carries a potential for improving exercise capacity and quality of life in these patients. Larger scale studies are warranted to further investigate the effect of exergaming in this patient population.
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Affiliation(s)
- Yoav Hammer
- Department of CardiologyRabin Medical CenterPetach TikvaIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Aviv A. Shaul
- Department of CardiologyRabin Medical CenterPetach TikvaIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Binyamin Ben‐Avraham
- Department of CardiologyRabin Medical CenterPetach TikvaIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Osnat Itzhaki Ben Zadok
- Department of CardiologyRabin Medical CenterPetach TikvaIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Yaron D. Barac
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael,Department of Cardio‐Thoracic SurgeryRabin Medical CenterPetach TikvaIsrael
| | - Victor Rubchevsky
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael,Department of Cardio‐Thoracic SurgeryRabin Medical CenterPetach TikvaIsrael
| | - Vicky Yaari
- Department of CardiologyRabin Medical CenterPetach TikvaIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Ema Gutrov
- Department of CardiologyRabin Medical CenterPetach TikvaIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Anna Strömberg
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden,Department of CardiologyLinköping UniversityLinköpingSweden
| | - Leonie Klompstra
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Tuvia Ben‐Gal
- Department of CardiologyRabin Medical CenterPetach TikvaIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
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Effects of Exergaming in Patients with Cardiovascular Disease Compared to Conventional Cardiac Rehabilitation: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063492. [PMID: 35329177 PMCID: PMC8950475 DOI: 10.3390/ijerph19063492] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 02/04/2023]
Abstract
Background: Exercise-based cardiac rehabilitation (CR) programs are used for improving prognosis and quality of life in patients with cardiovascular disease (CVD). Nonetheless, adherence to these programs is low, and exercise-based CR programs based on virtual reality (i.e., exergaming) have been proposed as an alternative to conventional CR programs. However, whether exergaming programs are superior to conventional CR programs in patients with CVD is not known. Objective: This systematic review with meta-analysis was conducted to explore whether exergaming enhances exercise capacity, quality of life, mental health, motivation, and exercise adherence to a greater extent than conventional CR programs in patients with CVD. Method: Electronic searches were carried out in PubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases up to June 2021. Meta-analyses were performed using robust variance estimation with small-sample corrections. The effect sizes were calculated as the mean differences (MD) or standardized mean differences (SMD) as appropriate. The SMD magnitude was classified as trivial (<0.20), small (0.20−0.49), medium (0.50−0.79), or large (≥0.80). Heterogeneity was interpreted based on the I2 statistics as low (25%), moderate (50%), or high (75%). Results: Pooled analyses showed no differences between exergaming and conventional CR programs for enhancing exercise capacity (i.e., distance covered in the six-minute walk test) (MD+ = 14.07 m (95% confidence interval (CI) −38.18 to 66.32 m); p = 0.426) and mental health (SMD+ = 0.17 (95% CI −0.36 to 0.70); p = 0.358). The results showed a small, statistically nonsignificant improvement in quality of life in favor of exergaming (SMD+ = 0.22 (95% CI = −0.37 to 0.81); p = 0.294). Moderate heterogeneity was found for exercise capacity (I2 = 53.7%), while no heterogeneity was found for quality of life (I2 = 3.3%) and mental health (I2 = 0.0%). Conclusions: Exergaming seems not to be superior to conventional CR programs for improving exercise capacity, quality of life, or mental health in patients with CVD.
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The Promise of Digital Self-Management: A Reflection about the Effects of Patient-Targeted e-Health Tools on Self-Management and Wellbeing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031360. [PMID: 35162383 PMCID: PMC8835597 DOI: 10.3390/ijerph19031360] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 02/05/2023]
Abstract
Increasingly, people have direct access to e-Health resources such as health information on the Internet, personal health portals, and wearable self-management applications, which have the potential to reinforce the simultaneously growing focus on self-management and wellbeing. To examine these relationships, we searched using keywords self-management, patient-targeting e-Health tools, and health as wellbeing. Direct access to the health information on the Internet or diagnostic apps on a smartphone can help people to self-manage health issues, but also leads to uncertainty, stress, and avoidance. Uncertainties relate to the quality of information and to use and misuse of information. Most self-management support programs focus on medical management. The relationship between self-management and wellbeing is not straightforward. While the influence of stress and negative social emotions on self-management is recognized as an important cause of the negative spiral, empirical research on this topic is limited to health literacy studies. Evidence on health apps showed positive effects on specific actions and symptoms and potential for increasing awareness and ownership by people. Effects on more complex behaviors such as participation cannot be established. This review discovers relatively unknown and understudied angles and perspectives about the relationship between e-Health, self-management, and wellbeing.
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5
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Cruz-Martínez RR, Wentzel J, Bente BE, Sanderman R, van Gemert-Pijnen JE. Toward the Value Sensitive Design of eHealth Technologies to Support Self-management of Cardiovascular Diseases: Content Analysis. JMIR Cardio 2021; 5:e31985. [PMID: 34855608 PMCID: PMC8686487 DOI: 10.2196/31985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/16/2021] [Accepted: 10/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND eHealth can revolutionize the way self-management support is offered to chronically ill individuals such as those with a cardiovascular disease (CVD). However, patients' fluctuating motivation to actually perform self-management is an important factor for which to account. Tailoring and personalizing eHealth to fit with the values of individuals promises to be an effective motivational strategy. Nevertheless, how specific eHealth technologies and design features could potentially contribute to values of individuals with a CVD has not been explicitly studied before. OBJECTIVE This study sought to connect a set of empirically validated, health-related values of individuals with a CVD with existing eHealth technologies and their design features. The study searched for potential connections between design features and values with the goal to advance knowledge about how eHealth technologies can actually be more meaningful and motivating for end users. METHODS Undertaking a technical investigation that fits with the value sensitive design framework, a content analysis of existing eHealth technologies was conducted. We matched 11 empirically validated values of CVD patients with 70 design features from 10 eHealth technologies that were previously identified in a systematic review. The analysis consisted mainly of a deductive coding stage performed independently by 3 members of the study team. In addition, researchers and developers of 6 of the 10 reviewed technologies provided input about potential feature-value connections. RESULTS In total, 98 connections were made between eHealth design features and patient values. This meant that some design features could contribute to multiple values. Importantly, some values were more often addressed than others. CVD patients' values most often addressed were related to (1) having or maintaining a healthy lifestyle, (2) having an overview of personal health data, (3) having reliable information and advice, (4) having extrinsic motivators to accomplish goals or health-related activities, and (5) receiving personalized care. In contrast, values less often addressed concerned (6) perceiving low thresholds to access health care, (7) receiving social support, (8) preserving a sense of autonomy over life, and (9) not feeling fear, anxiety, or insecurity about health. Last, 2 largely unaddressed values were related to (10) having confidence and self-efficacy in the treatment or ability to achieve goals and (11) desiring to be seen as a person rather than a patient. CONCLUSIONS Positively, existing eHealth technologies could be connected with CVD patients' values, largely through design features that relate to educational support, self-monitoring support, behavior change support, feedback, and motivational incentives. Other design features such as reminders, prompts or cues, peer-based or expert-based human support, and general system personalization were also connected with values but in narrower ways. In future studies, the inferred feature-value connections must be validated with empirical data from individuals with a CVD or similar chronic conditions.
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Affiliation(s)
- Roberto Rafael Cruz-Martínez
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Jobke Wentzel
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.,Department of Health and Social Studies, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | - Britt Elise Bente
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Robbert Sanderman
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.,General Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Julia Ewc van Gemert-Pijnen
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
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Niño de Guzmán Quispe E, Martínez García L, Orrego Villagrán C, Heijmans M, Sunol R, Fraile-Navarro D, Pérez-Bracchiglione J, Ninov L, Salas-Gama K, Viteri García A, Alonso-Coello P. The Perspectives of Patients with Chronic Diseases and Their Caregivers on Self-Management Interventions: A Scoping Review of Reviews. THE PATIENT 2021; 14:719-740. [PMID: 33871808 PMCID: PMC8563562 DOI: 10.1007/s40271-021-00514-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Self-management (SM) interventions are supportive interventions systematically provided by healthcare professionals, peers, or laypersons to increase the skills and confidence of patients in their ability to manage chronic diseases. We had two objectives: (1) to summarise the preferences and experiences of patients and their caregivers (informal caregivers and healthcare professionals) with SM in four chronic diseases and (2) to identify and describe the relevant outcomes for SM interventions from these perspectives. METHODS We conducted a mixed-methods scoping review of reviews. We searched three databases until December 2020 for quantitative, qualitative, or mixed-methods reviews exploring patients' and caregivers' preferences or experiences with SM in type 2 diabetes mellitus (T2DM), obesity, chronic obstructive pulmonary disease (COPD), and heart failure (HF). Quantitative data were narratively synthesised, and qualitative data followed a three-step descriptive thematic synthesis. Identified themes were categorised into outcomes or modifiable factors of SM interventions. RESULTS We included 148 reviews covering T2DM (n = 53 [35.8%]), obesity (n = 20 [13.5%]), COPD (n = 32 [21.6%]), HF (n = 38 [25.7%]), and those with more than one disease (n = 5 [3.4%]). We identified 12 main themes. Eight described the process of SM (disease progression, SM behaviours, social support, interaction with healthcare professionals, access to healthcare, costs for patients, culturally defined roles and perceptions, and health knowledge), and four described their experiences with SM interventions (the perceived benefit of the intervention, individualised care, sense of community with peers, and usability of equipment). Most themes and subthemes were categorised as outcomes of SM interventions. CONCLUSION The process of SM shaped the perspectives of patients and their caregivers on SM interventions. Their perspectives were influenced by the perceived benefit of the intervention, the sense of community with peers, the intervention's usability, and the level of individualised care. Our findings can inform the selection of patient-important outcomes, decision-making processes, including the formulation of recommendations, and the design and implementation of SM interventions.
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Affiliation(s)
- Ena Niño de Guzmán Quispe
- Iberoamerican Cochrane Centre (IbCC)-Sant Pau Biomedical Research Institute (IIB-Sant Pau), C/ Sant Antoni Maria Claret 167. Pabellón 18, Planta 0, 08025, Barcelona, Spain.
| | - Laura Martínez García
- Iberoamerican Cochrane Centre (IbCC)-Sant Pau Biomedical Research Institute (IIB-Sant Pau), C/ Sant Antoni Maria Claret 167. Pabellón 18, Planta 0, 08025, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carola Orrego Villagrán
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Monique Heijmans
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Rosa Sunol
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Fraile-Navarro
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Madrid Primary Health Care Service, Madrid, Spain
| | | | | | - Karla Salas-Gama
- Health Services Research Group, Institut de Recerca Vall d'Hebron Hospital, Barcelona, Spain
- Vall d'Hebron University Hospital, Barcelona, Spain
| | - Andrés Viteri García
- Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC), Universidad UTE, Quito, Ecuador
- Centro Asociado Cochrane de Ecuador, Universidad UTE, Quito, Ecuador
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre (IbCC)-Sant Pau Biomedical Research Institute (IIB-Sant Pau), C/ Sant Antoni Maria Claret 167. Pabellón 18, Planta 0, 08025, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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7
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Davis AJ, Parker HM, Gallagher R. Gamified applications for secondary prevention in patients with high cardiovascular disease risk: A systematic review of effectiveness and acceptability. J Clin Nurs 2021; 30:3001-3010. [PMID: 33872436 DOI: 10.1111/jocn.15808] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 02/26/2021] [Accepted: 03/16/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Gamified health mobile applications (apps) are promoted as innovative approaches to self-management and risk factor reduction. However, information is lacking on effectiveness or feasibility in older patients at high risk for cardiovascular diseases (CVD), which limits uptake and recommendations by nurses. This study aimed to evaluate the effectiveness and acceptability of gamified apps for CVD secondary prevention. METHODS EQUATOR PRISMA checklist was used to guide the systematic review. PubMed, Embase and SCOPUS were searched from inception to January 2020 for studies evaluating app interventions incorporating ≥2 game tactics and targeting secondary prevention in patients diagnosed with heart disease, hypertension, stroke or type 2 diabetes. Narrative summaries of results were used as meta-analysis were not possible. The PROSPERO ID number was CRD42020209791. RESULTS Seven studies involving 657 patients were included. Gamified apps resulted in more improvement in physical activity, HbA1C and diabetes self-management empowerment compared to multiple different comparators, and more physical activity motivation compared to a neutral content control app. Heart failure knowledge also improved significantly. However, no benefits above usual care were evident for blood pressure or body mass index, or from app use for heart failure self-management, medication adherence or atrial fibrillation knowledge. App acceptability in terms of usage declined with time but was high for the game components of challenges, medication monitoring, viewing of leader boards and badges and walking training participation. Enjoyment was highest for elements that featured surprise/novelty, having teammates, challenges, good graphic design and clarity. CONCLUSIONS Gamified mobile apps show the potential to improve secondary prevention in high CVD risk patients. Indications for acceptability were evident, with higher adherence than clinic-based secondary prevention programmes. However, further well-designed randomised controlled trials, which track app usage are needed to confirm this potential and encourage nurses to recommend these types of apps.
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Affiliation(s)
- Angus J Davis
- Sydney School of Nursing, University of Sydney, Sydney, Australia
| | - Helen M Parker
- Charles Perkins Centre, University of Sydney, Sydney, Australia.,School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Robyn Gallagher
- Sydney School of Nursing, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia
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Radhakrishnan K, Julien C, O'Hair M, Baranowski T, Lee G, Allen C, Sagna A, Thomaz E, Kim M. Usability Testing of a Sensor-Controlled Digital Game to Engage Older Adults with Heart Failure in Physical Activity and Weight Monitoring. Appl Clin Inform 2020; 11:873-881. [PMID: 33378780 DOI: 10.1055/s-0040-1721399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Poor self-management of heart failure (HF) has contributed to poor health outcomes. Sensor-controlled digital games (SCDGs) integrates data from behavior-tracking sensors to trigger progress, rewards, content, and positive feedback in a digital game to motivate real-time behaviors. OBJECTIVES To assess the usability of an SCDG prototype over a week of game-playing among 10 older adults with HF in their homes. METHODS During initial play, participants' SCDG experiences were observed in their homes using a checklist based on the seven-item Serious Game User Evaluator (SeGUE) instrument. After a week of game-playing, participants completed a survey guided by the Intrinsic Motivation Inventory, to provide their perceptions of the SCDG's usability. Qualitative analysis via semistructured interview-derived themes on experiences playing the SCDG, perceptions regarding engaging with the SCDG, and any usability issues encountered. RESULTS Ten HF participants (50% women and 50% White) played the SCDG for an average of 6 out of 7 days. Nine found the SCDG to be interesting, satisfying, and easy to play. The average step count over a week was 4,117 steps (range: 967-9,892). Average adherence with weight monitoring was 5.9 days in a week. Qualitative analysis yielded outcomes regarding attitudes toward SCDG, and barriers and facilitators that influenced participants' engagement with the SCDG. CONCLUSION To the best of the authors' knowledge, this usability and feasibility study is the first to report an SCDG designed to improve HF self-management behaviors of older adults in their homes. Future research should consider several issues, such as user profiles, prior game-playing experiences, and network conditions most suitable for connected health interventions for older adults living in the community.
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Affiliation(s)
| | - Christine Julien
- Department of Electrical and Computer Engineering, Cockrell School of Engineering, The University of Texas, Austin, Texas, United States
| | - Matthew O'Hair
- Owner and Game Developer, Good Life Games, Inc., Austin, Texas, United States
| | - Thomas Baranowski
- Distinguished Emeritus Professor Pediatrics, Baylor College of Medicine, Houston, Texas, United States
| | - Grace Lee
- Department of Electrical and Computer Engineering, Cockrell School of Engineering, The University of Texas, Austin, Texas, United States
| | - Catherine Allen
- School of Nursing, The University of Texas, Austin, Texas, United States
| | - Atami Sagna
- School of Nursing, The University of Texas, Austin, Texas, United States
| | - Edison Thomaz
- Department of Electrical and Computer Engineering, Cockrell School of Engineering, The University of Texas, Austin, Texas, United States
| | - Miyong Kim
- School of Nursing, The University of Texas, Austin, Texas, United States
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9
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Radhakrishnan K, Baranowski T, O'Hair M, Fournier CA, Spranger CB, Kim MT. Personalizing Sensor-Controlled Digital Gaming to Self-Management Needs of Older Adults with Heart Failure: A Qualitative Study. Games Health J 2020; 9:304-310. [PMID: 32155355 PMCID: PMC7457967 DOI: 10.1089/g4h.2019.0222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objectives: In older persons with heart failure (HF), an inability to self-manage their disease condition can result in poor health outcomes and quality of life. With the rise in smartphone use and digital game playing among older adults, digital tools such as sensor-controlled digital games (SCDGs) can offer accessible health-promoting tools that are enjoyable and easy to use. However, designing SCDGs that are compelling and aligned with their life values and self-management needs can be challenging. This article describes a qualitative study with older adults with HF who were recruited from a cardiac rehabilitation laboratory in central Texas to identify their perceptions and expectations regarding a SCDG for HF self-management. Materials and Methods: A low-fidelity prototype that demonstrated the features of a SCDG was used to obtain the participants' perceptions about the value of SCDGs for HF self-management with respect to content, customization, flexibility, and usability through qualitative interviews. Results: We interviewed 15 patients with HF (53% women; age range, 53-90 years; 60% white). The concept of SCDGs for HF self-management was highly acceptable (80%). Participants provided suggestions for game characters, progress in the game, and game notifications and incentives. Perceived benefits included helping users track their behaviors and establish routines, become informed on strategies to manage HF, and empower themselves to take charge of their health. Conclusions: The study's findings will guide personalization of SCDG development to motivate patient engagement in HF self-management behaviors.
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Affiliation(s)
| | - Thomas Baranowski
- Department of Pediatrics-Nutrition, Baylor College of Medicine, Houston, Texas
| | | | | | | | - Miyong T. Kim
- School of Nursing, The University of Texas–Austin, Austin, Texas
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Ingadottir B, Jaarsma T, Klompstra L, Aidemark J, Askenäs L, Bahat Y, Ben Gal O, Berglund A, Berglund E, Höchsmann C, Plotnik M, Trappenburg JC, Schmidt-Trucksäss A, Strömberg A. Let the games begin: Serious games in prevention and rehabilitation to improve outcomes in patients with cardiovascular disease. Eur J Cardiovasc Nurs 2020; 19:558-560. [PMID: 32538132 DOI: 10.1177/1474515120934058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brynja Ingadottir
- University of Iceland and Landspitali - the National University Hospital of Iceland, Iceland
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Jan Aidemark
- Department of Informatics, Linnaeus University, Sweden
| | - Linda Askenäs
- Department of Informatics, Linnaeus University, Sweden
| | - Yotam Bahat
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Israel
| | - Oran Ben Gal
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Israel
| | - Aseel Berglund
- Department of Computer and Information Science, Linköping University, Sweden
| | - Erik Berglund
- Department of Computer and Information Science, Linköping University, Sweden
| | - Christoph Höchsmann
- Pennington Biomedical Research Center, Ingestive Behavior, Weight Management & Health Promotion Laboratory, USA
| | - Meir Plotnik
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Israel.,Department of Physiology and Pharmacology, Tel Aviv University, Israel
| | - Jaap Ca Trappenburg
- Department of Public Health, Healthcare Innovation and Evaluation and Medical Humanities, Julius Center, The Netherlands
| | | | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden.,Department of Cardiology, Linköping University, Sweden
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Jaarsma T, Klompstra L, Ben Gal T, Ben Avraham B, Boyne J, Bäck M, Chialà O, Dickstein K, Evangelista L, Hagenow A, Hoes AW, Hägglund E, Piepoli MF, Vellone E, Zuithoff NPA, Mårtensson J, Strömberg A. Effects of exergaming on exercise capacity in patients with heart failure: results of an international multicentre randomized controlled trial. Eur J Heart Fail 2020; 23:114-124. [PMID: 32167657 DOI: 10.1002/ejhf.1754] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/09/2020] [Accepted: 01/16/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Division of Nursing, Linköping University, Linköping, Sweden
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Division of Nursing, Linköping University, Linköping, Sweden
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Binyamin Ben Avraham
- Heart Failure Unit, Cardiology department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Josiane Boyne
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maria Bäck
- Department of Health, Medicine and Caring Sciences, Division of Physiotherapy, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Oronzo Chialà
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Kenneth Dickstein
- University of Bergen, Stavanger University Hospital, Stavanger, Norway
| | | | - Andreas Hagenow
- Center for Clinical Research Südbrandenburg, Elsterweda, Germany
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Eva Hägglund
- Department of Cardiology, Karolinska Theme of Heart and Vessel, Heart Failure, Karolinska University Hospital, Stockholm, Sweden
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza, Italy.,University of Parma, IT2 Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Jan Mårtensson
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Division of Nursing, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden
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12
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Analyzing Consumer Loyalty through Service Experience and Service Convenience: Differences between Instructor Fitness Classes and Virtual Fitness Classes. SUSTAINABILITY 2020. [DOI: 10.3390/su12030828] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The eruption of technology has revolutionized the sports sector, incorporating new elements and new forms, and has therefore targeted sports activities. The inclusion of virtual fitness classes is leading to an increase in the offers available to consumers, expanding the hours that consumers can exercise and leading to a greater variability of customer services. The present study intends to go deeper into the knowledge of the fitness center sector in the Spanish context by evaluating the poorly analyzed area of directed activities, either with a teacher or in a virtual mode, and how these are perceived by the users of the centers. The sample consisted of a total of 1943 users, 1143 of whom were customers who conducted fitness activities directed by instructors, and 800 questionnaires were completed by customers who conducted virtual fitness activities in fitness centers classified as low-cost, medium, and boutique business models. The relationships between service experience, service convenience, satisfaction, and future intentions were analyzed. The results show positive relationships in all the variables studied in the instructor fitness classes. However, they are not significant in some variables studied involving virtual fitness classes.
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Benzing V, Schmidt M. Exergaming for Children and Adolescents: Strengths, Weaknesses, Opportunities and Threats. J Clin Med 2018; 7:E422. [PMID: 30413016 PMCID: PMC6262613 DOI: 10.3390/jcm7110422] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 10/31/2018] [Accepted: 11/02/2018] [Indexed: 12/12/2022] Open
Abstract
Exergaming, or active video gaming, has become an emerging trend in fitness, education and health sectors. It is defined as digital games that require bodily movements to play, stimulating an active gaming experience to function as a form of physical activity (PA). Since exergaming is becoming more popular, claims have been made on the usefulness of exergaming. It has, for example, been entitled as being "the future of fitness" by the American College of Sports Medicine, promoting PA and health in children and adolescents. However, research also suggests that long-term engagement in exergaming is difficult to achieve, and there is a noticeable reservation towards exergaming by parents, teachers and caregivers. To provide an overview and to outline the future directions of exergaming, the aim of this review was to critically illustrate the strengths, weaknesses, opportunities and threats of exergaming to promote PA and health in children and youth. The available evidence indicates that exergaming has the potential to improve health via an increase in PA. However, it seems that this potential is frequently underexploited, and further developments such as customized exergames are needed.
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Affiliation(s)
- Valentin Benzing
- Institute of Sport Science, University of Bern, 3012 Bern, Switzerland.
| | - Mirko Schmidt
- Institute of Sport Science, University of Bern, 3012 Bern, Switzerland.
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