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Pouls BPH, Bekker CL, Gundogan F, Hebing RCF, van Onzenoort HAW, van de Ven LI, Vonkeman HE, Tieben R, Vriezekolk JE, van Dulmen S, Van den Bemt B. Gaming for Adherence to Medication using Ehealth in Rheumatoid arthritis (GAMER) study: a randomised controlled trial. RMD Open 2022; 8:rmdopen-2022-002616. [PMID: 36410776 PMCID: PMC9680317 DOI: 10.1136/rmdopen-2022-002616] [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: 07/26/2022] [Accepted: 10/12/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To examine the effect on adherence to disease modifying anti-rheumatic drugs (DMARDs) in participants with rheumatoid arthritis (RA) of a serious game that targeted implicit attitudes toward medication. Methods A multicentre randomised controlled trial (RCT) was performed with adults with RA that used DMARDs and possessed a smartphone/tablet. Control and intervention groups received care as usual. The intervention group played the serious game at will during 3 months. Game play data and online questionnaires Compliance Questionnaire on Rheumatology (CQR), Beliefs about Medicine Questionnaire (BMQ), Health Assessment Questionnaire (HAQ) and Rheumatoid Arthritis Disease Activity Index (RADAI) were collected. Primary outcome was DMARD implementation adherence operationalised as the difference in proportion of non-adherent participants (<80% taking adherence) between intervention and control group after 3 months using a Chi-squared test. Two sample t-tests and Wilcoxon rank-sum test were performed to test for differences on secondary outcomes. Results Of the 110 intervention participants that started the study, 87 participants (79%) installed the game and had a median playtime of 9.7 hours at 3 months. Overall, 186 participants completed the study. Adherence in intervention group (63%) and control group (54%) did not differ significantly (p=0.13) at 3 months. Neither were there differences oberved in CQR continuous score, beliefs about medication (BMQ) or clinical outcomes (HAQ and RADAI). Conclusion A serious game aimed at reinterpreting attitudes toward medication failed to show an effect on adherence to DMARDs or clinical outcomes in patients with RA. The game was played frequently indicating that it can be an effective channel for reaching patients. Trial registration number NL7217.
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Affiliation(s)
- Bart P H Pouls
- Research & Innovation, Sint Maartenskliniek, Ubbergen, Gelderland, The Netherlands,Department of Pharmacy Radboudumc, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy Radboudumc, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
| | - Fatma Gundogan
- Pharmacy, Gelre Ziekenhuizen Apeldoorn, Apeldoorn, Gelderland, The Netherlands
| | - Renske CF Hebing
- Pharmacy, Amsterdam Rheumatology and immunology Centre Reade, Amsterdam, Noord Holland, The Netherlands
| | - Hein AW van Onzenoort
- Department of Pharmacy Radboudumc, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands,Pharmacy, Amphia Hospital, Breda, North Brabant, The Netherlands
| | | | - Harald E Vonkeman
- Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands,Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Rob Tieben
- Research, Development and Innovation, Game Solutions Lab, Eindhoven, The Netherlands
| | - Johanna E Vriezekolk
- Research & Innovation, Sint Maartenskliniek, Ubbergen, Gelderland, The Netherlands
| | - Sandra van Dulmen
- Healthcare Communication, Netherlands Institute for Health Services Research, Utrecht, The Netherlands,Department of Primary and Community Care Radboudumc, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Bart Van den Bemt
- Research & Innovation, Sint Maartenskliniek, Ubbergen, Gelderland, The Netherlands,Department of Pharmacy Radboudumc, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
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Abstract
Over the years, there has been a significant increase in the adoption of game-based interventions for behaviour change associated with many fields such as health, education, and psychology. This is due to the significance of the players’ intrinsic motivation that is naturally generated to play games and the substantial impact they can have on players. Many review papers measure the effectiveness of the use of gaming on changing behaviours; however, these studies neglect the game features involved in the game design process, which have an impact of stimulating behaviour change. Therefore, this paper aimed to identify game design mechanics and features that are reported to commonly influence behaviour change during and/or after the interventions. This paper identified key theories of behaviour change that inform the game design process, providing insights that can be adopted by game designers for informing considerations on the use of game features for moderating behaviour in their own games.
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Pouls BP, Bekker CL, van Dulmen S, Vriezekolk JE, van den Bemt BJ. A Serious Puzzle Game to Enhance Adherence to Antirheumatic Drugs in Patients With Rheumatoid Arthritis: Systematic Development Using Intervention Mapping. JMIR Serious Games 2022; 10:e31570. [PMID: 35179510 PMCID: PMC8900908 DOI: 10.2196/31570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/08/2021] [Accepted: 11/06/2021] [Indexed: 12/14/2022] Open
Abstract
Background Patients’ implicit attitudes toward medication need and concerns may influence their adherence. Targeting these implicit attitudes by combining game-entertainment with medication-related triggers might improve medication adherence in patients with rheumatoid arthritis (RA). Objective The aim of this study was to describe the systematic development of a serious game to enhance adherence to antirheumatic drugs by using intervention mapping. Methods A serious game was developed using the intervention mapping framework guided by a multidisciplinary expert group, which proceeded along 6 steps: (1) exploring the problem by assessing the relationship between medication adherence and implicit attitudes, (2) defining change objectives, (3) selecting evidence-based behavior change techniques that focused on adjusting implicit attitudes, (4) designing the intervention, (5) guaranteeing implementation by focusing on intrinsic motivation, and (6) planning a scientific evaluation. Results Based on the problem assessment and guided by the Dual-Attitude Model, implicit negative and illness-related attitudes of patients with RA were defined as the main target for the intervention. Consequently, the change objective was “after the intervention, participants have a more positive attitude toward antirheumatic drugs.” Attention bias modification, evaluative conditioning, and goal priming were the techniques chosen to implicitly target medication needs. These techniques were redesigned into medication-related triggers and built in the serious puzzle game. Thirty-seven patients with RA tested the game at several stages. Intrinsic motivation was led by the self-determination theory and addressed the 3 needs, that is, competence, autonomy, and relatedness. The intervention will be evaluated in a randomized clinical trial that assesses the effect of playing the serious game on antirheumatic drug adherence. Conclusions We systematically developed a serious game app to enhance adherence to antirheumatic drugs among patients with RA by using the intervention mapping framework. This paper could serve as a guideline for other health care providers when developing similar interventions.
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Affiliation(s)
- Bart Ph Pouls
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Sandra van Dulmen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands.,Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Johanna E Vriezekolk
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands
| | - Bart Jf van den Bemt
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
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Baghaei N, Fowler A, Maddison R. Supporting Disease Prevention and Lifestyle Changes Through Gaming. Games Health J 2020; 9:387-388. [PMID: 33170044 DOI: 10.1089/g4h.2020.0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nilufar Baghaei
- School of Natural and Computational Sciences, Massey University, Auckland, New Zealand
| | - Allan Fowler
- School of Computer Science, University of Auckland, Auckland, New Zealand
| | - Ralph Maddison
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.,School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
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