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Slater CN, Schroeder K, Fultz A, Kuschner ES, O'Malley L, Johnson K, Benvenuti T, Chittams J, Quinn RJ, Graham Thomas J, Pinto-Martin J, Levy SE, Kral TVE. Insights from user experience and evaluation of a mobile health nutrition intervention for children with autism: A qualitative study. J Hum Nutr Diet 2024. [PMID: 39248190 DOI: 10.1111/jhn.13365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 08/17/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Children with autism spectrum disorder (ASD) experience high rates of atypical eating behaviours, such as food neophobia. Mobile health (mHealth) interventions have been found to improve communication, behaviour and social skills for children with ASD. However, there is limited evidence examining mHealth nutrition interventions among children with ASD. METHODS The present study comprised a qualitative descriptive study that used qualitative content analysis to explore parent and child experiences with a novel mHealth nutrition intervention. Ten parent-child dyads provided user feedback and evaluation of the intervention. Data collection tools included a semistructured interview guide and a quantitative questionnaire with open-ended questions. Data analysis of the interview transcripts and open-ended questionnaire responses was an iterative process that continued until saturation was achieved. Descriptive statistics were used to analyse quantitative questionnaire data. RESULTS Analysis of the qualitative semistructured interviews led to emergence of three themes: (1) positive intervention outcomes; (2) parent suggestions for improvement; and (3) barriers to engagement. Each theme included subthemes. Questionnaire data revealed the ability to pick rewards and the virtual character that reinforced dietary goals ("Nutrition Ninja") were the most liked components of the application. Sending messages within the application and the Nutrition Ninja game were the least liked components of the application. CONCLUSIONS Collectively, findings indicated that the app served as an interactive tool prompting dietary change and conversations within families. Yet, for some families, the intervention design, resistance to change or child disinterest hindered use and implementation of the intervention.
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Affiliation(s)
- Courtney N Slater
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Krista Schroeder
- Department of Nursing, Temple University College of Public Health, Philadelphia, PA, USA
| | - Amanda Fultz
- Center for Health Behavior Research, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Emily S Kuschner
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Departments of Psychiatry and Radiology, Children's Hospital of Philadelphia, PA, USA
| | - Lauren O'Malley
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Jesse Chittams
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Ryan J Quinn
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - J Graham Thomas
- Weight Control and Diabetes Research Center, Brown University School of Medicine and The Miriam Hospital, Providence, RI, USA
| | - Jennifer Pinto-Martin
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan E Levy
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tanja V E Kral
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Darville-Sanders G, Burns J, Chavanduka T, Anderson-Lewis C. The Male Domain-Digital Game-Based Learning for Human Papillomavirus Vaccination Among Young Males. Games Health J 2022; 11:312-320. [PMID: 35856843 DOI: 10.1089/g4h.2021.0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Human papillomavirus (HPV) is the most common sexually transmitted disease, with the highest infection rates among those sexually active under 25. Although vaccination can reduce HPV cancers among men, public health interventions have primarily targeted females. Increased gaming rates among men provide innovative opportunities to motivate behavior change. This study sought to explore which game development and design strategies are most effective in a game for sexual health, specifically focused on HPV. We also sought to capture information relevant to preferred gaming platforms and game mechanics (health messages, avatars, and visual imagery). Materials and Methods: Twenty-two (n = 22) qualitative interviews were conducted with experts. Using grounded theory, interview data was coded, and emergent themes were identified. Results: Game mechanics most mentioned included simulation/role-playing, social interaction, narrative, and rewards. Experts felt it was important to keep the game in the context of the target audience and integrate the game into an existing game/game scenario or application. Experts also felt the game should link to external resources and enlist partnerships or collaborations with external health agencies. Moreover, while there are benefits to each gaming platform, games on mobile phones and tablets are most appropriate. Conclusion: Digital games are a nonconfrontational approach to discussing HPV and can increase knowledge/awareness and positively influence behavior change toward vaccine uptake. Digital games present a safe environment for role-playing through simulated activities without real-world consequences.
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Affiliation(s)
| | - Jade Burns
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Tanaka Chavanduka
- Department of Health Psychology and Clinical Science, The City University of New York, New York, New York, USA
| | - Charkarra Anderson-Lewis
- College of Nursing and Health Professions, The University of Southern Mississippi, Hattiesburg, Mississippi, USA
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Guldager JD, Kjær SL, Grittner U, Stock C. Efficacy of the Virtual Reality Intervention VR FestLab on Alcohol Refusal Self-Efficacy: A Cluster-Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3293. [PMID: 35328977 PMCID: PMC8955690 DOI: 10.3390/ijerph19063293] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 02/04/2023]
Abstract
It is currently unknown whether a virtual social environment can support young people in building their skills to overcome peer pressure when offered alcohol. This study evaluated the efficacy of the newly developed virtual reality simulation game VR FestLab on the refusal self-efficacy regarding social pressures to drink of Danish male and female students aged 15-18. VR FestLab features a party setting where adolescents can "steer" their own party experience. Eleven schools were included in a cluster-randomized controlled trial and allocated to either the intervention (n = 181) or the active control group (n = 191). Students in intervention schools played VR FestLab, while those in the control group played the VR game Oculus Quest-First Steps. The primary outcome measure was the social pressure subscale of the drinking refusal self-efficacy scale (DRSEQ-RA). The intervention effects were measured immediately after the intervention/control session (T1) and after a 6-week follow-up (T2). Data were examined using linear mixed regression models. Our study did not demonstrate a significant effect of drinking refusal self-efficacy at T1. For all secondary outcomes, we observed no substantial differences between the intervention and control groups. This study provides new insights into the feasibility and effectiveness of an innovative virtual reality alcohol prevention tool. VR FestLab can be an innovative and promising contribution to complement existing school-based alcohol prevention, but more research is needed to improve its effectiveness.
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Affiliation(s)
- Julie Dalgaard Guldager
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Degnevej 14, DK6705 Esbjerg, Denmark; (J.D.G.); (S.L.K.)
- Department of Physiotherapy, University College South Denmark, Degnevej 16, DK6705 Esbjerg, Denmark
| | - Satayesh Lavasani Kjær
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Degnevej 14, DK6705 Esbjerg, Denmark; (J.D.G.); (S.L.K.)
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany;
| | - Christiane Stock
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Degnevej 14, DK6705 Esbjerg, Denmark; (J.D.G.); (S.L.K.)
- Institute for Health and Nursing Science, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
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Abstract
Virtual Reality-simulations offer new opportunities for alcohol prevention in adolescents. As an innovative medium, Virtual Reality can be attractive for the target group, and avatar-based pathways allow tailoring prevention in a gender-specific manner. However, tailoring may reproduce gender stereotypes and be exclusive. Therefore, this systematic review aims to summaries existing evidence regarding Virtual Reality-simulations for alcohol prevention targeting adolescents and to examine how gender is considered. A systematic search was conducted in seven databases. Two reviewers independently performed screening, data extraction, and quality assessment. Out of 224 search hits, four publications derived out of an Australian, a Danish, and a US-American project met the inclusion criteria. Research designs included qualitative (2), quantitative (1), and mixed-method approaches (1). Qualitative methods focused on development, evaluation, and participatory methods in the creation process, demonstrating adolescents’ involvement in Virtual Reality design. Adolescents appreciated the realism and the exposure to peer pressure and to negative alcohol consequences. Quantitative designs focused mainly on measuring alcohol-related outcomes (e.g., attitude and behavioral intentions towards binge drinking), and positive changes were found. In all studies, gender was assessed in the male-female dichotomy. Further gender-sensitive research is needed to develop and test the possibilities and pitfalls of tailoring Virtual Reality-simulations.
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Holmes LG, Strassberg DS, Himle MB. Family Sexuality Communication for Adolescent Girls on the Autism Spectrum. J Autism Dev Disord 2019; 49:2403-2416. [DOI: 10.1007/s10803-019-03904-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Jerdan SW, Grindle M, van Woerden HC, Kamel Boulos MN. Head-Mounted Virtual Reality and Mental Health: Critical Review of Current Research. JMIR Serious Games 2018; 6:e14. [PMID: 29980500 PMCID: PMC6054705 DOI: 10.2196/games.9226] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/11/2018] [Accepted: 04/03/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND eHealth interventions are becoming increasingly used in public health, with virtual reality (VR) being one of the most exciting recent developments. VR consists of a three-dimensional, computer-generated environment viewed through a head-mounted display. This medium has provided new possibilities to adapt problematic behaviors that affect mental health. VR is no longer unaffordable for individuals, and with mobile phone technology being able to track movements and project images through mobile head-mounted devices, VR is now a mobile tool that can be used at work, home, or on the move. OBJECTIVE In line with recent advances in technology, in this review, we aimed to critically assess the current state of research surrounding mental health. METHODS We compiled a table of 82 studies that made use of head-mounted devices in their interventions. RESULTS Our review demonstrated that VR is effective in provoking realistic reactions to feared stimuli, particularly for anxiety; moreover, it proved that the immersive nature of VR is an ideal fit for the management of pain. However, the lack of studies surrounding depression and stress highlight the literature gaps that still exist. CONCLUSIONS Virtual environments that promote positive stimuli combined with health knowledge could prove to be a valuable tool for public health and mental health. The current state of research highlights the importance of the nature and content of VR interventions for improved mental health. While future research should look to incorporate more mobile forms of VR, a more rigorous reporting of VR and computer hardware and software may help us understand the relationship (if any) between increased specifications and the efficacy of treatment.
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Affiliation(s)
- Shaun W Jerdan
- Department of Digital Health, Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom
| | - Mark Grindle
- Department of Digital Health, Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom
| | - Hugo C van Woerden
- Public Health Directorate, NHS Highland, Inverness, United Kingdom.,Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom
| | - Maged N Kamel Boulos
- The Alexander Graham Bell Centre for Digital Health, Moray College UHI, University of the Highlands and Islands, Elgin, United Kingdom
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Brundage SB, Brinton JM, Hancock AB. Utility of virtual reality environments to examine physiological reactivity and subjective distress in adults who stutter. JOURNAL OF FLUENCY DISORDERS 2016; 50:85-95. [PMID: 27720393 DOI: 10.1016/j.jfludis.2016.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 09/23/2016] [Accepted: 10/02/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Virtual reality environments (VREs) allow for immersion in speaking environments that mimic real-life interactions while maintaining researcher control. VREs have been used successfully to engender arousal in other disorders. The purpose of this study was to investigate the utility of virtual reality environments to examine physiological reactivity and subjective ratings of distress in persons who stutter (PWS). METHOD Subjective and objective measures of arousal were collected from 10PWS during four-minute speeches to a virtual audience and to a virtual empty room. RESULTS Stuttering frequency and physiological measures (skin conductance level and heart rate) did not differ across speaking conditions, but subjective ratings of distress were significantly higher in the virtual audience condition compared to the virtual empty room. CONCLUSION VREs have utility in elevating subjective ratings of distress in PWS. VREs have the potential to be useful tools for practicing treatment targets in a safe, controlled, and systematic manner.
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