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Appl Clin Inform 2020; 11(05): 873-881
DOI: 10.1055/s-0040-1721399
Research Article

Usability Testing of a Sensor-Controlled Digital Game to Engage Older Adults with Heart Failure in Physical Activity and Weight Monitoring

Kavita Radhakrishnan
1   School of Nursing, The University of Texas, Austin, Texas, United States
,
Christine Julien
2   Department of Electrical and Computer Engineering, Cockrell School of Engineering, The University of Texas, Austin, Texas, United States
,
Matthew O'Hair
3   Owner and Game Developer, Good Life Games, Inc., Austin, Texas, United States
,
Thomas Baranowski
4   Distinguished Emeritus Professor Pediatrics, Baylor College of Medicine, Houston, Texas, United States
,
Grace Lee
2   Department of Electrical and Computer Engineering, Cockrell School of Engineering, The University of Texas, Austin, Texas, United States
,
Catherine Allen
1   School of Nursing, The University of Texas, Austin, Texas, United States
,
Atami Sagna
1   School of Nursing, The University of Texas, Austin, Texas, United States
,
Edison Thomaz
2   Department of Electrical and Computer Engineering, Cockrell School of Engineering, The University of Texas, Austin, Texas, United States
,
Miyong Kim
1   School of Nursing, The University of Texas, Austin, Texas, United States
› Author Affiliations Funding Research reported here was supported by the National Institute of Nursing Research of the National Institutes of Health under award number: R21NR018229. The content is the sole responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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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.

Keywords

heart failure - digital game - connected sensors - older adults - self-management

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects, and was reviewed by The University of Texas at Austin Institutional Review Board.




Publication History

Received: 08 June 2020

Accepted: 26 October 2020

Article published online:
30 December 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Benjamin EJ, Blaha MJ, Chiuve SE. et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2017 Update: a report from the American Heart Association. Circulation 2017; 135 (10) e146-e603
    CrossrefPubMedGoogle Scholar
  • 2 Hall MJ, Levant S, DeFrances CJ. Hospitalization for congestive heart failure: United States, 2000-2010. NCHS Data Brief 2012; 108 (108) 1-8
    PubMedGoogle Scholar
  • 3 Jonkman NH, Westland H, Groenwold RH. et al. Do self-management interventions work in patients with heart failure? An individual patient data meta-analysis. Circulation 2016; 133 (12) 1189-1198
    CrossrefPubMedGoogle Scholar
  • 4 Lainscak M, Blue L, Clark AL. et al. Self-care management of heart failure: practical recommendations from the Patient Care Committee of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2011; 13 (02) 115-126
    CrossrefPubMedGoogle Scholar
  • 5 Marston HR, Hall AK. Gamification: applications for health promotion and health information technology engagement. In: Novák D, Tulu B, Brendryen H. eds. Handbook of Research on Holistic Perspectives in Gamification for Clinical Practice. Hershey, PA: IGI Global; 2016: 78-104
    CrossrefGoogle Scholar
  • 6 Radhakrishnan K, Baranowski T, Julien C, Thomaz E, Kim M. Role of digital games in self-management of cardiovascular diseases: a scoping review. Games Health J 2019; 8 (02) 65-73
    CrossrefPubMedGoogle Scholar
  • 7 Bleakley CM, Charles D, Porter-Armstrong A, McNeill MD, McDonough SM, McCormack B. Gaming for health: a systematic review of the physical and cognitive effects of interactive computer games in older adults. J Appl Gerontol 2015; 34 (03) NP166-NP189
    CrossrefPubMedGoogle Scholar
  • 8 Hall AK, Chavarria E, Maneeratana V, Chaney BH, Bernhardt JM. Health benefits of digital videogames for older adults: a systematic review of the literature. Games Health J 2012; 1 (06) 402-410
    CrossrefPubMedGoogle Scholar
  • 9 Zanella A, Bui N, Castellani A, Vangelista L, Zorzi M. Internet of things for smart cities. IEEE Internet Things J 2014; 1 (01) 22-32
    CrossrefPubMedGoogle Scholar
  • 10 Brox E, Fernandez-Luque L, Tøllefsen T. Healthy gaming - video game design to promote health. Appl Clin Inform 2011; 2 (02) 128-142
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Vieira Á, Gabriel J, Melo C, Machado J. Kinect system in home-based cardiovascular rehabilitation. Proc Inst Mech Eng H 2017; 231 (01) 40-47
    CrossrefPubMedGoogle Scholar
  • 12 Schlomann A, von Storch K, Rasche P, Rietz C. Means of motivation or of stress? The use of fitness trackers for self-monitoring by older adults. HeilberufeScience 2016; 7 (03) 111-116
    CrossrefPubMedGoogle Scholar
  • 13 Rasche P, Schäfer K, Theis S, Bröhl C, Wille M, Mertens A. Age-related usability investigation of an activity tracker. Int J Hum Factors Ergon 2016; 4 (3/4): 187-212
    CrossrefPubMedGoogle Scholar
  • 14 Duggan M. Gaming and gamers. Accessed July 5, 2016 at: http://www.pewinternet.org/2015/12/15/gaming-and-gamers
    PubMedGoogle Scholar
  • 15 Anderson M, Perrin A. Tech adoption climbs among older adults. Accessed October 30, 2018 at: http://www.pewinternet.org/2017/05/17/tech-adoption-climbs-among-older-adults
    PubMedGoogle Scholar
  • 16 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 (04) 304-310
    CrossrefPubMedGoogle Scholar
  • 17 Withings: Go–Sections. . Accessed April 20, 2020 at: https://support.withings.com/hc/en-us/categories/202313048-Go
    PubMed
  • 18 Meet your new accountability partner. . Accessed April 20, 2020 at: https://www.withings.com/us/en/body
    PubMed
  • 19 Healthmate W. A Fitness, Activity and Health Tracker App. Version 4.5.6. Accessed Apr 20, 2020 at: https://www.withings.com/us/en/health-mate
    PubMedGoogle Scholar
  • 20 DeWalt DA, Schillinger D, Ruo B. et al. Multisite randomized trial of a single-session versus multisession literacy-sensitive self-care intervention for patients with heart failure. Circulation 2012; 125 (23) 2854-2862
    CrossrefPubMedGoogle Scholar
  • 21 Heart Failure Society of America, Heart Failure Educational Modules. . Accessed July 31, 2020 at: https://hfsa.org/heart-failure-educational-modules
    PubMed
  • 22 Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini-cog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry 2000; 15 (11) 1021-1027
    CrossrefPubMedGoogle Scholar
  • 23 Creswell JW, Plano Clark VL. Designing and Conducting Mixed Methods Research. 3rd ed.. Thousand Oaks, CA: SAGE; 2018
    Google Scholar
  • 24 Nawaz A, Skjæret N, Helbostad JL, Vereijken B, Boulton E, Svanaes D. Usability and acceptability of balance exergames in older adults: a scoping review. Health Informatics J 2016; 22 (04) 911-931
    CrossrefPubMedGoogle Scholar
  • 25 Moreno-Ger P, Torrente J, Hsieh YG, Lester WT. Usability testing for serious games: making informed design decisions with user data. Adv Hum Comput Interact 2012; 2012: 369637
    CrossrefPubMedGoogle Scholar
  • 26 McAuley E, Duncan T, Tammen VV. Psychometric properties of the Intrinsic Motivation Inventory in a competitive sport setting: a confirmatory factor analysis. Res Q Exerc Sport 1989; 60 (01) 48-58
    CrossrefPubMedGoogle Scholar
  • 27 Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3 (02) 77-101
    CrossrefPubMedGoogle Scholar
  • 28 Yancy CW, Jessup M, Bozkurt B. et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation 2017; 136 (06) e137-e161
    CrossrefPubMedGoogle Scholar
  • 29 Kaufman D. et al. Older adults' digital gameplay: patterns, benefits, and challenges. Simul Gaming 2016; 47 (04) 465-489
    CrossrefPubMedGoogle Scholar
  • 30 Marston HR. Older adults as 21st century game designers. Comput Games J 2012; 1 (01) 90-102
    CrossrefPubMedGoogle Scholar
  • 31 Radhakrishnan K, Toprac P, O'Hair M. et al. Interactive digital e-health game for heart failure self-management: a feasibility study. Games Health J 2016; 5 (06) 366-374
    CrossrefPubMedGoogle Scholar