Interactive Digital e-Health Game for Heart Failure Self-Management: A Feasibility Study

Abstract

Objective: To develop and test the prototype of a serious digital game for improving community-dwelling older adults' heart failure (HF) knowledge and self-management behaviors. The serious game innovatively incorporates evidence-based HF guidelines with contemporary game technology. Materials and Methods: The study included three phases: development of the game prototype, its usability assessment, and evaluation of the game's functionality. Usability testing included researchers' usability assessment, followed by research personnel's observations of participants playing the game, and participants' completion of a usability survey. Next, in a pretest-post-test design, validated instruments-the Atlanta Heart Failure Knowledge Test and the Self Care for Heart Failure Index-were used to measure improvement in HF self-management knowledge and behaviors related to HF self-maintenance, self-management, and self-efficacy, respectively. A postgame survey assessed participants' perceptions of the game. Results: During usability testing, with seven participants, 100%, 100%, and 86% found the game easy to play, enjoyable, and helpful for learning about HF, respectively. In the subsequent functionality testing, with 19 participants, 89% found the game interesting, enjoyable, and easy to play. Playing the game resulted in a significant improvement in HF self-management knowledge, a nonsignificant improvement in self-reported behaviors related to HF self-maintenance, and no difference in HF self-efficacy scores. Participants with lower education level and age preferred games to any other medium for receiving information. Conclusion: It is feasible to develop a serious digital game that community-dwelling older adults with HF find both satisfying and acceptable and that can improve their self-management knowledge.

Role of Digital Games in Self-Management of Cardiovascular Diseases: A Scoping Review

“…Although the search was restricted to articles published in the last 10 years, all eight were published within the last three. Five (63%) were conducted in continental Europe, [24][25][26][27][28] two in United States, 29,30 and one in Jamaica. 31…”

“…Only two of the eight (25%) studies reported a control group. 25,29 Three studies (38%) used a pretest-posttest design, 26,30,31 and three others (38%) evaluated the feasibility of the intervention by collecting adherence outcomes 27,28 or perspectives on the use of the gaming intervention. 24 Six studies did not report any theoretical framework guiding the design of either the study or the game intervention.…”

“…The remaining two studies used a gamification framework (leaderboards, surprise element, rewards, feedback, badges, and levels 28 ), framework to inform game feedback, or Gagne's learning principles to inform content delivery within the game. 30 Sample sizes were low, ranging from 10 to 116, with only one study reporting a sample size greater than 50. 29 Study periods ranged from 2 weeks to 6 months, and in 50% of the studies, the study duration was 6 weeks or fewer.…”

“…Male gender constituted the majority in six studies (75%) with three studies reporting >75% participation by males. 25,27,30 Race was reported in only three studies with two of those studies reporting >80% participation by Whites. 25,30 Finally, the cardiac diseases selected for this review ranged evenly across the studies, with coronary artery disease, hypertension, and myocardial infarction each represented in three studies.…”

Personalizing Sensor-Controlled Digital Gaming to Self-Management Needs of Older Adults with Heart Failure: A Qualitative Study

“…The interviews solicited information on the impact of HF on quality of life and desired goals for HF self-management. A low-fidelity prototype of the SCDG was developed for the interview using images that presented potential features of a HF digital game, images from a prior HF game, 18 and commercially available sensor devices. A simulation game genre to simulate empathy with a game avatar, which progresses on a mountain and experiences health status changes based on participants' real-time behaviors that are tracked by sensors, was used in the prototype.…”