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

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 healthpromoting 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.

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

“…While participants in prior studies 16,30 have preferred more realistic game characters that reflect their active selves, the participants in our study were not satisfied with the SCDG's active older avatar. Perhaps, game developers need to present a balance in covering the wide spectrum of how aging is perceived; the full crop of white hair for the avatar in our study did not meet that balance!…”

“…Regardless of the smartphone platform (i.e., iOS or Android) or of internet connectivity supported by home Wi-Fi or a smartphone hotspot, participants were able to play the SCDG on the basis of their real-time behaviors. For this study, we recruited only participants who already had smartphones, having found in our preliminary study 16 that 85% of participants owned smartphones and did not want to use multiple phones. Therefore, the present study demonstrates that a complex technology such as the SCDG may be ready to be scaled to a large number of older adults living in the community for disease self-management.…”

“…The SCDG's development was informed by a preliminary study where a low-fidelity prototype was used to obtain the perceptions of 15 HF older adults on using digital games and sensors for HF self-management. 16 The objective of this study is to assess the usability of a fully developed SCDG prototype over a week of game playing among older adults with HF living in their homes.…”

What is the Current and Future Status of Digital Mental Health Interventions?

“…The use of digital phenotyping, defined as the "moment-by-moment quantification of the individual-level human phenotype in-situ using data from smartphones and other personal digital devices" (Torous et al, 2016, p. 2), is changing the world of mental health care. More and more research is being conducted to analyze whether these data allow more accurate predictions in the prevention, treatment, and facilitation of support resources to promote motivation for self-management of health behavior (Radhakrishnan et al, 2020). Specifically, EMAs, via smartphone apps, appear to be a useful clinical tool, allowing healthcare professionals to build a digital phenotype (Lopez-Morinigo et al, 2021).…”

Designing Personalized Persuasive Game Elements for Older Adults in Health Apps

“…The effects of age, gender and cognitive ability on persuasion strategy sensitivity have also been studied in the literature [40]. Kavita et al [41] found through qualitative interview studies that in health management, the gamification elements chosen by each older user differed even with the same gamification mechanics.…”