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

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.

Effects of Exergaming in Patients with Cardiovascular Disease Compared to Conventional Cardiac Rehabilitation: A Systematic Review and Meta-Analysis

“…In brief, from a total of 1524 studies after deleting duplicates, 20 studies were eligible for full-text analysis after reviewing titles and abstracts. After reviewing the full texts, eight studies were included [ 24 , 28 , 29 , 38 , 39 , 40 , 41 , 42 ], and 12 were excluded for the following reasons: no exercise-based CR intervention ( n = 9) [ 22 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ], patients with other pathologies were also included ( n = 1) [ 51 ], the patients included were the same as another publication and study design did not fulfill our inclusion criteria ( n = 1) [ 52 ], and lack of information/abstract ( n = 1) [ 53 ]. Although efforts were made to localize unpublished studies, all included studies had been published in peer-reviewed journals.…”

Feasibility of a Sensor-Controlled Digital Game for Heart Failure Self-management: Randomized Controlled Trial

“…Digital literacy is often a concern when digital health interventions are implemented with older adults [ 73 ]. Our study team’s prior experience in conducting usability assessments with older adults with HF as well as in installation of, and training for, devices and apps at the participants’ homes [ 25 ] helped us to design the information and content to support the participants’ self-installation of the apps and use of the devices. Nevertheless, the study might have suffered from selection bias because participation was voluntary and participants already comfortable with using technology might have been especially motivated to participate.…”

“…The description of the design, development, and usability assessment phase of the SCDG has been detailed elsewhere [ 25 ]. Guided by the Fogg behavioral model [ 36 ] and played on a smartphone, the Heart Health Mountain SCDG presented a narrative in which the older adult player helps an avatar to climb a mountain in a forested area, with the game’s goal being to avoid hospitalization.…”

“…Digital games that serve as affordable, portable, scalable tools while being enjoyable and easy to use can help contextualize health behaviors [ 16 ] and motivate clinically significant behavior changes, thereby improving health outcomes [ 17 ]. Digital games can combine appealing stories [ 18 ] and interests and hobbies [ 19 ] with active learning [ 20 ], incentives [ 21 ], and social connections [ 22 ] to offer an accessible, engaging, and immersive habit-forming medium [ 23 ] while objectively measuring these behaviors [ 24 , 25 ]. Well-designed digital games have significantly improved physical (eg, balance and mobility) and cognitive (eg, processing speed) health outcomes [ 26 ] as well as behavioral outcomes for chronic diseases (eg, dietary changes for diabetes) [ 17 , 27 ].…”

Sensor-Controlled Digital Game for Heart Failure Self-management: Protocol for a Randomized Controlled Trial

“…Furthermore, prior research has indicated that they can also contextualize health behaviors [ 26 ], motivate behavioral changes, and improve health outcomes [ 27 ]. Thus, SCDGs offer an immersive and accessible way to objectively measure self-management behaviors and improve adherence [ 28 ]. Our previous research [ 29 ] conducting an SCDG intervention with 38 adults (aged ≥55 years) with HF from Texas and Oklahoma demonstrated improvements in weight monitoring and physical activity, and the intervention showed a high rate of acceptability (92%) from participants.…”