Gamification in Oral Health (Preprint)

BACKGROUND Our modern way of life, health and well-being depend on the individual's health behaviors. Motivation is a major factor of health behaviour change, and intrinsically motivated behavior change is desirable as it is both sustained and directly contributes to well-being. This raises the immediate question about what kind of interventions are best positioned to intrinsically motivate health behavior change. OBJECTIVE With this study we wanted to analyse the presence and efficiency of gamification mechanisms in oral healthcare-themed digital games and apps on promoting user engagement to comply with prevention policies. METHODS The search query was based on the electronic database PubMed. Applying exclusion and inclusion criteria, this study is focused on scholar work reporting original research of the value of gamification on oral healthcare. The final pool of data was scrutinized for the gamification features, evidence-based oral health and behavior change techniques. RESULTS Apps with high quality evidence-based educational content for oral self-care, employing gamification features and behavior change techniques, provide excellent results in functionality, effectiveness, efficiency and satisfaction. However, some authors highlighted issues such as the need to improve engagement, aesthetics, evidence-based information content, behavior change taxonomies, psychological needs, evaluation, validation, quality assessment and professional regulation of the oral healthcare apps. CONCLUSIONS In this systematic review, we did not find any app that included all the segments for learning, performing, and maintaining proper oral health care. Evidence-based oral healthcare gamification features represent potential new approaches for health care providers to change behavior in the form of learning, performing and maintaining proper oral hygiene. Evaluation, validation, quality assurance, best practice standards and guidelines are needed for improving app use.

Download Full-text

Barriers and Facilitators That Influence Providers’ Ability to Educate, Monitor, and Treat Substance Use in First-Episode Psychosis Programs Using the Theoretical Domains Framework

Qualitative Health Research ◽

10.1177/1049732321993443 ◽

2021 ◽

pp. 104973232199344

Author(s):

Oladunni Oluwoye ◽

Elizabeth Fraser

Keyword(s):

Substance Use ◽

Behavior Change ◽

Theoretical Domains Framework ◽

First Episode Psychosis ◽

Barriers And Facilitators ◽

First Episode ◽

Evidence Based ◽

Behavior Change Techniques ◽

Episode Psychosis ◽

And Behavior

In this qualitative study, we explore providers’ experiences with addressing substance use among individuals with first-episode psychosis (FEP) enrolled in coordinated specialty care (CSC) programs. Three focus groups were conducted with 24 providers from CSC programs for FEP in Washington. Questions were focused on barriers and facilitators to addressing substance use using the Theoretical Domains Framework (TDF) as a guide. Thematic analysis was used to code all transcripts. Identified TDF domains were then mapped onto the COM-B (Capability, Opportunity, Motivation, Behavior) intervention functions and behavior change techniques. Seven theoretical domains were identified as the most relevant to addressing substance use: “Knowledge,” “Skills,” “Environmental Context and Resources,” “Social Influences,” “Social and Professional Role and Identity,” “Beliefs about Capabilities,” and “Reinforcement.” The use of the TDF provides a framework to explore barriers and facilitators for targeting substance use and suggestions for behavior change techniques when considering implementation of evidence-based strategies to enhance CSC models.

Download Full-text

Refining an Oral Health Care Partner Intervention Using Behavior Change Techniques

Innovation in Aging ◽

10.1093/geroni/igab046.1599 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 415-415

Author(s):

Rachel Hirschey ◽

Courtney Caiola ◽

Ya-Ning Chan ◽

Brenda Plassman ◽

Bei Wu ◽

...

Keyword(s):

Health Care ◽

Oral Health ◽

Behavior Change ◽

Oral Hygiene ◽

Oral Care ◽

The Self ◽

Behavior Changes ◽

Behavior Change Techniques ◽

Mild Dementia ◽

Use Behavior

Abstract Following a pilot, we refined an oral health carepartner intervention for individuals with mild dementia (IMD). In this intervention, we use behavior change techniques (BCTs) to foster changes by carepartners including using new oral-care techniques and developing skills for using cueing and communications approaches to support behavior changes by IMD (duration and frequency of toothbrushing and oral-hygiene skills); thus, improving plaque and gingival indices. We describe our approach to refining the intervention manual including a) completing the self-paced BCT taxonomy course, b) developing a coding schema, c) coding the original manual for evidence of BCTs, and d) refining the manual to improve use of BCTS in the refined intervention. Our results detail how BCTs can be applied to refine and improve interventions. This research demonstrates the value in using BCTs for interventions to address how carepartners and IMD can collaborate to improve oral hygiene care.

Download Full-text

Commentary: De-implementation Science: A Virtuous Cycle of Ceasing and Desisting Low-Value Care Before Implementing New High Value Care

Ethnicity & Disease ◽

10.18865/ed.27.4.463 ◽

2017 ◽

Vol 27 (4) ◽

pp. 463 ◽

Cited By ~ 6

Author(s):

Karina W. Davidson ◽

Siqin Ye ◽

George A. Mensah

Keyword(s):

Behavior Change ◽

Implementation Science ◽

Feedback Loop ◽

Quality Care ◽

Evidence Based ◽

High Quality ◽

Behavior Change Techniques ◽

Virtuous Cycle ◽

And Behavior ◽

Evidence Based Care

Implementation science has traditionally focused on increasing the delivery of evidence-based care. The science of systematically stopping low-value and wasteful care is substantially under-recognized, and if successful, may decrease the workload of clinicians. De-implementation science identifies problem areas of low-value and wasteful practice, carries out rigorous scientific examination of the factors that initiate and maintain such behaviors, and then employs evidence-based interventions to cease these practices. In this commentary, we describe how this approach for de-implementation might require a different set of health systems supports, economic and non-economic levers, and behavior change techniques that can lead to a virtuous cycle, ie, a complex chain of events that positively reinforce themselves through a feedback loop of removing low-value care to make room for high quality care. Ethn Dis. 2017;27(4):463-468; doi:10.18865/ ed.27.4.463.

Download Full-text

Responding to the Psychological Needs of Health Workers During Pandemic: Ten Lessons From Humanitarian Work

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2020.356 ◽

2020 ◽

pp. 1-7

Author(s):

Elena Cherepanov

Keyword(s):

Health Care ◽

Health Care Providers ◽

Disaster Preparedness ◽

Health Workers ◽

Well Being ◽

Psychological Needs ◽

Self Awareness ◽

Aid Workers ◽

Care Providers ◽

Humanitarian Aid Workers

ABSTRACT When a complex emergency (CE) overwhelms infrastructure, the ability of health-care providers to work efficiently under duress saves lives. The author uses her experience of providing mental health supports to humanitarian aid workers and the pieces of training conducted for internal medicine practitioners to offer guidance on how to manage severe job-related stresses during the response to the coronavirus disease 2019 (COVID-19) pandemic. This work reminds responders about their professional mission and purpose, but its extreme physical and mental demands can take a toll on their well-being and health. In CEs, the sheer volume of work and the emotional over-engagement tend to produce toxic fantasies (eg, rescuer or helper fantasies), acting upon which threatens integrity of care and increases risks for both patients and providers. Accumulated fatigue and exposure to mass suffering and mortality can change the perceived value of life and increase reckless, risk-taking, and suicidal behaviors. Introducing a self-awareness framework prioritizes the awareness of the available choices and making situation-appropriate and informed decisions about balancing one’s own and others’ needs. The COVID-19 response has demonstrated that fostering peer supports, changing organizational culture, addressing self-awareness within a training and supervisory context, and strengthening supports for managers are important parts of disaster preparedness. It also revealed that more research is needed to better understand and meet the special psychological needs of health-care responders.

Download Full-text

Conversation Cards for Adolescents ©: a patient-centered communication and behavior change tool for adolescents with obesity and health care providers

Journal of Communications In Healthcare ◽

10.1080/17538068.2020.1765126 ◽

2020 ◽

Vol 13 (2) ◽

pp. 79-88

Author(s):

Maryam Kebbe ◽

Arnaldo Perez ◽

Annick Buchholz ◽

Tara-Leigh F. McHugh ◽

Shannon D. Scott ◽

...

Keyword(s):

Health Care ◽

Behavior Change ◽

Health Care Providers ◽

Care Providers ◽

Patient Centered ◽

And Behavior

Download Full-text

Behavior change techniques in mobile applications for sedentary behavior

Digital Health ◽

10.1177/2055207618785798 ◽

2018 ◽

Vol 4 ◽

pp. 205520761878579 ◽

Cited By ~ 10

Author(s):

Emily E Dunn ◽

Heather L Gainforth ◽

Jennifer E Robertson-Wilson

Keyword(s):

Physical Activity ◽

Behavior Change ◽

Sedentary Behavior ◽

Mobile Applications ◽

Health Behavior Change ◽

Behavior Change Techniques ◽

Self Monitoring ◽

Behavior Change Interventions ◽

And Behavior ◽

Keyword Searches

Objective Mobile applications (apps) are increasingly being utilized in health behavior change interventions. To determine the presence of underlying behavior change mechanisms, apps for physical activity have been coded for behavior change techniques (BCTs). However, apps for sedentary behavior have yet to be assessed for BCTs. Thus, the purpose of the present study was to review apps designed to decrease sedentary time and determine the presence of BCTs. Methods Systematic searches of the iTunes App and Google Play stores were completed using keyword searches. Two reviewers independently coded free ( n = 36) and paid ( n = 14) app descriptions using a taxonomy of 93 BCTs (December 2016–January 2017). A subsample ( n = 4) of free apps were trialed for one week by the reviewers and coded for the presence of BCTs (February 2017). Results In the free and paid app descriptions, only 10 of 93 BCTs were present with a mean of 2.42 BCTs (range 0–6) per app. The BCTs coded most frequently were “prompts/cues” ( n = 43), “information about health consequences” ( n = 31), and “self-monitoring of behavior” ( n = 17). For the four free apps that were trialed, three additional BCTs were coded that were not coded in the descriptions: “graded tasks,” “focus on past successes,” and “behavior substitution.” Conclusions These sedentary behavior apps have fewer BCTs compared with physical activity apps and traditional (i.e., non-app) physical activity and healthy eating interventions. The present study sheds light on the behavior change potential of sedentary behavior apps and provides practical insight about coding for BCTs in apps.

Download Full-text

Older Adults’ Experiences of Behavior Change Support in a Digital Fall Prevention Exercise Program: Qualitative Study Framed by the Self-determination Theory

Journal of Medical Internet Research ◽

10.2196/26235 ◽

2021 ◽

Vol 23 (7) ◽

pp. e26235

Author(s):

Beatrice Pettersson ◽

Rebecka Janols ◽

Maria Wiklund ◽

Lillemor Lundin-Olsson ◽

Marlene Sandlund

Keyword(s):

Older Adults ◽

Behavior Change ◽

Classification System ◽

Exercise Program ◽

Psychological Needs ◽

Self Determination ◽

Behavior Change Techniques ◽

And Behavior ◽

Behavior Change Support ◽

Step Program

Background Exercise is an effective intervention to prevent falls in older adults; however, long-term adherence is often poor. To increase adherence, additional support for behavior change has been advocated. However, consistency in the reporting of interventions using behavior change techniques is lacking. Recently, a classification system has been developed to increase consistency in studies using behavior change techniques within the self-determination theory. Objective This study aimed to explore expressions of self-determination among community-dwelling older adults using a self-managed digital fall prevention exercise program comprising behavior change support (the Safe Step program), which was developed in co-creation with intended users. Methods The qualitative study design was based on open-ended responses to questionnaires, and individual and focus group interviews. A deductive qualitative content analysis was applied using the classification system of motivation and behavior change techniques as an analytical matrix, followed by an inductive analysis. Twenty-five participants took part in a feasibility study and exercised in their homes with the Safe Step program for 4 months. The exercise program was available on computers, smartphones, and tablets, and was fully self-managed. Results In the deductive analysis, expressions of support were demonstrated for all three basic human psychological needs, namely, autonomy, competence, and relatedness. These expressions were related to 11 of the 21 motivation and behavior change techniques in the classification system. The inductive analysis indicated that autonomy (to be in control) was valued and enabled individual adaptations according to different rationales for realizing exercise goals. However, the experience of autonomy was also two-sided and depended on the participants’ competence in exercise and the use of technology. The clarity of the program and exercise videos was seen as key for support in performance and competent choices. Although augmented techniques for social support were requested, support through relatedness was found within the program. Conclusions In this study, the Safe Step program supported the establishment of new exercise routines, as well as the three basic human psychological needs, with autonomy and competence being expressed as central in this context. Based on the participants’ experiences, a proposed addition to the classification system used as an analytical matrix has been presented. Trial Registration ClinicalTrials.gov NCT02916849; https://clinicaltrials.gov/ct2/show/NCT02916849

Download Full-text

Health Care Providers’ Perspectives on Family Compliance and Behavior Change in a Childhood Obesity Program

Health Education & Behavior ◽

10.1177/1090198119831053 ◽

2019 ◽

Vol 46 (4) ◽

pp. 582-591

Author(s):

Michelle Pannor Silver ◽

Shawna M. Cronin

Keyword(s):

Health Care ◽

Childhood Obesity ◽

Behavior Change ◽

Health Care Providers ◽

Low Income ◽

Behavior Modification ◽

Care Providers ◽

Low Income Families ◽

Family Based ◽

And Behavior

Background. Evidence suggests that children and adolescents growing up in low-income families and those with underrepresented ethnocultural backgrounds tend to have high prevalence rates of obesity and more difficulty adhering to childhood obesity interventions. However, less is known about how intergenerational, family-based approaches to lifestyle interventions for childhood obesity support sustained behavior change. Aims. The aim of this study was to explore the perspectives of health care providers regarding family adherence and behavior change in a childhood obesity program that served ethnoculturally diverse and low-income families. Method. Semistructured in-person interviews were conducted with 18 providers at one of three hospitals participating in a Canadian family-based childhood obesity program. Data were thematically analyzed using a constant comparative approach. Results. The following key themes emerged as challenges from the provider’s perspective for family adherence and behavior modification in the childhood obesity program: divergent views about obesity, complicated lives and logistical priorities, parental role modeling, and intergenerational tensions. Discussion and Conclusion. This examination of providers’ perspectives on family adherence and behavior modification relevant to the management of childhood obesity highlight the importance of tailoring childhood obesity programs to the complex and diverse needs of families from diverse backgrounds. Recommendations include methods of service delivery that address logistical challenges and are better suited to extended families, particularly grandparents.

Download Full-text

Older Adults’ Experiences of Behavior Change Support in a Digital Fall Prevention Exercise Program: Qualitative Study Framed by the Self-determination Theory (Preprint)

10.2196/preprints.26235 ◽

2020 ◽

Author(s):

Beatrice Pettersson ◽

Rebecka Janols ◽

Maria Wiklund ◽

Lillemor Lundin-Olsson ◽

Marlene Sandlund

Keyword(s):

Older Adults ◽

Behavior Change ◽

Classification System ◽

Exercise Program ◽

Psychological Needs ◽

Self Determination ◽

Behavior Change Techniques ◽

And Behavior ◽

Behavior Change Support ◽

Step Program

BACKGROUND Exercise is an effective intervention to prevent falls in older adults; however, long-term adherence is often poor. To increase adherence, additional support for behavior change has been advocated. However, consistency in the reporting of interventions using behavior change techniques is lacking. Recently, a classification system has been developed to increase consistency in studies using behavior change techniques within the self-determination theory. OBJECTIVE This study aimed to explore expressions of self-determination among community-dwelling older adults using a self-managed digital fall prevention exercise program comprising behavior change support (the Safe Step program), which was developed in co-creation with intended users. METHODS The qualitative study design was based on open-ended responses to questionnaires, and individual and focus group interviews. A deductive qualitative content analysis was applied using the classification system of motivation and behavior change techniques as an analytical matrix, followed by an inductive analysis. Twenty-five participants took part in a feasibility study and exercised in their homes with the Safe Step program for 4 months. The exercise program was available on computers, smartphones, and tablets, and was fully self-managed. RESULTS In the deductive analysis, expressions of support were demonstrated for all three basic human psychological needs, namely, autonomy, competence, and relatedness. These expressions were related to 11 of the 21 motivation and behavior change techniques in the classification system. The inductive analysis indicated that autonomy (to be in control) was valued and enabled individual adaptations according to different rationales for realizing exercise goals. However, the experience of autonomy was also two-sided and depended on the participants’ competence in exercise and the use of technology. The clarity of the program and exercise videos was seen as key for support in performance and competent choices. Although augmented techniques for social support were requested, support through relatedness was found within the program. CONCLUSIONS In this study, the Safe Step program supported the establishment of new exercise routines, as well as the three basic human psychological needs, with autonomy and competence being expressed as central in this context. Based on the participants’ experiences, a proposed addition to the classification system used as an analytical matrix has been presented. CLINICALTRIAL ClinicalTrials.gov NCT02916849; https://clinicaltrials.gov/ct2/show/NCT02916849

Download Full-text

Creating a Theoretically Grounded, Gamified Health App: Lessons From Developing the Cigbreak Smoking Cessation Mobile Phone Game (Preprint)

10.2196/preprints.10252 ◽

2018 ◽

Author(s):

Elizabeth A Edwards ◽

Hope Caton ◽

Jim Lumsden ◽

Carol Rivas ◽

Liz Steed ◽

...

Keyword(s):

Health Care ◽

Smoking Cessation ◽

Behavior Change ◽

Mobile Phone ◽

Health Behavior Change ◽

User Preferences ◽

Behavior Change Techniques ◽

Smoking Cessation Advice ◽

Health Apps ◽

Wide Range

BACKGROUND Gaming techniques are increasingly recognized as effective methods for changing behavior and increasing user engagement with mobile phone apps. The rapid uptake of mobile phone games provides an unprecedented opportunity to reach large numbers of people and to influence a wide range of health-related behaviors. However, digital interventions are still nascent in the field of health care, and optimum gamified methods of achieving health behavior change are still being investigated. There is currently a lack of worked methodologies that app developers and health care professionals can follow to facilitate theoretically informed design of gamified health apps. OBJECTIVE This study aimed to present a series of steps undertaken during the development of Cigbreak, a gamified smoking cessation health app. METHODS A systematic and iterative approach was adopted by (1) forming an expert multidisciplinary design team, (2) defining the problem and establishing user preferences, (3) incorporating the evidence base, (4) integrating gamification, (5) adding behavior change techniques, (6) forming a logic model, and (7) user testing. A total of 10 focus groups were conducted with 73 smokers. RESULTS Users found the app an engaging and motivating way to gain smoking cessation advice and a helpful distraction from smoking; 84% (62/73) of smokers said they would play again and recommend it to a friend. CONCLUSIONS A dedicated gamified app to promote smoking cessation has the potential to modify smoking behavior and to deliver effective smoking cessation advice. Iterative, collaborative development using evidence-based behavior change techniques and gamification may help to make the game engaging and potentially effective. Gamified health apps developed in this way may have the potential to provide effective and low-cost health interventions in a wide range of clinical settings.

Download Full-text