Perspectives on the Gamification of an Interactive Health Technology for Postoperative Rehabilitation of Pediatric Anterior Cruciate Ligament Reconstruction: User-Centered Design Approach

Background Pediatric and adolescent athletes are a large demographic undergoing anterior cruciate ligament reconstruction (ACL-R). Postoperative rehabilitation is critical, requiring patients to complete home exercise programs (HEPs). To address obstacles to HEP adherence, we developed an interactive health technology, interACTION (iA), to monitor knee-specific rehabilitation. iA is a web-based platform that incorporates wearable motion sensors and a mobile app that provides feedback and allows remote monitoring. The Wheel of Sukr is a gamification mechanism that includes numerous behavioral elements. Objective This study aims to use a user-centered design process to incorporate behavioral change strategies derived from self-management theory into iA using the Wheel of Sukr, with the aim of influencing patient behavior. Methods In total, 10 athletes aged 10-18 years with a history of ACL-R were included in this study. Patients were between 4 weeks and 1 year post–ACL-R. Participants underwent a 60-minute triphasic interview. Phase 1 focused on elements of gaming that led to high participation and information regarding surgery and recovery. In phase 2, participants were asked to think aloud and rank cards representing the components of the Wheel of Sukr in order of interest. In phase 3, the patients reviewed the current version of iA. Interviews were recorded, transcribed, and checked for accuracy. Qualitative content analysis segmented the data and tagged meaningful codes until descriptive redundancy was achieved; next, 2 coders independently coded the data set. These elements were categorized according to the Wheel of Sukr framework. The mean age of participants was 12.8 (SD 1.32) years, and 70% (7/10) were female. Most participants (7/10, 70%) reported attending sessions twice weekly. All patients were prescribed home exercises. Self-reported HEP compliance was 75%-100% in 40% (4/10), 50%-75% in 40% (4/10), and 25%-50% of prescribed exercises in 20% (2/10) of the participants. Results The participants responded positively to an app that could track home exercises. Desirable features included exercise demonstrations, motivational components, and convenience. The participants listed sports specificity, competition, notifications, reminders, rewards, and social aspects of gameplay as features to incorporate. In the Wheel of Sukr card sort exercise, motivation was ranked first; self-management, second; and growth, esteem, and fun tied for the third position. The recommended gameplay components closely followed the themes from the Wheel of Sukr card sort activity. Conclusions The participants believe iA is a helpful addition to recovery and want the app to include exercise movement tracking and encouragement. Despite the small number of participants, thematic saturation was reached, suggesting the sample was sufficient to obtain a representative range of perspectives. Future work will implement motivation; self-management; and growth, confidence, and fun in the iA user experience. Young athlete ACL-R patients will complete typical clinical scenarios using increasingly developed prototypes of the gamified iA in a controlled setting.

Analysis of consumers’ negative perceptions of health tracking in insurance – a value sacrifice approach

Purpose This paper explores and identifies customer-value-related sacrifices that consumers attach to interactive health/life insurance. This paper aims to increase understanding of why individual consumers are not willing to embrace behaviour-tracking-based insurance applications. Design/methodology/approach The authors analysed data from a qualitative survey of Finnish insurance consumers who were not keen on adopting interactive insurance products. Findings Developed through thematic analysis, the framework presented in this paper illustrates consumers’ value sacrifices on four dimensions: economic, functional, emotional and symbolic value. Research limitations/implications The framework and insights emerging in the study hold several implications related to increased understanding of consumers’ perceptions of insurance and to developing interactive insurance services. In addition, this work provides a promising foundation and avenues for further considerations related to digital ethics in insurance. Originality/value To the best of the authors’ knowledge, this paper is the first piece applying a value sacrifice perspective in studying consumers’ unwillingness to adopt interactive insurance products.

Experiment in a Box (XB): An Interactive Technology Framework for Sustainable Health Practices

This paper presents the Experiment in a Box (XB) framework to support interactive technology design for building health skills. The XB provides a suite of experiments—time-limited, loosely structured evaluations of health heuristics for a user-as-experimenter to select from and then test in order to determine that heuristic’s efficacy, and to explore how it might be incorporated into the person’s life and when necessary, to support their health and wellbeing. The approach leverages self-determination theory to support user autonomy and competence to build actionable, personal health knowledge skills and practice (KSP). In the three studies of XB presented, we show that with even the short engagement of an XB experiment, participants develop health practices from the interventions that are still in use long after the intervention is finished. To situate the XB approach relative to other work around health practices in HCI in particular, we contribute two design continua for this design space: insourcing to outsourcing and habits to heuristics. From this analysis, we demonstrate that XB is situated in a largely under-explored area for interactive health interventions: the insourcing and heuristic oriented area of the design space. Overall, the work offers a new scaffolding, the XB Framework, to instantiate time-limited interactive technology interventions to support building KSP that can thrive in that person, significantly both post-interventions, and independent of that technology.

Interactive CovidCampus Simulation Game: Genesis, Design, and Outcomes

We explore how an AR simulation created by a multidisciplinary team evolved into a more interactive, student-centered learning game. The CovidCampus experience was designed to help college students understand how their decisions can affect their probability of infection throughout a day on campus. There were eight decision points throughout the day. Within group comparisons of immediate learning gains and self-reported behavioral changes were analyzed. Results revealed a significant increase in confidence in asking safety-related questions. Post-play, a significant majority of players listed new actions they would take to increase their safety; players were more agentic in their choices. This game allowed players to go back and replay with different choices, but only 7% chose to replay. Short, interactive desktop games may be an effective method for disseminating information about how to stay safer during a pandemic. The game appeared to positively change most players’ health behaviors related to mitigation of an infectious disease. Designers of interactive health games should strive to create multi-disciplinary teams, include constructs that allow players to agentically make decisions, and to compare outcomes over time.

Co-Use of Alcohol and Cannabis: Longitudinal Associations with Mental Health Outcomes in Young Adulthood

Increases in cannabis use among young people has heightened concern about the potential interactive health effects of cannabis with other drugs. We examined the longitudinal association between concurrent and simultaneous (SAM) co-use of alcohol and cannabis in young adulthood on mental health symptoms, substance use behaviors, and substance-related harms two years later. Data were drawn from Time 5 (T5; n = 464; 46% male) and 6 (T6; n = 478; 45% male) of the Victoria Healthy Youth Survey. At T5, 42% of participants used alcohol-only, 13% used concurrently, 41% used SAM, 1% were cannabis only users, and 3% abstained from cannabis and alcohol. Boys were more likely to use SAM. Higher T5 SAM use frequency was associated with heavier use of substances, more substance-related harms, and symptoms of psychosis and externalizing problems at T6. T5 Concurrent use was associated with conduct symptoms, illicit drug use, and alcohol use disorders at T6 relative to alcohol-only use. Cannabis is commonly used with alcohol and the findings suggest that any co-use (concurrent or simultaneous) may be problematic in young adulthood. Public health messages need to explicitly inform consumers about the possible consequences of using both alcohol and marijuana and the addictive pharmacological impact of using them together.

The Effects of an Interactive Health Coaching Application to Prevent Malnutrition and Muscle Loss in Esophageal Cancer Patients Receiving Neoadjuvant Concurrent Chemoradiotherapy: A Prospective Pilot study (Preprint)

BACKGROUND Excessive muscle loss is an important prognostic factor in esophageal cancer patients undergoing neoadjuvant chemoradiotherapy (NACRT) as reported in our previous research. OBJECTIVE We prospectively tested the effectiveness of a health coaching mobile application in preventing malnutrition and muscle loss in this patient population. METHODS Between July 2019 and May 2020, we enrolled 38 male patients with esophageal cancer scheduled for NACRT. For 8 weeks from the start of radiotherapy (RT), the patients used a health coaching mobile application, the Noom®, that interactively provided online advice about food intake, exercise, and weight changes. The skeletal muscle index (SMI) measured on computed tomography, and nutrition-related laboratory markers were assessed before and after RT. We evaluated the changes of SMI, nutritional and inflammatory factors between the patients who used a mobile application (Noom group) and our previous study cohort (usual care group). Additionally, we analyzed the factors associated with walk steps recorded in the application. RESULTS Two patients dropped out of the study (no application use [n=1]; treatment changed to a definitive aim [n=1]). The use (or activation) of the application was noted in approximately 70% of patients (36 patients) until the end of the trial. Compared to the 1:2 matched usual care group by propensity scores balanced with age, primary tumor location, tumor stage, pre-RT body mass index, and pre-RT SMI level, 30 operable patients showed less aggravation of the prognostic nutritional index (PNI) (-6.7 vs. -9.8, P=.04). However, there was no significant difference in the SMI change or the number of patients with excessive muscle loss (∆SMI/50 days > 10%). In patients with excessive muscle loss, walk steps significantly decreased in the last four weeks compared to those in the first four weeks. Age affected the absolute number of walk steps (P=.01), while pre-RT sarcopenia was related to the recovery of reduced walk steps (P=.03). CONCLUSIONS For esophageal cancer patients receiving NACRT, an interactive health coaching mobile application helped nutritional self-care with less decrease in PNI, although it did not prevent excessive muscle loss. Low physical activity estimated by the number of walking steps did not recover even a few weeks after the end of NACRT in patients with old age or pretreatment sarcopenia. An individualized care model with proper exercise as well as nutritional support may be required to reduce muscle loss and malnutrition.