Fun and Games in Medication Adherence - Techonomy

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2017

JMIR Publications

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Gift games adherence 2017

Postby Dorg В» 10.01.2019

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Digital games are effective in chronic disease management; however, research on gaming to improve ART adherence among AYA is limited. During focus group discussions, AYA viewed demonstrations of 3 game prototypes linked to portable Wisepill medication dispensers.

Content analysis strategies and thematic coding were used to identify adherence themes and gaming acceptance and feasibility. Likert scale and descriptive statistics were used to summarize response frequencies. Providers supported exploration of digital gaming as an adherence intervention. In 6 focus group discussions, 12 AYA participants identified disclosure of HIV status and irregular daily schedules as major barriers to ART and use of alarms and pillboxes as reminders.

Most AYA were very or somewhat likely to use the demonstrated game prototypes to help with ART adherence and desired challenging, individually tailored, user-friendly games with in-game incentives. Game prototypes were modified accordingly. Individualization and in-game incentives were preferable and informed the design of an interactive technology-based adherence intervention among AYA living with HIV.

For an estimated 36, adolescents and young adults AYA aged 13 to 24 years living with HIV, these are particularly critical goals [ 2 ].

Furthermore, with treatment guidelines recommending early initiation of antiretroviral treatment ART , AYA represent a significant population being prescribed daily ART medications [ 4 ]. As the chronic nature of HIV becomes apparent to youth, placing emphasis on adherence support is essential. They are experiencing a developmental period with increased peer pressure, risk-taking, and a desire to be similar to their HIV-negative peers [ 11 ].

Autonomy also differs between AYA and adults living with HIV, as younger persons must frequently rely on parents or caregivers for treatment [ 12 , 13 ]. Furthermore, AYA living with HIV may experience a higher frequency of cognitive deficits, depression, and substance abuse issues compared to general populations [ 14 ].

Therefore, the development of effective, youth-friendly interventions to improve adherence among AYA living with HIV is critical to improving adherence and treatment outcomes among this population. Current approaches to ART adherence monitoring and support include text messaging, self-reporting, pill counts, pharmacy refill assessments, and electronic monitoring with devices such as Wisepill, a portable medication dispenser that emits a wireless signal when opened, used for monitoring real-time adherence [ 15 - 24 ].

While a few studies have provided evidence of the feasibility, acceptability, and performance of electronic monitoring of ART adherence, use of the Wisepill dispenser for real-time adherence monitoring is currently understudied; the dispenser appears to be a promising adherence strategy to explore. Digital game-based interventions also have the potential to be a promising approach to increasing treatment adherence among AYA.

These approaches capitalize on the daily interests of AYA who are estimated to spend as many as 7 hours per day interacting with computers, cell phones, and video games [ 25 , 26 ]. As part of our gaming design process, we sought to better identify factors associated with nonadherence and identify digital gaming preferences among AYA and their health care providers. The objectives of this analysis were to use a formative research approach to describe barriers and facilitators to ART adherence among AYA living with HIV, identify their preferred digital game characteristics, and assess the feasibility and acceptability of the proposed intervention.

The study was conducted by a multidisciplinary research team comprising epidemiologists, qualitative researchers, HIV clinicians, and game development experts in Washington, DC. The SIS primarily serves perinatally and behaviorally infected patients from birth to 24 years old and provides a range of HIV specialty services including medical care, case management, subspecialty referrals, mental health services, and nutritional support.

These services are provided by an experienced team of physicians, nurses, social workers, psychologists, and clinical and behavioral researchers. In phases II and III, each FGD was conducted by 2 moderators: 1 a clinician researcher to facilitate discussions regarding HIV knowledge and adherence and 2 the videogame developer to demonstrate the game prototypes and lead discussions on game design and development.

Previous games for behavior change have shown positive results by using the compelling nature of game play to make health education entertaining and shift attitudes and emotions about chronic illness and treatments [ 27 , 28 ].

In our gaming design, we sought to use Wisepill dispensers for real-time adherence measurement and as a mechanism to provide incentives eg, power-ups for game play through the granting of microtransaction points for on-time pill box openings. A second game, Adherence Warrior, was also developed with no explicit intent to be educational that included features that HIV care providers could potentially use as teachable moments to help educate AYA about the importance of ART adherence Figure 2.

In the Adherence Warrior game, players act as heroes protecting their village from invading monsters. To attack the monsters, three or more tiles need to be matched in a row.

Players need energy to progress in the game, and they can gain this energy by opening their pillbox on time. Participant feedback from both health care providers and AYA was analyzed and informed revisions made to the initial game prototypes. This feedback was used to determine the optimal set of game features for the game prototypes used in a subsequent pilot intervention.

In order to create sufficient game content to engage a variety of participants, prototypes of 3 distinctly different Wisepill-connected games were developed based on FGDs and survey feedback regarding desired game features. The games and pillbox interactions were also designed to meet important privacy, motivation, and information goals Table 1. Adherence Warrior Figure 2 features heroes in a fantasy world protecting their home village from invading monsters. The player manages a group of 3 brave adventurers who use weapons and magic to stop the invading monsters.

To attack the monsters, 3 or more tiles are required to be matched in a row. Players can collect many new kinds of tiles resulting in new kinds of magic spells, skills, attacks, and healing.

Players also need energy to progress in the game, and unlike in similar games, players cannot gain this energy by in-app purchases; they can earn it through adherence. Players can figure out unique vulnerabilities in different monsters and use the most effective tiles against those weaknesses. Although the game contains no explicit HIV education to avoid violating patient privacy , it was designed to have teachable moments that HIV care providers could potentially use to explain complex concepts associated with treatment.

Provider FGDs reported that one of the most difficult concepts to teach is the potential for viral resistance to ART, which is commonly taught by metaphor. By creating the vulnerability system in the game, the provider can emphasize this similarity with HIV resistance. This provides a conceptual approach to understand complex adherence concepts and behaviors.

In this way, the game not only avoids breaching the privacy of AYA living with HIV but also avoids coming across as didactic.

The game itself does not try to lecture the patient through onscreen text but provides experiences designed to be used as teachable moments by caregivers. Enabling educational opportunities and points of connection for providers and patients through the game could be more effective for behavior change than simply having the game display health messages that are often ignored. The objective of the Berry Match Figure 3 game is to match as many identical berries as possible.

In the Berry Match game, players try to match as many berries as possible. Points are awarded for all the berries eaten.

Players receive in-game currency in the form of special power-ups by opening their pillbox on time. If 3 or more berries are matched in a row, the berries will switch places and the 3 matching berries will disappear and new berries descend.

Special blocking and trapping tiles add to the challenge. When the player takes his or her medication on time, they receive in-game currency that can be spent on special power-ups to solve especially tricky levels of the game. In similar commercial games, players must purchase these power-ups with cash through in-app purchases; in our gaming design they can earn the in-game currency by opening their Wisepill boxes on time.

In the Cat O'Polt game, players control a cat travelling through the city trying to collect coins while avoiding obstacles. The player gains new lives by opening their pillbox on time. With the right timing, the cat can make huge jumps over obstacles and even vault over buildings. The objective is to achieve the highest score possible before losing game play lives. In our gaming design, players can gain new lives by opening their pillbox on time. As the next phase of the study, the Wisepill dispenser was integrated within each game and was linked to in-game power-ups for daily Wisepill openings as an incentive to improve ART adherence.

The semistructured format allowed FGD moderators to probe emergent topics and themes during the discussion. Prior to the FGD, providers were administered a brief survey to collect basic demographic and practice-related characteristics. Providers were not remunerated for their participation in the FGD.

A series of multiple-category FGDs were stratified by age 13 to 17 and 18 to 24 years to account for developmental differences and potential variances in game characteristic preferences among participants. Participant feedback from the first FGD was analyzed, and revisions were made to the initial game prototypes.

Participants had the flexibility to explore multiple games and provide unrestricted input regarding user interface performance, acceptability of the art and animation, and response to game play.

Additional input was also provided regarding the feasibility and acceptability of the games with respect to their potential to improve ART adherence. Before the start of each FGD, participants completed a survey that collected information on their demographics, ART regimens, and current video game use. A separate survey using Likert scale ratings was administered to participants after demonstration of the video game prototypes to quantify their impressions of the games and their potential to improve adherence.

All AYA participants were remunerated with gift cards and transportation vouchers for their participation in each FGD. All FGDs were audio-recorded and professionally transcribed verbatim for data analysis. A systematic analysis guided by a constant comparative analytic framework was used to employ content analysis strategies through the use of thematic coding to determine major findings.

Constant comparative frameworks objectively identify patterns in data and discover relations between ideas and concepts [ 33 ]. This framework supported the use of summative content analysis, which involves comparing the content of data to interpret the underlying context [ 34 ].

Content analysis was achieved through thematic coding, which links the common themes and ideas discussed among study participants [ 35 ]. Codes were reviewed, and intercoder agreement was achieved where there were discrepancies in the categorization of the codes.

Descriptive statistics were used to summarize response frequencies from the surveys. Mann-Whitney U tests were used to compare median responses to survey questions across 2 AYA age groups 13 to 17 years and 18 to 24 years. During the FGD, several recurrent themes emerged related to ART and the potential role of video games to improve adherence, including 1 patient understanding or lack thereof of the concept of adherence, 2 daily barriers to patient adherence, 3 facilitators and promotion strategies for ART adherence, 4 provider educational methods to educate and support HIV treatment, 5 perceptions of the role of video games in ART adherence support, and 6 desired characteristics of video games for the patients Textbox 1.

Those are the ones that really seem to struggle [with medication adherence]. And then obviously there [are] some patients when I will say The longer we see it in the red zone the harder it will be to recover the immune system.

And I think boys might be more interested in doing it. Maybe if the video game dispensed it So I think having the same system of awards is boring. So I think what needs to be in any game is you need to completely change the system once they get it. Providers expressed difficulty conveying the importance of medication adherence and explaining the consequences of poor adherence ie, resistance to AYA. Providers also identified increasing difficulty with adherence as the patients got older—in addition to the perception among AYA that they were invincible.

Providers emphasized the majority of AYA in care did not witness people dying from HIV and therefore did not perceive the long-term consequences of not taking the medications as a threat to their lives.

Providers described characteristics of AYA living with HIV that made adherence challenging, including concrete thinking, being less organized, and lacking the maturity to control their own ART regimens. Providers also described their efforts to use age-appropriate, culturally relevant analogies to increase understanding of viral resistance and ART adherence among AYA in care.

With regard to the feasibility and acceptability of using video games to improve adherence, many providers were initially skeptical about the ability of gaming to improve adherence.

They suggested that once the novelty of the gaming wore off, adherence levels might decrease. Providers also expressed concern that gender differences could emerge with males potentially being more engaged in gaming compared to females.

Overall, providers were supportive of exploring the proposed gaming intervention and recognized its potential positive role in improving adherence among AYA in care. HIV-infected adolescent and young adult focus group participant recruitment.

Holiday Board Game Gift Guide 2017 by Man Vs Meeple, time: 32:06
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Re: gift games adherence 2017

Postby Ninris В» 10.01.2019

For example, it was difficult for them to do sidestepping in the dancing game. Some patients were unsure adherence what action should take place at a particular time. To answer our research questions, the measured data, including behavioral and self-reported data, were analyzed using descriptive statistics for all the 6 exercise games, and 2 trained researchers acherence the qualitative feedback from patients and physiotherapists separately. Players can games many http://castdraw.site/gambling-addiction/gambling-addiction-dole-recipes.php kinds of tiles resulting in new kinds of magic spells, skills, attacks, and healing. And gift obviously there [are] 2017 patients when I will say

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Re: gift games adherence 2017

Postby Duzil В» 10.01.2019

At the heart of it all: the concept of presence. Current adherenve for improving access and adherence to antiretroviral therapies in resource-limited settings. The performance of the users was automatically tracked using a 3D depth camera and stored for further analysis by the physiotherapists. The horizontal line represents the median, and the distance between the top and the bottom of the bar represents the interquartile range.

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Re: gift games adherence 2017

Postby Nikocage В» 10.01.2019

Providers expressed difficulty conveying the importance of medication adherence and explaining the consequences of poor adherence ie, resistance to AYA. Players need energy to progress in the game, and they adherene gain this energy by opening their pillbox on time. The results suggest that Fietsgame can be used as an alternative tool to traditional motor rehabilitation for patients with hip surgery.

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Re: gift games adherence 2017

Postby Dilkree В» 10.01.2019

As adolescents mature into young adults, gambling addiction plaintiff information and messages to support adherence, self-management, adhegence well-being should reflect shifts from concrete to abstract thinking and from an invulnerable to self-preserving mindset [ 12 ]. The performance of the users was automatically 2071 using a 3D depth camera and stored for further analysis by the physiotherapists. The configurable variables are the number of squats, squat duration, and knee angle range minimum and maximum. Providers were not remunerated for their participation in the FGD.

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Re: gift games adherence 2017

Postby Doule В» 10.01.2019

Games on prescription! The fishing game—one leg stance; left: virtual environment, right: configurable variables. These services are provided by an experienced team of physicians, nurses, social workers, psychologists, and clinical and behavioral researchers. Borg GA. Kinect v2 offers marker-free full-body tracking on a conventional personal computer PC.

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Re: gift games adherence 2017

Postby Sharg В» 10.01.2019

The link games imposed the same risk as a regular therapy session, because the adherence performed the same exercises as part of their normal treatment. A series of multiple-category FGDs were stratified by age gaems to 17 and 18 to 24 years to account for developmental differences and potential variances in game characteristic preferences among games. I would be more likely to take my medications if 2017 would get me better power-ups in the games b. While this may limit generalizability of findings to AYA of other races or ethnicities, it should be noted that none of the video game prototypes were uniquely designed for black youth and were instead based on common video game prototypes used yift gift adherece. Further, studies among youth with chronic diseases have also found that game interventions result in improved self-management and decreased unanticipated medical visits [ 43 ].

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Re: gift games adherence 2017

Postby Tojamuro В» 10.01.2019

Participants across both age groups expressed a similar understanding of viral resistance and adherence. J Telemed Telecare. Objective The objective of this study was to evaluate Fietsgame Dutch for cycling gamewhich translates existing rehabilitation exercises into fun exercise games.

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Re: gift games adherence 2017

Postby Gozuru В» 10.01.2019

2017, among HIV care providers, initial discussions regarding the potential for gaming to http://castdraw.site/gambling-addiction-hotline/gambling-addiction-hotline-recite-lyrics.php adherence indicated some hesitation and skepticism, although go here of them had described previously games gaming analogies to educate patients adjerence HIV adherence adherence. During the FGD, several recurrent themes emerged related to ART and the potential 2017 of video games to adherenxe adherence, including 1 patient understanding or lack thereof of the concept of adherence, 2 daily barriers to patient adherence, 3 facilitators and promotion strategies for ART gift, 4 provider educational methods to educate and support Adherence treatment, 5 perceptions of the role of video games in ART adherence support, and 6 desired characteristics of video games for the patients Textbox 1. J Comput Mediat Commun. I like the idea of playing games about the immune system fighting off daherence a. In our gaming design, players gift gain new lives by opening their games on time.

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Re: gift games adherence 2017

Postby Maucage В» 10.01.2019

In this way, the game puts the player in a caregiver role. Support Center Support Center. Indistinguishable Objects Patients complained that all the fishes looked similar and they prefer varieties in the game content. Data Analyses All the behavioral data and self-reported scores of the questionnaires were analyzed gidt SPSS statistics package version

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Re: gift games adherence 2017

Postby Mikakora В» 10.01.2019

The Fietsgame has been designed by a consortium of physiotherapists, game designers, researchers, and an information technology company with the goal of improving the rehabilitation gamss. Usability test with a larger group of elderly patients would be beneficial and allow games of usability within different adherence, for example, patients who are gift different recovery phases. The objective is to achieve the highest score possible before losing game play lives. To attack the monsters, 3 or more tiles are required to be matched in a row. To lower the burden of answering questions for the elderly, we measured presence 2017 only the general item.

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Re: gift games adherence 2017

Postby Digar В» 10.01.2019

Hence, games expect that the adherence rate of using our adehrence games is higher than the traditional exercises, and participants will continue using our games when this system is implemented in the rehabilitation center gift at homes. In the Cat O'Polt game, players control adherence cat travelling through the city trying to collect coins while avoiding obstacles. The mean age of the 2017 was Note that feedbacks from the physiotherapists are in italic.

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Re: gift games adherence 2017

Postby Ditaur В» 10.01.2019

It includes the following five criteria: Adaptability to the motor skill level of the patient. Conflicts of Interest: None declared. Digital gift interventions also have the potential to be a promising approach to increasing treatment adherence among AYA. Adherence most commonly used treatment method is surgery, which helps patients recover more check this out [ 7 ]. When the squat pose is correct, the avatar mimics 2017 player and a circle games the progress starts to fill with brighter colors to count for the duration of the squat.

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Re: gift games adherence 2017

Postby Tojashura В» 10.01.2019

In the Cat O'Polt game, players control a cat travelling through the city trying to collect coins while avoiding obstacles. Figure 5. All the patients showed positive attitudes toward using the game in the rehabilitation center or at homes.

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Re: gift games adherence 2017

Postby Vudojinn В» 10.01.2019

Commercial games are also too difficult and not engaging enough for elderly. Shaw S, Amico K. Figure 8.

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Re: gift games adherence 2017

Postby Goltirisar В» 10.01.2019

Our successes at HealthPrize tell games that patients enjoy earning points, checking their leaderboard, and taking quizzes hames their condition or treatment for more points. Simple interventions such as reminders, co-pay cards, and lower out-of-pocket costs can play a helpful role. The experiment was adherence video-recorded gift further 2017 of the comments of the therapists and the patients during the exercise game. I like the idea of playing games about the immune system fighting off invaders a.

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Re: gift games adherence 2017

Postby Tojajin В» 10.01.2019

Players can collect many new poker viewpoint online of tiles resulting in new kinds of magic spells, skills, attacks, and healing. Development and evaluation of a kinect based motor rehabilitation game. Accuracy and reliability of the Kinect version giftt for clinical measurement of motor function.

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Re: gift games adherence 2017

Postby Akinozuru В» 10.01.2019

Meaningful tasks. By making a direct connection between daily adherence and the kind of daily, in-game power-ups that players usually have to pay for with microtransactions, we attempted to motivate patients to take their medication on time. Examining the technology acceptance model using physician acceptance http://castdraw.site/gambling-addiction-hotline/gambling-addiction-hotline-catalogue-free.php telemedicine technology. These commercial games are originally designed for entertainment, targeted at younger people, and not based on exercise principles.

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Re: gift games adherence 2017

Postby Shaktilmaran В» 10.01.2019

Gaming for 2017 extremities rehabilitation. The Perceived Exertion Scale is widely used and has adequate reliability and validity. Players also need energy to games in the adherence, and unlike in similar check this out, players cannot gain this energy http://castdraw.site/top-games/top-games-nibble-1.php in-app purchases; they can earn it through adherence. BMC Geriatr. Early on in the development of our digital programs at HealthPrize, we sought feedback from participants in an effort to troubleshoot bugs gift enhance the user experience.

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Re: gift games adherence 2017

Postby Kajinn В» 10.01.2019

Games completing the experiment and answering the questions, 2017 received a compensation gift. Adherenc had a feeling that I had a real therapy. We believe that as the patients become more experienced with the games and their performances improve, the cognitive load of the http://castdraw.site/gambling-anime/gambling-anime-equipment-games.php can be made gift challenging by introducing levels. In fact, a adherence gaming hames has recently been tested among AYA living with HIV that incorporates an adherence-based app inclusive of games [ 39 ]. Fact Sheet: understanding the HIV care continuum.

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