Developing Digital Games to Address Airway Clearance Therapy in Children With Cystic Fibrosis: Participatory Design Process

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Abstract

Background

Children affected with cystic fibrosis do respiratory exercises to release the mucus stuck in their lungs.

Objective

The objective of our study was to develop prototypes of digital games that use breath pressure to make this daily physiotherapy more fun.

Methods

We used a participatory design approach and organized short events to invite contributors from different disciplines to develop game prototypes. From the 6 prototypes, 3 were tested by 10 children during a prestudy. The source code of the games, of which 2 continue to be developed, has been released on the internet under fair use licenses.

Results

We discuss 7 themes of importance in designing games for health, combining our experience with a review a posteriori of literature.

Conclusions

This study provides examples of games and their pitfalls as well as recommendations to create games for health in a participatory approach that enables everyone to improve and adapt the work done.

Related collections

Most cited references 29

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Modeling the efficacy of persuasive strategies for different gamer types in serious games for health

Rita Orji, Julita Vassileva, Regan L. Mandryk (2014)

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Longitudinal association between medication adherence and lung health in people with cystic fibrosis.

Kristin Riekert, Michael D P Boyle, Andrew Bilderback … (2011)

This study examined the relationship of medication adherence to frequency of pulmonary exacerbation and rate of decline in FEV(1)% predicted (FEV(1)). 95 CF patients aged 6 years or older and prescribed a pulmonary medication, were enrolled in a longitudinal retrospective review of medication adherence and health outcomes (the occurrence and frequency of intravenous (IV) antibiotic treatments and FEV(1)) over 12-months. Pharmacy refill records were used to calculate a medication possession ratio (MPR). Composite MPR predicted the occurrence of at least one pulmonary exacerbation requiring a course of IV antibiotics (IRR=2.34, p=0.05), but not the frequency of exacerbations, after controlling for gender, baseline FEV(1,) and regimen complexity. Composite MPR predicted baseline FEV(1) (estimate=29.81, p=.007), but not decline in FEV(1). These results demonstrate a significant relation between medication adherence and IV antibiotics in CF patients, highlighting the importance of addressing adherence during clinic visits to improve health outcomes. Copyright © 2011 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

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Is Open Access

Is Participatory Design Associated with the Effectiveness of Serious Digital Games for Healthy Lifestyle Promotion? A Meta-Analysis

Ann DeSmet, Debbe Thompson, Tom Baranowski … (2016)

Background Serious digital games can be effective at changing healthy lifestyles, but large differences in their effectiveness exist. The extent of user involvement in game design may contribute to game effectiveness by creating a better fit with user preferences. Participatory design (PD), which represents active user involvement as informant (ie, users are asked for input and feedback) or codesigner (ie, users as equal partners in the design) early on and throughout the game development, may be associated with higher game effectiveness, as opposed to no user involvement or limited user involvement. Objective This paper reports the results of a meta-analysis examining the moderating role of PD in the effectiveness of serious digital games for healthy lifestyle promotion. Methods Four databases were searched for peer-reviewed papers in English that were published or in press before October 2014, using a (group-) randomized controlled trial design. Effectiveness data were derived from another meta-analysis assessing the role of behavior change techniques and game features in serious game effectiveness. Results A total of 58 games evaluated in 61 studies were included. As previously reported, serious digital games had positive effects on healthy lifestyles and their determinants. Unexpectedly, PD (g=0.075, 95% CI 0.017 to 0.133) throughout game development was related to lower game effectiveness on behavior (Q=6.74, P<.05) than when users were only involved as testers (g=0.520, 95% CI 0.150 to 0.890, P<.01). Games developed with PD (g=0.171, 95% CI 0.061 to 0.281, P<.01) were also related to lower game effectiveness on self-efficacy (Q=7.83, P<.05) than when users were not involved in game design (g=0.384, 95% CI 0.283 to 0.485, P<.001). Some differences were noted depending on age group, publication year of the study, and on the specific role in PD (ie, informant or codesigner), and depending on the game design element. Games developed with PD were more effective in changing behavioral determinants when they included users in design elements on game dynamics (beta=.215, 95% CI .075 to .356, P<.01) and, more specifically, as an informant (beta=.235, 95% CI .079 to .329, P<.01). Involving users as informants in PD to create game levels was also related to higher game effectiveness (Q=7.02, P<.01). Codesign was related to higher effectiveness when used to create the game challenge (Q=11.23, P<.01), but to lower game effectiveness when used to create characters (Q=4.36, P<.05) and the game world (Q=3.99, P<.05). Conclusions The findings do not support higher effectiveness of games developed with PD. However, significant differences existed among PD games. More support was found for informant roles than for codesign roles. When PD was applied to game dynamics, levels, and game challenge, this was associated with higher effectiveness than when it was applied to game aesthetics. Since user involvement may have an important influence on reach, adoption, and implementation of the intervention, further research and design efforts are needed to enhance effectiveness of serious games developed with PD.

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Author and article information

Contributors

Fabio Balli:

Concordia University1455 de Maisonneuve WestMontreal, QC, H3G 1M8Canada1 514 848 2424info@fabioballi.net

ORCID: http://orcid.org/0000-0002-4769-5810

Journal

Journal ID (nlm-ta): JMIR Serious Games

Journal ID (iso-abbrev): JMIR Serious Games

Journal ID (publisher-id): JSG

Title: JMIR Serious Games

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 2291-9279

Publication date Collection: Oct-Dec 2018

Publication date (Electronic): 21 November 2018

Volume: 6

Issue: 4

Electronic Location Identifier: e18

Affiliations

[1 ] Breathing Games Montreal, QC Canada

[2 ] Concordia University Montreal, QC Canada

Author notes

Corresponding Author: Fabio Balli info@ 123456fabioballi.net

Author information

Fabio Balli http://orcid.org/0000-0002-4769-5810

Article

Publisher ID: v6i4e18

DOI: 10.2196/games.8964

PMC ID: 6282016

PubMed ID: 30463835

SO-VID: 766e28dc-5a0b-445f-984c-8f5a8a7ddae0

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Serious Games, is properly cited. The complete bibliographic information, a link to the original publication on http://games.jmir.org.as well as this copyright and license information must be included.

History

Date received : 14 September 2017

Date revision requested : 3 December 2017

Date revision received : 25 June 2018

Date accepted : 17 July 2018

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