Comparing the Effects of Gamification and Teach-Back Training Methods on Adherence to a Therapeutic Regimen in Patients After Coronary Artery Bypass Graft Surgery: Randomized Clinical Trial

Banafsheh Ghorbani, Alun C Jackson, Mohammad Noorchenarboo, Mohammad H Mandegar, Farshad Sharifi, Zohrehsadat Mirmoghtadaie, Fatemeh Bahramnezhad, Banafsheh Ghorbani, Alun C Jackson, Mohammad Noorchenarboo, Mohammad H Mandegar, Farshad Sharifi, Zohrehsadat Mirmoghtadaie, Fatemeh Bahramnezhad

Abstract

Background: Patients undergoing coronary artery bypass graft surgery (CABGS) may fail to adhere to their treatment regimen for many reasons. Among these, one of the most important reasons for nonadherence is the inadequate training of such patients or training using inappropriate methods.

Objective: This study aimed to compare the effect of gamification and teach-back training methods on adherence to a therapeutic regimen in patients after CABGS.

Methods: This randomized clinical trial was conducted on 123 patients undergoing CABGS in Tehran, Iran, in 2019. Training was provided to the teach-back group individually. In the gamification group, an app developed for the purpose was installed on each patient's smartphone, with training given via this device. The control group received usual care, or routine training. Adherence to the therapeutic regimen was assessed using a questionnaire on adherence to a therapeutic regimen (physical activity and dietary regimen) and an adherence scale as a pretest and a 1-month posttest.

Results: One-way analysis of variance (ANOVA) for comparing the mean scores of teach-back and gamification training methods showed that the mean normalized scores for the dietary regimen (P<.001, F=71.80), movement regimen (P<.001, F=124.53), and medication regimen (P<.001, F=9.66) before and after intervention were significantly different between the teach-back, gamification, and control groups. In addition, the results of the Dunnett test showed that the teach-back and gamification groups were significantly different from the control group in all three treatment regimen methods. There was no statistically significant difference in adherence to the therapeutic regimen between the teach-back and control groups.

Conclusions: Based on the results of this study, the use of teach-back and gamification training approaches may be suggested for patients after CABGS to facilitate adherence to the therapeutic regimen.

Trial registration: Iranian Registry of Clinical Trials IRCT20111203008286N8; https://en.irct.ir/trial/41507.

Keywords: coronary artery bypass graft; gamification; patient training; teach back; treatment regimen.

Conflict of interest statement

Conflicts of Interest: None declared.

©Banafsheh Ghorbani, Alun C Jackson, Mohammad Noorchenarboo, Mohammad H Mandegar, Farshad Sharifi, Zohrehsadat Mirmoghtadaie, Fatemeh Bahramnezhad. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 10.12.2021.

Figures

Figure 1
Figure 1
Sample screenshot from the physical activity section.
Figure 2
Figure 2
Consolidated Standards of Reporting Trials (CONSORT) flow diagram of this study.
Figure 3
Figure 3
Comparison of CIs between intervention groups (gamification and teach back) and the control group. CI: confidence interval.

References

    1. Sandau K, Boisjolie C, Hodges J. Use of the Minnesota Living With Heart Failure Questionnaire among elderly patients with aortic stenosis: results from a pilot study. J Cardiovasc Nurs. 2014;29(2):185–197. doi: 10.1097/JCN.0b013e318279b76f.
    1. Urden L, Stacy K, Lough M. Critical Care Nursing: Diagnosis and Management, 8th Edition, Kindle Edition, E-book. MO: Mosby; 2018.
    1. Plitnik KR. Coronary artery bypass grafting. Nursing2020 Critical Care. 2014;9(6):32–37. doi: 10.1097/01.ccn.0000455850.47502.49.
    1. Hasanpour-Dehkordi A, Khaledi-Far A, Khaledi-Far B, Salehi-Tali S. The effect of family training and support on the quality of life and cost of hospital readmissions in congestive heart failure patients in Iran. Appl Nurs Res. 2016 Aug;31:165–169. doi: 10.1016/j.apnr.2016.03.005.S0897-1897(16)30004-0
    1. Heydari A, Ziaee ES, Gazrani A. Relationship between awareness of disease and adherence to therapeutic regimen among cardiac patients. Int J Community Based Nurs Midwifery. 2015 Jan;3(1):23–30.
    1. Chi N, Demiris G. A systematic review of telehealth tools and interventions to support family caregivers. J Telemed Telecare. 2014 Dec 04;21(1):37–44. doi: 10.1177/1357633x14562734.
    1. Darabi L, Shokravi A, Ghaffari M. Comparison of two methods of direct and indirect education on osteoporosis preventive behaviors among female students. Int J Pediatr. 2017;5(8):5483–5492. doi: 10.22038/ijp.2017.20921.1766.
    1. Okafor EC, Osuagwu CC, Harman K. The underlying issues in knowledge elicitation. IJIKM. 2006;1:095–107. doi: 10.28945/116.
    1. Binder J, Krautz C, Engel K, Grützmann R, Fellner FA, Burger PHM, Scholz M. Leveraging medical imaging for medical education: a cinematic rendering-featured lecture. Ann Anat. 2019 Mar;222:159–165. doi: 10.1016/j.aanat.2018.12.004.S0940-9602(18)30161-4
    1. Christou E, Blaney A, Dunn N. Utilising games to generate awareness regarding gender inequality in Parliament. 5th Postgraduate Science and Technology Studies (STS) Conference; March 23-25, 2015; Lancaster University. 2015.
    1. More SM, Duggal PS, Welkar D, Kolhe S, Patil CD, Chavhan PG. Measurement of course outcomes attainment level for subject by using direct-indirect method. IJIR. 2016:1483–1487.
    1. Bradshaw M, Hultquist B. Innovative Teaching Strategies in Nursing and Related Health Professions. MA: Jones & Bartlett Learning; 2016.
    1. Caplin M, Saunders T. Utilizing teach-back to reinforce patient education: a step-by-step approach. Orthop Nurs. 2015;34(6):365–368. doi: 10.1097/nor.0000000000000197.
    1. Talevski J, Wong Shee A, Rasmussen B, Kemp G, Beauchamp A. Teach-back: a systematic review of implementation and impacts. PLoS One. 2020;15(4):e0231350. doi: 10.1371/journal.pone.0231350. PONE-D-20-01263
    1. Maningat P, Gordon BR, Breslow JL. How do we improve patient compliance and adherence to long-term statin therapy? Curr Atheroscler Rep. 2013 Jan 9;15(1):291–23. doi: 10.1007/s11883-012-0291-7.
    1. Miller S, Lattanzio M, Cohen S. "Teach-back" from a patient's perspective. Nursing. 2016;46(2):63–64. doi: 10.1097/01.nurse.0000476249.18503.f5.
    1. Kerman SF, Navidian A, Ebrahimi TE, Ghaderi S, Zirak M. Effect of home-based continuous care model on the quality of life of patients with myocardial infarction. Med Surg Nurs J. 2017;6(2):17–27.
    1. Cragun D, Zierhut H. Development of FOCUS-GC: framework for outcomes of clinical communication services in genetic counseling. J Genet Couns. 2018 Feb 12;27(1):33–58. doi: 10.1007/s10897-017-0145-0. 10.1007/s10897-017-0145-0
    1. Jager AJ, Wynia MK. Who gets a teach-back? Patient-reported incidence of experiencing a teach-back. J Health Commun. 2012 Oct;17(Suppl 3):294–302. doi: 10.1080/10810730.2012.712624.
    1. Sardi L, Idri A, Fernández-Alemán JL. A systematic review of gamification in e-Health. J Biomed Inform. 2017 Jul;71:31–48. doi: 10.1016/j.jbi.2017.05.011. S1532-0464(17)30106-5
    1. Bol N, van Weert JC, de Haes HC, Loos EF, Smets EM. The effect of modality and narration style on recall of online health information: results from a Web-based experiment. J Med Internet Res. 2015 Apr 24;17(4):e104. doi: 10.2196/jmir.4164. v17i4e104
    1. Krasulak M. Use of gamification in the process of selection of candidates for the position in the opinion of young adults in Poland. Jagiellonian J Manage. 2015;1(3):203–215. doi: 10.4467/2450114XJJM.15.015.4472.
    1. Antonaci A, Klemke R, Stracke Cm, Specht M. Towards implementing gamification in MOOCs. International Conference on Games and Learning Alliance; 2017; Portugal. 2017.
    1. Urh M, Vukovic G, Jereb E, Pintar R. The model for introduction of gamification into e-learning in higher education. Procedia: Soc Behav Sci. 2015;197:388–397. doi: 10.1016/j.sbspro.2015.07.154.
    1. Sanaie N, Bahramnezhad F, Zolfaghari M, Alhani F. The effect of family-centered empowerment model on treatment plans adherence of patients undergoing coronary artery bypass graft. Crit Care Nurs J. 2016 Jul 17;In Press(In Press):23–30. doi: 10.17795/ccn-6494.
    1. Negarandeh R, Mahmoodi H, Noktehdan H, Heshmat R, Shakibazadeh E. Teach back and pictorial image educational strategies on knowledge about diabetes and medication/dietary adherence among low health literate patients with type 2 diabetes. Prim Care Diabetes. 2013 Jul;7(2):111–8. doi: 10.1016/j.pcd.2012.11.001.S1751-9918(12)00221-5
    1. Ghanbari R, Nourozi Tabrizi K, Dalvandi A, Kavari H, Noroozi M. Effect of an effect of an educational program based on the teach-back method on adherence to treatment regimen in dialysis patients with end stage renal disease referred to Sina Hospital during 2015-2016. Iran J Rehabilitation Res Nurs. 2015;3(4):123–129.
    1. Dalir Z, Reihani Z, Mazlom R, Vakilian F. Effect of training based on teach back method on self-care in patients with heart failure. J Maz Univ Med Sci. 2016;25(134):209–220. [Persian]
    1. White M, Garbez R, Carroll M, Brinker E, Howie-Esquivel J. Is "teach-back" associated with knowledge retention and hospital readmission in hospitalized heart failure patients? Journal of Cardiovascular Nursing. J Cardiovasc Nurs. 2013;28(2):137–146. doi: 10.1097/jcn.0b013e31824987bd.
    1. Allam A, Kostova Z, Nakamoto K, Schulz PJ. The effect of social support features and gamification on a Web-based intervention for rheumatoid arthritis patients: randomized controlled trial. J Med Internet Res. 2015 Jan 09;17(1):e14. doi: 10.2196/jmir.3510. v17i1e14

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