Usability, Acceptability, Feasibility, and Effectiveness of a Gamified Mobile Health Intervention (Triumf) for Pediatric Patients: Qualitative Study

Riin Tark, Mait Metelitsa, Kirsti Akkermann, Kadri Saks, Sirje Mikkel, Kadri Haljas, Riin Tark, Mait Metelitsa, Kirsti Akkermann, Kadri Saks, Sirje Mikkel, Kadri Haljas

Abstract

Background: Mental disorders are notably prevalent in children with chronic illnesses, whereas a lack of access to psychological support might lead to potential mental health problems or disruptions in treatment. Digitally delivered psychological interventions have shown promising results as a supportive treatment measure for improving health outcomes during chronic illness.

Objective: This study aimed to evaluate the usability, acceptability, and feasibility of providing psychological and treatment support in a clinical setting via a mobile game environment. In addition, the study aimed to evaluate the preliminary effectiveness of the mobile health game.

Methods: Patients aged 7 to 14 years with less than a year from their diagnosis were eligible to participate in the study. In total, 15 patients were invited to participate by their doctor. A total of 9 patients (age range: 7-12 years; mean age 9.1 years) completed the 60-day-long study in which the Triumf mobile health game was delivered as a digital intervention. In an engaging game environment, patients were offered psychological and treatment support, cognitive challenges, and disease-specific information. The fully digital intervention was followed by a qualitative interview conducted by a trained psychologist. The results of the interview were analyzed in conjunction with patient specific in-game qualitative data. Ethical approval was obtained to conduct the study.

Results: Patients positively perceived the game, resulting in high usability and acceptability evaluations. Participants unanimously described the game as easy to use and engaging in terms of gamified activities, while also providing beneficial and trustworthy information. Furthermore, the overall positive evaluation was emphasized by an observed tendency to carry on gaming post study culmination (67%, 10/15). Psychological support and mini games were the most often used components of the game, simultaneously the participants also highlighted the education module as one of the most preferred. On average, the patients sought and received psychological support or education on 66.6 occasions during the 60-day intervention. Participants spent the most time collecting items from the city environment (on average 15.6 days, SD 8.1), indicative of exploratory behavior, based on the quantitative in-game collected data. During the intervention period, we observed a statistically significant decrease in general health problems (P=.003) and saw a trend toward a decrease in depression and anxiety symptoms.

Conclusions: This study demonstrated that a game environment could be a promising medium for delivering comprehensive supportive care to pediatric patients with cancer alongside standard treatment, with potential application across a variety of chronic conditions. Importantly, the results indicate that the study protocol was feasible with modifications to randomized controlled trials, and the game could be considered applicable in a clinical context. By giving an empirical evaluation of delivering psychological support via the game environment, our work stands to inform future mobile health interventions.

Keywords: cancer; chronic illness; coping skills; mHealth; mental health; mobile app; pediatrics; psychological feedback; psychological stress.

Conflict of interest statement

Conflicts of Interest: KH, RT, and MM are part of Triumf Health start-up and have been involved in the creation of the digital health intervention strategy. RT was one of the trained psychologists to conduct qualitative interviews.

©Riin Tark, Mait Metelitsa, Kirsti Akkermann, Kadri Saks, Sirje Mikkel, Kadri Haljas. Originally published in JMIR Serious Games (http://games.jmir.org), 30.09.2019.

Figures

Figure 1
Figure 1
Visual representation of the intervention, displaying a screenshot: (a) from the introduction to the game (storyline), (b) from customization, and (c) from the obstacle course mini-game.
Figure 2
Figure 2
Presentation of specific emotional states in emotional state-space circumplex created by core affect dimensions valence and arousal: (a) displays appearance of the prompted question, (b) displays all possible answers, whereas (c) and d) display the appearance of answers when moving towards sectors of the circumplex.
Figure 3
Figure 3
Participant flow diagram.

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