Background: Globally, 3 out of 20 children experience sexual abuse before the age of 18 years. Educating children about sexual abuse and prevention is an evidence-based strategy that is recommended for ending child sexual abuse. Digital games are increasingly being used to influence healthy behaviors in children and could be an efficient and friendly approach to educating children about sexual abuse prevention. However, little is known on the best way to develop a culturally sensitive game that targets children in Africa—where sexual education is still taboo—that would be engaging, effective, and acceptable to parents and caretakers. Objective: This study aimed to develop a socioculturally appropriate, mobile-based game for educating young children (<5 years) and parents and caretakers in Tanzania on sexual abuse prevention. Methods:  HappyToto children’s game was co-designed with 111 parents and caretakers (females: n=58, 52.3%; male: n=53, 47.7%) of children below 18 years of age and 24 child experts in Tanzania through surveys and focus group discussions conducted from March 2020 to April 2020. From these, we derived an overview of topics, sociocultural practices, social environment, and game interface designs that should be considered when designing child sexual abuse prevention (CSAP) education interventions. We also conducted paper prototyping and storyboarding sessions for the game’s interface, storylines, and options. To validate the application’s prototype, 32 parents (females: n=18, 56%; males: n=14, 44%) of children aged 3-5 years and 5 children (females: n=2, 40%; males: n=3, 60%) of the same age group played the game for half an hour on average. The parents undertook a pre-post intervention assessment on confidence and ability to engage in CSAP education conversations, as well as exit surveys on the usability and sociocultural acceptability of the game, while children were quizzed on the topics covered and their enjoyment of the game. Results: Parents and caregivers showed interest in the developed game during the conducted surveys, and each parent on average navigated through all the parts of the game. The confidence level of parents in talking about CSAP increased from an average of 3.56 (neutral) before using the game to 4.9 (confident) after using the game. The ability scores, calculated based on a range of topics included in CSAP education talks with children, also increased from 5.67 (out of 10) to 8.8 (out of 10) after the game was played. Both confidence level and ability scores were statistically significant (P<.001). All 5 children were interested in the game and enjoyed the game-provided activities. Conclusions: The HappyToto game can thus be an effective technology-based intervention for improving the knowledge and skills of parents and children in CSAP education.

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Background: Poor self-management of heart failure (HF) contributes to devastating health consequences. Our innovative sensor-controlled digital game (SCDG) integrates data from sensors to trigger game rewards, progress, and feedback based on the real-time behaviors of individuals with HF. Objective: The aim of this study is to compare daily weight monitoring and physical activity behavior adherence by older adults using an SCDG intervention versus a sensors-only intervention in a feasibility randomized controlled trial. Methods: English-speaking adults with HF aged 55 years or older who owned a smartphone and could walk unassisted were recruited from Texas and Oklahoma from November 2019 to August 2020. Both groups were given activity trackers and smart weighing scales to track behaviors for 12 weeks. The feasibility outcomes of recruitment, retention, intervention engagement, and satisfaction were assessed. In addition to daily weight monitoring and physical activity adherence, the participants’ knowledge, functional status, quality of life, self-reported HF behaviors, motivation to engage in behaviors, and HF-related hospitalization were also compared between the groups at baseline and at 6, 12, and 24 weeks. Results: A total of 38 participants with HF—intervention group (IG; 19/38, 50%) and control group (CG; 19/38, 50%)—were enrolled in the study. Of the 38 participants, 18 (47%) were women, 18 (47%) were aged 65 years or older, 21 (55%) had been hospitalized with HF in the past 6 months, and 29 (76%) were White. Furthermore, of these 38 participants, 31 (82%)—IG (15/19, 79%) and CG (16/19, 84%)—had both weight monitoring and physical activity data at the end of 12 weeks, and 27 (71%)—IG (14/19, 74%) and CG (13/19, 68%)—participated in follow-up assessments at 24 weeks. For the IG participants who installed the SCDG app (15/19, 79%), the number of days each player opened the game app was strongly associated with the number of days the player engaged in weight monitoring (r=0.72; P=.04) and the number of days with physical activity step data (r=0.9; P<.001). The IG participants who completed the satisfaction survey (13/19, 68%) reported that the SCDG was easy to use. Trends of improvement in daily weight monitoring and physical activity in the IG, as well as within-group improvements in HF functional status, quality of life, knowledge, self-efficacy, and HF hospitalization in both groups, were observed in this feasibility trial. Conclusions: Playing an SCDG on smartphones was feasible and acceptable for older adults with HF for motivating daily weight monitoring and physical activity. A larger efficacy trial of the SCDG intervention will be needed to validate trends of improvement in daily weight monitoring and physical activity behaviors. Trial Registration: ClinicalTrials.gov NCT03947983; https://clinicaltrials.gov/ct2/show/NCT03947983

This is the abstract only. Read the full text free (open access) on the JMIR Serious Games website. JMIR is the leading ehealth publisher: fast peer-review - open access - high impact.

Background: Poor self-management of heart failure (HF) contributes to devastating health consequences. Our innovative sensor-controlled digital game (SCDG) integrates data from sensors to trigger game rewards, progress, and feedback based on the real-time behaviors of individuals with HF. Objective: The aim of this study is to compare daily weight monitoring and physical activity behavior adherence by older adults using an SCDG intervention versus a sensors-only intervention in a feasibility randomized controlled trial. Methods: English-speaking adults with HF aged 55 years or older who owned a smartphone and could walk unassisted were recruited from Texas and Oklahoma from November 2019 to August 2020. Both groups were given activity trackers and smart weighing scales to track behaviors for 12 weeks. The feasibility outcomes of recruitment, retention, intervention engagement, and satisfaction were assessed. In addition to daily weight monitoring and physical activity adherence, the participants’ knowledge, functional status, quality of life, self-reported HF behaviors, motivation to engage in behaviors, and HF-related hospitalization were also compared between the groups at baseline and at 6, 12, and 24 weeks. Results: A total of 38 participants with HF—intervention group (IG; 19/38, 50%) and control group (CG; 19/38, 50%)—were enrolled in the study. Of the 38 participants, 18 (47%) were women, 18 (47%) were aged 65 years or older, 21 (55%) had been hospitalized with HF in the past 6 months, and 29 (76%) were White. Furthermore, of these 38 participants, 31 (82%)—IG (15/19, 79%) and CG (16/19, 84%)—had both weight monitoring and physical activity data at the end of 12 weeks, and 27 (71%)—IG (14/19, 74%) and CG (13/19, 68%)—participated in follow-up assessments at 24 weeks. For the IG participants who installed the SCDG app (15/19, 79%), the number of days each player opened the game app was strongly associated with the number of days the player engaged in weight monitoring (r=0.72; P=.04) and the number of days with physical activity step data (r=0.9; P<.001). The IG participants who completed the satisfaction survey (13/19, 68%) reported that the SCDG was easy to use. Trends of improvement in daily weight monitoring and physical activity in the IG, as well as within-group improvements in HF functional status, quality of life, knowledge, self-efficacy, and HF hospitalization in both groups, were observed in this feasibility trial. Conclusions: Playing an SCDG on smartphones was feasible and acceptable for older adults with HF for motivating daily weight monitoring and physical activity. A larger efficacy trial of the SCDG intervention will be needed to validate trends of improvement in daily weight monitoring and physical activity behaviors. Trial Registration: ClinicalTrials.gov NCT03947983; https://clinicaltrials.gov/ct2/show/NCT03947983

This is the abstract only. Read the full text free (open access) on the JMIR Serious Games website. JMIR is the leading ehealth publisher: fast peer-review - open access - high impact.

Serious games show a lot of potential for use in movement rehabilitation (eg, after a stroke, injury to the spinal cord, or limb loss). However, the nature of this research leads to diversity both in the background of the researchers and in the approaches of their investigation. Our close examination and categorization of virtual training software for upper limb prosthetic rehabilitation found that researchers typically followed one of two broad approaches: (1) focusing on the game design aspects to increase engagement and muscle training and (2) concentrating on an accurate representation of prosthetic training tasks, to induce task-specific skill transfer. Previous studies indicate muscle training alone does not lead to improved prosthetic control without a transfer-enabling task structure. However, the literature shows a recent surge in the number of game-based prosthetic training tools, which focus on engagement without heeding the importance of skill transfer. This influx appears to have been strongly influenced by the availability of both software and hardware, specifically the launch of a commercially available acquisition device and freely available high-profile game development engines. In this Viewpoint, we share our perspective on the current trends and progress of serious games for prosthetic training.

This is the abstract only. Read the full text free (open access) on the JMIR Serious Games website. JMIR is the leading ehealth publisher: fast peer-review - open access - high impact.

Serious games show a lot of potential for use in movement rehabilitation (eg, after a stroke, injury to the spinal cord, or limb loss). However, the nature of this research leads to diversity both in the background of the researchers and in the approaches of their investigation. Our close examination and categorization of virtual training software for upper limb prosthetic rehabilitation found that researchers typically followed one of two broad approaches: (1) focusing on the game design aspects to increase engagement and muscle training and (2) concentrating on an accurate representation of prosthetic training tasks, to induce task-specific skill transfer. Previous studies indicate muscle training alone does not lead to improved prosthetic control without a transfer-enabling task structure. However, the literature shows a recent surge in the number of game-based prosthetic training tools, which focus on engagement without heeding the importance of skill transfer. This influx appears to have been strongly influenced by the availability of both software and hardware, specifically the launch of a commercially available acquisition device and freely available high-profile game development engines. In this Viewpoint, we share our perspective on the current trends and progress of serious games for prosthetic training.

This is the abstract only. Read the full text free (open access) on the JMIR Serious Games website. JMIR is the leading ehealth publisher: fast peer-review - open access - high impact.