Ann DeSmet

Games for Health for Children - Current Status and Needed Research

Videogames for health (G4H) offer exciting, innovative, potentially highly effective methods for increasing knowledge, delivering persuasive messages, changing behaviors, and influencing health outcomes. Although early outcome results are promising, additional research is needed to determine the game design and behavior change procedures that best promote G4H effectiveness and to identify and minimize possible adverse effects. Guidelines for ideal use of different types of G4H by children and adolescents should be elucidated to enhance effectiveness and minimize adverse effects. G4H stakeholders include organizational implementers, policy makers, players and their families, researchers, designers, retailers, and publishers. All stakeholders should be involved in G4H development and have a voice in setting goals to capitalize on their insights to enhance effectiveness and use of the game. In the future, multiple targeted G4H should be available to meet a populations diverse health needs in developmentally appropriate ways. Substantial, consistent, and sophisticated research with appropriate levels of funding is needed to realize the benefits of G4H.

Determinants of self-reported bystander behavior in cyberbullying incidents amongst adolescents.

This study explores behavioral determinants of self-reported cyberbullying bystander behavior from a behavioral change theoretical perspective, to provide levers for interventions. Nine focus groups were conducted with 61 young adolescents (aged 12-16 years, 52% girls). Assertive defending, reporting to others, providing advice, and seeking support were the most mentioned behaviors. Self-reported bystander behavior heavily depended on contextual factors, and should not be considered a fixed participant role. Bystanders preferred to handle cyberbullying offline and in person, and comforting the victim was considered more feasible than facing the bully. Most prevailing behavioral determinants to defend or support the victim were low moral disengagement, that the victim is an ingroup member, and that the bystander is popular. Youngsters felt they received little encouragement from their environment to perform positive bystanding behavior, since peers have a high acceptance for not defending and perceived parental support for defending behavior is largely lacking. These results suggest multilevel models for cyberbullying research, and interventions are needed. With much previous research into cyberbullying insufficiently founded in theoretical models, the employed framework of the Integrative Model and Social Cognitive Theory may inspire future studies into bystander behavior.

Traditional and cyberbullying victimization as correlates of psychosocial distress and barriers to a healthy lifestyle among severely obese adolescents - a matched case-control study on prevalence and results from a cross-sectional study

BackgroundObese youth are at increased risk for peer victimization, which may heighten their risk of psychosocial problems and physical activity avoidance, and lower the effectiveness of professional and lifestyle weight-loss initiatives. Little is known about obese adolescents’ risk for victimization from cyber-bullying and how this relates to psychosocial functioning and healthy lifestyle barriers. The purpose of the study was to assess traditional and cyber-victimization among adolescents with severe obesity and its relation to psychosocial distress and barriers to healthy lifestyles.MethodsA sample of 102 obese adolescents (mean age = 15.32 ±1.71) in residential treatment was matched with 102 normal-weight youngsters from the Health Behavior in School-aged Children (HBSC) study (mean age = 15.30 ±1.73).ResultsAdolescents with obesity were significantly more often cyber-victimized than normal-weight peers. Obese youth victimized by traditional bullying experienced lower quality of life, lower motivation for physical activity and higher avoidance and emotional coping towards healthy lifestyles than those non-victimized. Obese cyber-victims experienced significantly higher suicidal ideation.ConclusionsTraditional and cyber-victimization may hinder treatment effectiveness and healthy lifestyle change in adolescents with obesity. Health professionals should pro-actively address peer victimization and psychosocial functioning during multidisciplinary obesity treatment. Schools could contribute to a better physical and psychosocial health of obese youth by implementing multi-behavioral health-promotion programs.

Mobilizing bystanders of cyberbullying : an exploratory study into behavioural determinants of defending the victim

This study explores behavioural determinants of defending behaviour in cyberbullying incidents. Three focus groups were conducted with youngsters aged 12-16 y. Major themes that were found as important behavioural determinants to defend the victim were a low moral disengagement, that the victim is an in-group member and that the bystander is popular. Bystanders preferred to handle cyberbullying offline and in person, and comforting the victim was considered more feasible than facing the bully. With a high peer acceptance of passive bystanding and lack of parental support for defending behaviour, youngsters do not receive much encouragement from their environment to exhibit defending behaviour towards victims. These preliminary results suggest befriending and peer support interventions hold promise, as well as environmental interventions with parents and teachers. These first results will need to be confirmed in more in-depth analyses and in quantitative research.

What practices do parents perceive as effective or ineffective in promoting a healthy diet, physical activity, and less sitting in children: parent focus groups

BackgroundTo support parents in improving the health of their young children, examples of effective parenting practices for a healthy diet, physical activity (PA) and sedentary behavior (SB) are needed. This study explores perceived effective and ineffective parenting practices in difficult situations concerning raising healthy children and investigates their relationship with Self-Determination Theory (SDT) and Social Cognitive Theory (SCT). The current study is formative work to inform the content of a randomized controlled trial.MethodsFour focus groups were conducted between June and October 2012 at worksites during lunch break. A total of 21 unrelated parents of primary schoolchildren (6 fathers, 15 mothers) participated. A short written questionnaire introduced typical difficult situations derived from parental anecdotal reports, concerning healthy diet, PA and SB. These situations formed the backbone for the subsequent focus group discussion. In October 2012, discussions were audio-recorded and analyzed in Nvivo to identify key response items using thematic analysis.ResultsParents experienced explaining why the child should behave healthily, monitoring, being consistent, offering alternatives, reacting empathetically, modeling, motivating, increasing intrinsic value and availability, and using time-out as effective practices, whereas anger was considered ineffective. Opinions were mixed about the effectiveness of giving as much freedom as possible, obliging, rewarding and punishing, and setting rules and agreements. Parenting practices were consistent with principles from both SDT and SCT.ConclusionsParents identified numerous perceived effective practices to respond to their child’s health-related behavior. Since many of them coincide with the evidence base and the success of a parenting program depends upon the degree to which parents’ concerns and motivations are integrated into the program design, important opportunities are created for future intervention programs.

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

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.

The IPS Fidelity Scale as a Guideline to Implement Supported Employment

Objective: Despite the wish of many people with SMI to work in a competitive job, employment rates are low. IPS is more effective than other vocational rehabilitation methods in achieving employment and its use should be extended to bridge the gap between user wish and reality. This study measures possibilities to implement IPS in Flanders, by investigating current use, barriers and facilitators across a wide range of services. Method: Semi-structured interviews with 17 vocational rehabilitation agencies were conducted, using the IPS Fidelity Scale and a list of open-ended questions on perceived barriers and opportunities. Results were analyzed via thematic analysis. Results: Results show an overall lack of implementation of IPS in Flanders, especially on the four core elements for which most evidence exists. An external style of attributing barriers to environment factors or client characteristics is apparent which could lead to a sense of resignation among counselors. Conclusions: The use of the IPS fidelity scale and open-ended questions has provided concrete levers to prepare for imple- mentation: a strong leadership in the agencies to encourage optimism towards regular employment for people with SMI; closer co-operations between employment agencies, care agencies and employers; and a more facilitating legislation concerning using IPS.

The effectiveness of asking behaviors among 9–11 year-old children in increasing home availability and children’s intake of fruit and vegetables: results from the Squire’s Quest II self-regulation game intervention

BackgroundHome environment has an important influence on children’s fruit and vegetable (FV) consumption, but children may in turn also impact their home FV environment, e.g. by asking for FV. The Squire’s Quest II serious game intervention aimed to increase asking behaviors to improve home FV availability and children’s FV intake. This study’s aims were to assess: 1) did asking behaviors at baseline predict home FV availability at baseline (T0) (RQ1); 2) were asking behaviors and home FV availability influenced by the intervention (RQ2); 3) did increases in asking behaviors predict increased home FV availability (RQ3); and 4) did increases in asking behaviors and increases in home FV availability mediate increases in FV intake among children (RQ4)?MethodsThis is a secondary analysis of a study using a randomized controlled trial, with 4 groups (each n = 100 child–parent dyads). All groups were analyzed together for this paper since groups did not vary on components relevant to our analysis. All children and parents (n = 400 dyads) received a self-regulation serious game intervention and parent material. The intervention ran for three months. Measurements were taken at baseline, immediately after intervention and at 3-month follow-up. Asking behavior and home FV availability were measured using questionnaires; child FV intake was measured using 24-h dietary recalls. ANCOVA methods (research question 1), linear mixed-effect models (research question 2), and Structural Equation Modeling (research questions 3 and 4) were used.ResultsBaseline child asking behaviors predicted baseline home FV availability. The intervention increased child asking behaviors and home FV availability. Increases in child asking behaviors, however, did not predict increased home FV availability. Increased child asking behaviors and home FV availability also did not mediate the increases in child FV intake.ConclusionsChildren influence their home FV environment through their asking behaviors, which can be enhanced via a serious game intervention. The obtained increases in asking behavior were, however, insufficient to affect home FV availability or intake. Other factors, such as child preferences, sample characteristics, intervention duration and parental direct involvement may play a role and warrant examination in future research.Trials RegistrationClinicalTrials.gov NCT01004094. Date registered 10/28/2009

Social differences in postponing a General Practitioner visit in Flanders, Belgium: which low‐income patients are most at risk?

One of the main goals of primary care is providing equitable health-care, meaning equal access, equal treatment and equal outcomes of healthcare for all in equal need. Some studies show that patients from lower socioeconomic groups visit a GP more often, while other studies show that they are more likely to postpone a visit to a GP. In this study, we want to explore within the social group of low-income patients living in Flanders, Belgium, which patients have a higher risk of postponing a visit to a GP. A face-to-face questionnaire was administered among 606 low-income users of Public Social Services. The questionnaire consisted of questions on socioeconomic and demographic characteristics, social networks, health and healthcare use. A multivariate logistic regression model was built to study the relationship between postponing or cancelling a GP visit which respondents thought they needed and variables on health, socio-demographic background. The multivariate regression indicates that depression, self-rated health and trust in the GP independently predict postponing a visit to a GP. Low-income people with a low trust in the GP, people with a poor self-rated health and people suffering from a severe depression are more likely to postpone or cancel a GP visit they thought they needed compared to other people on low incomes. This might indicate that the access to health-care for low-income people might be hindered by barriers which are not directly linked to the cost of the consultation.

SmartLife – Exergames and Smart Textiles to Promote Energy-Related Behaviours Among Adolescents

SmartLife aims to promote healthy living habits and avoid sedentary lifestyles in adolescents by creating a mobile game that requires lower body movement, and uses tailored feedback, based on physical activity indices measured by a smart shirt. To date, no serious games exist that tailor game play by real-time feedback on achievement of the target behaviour. This approach can improve current exergames by reaching higher levels of intensity in physical activity, which is needed to impact on health. The tailored approach also supports competence and feasibility and hence reduces drop-out and injury risks.