PROOF OF CONCEPT
According to Common Sense Media, about 67% of 5- to 8-year-olds own a mobile device, and spend, on average, an hour and 15 minutes a day using mobile media. Another study of youth from 2020 found that Roblox and Minecraft are the most popular games among children, both of which use avatar and role-play to navigate the game.
Kids at highest risk of obesity and diabetes are low-income, African-American and Hispanic. African-American and Hispanic parents also report being more accepting of their kids screen time, compared to other groups, and to believe in the educational benefits of these outlets.
The most popular health apps downloaded for children have 3 common features: avatars, gaming, and connection to social media (Common Sense Media).
Daily app usage among children rose to an all-time high during COVID-19, and experts believe this will never return to pre-COVID times.
THE SCIENCE BEHIND IT
Games, visualizations, and simulations have been effectively used over the past decade to influence BEHAVIOR CHANGE, such as eating nutritious foods and getting more active. Studies on the effectiveness of health apps have been shown in pediatric populations, and broadly to improve health practices associated with type 1 diabetes, obesity, and pain management.
Providers are now, more than ever, incentivized to find practical and innovative solutions to improve PATIENT ENGAGEMENT to ensure patients follow through with their treatment and are involved in decision-making.
With growing access and affordability of mobile devices, GAMING TRENDS favor a steep rise in gaming. Well-designed game apps will be essential clinical tools to promote children’s compliance with their care plan.
BEHAVIOR CHANGE
A 2021 scoping review of 148 smartphone-based interventions for physical activity concluded that these are promising strategies for improving PA in adolescents and adults.
A systematic review of 27, mostly randomized clinical trials, found modest evidence that health and fitness apps are effective at improving diet and physical activity among children and adults. The greatest benefit appears to be with multiple components compared to stand-alone apps. That is, patients saw better outcomes when the app was used in conjunction with other components, such as physical activity equipment, parental education, or face-to-face counseling.
High quality apps with strong foundations in behavioral change theory are effective at improving physical activity in adolescents.
Gaming apps have been shown to be more effective at improving children’s healthy food choice when they are repeatedly exposed to characters they liked, compared to children who did not like their character. The avatar choice has influences on men and women as well – when they were depicted by avatar’s that resembled them in virtual worlds, they were more likely to model the healthy behaviors of the avatar.
A review of 50 digital interventions for cancer management in all age groups concluded that they can be powerful tools at supporting patient health.
Digital health interventions are increasingly being used by providers to manage children’s health in other areas, such as asthma1 and mental health.
PATIENT ENGAGEMENT
The shift toward value-based care makes it clear that the Centers for Medicare and Medicaid Services (CMS) as well as private insurers are prioritizing quality of care and health outcomes in their reimbursement models.
mHealth can be a critical part of any medical practice’s patient engagement strategies. They make patient communication convenient, and improve patient engagement, especially when they allow for easier tracking of vital patient health data, provide feedback, coaching, and educational information.
Developers and health care providers are making greater efforts to make health apps interoperable with their EMRs. There is significant patient interest in mHealth and surveys show greater patient satisfaction when telemedicine options are in place.
VISIONARIES IN HEALTH TECHNOLOGY
Many thought leaders in the gaming industry view gaming interventions as a clear part of our future. They believe games can be cultivated to help us solve problems and improve our lives.
“…We thus call games “pastimes” and regard them as trifling fillers of the interstices of our lives. But they are much more important than that. They are clues to the future. And their serious cultivation now is perhaps our only salvation.” -Bernard Suits, Philosopher
“Anyone who sees a hurricane coming should warn others. I see a hurricane coming. Over the next generation or two, ever larger numbers of people, hundreds of millions, will become immersed in virtual worlds and online games. While we are playing, things we used to do on the outside, in “reality,” won’t be happening anymore, or won’t be happening in the same way. You can’t pull millions of person-hours out of a society without creating an atmospheric-level event… The exodus of these people from the real world, from our normal daily life, will create a change in social climate that makes global warming look like a tempest in a teacup.” - Edward Castronova, Professor
Jane McGonigal, PhD, author of the New York Times bestseller, Reality is Broken: Why Games Make Us Better and How They Can Change the World, was named as one of the ten most important innovators to watch in Business Week and has been featured The Economist.
Dr. McGonigal is the Director of Game Research and Development at the
Institute for the Future, a non-profit spin-off from the RAND Corporation in
Palo Alto, CA.
The Re-Mission games for young cancer patients were
conceived by Pam Omidyar and designed based on research
by the nonprofit HopeLab Foundation, with direct input from
young cancer patients and oncology doctors and nurses, and
game developers.
RESEARCH AND PUBLICATIONS
Impact of Digital Interventions on Children
Fox, J., Bailenson, J.N., & Binney, J. (2009). Virtual experiences, physical behaviors: The effect of presence on imitation of an eating avatar. PRESENCE: Teleoperators & Virtual Environments, 18(4), 294-303. https://doi.org/10.1162/pres.18.4.294
Gamberini, L., Barresi, G., Maier, A., & Scarpetta, F. 2008. A game a day keeps the doctor away: A short review of computer games in mental healthcare. Journal of CyberTherapy and Rehabilitation, 1(2), 127-145.
Kato, P. M. 2010. Video games in health care: Closing the gap. Review of General Psychology, 14(2), 113.
Graafland, M., Schraagen, J. M., & Schijven, M. P. 2012. Systematic review of serious games for medical education and surgical skills training. British journal of surgery, 99(10), 1322-1330.
Interactive Cause and Effect Comic-book Storytelling for Improving Nutrition Outcomes in Children. (2015). Amresh, A., Sinha, M., Birr, R., and Salla, R. DH '15: Proceedings of the 5th International Conference on Digital Health 2015. 9-14. https://doi.org/10.1145/2750511.2750533
Domin, A., Spruijt-Metz, D., Theisen, D., Ouzzahra, Y., & Vögele, C. (2021). Smartphone-Based Interventions for Physical Activity Promotion: Scoping Review of the Evidence Over the Last 10 Years. JMIR mHealth and uHealth, 9(7), e24308. https://doi.org/10.2196/24308
Schoeppe, S., Alley, S., Van Lippevelde, W., Bray, N. A., Williams, S. L., Duncan, M. J., & Vandelanotte, C. (2016). Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour: a systematic review. The international journal of behavioral nutrition and physical activity, 13(1), 127. https://doi.org/10.1186/s12966-016-0454-y
Lee, A. M., Chavez, S., Bian, J., Thompson, L. A., Gurka, M. J., Williamson, V. G., & Modave, F. (2019). Efficacy and Effectiveness of Mobile Health Technologies for Facilitating Physical Activity in Adolescents: Scoping Review. JMIR mHealth and uHealth, 7(2), e11847. https://doi.org/10.2196/11847
Ghazisaeidi, M., Safdari, R., Goodini, A., Mirzaiee, M., & Farzi, J. (2017). Digital games as an effective approach for cancer management: Opportunities and challenges. Journal of education and health promotion, 6, 30. https://doi.org/10.4103/jehp.jehp_146_14
Putnam, M. M., Richmond, E. M., Brunick, K. L., Wright, C. A., & Calvert, S. L. (2018). Influence of a Character-Based App on Children's Learning of Nutritional Information: Should Apps Be Served with a Side of Media Characters?. Games for health journal, 7(2), 121–126. https://doi.org/10.1089/g4h.2017.0116
Hswen, Y., Murti, V., Vormawor, A. A., Bhattacharjee, R., & Naslund, J. A. (2013). VIRTUAL AVATARS, GAMING, AND SOCIAL MEDIA: DESIGNING A MOBILE HEALTH APP TO HELP CHILDREN CHOOSE HEALTHIER FOOD OPTIONS. Journal of mobile technology in medicine, 2(2), 8–14. https://doi.org/10.7309/jmtm.2.2.3
Ferrante, G., Licari, A., Marseglia, G. L., & La Grutta, S. (2021). Digital health interventions in children with asthma. Clinical and experimental allergy: journal of the British Society for Allergy and Clinical Immunology, 51(2), 212–220. https://doi.org/10.1111/cea.13793
Hollis, C., Falconer, C. J., Martin, J. L., Whittington, C., Stockton, S., Glazebrook, C., & Davies, E. B. (2017). Annual Research Review: Digital health interventions for children and young people with mental health problems - a systematic and meta-review. Journal of child psychology and psychiatry, and allied disciplines, 58(4), 474–503. https://doi.org/10.1111/jcpp.12663
TECHNOLOGY FOR PATIENT ENGAGEMENT
Bhavnani, S. P., Narula, J., & Sengupta, P. P. (2016). Mobile technology and the digitization of healthcare. European heart journal, 37(18), 1428–1438. https://doi.org/10.1093/eurheartj/ehv770
Laing, S. S., Ocampo, P., Ocampo, C., Caravalho, J., Perez, G., & Baugh, S. (2021). Provider perceptions of mHealth engagement for low-resourced, safety-net communities. Public health nursing (Boston, Mass.), 38(1), 13–21. https://doi.org/10.1111/phn.12811
Kao, C. K., & Liebovitz, D. M. (2017). Consumer Mobile Health Apps: Current State, Barriers, and Future Directions. PM & R : the journal of injury, function, and rehabilitation, 9(5S), S106–S115. https://doi.org/10.1016/j.pmrj.2017.02.018
Higgins J. P. (2016). Smartphone Applications for Patients' Health and Fitness. The American journal of medicine, 129(1), 11–19. https://doi.org/10.1016/j.amjmed.2015.05.038
MEDIA USAGE TRENDS AMONG CHILDREN
Rideout, V., & Robb, M. B. (2020). The Common Sense census: Media use by kids age zero to eight, 2020. San Francisco, CA: Common Sense Media
Perez, S. (2020). Kids now spend nearly as much time watching TikTok as YouTube in US, UK and Spain. TechCrunch.