A systematic review of game technologies for pediatric patients

[EN] Children in hospital are subjected to multiple negative stimuli that may hinder their development and social interactions. Although game technologies are thought to improve children's experience in hospital, there is a lack of information on how they can be used effectively. This paper presents a systematic review of the literature on the existing approaches in this context to identify gaps for future research. A total of 1305 studies were identified, of which 75 were thoroughly analyzed according to our review protocol. The results show that the most common approach is to design mono-user games with traditional computers or monitor-based video consoles, which serve as a distractor or a motivator for physical rehabilitation for primary school children undergoing fearful procedures such as venipuncture, or those suffering chronic, neurological, or traumatic diseases/injures. We conclude that, on the one hand, game technologies seem to present physical and psychological benefits to pediatric patients, but more research is needed on this. On the other hand, future designers of games for pediatric hospitalization should consider: 1. The development for kindergarten patients and adolescents, 2. Address the psychological impact caused by long-term hospitalization, 3. Use collaboration as an effective game strategy to reduce patient isolation, 4. Have purposes other than distraction, such as socialization, coping with emotions, or fostering physical mobility, 5. Include parents/caregivers and hospital staff in the game activities; and 6. Exploit new technological artifacts such as robots and tangible interactive elements to encourage intrinsic motivation.This work is supported by the Spanish Ministry of Economy and Competitiveness and the European Development Regional Fund (EDRF-FEDER) with Project TIN2014-60077-R.El Jurdi, S.; Montaner-Marco, J.; García Sanjuan, F.; Jaén Martínez, FJ.; Nácher-Soler, VE. (2018). A systematic review of game technologies for pediatric patients. Computers in Biology and Medicine. 97:89-112. https://doi.org/10.1016/j.compbiomed.2018.04.019S891129

Therapeutic serious game design guidelines for stimulating cognitive abilities of children with speech and language delay

The creation of an effective therapeutic serious game (TSG) is highly dependent upon its design and the fundamental knowledge of the users. Furthermore, the TSG is designed for a purpose to the users by incorporating the needs of the users in all design components.Although numerous studies have been conducted on guidelines for designing serious games, to date, studies on the specific TSG’s design guidelines for stimulating the cognitive ability of children with speech and language delay (CSLD) has yet to be comprehensively studied.Therefore, this study focuses on the set of design guidelines for the development of TSG for CSLD, specifically on cognitive stimulation.The TSG design guidelines in this paper are derived through the study of relevant literature, and best practices gained from interviews with experts in the area of speech pathology.These guidelines would be useful for researchers and game designers to design TSG for CSLD focusing on cognitive stimulation

Using design to improve the healthcare experiences for children and young persons in primary care practices

Context of research: This thesis aims to develop design recommendations for primary care environments and medical equipment to improve the experience for children and young persons. Children and young persons may be particularly vulnerable to additional stress when trying to make sense of their medical care experiences due to the varying cognitive developmental level. The design of healthcare facilities has focused on functional effectiveness but has tended to ignore the psychological needs of the patients. Clinical environments and medical equipment have been found to impose an added stress for patients who are already suffering with the anxiety of illness. Methodology: Surveys and interviews were carried out with parents, healthcare professionals and design stakeholders to explore aspects of primary care environments and medical equipment. Parents (n = 228) were asked to rate twelve statements about emotions that their child might feel in waiting rooms, treatment rooms and about medical equipment. Semi-structured interviews (n = 4) were conducted with healthcare professionals with experience treating children and young persons. In-depth interviews (n = 10) were conducted with healthcare and children s design stakeholders including healthcare architects, medical product designers, children s product designers and healthcare practice staff. The topics explored included the processes and resources used in design and the main barriers faced, experiences of designing for children, young persons and people of different ages and the difficulties encountered. Findings: The parent and healthcare professional data identified that experiences were largely dictated by the provision of entertainment material, use of distraction, general décor of environments, behaviour of healthcare professionals towards both child and parent, and how the parent behaved in front of their child. The results from the design stakeholder interviews showed evidence of increased use of user-centred design techniques being incorporated into new, modern practices to respond to the psychological needs of patients but that also the provision of resources and standards could be a barrier to improved design options. The recommendations will encourage the inclusion of children- and young people-friendly design in current and future healthcare environments, and recommendations for future research

Development and evaluation of a training program for pediatric residents on physical activity interventions

Physical activity (PA) provides numerous health benefits; however, PA levels decline as children age. Primary care-based physical activity interventions (PAI) are moderately effective in increasing youth PA levels. Medical organizations recommend that physicians provide PAI; however, physician PAI rates are low. There are several barriers to PAI, including physicians' lack of PAI knowledge and skills. PAI medical education is severely limited. Therefore, there is a need to develop and evaluate medical education PAI curricula. The primary purpose of this study was to develop, implement, and evaluate a PAI curriculum for pediatric residents; focusing on pre to posttest changes in residents' PAI knowledge, attitudes, and behaviors (KAB). The secondary purpose was to determine residents' perceptions of the instructional strategies. An embedded mixed methods design was used, with qualitative data embedded in quantitative data. Participants (n = 13) were administered the KAB Assessment before and after the program and a Participant Feedback form after the program. Additionally, instructor field notes and focus group responses were collected. A paired t test showed a significant pretest to posttest increase in PAI knowledge scores. A MANOVA indicated a significant increase in positive PAI attitudes. Follow-up univariate analyses showed significant effects and near significant effects for the attitudes constructs of perceived knowledge and feasibility, respectively. Paired t tests showed a significant increase only for the PAI behavior of PA prescription. However, participants reported higher rates of PAI behaviors than in previous literature. Most useful, least useful, and alternative instructional strategies were considered; along with limitations, strengths, and future directions for this PAI curriculum study

The development and feasibility of gamified digital intervention aiming to promote physical activity in early childhood

This study aimed to develop a gamified digital intervention aiming to promote physical activity in early childhood. A further aim was to evaluate the feasibility of the intervention among the target group in child health clinics. The study consists of two phases. The development phase – a cross-sectional correlational study explored developmental factors associated with active play behaviour of 2.5-year-old toddlers (n = 717). Data were collected in child health clinics and consisted of the assessment of child’s neurological development and preference to participate in active play. Data were analyzed statistically. The results showed that delayed gross motor skills, self-help skills and auditory perception were negatively associated with a child’s preference to participate in physically active play. A quantitative systematic review explored previous gamified digital interventions that enhanced the physical activity self-efficacy of children. Data were collected from five electronic databases and analyzed narratively and statistically. The results showed that the gamified digital interventions are effective in enhancing the physical activity self-efficacy of children. The results from a correlational study and systematic review, together with National Physical Activity Recommendations, contributed to the development of the intervention. The feasibility and piloting phase – a mixed-method post-test feasibility study – evaluated the usability and acceptability of the intervention from the perspective of public health nurses (n = 5) and families with a child either 1.5 or 4 years old (n = 15). Data were collected using questionnaires and interviews, and analyzed statistically and with deductive qualitative content analyses. The results showed that the intervention was usable and acceptable. Suggestions for further development of the intervention consisted of simplifying the intervention, adding more gamified elements to be more attractive to children and adding more precise feedback for the parents. Based on these results, the intervention was modified and a cluster-randomized controlled study was planned to evaluate the effectiveness of the intervention.Varhaislapsuuden fyysistä aktiivisuutta edistävän pelillisen digitaalisen intervention kehittäminen ja soveltuvuus Tämän tutkimuksen tarkoituksena oli kehittää pelillisyyttä hyödyntävä digitaalinen interventio lasten fyysisen aktiivisuuden edistämiseen lastenneuvoloissa, sekä arvioida intervention soveltuvuutta lasten, perheiden ja terveydenhoitajien näkökulmasta. Tutkimus koostuu kahdesta vaiheesta. Kehittämisen vaiheessa, korrelatiivinen poikkileikkaustutkimus tutki 2,5-vuotiaiden lasten (n=717) kehityksen ja liikunnallisen leikin välisiä yhteyksiä. Aineisto kerättiin lastenneuvoloissa ja se koostui lasten neurologisen kehityksen arvioinneista ja liikunnalliseen leikkiin osallistumisen arvioinneista. Aineisto analysoitiin tilastollisin menetelmin. Tulosten mukaan motorinen kehitys, omatoimisuus ja kuullun ymmärtäminen olivat yhteydessä lapsen liikunnalliseen leikkiin osallistumiseen. Kvantitatiivisen systemaattisen katsauksen tarkoituksena oli tarkastella aiempia pelillisiä interventioita lasten fyysisen aktiivisuuden minäpystyvyyden edistämisen näkökulmasta. Aineisto kerätiin viidestä sähköisestä tietokannasta ja analysoitiin narratiivisesti ja tilastollisin menetelmin. Tulosten mukaan peli-interventiot ovat tehokkaita lasten fyysisen aktiivisuuden minäpystyvyyden edistämisessä. Korrelatiivisen tutkimuksen ja katsauksen tulokset sekä kansalliset lasten liikunnan suositukset toimivat intervention kehittämisen pohjana.  Soveltuvuuden ja pilotoinnin vaiheessa, monimenetelmäinen soveltuvuustutkimus arvioi intervention käytettävyyttä ja hyväksyttävyyttä terveydenhoitajien (n=5) sekä 1,5- ja 4-vuotiaiden lasten ja heidän perheidensä (n=15) näkökulmasta. Aineisto kerättiin kyselyin ja haastatteluin sekä analysoitiin tilastollisin menetelmin ja laadullisella deduktiivisella sisällön analyysilla. Tulosten mukaan interventio oli käytettävä ja hyväksyttävä. Tutkittavat toivat esiin intervention parantamisehdotuksia, jotka liittyivät intervention sujuvuuden ja pelillisten elementtien lisäämiseen sekä vanhemmille osoitetun yksityiskohtaisemman palautesysteemin luomiseen. Soveltuvuustutkimuksen tulosten perusteella interventiota muokattiin ja intervention vaikuttavuuden tutkimus suunniteltiin satunnaistettuna kontrolloituna tutkimuksena

Healthy eating interventions delivered in the family home: a systematic review

Unhealthy eating habits have long term health implications and can begin at a young age when children still consume the majority of their meals at home. As parents are the principal agents of change in children’s eating behaviours, the home environment is the logical location for the delivery of interventions targeting healthy family eating. Despite the recent proliferation of published studies of behaviour-change interventions delivered in the home, there has been little attempt to evaluate what makes such interventions successful. This review provides a systematic evaluation of all healthy eating interventions delivered to families in the home environment to date and seeks to identify the successful elements of these interventions and make recommendations for future work. Thirty nine studies are described, evaluated and synthesised. Results show that evidence- and theory-based interventions tended to be more successful than those that did not report detailed formative or evaluative work although details of theory application were often lacking. Careful analysis of the results did not show any further systematic similarities shared by successful interventions. Recommendations include the need for more clearly theoretically driven interventions, consistent approaches to measuring outcomes and clarity regarding target populations and desired outcomes