A Gamification Model to Encourage Positive Healthcare Behaviours in Young People with Long Term Conditions

EAI Endorsed Transactions on Serious Games Research Article A Gamification Model to Encourage Positive Healthcare Behaviours in Young People with Long Term Conditions Andrew S. Wilson1,*and Janet E. McDonagh2 1 School of Computing, Telecommunications and Networks. Faculty of Technology, Engineering and the Environment. Birmingham City University, Millennium Point, Curzon Street, Birmingham. B4 7XG. UK 2 University of Birmingham & Birmingham Children's Hospital NHS Foundation Trust. Steelhouse Lane, Birmingham B4 6NH UK. Abstract Young people living with long term conditions will eventually have to transfer their care to the adult setting. Failure to plan and coordinate this has been associated with poorer health outcomes and disruption to their care. Transition planning encourages both health literacy and health promoting behaviours in an age and developmentally appropriate way. In order to gauge the attainment of these skills the Birmingham Children’s Hospital Adolescent Rheumatology Team (UK) have developed a series of transitional care checklists. This paper focuses on discussing how the application of gamification (using game mechanics in non-game contexts) to these checklists could improve the engagement of young people in managing their self-care and provide a mechanism for doctors to quantifying the acquisition of these skills. Keywords: Gamification, adolescent, chronic conditions, transitional care, self-care Received on 11 December 2013, accepted on 05 March 2014, published on 22 May 2014 Copyright © 2014 Wilson and McDonagh, licensed to ICST. This is an open access article distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/3.0/), which permits unlimited use, distribution and reproduction in any medium so long as the original work is properly cited. doi: 10.4108/sg.1.2.e3 1. Introduction that is family centred. As the young person grows older they will eventually have to transfer to the adult healthcare setting. There is no set age for this in the UK but it normally occurs between 16 and 18 years of age. However it is more dependent upon local hospital policy rather than the young person’s confidence in being able to cope in the adult healthcare setting. With advances in healthcare people living with medical conditions such as asthma, diabetes, arthritis, cancer, cystic fibrosis, inflammatory bowel disease, congenital heart disease and after organ transplantation can expect to live longer and have healthier lives. The absence of a cure for these long term conditions means that in order to maintain positive health outcomes changes in behaviour for example adopting a healthier lifestyle (improving diet and taking exercise) as well as learning appropriate self-care skills are extremely important. This can be challenging for many people and potentially more so when the person diagnosed is relatively young. It is estimated that 1 in 7 11-15 year olds in England live with a long term medical condition [1] which may persist with them into their adult years. Transfer of care can be a cause of anxiety to both the young person and their family. This may be due to the change to a new physical location; they have to become familiar with a different style of healthcare environment and have to work with an unfamiliar clinical team. Studies investigating the pre-transfer period identified an increased risk for negative health outcomes if the transfer process was not appropriately managed. This included both increased incidence of graft loss in organ transplant patients [2] and an increased chance of mortality in them [3], worsening disease activity in young people with long term rheumatic conditions [4], or they are just lost in the healthcare system and consequently fail to attend clinics [5][6]. Those that Clinical care for young people who are diagnosed with a medical condition at an early age starts in an environment * Corresponding author. Email: EAI European Alliance for Innovation 1 EAI Endorsed Transactions on Serious Games 04 2013 – 05 2014 | Volume 1 | Issue 2 | e3 A.S. Wilson and J. E. McDonagh positive benefits to the young people. However we also identified that many of the games focussed on specific medical conditions and issues relating these. Therefore they would not necessarily provide all the information needed that is associated with the complex issues of transitional care. experience such lapses in healthcare have also been reported to have an increased risk of subsequent readmission to hospital [6][7]. Even in those with stable disease, poorer vocational outcomes have been reported post transfer [8]. In order to improve the chances for successful transfer it is accepted that the process should not be abrupt but purposely planned, taking into account the developmental status and readiness of the young person to negotiate the adult healthcare system [9]. This is known as transitional care and addresses the medical, psychosocial as well as educational and vocational needs of the young person. The Birmingham Children’s Hospital (BCH) Adolescent Rheumatology Team (UK) have produced a series of readiness checklists for early, mid and late adolescence which are used to help gauge how well the young person is progressing towards understanding their condition, its treatment and how to look after themselves. Education forms an important part of this but many young people and their families find it difficult to get the information they need and it is not always in appropriate style for them [10]. Therefore there is interest in how information can be presented in a youth friendly way and how technology can be used to support this [11]. Another factor in the development of computer games is the time and cost of their development. An alternative approach that takes advantage of the principles of games (fun) would be applying game mechanics to the process of knowledge and skill acquisition that are involved in transitional care. This principle is known as gamification and uses game techniques in non-game contexts. In this paper we will review the issues that are associated with transitional care, provide an overview of how transitional readiness is assessed and how gamification could be applied to the BCH Adolescent Rheumatology Team (UK) transition readiness check lists. We will discuss how this would provide an objective framework for the clinical team as well as encapsulating the processes in a more fun way in order to engage young people in understanding their medical conditions and encouraging them to actively participate in learning about and acquiring self-care skills. The internet has become an important source of health related information for young people and one in which they can actively participate for example by influencing the development of youth-centred online healthcare programmes [12][13]. It has also been recognised that with the growth of new forms of communication (...truncated)