Expectations about health and disease are known to directly affect health and treatment outcomes in healthy as well as in patient populations. The goal of this project was to apply this knowledge in the development of an innovative therapeutic intervention that combines implicit and explicit methods and can be used in healthy and patient populations with the aim to improve health outcomes. Furthermore, we aimed to test its usability and feasibility in a small group of healthy individuals and patients with chronic health conditions.
In Phase 1 (intervention development), the components of the multimodal training tool (i.e. eHealth and serious gaming content) were developed. First drafts of the serious gaming content were designed based on brainstorm sessions including members of the research group, external experts, and technical and design experts of a commercial game development company. In an iterative process, these drafts were further improved by the game development company based on continuous feedback from the research group and multiple functionality tests. Content for the eHealth environment was developed based on previous tailored eHealth modules, and combined with the serious gaming elements to form a comprehensive multimodal intervention.
The content of the eHealth and serious game elements was designed to be beneficial for health improvement in both healthy and patient populations. In the eHealth environment, the following modules were used to target conscious health-related processes: Goal Setting (introduction module) Relaxation, Lifestyle, Energy and Sleep, Thoughts and Your View on the World, and Long-term goals (final module). In the serious game, the same thematic elements were used in a gamified setting to influence subconscious health-related processes. Because the same thematic elements were used in both intervention components, they formed a unified whole as a multimodal intervention.
In Phase 2 (usability testing), the multimodal intervention was then subjected to further usability testing; 5 healthy individuals and 5 patients with chronic health conditions (i.e. chronic pain conditions and/or chronic skin conditions) were included in a usability study. Results of this study showed that healthy individuals and patients highly rated the design and user-friendliness of both the serious gaming content as well as the eHealth environment. Other elements that were highly rated by participants included the personal contact with an eCoach and the thematic content of the intervention. Based on the results of this phase, some changes were made in the intervention (e.g. refinement of the design of specific stimuli in the gaming environment and some minor text-based changes in the eHealth content, to improve clarity), and further changes (e.g. extension of the gaming content) will be made in the future.
In Phase 3 (feasibility testing), 5 healthy individuals and 5 patients with chronic health conditions participated in the multimodal intervention and were asked to fill out pre- and post-intervention questionnaires to assess the feasibility and preliminary intervention effects. The majority of participants completed the entire intervention and filled out all measurements, suggesting that the intervention was feasible. Participants generally felt that the eHealth environment positively affected their health and found especially the contact with the eCoach and the goal-setting elements very useful. Furthermore, despite the fact that 70% of participants reported to never play computer games in their daily lives, participants felt very capable in using the serious gaming elements, and rated it as being very clear, inviting, and attractive. Results of this phase further indicated that participants would like the option to use the intervention as an app and would appreciate an extension of the levels/challenges within the serious gaming content. Lastly, some users indicated that they would like to have more choice in avatar options.
To conclude, this project has resulted in a professional and user-friendly first version of a multimodal intervention that is feasible to use in healthy as well as in patient populations to positively affect health. In addition to the overall positive evaluation of content and user-friendliness of the intervention, this project has identified several areas to further extend and improve of the intervention that went beyond the scope of the current project (i.e. extending the intervention for use on mobile appliances, extending the challenges/levels in the intervention, and further extending the choice of avatar options). Results of this project may be used to further improve the intervention for further commercialization.
