developing and feasibility testing a gamified ‘app’ to prevent slips, trips and falls among the...
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Developing and feasibility testing a gamified app for learning to prevent slips, trips and falls among the over 65s
Dr Paul Dewick* and Dr Emma Stanmore**Alliance Manchester Business School*; School of Nursing, Midwifery & SocialWork** The University of Manchester
Games for Health Europe, Oct’ 31st – Nov’ 1st 2016 Original Thinking Applied
With acknowledgements to Dr David Hoyle, New Charter Group
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Real World
Engagement
Learning
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;
• Slips, trips & falls: leading cause of injury, injury related disability and death in older people (Vieira et al., 2016)
• Falls costs NHS £2.3 billion in 2013 (NICE, 2013)
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Gillespie et al. (2012), 159 trials, 79193 participants
Sherrington et al. (2008) 44 trials, 9603 participants
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Motivators References Barriers ReferencesMaintaininghealthandindependence
Sarkisian etal.2005;Yardleyetal. 2006
Poorhealthandpain
Rasinaho etal. 2006;Cohen-Mansfieldetal.2003
Self- efficacy Perkinsetal. 2008;McAuley etal. 2003
Environment:availableexercisefacilities,proximitytofacilities,weather
DeGroot&Fagerstom2011;CDC,1999
Prompts Castroetal. 2001 Lackofknowledge Huietal.,2001;Rhodesetal.,1999
Music Schutzer &Graves2004;Johnsonetal.2001
GP/Dr/HCPnotpromotingorgivingadvice
Balde etal. (2003)
Demographics:male,nonsmokers,fewerdiseases&lesspain, fitatbaseline
Stigglebout etal. 2006;Umstattd &Hallam,2007
LackofTransportandcost
Yardleyetal. 2006;DeGroot&Fagerstom,2011
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Aim and objectives
• Aim: to reduce incidences of slips, trips and falls among over 65s, attenuating the related high economic, social & psychological costs
• Objectives, from a user perspective: – motivate behavioural change to routinely engage
correctly in appropriate exercises to build strength and balance; and
– improve awareness of preventative or therapeutic interventions, and to reduce the fear of falling.
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We started with game thinking….
• abstract challenge
• rules
• interactivity
• levels
• storytelling
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....combined motivational insights....
• Collapse intrinsic and extrinsic motivation
• Keller’s (1987) ARCS model
• Ryan and Deci’s (2000) self-determination theory
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….added assessment….
• Objective 1 (exercise): – ‘Correct’ balance/ strength
exercises– Progress over programme
• Objective 2 (knowledge/awareness)– Declarative knowledge – Fear of falling
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….and some design ideas….
• character• game
environment• game play• reward structure• game look/feel
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….we procured the services of a creative agency….
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….with whom we mapped and challenged our assumptions….
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…and co-developed & tested a ‘skinny’ prototype app
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Next steps
• Address immediate shortcomings of the prototype app
• Conduct focus groups to investigate older people’s views of the prototype app
• Apply for further funding to co-develop and test a fully functioning app
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References• Balde A. Figueras J. Hawking, D.A., et al. Physician advice to the elderly about
physical activity JAPA, 11 (2003), pp. 90–97• Bullen, E., (2015), Indices of Deprivation 2015: Health Deprivation and Disability
domain, available at http://www.manchester.gov.uk/download/downloads/id/23515/f5_indices_of_deprivation_2015_-_health_deprivation_and_disability.pdf, last accessed October 2016
• Castro, C.M., King, A. C., Brassington G.S. (2001) Telephone versus mail interventions for maintenance of physical activity in older adults Health Psychol, 20, pp. 438–444
• Centers for Disease Control and Prevention Neighborhood safety and prevention of physical inactivity—selected states, 1996 MMWR, 48 (1999), pp. 143–146
• Cohen-Mansfield J. Marx M.S., Guralnik J.M. (2003) Motivators and barriers to exercise in an older community-dwelling population. JAPA, 11 (2003), pp. 242–253
• De Groot G.C.L., Fagerstom L. (2011) Older adults’ motivating factors and barriers to exercise to prevent falls. Scandinavian Journal of Occupational Therapy. 18: 153-60.
• Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Sherrington, C., Gates, S., Clemson, L. M., & Lamb, S. E., (2012), Interventions for preventing falls in older people living in the community. The Cochrane Database of Systematic Reviews, 9, CD007146, doi:10.1002/14651858.CD007146.pub3
• Hui, S. S., Morrow J.R. (2001) Levels of participation and knowledge of physical activity in Hong Kong adults and their associations with age JAPA, 9, pp. 372–385
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References• Johnson G., Otto D., Clair A. A. (2001) The effects of instrumental and vocal music
on adherence to a physical rehabilitation exercise program with persons who are elderly J. Music Therapy, 2 pp. 82–96
• Keller, J., (1987), Development and use of the ARCS model of instructional design, Journal of instructional development, 10 (3), pp.2-10
• McAuley E., Jerome G., Marquez D., Elavsky S., Blissmer B. (2003a) Exercise self-efficacy in older adults: social, affective, and behavioral influences. Annals of Behavioral Medicine. 25: 1-7
• National Institute for Health and Care Excellence (2013), Falls: assessment and prevention of falls in older people. Available at https://www.nice.org.uk/ guidance/cg161
• Perkins J.M., Multhaup K.S., Perkins H.W. Barton C. (2008) Self-efficacy and participation in physical and social activity among older adults in Spain and the United States. The Gerontologist, 48, 51-58.
• Rasinaho M., Hirvensalo M., Leinonen R., Lintunen T., Rantanen T. (2006). Motives for and barriers to physical activity among older adults with mobility limitations. Journal of Aging & Physical Activity. 15. 90-102.
• Rhodes R., Martin A., Taunton J., Rhodes E., Donnelly M., Elliot J. (1999) Factors associated with exercise adherence among older adults: an individual perspective. Sports Medicine. 28 (6) 397-411.
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References• Ryan, R.M. and Deci, E.L. (2000), Self determination theory and the facilitation of
intrinsic motivation, social development and well being, American Psychologist, 55, 68-78
• Schutzer K., Graves S. (2004) Barriers and motivations to exercise in older adults. Preventive Medicine. 39. 1056-61.
• Sherrington, C. Whitney, J., Lord, S., Herbert, R., Cumming, R., Close. J., (2008), Effective Exercise for the Prevention of Falls: A Systematic Review and Meta-Analysis, J Am Geriatric Society, DOI: 10.1111/j.1532-5415.2008.02014.x
• Stigglebout M., Hopman-Rock M., Crone M., Lecher L., Van Mechelen W. (2006) Predicting older adults' maintenance in exercise participation using an integrated social psychological model. Health Education Research. 21, 1-14.
• Umstattd R.M., Hallam J. (2007) Older adults exercise behaviour: Roles of selected constructs of Social Cognitive Theory. Journal of Aging and Physical Activity. 15. 206-19.
• Vieira, E.R., Palmer, R.C., Chaves, P.H.M., (2016), Prevention of falls in older people living in the community, BMJ, 353: i1419, doi: 10.1136/bmj.i1419
• Yardley L., Bishop F., Beyer N., Hauer K., Kempen G.I., Piot-Ziegler C., Todd C. Cuttelod T., Horne M., Lanta K., Holt A.R. (2006) Older people’s views of falls-prevention interventions in six European countries. The Gerontologist. 46: 650-60.