Study: Calling all diabetic gamers!

Get ready to add “gamification” to your latest buzzword toolkit. Researchers from Centre for Global eHealth Innovation, Techna Institute, University Health Network in Toronto, found that using an mHealth diabetes application (app) with the use of gamification incentives showed an improvement in the frequency of blood glucose monitoring in adolescents with type 1 diabetes.

Gamification is commonly used in other business sectors yet its application to healthcare is relatively new, wrote Joseph A. Cafazzo, PhD, and colleagues May 8 in the Journal of Medical Internet Research. The concept is the use of game design techniques, mechanics and thinking to enhance non-game experiences; this could include encouraging people to adopt applications and processes.

“The use of the rewards system and its apparent effect on eliciting positive health behavior is an example,” the authors wrote. “Although games have been used in previous healthcare behavioral interventions, few examples have demonstrated effectiveness. Rather than creating a diabetes-themed game, we believed that the use of gamelike features of routine self-management tasks would have a greater likelihood of success and could be sustained over longer periods.”

To pilot an mHealth intervention for the management of type 1 diabetes in adolescents, the researchers interviewed adolescents with type 1 diabetes and their family caregivers. Design principles were derived from a thematic analysis of the interviews. User-centered design was then used to develop the mobile app bant.

In the 12-week evaluation phase, a pilot group of 20 adolescents aged 12 to 16 years, with a glycated hemoglobin (HbA1C) of between 8 and 10 percent was sampled. Each participant was supplied with the bant app running on an iPhone or iPod Touch and a LifeScan glucometer with a Bluetooth adapter for automated transfers to the app. The outcome measure was the average daily frequency of blood glucose measurement during the pilot compared with the preceding 12 weeks.

Thematic analysis findings were the role of data collecting rather than decision making. “Design aspects of the resultant app emerged through the user-centered design process, including simple, automated transfer of glucometer readings; the use of a social community; and the concept of gamification, whereby routine behaviors and actions are rewarded in the form of iTunes music and apps,” the authors stated.

The evaluation showed that the daily average frequency of blood glucose measurement increased 50 percent (from 2.4 mg/dl to 3.6 mg/dl per day). A total of 161 rewards (average of eight rewards each) were distributed to participants. Satisfaction was high, with 88 percent stating that they would continue to use the system. Demonstrating improvements in HbA1C will require a properly powered study of sufficient duration.

“Extending this app to improved health outcomes will require the incentives to be tied not only to frequency of blood glucose monitoring but also to patient actions and decision making based on those readings such that glycemic control can be improved,” the authors concluded. “Although we cannot fully generalize these results without a control group trial, the findings indicate that the use of these design principles show promise in eliciting positive health behaviors in adolescents with type 1 diabetes.”