Reflective and Reflexive Stress Responses of Older Adults to Three Gaming Experiences In Relation to Their Cognitive Abilities: Mixed Methods Crossover Study

Assessing the Relationship Between Digital Trail Making Test Performance and IT Task Performance: Empirical Study

BACKGROUND

Cognitive functional ability affects the accessibility of IT and is thus something that should be controlled for in user experience (UX) research. However, many cognitive function assessment batteries are long and complex, making them impractical for use in conventional experimental time frames. Therefore, there is a need for a short and reliable cognitive assessment that has discriminant validity for cognitive functions needed for general IT tasks. One potential candidate is the Trail Making Test (TMT).

OBJECTIVE

This study investigated the usefulness of a digital TMT as a cognitive profiling tool in IT-related UX research by assessing its predictive validity on general IT task performance and exploring its discriminant validity according to discrete cognitive functions required to perform the IT task.

METHODS

A digital TMT (parts A and B) named Axon was administered to 27 healthy participants, followed by administration of 5 IT tasks in the form of CAPTCHAs (Completely Automated Public Turing tests to Tell Computers and Humans Apart). The discrete cognitive functions required to perform each CAPTCHA were rated by trained evaluators. To further explain and cross-validate our results, the original TMT and 2 psychological assessments of visuomotor and short-term memory function were administered.

RESULTS

Axon A and B were administrable in less than 5 minutes, and overall performance was significantly predictive of general IT task performance (F5,19=6.352; P=.001; Λ=0.374). This result was driven by performance on Axon B (F5,19=3.382; P=.02; Λ=0.529), particularly for IT tasks involving the combination of executive processing with visual object and pattern recognition. Furthermore, Axon was cross-validated with the original TMT (Pcorr=.001 and Pcorr=.017 for A and B, respectively) and visuomotor and short-term memory tasks.

CONCLUSIONS

The results demonstrate that variance in IT task performance among an age-homogenous neurotypical population can be related to intersubject variance in cognitive function as assessed by Axon. Although Axon's predictive validity seemed stronger for tasks involving the combination of executive function with visual object and pattern recognition, these cognitive functions are arguably relevant to the majority of IT interfaces. Considering its short administration time and remote implementability, the Axon digital TMT demonstrates the potential to be a useful cognitive profiling tool for IT-based UX research.

Meaningful learning: motivations of older adults in serious games

Social sustainability is the generation of significant behaviors through balanced levels of education, learning and awareness so that the population has a good standard of living, achieves self-improvement and supports society. This can be achieved with various strategies, one of which is learning through games, which has gained popularity in recent years due to positive results. This is effectively achieved through serious gaming, which is growing steadily, mostly in education and healthcare. This type of strategy has been typically used in young populations with a transparent interaction with technological processes that facilitate its application. However, one cannot neglect other populations such as the elderly, who may experience a technology gap and may not perceive this type of initiative in the best light. The purpose of this article is to identify the different motivations that can encourage older adults to use serious games to encourage learning processes through technology. For this purpose, different previous research on gaming experiences with older adults has been identified, from which it was possible to categorize a series of factors that motivate this population. Subsequently, we represented these factors by means of a model of motivation for the elderly and, to be able to use it, we have defined a set of heuristics based on this model. Finally, we used the heuristics by means of a questionnaire to evaluate the design of serious gaming for older adults, obtaining positive results for the use of these elements to guide the design and construction of serious games for learning in older adults.

Double-Bind of Recruitment of Older Adults Into Studies of Successful Aging via Assistive Information and Communication Technologies: Mapping Review

BACKGROUND

Two fields of research and development targeting the needs of the aging population of the world are flourishing, successful aging and assistive information and communication technologies (A-ICTs). The risks of ageist stereotypes emerging from how we communicate in both discourses are long known. This raises questions about whether using specific age criteria in the context of "aging deficits" can bias participation in, or compliance with, the research process by older adults who try to avoid age-related stigma.

OBJECTIVE

This study aimed to examine subject recruitment, study designs (based on age >65 years criteria), as well as discourses in research objectives and conclusions in health research on affordances of A-ICTs for older adults.

METHODS

A systematic mapping approach was used to characterize rationales, methods, stated objectives, and expected outcomes of studies indexed in PubMed and retrieved through the search logic (["Older Adults" OR Seniors OR Elderly] AND [ICT OR gerontechnology OR "Assistive Technology")] AND ("Healthy Aging" OR "Successful Aging" OR "healthy ageing" OR "successful ageing"). Inclusion criteria were as follows: the study should have recruited older participants (aged >65 years), been qualitative or quantitative research, and involved the introduction of at least one A-ICT for health-related improvements. Exclusion criteria were as follows: reviews, viewpoints, surveys, or studies that used information and communication technology for data collection instead of lifestyle interventions. Content, thematic, and discourse analyses were used to map the study characteristics and synthesize results with respect to the research question.

RESULTS

Of 180 studies that passed the search logic, 31 (17.2%) satisfied the inclusion criteria (6 randomized controlled trials, 4 purely quantitative studies, 9 focus groups, 2 observational studies, and 10 mixed methods studies). In all but one case, recruitment was pragmatic and nonrandom. Thematic analysis of rationales revealed a high likelihood of emphasis on the burdens of aging, such as rising costs of care (12/31, 39%) and age-related deficits (14/31, 45%). The objectives of the research fell under 4 categories: promotion of physical activity, acceptance and feasibility of robots and remote health monitoring systems, risk detection, and the future of A-ICTs in health care for older adults. Qualitative studies were more attentive to the nonageist research guidelines. Heterogeneity in the study results (both qualitative and quantitative) was not related to age but to individual agency, acceptance, and adherence. A combination of research strategies (participatory, longitudinal, playful, flexible, and need-based designs) proved successful in characterizing variations in study outcomes. Studies that documented recruitment dynamics revealed that fear of stigma was a factor that biased participants' engagement.

CONCLUSIONS

This review indicates that age is not an informative criterion for recruitment and retention of participants. Charting the dynamics of adoption of, and interaction with, A-ICTs is critical for advancing research and technology development.

Toward a digital citizen lab for capturing data about alternative ways of self-managing chronic pain: An attitudinal user study

Background

Myriad psychosocial and cultural factors influence personal ways of coping with chronic pain (CP). Mobile health (mHealth) apps facilitate creation of citizen laboratories outside clinical frameworks. However, issues of safety, privacy and technostress must be addressed. This attitudinal user study aimed to assess whether persons with persistent pain (PwPP) would be open to sharing qualitative and quantitative data about their self-management of CP via mHealth platforms.

Methods

In March 2020, we invited PwPPs, their personal or medical caregivers, or those interested in the development of an app for researching alternative ways of self-managing CP to complete an anonymous survey. We formulated an attitudinal survey within the theoretical framework of stress to estimate whether the novelty, unpredictability, and risks of data-sharing via mHealth apps concerned users. Descriptive statistics (% Part/Group) were used to interpret the survey, and open comments were reflectively analyzed to identify emerging themes.

Results

Of 202 responses (June 2021), 127 identified as PwPPs (average age 43.86 ± 14.97; 100/127 female), and listed several primary and secondary CP diagnoses. In almost 90% of PwPPs, physical and emotional wellbeing were affected by CP. More than 90% of PwPPs used alternative therapies (acupuncture, homeopathy, massage therapy, etc.). Attitude toward mHealth apps were positive even though nearly half of PwPPs were unfamiliar with them. More than 72% of respondents were open to using a health-related app as a research tool for data collection in real life situations. Comprehensive data collection (especially about psychosocial factors) was the most important requirement. More respondents (especially medical professionals) were concerned about health hazards of misinformation communicated via health-related information and communication systems (maximum 80%) than about privacy (maximum 40%). Qualitative analyses revealed several promises and impediments to creation of data-sharing platforms for CP.

Conclusions

This study shows a general willingness among PwPPs to become partners in studying alternative pain management. Despite a generally positive attitude toward the concept of sharing complex personal data to advance research, heterogeneity of attitudes shaped by personal experiences must be considered. Our study underlines the need for any digital strategy for CP research to be person-centered and flexible.

Depressed Mood Prediction of Elderly People with a Wearable Band

Depression in the elderly is an important social issue considering the population aging of the world. In particular, elderly living alone who has narrowed social relationship due to bereavement and retirement are more prone to be depressed. Long-term depressed mood can be a precursor to eventual depression as a disease. Our goal is how to predict the depressed mood of single household elderly from unobtrusive monitoring of their daily life. We have selected a wearable band with multiple sensors for monitoring elderly people. Depression questionnaire has been surveyed periodically to be used as the labels. Instead of working with depression patients, we recruited 14 single household elderly people from a nearby community. The wearable band provided daily activity and biometric data for 71 days. From the data, we generate a depressed mood prediction model. Multiple features from the collected sensor data are exploited for model generation. One general model is generated to be used as the baseline for the initial model deployment. Personal models are also generated for model refinement. The general model has a high recall of 80% in an MLP model. Individual models achieved an average recall of 82.7%. In this study, we have demonstrated that we can generate depressed mood prediction models with data collected from real daily living. Our work has shown the feasibility of using a wearable band as an unobtrusive depression monitoring sensor even for elderly people.

The Cognition and Flow Study (CogFlowS): A Mixed Method Evaluation of a Randomized Feasibility Trial of Cognitive Training in Dementia

Background: Cognitive training (CT) may be beneficial in delaying the onset or slowing dementia progression. CT has been evaluated quantitatively and qualitatively, but none have used mixed methods approaches. Objective: The aim of this study was to use a mixed methods approach to identify those who may selectively benefit from CT. Methods: This was an explanatory sequential mixed methods study involving a quantitative randomized trial of 12 weeks multi-domain CT in healthy older adults (HC, n = 20), and people living with mild cognitive impairment (MCI; n = 12) and dementia (n = 24). Quantitative outcomes included: cognition, mood, quality of life, and activities of daily living. 28 (10 HC, 6 MCI, 12 dementia) training participants completed semi-structured interviews with their carer. Quantitative and qualitative data were integrated using joint displays. Results: Three participants dropped out from the training early-on, leaving 25 participants with follow-up data for full integration (10 HC, 6 MCI, 9 dementia). Dropouts and lower adherence to training were more common in dementia participants with greater non-modifiable barriers. High adherers were more resilient to negative emotions, and poorer or fluctuating performance. Integrated analysis found the majority of participants (n = 24) benefited across outcomes, with no clear profile of individuals who benefited more than others. Participants made a number of key recommendations to improve adherence and minimize dropout to CT. Conclusion: Reasons for dropout and low adherence were identified, with recommendations provided for the design of CT for dementia. An individual approach to training should be adopted and low adherence should not preclude engagement with CT.

Conceptual Ambiguity Surrounding Gamification and Serious Games in Health Care: Literature Review and Development of Game-Based Intervention Reporting Guidelines (GAMING)

BACKGROUND

In health care, the use of game-based interventions to increase motivation, engagement, and overall sustainability of health behaviors is steadily becoming more common. The most prevalent types of game-based interventions in health care research are gamification and serious games. Various researchers have discussed substantial conceptual differences between these 2 concepts, supported by empirical studies showing differences in the effects on specific health behaviors. However, researchers also frequently report cases in which terms related to these 2 concepts are used ambiguously or even interchangeably. It remains unclear to what extent existing health care research explicitly distinguishes between gamification and serious games and whether it draws on existing conceptual considerations to do so.

OBJECTIVE

This study aims to address this lack of knowledge by capturing the current state of conceptualizations of gamification and serious games in health care research. Furthermore, we aim to provide tools for researchers to disambiguate the reporting of game-based interventions.

METHODS

We used a 2-step research approach. First, we conducted a systematic literature review of 206 studies, published in the Journal of Medical Internet Research and its sister journals, containing terms related to gamification, serious games, or both. We analyzed their conceptualizations of gamification and serious games, as well as the distinctions between the two concepts. Second, based on the literature review findings, we developed a set of guidelines for researchers reporting on game-based interventions and evaluated them with a group of 9 experts from the field.

RESULTS

Our results show that less than half of the concept mentions are accompanied by an explicit definition. To distinguish between the 2 concepts, we identified four common approaches: implicit distinction, synonymous use of terms, serious games as a type of gamified system, and distinction based on the full game dimension. Our Game-Based Intervention Reporting Guidelines (GAMING) consist of 25 items grouped into four topics: conceptual focus, contribution, mindfulness about related concepts, and individual concept definitions.

CONCLUSIONS

Conceptualizations of gamification and serious games in health care literature are strongly heterogeneous, leading to conceptual ambiguity. Following the GAMING can support authors in rigorous reporting on study results of game-based interventions.

Effective Gamification of the Stop-Signal Task: Two Controlled Laboratory Experiments

Background

A lack of ability to inhibit prepotent responses, or more generally a lack of impulse control, is associated with several disorders such as attention-deficit/hyperactivity disorder and schizophrenia as well as general damage to the prefrontal cortex. A stop-signal task (SST) is a reliable and established measure of response inhibition. However, using the SST as an objective assessment in diagnostic or research-focused settings places significant stress on participants as the task itself requires concentration and cognitive effort and is not particularly engaging. This can lead to decreased motivation to follow task instructions and poor data quality, which can affect assessment efficacy and might increase drop-out rates. Gamification—the application of game-based elements in nongame settings—has shown to improve engaged attention to a cognitive task, thus increasing participant motivation and data quality.

Objective

This study aims to design a gamified SST that improves participants’ engagement and validate this gamified SST against a standard SST.

Methods

We described the design of our gamified SST and reported on 2 separate studies that aim to validate the gamified SST relative to a standard SST. In study 1, a within-subject design was used to compare the performance of the SST and a stop-signal game (SSG). In study 2, we added eye tracking to the procedure to determine if overt attention was affected and aimed to replicate the findings from study 1 in a between-subjects design. Furthermore, in both studies, flow and motivational experiences were measured.

Results

In contrast, the behavioral performance was comparable between the tasks (P<.87; BF01=2.87), and the experience of flow and intrinsic motivation were rated higher in the SSG group, although this difference was not significant.

Conclusions

Overall, our findings provide evidence that the gamification of SST is possible and that the SSG is enjoyed more. Thus, when participant engagement is critical, we recommend using the SSG instead of the SST.

What Media Helps, What Media Hurts: A Mixed Methods Survey Study of Coping with COVID-19 Using the Media Repertoire Framework and the Appraisal Theory of Stress

Background

Social and physical distancing in response to the coronavirus disease (COVID-19) pandemic has made screen-mediated information and communication technologies (media) indispensable. Whether an increase in screen use is a source of or a relief for stress remains to be seen.

Objective

In the immediate aftermath of the COVID-19 lockdowns, we investigated the relation between subjective stress and changes in the pattern of media use. Based on Lazarus’s transactional model of appraisal and coping, and building on an earlier similar survey, we hypothesize that individual differences in the appraisal of media predict variations in approach or avoidance of media for coping with COVID-19 stress.

Methods

Between March 20 and April 20, 2020, a brief snowball survey entitled: “What media helps, what media hurts: coping with COVID19 through screens” was distributed via Concordia University’s mailing lists and social media (PERFORM Centre, EngAGE Centre, and Media Health Lab). Using a media repertoire method, we asked questions about preferences, changes in use, and personal appraisal of media experiences (approach, avoid, and ignore) as a result of the COVID-19 pandemic and investigated interindividual differences in media use by factors such as subjective stress, age, gender, and self-reported mental health.

Results

More than 90% of the survey respondents were in Canada and the east coast of the United States. From 685 completed responses, 169 respondents were “very stressed” and 452 were “slightly worried” about the pandemic. COVID-19 stress led to increased use of Facebook (χ²₃=11.76, P=.008), television (χ²₃=12.40, P=.006), YouTube (χ²₃=8.577, P=.04), and streaming services such as Netflix (χ²₃=10.71, P=.01). Respondents who considered their mental health “not good” were twice as likely to prefer streaming services as a coping tool for self-isolation. Women and nonbinary respondents were twice as likely than men to pick social media for coping. Individuals younger than 35 years were 3 times more likely to pick computer games, and individuals older than 55 years were more likely to pick network television or print media. Gender affected the appraisal of media (less in men than others) in terms of avoid (F_1,637=5.84, P=.02) and approach scores (F_1,637=14.31, P<.001). Subjective mental health affected the ignore score (less in those who said “good” than others; F_1,637=13.88, P<.001). The appraisal score and use increase explained variations in worrying about physical and mental health stress due to increased screen time. A qualitative analysis of open-ended questions revealed that media (especially social networks) were important for coping if they provided support and connection through the dissemination of factual and positive information while avoiding the overflow of sensational and false news.

Conclusions

The relationship between appraisal of media’s positive and negative facets vary with demographic differences in mental health resiliency. The media repertoire approach is an important tool in studies that focus on assessing the benefits and harms of screen overuse in different populations, especially in the context of the COVID-19 pandemic.