A Pilot Study of Preadolescents Using Focus Groups to Evaluate Appeal of a Video-Based Smoking Prevention Strategy

Feasibility of mobile health game "Fume" in supporting tobacco-related health literacy among early adolescents: A three-armed cluster randomized design

OBJECTIVE

New interventions supporting health literacy and a tobacco-free lifestyle in adolescence are needed to narrow the widening gap in existing health inequalities. Health games offer potential and could be utilized for example in school healthcare, but more research is needed to increase the understanding of the effects of game elements in health interventions. The aim of this feasibility study is to determine the short-term effectiveness of the tobacco-related mobile health game Fume and a non-gamified website in comparison with a no-intervention control group, regarding tobacco-related health literacy among 10-13-year-old early adolescents. In addition, we compare the demand for and acceptability of Fume to that of the website.

METHODS

In total, 151 early adolescents participated in this single-blinded, three-armed cluster randomized trial. The participants from three municipalities in southwest Finland were randomly allocated between a group with access to the health game Fume (n = 61), a group with access to the website (n = 47), and a group with no intervention (n = 43). The intervention groups first participated in a 20-min training session with Fume/the website, and then had two weeks to use Fume/the website based on their own interest. Short-term effectiveness was measured by primary (anti-smoking self-efficacy) and secondary (smoking outcome expectations, attitudes towards tobacco use, tobacco-use motives, motivation to decline tobacco use in the future, and knowledge about tobacco) outcomes derived from the theory-based determinants of tobacco-related health literacy and evaluated with self-assessment questionnaires at baseline and post-intervention (after a two-week follow-up). For evaluating the demand, the actual use of Fume/the website was tracked during the two-week period. Regarding acceptability, the raised interest towards Fume/the website and opinions about the interventions were evaluated post-intervention. Differences were tested with the McNemar, Fisher exact, and non-parametric tests.

RESULTS

Statistically significant favorable changes during the study period were found for positive (P = 0.002) and negative (P = 0.02) smoking outcome expectations and attitudes towards cigarette smoking (P = 0.01) within the group using Fume. No statistically significant changes were detected within the website or control groups. Statistically significant differences were not found for the change in outcome variables among the three groups. The number of visits (P < 0.001), number of separate visit days (P < 0.001) and total duration of use (P < 0.001) were larger for the group using Fume than for that using the website. Fume sparked more interest in early adolescents than the website did (P <  0.001). There were no statistically significant differences in opinions about Fume and those regarding the website.

CONCLUSIONS

The intervention with embedded game elements, the health game Fume, was found to be more feasible as a tobacco-related health education intervention than the non-gamified website among early adolescents in light of demand and acceptability (raised interest). Even though no change in anti-smoking self-efficacy was found, the results of this feasibility study demonstrated favorable short-term changes with Fume in some other theory-based determinants of tobacco-related health literacy.

Optimizing ART adherence: update for HIV treatment and prevention

Optimal adherence to antiretroviral therapy (ART) is central to achieving viral suppression and positive health outcomes in HIV-infected individuals. Virally suppressed individuals can also reduce the risk of HIV transmission to uninfected partners. Hence, adherence to ART has become both an HIV treatment and an HIV prevention strategy. However, achieving optimal ART adherence can be challenging, especially over the long term. It is increasingly important for clinicians and researchers to be abreast of the most recent developments in the field as new biomedical approaches to treatment emerge and as guidelines for the use of pre-exposure prophylaxis (PrEP) are disseminated to providers serving HIV affected populations. Several reviews have described numerous ART adherence interventions that have been developed and/or tested with the most recent review including literature up to 2012. To augment the literature, we present a review of ART adherence interventions from 2013 to the present. We included peer-reviewed journals as well as abstracts from two key conferences.

Assessing the Impact of an Interactive Mobile Game on Tobacco-Related Attitudes and Beliefs: The Truth Campaign's "Flavor Monsters"

Given that over 97 percent of American teens play videogames, it is not surprising that many “games for health” target youth. Although tobacco use is the leading cause of preventable death in the United States, few digital games focus on preventing this behavior. The aims of this study were twofold: (1) to determine if youth will play a game with tobacco-related information and themes and (2) to explain the relationship between the truth^® (Legacy, Washington, DC) campaign's “Flavor Monsters” gameplay and shifts in game-related tobacco knowledge, attitudes, and beliefs. First, two versions of the game, with different amounts of tobacco-related content, were developed to examine the influence of tobacco-related content on player engagement, length of play, awareness of the truth brand, and receptivity to the game. No statistically significant differences were found for engagement (P=0.81), length of play (P=0.10), or awareness of the truth brand (P=0.67). Using an online survey through a preexisting online panel of 13–24 year olds, a longitudinal (n=693) design was used whereby exposure to messages varied naturally over time. Because of the large number of anti-tobacco industry attitude questions, we created an Anti-Tobacco Industry (ATI) Index based on the results of a factor analysis. Although gameplay was not a predictor of lower levels of intention to smoke, level mastered was a significant positive predictor of ATI Index attitudes score at 3 months, controlling for baseline ATI Index score, age, gender, and ever cigarette use (P=0.002). Longitudinal findings indicate a cumulative and enduring effect, suggesting that anti-tobacco content can be successfully integrated within a mobile game to help increase anti-tobacco attitudes.

Enhancing Lay Counselor Capacity to Improve Patient Outcomes with Multimedia Technology

Multimedia technologies offer powerful tools to increase capacity of health workers to deliver standardized, effective, and engaging antiretroviral medication adherence counseling. Masivukeni-is an innovative multimedia-based, computer-driven, lay counselor-delivered intervention designed to help people living with HIV in resource-limited settings achieve optimal adherence. This pilot study examined medication adherence and key psychosocial outcomes among 55 non-adherent South African HIV+ patients, on antiretroviral therapy (ART) for at least 6 months, who were randomized to receive either Masivukeni or standard of care (SOC) counseling for ART non-adherence. At baseline, there were no significant differences between the SOC and Masivukeni groups on any outcome variables. At post-intervention (approximately 5-6 weeks after baseline), -clinic-based pill count adherence data available for 20 participants (10 per intervention arm) showed a 10 % improvement for-participants and a decrease of 8 % for SOC participants. Masivukeni participants reported significantly more positive attitudes towards disclosure and medication social support, less social rejection, and better clinic-patient relationships than did SOC participants. Masivukeni shows promise to promote optimal adherence and provides preliminary evidence that multimedia, computer-based technology can help lay counselors offer better adherence counseling than standard approaches.

Can exergames impart health messages? Game play, framing, and drivers of physical activity among children

This study examines the effectiveness of incorporating exergaming into physical education lessons as a platform for imparting health education messages and influencing children's beliefs about and attitudes toward physical activity. The authors launched a 6-week intervention program using Nintendo Wii games coupled with protection motivation theory-based health messaging among 5th-grade school children in Singapore. Results indicated that when children who were exposed to threat-framed messages played Wii exergames during physical education lessons, they reported more positive physical activity attitude, self-efficacy, and perceived behavioral control than did those who underwent regular physical education lessons and were exposed to the same message. In addition, among children playing Wii, the threat and coping frames had similar effects on the degree of message influence on physical activity attitudes and beliefs. The implications for schools, parents, and health policy are discussed.

Masivukeni: development of a multimedia based antiretroviral therapy adherence intervention for counselors and patients in South Africa

Effective medical treatment for HIV/AIDS requires patients' optimal adherence to antiretroviral therapy (ART). In resource-constrained settings, lack of adequate standardized counseling for patients on ART remains a significant barrier to adherence. Masivukeni ("Let's Wake Up" in Xhosa) is an innovative multimedia-based intervention designed to help people living with HIV in resource-limited settings achieve and maintain high levels of ART adherence. Adapted from a couples-based intervention tested in the United States (US), Masivukeni was developed through community-based participatory research with US and South African partners and informed by Ewart's Social Action Theory. Innovative computer-based multimedia strategies were used to translate a labor- and training-intensive intervention into one that could be readily and widely used by lay counselors with relatively little training with low-literacy patients. In this paper, we describe the foundations of this new intervention, the process of its development, and the evidence of its high acceptability and feasibility.

Adolescents and tobacco use: systematic review of qualitative research methodologies and partial synthesis of findings

After a brief overview of adolescent tobacco control, methodological features and content areas of 78 qualitative studies of adolescent smoking published in English prior to September 2002 were assessed. Narrative syntheses of three content areas - peer influences, access/sales issues, and dependence/addiction - were also undertaken. Many studies failed to provide sufficient sampling and subject characterization details and more effort was required to demonstrate data validity and reliability. Syntheses of the content areas revealed important common themes. Relationships to quantitative research were informative and suggested other research questions. The review highlights the heuristic value of qualitative research on adolescent smoking. Funding was provided by The Cancer Council New South Wales and NSW Health/Hunter Medical Research Institute.

Management of chronic pediatric diseases with interactive health games: theory and research findings

In randomized clinical trials, children and adolescents improved their self care and reduced their emergency clinical utilization after playing health education and disease management video games. A diabetes game reduced diabetes-related urgent and emergency visits by 77 percent after diabetic youngsters had the game at home for six months, compared to no reduction in clinical utilization in a control group of diabetic youngsters who took home an entertainment video game that had no health content. Positive impacts were also found in clinical trials of games for asthma self-management and smoking prevention.