Analyzing the impact of gamification on a mHealth application for treating urinary incontinence in prostate cancer patients
DOI:
https://doi.org/10.5753/jis.2024.4190Keywords:
Gamification, Self-care, Urinary incontinence, Prostate Cancer, IUProst, mHealth, EngagementAbstract
It is estimated that approximately one month after radical prostatectomy, a surgical procedure to remove the prostate, 80% of men experience urinary incontinence (UI). Behavioral therapy, which involves modifying the patient’s lifestyle habits, along with physical treatments such as exercises to strengthen the pelvic muscles and complementary behavioral therapies with techniques associated with personal beliefs, can be used to treat urinary incontinence in this context. IUProst® is a mobile health application (mHealth) designed to promote self-care and improve the quality of life for men who suffer from urinary incontinence due to prostate removal surgery caused by prostate cancer. Version 2.0 of IUProst® was released with several improvements, including adding gamification elements to encourage patient engagement in the execution of behavioral treatment exercises for urinary incontinence. This article presents the IUProst® application and analyzes the data generated by its use to understand the level of improvement that patients have experienced regarding urinary incontinence. It also examines the impact of gamification on exercise execution. The results demonstrate the clinical improvement in patients’ involuntary loss of urine, presenting less urine flow and reducing the feeling of urgency to go to the bathroom after using IUProst®. A comparative analysis is also included, considering the 60 days before and after the implementation of the gamification elements. During the 120 days considered, gamified data was collected for 60 days, and this period accounted for 83% of all exercises performed, despite the similar number of users using the application. The significant increase in exercise performance during the gamified period suggests that the gamification positively supported patient engagement.
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References
Abrams, P., Cardozo, L., Wagg, A., and Wein, A. (2017). Incontinence, volume 6. Tokio: Health Publications Ltd.
Aitken, M. and Gauntlett, C. (2013). Patient apps for improved healthcare: from novelty to mainstream. In Parsippany, NJ: IMS Institute for Healthcare Informatics.
Alqahtani, F., Meier, S., and Orji, R. (2021). Personality-based approach for tailoring persuasive mental health applications. User Modeling and User-Adapted Interaction, pages 1–43. DOI: https://doi.org/10.1007/s11257-021-09289-5.
Anjos, F., Carvalho, S., Oliveira, H., Mata, L., and Estevam, F. (2022). Iuprost: Gamificação de aplicação mhealth para tratamento da incontinência urinária causada pela prostatectomia radical. In Congresso Brasileiro de Informática em Saúde, pages 99–104, São Paulo. DOI: https://doi.org/10.5753/sbcas_estendido.2024.2824.
Anjos, F. M. S., Oliveira, H. M., Estevam, F. E., de Carvalho, S. T., and da Mata, L. R. F. (2023). Tratamento comportamental da incontinência urinária por meio de uma aplicação mhealth gamificada: primeiros resultados. In Anais Estendidos do XXII Simpósio Brasileiro de Jogos e Entretenimento Digital, pages 1–11. SBC. DOI: https://doi.org/10.5753/sbgames_estendido.2023.234181.
Azevedo, C. et al. (2021). Efetividade da acupuntura auricular associada ao treinamento muscular pélvico para controle da incontinência urinária pós-prostatectomia radical: ensaio clínico randomizado. PhD thesis, UFMG.
Bernardes, M. F. V. G., Chagas, S. d. C., Izidoro, L. C. d. R., Veloso, D. F. M., Chianca, T. C. M., and Mata, L. R. F. d. (2019). Impact of urinary incontinence on the quality of life of individuals undergoing radical prostatectomy. Revista Latino-Americana de Enfermagem, 27. DOI: https://doi.org/10.1590/1518-8345.2757.3131.
Bochicchio, M. A., Vaira, L., Mortara, A., and De Maria, R. (2019). A preliminar analysis and comparison of international projects on mobile devices and mhealth apps for heart failure. pages 280–285. DOI: https://doi.org/10.1109/EXPAT.2019.8876548.
Bowman, D., Kruijff, E., LaViola Jr, J. J., and Poupyrev, I. P. (2004). 3D User interfaces: theory and practice, CourseSmart eTextbook. Addison-Wesley.
Bucchiarone, A., Cicchetti, A., and Marconi, A. (2019). Gdf : A gamification design framework powered by model-driven engineering. In Proceedings - 2019 ACM/IEEE 22nd International Conference on Model Driven Engineering Languages and Systems Companion, MODELS-C 2019 :, pages 753–758. Institute of Electrical and Electronics Engineers Inc.. DOI: https://doi.org/10.1109/MODELS-C.2019.00117.
Chen, J. (2007). Flow in games (and everything else). Communications of the ACM, 50(4):31–34. DOI: https://doi.org/10.1145/1232743.1232769.
Chou, J., Hung, C., and Hung, Y. (2014). Design factors of mobile game for increasing gamer’s flow experience. In 2014 IEEE International Conference on Management of Innovation and Technology, pages 137–139. IEEE. DOI: https://doi.org/10.1109/ICMIT.2014.6942414.
de Oliveira, L. W. (2018). Framework l para desenvolvedores de mhealth no contexto de self-care e gamificação. Master’s thesis, UFG.
Deterding, S., Sicart, M., Nacke, L., O’Hara, K., and Dixon, D. (2011). Gamification. using game-design elements in non-gaming contexts. In CHI ’11 Extended Abstracts on Human Factors in Computing Systems, CHI EA ’11, page 2425–2428, New York, NY, USA. Association for Computing Machinery. DOI: https://doi.org/10.1145/1979742.1979575.
Dias, L. P. S., Barbosa, J. L. V., and Vianna, H. D. (2018). Gamification and serious games in depression care: A systematic mapping study. Telematics and Informatics, 35(1):213–224. DOI: https://doi.org/10.1016/j.tele.2017.11.002.
Duggal, K., Gupta, L. R., and Singh, P. (2021). Gamification and machine learning inspired approach for classroom engagement and learning. Mathematical Problems in Engineering, 2021. DOI: https://doi.org/10.1155/2021/9922775.
Estevam, F. E. B. (2022). Iuprost: Aplicativo móvel para controle da incontinência urinária em homens submetidos à prostatectomia radical. Master’s thesis, UFMG.
Fitts, P. M. and Posner, M. I. (1967). Human performance. Brooks/Cole.
Frawley, H. C., Dean, S. G., Slade, S. C., and Hay-Smith, E. J. C. (2017). Is pelvic-floor muscle training a physical therapy or a behavioral therapy? a call to name and report the physical, cognitive, and behavioral elements. Physical therapy, 97(4):425—437. DOI: https://doi.org/10.1093/ptj/pzx006.
Fullerton, T. (2014). Game design workshop: a playcentric approach to creating innovative games. CRC press.
Hall, L. M., Aljuraifani, R., and Hodges, P. W. (2018). Design of programs to train pelvic floor muscles in men with urinary dysfunction: systematic review. Neurourology and Urodynamics, 37(7):2053–2087. DOI: https://doi.org/10.1002/nau.23593.
Hodges, P. W., Stafford, R. E., Hall, L., Neumann, P., Morrison, S., Frawley, H., Doorbar-Baptist, S., Nahon, I., Crow, J., Thompson, J., et al. (2020). Reconsideration of pelvic floor muscle training to prevent and treat incontinence after radical prostatectomy. In Urologic Oncology: Seminars and Original Investigations, volume 38, pages 354–371. Elsevier. DOI: https://doi.org/10.1016/j.urolonc.2019.12.007.
Huizinga, J. (2014). Homo ludens ils 86. Routledge.
IEC, I. (2014). Iso/iec 25010: Systems and software engineering-systems and software quality requirements and evaluation (square)-guide to square. Switzerland: ISO.
INCA (2022). Estimativa 2020: Incidência de Câncer no Brasil, volume 1. INCA.
Izidoro, L. C. d. R., Mata, L. R. F. d., Azevedo, C., Paula, A. A. P. d., Pereira, M. G., Santos, J. E. M. d., Brasil, V. V., and Oliveira, L. M. d. A. C. (2022). Programa cognitivo-comportamental para controle de sintomas do trato urinário inferior pós-prostatectomia radical: ensaio clínico randomizado. Revista Brasileira de Enfermagem, 75. DOI: https://doi.org/10.1590/0034-7167-2021-0818pt.
Izidoro, L. C. d. R. and Soares (2021). Efetividade de programa cognitivo comportamental para controle da incontinência e melhoria de qualidade de vida após prostatectomia radical: um estudo piloto. PhD thesis, UFG - Goiânia.
Koivisto, J. and Hamari, J. (2019). The rise of motivational information systems: A review of gamification research. International Journal of Information Management, 45:191–210. DOI: https://doi.org/10.1016/j.ijinfomgt.2018.10.013.
Laxminarayan, S. and Istepanian, R. S. (2000). Unwired e-med: the next generation of wireless and internet telemedicine systems. IEEE Transactions on Information Technology in Biomedicine, 4(3):189–193. DOI: https://doi.org/10.1109/TITB.2000.5956074.
Li, C., Rusák, Z., Horváth, I., and Ji, L. (2016). Development of engagement evaluation method and learning mechanism in an engagement enhancing rehabilitation system. Engineering Applications of Artificial Intelligence, 51:182–190. DOI: https://doi.org/10.1016/j.engappai.2016.01.021.
Mata, L. R. F. d., Azevedo, C., Menezes, A. C., Chagas, S. d. C., Izidoro, L. C. d. R., Estevam, F. E. B., and Chianca, T. C. M. (2022). Adaptação transcultural e validação da urinary incontinence scale after radical prostatectomy para o contexto brasileiro. Revista Gaúcha de Enfermagem, 43. DOI: https://doi.org/10.1590/1983-1447.2022.20210163.pt.
Monteiro, P. O. A., Victora, C. G., Barros, F. C., and Tomasi E. (2000). Diagnóstico de sobrepeso em adolescentes: estudo do desempenho de diferentes critérios para o índice de massa corporal. Revista de Saúde Pública, 34(5):506–513.
Mungovan, S. F., Carlsson, S. V., Gass, G. C., Graham, P. L., Sandhu, J. S., Akin, O., Scardino, P. T., Eastham, J. A., and Patel, M. I. (2021). Preoperative exercise interventions to optimize continence outcomes following radical prostatectomy. Nature Reviews Urology, 18(5):259–281. DOI: https://doi.org/10.1038/s41585-021-00445-5.
Oliveira, H., Anjos, F., Estevam, F., Mata, L., and Carvalho, S. (2022). Iuprost: uma aplicação móvel em saúde para apoio ao tratamento de incontinência urinária pós-prostatectomia radical. In Congresso Brasileiro de Informática em Saúde, pages 143–148, São Paulo.
Oliveira, L. and Carvalho, S. (2020a). A gamification-based framework for mhealth developers in the context of self-care. In 2020 IEEE 33rd International Symposium on Computer-Based Medical Systems (CBMS), pages 138–141. DOI: https://doi.org/10.1109/CBMS49503.2020.00033.
Oliveira, L. W. and Carvalho, S. T. (2020b). A gamification-based framework for mhealth developers in the context of self-care. pages 138–141. DOI: https://doi.org/10.1109/CBMS49503.2020.00033.
Organization, W. H. (2015). A practical guide for engaging with mobile operators in mHealth. World Health Organization.
Overgård, M., Angelsen, A., Lydersen, S., and Mørkved, S. (2008). Does physiotherapist-guided pelvic floor muscle training reduce urinary incontinence after radical prostatectomy?: a randomised controlled trial. European urology, 54(2):438–448. DOI: https://doi.org/10.1016/j.eururo.2008.04.021.
Poletto, J. E., Rizzo, D. T., Baltieri, L., Cazzo, E., and Chaim, É. A. (2018). Influência da obesidade e das medidas antropométricas sobre a incontinência urinária e a qualidade de vida: um estudo piloto. RBONE-Revista Brasileira de Obesidade, Nutrição e Emagrecimento, 12(75):901–907.
Rezende, M. F. C., Oliveira, L. W., and Carvalho, S. T. (2021). Gamificação e autocuidado no tratamento do diabetes tipo 2. In Anais Estendidos do XXI Simpósio Brasileiro de Computação Aplicada à Saúde, pages 139–144. SBC. DOI: https://doi.org/10.5753/sbcas.2021.16115.
Rocha, T. A. H., Fachini, L. A., Thumé, E., Silva, N. C. d., Barbosa, A. C. Q., Carmo, M. d., and Rodrigues, J. M. (2016). Saúde móvel: novas perspectivas para a oferta de serviços em saúde. Epidemiologia e Serviços de Saúde, 25:159–170. DOI: https://doi.org/10.5123/S1679-49742016000100016.
Silva, I. d. J., Oliveira, M. d. F. V. d., Silva, S. É. D. d., Polaro, S. H. I., Radünz, V., Santos, E. K. A. d., and Santana, M. E. d. (2009). Cuidado, autocuidado e cuidado de si: uma compreensão paradigmática para o cuidado de enfermagem. Revista da Escola de Enfermagem da USP, 43:697–703. DOI: https://doi.org/10.1590/S0080-62342009000300028.
Tondello, G. F., Orji, R., and Nacke, L. E. (2017). Recommender systems for personalized gamification. ACM. DOI: https://doi.org/10.1145/3099023.3099114.
van Gaalen, A. E., Brouwer, J., Schönrock-Adema, J., Bouwkamp-Timmer, T., Jaarsma, A. D. C., and Georgiadis, J. R. (2021). Gamification of health professions education: a systematic review. Advances in Health Sciences Education, 26(2):683–711. DOI: https://doi.org/10.1007/s10459-020-10000-3.
Yousefi, B. H. and Mirkhezri, H. (2020). Lean gamification canvas: A new tool for innovative gamification design process. In 2020 International Serious Games Symposium (ISGS), pages 1–9. IEEE. DOI: https://doi.org/10.1109/ISGS51981.2020.9375297.
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