PERvasive serious GAMes suppOrted by virtual coachiNg

G4H conference - Workshop

21st of July

Adolescents with Type 1 diabetes

Brain

Muscles

Food

Body

Brain

Muscles

Insulin

Protein

Fat

Carbohydrates Glucose

Energy supply

Glucose Glucose Energy Glucose Energy

Insuline

Carbohydrates

Insulin

Carbohydrates

Normal

Insulin

Glucose Energy Carbohydrates Glucose Glucose

Diabetes type 1

Energy Carbohydrates

Diabetes type 1

Glucose Energy Carbohydrates Glucose Glucose

Diabetes type 2

Energy

Insuline Insulin

Carbohydrates

Diabetes type 2

2 times a day

2x Insulin Mixture (% Short acting / % Long acting)

4 times a day

3x Short acting Insulin + 1x Long acting Insulin

Continuously

Short acting Insulin in an Insulin pump

Insulin injections

Diet

Life style

Sport

Alcohol

Excercise

Disease

Emotions

Education

Treatment

• Self-management

• Knowledge

• Targets and goals

• Priorities

Conclusions

Introduction to Tako Game

The problem

• Motivate young people with diabetes to take self-care seriously and make appropriate self-care decisions independently

Change of behaviour

Treatment adherence

13

The solution: Tako Game

A serious game as a motivator to complete goals in the Care Plan…

… and a virtual coach offering personalized feedback

virtual coach

Care Plan

Sensor network

game

…connected to a network of sensor devices…

14

Engage users to support them in self-managing their chronic

condition

Engagement and fun: at the core

there is a game and a gamified

approach that motivates

adolescents to perform the activities

needed to manage diabetes

Utilities: help perform routine activities

linking them to the game

Blood glucose monitoring

Physical activity monitoring

Sharing with family and medical

staff

The objective of Tako Game

The game

15

Objective of the adventure game: to retrieve a sacred object stolen from the temple of

Takos (small squids in Japanese).

To progress in the game players must:

• Use their knowledge of basics of blood glucose management

• Adopt behaviour in real life compliant with those principles.

16

Activities in real life are monitored by a glucometer and a pedometer connected to the gamification platform. Goals achieved are rewarded by points, that can be spent to progress in the game

Game + gamification

virtual coach

gamification

Sensor network

game

Grifo multimedia • gamification platform • main adventure game • 2 mini-games

AiSolve: 5 mini-games

AiSolve

University of Twente

Coventry University: supervision of the game

ZGV hospital: usability test

Partners

Demonstration of PERGAMON framework

Break

Demonstration of PERGAMON framework

Usability research

Objectives

Piloting and evaluating the PERGAMON framework technology to test and analyze its performance and propose possible improvements to maximize its adequacy.

Task 5.1: Preparation of the pilot testing (leader ZVG)

Task 5.2: Pilot testing development (leader ZVG)

Task 5.3: Analysis of results and improvement to the PERGAMON technology framework (leader COVUNI)

Study population (1)

• A number of 30-50 patients will be involved.

• Inclusion criteria are:

– Diagnosis of Type 1 diabetes for at least six months

– > 12 and < 18 years old

– Written informed consent provided by adolescents and one of their parents/legal guardians.

Study population (2) – A reasonable understanding of the Dutch

– Access to a smartphone with an internet/data connection.

• Participants will be gender balanced and come from mixed socio-economical backgrounds.

Mixed methodology

• Self-report questionnaires (e.g., sociodemographic, PAID, SUS)

• Observation of the use of the serious pervasive game (collection of user stories)

• Structured user interview

• Focus group

Procedure

• Approaching participants, obtaining informed consent.

- ZGV will approach 30-50 patients (convenience sample)

- Written detailed information and informed consent will be

sent to the patients and families

- ZGV will ask parents/guardians and patients to sign the

informed consent and collect it before testing takes place

‘In situ’ testing

• PERGAMON game components will be tested ‘in situ’ for 15-20 minutes

• During the one hour ‘in situ’ visit patients will: - Receive general explanation of the PERGAMON project

- Receive general explanation of the PERGAMON components

- Receive specific explanation of pilot study testing

- Play the PERGAMON game components for 15-20 minutes

Testing at home

• PERGAMON framework technology will be tested at home for six/eight weeks

• After this period patients are invited to the ZGV to complete questionnaires (PAID, SUS) and tell about on their user experiences

• Participants will be invited for a focus group

Outcomes

• The prototype will be tested in several ways: – Ease of use; understanding game dynamics

– Emotional impact

– Social dimension

– Support of self-management; motivation for change

Analysis • Data from questionnaires will be collected and

analysed

• Quantitative descriptive analysis will be made using SPSS software

• Explorative approach for qualitative data

• The final report of results will contain outputs for the PERGAMON system changes

Ethics

• METC – UMC Utrecht; declaration that research does not fall under the Medical Research Involving Human Subjects Act

• Research is locally tested by ZGV and COVUNI to receive research declaration

Business opportunities

Gamification in Healthcare: Trend

0

2

4

6

8

10

12

14

2017 2018 2019 2020

Global Gamification Market: $10 Billion in 2020, with a CAGR of 42.4% Source: Mind Commerce

Market segmentation

9%

21%

15% 7%

13%

7%

19%

9% PharmaceuticalsHealth & WellnessEducationInsurance & FinancialRetailConsumer GoodsEntertainmentOther

Pharma, Health & Wellness and Education cover 45% of the whole market.

mHealth market segmentation

65%

16%

6% 3% 2%

8% Monitoring

Treatment

Health PractitionerSupportWellness

Source: PwC and GSMA, Touching lives through mobile health; Assessment of the global market opportunity, February 2012.

Monitoring and Treatment cover 81% of the whole mHealth market.

PERGAMON vs competitors

PERGAMON USPs:

• Seamlessly interconnected app (physical activity + dietary/medical intake + virtual practice)

• Adaptive and responsive system

• Gamified and contextual support system

ALL THINGS combined together in a gamification platform that offers modular backend framework that helps to build personalised user experience.

Business scenarios

1. Tako Game application for diabetes – B2B

1. Perfect enterprise solution for medical, insurance and device manufacturing firms.

3. Offers seamless integration of:

2. PERGAMON general framework – B2B

1. Application to other chronic diseases

2. Application to contexts other than health (e.g. corporate?)

TAKO GAME B2B2C model

Final users: Patients

• Reached through: – Healthcare providers

– Pharma companies & medical device vendors

– Insurance companies

– Publishing companies

• Support adolescents in self-management of diabetes

You

ng

dia

bet

ic p

atie

nts

Business channels to reach the patients

Pu

blis

hin

g co

mp

anie

s

• Join a partnership to enlarge their content offer, providing an innovative digital framework for their contents

Hea

lth

care

pro

vid

ers

• Improve the effectiveness of treatment, reduction of costs

Ph

arm

aceu

tica

l co

mp

anie

s • Foster

customer loyalty in a “value-based” reimbursement model

Hea

lth

Insu

ran

ce c

om

pan

ies • Improve

customer satisfaction by offering a useful, validated service, and reduce costs due to complications and hospital admissions

TAKO GAME B2B2C model

Software as a Service (SaaS)

- Set up fee for basic configuration (gamification platform +

games + sensor app + virtual coach)

- Monthly fee per user

- Fee for development of extra games to embed in the

framework

Ideas on how to overcome the barriers?

Lack of security and standards

Difficult discoverability

Resistance from healthcare providers

Solution costs

Regulations

Clinical studies

Mobile and wearable devices penetration

Patient-centred care demand

Technology innovation

Barriers Hygiene factors Opportunities

Source: «mHealth App Developer Economics 2014» report

Discussion

Visit our website: www.pergamonproject.eu

Discussion

• The PERGAMON framework is unique in its approach.

• The PERGAMON framework could be fruitful for other patient groups.

• Without scientific evidence I would not advise PERGAMON to my patients.

Discussion

• Every eHealth/mHealth application should be scientifically evaluated.

• Involvement of (mental) health care specialists is an important success factor in the implementation of eHealth/mHealth.

• There should be a quality assessment for eHealth/mHealth applications.