Despitesignificantadvancesintreatment,heartfailure(HF)continuestobetheleadingcauseof hospitalizationsamongolderadultsintheU.S.,withanestimatedannualcostof$32billion.Poorself- managementinolderadultswithHFcausespooradherencetobehaviorrecommendations,delaysin recognizingHFhealthcrisesandseekingclinicalassistance,leadingtofrequenthospitalizations,impaired functionalstatus,andpoorqualityoflife.However,recentlarge-scalestudiesofinterventionsdesignedto supportHFself-managementhavesufferedfromchallengesoflowerthananticipatedrecruitmentas participantswererequiredtotraveltointerventionsites,beingcomparedwithusualcareprogramsthatwere exceptionalbutexpensiveandhumanresource-intensiveorfailuretoengageparticipantstillendofstudy periods.Onepromisingapproachistheuseofsensor-controlleddigitalgames(SCDG),whichofferaffordable, portable,scalabletoolstofacilitateengagementinHFself-managementbehaviorsthatshowthepoorest adherence?weightmonitoringandphysicalactivity?whilebeingenjoyableandeasytouse.Theprimarygoal ofthisstudyistoobtaininitialefficacydataandundertakeacomprehensivefeasibilityassessmentofaSCDG interventionthatsynchronizeswithaBluetooth-enabledweightscaleandactivitytrackertoactivategame rewardsandfeedbackbasedonolderadultHFparticipants?real-timeweightmonitoringandexercise behaviors.
In Aim1, wewillassessthepreferences,andacceptabilityoftheSCDGamong10olderadultswith HFduringformativedesignprocess.
In Aim2, tomotivateparticipants?engagementinHFself-management behaviors,wewilldevelopaSCDG(?SafeatHome?)informedbyFogg?sbehavioralmodel,utilizinganarrative inwhichthegoalistohelpanavatarinthegameavoidre-hospitalizationandassessits?usability.
Aim3 will evaluatetheinitialefficacyoftheSCDGinterventionforprimaryoutcomeofrateofengagementinHFself- managementbehaviorofweight-monitoringandsecondaryoutcomesofphysicalactivityengagement,HFself- management-knowledge,andself-efficacy,HF-functionalstatus,hospitalization,andqualityoflife.Forthis study,wewillrecruitolderadultsdiagnosedwiththeNewYorkHeartAssociation?sHFclassificationItoIIIfrom out-patientHFsettingsincentralTexas,andwewillrandomize44patientstoeithertheSCDGintervention groupthatwillreceivesensorstrackingweightmonitoringandactivityandplaytheSCDGonamobile smartphonefor12weeksoracontrolgroupthatwillreceivesensorsandanapptrackingactivityandweight monitoring,andstandardizedwrittenHFeducationalmodules.
Aim4 willdeterminethefeasibilityoftheSCDG interventionandwillformthebasisfordesigningafuturelargerandlongerrandomizedcontrolledclinicaltrial. Ourprojectwillgeneratemuchneededinsightandguidancefordigitalgamingsolutionstomotivateadherence toHFself-managementbehaviorsandimprovethehealthoutcomesofolderadultswithHF.
Older adults with heart failure (HF) face significant healthcare burden and suffering, but effective HF self- management behaviors can reduce their hospitalizations and mortality. We propose the design and development of a sensor-controlled digital game intervention enhanced by real-time behavior-tracking sensors to improve older adults? knowledge, skills, and motivation to engage in the important HF self-management behaviors of weight monitoring and physical activity. This project will generate much needed insight and guidance regarding the use of digital gaming as an affordable, portable, scalable technology to improve older adults? self-management of HF and will potentially reduce the burden of HF.
