Abstract
Medical advances continue to improve morbidity and mortality of serious pediatric diseases, including cancer, driving research addressing diminished physical and psychological quality of life in children with these chronic conditions. Empowerment enhances resilience and positively influences health, disease, and therapy understanding. We describe the development and usability assessment of a prototype Empower Stars! mobile video game grounded in behavioral and exercise theories with the purpose of coupling physical exercise with empowerment over disease in children with cancer. Academic faculty, health-care providers, and community video game developers collaborated in this project. The iPadAir was selected as a delivery platform for its accelerometer and gyroscope features facilitating exercise design. Unity multiplatform technology provided animation and audiovisual features for immediate player feedback. Javascript, C#, Photoshop, Flash, and SketchUp were used for coding, creating graphical assets, Sprite sheets, and printing files, respectively. 3D-printed handles and case backing were used to adapt the iPad for physical exercise. Game usability, engagement, and enjoyment were assessed via a multilevel study of children undergoing cancer chemotherapy, their parents, and pediatric cancer health-care providers. Feedback crucial for ongoing game development was analyzed. A prototype Empower Stars! mobile video game was developed for children 7-14 years old with cancer. Active, sedentary, educational, and empowerment-centered elements intermix for 20 min of exercise within a 30 min "one-day treatment" gameplay session involving superheroes, space exploration, metaphorical cancer challenges, life restoration on a barren planet, and innumerable star rewards. No player "dies." Usability assessment data analyses showed widespread enthusiasm for integrating exercise with empowerment over cancer and the game itself. Favorite elements included collecting star rewards and planet terraforming. Traveling in space and the Healthy Food Choice game were least liked. The need for improved gameplay instructions was expressed by all groups. The usability study provided essential feedback for converting the prototype into alpha version of Empower Stars! Adapting exercise empowerment-promoting video game technology to mobile platforms facilitates usability and widespread dissemination for children with cancer. We discuss broader therapeutic applicability in diverse chronic pediatric diseases, including obesity, asthma, cystic fibrosis, diabetes, and juvenile idiopathic arthritis.
Highlights
Recent advances in pediatric medicine have resulted in markedly improved patient survival, increasing prevalence of those living with diverse serious and previously often fatal pediatric chronic diseases, including cardiac, pulmonary, renal, autoimmune disorders, and cancer [1,2,3,4,5]
The initial of concept of coupling physical exercise and mental empowerment as a video game intervention for children with cancer stemmed from several pivotal clinical observations: [1] the incredible determination and resilience of a child and their family members, when a child is diagnosed with and undergoes treatment for cancer, [2] the significant physical and emotional deconditioning that necessarily accompanies the months of pediatric cancer treatment involving surgery, radiation and chemotherapy, and its attendant adverse effects, and [3] the sense of empowerment exhibited by a child, whether young or older, when he or she overcomes a disease or treatment-related obstacle
It consisted of a series of discrete metaphorical mini-games centered on overcoming cancer-related challenges, and integrated physical exercise with promoting teamwork, a fighting spirit, and a sense of personal empowerment in children with cancer [36, 37, 39, 40]
Summary
Recent advances in pediatric medicine have resulted in markedly improved patient survival, increasing prevalence of those living with diverse serious and previously often fatal pediatric chronic diseases, including cardiac, pulmonary, renal, autoimmune disorders, and cancer [1,2,3,4,5]. Related physical and psychological comorbidities contribute to challenges of optimizing health and quality of life (QOL) for this growing population [2, 6,7,8,9,10]. A complimentary approach to addressing cancer-related physical and psychological comorbidities involves personal empowerment over disease [21]. Empowerment is a core patient-centered, multidimensional process that potentiates one’s positive influence over personal heath by promoting resilience and restoring hope [22,23,24]. Medical advances continue to improve morbidity and mortality of serious pediatric diseases, including cancer, driving research addressing diminished physical and psychological quality of life in children with these chronic conditions. Empowerment enhances resilience and positively influences health, disease, and therapy understanding. We describe the development and usability assessment of a prototype Empower Stars! mobile video game grounded in behavioral and exercise theories with the purpose of coupling physical exercise with empowerment over disease in children with cancer
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