Background: High maternal morbidity and mortality rates globally, especially in low-income and lower-middle-income countries, highlight the critical role of skilled health care providers (HCPs) in preventing pregnancy-related complications among disadvantaged populations. Lebanon, hosting over 1.5 million refugees, is no exception. HCPs face significant challenges, including resource constraints and limited professional development opportunities, underscoring the need for continuous learning and innovative educational interventions. Artificial intelligence (AI) and gamification show promise in enhancing clinical performance and evidence-based practice.
Objective: Considering the limited evidence on the effectiveness of integrating gamification and AI in a mobile app for professional development of HCPs providing maternal health services, this pilot study aims to assess the satisfaction and acceptability of HCPs with a novel mLearning tool, titled the "GAIN MHI" app (gamification, artificial intelligence, and mHealth network for maternal health improvement), at selected primary health care centers in Lebanon.
Methods: This is a cross-sectional study that presents data collected from 12 participating HCPs, primarily obstetricians and midwives who have been using the GAIN MHI mobile app for professional development and learning. The survey used included Likert scale questions to assess HCPs' satisfaction, engagement, and evaluation of the gamification and AI components of the app. Open-ended questions gathered qualitative feedback on app preferences and potential improvements. Statistical analysis was performed to derive insights from the quantitative data collected. Subsequently, a descriptive analysis was performed, presenting the frequencies and percentages of various participant characteristics, as well as responses to the survey across all sections.
Results: A total of 85% (n=10) of the HCPs, including midwives and doctors, were satisfied with the GAIN MHI mobile app, the user interface, and various content features. Engagement levels were robust (64.6%, SD 6.2%), notably impacting clinical routines and theoretical knowledge. The gamification and AI components garnered strong positive feedback, enhancing learning enjoyment (11/12, 92%). From a qualitative perspective, users expressed appreciation for the app's diverse content, user-friendliness, and motivation for continuous learning. Suggestions for expanding the content included a wide range of health topics, highlighting the app's potential applicability in various health care fields.
Conclusions: HCPs, especially those practicing in underserved areas, face challenges in accessing professional development opportunities, highlighting the need for innovative pedagogical approaches using mobile technologies. This pilot study underlines the potential of using AI-based digital solutions
Background: Tics and comorbidities significantly impact the social interactions and mental health of adolescents with Tourette syndrome (TS). Psychoeducation is an initial intervention for TS. Gamification is a common psychoeducational intervention for youths with chronic conditions. However, the effectiveness of board games in improving tic severity and mental health in adolescents with TS remains underexplored.
Objective: We developed a serious board game to investigate its effects on tic severity, mental health, social adjustment, and depression in adolescents with TS.
Methods: A single-blinded, 2-arm, parallel randomized controlled study was conducted. From September 2022 to July 2024, participants were recruited from a medical center in northern Taiwan. Seventy-nine adolescents with TS aged 12 to 18 years were randomly assigned to either a control group (n=39) or an intervention group (n=40). Both groups received care as usual (daily pyridoxine [50 mg] and psychoeducation), while the intervention group additionally participated in a weekly 60-minute board game session over a 4-week period. Outcome measures included the Yale Global Tic Severity Scale, Positive Mental Health Scale, Social Adjustment Scale for Adolescents with TS, and Beck Youth Inventory II - Depression scale.
Results: Generalized estimation equation results showed that, compared to the control group, the intervention group demonstrated significant improvements in positive mental health at the postintervention (β=5.19, 95% CI 0.36 to 10.02, P=.04) and follow-up (β=7.14, 95% CI 2.15 to 12.14, P=.005), with time-dependent effects. The intervention group also showed significant improvements in social adjustment (β=4.24, 95% CI 1.79 to 6.69, P<.001) and depression (β=-3.06, 95% CI -6.04 to -0.11, P=.04) at follow-up. No significant differences were observed between the 2 groups in tic severity.
Conclusions: The serious board game developed in this study significantly enhanced psychosocial functioning in adolescents with TS. As an alternative to verbal and written health communication, the board game serves as an innovative psychoeducational instrument for health care professionals to help adolescents with TS in tic management and mental health promotion. Future studies can develop and validate the feasibility of a digital version of the board game.
Trial registration: ClinicalTrials.gov NCT05566236; https://clinicaltrials.gov/study/NCT05566236.
Background: Intrauterine devices (IUDs) are safe and effective long-acting reversible contraceptive therapies that are also used as minimally invasive treatment for heavy menstrual bleeding, endometrial hyperplasia, and early-stage endometrial cancer. Despite many advantages, IUDs are underused predominantly due to patient discomfort. Although many techniques have been explored previously in the literature, there is currently little consensus on effective analgesic strategies. Virtual reality (VR) has demonstrated moderate benefits in acute pain management and has been explored for outpatient hysteroscopy.
Objective: This study aims to explore the effectiveness of VR in improving patient pain and anxiety during outpatient IUD insertion.
Methods: This randomized controlled trial compared the use of a VR headset to standard care during IUD insertion in the outpatient clinic setting. VR content was delivered via smartphone and headset, providing patients with a relaxing 3D video environment. Outcomes measured were patient-reported pain and anxiety, as well as satisfaction reported using a questionnaire. Secondary outcomes included clinician-reported ease of insertion and time required to complete the procedure.
Results: A total of 70 patients were recruited, with 34 randomized to the control group and 36 randomized to VR headset use. Patients with VR headsets reported a mean pain score of 5.5 (SD 3.2) during IUD insertion, which was not significantly different to 4.3 (SD 3.2) for the control group (P=.15). Mean anxiety scores during the procedure were 4 (SD 3) in the VR group, compared to 4.8 (SD 3.5) in the control group, which was also not significantly different (P=.37). Anxiety was the most significant predictor of pain, and this, in turn, significantly increased insertion time (P<.001). Among patients who responded to and benefitted from VR use, baseline anxiety was significantly lower than in those who did not (P<.001). Satisfaction with the use of VR headsets was overall high, and recommendation scores for the use of VR headsets were also high. There were no significant adverse effects experienced with the use of the intervention, with only 1 patient reporting nausea after IUD insertion.
Conclusions: The use of VR headsets did not significantly alter the pain or anxiety experienced by patients during IUD insertion; however, satisfaction and recommendation that others use VR were high, which may suggest other benefits to their use. In addition, preprocedural anxiety appears to have a significant adverse impact on pain scores and the ability of patients to benefit from the VR headsets. This is an important contribution to the previously ambiguous data regarding VR use for gynecological procedures and highlights a new avenue for improving the patient experience.
Background: Simulation-based training is widely used in resuscitation education, yet limited research exists on how serious smartphone games-especially when used independently at home-impact stress levels during simulated adult basic life support (BLS). Understanding this relationship may offer new approaches to preparing health care students for high-stress clinical situations.
Objective: This study aimed to evaluate the impact of a home-based serious resuscitation game, MOBICPR, on physiological stress markers among nursing students performing simulated adult BLS.
Methods: In this single-center, randomized, waitlist controlled trial, 43 first-year nursing students were assigned to either an intervention group (IG) or a waitlist control group (WL-CG). Stress was measured at baseline and 2-week and 4-week follow-ups using electrodermal activity (EDA), blood volume pulse (BVP), heart rate (HR), and body temperature (BT) collected via the Empatica E4 wearable (Empatica Inc., USA). Each data collection point included 3 phases: mandala coloring before and after simulated adult BLS performance, and the adult BLS scenario itself. The MOBICPR game-a serious mobile game designed per the 2021 European Resuscitation Council adult BLS guidelines-was played at home over 2 weeks by IG (weeks 0-2) and WL-CG (weeks 2-4). A random forest classifier, trained on the AffectiveRoad dataset, predicted stress levels (none, moderate, and high) based on physiological signals.
Results: Of 124 students invited, 43 participated (22 in IG, 21 in WL-CG; 38/43, 88% female; mean age of 19, SD 0.6 years). EDA, BVP, and BT significantly changed across measurement phases in both groups (P<.05), while HR did not show consistent differences (P>.05). Stress classification showed a significant decrease in stress after simulated adult BLS in the IG at the 2-week follow-up (P=.04), but not in the WL-CG. After 2 weeks of gameplay, 12 of 22 participants in the IG had lower stress levels after performing simulated adult BLS compared to before, suggesting an adaptive stress response. No significant group-level stress reductions were observed over time.
Conclusions: Short-term, home-based gameplay using a serious resuscitation game modestly influenced physiological indicators of stress during simulated adult BLS among nursing students. While overall group stress levels remained stable, individualized responses suggested improved coping for some. Incorporating serious games into curricula could offer learners safe, gamified environments to rehearse stressful clinical scenarios. Future research should explore optimal game frequency and content depth to maximize educational and emotional resilience outcomes.
Background: Unhealthy behaviors can cause so-called noncommunicable diseases (NCDs), which are on the rise. Notable examples include chronic respiratory diseases, diabetes, cardiovascular diseases, and various types of cancer. They are responsible for approximately 41 million deaths annually, which accounts for a staggering 74% of all global deaths. Major risk factors include physical inactivity, the use of tobacco, unhealthy diets, the harmful use of alcohol, and poor mental health, which can be classified as modifiable behavioral risk factors. Other factors include metabolic and environmental risk factors, such as air pollution. Many individuals struggle to make informed decisions about their health, which contributes to the risk factors mentioned earlier and, ultimately, can lead to the development of one or more NCD.
Objective: This research presents design and standardization considerations to enable the exchange of medical and game data to maximize their impact and usefulness. Serious games and gamified applications that strategically use behavior change techniques and educational content can help users change their behavior on a lasting basis, thereby reducing the aforementioned NCD risk factors. Still, each of them is currently independently designed and cannot interact with other applications.
Methods: We previously developed serious games and gamified applications to prevent NCDs. These served as the foundation of an interoperable framework for NCD prevention games and applications. On the basis of a comprehensive analysis, 6 key areas were identified, ultimately leading to a framework definition that was then evaluated against the already-developed games and applications.
Results: This paper presented a novel interoperable framework to support the design and development of serious games and gamified applications that enable individuals to achieve sustainable behavior change and improve their overall health and well-being by defining 6 key areas, emphasizing interoperability, and exchanging meaningful medical and game data.
Conclusions: The framework presented in this study covers the major design and implementation aspects of NCD prevention games and applications in 6 key areas. Therefore, researchers should consider these guidelines when creating novel serious games and applications in those areas. The framework also intensively encourages the use of standards in the domain of medical informatics to ensure the semantic interoperability of patients' data produced. Thus, it promotes the exchange of meaningful data to improve patient care and anonymous data use for research.
Background: Suicide is a leading cause of preventable death worldwide. Nurses play a critical role in suicide prevention; yet, they face significant obstacles. Improving the evaluation and management of patients at risk of suicide requires innovative training techniques that safely and effectively enhance nursing students' skills, knowledge, and confidence. Virtual simulation (VS) based training can be particularly effective because it allows interaction with patients without the risk of causing harm.
Objective: The purpose of this study was to evaluate the pedagogical effectiveness of a novel VS tool featuring a fully automated and emotionally reactive virtual patient by assessing its ability to assist nursing students in learning suicide risk assessment. VS also included an online group debriefing, co-run by a nurse and a medical teacher.
Methods: A randomized controlled investigation was conducted with 68 first-year nursing students recruited from nursing schools offline and online. They were divided into a control group receiving teaching as usual (TAU) and an intervention group receiving TAU plus VS. The intervention was purely web-based and unblinded. Outcomes were self-assessed through questionnaires using Kirkpatrick Training Evaluation Model, which focuses on knowledge, skills, confidence, empathy, and satisfaction among students.
Results: The VS group exhibited significantly higher confidence (3 points of increase after TAU vs 10.6 points of increase after VS, B=7.2; SE 2.5; t111.5=2.8; P=.006) and a marginally enhanced ability to respond appropriately to suicidal thoughts (1.6 points of improvement after TAU vs 6.4 points of improvement after VS, B=-4.5; SE 2.5; t119.5=-1.8; P=.08) compared with the control group. However, there were no significant differences in knowledge acquisition or the general level of empathy. Satisfaction with VS was high, particularly regarding the authenticity of the virtual patient. Authenticity was perceived as greater when emotional prosody was included with facial emotions.
Conclusions: The use of VS demonstrated promising results in enhancing nursing students' confidence in detecting suicide risk and their skills in counseling individuals experiencing a suicide crisis, suggesting its incorporation into routine teaching methods. Further research is needed to explore its long-term benefits for students and its impact on patient outcomes.
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