Evaluating the Effectiveness of a Serious Game to Enhance Self-Management Skills Among Adolescents and Young Adults With Spinal Cord Dysfunction

This study will evaluate the efficacy of a newly developed serious game, SCI HARD, to enhance self-management skills, self-reported health behaviors, and QOL among adolescents and young adults with spinal cord injury and disease (SCI/D). SCI HARD was designed by the project PI, Dr. Meade, in collaboration with the UM3D Lab between 2010 and 2013 with funding from a NIDRR (National Institute on Disability and Rehabilitation Research) Field Initiated Development Grant to assist persons with SCI develop and apply the necessary skills to keep their bodies healthy while managing the many aspects of SCI care. The study makes a unique contribution to rehabilitation by emphasizing the concepts of personal responsibility and control over one's health and life as a whole. By selecting an innovative approach for program implementation, we also attempt to address the high cost of care delivery and lack of health care access to underserved populations with SCI/D living across the United States (US).

BACKGROUND AND LITERATURE REVIEW As defined by the computer gaming industry, a serious game is "a game designed for a primary purpose other than pure entertainment." Serious games based on development of self-management skills have been developed for asthma, diabetes, safe sex negotiation, and promoting nutrition and physical activities. They have been effective in improving self-care, increasing self-efficacy, reducing symptoms, minimizing secondary conditions, reducing emergency room visits and decreasing health care costs.

The game application being assessed in this project is based on the self-management principles and specifically on the Health Mechanics Program, an evidence-based self-management program which was developed by Dr. Meade. Many of the individuals who sustain traumatic SCI are from the millennial generation. While the mean age for individuals with SCI is 40.2 years old, approximately half are in the 16 to 29 age range at the time of injury. Younger patients with traumatic SCI are overwhelmingly male, many of whom need medical care for the first time in their lives. These individuals are likely to be single (never-married) and many have a high-school education or less. A significant component of this group was injured through participation in high-risk behaviors or acts of violence; the group tends to have lower literacy levels and fewer resources, with many being from ethnic and racial minority backgrounds.

As previously discussed, individuals in this group, tend to have a high degree of technical sophistication which can be leveraged to promote the transfer of knowledge and self-management skills. In particular, games that can be downloaded and played on a mobile platform, such as a smartphone, are likely to be accessed and played by members of this group.

Data from the Pew Internet and American Life Project indicates that most Americans age 16 to 24 play computer or electronic games - including 97% of American teenagers and 81% of adults 18 to 29 years old. African Americans appear equally likely to play electronic games as Non-Hispanic Whites (both 51%) while English-Speaking Hispanics appear more likely to do so (63%; though that was attributed to the youth of the group). While most adult gamers play on the computers (73%), teens and young adults are increasingly playing on portable gaming devices (62%) and cell phones (50%). African Americans and Hispanics are more likely than non-Hispanic, Whites to play games on smaller, mobile gadgets. 55% of teens own a portable gaming device, 74% own an iPod or MP3 player, and 60% have a desktop or laptop computer.