The Effect of Social Support Features and Gamification on a Web-Based Intervention for Rheumatoid Arthritis Patients: Randomized Controlled Trial

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dc.contributor.authorAllam, Ahmeden
dc.contributor.authorKostova, Zlatinaen
dc.contributor.authorNakamoto, Kenten
dc.contributor.authorSchulz, Peter Johannesen
dc.date.accessioned2019-11-22T13:56:54Zen
dc.date.available2019-11-22T13:56:54Zen
dc.date.issued2015-01en
dc.description.abstractBackground: Rheumatoid arthritis (RA) is chronic systematic disease that affects people during the most productive period of their lives. Web-based health interventions have been effective in many studies; however, there is little evidence and few studies showing the effectiveness of online social support and especially gamification on patients' behavioral and health outcomes. Objective: The aim of this study was to look into the effects of a Web-based intervention that included online social support features and gamification on physical activity, health care utilization, medication overuse, empowerment, and RA knowledge of RA patients. The effect of gamification on website use was also investigated. Methods: We conducted a 5-arm parallel randomized controlled trial for RA patients in Ticino (Italian-speaking part of Switzerland). A total of 157 patients were recruited through brochures left with physicians and were randomly allocated to 1 of 4 experimental conditions with different types of access to online social support and gamification features and a control group that had no access to the website. Data were collected at 3 time points through questionnaires at baseline, posttest 2 months later, and at follow-up after another 2 months. Primary outcomes were physical activity, health care utilization, and medication overuse; secondary outcomes included empowerment and RA knowledge. All outcomes were self-reported. Intention-to-treat analysis was followed and multilevel linear mixed models were used to study the change of outcomes over time. Results: The best-fit multilevel models (growth curve models) that described the change in the primary outcomes over the course of the intervention included time and empowerment as time-variant predictors. The growth curve analyses of experimental conditions were compared to the control group. Physical activity increased over time for patients having access to social support sections plus gaming (unstandardized beta coefficient [B]=3.39, P=.02). Health care utilization showed a significant decrease for patients accessing social support features (B=-0.41, P=.01) and patients accessing both social support features and gaming (B=-0.33, P=.03). Patients who had access to either social support sections or the gaming experience of the website gained more empowerment (B=2.59, P=.03; B=2.29, P=.05; respectively). Patients who were offered a gamified experience used the website more often than the ones without gaming (t(91)=-2.41, P=.02; U=812, P=.02). Conclusions: The Web-based intervention had a positive impact (more desirable outcomes) on intervention groups compared to the control group. Social support sections on the website decreased health care utilization and medication overuse and increased empowerment. Gamification alone or with social support increased physical activity and empowerment and decreased health care utilization. This study provides evidence demonstrating the potential positive effect of gamification and online social support on health and behavioral outcomes.en
dc.description.notesThe study was supported and funded by the Swiss National Science Foundation under project number PDFMP1_135114/1. Moreover, the authors would like to thank "Lega Ticinise per la lotta conro il reumatismo" and all the collaborating physicians for their help in the patients' recruitment and their availability and support during the intervention.en
dc.description.sponsorshipSwiss National Science FoundationSwiss National Science Foundation (SNSF) [PDFMP1_135114/1]en
dc.format.mimetypeapplication/pdfen
dc.identifier.doihttps://doi.org/10.2196/jmir.3510en
dc.identifier.eissn1438-8871en
dc.identifier.issue1en
dc.identifier.othere14en
dc.identifier.pmid25574939en
dc.identifier.urihttp://hdl.handle.net/10919/95839en
dc.identifier.volume17en
dc.language.isoenen
dc.rightsCreative Commons Attribution 2.0 Genericen
dc.rights.urihttp://creativecommons.org/licenses/by/2.0/en
dc.subjectsocial supporten
dc.subjectgamingen
dc.subjectexperimental gamesen
dc.subjecteHealthen
dc.subjectrheumatoid arthritisen
dc.subjectrandomized controlled trialen
dc.subjectmultilevel analysisen
dc.subjectpatient empowermenten
dc.subjectphysical activityen
dc.subjecthealth care utilizationen
dc.titleThe Effect of Social Support Features and Gamification on a Web-Based Intervention for Rheumatoid Arthritis Patients: Randomized Controlled Trialen
dc.title.serialJournal of Medical Internet Researchen
dc.typeArticle - Refereeden
dc.type.dcmitypeTexten
dc.type.dcmitypeStillImageen

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