Gamified digital health solution for people with multiple sclerosis
Due to digitalization of healthcare, there is a strong vision that digital tools will also be used by patients to target specific health conditions. However, there is not much evidence yet that this would bring value in the care process.
More Stamina is a research project where a multidisciplinary team will investigate the challenges that targeted solutions for chronic conditions face, and will explore their potential value for patients and healthcare providers. At the same time, the project is creating a setup where commercialization of such solutions would be feasible.
-We are exploring how can digital health solutions survive beyond “laboratory” conditions. In general, most of these digital health innovations tend to exist either as a project that gets funded by grants and then stops existing once the funding is over, or as some startup that is trying to find out how to make ends meet. Our project looks at this issue asking two questions: on the one hand “how do we integrate these solutions to the healthcare system?” and on the other “how can these solutions become sustainable on their own?”, says Dr. Guido Giunti from the Faculty of Medicine at the University of Oulu.
Why multiple sclerosis?
-We have been working on multiple sclerosis for a long time, following and building upon the evidence we have created. We have a multidisciplinary team with people with technical, medical and business backgrounds, working in industry and academia looking at this problem from multiple angles, comments Professor Minna Isomursu from the Faculty of Information Technology and Electrical Engineering at the University of Oulu.
Multiple sclerosis (MS) is one of the world’s most common neurologic disorders in young adults. More than 12,000 Finns live with this condition and almost 3 million in the whole world. MS affects females 3 times more than males, and it affects them in their most productive moment of their lives. The course of MS is varied and unpredictable, often leading people with MS to accumulate a large number of disabilities.
People with MS suffer a wide range of symptoms like fatigue, altered sensation, cognitive and mental health problems and even physical mobility issues. Fatigue is the most common, frustrating, overwhelming, and often disabling symptom for people with MS.
The clinical tests with real patients start soon in several countries. Researchers expect the first tests to start during the first half of 2021. In Finland co-operative partner for the clinical tests is Oulu University Hospital but there are also several international institutions working in this project: Hospital Italiano de Buenos Aires (Argentina), Universidad de Sevilla (Spain), Fundación DINAC (Spain), Hospital Nithas Visa (Spain), and Kliniken Valens (Switzerland).
-We will be providing patients with our digital health solution and explore their experience using the tool. The tests will give us information how the solution changes the care delivery, and what kind of value it can provide for the patients and healthcare professionals. When the solution succeeds in creating value for everyone, it is realistic to think it can be adopted for sustainable use.” says Professor Isomursu.
As a result from this project, researchers expect mainly to learn about:
1) How can mobile apps be integrated with the care process of chronic conditions? Can care become more patient centered, personalized and effective with the help of a mobile solution?
2) Do the patients find a mobile app in their care valuable? What value will it create? Will the patients feel healthier? Will they feel more empowered? Will they feel they will receive better care?
Gamification elements for immersive interaction
More Stamina uses gamification elements to facilitate engagement and represent difficult concepts like how much “energy” a person has. A person’s overall energy for the day is represented through a visual metaphor in which a progress bar shows how many Stamina Credits, the person has left. Each day starts with a clean list so that the persons with MS can be more intentional about the things they want to accomplish.
-As persons with MS “spend” their Stamina Credits, they will get a more tangible notion and bridge the gap between the abstract concept of “energy” to their actual experience at the end of the day, comments Guido Giunti.
As persons with MS use the tool, a record is shown in their user profile, awarding medals for completing certain objectives like completing all daily tasks 3 days in a row, always responding effort assessments, or continuously assessing correctly one task, among others. These will provide clear and unambiguous feedback to the people with MS that they are progressing and encourage them to keep heading in the “right” direction.
More Stamina is a self-management tool designed to help people with MS manage their energy. The app uses wearable sensors and context information to generate personalized recommendations so that people with MS learn how to deal with their fatigue and have a better quality of life. More Stamina uses the anonymized data it collects to explore also hidden patterns and characteristics of living with MS, so that new ways of helping patients can be created.
The work on this research has scientific significance as it creates new algorithms and data about managing fatigue. It will also create scientific knowledge about value co-creation logic in adoption of mobile health solution in healthcare systems in different contexts. The impact that this research will have is that not only it will evaluate the efficacy of a digital health solution, but it will also provide insight as to how can healthcare infrastructures be modified in a way that would optimize value creation.
The team members are described here: http://www.morestaminaapp.com/team/
More about the More Stamina: http://www.morestaminaapp.com/
Links to the selected publications
Understanding the needs of people with MS
Giunti G, Kool J, Rivera Romero O, Dorronzoro Zubiete E Exploring the Specific Needs of Persons with Multiple Sclerosis for mHealth Solutions for Physical Activity: Mixed-Methods Study JMIR Mhealth Uhealth 2018;6(2):e37. https://mhealth.jmir.org/2018/2/e37/
Exploring what is commercially available for MS
Giunti G, Guisado-Fernandez E, Caulfield B. Connected Health in Multiple Sclerosis: A Mobile Applications Review. 2017 IEEE 30th Int. Symp. Comput. Med. Syst., IEEE; 2017, p. 660–5. http://ieeexplore.ieee.org/document/8104274/
Giunti G, Guisado Fernández E, Dorronzoro Zubiete E, Rivera Romero O. Supply and Demand in mHealth Apps for Persons With Multiple Sclerosis: Systematic Search in App Stores and Scoping Literature Review. JMIR MHealth UHealth 2018;6:e10512. https://mhealth.jmir.org/2018/5/e10512/
Co-creating potential digital health solutions
Giunti G. Gamified design for health workshop. Stud Health Technol Inform. 2016;225:605-606. doi:10.3233/978-1-61499-658-3-605. http://ebooks.iospress.nl/publication/43118
Design model for digital health solutions for chronic conditions
Giunti G. 3MD for Chronic Conditions, a Model for Motivational mHealth Design: Embedded Case Study. JMIR Serious Games 2018;6:e11631. https://games.jmir.org/2018/3/e11631/
Designing the More Stamina concept
Giunti G, Mylonopoulou V, Rivera Romero O. More Stamina, a Gamified mHealth Solution for Persons with Multiple Sclerosis: Research Through Design. JMIR mHealth uHealth. 2018;6(3):e51. https://mhealth.jmir.org/2018/3/e51/
Testing the prototype with people with MS
Giunti G,Rivera-Romero O, et al. Evaluation of More Stamina, a Mobile App for Fatigue Management in Persons with Multiple Sclerosis: Protocol for a Feasibility, Acceptability, and Usability Study. JMIR Res Protoc 2020;9:1–11. https://www.researchprotocols.org/2020/8/e18196/