University of Massachusetts Medical School, Worcester, MA, United States.
JMIR Serious Games. 2016 May 26;4(1):e3. doi: 10.2196/games.4566.
Smoking is still the number one preventable cause of death. Cravings-an intense desire or longing for a cigarette-are a major contributor to quit attempt failure. New tools to help smokers' manage their cravings are needed.
To present a case study of the development process and testing of a distraction/motivation game (Crave-Out) to help manage cravings.
We used a phased approach: in Phase 1 (alpha testing), we tested and refined the game concept, using a Web-based prototype. In Phase 2 (beta testing), we evaluated the distraction/motivation potential of the mobile game prototype, using a prepost design. After varying duration of abstinence, smokers completed the Questionnaire of Smoking Urge-Brief (QSU-Brief) measurement before and after playing Crave-Out. Paired t tests were used to compare pregame and postgame QSU-Brief levels. To test dissemination potential, we released the game on the Apple iTunes App Store and tracked downloads between December 22, 2011, and May 5, 2014.
Our concept refinement resulted in a multilevel, pattern memory challenge game, with each level increasing in difficulty. Smokers could play the game as long as they wanted. At the end of each level, smokers were provided clear goals for the next level and rewards (positive reinforcement using motivational tokens that represented a benefit of quitting smoking). Negative reinforcement was removed in alpha testing as smokers felt it reminded them of smoking. Measurement of QSU-Brief (N=30) resulted in a pregame mean of 3.24 (SD 1.65) and postgame mean of 2.99 (SD 1.40) with an overall decrease of 0.25 in cravings (not statistically significant). In a subset analysis, the QSU-Brief decrease was significant for smokers abstinent for more than 48 hours (N=5) with a pregame mean of 2.84 (SD 1.16) and a postgame mean of 2.0 (SD 0.94; change=0.84; P =.03). Between December 22, 2011, and May 29, 2014, the game was downloaded 3372 times from the App-Store, with 1526 smokers visiting the online resource www.decide2quit.org linked to the game.
Overall, playing the game resulted in small, but nonsignificant decreases in cravings, with changes greater for those had already quit for more than 48 hours. Lessons learned can inform further development. Future research could incorporate mHealth games in multicomponent cessation interventions.
Clinicaltrials.gov NCT00797628; https://clinicaltrials.gov/ct2/show/NCT00797628 (Archived by WebCite at http://www.webcitation.org/6hbJr6LWG).
吸烟仍然是头号可预防的死亡原因。吸烟欲望——对香烟的强烈渴望或渴望——是戒烟尝试失败的主要原因。需要新的工具来帮助吸烟者控制他们的吸烟欲望。
介绍一种帮助控制吸烟欲望的分散注意力/激励游戏（Crave-Out）的开发过程和测试情况。
我们采用了分阶段的方法：在第 1 阶段（alpha 测试）中，我们使用基于 Web 的原型测试和改进了游戏概念。在第 2 阶段（beta 测试）中，我们使用预-后设计评估了移动游戏原型的分散注意力/激励潜力。在不同的禁欲时间后，吸烟者在玩 Crave-Out 前后完成了吸烟欲望简要问卷（QSU-Brief）测量。使用配对 t 检验比较游戏前后的 QSU-Brief 水平。为了测试传播潜力，我们在苹果 iTunes App Store 上发布了游戏，并在 2011 年 12 月 22 日至 2014 年 5 月 5 日之间跟踪下载情况。
我们的概念改进产生了一个多层次、模式记忆挑战游戏，每个层次的难度都在增加。吸烟者可以根据自己的意愿玩游戏。在每个关卡结束时，吸烟者都会获得下一个关卡的明确目标和奖励（使用代表戒烟益处的激励代币进行积极强化）。在 alpha 测试中，我们去除了消极强化，因为吸烟者觉得这让他们想起了吸烟。对 30 名吸烟者进行的 QSU-Brief 测量结果显示，游戏前的平均得分是 3.24（标准差 1.65），游戏后的平均得分是 2.99（标准差 1.40），总体吸烟欲望下降了 0.25（无统计学意义）。在一个亚组分析中，对于禁欲时间超过 48 小时的吸烟者（N=5），QSU-Brief 的下降具有显著意义，游戏前的平均得分是 2.84（标准差 1.16），游戏后的平均得分是 2.0（标准差 0.94；变化=0.84；P=.03）。在 2011 年 12 月 22 日至 2014 年 5 月 29 日期间，游戏从 App Store 下载了 3372 次，有 1526 名吸烟者访问了与游戏相关的在线资源 www.decide2quit.org。
总体而言，玩游戏会导致吸烟欲望的微小但无统计学意义的下降，对于已经禁欲超过 48 小时的吸烟者来说，变化更大。所吸取的经验教训可以为进一步的发展提供信息。未来的研究可以将移动健康游戏纳入多组分戒烟干预措施中。
Clinicaltrials.gov NCT00797628；https://clinicaltrials.gov/ct2/show/NCT00797628（由 WebCite 存档，http://www.webcitation.org/6hbJr6LWG）。
