Abraham Olufunmilola, Rosenberger Claire, Tierney Kathleen, Birstler Jen
Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, United States.
Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States.
JMIR Serious Games. 2021 Dec 23;9(4):e33975. doi: 10.2196/33975.
The misuse of opioid medications among adolescents is a serious problem in the United States. Serious games (SGs) are a novel way to promote the safe and responsible management of opioid medications among adolescents, thereby reducing the number of adolescent opioid misuse cases reported annually.
This study aimed to examine the effect of the SG MedSMART: Adventures in PharmaCity on adolescents' opioid safety knowledge, awareness, behavioral intent, and self-efficacy.
A nationally representative sample of adolescents aged 12 to 18 years were recruited online through Qualtrics panels from October to November 2020. Data collection consisted of a pregame survey, 30 minutes of gameplay, and a postgame survey. The pregame and postgame surveys included 66 items examining the participants' baseline opioid knowledge, safety, use, and demographic information. The postgame survey had 25 additional questions regarding the MedSMART game. Gameplay scenarios included 5 levels intended to mimic adolescents' daily life while educating the players about appropriate opioid storage and disposable practices, negative consequences of sharing opioid medications, and the use of Narcan. Survey questions were divided into 10 categories to represent key concepts and were summarized into concept scores. Differences in concept scores were described by overall mean (SD) when stratified by gender, race, school, grade, and age. Differences of change in concept score were analyzed using the Kruskal-Wallis and correlation tests.
A total of 117 responses were analyzed. The results showed significant improvement on all concept scores except for Narcan knowledge (mean change -0.04, SD 0.29; P=.60) and safe storage (mean change 0.03, SD 0.20; P=.09). Female participants had greater improvement than males for safe disposal (female mean 0.12, SD 0.25 vs male mean 0.04, SD 0.17; P=.05). Male participants had higher improvement than female participants for misuse behavior (female mean 0.05, SD 0.28 vs male mean 0.14, SD 0.27; P=.04). Perceived knowledge for participants who had non-White or Hispanic racial backgrounds had higher improvement than for non-Hispanic White participants (non-White mean 1.10, SD 1.06 vs White mean 0.75, SD 0.91; P=.03). Older grades were associated with greater improvement in opioid knowledge (correlation coefficient -0.23, 95% CI -0.40 to -0.05; P=.01). There were 28 (23.9%) participants who played all 5 levels of the game and had better improvement in opioid use self-efficacy.
Our findings suggest MedSMART: Adventures in PharmaCity can be used as an effective tool to educate adolescents on the safe and responsible use of prescribed opioid medications. Future testing of the effectiveness of this SG should involve a randomized controlled trial. Additionally, the feasibility of implementing and disseminating MedSMART: Adventures in PharmaCity in schools and health care settings such as adolescent health or primary care clinics, emergency departments, and pharmacies should be investigated.
在美国，青少年滥用阿片类药物是一个严重问题。严肃游戏（SGs）是一种新颖的方式，可促进青少年对阿片类药物进行安全且负责任的管理，从而减少每年报告的青少年阿片类药物滥用案例数量。
本研究旨在考察SG MedSMART：《药城历险记》对青少年阿片类药物安全知识、意识、行为意图和自我效能的影响。
2020年10月至11月，通过Qualtrics面板在线招募了12至18岁具有全国代表性的青少年样本。数据收集包括赛前调查、30分钟的游戏过程以及赛后调查。赛前和赛后调查包含66个项目，用于考察参与者的基线阿片类药物知识、安全性、使用情况及人口统计学信息。赛后调查还有另外25个关于MedSMART游戏的问题。游戏场景包括5个关卡，旨在模拟青少年的日常生活，同时向玩家传授阿片类药物的正确储存和处置方法、分享阿片类药物的负面后果以及纳洛酮的使用。调查问题分为10个类别以代表关键概念，并汇总为概念得分。当按性别、种族、学校、年级和年龄分层时，概念得分的差异通过总体均值（标准差）来描述。使用Kruskal-Wallis检验和相关性检验分析概念得分变化的差异。
共分析了117份回复。结果显示，除纳洛酮知识（平均变化-0.04，标准差0.29；P = 0.60）和安全储存（平均变化0.03，标准差0.20；P = 0.09）外，所有概念得分均有显著提高。女性参与者在安全处置方面的改善比男性更大（女性平均0.12，标准差0.25；男性平均0.04，标准差0.17；P = 0.05）。男性参与者在滥用行为方面的改善比女性参与者更高（女性平均0.05，标准差0.28；男性平均0.14，标准差0.27；P = 0.04）。非白人或西班牙裔种族背景的参与者在感知知识方面的改善比非西班牙裔白人参与者更高（非白人平均1.10，标准差1.06；白人平均0.75，标准差0.91；P = 0.03）。较高年级与阿片类药物知识的更大改善相关（相关系数-0.23，95%置信区间-0.40至-0.05；P = 0.01）。有28名（23.9%）参与者玩了游戏的所有5个关卡，且在阿片类药物使用自我效能方面有更好的改善。
我们的研究结果表明，MedSMART：《药城历险记》可作为一种有效工具，用于教育青少年安全且负责任地使用处方阿片类药物。该严肃游戏有效性的未来测试应包括随机对照试验。此外，应调查在学校以及青少年健康或初级保健诊所、急诊科和药房等医疗保健环境中实施和推广MedSMART：《药城历险记》的可行性。
