Chang Ling-Sai, Kuo Ho-Chang, Suen Jason Jyh-Bin, Yang Pei-Hsin, Hou Chiu-Ping, Sun Hui-Ru, Lee Zon-Min, Huang Ying-Hsien
Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
Department of Digital Media Design, I-Shou University, Kaohsiung 83301, Taiwan.
Children (Basel). 2023 Mar 17;10(3):574. doi: 10.3390/children10030574.
(1) Objective: Atopic dermatitis (AD) is a recurring skin disease that affects children's daily activities and sleep quality. Due to the limitations of children's understanding and ability to express themselves, shared decision making (SDM) is often made by guardians, which thus affects the acceptance and effectiveness of children's treatments. Previous studies have demonstrated that involving both children and parents in decision making may help improve treatment outcomes; thus, we designed a multimedia mixed reality (MR) interactive game of SDM for children with moderate to severe AD. (2) Methods: Research participants included 6-18-year-old patients with moderate to severe AD. This research consisted of the following steps: designing SDM; character setting and visual design; performing games; system modification and optimization; screen editing and dubbing; and user testing and questionnaires by the System Usability Scale (SUS). (3) Results: We completed the SDM design for children with moderate to severe AD. Four different treatments were biologics, oral immune-modulating drugs, phototherapy, and wet wrap. An animated PowerPoint slide showed the AD apple rolling around before treatments and the AD apple sleeping soundly after treatments. Instructions with video teaching for the four different treatments were played, and then, the MR was turned on so that the patients could help the AD apple in the metaverse to undergo these four treatments. A total of 12 moderate to severe AD patients and six control patients used the game, all aged between six and eighteen years old, with an average SUS score of 81.0 and a standard error of 2.1 points. Adjective ratings yielded a rating between good and excellent. The game showed acceptable usability. We found no statistically significant differences in SUS scores between patients with and without moderate to severe AD or between boys and girls nor significant associations between SUS and age or severity. The analysis identified that the two items with the lowest SUS scores were "I think that I would need the support of a technical person to be able to use this product" and "I needed to learn a lot of things before I could get going with this product". Both of these comments show the limitations of this game. (4) Conclusions: Overall, this study provides the first MR SDM game that has passed the SUS and can be used as an aid in clinical SDM.
（1）目的：特应性皮炎（AD）是一种复发性皮肤病，会影响儿童的日常活动和睡眠质量。由于儿童理解和表达能力的限制，共同决策（SDM）通常由监护人做出，这进而影响了儿童治疗的接受度和效果。先前的研究表明，让儿童和父母都参与决策可能有助于改善治疗结果；因此，我们为中重度AD儿童设计了一款多媒体混合现实（MR）交互式共同决策游戏。（2）方法：研究参与者包括6至18岁的中重度AD患者。本研究包括以下步骤：设计共同决策；角色设定和视觉设计；进行游戏；系统修改和优化；屏幕编辑和配音；以及通过系统可用性量表（SUS）进行用户测试和问卷调查。（3）结果：我们完成了中重度AD儿童的共同决策设计。四种不同的治疗方法是生物制剂、口服免疫调节药物、光疗和湿敷。一个动画PowerPoint幻灯片展示了治疗前AD苹果四处滚动以及治疗后AD苹果安然入睡的情景。播放了针对四种不同治疗方法的视频教学说明，然后开启MR，以便患者在元宇宙中帮助AD苹果接受这四种治疗。共有12名中重度AD患者和6名对照患者使用了该游戏，所有患者年龄均在6至18岁之间，平均SUS评分为81.0，标准误差为2.1分。形容词评级得出的评价在良好到优秀之间。该游戏显示出可接受的可用性。我们发现，中重度AD患者与非中重度AD患者之间、男孩与女孩之间的SUS评分没有统计学上的显著差异，SUS与年龄或严重程度之间也没有显著关联。分析确定SUS评分最低的两个项目是“我认为我需要技术人员的支持才能使用这个产品”和“在我能够使用这个产品之前，我需要学习很多东西”。这两条评论都显示了这款游戏的局限性。（4）结论：总体而言，本研究提供了第一款通过SUS测试的MR共同决策游戏，可作为临床共同决策的辅助工具。
