Janssen Jeroen, Châtel Bas, Den Heijer Nora, Tieben Rob, Deen Menno, Corten Rense, Peeters Geeske, Olde Rikkert Marcel
Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands.
Games for Health, Eindhoven, Netherlands.
JMIR Form Res. 2023 Oct 20;7:e45173. doi: 10.2196/45173.
Digital loneliness interventions for older adults are promising, yet conclusive evidence is lacking due to a lack of randomized controlled trials (RCTs) and difficulties with recruitment. Process evaluation of performed RCTs is essential to inform future interventions. Still, it is rarely carried out, resulting in an overly optimistic view of the impact of eHealth interventions on loneliness in older adults and options to conduct such research entirely remotely.
We describe a mixed methods process evaluation of a digitally conducted RCT assessing the effectiveness of a mobile social gaming app to facilitate meaningful social interactions in older adults.
We analyzed the questionnaire and game data of the RCT participants to evaluate recruitment and onboarding, intervention adherence, and intervention acceptability. The RCT participants were allocated either to the main group of older adults (aged 65 years or older) or the side group (aged between 18 and 64 years). The side group used networking to play with the older adults. We also conducted 6 post-RCT evaluation interviews and 1 focus group with a total of 4 RCT participants and 5 welfare organization representatives that aided in RCT recruitment.
In total, 371 people aged 18 years or older signed up for the RCT, of which 64% (238/371) were aged 65 years or older. Of the total sample, 20% (76/371) installed the app and signed informed consent, showing a large dropout during onboarding. The high number of questions was a relevant barrier for participants. Both questionnaire and gameplay adherence were low. Participants indicated that the games elicited contact and a feeling of togetherness and proposed challenging and competitive games with increasing difficulty levels. They suggested focusing on enjoying the games rather than administering questionnaires.
Conducting a remote digital trial of a social gaming intervention for older adults is a great challenge. Remote recruitment and informed consent acquisition may often not result in sufficient participation. Personal engagement with fellow participants and researchers might be essential for adherence and enjoyment. Future digital gaming interventions should start with small-scale studies with in-person contact, repeated instructions, and fewer questionnaires.
针对老年人的数字孤独干预措施前景广阔，但由于缺乏随机对照试验（RCT）以及招募困难，尚无确凿证据。对已开展的随机对照试验进行过程评估对于指导未来的干预措施至关重要。然而，此类评估很少进行，导致人们对电子健康干预措施对老年人孤独感的影响过于乐观，也缺乏完全远程开展此类研究的方法。
我们描述了一项针对通过数字方式开展的随机对照试验的混合方法过程评估，该试验旨在评估一款移动社交游戏应用程序促进老年人进行有意义社交互动的有效性。
我们分析了随机对照试验参与者的问卷和游戏数据，以评估招募和入组情况、干预依从性和干预可接受性。随机对照试验的参与者被分配到主要老年人群组（65岁及以上）或次要群组（18至64岁）。次要群组通过网络与老年人一起玩游戏。我们还在随机对照试验结束后进行了6次评估访谈和1次焦点小组讨论，共有4名随机对照试验参与者和5名福利组织代表参与，这些人曾协助随机对照试验的招募工作。
共有371名18岁及以上的人报名参加了随机对照试验，其中64%（238/371）为65岁及以上。在总样本中，20%（76/371）安装了应用程序并签署了知情同意书，这表明在入组过程中有大量人员退出。问题数量过多是参与者面临的一个相关障碍。问卷和游戏玩法的依从性都很低。参与者表示，这些游戏引发了联系和团聚感，并建议设计难度逐渐增加的具有挑战性和竞争性的游戏。他们建议专注于享受游戏，而不是填写问卷。
对老年人进行社交游戏干预的远程数字试验是一项巨大挑战。远程招募和获取知情同意往往可能无法带来足够的参与度。与其他参与者和研究人员的个人互动可能对依从性和游戏体验至关重要。未来的数字游戏干预应以小规模研究起步，采用面对面接触、反复指导并减少问卷数量。
