New Charter Group, the University of Manchester (Manchester Institute of Innovation Research, Alliance Manchester Business School and Division of Nursing, Midwifery and Social Work) and Reason Digital have been collaborating on an innovative approach to the growing problem of slips, trips and falls among older people, and how digital interventions can help.
The first digital health intervention being developed by the team is an application using ‘gamification’ to reduce the risk of slips, trips and falls amongst older people. Gamification describes the ways in which ‘game thinking’ can be used to engage people and change behaviours in real-world, non-game situations. There is growing evidence from a number of fields that game thinking can transform learning and the modification of behaviours.
Slips, trips and falls are a principle cause of accidental death in older people in the UK. Around one in three people over 65 and half of people over 80 fall at least once a year, with devastating effects, such as chronic mobility problems and social isolation. Furthermore, health inequalities and disadvantage mean the tenants of social landlords are much more likely to suffer health challenges that increase their risk of slips, trips and falls than people in the general population.
The multi-disciplinary approach by the team has been made possible by Impact Acceleration Account funding from the Economic and Social Research Council. The award has funded the creation of a ‘skinny prototype’, produced using an agile development approach.
Game thinking has been incorporated into the prototype app, which is intended to offer a catalyst for change in the situations, circumstances and behaviours of older people that increase their risk of a slip, trip or fall. For example:
- Goal setting: the app provides an abstract challenge in a straightforward scenario, maintaining a strong connection between cause (exercise to improve strength, balance and co-ordination, and increased awareness of trip hazards) and effect (reduced incidences and fear of slips, trips and falls, and improved healthy life expectancy).
- Rewards are provided through the use of digital badges, which are awarded for self-reporting the completion of exercises or correctly spotting hazards around a virtual home.
- Visual reinforcement of progress against personalised goals is developed within the design (for example, changing colour of a virtual character’s clothes) and by leader-boards of other users’ performance and achievements.
New Charter’s older customers have been actively involved in testing the prototype. The testing has confirmed findings from a range of research, which has identified that touch is a natural method of user-device interaction among older people. Overall, user satisfaction with the look, feel and usability of the prototype has been high. Some of the issues emerging during testing of the prototype reaffirmed Apple’s guidelines for human-machine interfaces; and have included:
- Interface design because some older customers struggled with certain aspects of the iconography.
- Navigation presented occasional challenges. For example, users did not recognise the bottom tab bar as a navigation tool, even after they had accidentally clicked on it. Others did not realise that more content was available beneath ‘the fold’ in the application. Some of the terminology used on the navigation bar appeared confusing for some participants, leading to them going into the wrong tab when trying to complete specific tasks.
- Almost all of the older customers involved in the testing struggled to read the smallest font size used in the prototype.
A digital intervention for health that uses game thinking with the goal of improving the quality of older people’s lives isn’t straightforward, but then, ground-breaking innovation rarely is!
The research in this field provides examples of some key challenges that must be overcome, such as: the complexity in older people’s situations, circumstances and behaviours; the reach and impact of an application among older people (including levels of digital literacy); and the fundamental importance of user-shaped co-creation in the development of digital interventions for health.
The success in the agile way of working developed by the multi-disciplinary team will continue, subject to further funding, until a near-complete version of the application is available for more formal, extensive testing.
The award of funding by the Economic and Social Research Council has enabled the team to realise a proof of concept and develop a skinny prototype of an app that shows significant promise. The intention is that by the end of 2017, the team will be ready to apply for funding to enable cost-effective testing of the prototype in a full randomised and controlled trial.
Digital interventions for health based on game thinking are likely to grow in importance over the next few years; they offer an innovative, inexpensive and accessible approach that is readily adaptable and scalable to the range of contexts, situations, circumstances and behaviours of individuals and groups facing different challenges to their health and well-being.
David Hoyle is the business impact and innovation lead at New Charter Group.