InsuOnline, an electronic game for medical education on insulin therapy: A randomized controlled trial with primary care physicians

Journal of Medical Internet Research

Volumn 19, Issue 3, 2017, Pages

  Diehl, Leandro Arthur ^a   Souza, Rodrigo Martins ^b   Gordan, Pedro Alejandro ^a   Esteves, Roberto Zonato ^c,d   Coelho, Izabel Cristina Meister ^d  

^a STATE UNIVERSITY OF LONDRINA   (Brazil)

^b Oniria Software Industry   (Brazil)

^c STATE UNIVERSITY OF MARINGÁ   (Brazil)

^d Pequeno Principe Hospital   (Brazil)

Author keywords

Continuing medical education; Diabetes mellitus; Educational technology; Insulin; Medical education; Video games

Indexed keywords

INSULIN;

CONTROLLED STUDY; DIABETES MELLITUS; FEMALE; GENERAL PRACTITIONER; HUMAN; MALE; MEDICAL EDUCATION; MIDDLE AGED; PROCEDURES; PSYCHOLOGY; QUESTIONNAIRE; RANDOMIZED CONTROLLED TRIAL; VIDEO GAME;

DIABETES MELLITUS; EDUCATION, MEDICAL, CONTINUING; FEMALE; HUMANS; INSULIN; MALE; MIDDLE AGED; PHYSICIANS, PRIMARY CARE; SURVEYS AND QUESTIONNAIRES; VIDEO GAMES;

EID: 85016433470     PISSN: None     EISSN: 14388871     Source Type: Journal    
DOI: 10.2196/jmir.6944     Document Type: Article

References (66)

1. World Health Organization. Global report on diabetes. Geneva: World Health Organization; 2016.
2. DeWitt DE, Hirsch IB. Outpatient insulin therapy in type 1 and type 2 diabetes mellitus: Scientific review. J Am Med Assoc 2003 May 7;289(17):2254-2264. [Medline: 12734137]
3. Mendes AB, Fittipaldi JA, Neves RC, Chacra AR, Moreira ED. Prevalence and correlates of inadequate glycaemic control: Results from a nationwide survey in 6,671 adults with diabetes in Brazil. Acta Diabetol 2010 Jun;47(2):137-145 [FREE Full text] [doi: 10.1007/s00592-009-0138-z] [Medline: 19655083]
4. Ford ES, Li C, Little RR, Mokdad AH. Trends in A1C concentrations among U.S. adults with diagnosed diabetes from 1999 to 2004. Diabetes Care 2008 Jan;31(1):102-104. [doi: 10.2337/dc07-0565] [Medline: 17934146]
5. American Diabetes Association. Standards of medical care in diabetes-2014. Diabetes Care 2014 Jan;37(Suppl 1):S14-S80. [doi: 10.2337/dc14-S014] [Medline: 24357209]
6. Rubin DJ, Moshang J, Jabbour SA. Diabetes knowledge: Are resident physicians and nurses adequately prepared to manage diabetes?. Endocr Pract 2007;13(1):17-21. [doi: 10.4158/EP.13.1.17] [Medline: 17360296]
7. Hayes RP, Fitzgerald JT, Jacober SJ. Primary care physician beliefs about insulin initiation in patients with type 2 diabetes. Int J Clin Pract 2008 Jun;62(6):860-868 [FREE Full text] [doi: 10.1111/j.1742-1241.2008.01742.x] [Medline: 18393965]
8. Peyrot M, Rubin RR, Lauritzen T, Skovlund SE, Snoek FJ, Matthews DR, International DAWN Advisory Panel. Resistance to insulin therapy among patients and providers: Results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study. Diabetes Care 2005 Nov;28(11):2673-2679. [Medline: 16249538]
9. Riddle MC. The underuse of insulin therapy in North America. Diabetes Metab Res Rev 2002;18(Suppl 3):S42-S49. [doi: 10.1002/dmrr.277] [Medline: 12324985]
10. Nichols GA, Koo YH, Shah SN. Delay of insulin addition to oral combination therapy despite inadequate glycemic control: Delay of insulin therapy. J Gen Intern Med 2007 Apr;22(4):453-458 [FREE Full text] [doi: 10.1007/s11606-007-0139-y] [Medline: 17372792]
11. Rubino A, McQuay LJ, Gough SC, Kvasz M, Tennis P. Delayed initiation of subcutaneous insulin therapy after failure of oral glucose-lowering agents in patients with Type 2 diabetes: A population-based analysis in the UK. Diabet Med 2007 Dec;24(12):1412-1418. [doi: 10.1111/j.1464-5491.2007.02279.x] [Medline: 18042083]
12. Peyrot M, Rubin RR, Khunti K. Addressing barriers to initiation of insulin in patients with type 2 diabetes. Prim Care Diabetes 2010 Apr;4(Suppl 1):S11-S18. [doi: 10.1016/S1751-9918(10)60004-6] [Medline: 20394886]
13. Sharp LK, Lipsky MS. Continuing medical education and attitudes of health care providers toward treating diabetes. J Contin Educ Health Prof 2002;22(2):103-112. [doi: 10.1002/chp.1340220206] [Medline: 12099119]
14. Johnson L, Adams S, Cummins M. NMC. Austin: The New Media Consortium; 2012. The NMC Horizon Report: Higher Education Edition URL: Http://www.nmc.org/publications/horizon-report-2012-higher-ed-edition [accessed 2012-12-21] [WebCite Cache ID 6D4zxQo5K]
15. Gee JP. What Video Games Have to Teach Us About Learning and Literacy. New York: Palgrave Macmillan; 2004.
16. Prensky M. Digital game-based learning. New York: McGraw-Hill; 2001.
17. Kron FW, Gjerde CL, Sen A, Fetters MD. Medical student attitudes toward video games and related new media technologies in medical education. BMC Med Educ 2010;10:50 [FREE Full text] [doi: 10.1186/1472-6920-10-50] [Medline: 20576125]
18. Diehl LA, de Souza RM, Gordan PA, Esteves RZ, Coelho IC. Gaming habits and opinions of Brazilian medical school faculty and students: what s next?. Games Health J 2014 Apr;3(2):79-85. [doi: 10.1089/g4h.2013.0069] [Medline: 26196048]
19. Mayo MJ. Games for science and engineering education. Commun ACM 2007 Jul 01;50(7):30. [doi: 10.1145/1272516.1272536]
20. Murphy C. Goodgamesbydesign. 2011. Why games work and the science of learning URL: Http://www.goodgamesbydesign.com/Files/WhyGamesWork-TheScienceOfLearning-CMurphy-2011.pdf [accessed 2012-12-21] [WebCite Cache ID 6D50AGPB3]
21. Yusoff A. Eprints.soton. Southampton: University of Southampton, Faculty of Engineering, Sciences and Mathematics, Doctoral Thesis; 2010. A conceptual framework for serious games and its validation URL: Http://eprints.soton.ac.uk/171663/ 1/Thesis-017b.pdf [accessed 2016-10-28] [WebCite Cache ID 6IbUQ9E0d]
22. Ziv A, Small SD, Wolpe PR. Patient safety and simulation-based medical education. Med Teach 2000;22(5):489-495. [doi: 10.1080/01421590050110777] [Medline: 21271963]
23. Demirbilek M. The use of electronic games in distance learning as a tool for teaching-learning. In: Rogers PL, Berg GA, Boettcher JV, Howard C, Justice L, Schenk KD, editors. Encyclopedia of distance learning. Hershey: IGI Global; 2009:2209-2223.
24. Brown SJ, Lieberman DA, Germeny BA, Fan YC, Wilson DM, Pasta DJ. Educational video game for juvenile diabetes: Results of a controlled trial. Med Inform (Lond) 1997;22(1):77-89. [Medline: 9183781]
25. Patterson N, Wolfenstein M, Millar S, Halverson R, Squire K. Wcer.wisc.edu. Madison: University of Wisconsin-Madison; 2011. Games and Simulations for Diabetes Education URL: Http://wcer.wisc.edu/publications/abstract/wcer-working-paper-no. -2011-1 [accessed 2012-12-21] [WebCite Cache ID 6D538StfS]
26. DeShazo J, Harris L, Pratt W. Effective intervention or child's play? A review of video games for diabetes education. Diabetes Technol Ther 2010 Oct;12(10):815-822. [doi: 10.1089/dia.2010.0030] [Medline: 20807119]
27. Lehmann ED. Interactive educational simulators in diabetes care. Med Inform (Lond) 1997;22(1):47-76. [Medline: 9183780]
28. Thompson D, Baranowski T, Buday R. Conceptual model for the design of a serious video game promoting self-management among youth with type 1 diabetes. J Diabetes Sci Technol 2010 May 01;4(3):744-749 [FREE Full text] [doi: 10.1177/193229681000400331] [Medline: 20513343]
29. O'Connor PJ, Sperl-Hillen JM, Johnson PE, Rush WA, Asche SE, Dutta P, et al. Simulated physician learning intervention to improve safety and quality of diabetes care: A randomized trial. Diabetes Care 2009 Apr;32(4):585-590 [FREE Full text] [doi: 10.2337/dc08-0944] [Medline: 19171723]
30. Harris SB, Leiter LA, Webster-Bogaert S, Van DM, O'Neill C. Teleconferenced educational detailing: Diabetes education for primary care physicians. J Contin Educ Health Prof 2005;25(2):87-97. [doi: 10.1002/chp.13] [Medline: 16078807]
31. Tatti P, Lehmann ED. Utility of the AIDA diabetes simulator as an interactive educational teaching tool for general practitioners (primary care physicians). Diabetes Technol Ther 2001;3(1):133-140. [doi: 10.1089/152091501750220118] [Medline: 11469705]
32. Miller D, Roberts P. Using computer simulation as an insulin prescribing virtual preceptorship. In: Diabetes. Alexandria: American Diabetes Association; 2011 Jul Presented at: 71st American Diabetes Association Scientific Sessions; June 24-28, 2011; San Diego p. A197.
33. Simation Medical. Learntotreat. Victoria: Simation Medical Ltd; 2012. Learn to Treat Diabetes URL: Http://learntotreat. com [accessed 2012-12-21] [WebCite Cache ID 6D5AeMpBa]
34. American Diabetes Association, Therasim. Therasim. Durham: Therasim, Inc; 2010. Interactive Patient Simulation URL: Http://therasim.net/ada01/login.php [accessed 2012-12-21] [WebCite Cache ID 6D5AhLo43]
35. Diehl LA, Souza RM, Alves JB, Gordan PA, Esteves RZ, Jorge ML, et al. InsuOnline, a serious game to teach insulin therapy to primary care physicians: Design of the game and a randomized controlled trial for educational validation. JMIR Res Protoc 2013 Jan 21;2(1):e5 [FREE Full text] [doi: 10.2196/resprot.2431] [Medline: 23612462]
36. Diehl LA, de Souza RM, Gordan PA, Esteves RZ, Coelho ICM. User assessment of InsuOnLine, a game to fight clinical inertia in diabetes: A pilot study. Games Health J 2015 Oct;4(5):335-343. [doi: 10.1089/g4h.2014.0111] [Medline: 26287924]
37. Diehl LA, Gordan PA, Esteves RZ, Coelho IC. Effectiveness of a serious game for medical education on insulin therapy: A pilot study. Arch Endocrinol Metab 2015 Oct;59(5):470-473 [FREE Full text] [doi: 10.1590/2359-3997000000118] [Medline: 26537410]
38. Randomness and Integrity Services Ltd. Random. Dublin: Randomness and Integrity Services Ltd; 2016. What's this fuss about true randomness? URL: Https://www.random.org/ [accessed 2016-10-27] [WebCite Cache ID 6la0TCBJ5]
39. Bates B. Game design. Boston: Thomson Course Technology PTR; 2004.
40. Aldrich C. The complete guide to simulations and serious games: How the most valuable content will be created in the age beyond Gutenberg to Google. San Francisco: Pfeiffer; 2009.
41. Collins J. Education techniques for lifelong learning: Principles of adult learning. Radiographics 2004 Sep;24(5):1483-1489. [doi: 10.1148/rg.245045020] [Medline: 15371622]
42. Barrows H. Problem-based learning applied to medical education. Springfield: Southern Illinois University School of Medicine; 2000.
43. Knowles M. The modern practice of adult education: From pedagogy to andragogy. New York: Association Press; 1980.
44. American Diabetes Association. Practical Insulin: A Handbook for Prescribing Providers. Alexandria: American Diabetes Association; 2011.
45. Beaser RS. Joslin s insulin deskbook: Designing and initiating insulin treatment programs. Boston: Joslin Diabetes Center; 2008.
46. Brazilian Diabetes Society. Guidelines from the Brazilian Diabetes Society 2013-2014. São Paulo: AC Farmac utica; 2014.
47. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD). Management of hyperglycemia in type 2 diabetes: A patient-centered approach: Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2012 Jun;35(6):1364-1379 [FREE Full text] [doi: 10.2337/dc12-0413] [Medline: 22517736]
48. Lerario AC, Chacra AR, Pimazoni-Netto A, Malerbi D, Gross JL, Oliveira JE, et al. Algorithm for the treatment of type 2 diabetes: A position statement of Brazilian Diabetes Society. Diabetol Metab Syndr 2010 Jun 08;2(1):35 [FREE Full text] [doi: 10.1186/1758-5996-2-35] [Medline: 20529311]
49. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, American Diabetes Association, European Association for Study of Diabetes. Medical management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy: A consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2009 Jan;32(1):193-203 [FREE Full text] [doi: 10.2337/dc08-9025] [Medline: 18945920]
50. Lakkis NA, Maalouf GJ, Mahmassani DM, Hamadeh GN. Insulin therapy attitudes and beliefs of physicians in Middle Eastern Arab countries. Fam Pract 2013 Oct;30(5):560-567 [FREE Full text] [doi: 10.1093/fampra/cmt022] [Medline: 23729488]
51. Reichlin L, Mani N, McArthur K, Harris AM, Rajan N, Dacso CC. Assessing the acceptability and usability of an interactive serious game in aiding treatment decisions for patients with localized prostate cancer. J Med Internet Res 2011 Jan 12;13(1):e4 [FREE Full text] [doi: 10.2196/jmir.1519] [Medline: 21239374]
52. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. Br Med J 2010;340:c332 [FREE Full text] [Medline: 20332509]
53. Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale: L Erlbaum Associates; 1988.
54. Bland JM, Altman DG. Cronbach's alpha. Br Med J 1997 Feb 22;314(7080):572 [FREE Full text] [Medline: 9055718]
55. Akl EA, Sackett KM, Erdley WS, Mustafa RA, Fiander M, Gabriel C, et al. Educational games for health professionals. Cochrane Database Syst Rev 2013;1:CD006411. [doi: 10.1002/14651858.CD006411.pub3] [Medline: 23440807]
56. Abdulmajed H, Park YS, Tekian A. Assessment of educational games for health professions: A systematic review of trends and outcomes. Med Teach 2015 Apr;37(Suppl 1):S27-S32. [doi: 10.3109/0142159X.2015.1006609] [Medline: 25803590]
57. Nicolaidou I, Antoniades A, Constantinou R, Marangos C, Kyriacou E, Bamidis P, et al. A virtual emergency telemedicine serious game in medical training: A quantitative, professional feedback-informed evaluation study. J Med Internet Res 2015;17(6):e150 [FREE Full text] [doi: 10.2196/jmir.3667] [Medline: 26084866]
58. Koster R. A theory of fun for game design. Sebastopol: O'Reilly Media; 2013.
59. Segev A, Rovner M, Appel DI, Abrams AW, Rotem M, Bloch Y. Possible biases of researchers attitudes toward video games: Publication trends analysis of the medical literature. J Med Internet Res 2016 Jul 18;18(7):e196 [FREE Full text] [doi: 10.2196/jmir.5935] [Medline: 27430187]
60. Kato PM. Evaluating efficacy and validating games for health. Games Health J 2012 Feb;1(1):74-76. [doi: 10.1089/g4h.2012.1017] [Medline: 26196436]
61. Olsen T, Procci K, Bowers C. Serious games usability testing: How to ensure proper usability, playability, and effectiveness. In: Design, user experience, and usability: Theory, methods, tools and practice : First international conference, DUXU 2011, held as part of HCI International 2011, Orlando, FL, USA, July 9-14, 2011 : Proceedings. Berlin: Springer; 2011 Presented at: HCI International; July 9-14, 2011; Orlando p. 625-634.
62. Moore DE, Green JS, Gallis HA. Achieving desired results and improved outcomes: Integrating planning and assessment throughout learning activities. J Contin Educ Health Prof 2009;29(1):1-15. [doi: 10.1002/chp.20001] [Medline: 19288562]
63. Baranowski T, Buday R, Thompson DI, Baranowski J. Playing for real: Video games and stories for health-related behavior change. Am J Prev Med 2008 Jan;34(1):74-82 [FREE Full text] [doi: 10.1016/j.amepre.2007.09.027] [Medline: 18083454]
64. Olson JM, Zanna MP. Attitudes and attitude change. Annu Rev Psychol 1993 Jan;44(1):117-154. [doi: 10.1146/annurev.ps.44.020193.001001]
65. Malone TW, Lepper MR. Making learning fun: A taxonomy of intrinsic motivations for learning. In: Snow RE, Farr MJ, editors. Aptitude, learning, and instruction. Volume 3: Conative and affective process analyses. Hillsdale: L. Erlbaum Associates; 1987.
66. Moreno-Ger P, Torrente J, Hsieh YG, Lester WT. Usability testing for serious games: Making informed design decisions with user data. Advances in Human-Computer Interaction 2012;2012:1-13. [doi: 10.1155/2012/369637]