iLift: A health behavior change support system for lifting and transfer techniques to prevent lower-back injuries in healthcare.

OBJECTIVE: Lower back problems are a common cause of sick leave of employees in Dutch care homes and hospitals. In the Netherlands over 40% of reported sick leave is due to back problems, mainly caused by carrying out heavy work. The goal of the iLift project was to develop a game for nursing personnel to train them in lifting and transfer techniques. The main focus was not on testing for the effectiveness of the game itself, but rather on the design of the game as an autogenous trigger and its place in a behavioral change support system. In this article, the design and development of such a health behavior change support system is addressed, describing cycles of design and evaluation. METHODS: (a) To define the problem space, use context and user context, focus group interviews were conducted with Occupational Therapists (n=4), Nurses (n=10) and Caregivers (n=12) and a thematic analysis was performed. We interviewed experts (n=5) on the subject of lifting and transferring techniques. (b) A design science research approach resulted in a playable prototype. An expert panel conducted analysis of video-recorded playing activities. (c) Field experiment: We performed a dynamic analysis in order to investigate the feasibility of the prototype through biometric data from player sessions (n=620) by healthcare professionals (n=37). RESULTS: (a) Occupational Therapists, Nurses and Caregivers did not recognise a lack of knowledge with training in lifting and transferring techniques. All groups considered their workload, time pressure and a culturally determined habit to place the patient's well being above their own as the main reason not to apply appropriate lifting and transferring techniques. This led to a shift in focus from a serious game teaching lifting and transferring techniques to a health behavior change support system containing a game with the intention to influence behavior. (b) Building and testing (subcomponents of) the prototype resulted in design choices regarding players perspective, auditory and visual feedback, overall playability and perceived immersiveness. This design process also addressed the behavior shaping capacities of the game and its place within the health behavior change support system. An expert panel on lifting and transferring techniques validated the provoked in-game activities as being authentic. (c) Regression analysis showed an increase of the game score and dashboard score when more sessions were played, indicating an in-game training effect. A post-hoc test revealed that from an average of 10 playing sessions or more, the dashboard score and the game score align, which indicates behavioral change towards executing appropriate static lifting and transferring techniques. CONCLUSIONS: Data gathered in the final field test shows an in-game training effect, causing players to exhibit correct techniques for static lifting and transferring techniques but also revealed the necessity for future social system development and especially regarding intervention acceptance. Social system factors showed a strong impact on the games persuasive capacities and its autogenous intent.

Determinants that shape public attitudes towards the mentally ill: a Dutch public study.

BACKGROUND: The stigmatisation of the mentally ill is considered a well-established fact. To improve negative attitudes among the general public, we need to identify the factors that cause them. Drawing from previous studies, we combined a variety of variables to examine a comprehensive explanative model. OBJECTIVES: We examined a sample of the Dutch public on their willingness to interact with mental patients. We examined a number of determinants concerning their influence on levels of social distance: demographical characteristics of the public, their beliefs about stereotypes of mental patients, their beliefs about causes of mental problems, their familiarity with mental illness. METHODS: We employed a questionnaire survey among two sub-samples of the Dutch public (n = 812, response 33%). RESULTS: Attributing psychiatric problems to structural causes (i.e. causes beyond patients' control and responsibility, such as genetic transmission) is associated with less social distance. Conversely, attribution to individual factors (e.g. drug abuse) related to more distant attitudes. Stereotypical beliefs about mental patients (e.g. untrustworthiness, aggressiveness, causing disturbances) relate to more social distance from mental patients. CONCLUSIONS: Results implied that our comprehensive model explains only a modest amount of variance, but shows that to improve public mental health literacy and attitudes should first deal with the most negative stereotypical beliefs.