Search

This article analyzes the connection between gamification and business success, focusing on customer retention, new customer acquisition, and transforming user perceptions. Based on a qualitative comparative analysis of 40 high-profile gamification projects, it shows that a combination of three key features—virtualization, social comparison, and tangible rewards—explain the various pathways to success. Each pathway requires the presence—and sometimes absence—of different design features, and firms do best when they focus on one or two objectives rather than all three at once. The article presents a framework for designing and implementing gamification more strategically and effectively, noting the ethical questions that arise. [ABSTRACT FROM AUTHOR]

Objective To explore the cost-effectiveness of a web-based support tool for parents of children with Juvenile idiopathic arthritis. Methods A multi-centred randomized controlled trial was conducted in paediatric rheumatology centres in England. The WebParC intervention consisted of online information about JIA and its treatment and a toolkit using cognitive-behavioural therapy principles to support parents manage their child's JIA. An economic evaluation was performed alongside the trial involving 220 parents. The primary outcome was the self-report Pediatric Inventory for Parents measure of illness-related parenting stress, with two dimensions: difficulty and frequency. These measures along with costs were assessed post intervention at 4 and 12 months. Costs were calculated for healthcare usage using a UK NHS economic perspective. Data was collected and analysed on the impact of caring costs on families. Uncertainty around cost-effectiveness was explored using bootstrapping and cost-effectiveness acceptability curves. Results The intervention arm showed improved average Pediatric Inventory for Parents scores for the dimensions of frequency and difficulty, of 1.5 and 3.6 respectively at 4 months and 0.35 and 0.39 at 12 months, representing improved PIP scores for the intervention arm. At both 4 and 12 month follow-up, the average total cost per case was higher in the control group when compared with the intervention arm with mean differences of £360 (95% CI £29.6 to £691) at 4 months and £203 (95% CI £16 to £390) at 12 months. The probability of the intervention being cost-effective ranged between 49% and 54%. Conclusion The WebParC intervention led to reductions in primary and secondary healthcare resource use and costs at 4 and 12 months. The intervention demonstrated particular savings for rheumatology services at both follow-ups. Future economies of scale could be realised by health providers with increased opportunities for cost-effectiveness over time. Trial registration ISRCTN, ISRCTN13159730. [ABSTRACT FROM AUTHOR]

Background: Low-quality data presents a significant challenge for community health workers (CHWs) in low and middle-income countries (LMICs). Mobile health (mHealth) applications offer a solution by enabling CHWs to record and submit data electronically. However, the barriers and benefits of mHealth usage among CHWs in informal urban settlements remain poorly understood. This study sought to determine the barriers and benefits of mHealth among CHWs in Banda parish, Kampala. Methods: This qualitative study involved 12 key informant interviews (KIIs) among focal persons from Kampala City Council Authority (KCCA) and NGOs involved in data collected by CHWs, and officials from the Ministry of Health (MOH) and two mixed-sex Focused Group Discussions (FGDs) of CHWs from Banda parish, Kampala district. Data analysis utilised Atlas Ti Version 7.5.7. Thematic analysis was conducted, and themes were aligned with the social-ecological model. Results: Three themes of institutional and policy, community and interpersonal, and individual aligning to the Social ecological model highlighted the factors contributing to barriers and the benefits of mHealth among CHWs for iCCM. The key barriers to usability, acceptability and sustainability included high training costs, CHW demotivation, infrastructure limitations, data security concerns, community awareness deficits, and skill deficiencies. Conversely, mHealth offers benefits such as timely data submission, enhanced data quality, geo-mapping capabilities, improved CHW performance monitoring, community health surveillance, cost-effective reporting, and CHW empowering with technology. Conclusion: Despite limited mHealth experience, CHWs expressed enthusiasm for its potential. Implementation was viewed as a solution to multiple challenges, facilitating access to health information, efficient data reporting, and administrative processes, particularly in resource-constrained settings. Successful mHealth implementation requires addressing CHWs' demotivation, ensuring reliable power and network connectivity, and enhancing capacity for digital data ethics and management. By overcoming these barriers, mHealth can significantly enhance healthcare delivery at the community level, leveraging technology to optimize resource utilization and improve health outcomes. mHealth holds promise for transforming CHW practices, yet its effective integration necessitates targeted interventions to address systemic challenges and ensure sustainable implementation in LMIC contexts. [ABSTRACT FROM AUTHOR]

Introduction. The coronavirus disease 2019 (COVID-19) pandemic necessitated the suspension of most educational activities and a shift from face-to-face (FTF) education to virtual education (VE). These changes were associated with new educational experiences for both instructors and students. This study aimed to explore nursing instructors' and students' experiences of VE during the COVID-19 pandemic. Method. This descriptive qualitative study was carried out in 2021. Participants were 21 bachelor's, master's, and Ph.D. nursing students and six nursing instructors purposively selected from the Faculty of Nursing and Midwifery of Tehran University of Medical Sciences, Tehran, Iran. Data were gathered through FTF or online in-depth semistructured interviews and were analyzed through conventional qualitative content analysis as proposed by Graneheim and Lundman (2004). Results. Eight subthemes and three main themes were developed during data analysis. The main themes and subthemes were VE as a double-edged sword (VE as a threat, VE as an opportunity, and necessity to improve VE), weaknesses in clinical education (reduced quality of clinical education and necessity to compensate for students' retarded clinical learning), and reduced reliability of virtual student evaluation (cheating as a problem of virtual evaluation, stresses and tensions of virtual evaluation, and necessity to use new strategies in virtual evaluation). Conclusion. Despite the different shortcomings and challenges of VE during the COVID-19 pandemic, educational experiences gained in this period can be used to improve the quality of nursing VE in future epidemics and pandemics. [ABSTRACT FROM AUTHOR]

Objective(s): The aim of this paper was to report on qualitative survey responses provided by older Australian adults regarding their preferences for Internet‐based services and content. Methods: Two qualitative questions ('What type of Internet‐based mental health and well‐being (1) services, and (2) content would be of most interest to you?') from a broader survey investigating the mental and physical health of older Australians were thematically analysed for commonly occurring themes. Eighty‐nine participants aged 65 years or older (mean age = 71 years, SD = 5.30) responded to at least one qualitative question. Participants were primarily female (60%, n = 53), born in Australia (65%, n = 58), in a relationship (58%, n = 52), living in the community (79%, n = 70) and relatively well educated, with the majority having completed a university degree (38%, n = 34). Results: Themes indicated that participants were most interested in Facebook‐style services (n = 17), chat groups (n = 16) and email‐based services (n = 4) designed specifically for older adults (n = 14). However, some concerns were raised regarding the trustworthiness of Internet‐based services, with the largest proportion of participants (n = 22) noting that they were unlikely to use Internet‐ or social media‐based services. The primary content‐related themes were mental fitness (n = 34), grief and loss (n = 20), health information (n = 13), socialisation (n = 11) and physical fitness (n = 10). Conclusions: Participants indicated interest in tailor‐made Facebook‐style services for older adults that allow them to communicate with their peers and create new social networks and incorporate content relating to strategies for working on mental and physical fitness, information on coping with grief and loss, as well as health information. These findings can be used by organisations to develop Internet‐based services and content for older Australian adults. [ABSTRACT FROM AUTHOR]

Introduction: The aim is to perform an economic evaluation alongside a randomized controlled trial comparing guided self‐help cognitive behavioral therapy‐enhanced (CBT‐E) for binge‐eating disorder (BED) to a waiting list control condition. Methods: BED patients (N = 212) were randomly assigned to guided self‐help CBT‐E or the 3‐month waiting list. Measurements took place at baseline and the end‐of‐treatment. The cost‐effectiveness analysis was performed using the number of binge‐eating episodes during the last 28 days as an outcome indicator according to the eating disorder examination. A cost‐utility analysis was performed using the EuroQol‐5D. Results: The difference in societal costs over the 3 months of the intervention between both conditions was €679 (confidence interval [CI] 50–1330). The incremental costs associated with one incremental binge eating episode prevented in the guided self‐help condition was approximately €18 (CI 1–41). From a societal perspective there was a 96% likelihood that guided self‐help CBT‐E led to a greater number of binge‐eating episodes prevented, but at higher costs. Each additional quality‐adjusted life year (QALY) gained was associated with incremental costs of €34,000 (CI 2494–154,530). With a 95% likelihood guided self‐help CBT‐E led to greater QALY gain at higher costs compared to waiting for treatment. Based on the National Institute for Health and Clinical Excellence willingness‐to‐pay threshold of €35,000 per QALY, guided self‐help CBT‐E can be considered cost‐effective with a likelihood of 95% from a societal perspective. Discussion: Guided self‐help CBT‐E is likely a cost‐effective treatment for BED in the short‐term (3‐month course of treatment). Comparison to treatment‐as‐usual is recommended for future research, as it enables an economic evaluation with a longer time horizon. Public Significance: Offering treatment remotely has several benefits for patients suffering from binge‐eating disorders. Guided self‐help CBT‐E is an efficacious and likely cost‐effective treatment, reducing binge eating and improving quality‐of‐life, albeit at higher societal costs. [ABSTRACT FROM AUTHOR]

Digital health interventions have been shown to be clinically-effective for type 2 diabetes mellitus (T2DM) and hypertension prevention and treatment. This study synthesizes and compares the cost-effectiveness of text-messaging, smartphone application, and websites by searching CINAHL, Cochrane Central, Embase, Medline and PsycInfo for full economic or cost-minimisation studies of digital health interventions in adults with or at risk of T2DM and/or hypertension. Costs and health effects are synthesised narratively. Study quality appraisal using the Consensus on Health Economic Criteria (CHEC) list results in recommendations for future health economic evaluations of digital health interventions. Of 3056 records identified, 14 studies are included (7 studies applied text-messaging, 4 employed smartphone applications, and 5 used websites). Ten studies are cost-utility analyses: incremental cost-utility ratios (ICUR) vary from dominant to €75,233/quality-adjusted life year (QALY), with a median of €3840/QALY (interquartile range €16,179). One study finds no QALY difference. None of the three digital health intervention modes is associated with substantially better cost-effectiveness. Interventions are consistently cost-effective in populations with (pre)T2DM but not in populations with hypertension. Mean quality score is 63.0% (standard deviation 13.7%). Substandard application of time horizon, sensitivity analysis, and subgroup analysis next to transparency concerns (regarding competing alternatives, perspective, and costing) downgrades quality of evidence. In conclusion, smartphone application, text-messaging, and website-based interventions are cost-effective without substantial differences between the different delivery modes. Future health economic studies should increase transparency, conduct sufficient sensitivity analyses, and appraise the ICUR more critically in light of a reasoned willingness-to-pay threshold. Registration: PROSPERO (CRD42021247845). [ABSTRACT FROM AUTHOR]

Background: UK cancer survival rates are much lower compared with other high-income countries. In primary care, there are opportunities for GPs and other healthcare professionals to act more quickly in response to presented symptoms that might represent cancer. ThinkCancer! is a complex behaviour change intervention aimed at primary care practice teams to improve the timely diagnosis of cancer. Aim: To explore the costs of delivering the ThinkCancer! intervention to expedite cancer diagnosis in primary care. Design & setting: Feasibility economic analysis using a micro-costing approach, which was undertaken in 19 general practices in Wales, UK. Method: From an NHS perspective, micro-costing methodology was used to determine whether it was feasible to gather sufficient economic data to cost the ThinkCancer! intervention. Owing to the COVID-19 pandemic, ThinkCancer! was mainly delivered remotely online in a digital format. Budget impact analysis (BIA) and sensitivity analysis were conducted to explore the costs of face-to-face delivery of the ThinkCancer! intervention as intended pre-COVID-19. Results: The total costs of delivering the ThinkCancer! intervention across 19 general practices in Wales was £25 030, with an average cost per practice of £1317 (standard deviation [SD]: 578.2). Findings from the BIA indicated a total cost of £34 630 for face-to-face delivery. Conclusion: Data collection methods were successful in gathering sufficient health economics data to cost the ThinkCancer! intervention. Results of this feasibility study will be used to inform a future definitive economic evaluation alongside a pragmatic randomised controlled trial (RCT). [ABSTRACT FROM AUTHOR]

Introduction: Technology can improve the health care outcomes of the elderly. However, there are many barriers to the adoption of mobile monitoring and care systems (MMCs) by the elderly reported in literature. The main purpose of this research was to investigate why elderly people do not adopt MMCs to improve the quality of their health care. Methods: The study made use of semi-structured interviews to collect data in the Buffalo City Metropolitan Municipality, South Africa. The study sample consisted of 15 purposively chosen study participants, representing a diverse racial profile, in order to investigate the adoption of MMCs of the elderly in their home environment. The interviews were analysed thematically. Results: The study found that social challenges like technology anxiety, the intrusive nature of the technology and attitude towards the technology will affect adoption of MMCs. Government need to address the standardisation, data governance and interoperability of the systems. The cost of MMCs were seen as an inhibitor, but could be off set against the perceived return on investment of health care. While the elderly acknowledged that MMCs can improve their independence, the design of the MMCs and training to use it was identified as barriers to the adoption. Conclusion: The study, therefore, recommends collaborative engagements amongst government, business and the elderly to facilitate the adoption of MMCs in the elderly community to improve the quality of health care. [ABSTRACT FROM AUTHOR]

In view of the staggering disease and economic burden of mental disorders, internet and mobile-based interventions (IMIs) targeting mental disorders have often been touted to be cost-effective; however, available evidence is inconclusive and outdated. This review aimed to provide an overview of the cost-effectiveness of IMIs for mental disorders and symptoms. A systematic search was conducted for trial-based economic evaluations published before 10th May 2021. Electronic databases (including MEDLINE, PsycINFO, CENTRAL, PSYNDEX, and NHS Economic Evaluations Database) were searched for randomized controlled trials examining IMIs targeting mental disorders and symptoms and conducting a full health economic evaluation. Methodological quality and risk of bias were assessed. Cost-effectiveness was assumed at or below £30,000 per quality-adjusted life year gained. Of the 4044 studies, 36 economic evaluations were reviewed. Guided IMIs were likely to be cost-effective in depression and anxiety. The quality of most evaluations was good, albeit with some risks of bias. Heterogeneity across studies was high because of factors such as different costing methods, design, comparison groups, and outcomes used. IMIs for anxiety and depression have potential to be cost-effective. However, more research is needed into unguided (preventive) IMIs with active control conditions (e.g., treatment as usual) and longer time horizon across a wider range of disorders. Trial registration: PROSPERO Registration No. CRD42018093808. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To estimate the cost savings associated with a pedometer-based, web-mediated physical activity intervention in a cohort of US veterans with chronic obstructive pulmonary disease (COPD). STUDY DESIGN: Economic analysis. METHODS: We constructed a decision tree from the health care system perspective incorporating adjusted relative risk of a pedometer-based, web-mediated intervention for COPD- related acute exacerbations, acute exacerbation--related costs (ie, emergency department visits and hospitalizations), and intervention-related costs. Total COPD-related costs were estimated per patient across 12 months. Probabilistic sensitivity analysis with Monte Carlo simulation was used to estimate uncertainty in the model findings. RESULTS: In the deterministic (base case) model, the model estimated costs to be $4236 per participant who used the pedometer-based, web-mediated intervention compared with $7913 per participant in the control group (estimated $3677 saved in 1 year compared with the control group). The model findings were robust to probabilistic sensitivity analysis, with a difference in mean costs of $4582 (95% probability interval, $4084-$5080; P < .001). Cost savings in the model were driven by the adjusted relative risk of the web-based intervention, probability of a COPD-related acute exacerbation, rate of hospitalization, probability of hospitalization, and cost of hospitalization. CONCLUSIONS: A pedometer-based, web-mediated physical activity intervention yielded substantial cost savings. Increased implementation of the intervention could markedly reduce the economic burden of COPD for payers and patients. [ABSTRACT FROM AUTHOR]

Using city-level data from China for the period 2003–15, this paper studies how the Internet affects economic disparities between cities through its heterogeneous impact on the economic growth of cities with different penetration rates and population sizes. The results show that the Internet widens the economic disparities between cities with low Internet penetration rates and cities with high Internet penetration rates, and even if the penetration gap between cities is bridged in the future, the Internet will still widen the economic gap between large and small cities due to the reinforcing effect of city size. [ABSTRACT FROM AUTHOR]