Behavioral Theories and Motivational Features Underlying eHealth Interventions for Adolescent Antiretroviral Adherence: Systematic Review.

BACKGROUND: eHealth systems provide new opportunities for the delivery of antiretroviral therapy (ART) adherence interventions for adolescents. They may be more effective if grounded in health behavior theories and behavior change techniques (BCTs). Prior reviews have examined the effectiveness, feasibility, and acceptability of these eHealth systems. However, studies have not systematically explored the use of health behavior theories and BCTs in the design of these applications. OBJECTIVE: The purpose of this review was to explore whether health behavior theories and BCTs were considered to ground designs of eHealth systems supporting adolescents' (10-24 years) ART adherence. More specifically, we examined which specific theories and BCTs were applied, and how these BCTs were implemented as design features. Additionally, we investigated the quality and effect of eHealth systems. METHODS: A systematic search was performed on IEEE Xplore, ACM, ScienceDirect, PubMed, Scopus, and Web of Science databases from 2000 to 2020. Theory use and BCTs were coded using the Theory Coding Scheme and the Behavior Change Technique Taxonomy version 1 (BCTTv1), respectively. Design features were identified using the lenses of motivational design for mobile health (mHealth). The number of BCTs and design features for each eHealth system and their prevalence across all systems were assessed. RESULTS: This review identified 16 eHealth systems aiming to support ART adherence among adolescents. System types include SMS text message reminders (n=6), phone call reminders (n=3), combined SMS text message and phone call reminders (n=1), electronic adherence monitoring devices (n=3), smartphone apps (n=1), smartphone serious games (n=1), gamified smartphone apps (n=1), leveraging existing social media (n=2), web-based applications (n=1), videoconferencing (n=1), and desktop applications (n=1). Nine were grounded in theory, of which 3 used theories extensively. The impact of adolescent developmental changes on ART adherence was not made explicit. A total of 42 different BCTs and 24 motivational design features were used across systems. Ten systems reported positive effects on 1 or more outcomes; however, of these ten systems, only 3 reported exclusively positive effects on all the outcomes they measured. As much as 6 out of 16 reported purely no effect in all the outcomes measured. CONCLUSIONS: Basic applications (SMS text messaging and phone calls) were most frequent, although more advanced systems such as mobile apps and games are also emerging. This review indicated gaps in the use of theory and BCTs, and particularly the impact of developmental changes on ART adherence was not adequately considered. Together with adopting a developmental orientation, future eHealth systems should effectively leverage health theories and consider developing more advanced systems that open the door to using BCTs more comprehensively. Overall, the impact of eHealth systems on adolescent ART adherence and its mediators is promising, but conclusive evidence on effect still needs to be provided.

The Use of the Term Virtual Reality in Post-Stroke Rehabilitation: A Scoping Review and Commentary.

Virtual reality (VR) offers many opportunities for post-stroke rehabilitation. However, "VR" can refer to several types of computer-based rehabilitation systems. Since these systems may impact the feasibility and the efficacy of VR interventions, consistent terminology is important. In this study, we aimed to optimize the terminology for VR-based post-stroke rehabilitation by assessing whether and how review papers on this topic defined VR and what types of mixed reality systems were discussed. In addition, this review can inspire the use of consistent terminology for other researchers working with VR. We assessed the use of the term VR in review papers on post-stroke rehabilitation extracted from Scopus, Web of Science and PubMed. We also developed a taxonomy distinguishing 16 mixed reality systems based on three factors: immersive versus semi-immersive displays, the way in which real and virtual information is mixed, and the main input device. 64% of the included review papers (N = 121) explicitly defined VR and 33% of them described different subtypes of VR, with immersive and non-immersive VR as the most common distinction. The most frequently discussed input devices were motion-capture cameras and handheld devices, while regular 2D monitors were the most frequently mentioned output devices. Our analysis revealed that reviews on post-stroke VR rehabilitation did not or only broadly defined "VR" and did not focus on a specific system. Since the efficacy and feasibility of rehabilitation may depend on the specific system, we propose a new data-driven taxonomy to distinguish different systems, which is expected to facilitate communication amongst researchers and clinicians working with virtual reality.

Energy Expenditure During Xbox Kinect Play in Early Adolescents: The Relationship with Player Mode and Game Enjoyment.

OBJECTIVE: There has been growing interest in the use of active videogames to influence levels of physical activity. Most studies have investigated energy expenditure in general, without taking into account moderating factors such as player mode and game enjoyment. This study therefore examines whether children's energy expenditure and game enjoyment are higher when games are played in a two-player mode than in a single-player mode. MATERIALS AND METHODS: Forty-three children from the 7th grade who exhibited an inactive lifestyle engaged in six sports exergames on an Xbox(®) Kinect(®) (Microsoft, Redmond, WA) console. The player mode (single-player or two-player mode) was manipulated (within-subjects design). The primary parameters were "energy expenditure," which was measured with a SenseWear(®) device (Bodymedia Inc., Pittsburgh, PA), and "game enjoyment," which was assessed through self-report. RESULTS: On average, Kinect play elicits moderate physical activity (approximately 4 metabolic equivalents of task). Games that are played in a two-player mode elicit more energy than games that are played in a single-player mode. However, this was only the case for simultaneous play (boxing, dancing, and tennis), not for turn-based play (bowling, baseball, and golf). Furthermore, participants generally liked exergaming, regardless of their sex or the player mode. Finally, no significant correlation was found between energy expenditure and game enjoyment. CONCLUSIONS: This study has shown that Kinect play elicits physical activity of moderate intensity. Furthermore, Kinect play is generally enjoyed by both boys and girls. Simultaneous play may be the best suited to increase levels of physical activity in early adolescents who exhibit an inactive lifestyle.