title: Development and usability evaluation of the mHealth Tool for Lung Cancer (mHealth TLC): a virtual world health game for lung cancer patients.
abstract: OBJECTIVE
  To test the feasibility and usability of mHealth TLC, an interactive, immersive 3-dimensional iPad health game that coaches lung cancer patients toward assertive communication strategies during first-person virtual clinics visits.
  
  
  METHODS
  We observed players and conducted semi-structured interviews. Research questions focused on scenario believability, the impact of technical issues, transparency of game goals, and potential of mHealth TLC to decrease lung cancer stigma (LCS) and improve patient-clinician communication.
  
  
  RESULTS
  Eight users confirmed mHealth TLC to be: (1) believable, (2) clinic-appropriate, and (3) helpful in support of informed healthcare consumers. Concerns were expressed about emotionally charged content and plans to use mHealth TLC in clinic settings as opposed to at home.
  
  
  CONCLUSIONS
  Although the dialog and interactions addressed emotionally charged issues, players were able to engage, learn, and benefit from role-play in a virtual world. Health games have the potential to improve patient-clinician communication, and mHealth TLC specifically may decrease LCS, and promote optimal self-management.
  
  
  CONCLUSIONS
  Process reflection revealed the need for health games to be created by experienced game developers in collaboration with health care experts. To prepare for this best practice, research institutions and game developers interested in health games should proactively seek out networking and collaboration opportunities.
authors.affiliation: Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, USA.
authors.forename: Cati G
authors.initials: CG
authors.lastname: Brown-Johnson
authors.affiliation: S/M Operating Units, University of California, San Francisco, San Francisco, USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Berrean
authors.affiliation: Department of Physiological Nursing, University of California, San Francisco, San Francisco, USA. Electronic address: janine.cataldo@ucsf.edu.
authors.forename: Janine K
authors.initials: JK
authors.lastname: Cataldo
mesh_terms: D003661:Decision Support Techniques; D005260:Female; D005717:Games, Experimental; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008175:Lung Neoplasms / Q000523:psychology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011788:Quality of Life; D015203:Reproducibility of Results; D012648:Self Care; D057545:Social Stigma; D014584:User-Computer Interface
keywords: Health games; Lung cancer; Stigma; Usability; Validation; Virtual worlds