title: iLift: A health behavior change support system for lifting and transfer techniques to prevent lower-back injuries in healthcare.
abstract: 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.
  
  
  
  (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).
  
  
  
  (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.
  
  
  
  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.
authors.affiliation: NHL University of Applied Sciences, Leeuwarden, The Netherlands. Electronic address: kuipersd@nhl.nl.
authors.forename: Derek A
authors.initials: DA
authors.lastname: Kuipers
authors.affiliation: NHL University of Applied Sciences, Leeuwarden, The Netherlands; University of Technology Delft, Industrial Design Engineering, The Netherlands.
authors.forename: Bard O
authors.initials: BO
authors.lastname: Wartena
authors.affiliation: NHL University of Applied Sciences, Leeuwarden, The Netherlands.
authors.forename: Boudewijn H
authors.initials: BH
authors.lastname: Dijkstra
authors.affiliation: NHL University of Applied Sciences, Leeuwarden, The Netherlands.
authors.forename: Gijs
authors.initials: G
authors.lastname: Terlouw
authors.affiliation: NHL University of Applied Sciences, Leeuwarden, The Netherlands.
authors.forename: Job T B
authors.initials: JT
authors.lastname: van T Veer
authors.affiliation: NHL University of Applied Sciences, Leeuwarden, The Netherlands.
authors.forename: Hylke W
authors.initials: HW
authors.lastname: van Dijk
authors.affiliation: MCL Academy of Leeuwarden, The Netherlands.
authors.forename: Jelle T
authors.initials: JT
authors.lastname: Prins
authors.affiliation: Medical Center Leeuwarden, Surgery Department, Leeuwarden, The Netherlands; Post Graduate School of Medicine, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Jean Pierre E N
authors.initials: JP
authors.lastname: Pierie
mesh_terms: D019567:Back Injuries / Q000209:etiology / Q000517:prevention & control*; D001696:Biomechanical Phenomena; D003695:Delivery of Health Care; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D006282:Health Personnel / Q000523:psychology*; D006293:Health Promotion; D006801:Humans; D017770:Lifting / Q000009:adverse effects*; D008297:Male; D009426:Netherlands; D018910:Video Games
keywords: Design; Health behavior change support system; Lifting and transfer techniques; Serious gaming