![]() ![]() Intention to engage was used as a surrogate to study potential long-term engagement. Furthermore, we measured the intention to engage, that is, the intention to perform the breathing training regularly. Additionally, perceived effectiveness was measured to ensure that the gameful design elements do not weaken the instrumental aspect of the task. As a basis for the gameful breathing training, we used Breeze (Centre for Digital Health Interventions), which was first introduced by Shih et al. This perceived intrinsic value serves as a concept to evaluate the effectiveness of the visual components of the gameful design. In this study, we compare gameful and standard slow-paced breathing training visualizations regarding the intrinsic dimension of the experiential value. Furthermore, whether participants would have the intention to engage in such breathing training in their everyday life, guided by these different visualizations, remains unknown. However, they did not investigate gameful visualizations, and they did not report the experiential values of these different visualizations. The authors found that some types of guidance are more effective than others. Chittaro et al researched the effectiveness of different nongame breathing training guidance based on visualizations and audio. While the study found that gameful breathing training is as effective as normal breathing training, it did not investigate whether there was an experiential gain in gameful breathing training. For example, a previous study collected breathing rate recordings and heart rate variability-derived measures to ensure that gameful breathing training does not impair the effectiveness of breathing training. However, it must be ensured that an increase in experiential values does not reduce the effects regarding relaxation. Meaningful engagement can be the deciding factor for the continued use of a system. ![]() In terms of breathing training, the instrumental value is the effectiveness of the training in inducing the desired effects, such as relaxation. It constitutes the experiential and instrumental values of a gamified system. Liu et al introduced the term meaningful engagement as the main goal of gamification. It is thus not surprising that experiential values, such as fulfillment, enjoyment, meaningfulness, or playfulness, have received growing recognition in recent years. Therefore, the combination of technology to influence human behavior and gamification in the health care context offers a promising benefit for people, especially regarding health behavior change and long-term usage. This approach is motivated by the notion that playing a game is generally considered an enjoyable experience. Gamification adds game elements to nongame tasks to make them more engaging and enjoyable. One approach to addressing low long-term adherence might be to approach intrinsic motivation through gamification. It has been shown that breathing training apps have very low long-term adherence, even though the number of installations is high. While adapting to such healthy behaviors can help prevent the onset of many diseases, behavior changes are challenging to sustain long-term. The users usually breathe following a specific breathing pattern for example, 5 seconds inhalation and 5 seconds exhalation. Usually, such breathing training applications consist of an animation that guides users to breathe at a rate of 6 breaths per minute. This increase in the use of digital technologies and the positive effects of breathing training have led to the development of various applications that support breathing training. Moreover, persuasive technologies and digital interventions are showing promise in influencing personal and health behavior changes. For example, smartphone apps can support health and medical actions. The use of smartphones and apps is increasing as they support users’ daily activities. ![]() Therefore, often the main goal of slow-paced breathing training is to induce relaxation. The latter corresponds to the activity of the parasympathetic nervous system. Slow-paced breathing has been shown to influence heart rate variability and cardiac vagal tone positively. It has the potential to help ease the burden of mental illnesses and chronic diseases, such as hypertension, type 2 diabetes, and chronic pain. Slow-paced breathing training has been positively associated with psychological and physiological well-being. ![]()
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