Karina Ilskens

Background: People with intellectual disabilities have a higher prevalence of certain chronic diseases and higher avoidable mortality. Some of these diseases or their exacerbation could be avoided through disease prevention and health promotion interventions, as people with intellectual disabilities have high rates of unhealthy eating habits, stress, lower levels of mobility and similar addictive behaviours to the general population. At the same time, they face significant barriers to accessing preventive healthcare interventions.Objective: To test the effectiveness of an advanced practice nurse-led case management and prevention intervention for people with intellectual disabilities on health status after 12 months.Design: Two-arm parallel randomised-controlled trial with waiting list.Setting(s): Community setting in an urban area of Hamburg, Germany.Participants: 214 adults with an ICD-10 diagnosis F70-79 and a care level below 4 according to German Social Code XI, who were not at the end-of-life.Methods: The intervention consisted of case management, social space analysis, prevention planning and counselling in four outreach home visits on the topics of addiction, mobility, nutrition and stress. The control group received usual care. Participants were allocated using permuted block randomisation. The primary outcome was health status (WHODAS, 0-100) at 12 months (t2). Secondary outcomes were health status at 6 months (t1), resilience (RS-11, 7-77) and health-related quality of life (EQ5D, 0-100) at t1 and t2. Lower scores indicate better health status and higher scores better resilience and quality of life. Raters and analysts were blinded. Analyses were performed with ANCOVAs and Bonferroni correction to α= 0.025 and 97.5% confidence intervals (CI).Results: We randomised 107 participants to each group. For the primary outcome health status at t2 (n=167), the mean difference (MD) was -4.38 (CI: -8.13 to -0.62, ή²= 0.041). For the secondary outcome of health status at t1, the MD was -1.06 (CI: -3.51 to 5.62, ή²= 0.002). For resilience, the MD was +0.51 (CI: -3.11 to 2.10, ή²= 0.001) at t1 and +2.70 (CI: -5.78 to 0.39 ή²=0.022) at t2. For health-related quality of life, a MD of +0.72 (CI: -5.88 to 7.32, ή²=0.000) at t1 and -1.19 (CI: -8.71 to 6.33 ή²= 0.001) at t2 were measured.Conclusions: Overall, a nurse-led intervention focusing on prevention and case management can lead to a statistically significant change in health after 12 months, but not for the secondary outcomes. The current literature on minimal clinically important differences indicates that the effect is also clinically important.

Background: Sexually transmitted infections (STIs) represent a global health risk. Adolescents are at increased risk of infection for several reasons such as lack of knowledge, risky sexual behaviors, and lack of behavioral sills (eg, to negotiate safer sex). Given the fact that adolescents often use digital media and that serious games are considered to have the potential to change knowledge, attitudes and behavior, serious games represent an opportunity for the prevention of STIs. Objective: The aim of this systematic review was to identify and systematically summarize the dimensions that have been investigated in primary studies on serious games targeting STI prevention among adolescents. Methods: A systematic review was conducted in PubMed and Web of Science. Studies published from 2009 to 2021 were included that assessed the effectiveness of serious games on adolescent sexual health. A total of 18 studies met the inclusion criteria and were categorized according to dimensions of effectiveness and user experience. Results: Various dimensions of effectiveness and aspects of user experience were investigated in the primary studies. In total, 9 dimensions of effectiveness were observed: sexual behavior, behavioral intentions, knowledge, attitudes and beliefs, self-efficacy and personal limitations, character traits and future orientation, environmental and individual risk factors, risk perception and risk assessment, as well as normative beliefs and (social) norms. Furthermore, several dimensions related to user experience were investigated in primary studies, that is, motivation, acceptability, trustworthiness, comprehensibility, handling and control, perceived effectiveness, as well as satisfaction. Conclusions: This review provides an overview of serious games interventions that are vastly different in approach, content, and even platform. In previous studies, knowledge has already been comprehensively assessed, and a positive influence of serious games on knowledge about sexual topics is evident. The results clearly show that adolescents’ sexual knowledge has been increased by the serious games interventions. However, methodological and content differences in the surveys make it difficult to draw conclusions about the effectiveness related to changes in attitudes and behavior.

BACKGROUND Sexually transmitted infections (STIs) represent a global health risk. Adolescents are at increased risk of infection for several reasons such as lack of knowledge, risky sexual behaviors, and lack of behavioral sills (eg, to negotiate safer sex). Given the fact that adolescents often use digital media and that serious games are considered to have the potential to change knowledge, attitudes and behavior, serious games represent an opportunity for the prevention of STIs. OBJECTIVE The aim of this systematic review was to identify and systematically summarize the dimensions that have been investigated in primary studies on serious games targeting STI prevention among adolescents. METHODS A systematic review was conducted in PubMed and Web of Science. Studies published from 2009 to 2021 were included that assessed the effectiveness of serious games on adolescent sexual health. A total of 18 studies met the inclusion criteria and were categorized according to dimensions of effectiveness and user experience. RESULTS Various dimensions of effectiveness and aspects of user experience were investigated in the primary studies. In total, 9 dimensions of effectiveness were observed: sexual behavior, behavioral intentions, knowledge, attitudes and beliefs, self-efficacy and personal limitations, character traits and future orientation, environmental and individual risk factors, risk perception and risk assessment, as well as normative beliefs and (social) norms. Furthermore, several dimensions related to user experience were investigated in primary studies, that is, motivation, acceptability, trustworthiness, comprehensibility, handling and control, perceived effectiveness, as well as satisfaction. CONCLUSIONS This review provides an overview of serious games interventions that are vastly different in approach, content, and even platform. In previous studies, knowledge has already been comprehensively assessed, and a positive influence of serious games on knowledge about sexual topics is evident. The results clearly show that adolescents’ sexual knowledge has been increased by the serious games interventions. However, methodological and content differences in the surveys make it difficult to draw conclusions about the effectiveness related to changes in attitudes and behavior.