Background Opportunities in digital distribution place mobile games as a promising platform for games for health. However, designing a game that can compete in the saturated mobile games market and deliver persuasive health messages can feel like an insurmountable challenge. Although user-centered design is widely advocated, factors such as the user’s subject domain expertise, budget constraints, and poor data collection methods can restrict the benefits of user involvement. Objective This study aimed to develop a playable and acceptable game for health, targeted at young key populations in the Philippines. Methods Authors identified a range of user-centered design methods to be used in tandem from published literature. The resulting design process involved a phased approach, with 40 primary and secondary users engaged during the initial ideation and prototype testing stages. Selected methods included participatory design workshops, playtests, playability heuristics, and focus group discussions. Subject domain experts were allocated roles in the development team. Data were analyzed using a framework approach. Conceptual frameworks in health intervention acceptability and game design guided the analysis. In-game events were captured through the Unity Analytics service to monitor uptake and game use over a 12-month period. Results Early user involvement revealed a strong desire for online multiplayer gameplay, yet most reported that access to this type of game was restricted because of technical and economic constraints. A role-playing game (RPG) with combat elements was identified as a very appealing gameplay style. Findings guided us to a game that could be played offline and that blended RPG elements, such as narrative and turn-based combat, with match-3 puzzles. Although the game received a positive response during playtests, gameplay was at times perceived as repetitive and predicted to only appeal to casual gamers. Knowledge transfer was predominantly achieved through interpretation of the game’s narrative, highlighting this as an important design element. Uptake of the game was positive; between December 1, 2017, and December 1, 2018, 3325 unique device installs were reported globally. Game metrics provided evidence of adoption by young key populations in the Philippines. Game uptake and use were substantially higher in regions where direct engagement with target users took place. Conclusions User-centered design activities supported the identification of important contextual requirements. Multiple data collection methods enabled triangulation of findings to mediate the inherent biases of the different techniques. Game acceptance is dependent on the ability of the development team to implement design solutions that address the needs and desires of target users. If target users are expected to develop design solutions, they must have adequate expertise and a significant role within the development team. Facilitating meaningful partnerships between health professionals, the games industry, and end users will support the games for health industry as it matures.

BackgroundPaper-based adverse drug reaction (ADR) reporting has been in practice for more than 6 decades. Health professionals remain the primary source of reports, while the value of patients’ reporting is yet unclear. With the increasing popularity of using electronic gadgets in health, it is expected that the electronic transmission of reports will become the norm within a few years.ObjectiveThe aims of this study are to investigate whether short messaging service or texting can provide an alternative or supplemental method for ADR reporting given the increasing role of mobile phones in health care monitoring; to determine the usefulness of texting in addition to paper-based reporting of ADRs by resident physicians; and to describe the barriers to ADR reporting and estimate the cost for setting up and maintaining a texting-computer reporting system.MethodsThis was a pre-post cross-sectional study that measured the number of ADRs texted by 51 resident physicians for 12 months from the Department of Obstetrics and Gynecology and the Department of Adult Medicine of a tertiary government hospital in Manila, Philippines, with 1350-bed capacity. Reports were captured by a texting-computer reporting system. Prior to its implementation, key informant interview and focus group discussion were conducted. Baseline information and practice on the existing paper-based reporting system were culled from the records of the hospital’s Pharmacy and Therapeutics Committee. A postintervention survey questionnaire was administered at the end of 12 months.ResultsOnly 3 ADRs were texted by 51 resident physicians in 12 months (reporting rate 3/51 or 6%). By contrast, 240 ADRs from the paper-based reporting system from 848 resident physicians of the study hospital were collected and tabulated (reporting rate 240/848 or 28.3%). Texting ADRs was not efficient because of power interruption, competition with the existing paper-based reporting system, and unforeseen expiration of prepaid text loads/credits. The 3 ADRs texted were a report of vivid dreams and nightmares, a report of disturbing dreams and memory lapses, both of which were due to montelukast use, and a report of hepatitis from an isoniazid/rifampicin fixed-dose combination. Nineteen of 51 resident physicians (37%) registered in the reporting system responded to the postintervention survey. The most common reasons for not reporting ADRs were no adverse reaction identified 11/19 (58%) and restrictive reporting syntax 4/19 (21%). All doctors preferred a free form of reporting. The direct cost of the texting-based reporting system was calculated to be US $5581.40 and the indirect cost was US $9989.40. The total cost for texting-based ADR reporting system for 12 months was US $15,570.79.ConclusionsReporting of ADRs via texting could be lower compared with an existing ADR paper-based system. Problems of Internet connectivity, reporting syntax, and expiration and reliability of text loads/credits should be addressed while implementing a text-based ADR reporting system in a developin...

Introduction: Hospital-acquired infections (HAIs) are associated with increased morbidity and mortality, especially in developing countries. However, limited information is available about the risk of HAIs in naturally ventilated wards (NVWs) and mechanically ventilated intensive care units (MVICUs) of public hospitals in the Philippines. We aimed to assess the association between HAIs and type of ventilation in an urban tertiary care hospital in the Philippines. Methodology: A cross-sectional point-prevalence survey of infections was done in NVWs and MVICUs of a tertiary care hospital in December 2013. Multivariate analyses were done to examine the associations between HAIs and type of ventilation and other risk factors. Results: Of the 224 patients surveyed, 63 (28%) patients had 69 HAIs. Pneumonia was the most common HAI (35%). Wards near areas with high vehicular activity had more respiratory HAI cases. Being immunocompromised is a risk factor for HAI for pediatric and adult patients. Among pediatric patients, staying in MVICUs had a lower risk for HAIs (adjusted odds ratio [AOR]: 0.33; 95% confidence interval [CI]: 0.10-1.08) compared to staying in NVWs. For adult patients, a higher risk for HAIs (AOR: 2.41; 95% CI: 0.29-18.20) was observed in MVICUs compared to NVWs. Conclusions: Type of ventilation is not a risk factor for HAIs. Patients who are immunocompromised may be at a higher risk for HAI. Indoor air pollution, proximity to congested main thoroughfare, and increased human foot traffic may contribute to the susceptibility of patients to HAIs. Hospital layout should be considered in infection control.

Background. The roll-over test is a simple, easily available clinical test using the sphygmomanometer to predict pregnancy-induced hypertension starting at 20 weeks age of gestation (AOG). However, the roll-over test is not part of the standard prenatal care in government health facilities even if health workers can easily perform the test. Objectives. To validate the roll-over test at the 20th weeks of gestation and to determine the risk factors for preeclampsia in 4 health districts of Surigao City, a province in the CARAGA Region of the Philippines. Methods. A total of 190 pregnant women without history of hypertension during their previous pregnancies from 4 health districts in Surigao City, Philippines were consecutively enrolled from May 2014 to October 2014 in a cross-sectional study design. The roll-over test was done using the method described in Williams Obstetrics and the validity of the roll-over test was measured. Bivariate and multivariate analyses were done to determine risk factors for preeclampsia. Results. Seven of the 190 women developed preeclampsia. The sensitivity of the rollover test done at 20 weeks AOG was 43% and the specificity was 81%. Maternal age, history of urinary tract infection (UTI) and a positive rollover test were associated with preeclampsia. Conclusion. Pregnant women whose ages are <20 years or >29 years old, or who had a history of UTI, or a positive roll-over test are more likely to develop preeclampsia. Roll-over test has a low sensitivity at 20 weeks AOG. More studies are warranted to explore the improvement of its predictive value in other AOG.

The uncertainties on the efficacy and safety of Dengvaxia continue to haunt doctors, parents, and lawmakers alike in the Philippines. After the mass immunization of about 850,000 children with Dengvaxia, there has been a continuing report of deaths, unofficially 29 to date among those who received the vaccine between 2016-2017. Countries in the Asia Pacific region, including the Philippines, were one of the sites for the Dengvaxia Clinical Trial. In 2014, the Efficacy Trial of Dengvaxia covering the period after completion of the 3 doses up to the 28th day was published by Capeding, et al. An overall efficacy rate of 56.5% was reported but it can be misleading since the efficacy rates for each serotype varied widely. The uncertainties on the efficacy and safety of Dengvaxia continue to haunt doctors, parents, and lawmakers alike in the Philippines. After the mass immunization of about 850,000 children with Dengvaxia, there has been a continuing report of deaths, unofficially 29 to date among those who received the vaccine between 2016-2017. Countries in the Asia Pacific region, including the Philippines, were one of the sites for the Dengvaxia Clinical Trial. In 2014, the Efficacy Trial of Dengvaxia covering the period after completion of the 3 doses up to the 28th day was published by Capeding, et al. An overall efficacy rate of 56.5% was reported but it can be misleading since the efficacy rates for each serotype varied widely. The uncertainties on the efficacy and safety of Dengvaxia continue to haunt doctors, parents, and lawmakers alike in the Philippines. After the mass immunization of about 850,000 children with Dengvaxia, there has been a continuing report of deaths, unofficially 29 to date among those who received the vaccine between 2016-2017. Countries in the Asia Pacific region, including the Philippines, were one of the sites for the Dengvaxia Clinical Trial. In 2014, the Efficacy Trial of Dengvaxia covering the period after completion of the 3 doses up to the 28th day was published by Capeding, et al. An overall efficacy rate of 56.5% was reported but it can be misleading since the efficacy rates for each serotype varied widely.