Adaptation of a health game for adults over 50 and examination of its acceptability, feasibility, and preliminary impact when implemented with a nutrition education intervention

Background: Diabetes impacts greater than 37 million people in the United States. Adults over 45 years, racial-ethnic minorities, and those who are overweight or obese are at increased risk for type 2 diabetes mellitus (T2DM). Digital health games offer one innovative opportunity to engage, educate, and motivate adults at risk for T2DM about healthy lifestyle changes. Objective : Describe the adaptation of an educational exergame for adults over 50 and examine feasibility, acceptability, and implementation within a health education intervention in African American adults at risk for T2DM. Method : Mixed methods were used: exploratory adaptation phase involving expert inter-views and constituent focus groups; a randomized two-group (nutrition workshop alone vs workshop plus game) pilot exploring adherence and preliminary outcomes (i.e., eating habits, physical activity level, body mass index); and a post-gameplay explanatory component examining acceptability and feasibility. Results : Exploratory phase findings identified areas for game adaptation, such as modifying graphics and adjusting movement to user preferences and abilities. The pilot sample included 24 African American women with T2DM risk factors (Mean age = 63.1). Preliminary outcomes suggest pre-post intervention changes in the direction of improvement for both groups; however, there were no statistically significant differences between groups. Intervention adherence was slightly higher for the game-plus workshop group. Accept-ability and feasibility feedback of the game was generally positive. Conclusion: Constituent and expert input helped inform game adaptation. Preliminary outcomes and acceptability/feasibility feedback of game implementation within a health education intervention showed promise in engaging adults over 50 with T2DM risk factors about topics of healthy eating and physical activity. Continued research is suggested to develop/adapt health games to promote healthy lifestyle change in diverse older adults (e.g., adults over 65; racial-ethnic minority groups;) and to conduct large-scale studies to evaluate the impact of health games in diverse groups and settings.