Life and Death in the Age of Malaria

David Scharf, National Geographic (2007) Life and Death in the Age of Malaria

Project Team Laurie Hartjes & Linda Baumann School of Nursing Ulrike Dieterle Ebling Library Les Howles, Dan LaValley, Jasun Carr and Bruce Barton Division of Information Technology Contact: [email_address] 608-263-5315 University of Wisconsin - Madison

Session Objectives

Describe problem being addressed

Rapid prototyping process

Plan for evaluation

Global burden of malaria: ~ 3000 deaths per day ~ 300-500 million cases per year ~ 3.2 billion humans living in risk regions Can be rapidly fatal if complications develop Travelers often underestimate risk

Purpose: To develop and evaluate a malaria risk reduction intervention targeting study abroad students more focus on globalization more students studying in developing countries more health risks, including malaria

No Magic Bullets

No vaccine

Risk varies with location, weather patterns, activities,

and personal characteristics

All personal prevention measures require knowledge

and motivation

bed nets

insect repellents

protective clothing

avoiding outdoor activities from dusk to dawn

anti-malarial drugs

The Beginning…

January 2007

Rapid Prototype Process #1

linear simulation storyboard

Theoretical Framework

A complementary union:

Self-regulation of health and illness behavior

Cognitive theory of multimedia learning

and evolving principles of multimedia learning

Information

Concrete

experiential

Abstract

external sources

Cognitive Representation Identity Cause Timeline Consequences Control/Cure Coherence Emotional Representation Appraisal of Response Impact Emotional Response Appraisal of Change in Emotion Cognitive Response Self-Regulation Model Leventhal, Nerenz, Steele (1984)

An iterative process

Sequencing Coherence Well-ordered problems Signaling Cycles of expertise Contiguity Avoidance of redundancy Practice Personalization Customize “ Pleasantly frustrating challenges” Modality effects Mental model construction Learner control Just-in-time (JIT) information 1. Clark and Mayer (2003). eLearning and the science of instruction. San Francisco: Pfeiffer. 2. Mayer, R.E. (2005). The Cambridge Handbook of Multimedia Learning. Cambridge: Cambridge University Press. Principles of Multimedia Learning

Preliminary user testing: Ask early and ask often!

Pedagogical Agents

Malaria: Beating the Bugs Vito the Squito Strikes Back Sign in: Laurie Go Hi. I’m Vito. Click the audio button to find out more about why I’m striking back. Ver. 4.19.07

Dear Laurie, Congratulations. You have been awarded a scholarship to work in Uganda to study the gorilla population for the Wildlife Conservation Society. You will be assisting researchers looking at the infectious disease connections between the endangered mountain gorilla population and humans living within the gorilla habitat range. As part of your orientation we’ve sent you a short video which shows you the exciting environment you will be working in ….. Sounds exciting! But watch out! Different environments mean different health risks. Continue

Malaria is a preventable disease

The STINGER - true story about a study abroad student who contracts malaria, as told by the student or a family member

Followed by this message:

You are about to travel to a risk zone where malaria is a real threat

You need to learn the facts to protect yourself

Let’s get started!

You need to make good decisions at every stage of your travel to prevent infection with malaria parasites….. Trip Planning While Abroad Return Home Begin here This journey will present many challenges. But don’t worry, I know all about malaria and I’ll be traveling with you. HOME PAGE

Trip Planning: Step by Step Packing Your risk meter is at 98%. Your goal is to reduce your risk of contracting malaria to at least 40% before departure. Remember, a low score equals a lowered risk. Home Risk Meter=98% 100% Wishes    You have three wishes you can use anytime to undo bad decisions. Tip: If you don’t go through the short malaria tutorial now (see above), you’ll wish you had. You’ll also reduce your risk by 3% for viewing it.. 0% Malaria Tutorial During each step of your trip planning process you will make decisions that impact your risk of malaria infection. Click on “Get Advice” to begin. Medications Get Advice

Get Advice Click me anytime for advice and helpful tips. Trip Planning: Step by Step Select each step and make decisions to reduce your risk for contracting malaria. Home Risk Meter=98% 100% Wishes    0% Packing Roll your mouse over each source to get a snippet of what they have to offer. Accept advice only from sources you think will provide credible information about preventing malaria. The risk meter monitors how your decisions impact your risk of contracting malaria. Vito is watching out for you and will give you helpful feedback. Malaria Tutorial Medications Get Advice Classmate David Travel Health Specialist Airlines URL.gov Professor Gordon Clinician Travel Agent Classmate Amanda URL.com

Trip Planning Step by Step Select each step and make decisions to reduce your risk for contracting malaria. Home Risk Meter=93% 100% Wishes    0% Packing Get Advice Clinician Malaria Tutorial Roll your mouse over each source to get a snippet of what they have to offer. Accept advice only from sources you think will provide credible information about preventing malaria. The risk meter monitors how your decisions impact your risk of contracting malaria. Veto is watching out for you and will give you some helpful feedback along the way. Tell me more . (get another 2% reduction) Good decision! . The seriousness of malaria is being minimized due to lack of familiarity with this disease. More travel details should have been obtained and resources consulted to calculate your specific level of risk. Your risk has just been reduced by 5%. Medications Get Advice Classmate Jasun Travel Health Specialist Airlines Internet Professor Travel Agent Classmate Amanda Internet The clinician says: You’re going to be mainly in Kampala to start out with. I doubt there’s transmission in the city. I’ll refill your acne prescription and also prescribe something for traveler’s diarrhea.” Based on this snippet, would you like to take this person’s advice on preventing malaria?

Trip Planning Step by Step Select each step and make decisions to reduce your risk for contracting malaria. Medications: What kind do I bring with me? Packing Malaria Tutorial Decision Advice bubble Listen to the conversation and then make a decision about what medication, if any, to use. Travel Health Specialist Professor Gordon Student David Student Amanda Clinician Librarian Pharmacist “ Keep in mind that each drug option has different side-effects and the effectiveness varies. Here are some important differences between the drugs……” 0% 100% Risk Meter=93% Home Medications Get Advice

Packing Trip Planning: Step by Step Select each step and make decisions to reduce your risk for contracting malaria. Packing Malaria Tutorial You’re packing a suitcase for your trip. There are four essential items you must pack for greatest risk reduction. Organize your suitcase by removing and adding items to include the essential items, and you’ll be rewarded by removing the least important items in the suitcase to do so. Add  Remove --> Feedback text:

Net - Permethrin impregnated

Net without permethrin

Protective clothing such as

hat, pants, long sleeves

DEET 30% or higher

iPod

Binoculars

2 Novels

Anti-malaria medication

Protective clothing impregnated with permethrin

toothbrush

Potential items to pack Risk Meter here Medications Get Advice 10%

You need to make good decisions at every stage of your travel to prevent contracting malaria….. Trip Planning While Abroad Return Home You’ve now traveled 24 hours and arrived in Entebbe, Uganda. Although you’re prepared, you still need to be vigilant…Click “While Abroad” to begin. Malaria Tutorial

Review of your decisions Get advice Medications Here’s a summary of the major decisions you made, with feedback Packing The City Jungle Trek Home Stay Medication Seeking Care Summary feedback would be included here Parasite Probes Trip Planning While Abroad Return Home

The end of the beginning…

What we learned from user testing:

A less linear design was more attractive

Players desired more “game” & threat of death

Players desired more locations and scenarios to add variety and challenge

Saved:

3 phases of travel

Use of resource characters

Immediate and summative feedback

Practicing risk reduction decision-making

Theoretical frameworks: self-regulation model and principles of the cognitive theory of multimedia learning

Use of audio for resource character voices and musical clips pertinent to environment abroad

Changed:

Repeated use of prevention actions across multiple

“ sim-students” in every phase of travel

Randomized “events” offer a variety of outcomes for

repeat players

More sophisticated risk formulas required

Efficient mechanism for content updates is essential

Cognitive overload is addressed by repetition of core content & player control of prevention choices and resource utilization

Prototype #2 September 2007 Role: Player advises 6 “sim-students” about malaria risk reduction using pre-existing knowledge, use of game resources, and trial and error Goal: Keep 6 “sim-students” alive and healthy through 16 weeks Challenge: Player is assigned more “sim-students” as game progresses must triage needs and work within budget Outcome: Players engage in more consistent risk reduction activities when immersed in destinations with malaria transmission

Risk Variables Risk Equations

Development Disclaimer: As with first rapid prototyping process, the focus is on game play, so all content and graphics are place holders (by design) during the programming and user testing process.

20-year-old theater major going to Uganda for a semester at Makerrere University. During school break she plans to travel with a University performance group

20-year-old theater major going to Uganda for a semester at Makerrere University. During school break she plans to travel with a University performance group doing AIDS

Yulia is 24-years old and is double majoring in Sociology and Political Science. As part of her Capstone project, she will be heading to

DEET 34%

$10

Yulia is 24-years old and is double majoring in Sociology and Political Science. As part of her Capstone project, she will be heading to Picaridin $3

Yulia is 24-years old and is double majoring in Sociology and Political Science. As part of her Capstone project, she will be heading to

Yulia is 24-years old and is double majoring in Sociology and Political Science. As part of her Capstone project, she will be heading to Hello, my name is Paul Hughes and I have additional education focused on travel health risk reduction. I see travelers before departure to make specific plans based on destination, activities, and the health needs of the traveler. Chagas’ disease is also called American Trypanosomiasis. As the name infers, it’s found in Mexico and Central and South American. There is a similar parasitic disease in Uganda called African Trypansomiasis. You may have heard it referred to as “sleeping sickness” and it’s spread by the painful bite of a tsetse fly. It is the travelers to rural areas who are most at risk for these two types of parasites..

Plan for Evaluation

Formal user-testing process

Validity testing with experts

Randomized trial

3 versions of game varying the feedback strategy

pre/post testing

January 2009 recruitment from a pool of 6000 study abroad students at 13 four year UW System campuses

Evaluation

3 arm randomized trial

Pretest Measures: Knowledge Self-efficacy Emotion Automated Explanatory Feedback (AEF) Corrective Feedback (CF) Directional only Player-controlled Explanatory Feedback (PCEF) Post-test Measures: Knowledge, Self-efficacy, Emotion Game score Player satisfaction

Evaluation