game based learning health behavior change: a visit ...edaud.org/handouts/5.2.pdf•theory of...
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Game‐Based Learning and Health Behavior Change: A Visit to WhisperwellDEANNA K. MEINKE PHD,MATTHEUS P. UECKERMANN PHDODILE H. CLAVIER PHD
Overview
• Public Health Obligation
• Changing Health Behavior
• Dangerous Decibels
• STEM Education
• Serious Games
• A Visit to Whisperwell: “Song of the Starbird”
• Outcomes and Future Plans
Public Health Obligation
Is NIHL a problem for youth?
• 1943: Loch (8‐14 years) 15% Males; 5% Females• 1950: Guild
• 1967: Anderson
• 1967: Weber et al.
• 1972: Lipscomb
• 1974: Cozad et al.
• 1975: Hull et al.
• 1990: Montgomery & Fujikawa
• 1992: Brookhouser et al.
• 1996: League for the Hard of Hearing
• 1997: Holmes
• 1998: Niskar et al.
• 2001: Niskar et al. (6‐19 years) (12‐19 years)
• 2010: Shargorodsky et al., 2010* (12‐19 years)
• 2011: Henderson et al. (12‐19 years)
• 2017: Su et al. (12‐19 years)
12.5%
16.8%
15.5%
12.8%
Public Health Obligation
• Audiologists are morally and ethically obligated to provide intervention;
• NIHL progresses without intervention
• Some cases of tinnitus may be preventable
• Financial and social costs escalate without intervention
• Prevention is a standard of care
Prevention: Primary, secondary and tertiary
• Primary prevention strategies intend to avoid the development of
disease.
• Secondary prevention strategies attempt to diagnose and treat an
existing disease in its early stages before it results in significant
morbidity.
• Tertiary prevention These treatments aim to reduce the negative impact
of established disease by restoring function and reducing disease‐related
complications.
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• Sec. 303.13 (b) (2)
• Statute/Regs Main » Regulations » Part C » Subpart A » Section 303.13 » b » 2
• (2) Audiology services include—
• (i) Identification of children with auditory impairments, using at‐risk criteria and appropriate audiologic screening techniques;
• (ii) Determination of the range, nature, and degree of hearing loss and communication functions, by use of audiological evaluation procedures;
• (iii) Referral for medical and other services necessary for the habilitation or rehabilitation of an infant or toddler with a disability who has an auditory impairment;
• (iv) Provision of auditory training, aural rehabilitation, speech reading and listening devices, orientation and training, and other services;
• (v) Provision of services for prevention of hearing loss; and
• (vi) Determination of the child’s individual amplification, including selecting, fitting, and dispensing appropriate listening and vibrotactile devices, and evaluating the effectiveness of those devices.
• Sec. 300.34 (c) (1) (iv)
• Statute/Regs Main » Regulations » Part B » Subpart A » Section 300.34 » c » 1 » iv
• (iv) Creation and administration of programs for prevention of hearing loss;
Healthy People 2020
• ENT‐VSL‐6.2Increase the proportion of adolescents aged 12 to 19 years who have ever used hearing protection devices (earplugs, earmuffs) when exposed to loud sounds or noise
• ENT‐VSL‐7Reduce the proportion of adolescents who have elevated hearing thresholds, or audiometric notches, in high frequencies (3, 4, or 6 kHz) in both ears, signifying noise‐induced hearing loss
• ECBP‐4Increase the proportion of elementary, middle, and senior high schools that provide school health education to promote personal health and wellness in the following areas: hand washing or hand hygiene; oral health; growth and development; sun safety and skin cancer prevention; benefits of rest and sleep; ways to prevent vision and hearing loss; and the importance of health screenings and checkups
Changing Health Behaviors
What is a health behavior you have tried to change? Does this work?
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CHANGE BEHAVIORS
RAISE AWARENESS
Num
ber
of p
eopl
e re
ache
d
Deg
ree
of li
fe c
hang
ing
influ
ence
Martin & Meinke, 2010
1 to 1 Care
TV, radio, mass media, apps
Num
ber
of p
eopl
e re
ache
d
Deg
ree
of li
fe c
hang
ing
influ
ence
Family
Classroom orSmall Group
Community Events
Community MediaRadio / TV
Website
Public outreach – exhibits, malls, fairs
School Events
AAA/ ASHANIDCD
Audiologists
StateRegionalSchool Districts
Health Communication
• Health communication is the study and use of communication strategies to inform and influence choices people make about their health.
• Health communication science provides the evidence basis for intervention programs based on theoretical foundations.
https://www.cancer.gov/publications/health‐communication/pink‐book.pdf
What influences (hearing) health behaviors?
• Knowledge
• Attitudes
• Beliefs
• Self‐efficacy
• Access to resources
Relevant Behavior Change Theories
• Theory of Reasoned Action and Planned Behavior
• Social Cognitive Theory
• Health Belief Model
• Socio‐Ecological Model
Sobel J and Meikle M, (2008) Applying Health Behavior Theory to Hearing-Conservation Interventions. Seminars Hearing, Vol 29: 81-89.
SelfPast ExperienceKnowledgeAttitudesBeliefsBehaviors
Individual
AffiliationsSchoolsBusinessesProfessionsGroups
RelationshipsFamilyFriends / PeersCo‐workers
CulturalValuesNorms
Socio-Ecological Model of Hearing Health Promotion
Public Policy
RulesLaws
Sobel & Meinke, 2017
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Dangerous Decibels
Dangerous Decibels is:
An international, good-faith partnershipbetween experts in hearing science, public heath, noise, evaluation and education who
are passionately dedicated to preventing noise induced hearing loss and tinnitus
People based, not institution based
International Dissemination Partners: North America
Other Affiliates/Collaborators/Funders
International Dissemination Partners: Asia
Other Affiliates/Collaborators/Funders
International Dissemination Partners:Oceania
Other Affiliates/Collaborators/Funders
International Dissemination Partners:South America
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Developing Partnerships: Dangerous Decibels®
To reduce the incidenceof noise induced hearing loss
and tinnitus
EVIDENCE BASED PROGRAM
Dangerous Decibels development
HUNDREDS of contributors
Museum exhibit developers
Hearing scientists
Teachers
Student advisors
Community advisors
Engineers
Evaluation specialists
Health communications scientists
Programmers
Writers
Graphic artists
Cabinet makers
Administrators
Text editors
Grant writers
Nurses
Physicians
Audiologists
Electricians
Outreach specialists
Dangerous Decibels: Support
1999-2018
15 Private foundation/corporate grants
(US, Canada, NZ, Brazil, Singapore)
7 US Government grants NIH & CDC
1 NZ Government grant ACC
1 NUS research grant
To reduce the incidenceof noise induced hearing loss
and tinnitus
HOW?
By changing
knowledge, attitudes, beliefs and behaviors
about sound exposure
and use of hearing protective strategies
Educate early
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Education
Exhibits Research
Dangerous Decibels® Activities
• K‐12 Classroom program
• Educator training
• Website information
• Online Virtual Exhibit
• Dangerous Decibels exhibits
• Jolene
• Public health research
K‐12 Classroom Program
Teaching method: Inquiry‐based learning
“Tell me and I forget,
show me and I remember,
involve me and I understand.”
Banchi, H. & Bell, R. The Many Levels of Inquiry. Science and Children, 46(2), 26-29, 2008
• 50 minutes duration
• 9 modules
• Highly interactive
• Low‐tech
• Portable
• Low cost consumables
• Maximum of 30 participants
Classifying safe and dangerous sounds
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Measuring sound pressure at different distances Modeling hair bundle damage from sound exposure
Gaining confidence in using hearing protection
Malay
Mandarin
Español
Português
Program adaptations
• Workers (occupational)
• Military
• Parents
• Recreational shooters
• Musicians
Educator Workshops
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Educator Training Workshops: Who attends?
Museum educators
High school students
University students
Audiologists
Speech Pathologists
School nurses
Basic scientists
Nurses
Physicians
Administrators
Industrial hygienists
School teachers
Corporate staff
School hearing screening techs
Medical safety officers
Parents
Website InformationWWW.DANGEROUSDECIBELS.ORG
Number of sessions per cityWebsite users from 231 countries
Virtual Exhibit
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Online Virtual Exhibit at www.dangerousdecibels.org
Museum Exhibit
• First exhibition in the world dedicated to reducing noise induced hearing loss and tinnitus
• 12 exhibit components ‐ 2000 ft2 / 186 m2
• Open June 1, 2002 to May 5, 2011
• Over 5,000,000 visitors
JoleneEDUCATIONAL MANNEQUIN
www.dangerousdecibels.org/jolene.cfm
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Research
Dangerous Decibels Four-Intervention EvaluationPercent of students who answered 75% or more correctly
Web‐based
STEM Education
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• Concern about the ability of the United States to compete in the global economy has lent urgency to calls for reform of science, technology, engineering, and mathematics (STEM) education.
• U.S. policymakers have called for increasing the number and diversity of students pursuing degrees and careers in STEM fields
• In the U.S. average mathematics and science literacy scores are below the average scores for all developed countries.
NSB, Science and Engineering Indicators 2016
Need for Education
Serious Games
Serious Games
• Function as a bridge technology that converts gaming
from a social pastime to a powerful educational tool that
challenges students with game‐based problem solving,
conceptual reasoning and goal‐oriented decisions.
https://grants.nih.gov/grants/guide/pa‐files/par‐14‐325.html
Serious Games
• Serious games provide real time student assessment.
Unlike standardized classroom testing where student
achievement is a pass or fail process, well‐designed
educational gaming assessment is interactive, does not
punish the student, and provides feedback on how to
move to the next level of play.
https://grants.nih.gov/grants/guide/pa‐files/par‐14‐325.html
Benefits of Serious Games
• Engagement
• Designed for success
• Sharing
• Learn by doing
• Monitoring process
• Risk free Research ObjectivesPHASE I : FEASIBILITY
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Specific Aims
• To develop and test an engaging video game based onthe evidence‐based Dangerous Decibels® program.
• To teach STEM concepts associated with the biologyand physiology of the auditory system, the physics ofsound and wave propagation, and the mathematicalconstructs that allow problem solving with numbers.
• To convey positive hearing health behaviors by focusingon key educational messages related to the preventionof noise‐induced hearing loss (NIHL) and tinnitus
PROTOTYPE STEM CONCEPTS
• Primary: The amplitude of sound is higher closer to the source of the sound.
• Secondary: Hearing damage depends on two variables: exposure time and sound amplitude.
Serious Game Design Assessment Framework (SGDAF)
Mitgutsch and Alvarado 2012
PROTOTYPE HEALTH CONCEPTS
• Primary: Loud sounds can permanently damage your hearing.
• Secondary: The longer you are exposed to loud sounds, the more you can damage your hearing.
Fictional Narrative Framing
• 5th to 7th graders with minimal gameplay experience
• Touch‐ or touch‐and‐drag interactions on a touch screen
• Hearing health is relevant to this age group due to exposures to noisy activities and environments.
• Topic integrates well with physics of sound and hearing is part of common core science curriculum for this age group.
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Aesthetics, Mechanics, and Content
Aesthetics, Mechanics, and Content Aesthetics, Mechanics, and Content:Decibel Meter
Hearing Health MeterSong of the Starbird: Main Level
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Recovering Hidden Song Disks
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Hearing Range and Waves
Game Sound Sources (Creatures)
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Inverse Square Law
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Qualitative Summative Study: Methods
• 5th‐7th grade students (n=26) in 3 groups
• 5th‐7th grade teachers (n=6)
• Location: classroom
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Methods and Analysis
• 20 minute game play
• 1 on 1 verbal interview
Game Play
• 4 classroom program activities
• 1 on 1 verbal interview
Dangerous Decibels Activities • Task description
• Task description
Descriptive & Qualitative Analysis
RESULTS: STEM Concepts: After the game play
• Primary Concept: The amplitude of sound is higher closer to the source of the sound.
• Interview Question: “What happens when you move closer to the place that sound comes from?”
• 80% (n=20) students responded “It gets louder”
• “Far away it's quiet, but louder when you get closer.”
• “If you get closer it gets louder if you move far away it gets quiet. And if you get closer and it gets louder it starts to damage your ears.”
• “When you got close, the ring on the side would go higher and you knew it was getting louder.”
RESULTS: After the Game Play
• Secondary Concept: Hearing damage depends on two variables: exposure time and sound amplitude
• “Something that could damage your ears is if you are hearing something too loud or are too close to something that is too loud—maybe that could damage your ears.”
• “Don’t get too close to loud stuff so it doesn’t damage our ears.”
• “If you get closer it gets louder if you move far away it gets quiet. And if you get closer and it gets louder it starts to damage your ears.”
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STEM Outcome Summary: Game Play
• The concept that sound becomes louder when moving closer to the sound source was clearly and correctly understood by all of the students.
• The concept that hearing damage occurs when getting closer to loud sounds was also well understood.
• The concept of exposure time, while implicit in the game, was probably not as well captured by the students.
Hearing Health Concepts: After the game play
• Relevant Interview Questions:
• “Do you have any ideas about what might damage your hearing and make it hard to hear sound?”
• “Do you think it is possible for loud sound to damage the ear?”
• “Is it important to hear well?”
Hearing Health Concepts: After the game play
Primary Concept: Loud sounds can permanently damage your hearing.
• “Loud might hurt your hearing.”
• “When we play the game, I know why when you go really close, you have to go back because the hair cells get damaged.”
• “Yes because it is saying that when you have that thing that was saying 18,000 hairs or something like that, every time you got close and your screen got smaller you’d always remove the hairs by the time you go. And whenever you loose all your hairs you become deaf.”
Hearing Health Concepts: After the game play
Secondary Concept: The longer you are exposed to loud sounds, the more you can damage your hearing.
• No question in the survey specifically addressed time spent versus proximity to the loud sounds. However, even with open‐ended questions, students did not seem to realize the relationship between time and distance relative to hearing damage.
Hearing Health Outcome Summary: Game Play
• Overall students clearly identified loud sounds as a threat to their health and understood that the hair cells in the ear can get damaged when exposed to loud sounds.
• They also understood that if enough damage occurs, the loss of hair cells could lead to hearing loss and deafness.
• One missing concept was that related to duration of exposure which was not clearly recognized by the students.
Ear Anatomy & Physiology Outcomes
• In general, the students had a poor understanding of how the ear works and labeled the picture incorrectly most of the time .
• Overall, students tended to mix up the various parts of the ear or the order of the sound propagation.
• However, students generally recognized that the sound goes in through the ear and then connects to the brain.
• Students also clearly recognized that the ear includes fragile hair cells that can be damaged by sound, and that the loss of hair cells leads to hearing loss and deafness .
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Qualitative Analysis
• To provide a more global analysis of the verbal
interview responses, recorded interviews were
transcribed and coded into NVivo v. 11.0 for
qualitative analysis
Attitudes toward the game
Interview Questions “Did you have fun playing the game (activity)? Why or why not?”
• A response of “I didn’t get the puzzle at the beginning” was coded as negative attitude. In contrast, a response of “Yes, I had fun playing the game because on the game we had to find the circles” was coded as positive attitude.
Attitudes
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Game Activities
Percent of Subjects
Event
Negative Neutral Positive
Game recommendations from students
• Provide instructions for the game.
• Provide hints for the game.
• Add more levels, more “monsters,” and more disks to find.
Teacher Survey Summary
• Teachers found the game “interesting” and “challenging” or “fun”. Some were worried that players did not really understand what they were doing because the content was implicit instead of explicit.
• Teachers agreed unanimously that students were “very engaged” with the game as well as the activities provided.
• Teachers agreed that the game was very useful as a teaching tool but some wished there had been more opportunity for some instructions and “pre‐teaching.”
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Teacher Survey Summary• Interestingly, some of the teachers were more interested in the “explicit” puzzle at the beginning of the game, and feared that the kids did not get much from the game. The outcomes reported above clearly show that the kids learned much from the game, and not much from the more “explicit” puzzle.
• Most teachers (4 out of six) found the game would be very useful to help students understand the danger of loud sounds, but two of them felt that the kids did not necessarily understand the connection between loud sounds and hearing damage.
• Most teachers (5 out of six) felt they would use the game in their classroom if available. One teacher was not sure how to integrate the game in the classroom.
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Summary
• Serious gaming looks promising as a means of understanding STEM concepts and hearing health concepts.
• Gaming requires a different approach to education; more implicit and less explicit content.
• Qualitative research design is useful for capturing the implicit knowledge.
• Students and teachers respond positively towards the use of Song of the Starbird in classrooms.
Future Directions
• Phase II proposal underway to further develop and refine the game and associated learning activities.
• Expand STEM concepts
• Stimulate STEM career interest
• Expand and build upon Hearing Health concepts
• Incorporate social behavior constructs and self‐efficacy
• Serious game will be designed to be an adjunct to classroom learning.
• Program and game coaching by high school students
Acknowledgement:Graduate Research Assistants
Carla White, Kinzee Hubacek, Jen Ruths, Ashley Stumpf, Liz Zakrzewski, Katy Hickey and Katie Steffens.
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