This thesis is part of the THERAPEUTIC project, which is dedicated to developing a hybrid digital environment for the therapeutic education of patients with osteoporosis and to supporting them in making behavioral changes (diet, physical activity, etc.) related to their condition. The hybrid environment developed will, in particular, aim to: 1) Model and make information tangible (effects of the disease and treatment, engagement, etc.) by adapting it to the specific conditions, perceptions, and needs of each patient; 2) Support sustainable behavioral changes and foster motivation during therapeutic education sessions in the hospital and at home from a long-term perspective, by incorporating hybrid gamification tailored to patients’ motivation and engagement.

The proposed dissertation focuses on the second pillar of the project, which concerns supporting patient motivation and engagement across the various settings and timeframes of therapeutic education.

Gamification is defined as the use of game design elements in non-game contexts (Deterding et al. 2011). Systematic literature reviews have shown that the motivational affordances associated with gamification can improve motivation, engagement, and learning outcomes in education and support behavioral change in the health sector (Hallifax et al. 2019). In particular, Koivisto and Malik (2021) highlight the potential of gamification for older adults in health-related contexts, a finding supported by other studies (Kappen et al. 2016; Altmeyer et al. 2018). Martinho et al. (2020) observed that the use of gamification techniques to support older adults was beneficial for improving their physical, cognitive, social, and emotional health as well as their well-being.

This thesis aims to develop tools to support behavioral change from a long-term perspective by fostering motivation in different settings (taking into account the alternation of TPE sessions at the hospital and at home) and by making the TPE environment more tangible. The doctoral student will study how to design a hybrid gamification approach tailored to patients’ motivation, preferences, and needs, and how to dynamically adapt motivational strategies to their behaviors in order to foster sustained engagement.

The primary objective of this dissertation is to investigate how to implement motivational strategies (gamification elements) within the specific context of hybrid environments, which alternate between group TPE sessions at the hospital and individual activities at home. Initially, the focus will be on identifying relevant game elements and motivational strategies for patients. Next, we will explore avenues for developing artifacts that combine digital and physical properties. We will conduct initial laboratory experiments to assess the feasibility of prototypes in terms of activity tracking, updating game elements, and visualization capabilities.
The second objective of the thesis will be to develop models and algorithms to personalize and/or dynamically adapt gamification from a long-term perspective and to measure the impact of such an adaptation on patient engagement and motivation. More eco-friendly settings will be considered at the ETP medical center and/or in patients’ homes.