Using Computer Games to Help Patients Understand Health Risks

    • November 21, 2010

The Problem. As a former reporter for the Associated Press, Jessica Ancker knew how to present information. However, over time, what captured her imagination was the effect of providing people with information, particularly about health risks. Ancker was intrigued about whether there was any effect on people's decisions if they received information in different forms.

Grantee Perspective. Deciding to make research her new career, Ancker earned an MPH from the Columbia University Mailman School of Public Health, and then enrolled in Columbia's doctoral program.

There, she met Rita Kukafka, DrPH, MA, an associate professor who was heading up the Robert Wood Johnson Foundation (RWJF) Public Health Informatics Fellows Training Program at Columbia's medical school (College of Physicians and Surgeons). Kukafka had a dual appointment in the medical school, where the informatics program was based, and the school of public health. Ancker told Kukafka about her interest in helping patients better understand the risks and probabilities of disease. Kukafka told her how public health informatics—the systematic application of information, computer science and technology to public health practice, research and learning—could help her pursue that goal.

"As I started working with Jessica, her ability to understand how informatics could apply to work in public health became clearer," Kukafka said. "I was able to influence Jessica's thinking to see there could be an informatics solution to a public health problem of explaining risk and probability to patients." Ancker decided to switch to the biomedical informatics doctoral program at Columbia's medical school as an RWJF fellow, starting in 2005.

Research project as a fellow. Through the public informatics fellowship, Ancker learned computer programming and began to design computer games that people could play to understand the risks and probabilities of certain diseases or treatments. For her dissertation, Ancker worked closely with Kukafka and designed a study to assess the effect of computer games on patients' risk perceptions and decisions.

"In the school of public health, I wasn't meeting people who were focused on communicating with patients, oddly enough," Ancker said. "Rita was doing that research—direct communication with patients via the Web or e-mail or advertising. That was a real draw for me."

Ancker saw several advantages to using computer games to communicate hard-to-grasp statistics and probabilities about vaccine side effects, the focus of her work. First, computer games are fun and popular, especially with younger people. Computer games may also help people process information at a deeper level than simply reading information because they are interacting with the information. Computer games are also a way to convey complex statistical information to people who posses more rudimentary skills in this area, she said.

In Ancker's study, participants either viewed simple graphics or played a computer game similar to "Minesweeper" to better grasp the statistical probability of side effects from a vaccine. In the computer game, participants clicked on orange squares looking for figures hidden by the squares. The figures were either yellow, indicating they were healthy, or blue, indicating they were sick. The game ended when participants found a blue figure.

To Ancker's surprise, participants who searched more squares before finding a blue figure assessed the risk of vaccine side effects higher than those who found the blue figure right away. She had thought that finding the blue figure immediately would give people the feeling that the risk was high. She believes the result may be due to the fact that when using the interactive computer game, participants may have had to click many times to find a "healthy" figure. Ancker's findings appeared in Medical Decision Making (April 2010).

"My best guess is that the actual experience of playing the game made you think about the fact that you could get sick, and you had more time to dwell on this idea that maybe you're going to get sick," she said.

Despite the unexpected finding, Ancker believes that computer games can play a role in educating patients about health risks. For example, if playing computer games tends to increase patients' perceptions of risk, these games might be appropriate to educate people about the long-term consequences of poor diet, lack of exercise or smoking.

Using the skills she gained. Since completing the fellowship, Ancker has taken a position as an assistant professor at the Weill Cornell Medical College in New York. She secured her position with the help of the fellowship and a strong recommendation from Kukafka.

"The skills I learned through this fellowship made a huge impact on the people who hired me," she said. "They cared that I know how to do this research and that I understand the policy implications and the big picture."

At Weill Cornell, Ancker is continuing her research on the effects of health information technology on medical decision-making by patients and providers. She is also working with a team of researchers to measure the impact of informatics systems. In one project, Ancker and her colleagues are working with a regional health information organization in New York City that brokers health information exchanges between hospitals and physicians' offices.

They will be evaluating a project that is building personal electronic health records for patients. The records will include all of the data from a patient's doctors, laboratory results, medication information and hospitalization records. Patients will be able to view their information on any computer using a password. Ancker's research will focus on whether patients with personal electronic health records have fewer rehospitalizations because their medical information is easily accessible to them and to visiting nurses.

Benefits from her fellows network. Ancker said that the RWJF fellowship not only provided her with valuable skills and a mentor but with colleagues from whom she continues to learn. As part of the RWJF fellowship, the fellows from the four participating schools met twice a year to network, exchange ideas and present their research.

"Those meetings gave us a much broader understanding of what was taking place in public health informatics," she said. "Frequently graduate students tend to become very narrow and focused so they can finish their dissertation. We get blind spots and don't understand the broader context. The meetings helped me understand the broader context of public health informatics."

As an example, through these meetings, Ancker learned about a federal initiative to build a health information technology system that will allow providers to exchange electronic health records. By learning about that work, Ancker and her colleagues can target their research to areas that are likely to be funded and, she hopes, can ultimately make an impact on public health.

RWJF Perspective: From 2005 to 2010, RWJF supported the Public Health Informatics Fellows Training Program, which funded four universities with informatics programs supported by the National Library of Medicine to increase their ability to train informaticians who specialize in public health and to develop future leaders in public health informatics. Predoctoral, doctoral and postdoctoral students were eligible to participate in the two-year fellowship program.

"RWJF was looking to improve how public health departments used information systems to fulfill their missions. A key challenge for those departments was the lack of a robust public health informatics academic community that could conduct research, develop trained informaticians and spread best practices. This program enabled us to establish public health informatics as a legitimate and recognized branch of informatics," said Stephen J. Downs, an assistant vice president at RWJF and deputy director of its Health Group.