Teaching kids about asthma can be fun

Wednesday, 16 Sep 2015

An interactive educational game that has just been launched in Australia teaches kids about all the important aspects of asthma care in a fun way, say two leading respiratory experts from the US.

 The days when children were seen but not heard are long gone, and now even young kids are involved in decisions that affect them. This makes good sense in many situations, and certainly when children have a chronic health condition.

For these kids, being engaged in their own medical care can improve their self-management skills and understanding of their condition. It can also promote self-efficacy, or the belief that they can perform a task or manage a situation, preparing them for the time when they will be less reliant on parental or caregiver involvement.

According to paediatric respiratory specialist Dr Gregory Sawicki, from the Boston Children’s Hospital in the US, if children learn to manage their condition in collaboration with healthcare professionals and their caregivers, they may be more likely to have improved health outcomes.

But attempts to get kids involved are often not entirely successful. Dr Sawicki says it can be tricky to engage children in a developmentally appropriate way that doesn’t come across as a test. He also points out that because educational approaches often focus on parents and caregivers, they don’t appeal to children.

“Normalising a health condition for children is another challenge,” he said. “Kids with a chronic condition do not want every activity they engage in to be related to being sick or different.”

Paediatric asthma specialist Dr Ann Wu, from the Harvard Medical School and Harvard Pilgrim Health Care Institute in the US, also suggests that parents and healthcare professionals often don’t have time to teach kids, or don’t try because they think children aren’t ready to understand health concepts. “It’s true that not all health education concepts are easy for kids to understand, but kids can understand basic concepts,” she said.

Failing to get these kids engaged in their own care can have serious consequences. Dr Sawicki says lack of engagement can increase struggles between children and their caregivers or parents when it comes to completing treatment on a daily basis. Some 50-88% of children and adolescents with chronic diseases are non-adherent to their prescribed regimens.1

He also adds that if children do not fully understand their condition they are at risk of neglecting or ignoring symptoms. In asthma, this can lead to more asthma flares, emergency visits and hospitalisations.

So what more can be done to better engage these children in health education?

US company LifeGuard Games is optimistic it has found an effective way to reach kids with asthma, one of the most common chronic diseases of childhood, which affects about 1 in 9 Australian children.

It has developed an interactive educational game called Wellapets that teaches kids aged 6-11 years how to manage their asthma. Children care for a virtual pet that also has asthma and whose care mirrors their own care needs. The game is available as an application (app) on a smartphone or tablet, and is free from the adverts and microtransactions that plague many mobile apps.

Dr Wu, who advised on the development of the game, says Wellapets teaches kids about all the important aspects of asthma care in a fun way. “Kids learn about triggers for asthma, the importance of using a spacer with inhalers, the difference between controller medicines that you take daily and rescue medicines that you take for asthma flares,” she explained.

“For children who are already using mobile apps and playing video games, I recommend Wellapets as an additional game that can teach them about asthma.”

Although the idea of using interactive games to support health education for children has been around for a while, it’s gaining momentum because so many children play video games these days. Also, because these games are now available as apps on hand-held devices, they are highly accessible and children can play them anywhere. So it’s now easier than ever before to reach kids where they enjoy spending their time.

Several gaming apps have emerged targeting asthma, as well as other chronic conditions in children such as cancer and diabetes, aimed at improving patient outcomes. Unlike more traditional learning approaches, these ‘serious games’ aim to teach children while they play, so they don’t realise they are learning. They typically include elements that make them a good tool for learning, including repetition, multiple levels of achievement, competition and personalised incentives and rewards.

The format has been proven to work, with several studies2–4 showing that interactive games are successful in affecting behaviour related to wellbeing.

In a six-month randomised controlled trial, a video game designed to improve self-care among children and adolescents with diabetes was shown to improve self-efficacy, communication with parents about diabetes and self-care behaviours (such as monitoring blood glucose levels regularly and eating the right foods). It also reduced unscheduled urgent doctor visits.3

Similarly encouraging results were shown in a randomised trial looking at a video game for adolescents and young adults who were undergoing cancer therapy. Patients who played the game were significantly better at adhering to treatment and had improved cancer-related self-efficacy and knowledge.4

Dr Sawicki, who also advised on the development of Wellapets, sees gaming apps for children with chronic diseases as a welcome innovation. “As more people have electronic tablets and platforms to educate their children or entertain them, harnessing this technology for health education has great promise,” he said.

He believes games such as Wellapets have the potential to augment routine clinical care and health education approaches by providing a fun environment for children to learn about their health conditions. “Turning education into a game may also reduce the stigma of illness from such education,” he added.

At the moment, there are only a relatively small number of gaming apps aimed at improving outcomes for children with chronic diseases. But Dr Wu predicts significant growth in this area. “With the increase in the number of wearable devices on the market, more mobile health apps are sure to be developed as well,” she said.

On the whole she views this as a positive thing, but notes that there is a great need for a formal process for reviewing mobile health apps to help people choose, and doctors recommend, the most appropriate apps.

Before this happens, she says the best thing is for doctors to try out the apps themselves so they know the content of the games before recommending them to their patients.


  1. McGrady ME, Hommel KA. Medication Adherence and Health Care Utilization in Pediatric Chronic Illness: A Systematic Review. Pediatrics 2013; 132(4): 730–40. (link)
  2. Kato PM. Video Games in Health Care: Closing the Gap. Rev Gen Psychol 2010; 14(2): 113–21. (link)
  3. Brown SJ, Lieberman DA, et al. Educational video game for juvenile diabetes: results of a controlled trial. Med Inform 1997; 22(1): 77–89. (link)
  4. Kato PM, Cole SW, Bradlyn AS, Pollock BH. A Video Game Improves Behavioral Outcomes in Adolescents and Young Adults With Cancer: A Randomised Trial. Pediatrics 2008; 122(2): e305–17. (link)

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