Logo PTI Logo FedCSIS

Proceedings of the 20th Conference on Computer Science and Intelligence Systems (FedCSIS)

Annals of Computer Science and Information Systems, Volume 43

Adoption and Evaluation of Mobile Gaming Applications for Pain Management in Paediatric Oncology: A Culturally Contextualised TAM-Based Framework and Mixed-Methods Pilot Study in Saudi Arabia

, ,

DOI: http://dx.doi.org/10.15439/2025F3503

Citation: Proceedings of the 20th Conference on Computer Science and Intelligence Systems (FedCSIS), M. Bolanowski, M. Ganzha, L. Maciaszek, M. Paprzycki, D. Ślęzak (eds). ACSIS, Vol. 43, pages 73–86 ()

Full text

Abstract. Background: This pilot study has aimed to explore the adoption and effectiveness of mobile gaming applications as non-pharmacological tools for pain management in paediatric oncology within Saudi Arabia. Grounded in a culturally extended Technology Acceptance Model (TAM), the study has incorporated constructs such as Social Influence, Trust, System Quality, and Accessibility to understand technology uptake in a culturally conservative context. Methods: A mixed-methods pilot study was conducted at the King Fahad National Centre for Children's Cancer Emergency in Riyadh. Quantitative data were collected from 80 participants---50 parents and 30 healthcare providers---using a structured TAM-based survey instrument, with convenience sampling employed for feasibility. Parallelly, qualitative data were gathered from four participants (two parents and two healthcare providers) via semi-structured interviews, analysed thematically using a phenomenological approach. The instruments were pre-tested for cultural and linguistic appropriateness through expert review and back-translation. Results: Survey constructs showed strong reliability (α = 0.87--0.93). All six hypotheses were statistically supported, validating the extended TAM framework. Qualitative data prompted question wording changes and highlighted format preferences: parents preferred in-person interviews, providers preferred virtual. Conclusion: Findings confirm the instrument's reliability and support the extended TAM model. Qualitative input emphasizes the need for adaptable, culturally appropriate tools across user groups.

References

  1. J. Arthur and E. Bruera, ‘Balancing opioid analgesia with the risk of nonmedical opioid use in patients with cancer’, Nature Reviews Clinical Oncology, vol. 16, no. 4, pp. 213–226, 2019, https://dx.doi.org/10.1038/s41571-018-0143-7.
  2. J. Finianos, H. Abu-Saad Huijer, and J. MIRO, ‘Chronic pain in young people: The situation in Lebanon’, 2021.
  3. D. Madi and M. Clinton, ‘Pain and its impact on the functional ability in children treated at the children’s cancer center of lebanon’, Journal of pediatric nursing, vol. 39, pp. e11–e20, 2018.
  4. B. M. Scarborough and C. B. Smith, ‘Optimal pain management for patients with cancer in the modern era’, CA: a cancer journal for clinicians, vol. 68, no. 3, pp. 182–196, 2018.
  5. C. Baggott, F. Gibson, B. Coll, R. Kletter, P. Zeltzer, and C. Miaskowski, ‘Initial evaluation of an electronic symptom diary for adolescents with cancer’, JMIR research protocols, vol. 1, no. 2, p. e2175, 2012.
  6. W. A. Ramsey, R. E. Heidelberg, A. M. Gilbert, M. B. Heneghan, S. M. Badawy, and N. M. Alberts, ‘eHealth and mHealth interventions in pediatric cancer: A systematic review of interventions across the cancer continuum’, Psycho-Oncology, vol. 29, no. 1, pp. 17–37, Jan. 2020, https://doi.org/10.1002/pon.5280.
  7. M. Linares Barbero, M. Gallego, and Y. Bueno, ‘Analyzing the critical success factors in the online-game development: a framework proposal using the Delphi-Topsis Method’, 2023.
  8. P. M. Kato, S. W. Cole, A. S. Bradlyn, and B. H. Pollock, ‘A video game improves behavioral outcomes in adolescents and young adults with cancer: a randomized trial’, Pediatrics, vol. 122, no. 2, pp. e305–e317, 2008.
  9. E. F. Law et al., ‘Videogame Distraction using Virtual Reality Technology for Children Experiencing Cold Pressor Pain: The Role of Cognitive Processing’, Journal of Pediatric Psychology, vol. 36, no. 1, pp. 84–94, Jan. 2011, https://dx.doi.org/10.1093/jpepsy/jsq063.
  10. B. A. Primack et al., ‘Role of Video Games in Improving Health-Related Outcomes: A Systematic Review’, American Journal of Preventive Medicine, vol. 42, no. 6, pp. 630–638, 2012, https://doi.org/10.1016/j.amepre.2012.02.023.
  11. M. Shaygan and A. Jaberi, ‘The effect of a smartphone-based pain management application on pain intensity and quality of life in adolescents with chronic pain’, Scientific Reports, vol. 11, no. 1, p. 6588, 2021, https://dx.doi.org/10.1038/s41598-021-86156-8.
  12. A. Alshahrani, D. Stewart, and K. MacLure, ‘A systematic review of the adoption and acceptance of eHealth in Saudi Arabia: Views of multiple stakeholders’, International journal of medical informatics, vol. 128, pp. 7–17, 2019.
  13. S. Binkheder, R. Aldekhyyel, and J. Almulhem, ‘Health informatics publication trends in Saudi Arabia: a bibliometric analysis over the last twenty-four years’, Journal of the Medical Library Association: JMLA, vol. 109, no. 2, p. 219, 2021.
  14. S. A. Alghamdi, ‘Key factors influencing the adoption and utilisation of E-Government systems and services in Saudi Arabia’. University of Sussex, 2017.
  15. F. Alshehri and F. Alshaikh, ‘Exploring the constituent elements of a successful mobile health intervention for prediabetic patients in King Saud University Medical City Hospitals in Saudi Arabia: cross-sectional study’, JMIR Formative Research, vol. 5, no. 7, p. e22968, 2021.
  16. I. Y. Alyoussef, ‘Acceptance of a flipped classroom to improve university students’ learning: An empirical study on the TAM model and the unified theory of acceptance and use of technology (UTAUT)’, Heliyon, vol. 8, no. 12, 2022.
  17. E. Jonsson and M. Wikström, ‘Exploring the Technology Acceptance Behaviour Among Swedish Doctors: A Single Case Study of an Innovative Ovarian Cancer Diagnosis Tool’, 2023.
  18. J. Cho and H. E. Lee, ‘Post-adoption beliefs and continuance intention of smart device use among people with physical disabilities’, Disability and health journal, vol. 13, no. 2, p. 100878, 2020.
  19. Y. Ji, T. K. W. Leung, X. Dai, N. Du, and D. F. K. Wong, ‘Gaming Disorder: Unraveling the Role of Problematic Affective, Cognitive, and Executive Functioning-A Systematic Review and Meta-Analytic Structural Equation Modeling’, Computers in Human Behavior, p. 108348, 2024.
  20. V. Braun and V. Clarke, ‘One size fits all? What counts as quality practice in (reflexive) thematic analysis?’, Qualitative research in psychology, vol. 18, no. 3, pp. 328–352, 2021.
  21. J. W. Creswell and C. N. Poth, Qualitative inquiry and research design: Choosing among five approaches. Sage publications, 2016.
  22. M. Hennink and B. N. Kaiser, ‘Sample sizes for saturation in qualitative research: A systematic review of empirical tests’, Social science & medicine, vol. 292, p. 114523, 2022.
  23. J. F. Hunter, Z. N. Kain, and M. A. Fortier, ‘Pain relief in the palm of your hand: Harnessing mobile health to manage pediatric pain’, Paediatric Anaesthesia, vol. 29, no. 2, pp. 120–124, 2019, https://dx.doi.org/10.1111/pan.13547.
  24. J. Amaram-Davila, M. Davis, and A. Reddy, ‘Opioids and cancer mortality’, Current treatment options in oncology, vol. 21, pp. 1–13, 2020.
  25. D. Koller and R. D. Goldman, ‘Distraction Techniques for Children Undergoing Procedures: A Critical Review of Pediatric Research’, Journal of Pediatric Nursing, vol. 27, no. 6, pp. 652–681, 2012, https://doi.org/10.1016/j.pedn.2011.08.001.
  26. E. M. Wilson-Smith, ‘Procedural Pain Management in Neonates, Infants and Children’, Reviews in Pain, vol. 5, no. 3, pp. 4–12, Sep. 2011, https://dx.doi.org/10.1177/204946371100500303.
  27. C. Brasher et al., ‘Postoperative Pain Management in Children and Infants: An Update’, Pediatric Drugs, vol. 16, no. 2, pp. 129–140, 2014, https://dx.doi.org/10.1007/s40272-013-0062-0.
  28. D. M. L. Van Ryckeghem, S. Van Damme, C. Eccleston, and G. Crombez, ‘The efficacy of attentional distraction and sensory monitoring in chronic pain patients: A meta-analysis’, Clinical Psychology Review, vol. 59, pp. 16–29, 2018, https://doi.org/10.1016/j.cpr.2017.10.008.
  29. L. M. Dahlquist, K. D. McKenna, K. K. Jones, L. Dillinger, K. E. Weiss, and C. S. Ackerman, Active and passive distraction using a head-mounted display helmet: Effects on cold pressor pain in children., vol. 26. Dahlquist, Lynnda M.: Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD, US, 21250, dahlquis@umbc.edu: American Psychological Association, 2007. https://dx.doi.org/10.1037/0278-6133.26.6.794.
  30. J. I. Gold and N. E. Mahrer, ‘Is Virtual Reality Ready for Prime Time in the Medical Space? A Randomized Control Trial of Pediatric Virtual Reality for Acute Procedural Pain Management’, Journal of Pediatric Psychology, vol. 43, no. 3, pp. 266–275, Apr. 2018, https://dx.doi.org/10.1093/jpepsy/jsx129.
  31. F. Mikaeli Manee et al., ‘Smartphone and Iranian Women: Prevalence and Predictors of Problematic Smartphone Use’, International Journal of Psychology (IPA), vol. 15, no. 2, pp. 31–85, 2021.
  32. Y. A. W. De Kort, W. A. IJsselsteijn, and K. Poels, ‘Digital games as social presence technology: Development of the Social Presence in Gaming Questionnaire (SPGQ)’, Proceedings of PRESENCE, vol. 195203, pp. 1–9, 2007.
  33. C. S. Bruggers et al., A Prototype Exercise–Empowerment Mobile Video Game for Children With Cancer, and Its Usability Assessment: Developing Digital Empowerment Interventions for Pediatric Diseases, vol. 6. 2018. [Online]. Available: https://www.frontiersin.org/articles/10.3389/fped.2018.00069
  34. F. D. Davis, ‘Perceived usefulness, perceived ease of use, and user acceptance of information technology’, MIS quarterly, pp. 319–340, 1989.
  35. I.-C. Chang, P.-C. Chou, R. K.-J. Yeh, and H.-T. Tseng, ‘Factors influencing Chinese tourists’ intentions to use the Taiwan Medical Travel App’, Telematics and Informatics, vol. 33, no. 2, pp. 401–409, 2016.
  36. V. Venkatesh, M. G. Morris, G. B. Davis, and F. D. Davis, ‘User acceptance of information technology: Toward a unified view’, MIS quarterly, pp. 425–478, 2003.
  37. I. Ajzen, ‘Handbook of Theories of Social Psychology: Volume 1’. SAGE Publications Ltd, London, 2012. https://dx.doi.org/10.4135/9781446249215 NV - 1.
  38. M. Altalhi, ‘Toward the sustainability of mobile learning applications in higher education: an empirical study’, Universal Access in the Information Society, vol. 23, no. 3, pp. 1103–1113, 2024.
  39. F. D. Davis, ‘Technology acceptance model: TAM’, Al-Suqri, MN, Al-Aufi, AS: Information Seeking Behavior and Technology Adoption, vol. 205, p. 219, 1989.
  40. V. Venkatesh and F. D. Davis, ‘A theoretical extension of the technology acceptance model: Four longitudinal field studies’, Management science, vol. 46, no. 2, pp. 186–204, 2000.
  41. M. K. Lee, Y. H. Yun, H.-A. Park, E. S. Lee, K. H. Jung, and D.-Y. Noh, ‘A Web-based self-management exercise and diet intervention for breast cancer survivors: Pilot randomized controlled trial’, International Journal of Nursing Studies, vol. 51, no. 12, pp. 1557–1567, 2014, https://doi.org/10.1016/j.ijnurstu.2014.04.012.
  42. B. Rahimi, H. Nadri, H. L. Afshar, and T. Timpka, ‘A systematic review of the technology acceptance model in health informatics’, Applied clinical informatics, vol. 9, no. 03, pp. 604–634, 2018.
  43. A. Alzahrani, V. Gay, and R. Alturki, ‘Exploring Saudi individuals’ perspectives and needs to design a hypertension management mobile technology solution: Qualitative study’, International Journal of Environmental Research and Public Health, vol. 19, no. 19, p. 12956, 2022.
  44. C. Martinelli, C. Pucci, and G. Ciofani, ‘Nanostructured carriers as innovative tools for cancer diagnosis and therapy’, APL Bioengineering, vol. 3, no. 1, Mar. 2019, https://dx.doi.org/10.1063/1.5079943.
  45. C. Pucci, C. Martinelli, and G. Ciofani, ‘Innovative approaches for cancer treatment: Current perspectives and new challenges’, ecancermedicalscience, vol. 13, 2019.
  46. W. H. DeLone and E. R. McLean, ‘Measuring e-commerce success: Applying the DeLone & McLean information systems success model’, International Journal of electronic commerce, vol. 9, no. 1, pp. 31–47, 2004.
  47. D. Smart et al., ‘What Influences Parents and Practitioners’ Decisions to Share Personal Information within an Early Help (Social Care) Context? Implications for Practice in Sharing Digital Data across Sectors’, The British Journal of Social Work, vol. 52, no. 4, pp. 2146–2165, 2022.
  48. E. Oppong, R. E. Hinson, O. Adeola, O. Muritala, and J. P. Kosiba, ‘The effect of mobile health service quality on user satisfaction and continual usage’, Total Quality Management & Business Excellence, vol. 32, no. 1–2, pp. 177–198, 2021.
  49. N. Aljohani and D. Chandran, ‘Adoption of M-Health applications: the Saudi Arabian healthcare perspectives’, 2019.
  50. M. Hubert, M. Blut, C. Brock, R. W. Zhang, V. Koch, and R. Riedl, ‘The influence of acceptance and adoption drivers on smart home usage’, European journal of marketing, vol. 53, no. 6, pp. 1073–1098, 2019.
  51. A. Alaiad, M. Alsharo, and Y. Alnsour, ‘The determinants of m-health adoption in developing countries: an empirical investigation’, Applied clinical informatics, vol. 10, no. 05, pp. 820–840, 2019.
  52. M. Linares, M. D. Gallego, and S. Bueno, ‘Proposing a TAM-SDT-based model to examine the user acceptance of massively multiplayer online games’, International Journal of Environmental Research and Public Health, vol. 18, no. 7, p. 3687, 2021.
  53. Y. Zhou, Y. Zhou, and K. Machtmes, ‘Mixed methods integration strategies used in education: A systematic review’, Methodological Innovations, vol. 17, no. 1, pp. 41–49, 2024.
  54. C. W. E. Chai, ‘A Serious Game Intervention for Increasing Motivation of Children with Cancer to Fight Cancer’, 2022.
  55. Y. Sana’a, ‘A critical review of models and theories in field of individual acceptance of technology’, International journal of hybrid information technology, vol. 9, no. 6, pp. 143–158, 2016.
  56. L. Xue, A. M. Rashid, and S. Ouyang, ‘The Unified Theory of Acceptance and Use of Technology (UTAUT) in Higher Education: A Systematic Review’, SAGE Open, vol. 14, no. 1, p. 21582440241229570, 2024.
  57. F. L. Broekman, J. T. Piotrowski, H. W. Beentjes, and P. M. Valkenburg, ‘App features that fulfill parents’ needs in apps for children’, Mobile media & communication, vol. 6, no. 3, pp. 367–389, 2018.
  58. J. W. Creswell and V. L. P. Clark, Designing and conducting mixed methods research. Sage publications, 2017.
  59. R. W. Emerson, ‘Convenience sampling revisited: Embracing its limitations through thoughtful study design’, Journal of Visual Impairment & Blindness, vol. 115, no. 1, pp. 76–77, 2021.
  60. F. D. Davis, R. P. Bagozzi, and P. R. Warshaw, ‘User acceptance of computer technology: A comparison of two theoretical models’, Management science, vol. 35, no. 8, pp. 982–1003, 1989.
  61. U. Ozolins, S. Hale, X. Cheng, A. Hyatt, and P. Schofield, ‘Translation and back-translation methodology in health research–a critique’, Expert review of pharmacoeconomics & outcomes research, vol. 20, no. 1, pp. 69–77, 2020.
  62. V. Braun and V. Clarke, ‘Using thematic analysis in psychology’, Qualitative research in psychology, vol. 3, no. 2, pp. 77–101, 2006.
  63. J. F. Hair Jr, W. C. Black, B. J. Babin, and R. E. Anderson, ‘Multivariate data analysis’, in Multivariate data analysis, 2010, pp. 785–785.