Supporting bariatric surgery patients in their aftercare journey: a playful technological intervention “Truth-or-Dare?"

Background
The amount of people coping with obesity keeps on increasing. While the physical comorbidities are clearly visible, mental issues such as a low self-image are just as damaging. Bariatric
surgery is currently the most effective treatment with long-term results [2, 3]. Its effectiveness is however often expressed in postoperative weight loss, leaving the impact on psychological health aside [3].
Methods
To support bariatric patients in the aftercare pathway, we designed Truth-or-Dare. Combining
a physical artefact and a mobile app, Truth-or-Dare is a playful way to track patients' mental state, using challenges to help them to establish a better self-image and a physical exercise routine. The frame attracts attention by dropping magnetic wooden blocks, indicating it is time to play! The app displays a personalized exercise or reflection challenge. By placing the block back on one side of the frame the choice is made: truth or dare? The Truth-or-Dare frame and app have been used by a former bariatric patient for two weeks. Every 6-12 hours a block fell out of the frame. We conducted two semistructured interviews, the first focused on the experience and initial thoughts about the product, the
second informed by the data gathered. During the deployment, we also implemented a feedback loop to collect participants’ experiences with the challenges, allowing to understand which strategy was the most effective for a patient and to iterate on them.
Findings
The challenges were positively perceived by the participant and helped her to become more
aware of her behavior and mindset. While she enjoyed taking her time to perform each
challenge, she felt pressed and rushed by the too short interval between challenges. She often rated
the challenges as unpleasant, complicated or annoying, yet motivating. If a challenge is annoying, it does not mean it is not motivating. “If I would not want challenges like that, I would ignore my problems.” We observed a pattern of switching between truth and dare challenges, mainly triggered by the physical properties of the board.
Discussion
Playful Truth-or-Dare challenges implemented in a physical artefact and a related app are a
new intervention approach for mental wellbeing after bariatric surgery. It shows potential
in raising awareness amongst patients around their behaviors and motivating them throughout their journey. As the product is placed in a shared environment, family members are encouraged to join, which has a positive influence on both the patient and partner [1]. The design of the physical
product uses friction as a motivational mechanism: (a) a block on the ground calls for action. Will the patient remove it without performing a challenge or engage with the game? (b) placing the block
back, one can choose Truth or Dare. Yet, the board is designed to prevent one type of challenge to be chosen too often. These moments of friction act as triggers to step outside the comfort zone. Further research is necessary to refine the challenges, or even personalize them, and to investigate the longterm effect of Truth-or-Dare on patients’ mental wellbeing and self-image.