Serious Games for constipation management for people with intellectual disabilities: A scoping review and narrative synthesis

Introduction: People with intellectual disability (PwID) are 2% of the UK population. Constipation and bowel movement (BM) problems (diarrhoea/faecal incontinence etc.) affects over a third of PwID and is a serious cause of morbidity and mortality. Pw ID rely heavily on outside support (family/professional carers/healthcare professionals), many of whom are ignorant to bowel related harms. There is significant stigma to discuss BM particularly constipation. Serious Games (SG) are increasingly used for education of health needs. This review examines if game-based technology can assist improving knowledge and reducing stigma of BM problems particularly constipation. Objective: To identify and gain evidence of SGs aimed at improving knowledge of BM management particularly constipation. Methods: A systematic search of publications between 2010 and 2024 was conducted following the PRISMA ScR statement for scoping reviews. The search inclusion/exclusion criteria were designed and overseen by an information specialist. PUBMED, EMBASE and PsychINFO databases were searched. Extracted variables included SG title, co-production and expert involvement, target outcome, evaluation methodology, effectiveness, sustainability and game platform. Results were narratively synthesised. Results: Of 2966 papers retrieved, three were selected for inclusion, none RCTs. All three included SGs aimed to teach BM management or recognition to healthcare workers/ professionals. Two studies evaluated game efficacy. No SGs were assessed after initial trials, none were implemented in clinical practice. Only one game successfully improved participant knowledge. All game creators consulted experts during game design, but none consulted patients. None discussed reducing stigma amongst their audience. Conclusion: Only one of three SGs identified improved BM knowledge in healthcare workers/professionals and was not specific to PwID. There is potential to co-produce with PwID and their carers a SG to support BM problems particularly constipation to reduce stigma, improve outcomes and be a templar for other similarly vulnerable groups like those with dementia.