JMIR Serious Games

A multidisciplinary journal on gaming and gamification for health education/promotion, teaching and social change.

Toward effective gamification for elderly people

Rationale The rapidly aging world population increases the burden on healthcare services. By supporting a more healthy lifestyle, elderly can extend their time of autonomy and independence. eHealth is therefore hypothesised to help to alleviate the increasing demand for elderly care. However, adherence to the technology presented to the end-user is low and decreases over time. Thus, there is a need for methods to increase adherence of the elderly user (age 65 and up). One way to achieve this might be through offering long-term motivating content that is tailored to the demands of the user. A strategy that has recently emerged is gamification: applying game elements to non-game fields, to motivate and increase user activity and retention. Although gamification is a much used concept to engage people of younger generations, there is little knowledge on the effect of game-based motivation strategies on the older adult. This research aims to develop a view on the conceptualisation of gamification and in specific on the opportunities for applying gamification to increase long-term motivation for elderly, which may be achieved by tailoring game content to the user. Methods Literature was researched to create a state of the art on three aspects relevant for our aim: 1) how gamification is currently being conceptualised, 2) experiences with and knowledge of gamification to engage older adults and 3) methods to tailor content to the user. Results The result of this study showed that there is no consensus about definitions of gamification and that there is a variety in approaches towards the realisation of the concept gamification. Results also show that there is only a very small amount of information regarding the application of gamification to engage elderly. While this information does indicate the potential of gamification for this purpose and target group, there is a significant gap in knowledge on its real effectiveness. Lastly, results show that within existing user classifications there is one theory that appears suitable for use in this context, which is based on the hypothesised existence of a relation between preference for game content and personality. However, further research on that particular theory is needed since methods to map elderly onto this classification are absent, and the effectiveness of the use of this classification for tailoring content is not known. Conclusion Gamification shows promising aspects towards the engagement of elderly in eHealth applications. There is however a gap in knowledge on the use and effectiveness of gamification in this context.

Journal Description

JMIR Serious Games (JSG, ISSN 2291-9279) is a sister journal of the Journal of Medical Internet Research (JMIR), the top cited journal in health informatics (Impact Factor 2013: 4.7). JSG is a multidisciplinary journal devoted to computer/web applications that incorporate elements of gaming to solve serious problems such as health education/promotion, teaching and education, or social change.
The journal also considers commentary and research in the fields of video games violence and video games addiction.

 

Recent Articles:

  • Screenshots of Monster Manor. Children can input their blood glucose measurements using an on-screen numeric pad and earn virtual coins to buy various in-game items that are essential for progression through the game.

    Digital Games for Type 1 and Type 2 Diabetes: Underpinning Theory With Three Illustrative Examples

    Abstract:

    Digital games are an important class of eHealth interventions in diabetes, made possible by the Internet and a good range of affordable mobile devices (eg, mobile phones and tablets) available to consumers these days. Gamifying disease management can help children, adolescents, and adults with diabetes to better cope with their lifelong condition. Gamification and social in-game components are used to motivate players/patients and positively change their behavior and lifestyle. In this paper, we start by presenting the main challenges facing people with diabetes—children/adolescents and adults—from a clinical perspective, followed by three short illustrative examples of mobile and desktop game apps and platforms designed by Ayogo Health, Inc. (Vancouver, BC, Canada) for type 1 diabetes (one example) and type 2 diabetes (two examples). The games target different age groups with different needs—children with type 1 diabetes versus adults with type 2 diabetes. The paper is not meant to be an exhaustive review of all digital game offerings available for people with type 1 and type 2 diabetes, but rather to serve as a taster of a few of the game genres on offer today for both types of diabetes, with a brief discussion of (1) some of the underpinning psychological mechanisms of gamified digital interventions and platforms as self-management adherence tools, and more, in diabetes, and (2) some of the hypothesized potential benefits that might be gained from their routine use by people with diabetes. More research evidence from full-scale evaluation studies is needed and expected in the near future that will quantify, qualify, and establish the evidence base concerning this gamification potential, such as what works in each age group/patient type, what does not, and under which settings and criteria.

  • Image of social media and video gaming system developed based on focus group findings.
(cc) Tatla et al. CC-BY-SA-2.0, please cite as (http://games.jmir.org/article/viewFile/3401/1/48312).

    Therapists’ Perceptions of Social Media and Video Game Technologies in Upper Limb Rehabilitation

    Abstract:

    Background: The application of technologies, such as video gaming and social media for rehabilitation, is garnering interest in the medical field. However, little research has examined clinicians’ perspectives regarding technology adoption by their clients. Objective: The objective of our study was to explore therapists’ perceptions of how young people and adults with hemiplegia use gaming and social media technologies in daily life and in rehabilitation, and to identify barriers to using these technologies in rehabilitation. Methods: We conducted two focus groups comprised of ten occupational therapists/physiotherapists who provide neurorehabilitation to individuals with hemiplegia secondary to stroke or cerebral palsy. Data was analyzed using inductive thematic analysis. The diffusion of innovations theory provided a framework to interpret emerging themes. Results: Therapists were using technology in a limited capacity. They identified barriers to using social media and gaming technology with their clients, including a lack of age appropriateness, privacy issues with social media, limited transfer of training, and a lack of accessibility of current systems. Therapists also questioned their role in the context of technology-based interventions. The opportunity for social interaction was perceived as a major benefit of integrated gaming and social media. Conclusions: This study reveals the complexities associated with adopting new technologies in clinical practice, including the need to consider both client and clinician factors. Despite reporting several challenges with applying gaming and social media technology with clinical populations, therapists identified opportunities for increased social interactions and were willing to help shape the development of an upper limb training system that could more readily meet the needs of clients with hemiplegia. By considering the needs of both therapists and clients, technology developers may increase the likelihood that clinicians will adopt innovative technologies.

  • The image was developed by the research team that author Matthew Shepherd is a part of, so the  image is owned by them.

    The Design and Relevance of a Computerized Gamified Depression Therapy Program for Indigenous Māori Adolescents

    Abstract:

    Background: Depression is a major health issue among Māori indigenous adolescents, yet there has been little investigation into the relevance or effectiveness of psychological treatments for them. Further, consumer views are critical for engagement and adherence to therapy. However, there is little research regarding indigenous communities’ opinions about psychological interventions for depression. Objective: The objective of this study was to conduct semistructured interviews with Māori (indigenous New Zealand) young people (taitamariki) and their families to find out their opinions of a prototype computerized cognitive behavioral therapy (cCBT) program called Smart, Positive, Active, Realistic, X-factor thoughts (SPARX), a free online computer game intended to help young persons with mild to moderate depression, feeling down, stress or anxiety. The program will teach them how to resolve their issues on their own using Cognitive Behavioural Therapy as psychotherapeutic approach. Methods: There were seven focus groups on the subject of the design and cultural relevance of SPARX that were held, with a total of 26 participants (19 taitamarki, 7 parents/caregivers, all Māori). There were five of the groups that were with whānau (family groups) (n=14), one group was with Māori teenage mothers (n=4), and one group was with taitamariki (n=8). The general inductive approach was used to analyze focus group data. Results: SPARX computerized therapy has good face validity and is seen as potentially effective and appealing for Māori people. Cultural relevance was viewed as being important for the engagement of Māori young people with SPARX. Whānau are important for young peoples’ well-being. Participants generated ideas for improving SPARX for Māori and for the inclusion of whānau in its delivery. Conclusions: SPARX computerized therapy had good face validity for indigenous young people and families. In general, Māori participants were positive about the SPARX prototype and considered it both appealing and applicable to them. The results of this study were used to refine SPARX prior to it being delivered to taitamariki and non-Māori young people. Trial Registration: The New Zealand Northern Y Regional Ethics Committee; http://ethics.health.govt.nz/home; NTY/09/003; (Archived by WebCite at http://www.webcitation/6VYgHXKaR).

  • Fantasy Baseball, ESPN Illustration.

    Active Fantasy Sports: Rationale and Feasibility of Leveraging Online Fantasy Sports to Promote Physical Activity

    Abstract:

    Background: The popularity of active video games (AVGs) has skyrocketed over the last decade. However, research suggests that the most popular AVGs, which rely on synchronous integration between players’ activity and game features, fail to promote physical activity outside of the game or for extended periods of engagement. This limitation has led researchers to consider AVGs that involve asynchronous integration of players’ ongoing physical activity with game features. Rather than build an AVG de novo, we selected an established sedentary video game uniquely well suited for the incorporation of asynchronous activity: online fantasy sports. Objective: The primary aim of this study was to explore the feasibility of a new asynchronous AVG—active fantasy sports—designed to promote physical activity. Methods: We conducted two pilot studies of an active fantasy sports game designed to promote physical activity. Participants wore a low cost triaxial accelerometer and participated in an online fantasy baseball (Study 1, n=9, 13-weeks) or fantasy basketball (Study 2, n=10, 17-weeks) league. Privileges within the game were made contingent on meeting weekly physical activity goals (eg, averaging 10,000 steps/day). Results: Across the two studies, the feasibility of integrating physical activity contingent features and privileges into online fantasy sports games was supported. Participants found the active fantasy sports game enjoyable, as or more enjoyable than traditional (sedentary) online fantasy sports (Study 1: t8=4.43, P<.01; Study 2: t9=2.09, P=.07). Participants in Study 1 increased their average steps/day, t8=2.63, P<.05, while participants in Study 2 maintained (ie, did not change) their activity, t9=1.57, P=.15). In postassessment interviews, social support within the game was cited as a key motivating factor for increasing physical activity. Conclusions: Preliminary evidence supports potential for the active fantasy sports system as a sustainable and scalable intervention for promoting adult physical activity.

  • This figure is the TouchBall virtual environment.

    Virtual Rehabilitation for Multiple Sclerosis Using a Kinect-Based System: Randomized Controlled Trial

    Abstract:

    Background: The methods used for the motor rehabilitation of patients with neurological disorders include a number of different rehabilitation exercises. For patients who have been diagnosed with multiple sclerosis (MS), the performance of motor rehabilitation exercises is essential. Nevertheless, this rehabilitation may be tedious, negatively influencing patients’ motivation and adherence to treatment. Objective: We present RemoviEM, a system based on Kinect that uses virtual reality (VR) and natural user interfaces (NUI) to offer patients with MS an intuitive and motivating way to perform several motor rehabilitation exercises. It offers therapists a new motor rehabilitation tool for the rehabilitation process, providing feedback on the patient’s progress. Moreover, it is a low-cost system, a feature that can facilitate its integration in clinical rehabilitation centers. Methods: A randomized and controlled single blinded study was carried out to assess the influence of a Kinect-based virtual rehabilitation system on the balance rehabilitation of patients with MS. This study describes RemoviEM and evaluates its effectiveness compared to standard rehabilitation. To achieve this objective, a clinical trial was carried out. Eleven patients from a MS association participated in the clinical trial. The mean age was 44.82 (SD 10.44) and the mean time from diagnosis (years) was 9.77 (SD 10.40). Clinical effectiveness was evaluated using clinical balance scales. Results: Significant group-by-time interaction was detected in the scores of the Berg Balance Scale (P=.011) and the Anterior Reach Test in standing position (P=.011). Post-hoc analysis showed greater improvement in the experimental group for these variables than in the control group for these variables. The Suitability Evaluation Questionnaire (SEQ) showed good results in usability, acceptance, security, and safety for the evaluated system. Conclusions: The results obtained suggest that RemoviEM represents a motivational and effective alternative to traditional motor rehabilitation for MS patients. These results have encouraged us to improve the system with new exercises, which are currently being developed.

  • How to assess serious games applied in healthcare.

    How to Systematically Assess Serious Games Applied to Health Care

    Abstract:

    The usefulness and effectiveness of specific serious games in the medical domain is often unclear. This is caused by a lack of supporting evidence on validity of individual games, as well as a lack of publicly available information. Moreover, insufficient understanding of design principles among the individuals and institutions that develop or apply a medical serious game compromises their use. This article provides the first consensus-based framework for the assessment of specific medical serious games. The framework provides 62 items in 5 main themes, aimed at assessing a serious game’s rationale, functionality, validity, and data safety. This will allow caregivers and educators to make balanced choices when applying a serious game for healthcare purposes. Furthermore, the framework provides game manufacturers with standards for the development of new, valid serious games.

  • Diabetes Island Presentation photo. Image taken by the authors of the article.

    Diabetes Island: Preliminary Impact of a Virtual World Self-Care Educational Intervention for African Americans With Type 2 Diabetes

    Abstract:

    Background: Diabetes is a serious worldwide public health challenge. The burden of diabetes, including prevalence and risk of complications, is greater for minorities, particularly African Americans. Internet-based immersive virtual worlds offer a unique opportunity to reach large and diverse populations with diabetes for self-management education and support. Objective: The objective of the study was to examine the acceptability, usage, and preliminary outcome of a virtual world intervention, Diabetes Island, in low-income African Americans with type 2 diabetes. The main hypotheses were that the intervention would: (1) be perceived as acceptable and useful; and (2) improve diabetes self-care (eg, behaviors and barriers) and self-care related outcomes, including glycemic control (A1C), body mass index (BMI), and psychosocial factors (ie, empowerment and distress) over six months. Methods: The evaluation of the intervention impact used a single-group repeated measures design, including three assessment time points: (1) baseline, (2) 3 month (mid intervention), and (3) 6 month (immediate post intervention). Participants were recruited from a university primary care clinic. A total of 41 participants enrolled in the 6 month intervention study. The intervention components included: (1) a study website for communication, feedback, and tracking; and (2) access to an immersive virtual world (Diabetes Island) through Second Life, where a variety of diabetes self-care education activities and resources were available. Outcome measures included A1C, BMI, self-care behaviors, barriers to adherence, eating habits, empowerment, and distress. In addition, acceptability and usage were examined. A series of mixed-effects analyses, with time as a single repeated measures factor, were performed to examine preliminary outcomes. Results: The intervention study sample (N=41) characteristics were: (1) mean age of 55 years, (2) 71% (29/41) female, (3) 100% (41/41) African American, and (4) 76% (31/41) reported annual incomes below US $20,000. Significant changes over time in the expected direction were observed for BMI (P<.02); diabetes-related distress (P<.02); global (P<.01) and dietary (P<.01) environmental barriers to self-care; one physical activity subscale (P<.04); and one dietary intake (P<.01) subscale. The participant feedback regarding the intervention (eg, ease of use, interest, and perceived impact) was consistently positive. The usage patterns showed that the majority of participants logged in regularly during the first two months, and around half logged in each week on average across the six month period. Conclusions: This study demonstrated promising initial results of an immersive virtual world approach to reaching underserved individuals with diabetes to deliver diabetes self-management education. This intervention model and method show promise and could be tailored for other populations. A large scale controlled trial is needed to further examine efficacy.

  • This is a royalty free image by digidreamgrafix (http://www.freedigitalphotos.net/images/Cars_Buses_and_Truck_g71-Traveling_At_Speed_Of_Light_p154097.html).

    Assessing Video Games to Improve Driving Skills: A Literature Review and Observational Study

    Abstract:

    Background: For individuals, especially older adults, playing video games is a promising tool for improving their driving skills. The ease of use, wide availability, and interactivity of gaming consoles make them an attractive simulation tool. Objective: The objective of this study was to look at the feasibility and effects of installing video game consoles in the homes of individuals looking to improve their driving skills. Methods: A systematic literature review was conducted to assess the effect of playing video games on improving driving skills. An observatory study was performed to evaluate the feasibility of using an Xbox 360 Kinect console for improving driving skills. Results: Twenty–nine articles, which discuss the implementation of video games in improving driving skills were found in literature. On our study, it was found the Xbox 360 with Kinect is capable of improving physical and mental activities. Xbox Video games were introduced to engage players in physical, visual and cognitive activities including endurance, postural sway, reaction time, eyesight, eye movement, attention and concentration, difficulties with orientation, and semantic fluency. However, manual dexterity, visuo-spatial perception and binocular vision could not be addressed by these games. It was observed that Xbox Kinect (by incorporating Kinect sensor facilities) combines physical, visual and cognitive engagement of players. These results were consistent with those from the literature review. Conclusions: From the research that has been carried out, we can conclude that video game consoles are a viable solution for improving user’s physical and mental state. In future we propose to carry a thorough evaluation of the effects of video games on driving skills in elderly people.

  • Screen shot of

    Just a Fad? Gamification in Health and Fitness Apps

    Abstract:

    Background: Gamification has been a predominant focus of the health app industry in recent years. However, to our knowledge, there has yet to be a review of gamification elements in relation to health behavior constructs, or insight into the true proliferation of gamification in health apps. Objective: The objective of this study was to identify the extent to which gamification is used in health apps, and analyze gamification of health and fitness apps as a potential component of influence on a consumer’s health behavior. Methods: An analysis of health and fitness apps related to physical activity and diet was conducted among apps in the Apple App Store in the winter of 2014. This analysis reviewed a sample of 132 apps for the 10 effective game elements, the 6 core components of health gamification, and 13 core health behavior constructs. A regression analysis was conducted in order to measure the correlation between health behavior constructs, gamification components, and effective game elements. Results: This review of the most popular apps showed widespread use of gamification principles, but low adherence to any professional guidelines or industry standard. Regression analysis showed that game elements were associated with gamification (P<.001). Behavioral theory was associated with gamification (P<.05), but not game elements, and upon further analysis gamification was only associated with composite motivational behavior scores (P<.001), and not capacity or opportunity/trigger. Conclusions: This research, to our knowledge, represents the first comprehensive review of gamification use in health and fitness apps, and the potential to impact health behavior. The results show that use of gamification in health and fitness apps has become immensely popular, as evidenced by the number of apps found in the Apple App Store containing at least some components of gamification. This shows a lack of integrating important elements of behavioral theory from the app industry, which can potentially impact the efficacy of gamification apps to change behavior. Apps represent a very promising, burgeoning market and landscape in which to disseminate health behavior change interventions. Initial results show an abundant use of gamification in health and fitness apps, which necessitates the in-depth study and evaluation of the potential of gamification to change health behaviors.

  • Welcome screen for the game The Cure created by Max Nanis.

    The Cure: Design and Evaluation of a Crowdsourcing Game for Gene Selection for Breast Cancer Survival Prediction

    Abstract:

    Background: Molecular signatures for predicting breast cancer prognosis could greatly improve care through personalization of treatment. Computational analyses of genome-wide expression datasets have identified such signatures, but these signatures leave much to be desired in terms of accuracy, reproducibility, and biological interpretability. Methods that take advantage of structured prior knowledge (eg, protein interaction networks) show promise in helping to define better signatures, but most knowledge remains unstructured. Crowdsourcing via scientific discovery games is an emerging methodology that has the potential to tap into human intelligence at scales and in modes unheard of before. Objective: The main objective of this study was to test the hypothesis that knowledge linking expression patterns of specific genes to breast cancer outcomes could be captured from players of an open, Web-based game. We envisioned capturing knowledge both from the player’s prior experience and from their ability to interpret text related to candidate genes presented to them in the context of the game. Methods: We developed and evaluated an online game called The Cure that captured information from players regarding genes for use as predictors of breast cancer survival. Information gathered from game play was aggregated using a voting approach, and used to create rankings of genes. The top genes from these rankings were evaluated using annotation enrichment analysis, comparison to prior predictor gene sets, and by using them to train and test machine learning systems for predicting 10 year survival. Results: Between its launch in September 2012 and September 2013, The Cure attracted more than 1000 registered players, who collectively played nearly 10,000 games. Gene sets assembled through aggregation of the collected data showed significant enrichment for genes known to be related to key concepts such as cancer, disease progression, and recurrence. In terms of the predictive accuracy of models trained using this information, these gene sets provided comparable performance to gene sets generated using other methods, including those used in commercial tests. The Cure is available on the Internet. Conclusions: The principal contribution of this work is to show that crowdsourcing games can be developed as a means to address problems involving domain knowledge. While most prior work on scientific discovery games and crowdsourcing in general takes as a premise that contributors have little or no expertise, here we demonstrated a crowdsourcing system that succeeded in capturing expert knowledge.

  • Public domain. Created by A. Gillum as part of his responsibilities at the USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine. A. Gillum is aware of how this image is being used and has provided permission.

    What Serious Video Games Can Offer Child Obesity Prevention

    Authors List:

    Abstract:

    Childhood obesity is a worldwide issue, and effective methods encouraging children to adopt healthy diet and physical activity behaviors are needed. This viewpoint addresses the promise of serious video games, and why they may offer one method for helping children eat healthier and become more physically active. Lessons learned are provided, as well as examples gleaned from personal experiences.

  • Brain activations for the “phobic>clean” contrast.

    A Functional Magnetic Resonance Imaging Assessment of Small Animals’ Phobia Using Virtual Reality as a Stimulus

    Abstract:

    Background: To date, still images or videos of real animals have been used in functional magnetic resonance imaging protocols to evaluate the brain activations associated with small animals’ phobia. Objective: The objective of our study was to evaluate the brain activations associated with small animals’ phobia through the use of virtual environments. This context will have the added benefit of allowing the subject to move and interact with the environment, giving the subject the illusion of being there. Methods: We have analyzed the brain activation in a group of phobic people while they navigated in a virtual environment that included the small animals that were the object of their phobia. Results: We have found brain activation mainly in the left occipital inferior lobe (P<.05 corrected, cluster size=36), related to the enhanced visual attention to the phobic stimuli; and in the superior frontal gyrus (P<.005 uncorrected, cluster size=13), which is an area that has been previously related to the feeling of self-awareness. Conclusions: In our opinion, these results demonstrate that virtual stimulus can enhance brain activations consistent with previous studies with still images, but in an environment closer to the real situation the subject would face in their daily lives.

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  • Toward effective gamification for elderly people

    Date Submitted: Apr 20, 2015

    Open Peer Review Period: Apr 21, 2015 - Jun 16, 2015

    Rationale The rapidly aging world population increases the burden on healthcare services. By supporting a more healthy lifestyle, elderly can extend their time of autonomy and independence. eHealth i...

    Rationale The rapidly aging world population increases the burden on healthcare services. By supporting a more healthy lifestyle, elderly can extend their time of autonomy and independence. eHealth is therefore hypothesised to help to alleviate the increasing demand for elderly care. However, adherence to the technology presented to the end-user is low and decreases over time. Thus, there is a need for methods to increase adherence of the elderly user (age 65 and up). One way to achieve this might be through offering long-term motivating content that is tailored to the demands of the user. A strategy that has recently emerged is gamification: applying game elements to non-game fields, to motivate and increase user activity and retention. Although gamification is a much used concept to engage people of younger generations, there is little knowledge on the effect of game-based motivation strategies on the older adult. This research aims to develop a view on the conceptualisation of gamification and in specific on the opportunities for applying gamification to increase long-term motivation for elderly, which may be achieved by tailoring game content to the user. Methods Literature was researched to create a state of the art on three aspects relevant for our aim: 1) how gamification is currently being conceptualised, 2) experiences with and knowledge of gamification to engage older adults and 3) methods to tailor content to the user. Results The result of this study showed that there is no consensus about definitions of gamification and that there is a variety in approaches towards the realisation of the concept gamification. Results also show that there is only a very small amount of information regarding the application of gamification to engage elderly. While this information does indicate the potential of gamification for this purpose and target group, there is a significant gap in knowledge on its real effectiveness. Lastly, results show that within existing user classifications there is one theory that appears suitable for use in this context, which is based on the hypothesised existence of a relation between preference for game content and personality. However, further research on that particular theory is needed since methods to map elderly onto this classification are absent, and the effectiveness of the use of this classification for tailoring content is not known. Conclusion Gamification shows promising aspects towards the engagement of elderly in eHealth applications. There is however a gap in knowledge on the use and effectiveness of gamification in this context.