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JMIR Serious Games

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


Journal Description

JMIR Serious Games (JSG, ISSN 2291-9279) is a sister journal of the Journal of Medical Internet Research (JMIR), one of the most cited journals in health informatics (Impact Factor 2016: 5.175). JSG has a projected impact factor (2016) of 3.32. JSG is a multidisciplinary journal devoted to computer/web/mobile 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.

JMIR Serious Games is indexed in Pubmed, PubMed Central, and also in Thomson Reuters new Emerging Sources Citation Index (ESCI).


Recent Articles:

  • Source: Pixabay; Copyright: Sasint; URL:; License: Public Domain (CC0).

    The Role of Transfer in Designing Games and Simulations for Health: Systematic Review


    Background: The usefulness and importance of serious games and simulations in learning and behavior change for health and health-related issues are widely recognized. Studies have addressed games and simulations as interventions, mostly in comparison with their analog counterparts. Numerous complex design choices have to be made with serious games and simulations for health, including choices that directly contribute to the effects of the intervention. One of these decisions is the way an intervention is expected to lead to desirable transfer effects. Most designs adopt a first-class transfer rationale, whereas the second class of transfer types seems a rarity in serious games and simulations for health. Objective: This study sought to review the literature specifically on the second class of transfer types in the design of serious games and simulations. Focusing on game-like interventions for health and health care, this study aimed to (1) determine whether the second class of transfer is recognized as a road for transfer in game-like interventions, (2) review the application of the second class of transfer type in designing game-like interventions, and (3) assess studies that include second-class transfer types reporting transfer outcomes. Methods: A total of 6 Web-based databases were systematically searched by titles, abstracts, and keywords using the search strategy (video games OR game OR games OR gaming OR computer simulation*) AND (software design OR design) AND (fidelity OR fidelities OR transfer* OR behaviour OR behavior). The databases searched were identified as relevant to health, education, and social science. Results: A total of 15 relevant studies were included, covering a range of game-like interventions, all more or less mentioning design parameters aimed at transfer. We found 9 studies where first-class transfer was part of the design of the intervention. In total, 8 studies dealt with transfer concepts and fidelity types in game-like intervention design in general; 3 studies dealt with the concept of second-class transfer types and reported effects, and 2 of those recognized transfer as a design parameter. Conclusions: In studies on game-like interventions for health and health care, transfer is regarded as a desirable effect but not as a basic principle for design. None of the studies determined the second class of transfer or instances thereof, although in 3 cases a nonliteral transfer type was present. We also found that studies on game-like interventions for health do not elucidate design choices made and rarely provide design principles for future work. Games and simulations for health abundantly build upon the principles of first-class transfer, but the adoption of second-class transfer types proves scarce. It is likely to be worthwhile to explore the possibilities of second-class transfer types, as they may considerably influence educational objectives in terms of future serious game design for health.

  • Source: The Authors /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    Breaking Health Insurance Knowledge Barriers Through Games: Pilot Test of Health Care America


    Background: Having health insurance is associated with a number of beneficial health outcomes. However, previous research suggests that patients tend to avoid health insurance information and often misunderstand or lack knowledge about many health insurance terms. Health insurance knowledge is particularly low among young adults. Objective: The purpose of this study was to design and test an interactive newsgame (newsgames are games that apply journalistic principles in their creation, for example, gathering stories to immerse the player in narratives) about health insurance. This game included entry-level information through scenarios and was designed through the collation of national news stories, local personal accounts, and health insurance company information. Methods: A total of 72 (N=72) participants completed in-person, individual gaming sessions. Participants completed a survey before and after game play. Results: Participants indicated a greater self-reported understanding of how to use health insurance from pre- (mean=3.38, SD=0.98) to postgame play (mean=3.76, SD=0.76); t71=−3.56, P=.001. For all health insurance terms, participants self-reported a greater understanding following game play. Finally, participants provided a greater number of correct definitions for terms after playing the game, (mean=3.91, SD=2.15) than they did before game play (mean=2.59, SD=1.68); t31=−3.61, P=.001. Significant differences from pre- to postgame play differed by health insurance term. Conclusions: A game is a practical solution to a difficult health issue—the game can be played anywhere, including on a mobile device, is interactive and will thus engage an apathetic audience, and is cost-efficient in its execution.

  • A group of students and Pokémon GO players at the project explanation in one of the university recreation fields. Source: Image created by the Authors; Copyright: The Authors; License: Creative Commons Attribution (CC-BY).

    Examining Motivations to Play Pokémon GO and Their Influence on Perceived Outcomes and Physical Activity


    Background: Pokémon GO is the most played augmented reality game in history. With more than 44 million players at the peak of its popularity, the game has sparked interest on its effects on the young population’s health. Objective: This pilot study examined motivations to start playing Pokémon GO among a sample of US college students, and how motivations were associated with perceived outcomes of the playing experience and physical activity derived while playing. Methods: In November 2016, we asked a sample of 47 US college students (all Pokémon GO players) to complete online surveys and install an ecological momentary assessment (EMA) tool and step counter on their smartphones. The EMA tool prompted a set of questions on playing behavior and physical activity, 3 times per day (12:00 PM, 7:00 PM, and 10:00 PM), for 7 days. We used a factorial analysis to identify 3 distinctive groups of players based on their motivations to start playing Pokémon GO. We tested differences across motivation groups related to 5 unique outcomes using 1-way analysis of variance. Results: We extracted 3 interpretable factors from the clustering of motivations to start playing Pokémon GO: Pokémon and video game fans (n=26, 55% of the sample), physical activity seekers (n=8, 17%), and curious & social (n=13, 28%). The clusters differed significantly on the enjoyment of different aspects of the game, particularly battling, discovering new places, and meeting new people, as well as differences in agreement that playing improved mood and made them more social. Days when playing Pokémon GO were associated with higher number of steps reported at the end of the day, especially among physical activity seekers, but also for Pokémon and video game fans. All groups perceived traffic as a major threat to playing. Conclusions: Days during which Pokémon GO was played were positively associated with a set of beneficial health behaviors, including higher physical activity levels, more socialization, and better mood. Results, however, depended on personal motivations and expectations when joining the game. These results highlight the importance of taking motivation into account when attempting to extract conclusions from the Pokémon GO phenomenon to enhance future exergames’ designs or health interventions.

  • Recipe box. Source: Figure 2 from; Copyright: the authors; License: Creative Commons Attribution (CC-BY).

    Mommio’s Recipe Box: Assessment of the Cooking Habits of Mothers of Preschoolers and Their Perceptions of Recipes for a Video Game


    Background: Vegetables are an important part of a healthy diet because they help prevent several chronic diseases. Mothers of preschoolers reported difficulty getting their young children to eat vegetables, and many did not know how to cook child-pleasing recipes. Objective: The cooking habits of mothers of preschoolers, their perceptions of recipes designed for their children, and the involvement of their children in food preparation were assessed to inform a food parenting video game called Mommio. Methods: A cross-sectional survey design was used. Eligibility criteria included mothers of 3- to 5-year-old children who reported difficulty getting their children to eat vegetables. Participants completed a demographic questionnaire with questions about their food preparation practices. They were asked to select up to 4 of the 10 provided recipes they wanted to try and to prepare and report back on their experiences. Results: Most (46) of the 50 recipes included in Mommio’s in-game recipe box were evaluated at least once and some up to 5 times with a total of 85 evaluations. This well-educated, mostly employed, sample of 27 mothers of preschoolers preferred simple, quick recipes. They ate primarily at home, made dinners from scratch, and indicated that the 46 recipes were generally simple, quick, and easy to prepare. Involvement in preparation enhanced their child’s acceptance of the food. Prior food and preparation preferences influenced the children’s acceptance of the dish at the ensuing meal. Conclusions: The high rate of home recipe preparation indicated that including a recipe selection and preparation component in a food parenting video game could be attractive and may enhance effectiveness. Mothers reported that the recipes provided were generally easy to prepare, tasted good, and the instructions were easy to understand, suggesting they could be helpful to the mothers when playing a vegetable parenting game. Some mothers reported that involving their children in recipe preparation influenced their children’s willingness to eat the vegetables. The highest rated recipes are being included in the game, and mothers will be encouraged to involve their children in recipe preparation.

  • The cycling game. Source: The Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Usability Test of Exercise Games Designed for Rehabilitation of Elderly Patients After Hip Replacement Surgery: Pilot Study


    Background: Patients who receive rehabilitation after hip replacement surgery are shown to have increased muscle strength and better functional performance. However, traditional physiotherapy is often tedious and leads to poor adherence. Exercise games, provide ways for increasing the engagement of elderly patients and increase the uptake of rehabilitation exercises. Objective: The objective of this study was to evaluate Fietsgame (Dutch for cycling game), which translates existing rehabilitation exercises into fun exercise games. The system connects exercise games with a patient’s personal record and a therapist interface by an Internet of Things server. Thus, both the patient and physiotherapist can monitor the patient’s medical status. Methods: This paper describes a pilot study that evaluates the usability of the Fietsgame. The study was conducted in a rehabilitation center with 9 participants, including 2 physiotherapists and 7 patients. The patients were asked to play 6 exercise games, each lasting about 5 min, under the guidance of a physiotherapist. The mean age of the patients was 74.57 years (standard deviation [SD] 8.28); all the patients were in the recovery process after hip surgery. Surveys were developed to quantitatively measure the usability factors, including presence, enjoyment, pain, exertion, and technology acceptance. Comments on advantages and suggested improvements of our game system provided by the physiotherapists and patients were summarized and their implications were discussed. Results: The results showed that after successfully playing the games, 75% to 100% of the patients experienced high levels of enjoyment in all the games except the squats game. Patients reported the highest level of exertion in squats when compared with other exercise games. Lunges resulted in the highest dropout rate (43%) due to interference with the Kinect v2 from support chairs. All the patients (100%) found the game system useful and easy to use, felt that it would be a useful tool in their further rehabilitation, and expressed that they would like to use the game in the future. The therapists indicated that the exercise games highly meet the criteria of motor rehabilitation, and they intend to continue using the game as part of their rehabilitation treatment of patients. Comments from the patients and physiotherapists suggest that real-time corrective feedback when patients perform the exercises wrongly and a more personalized user interface with options for increasing or decreasing cognitive load are needed. Conclusions: The results suggest that Fietsgame can be used as an alternative tool to traditional motor rehabilitation for patients with hip surgery. Lunges and squats are found to be more beneficial for patients who have relatively better balance skills. A follow-up randomized controlled study will be conducted to test the effectiveness of the Fietsgame to investigate how motivating it is over a longer period of time.

  • REWIRE neglect exergame Gathering Apples. Source: Image created by the authors; Copyright: The authors; URL:; License: Creative Commons Attribution (CC-BY).

    User Perspectives on Exergames Designed to Explore the Hemineglected Space for Stroke Patients With Visuospatial Neglect: Usability Study


    Background: Visuospatial neglect due to stroke is characterized by the inability to perceive stimuli emerging in the area opposite to the side of brain damage. Besides adopting conventional rehabilitation methods to treat neglect symptoms, the use of virtual reality (VR) is becoming increasingly popular. We designed a series of 9 exergames aimed to improve exploration of the neglected side of space. When new VR interventions are designed, it is important to assess the usability aspects of such management strategies within the target population. To date, most studies used questionnaires to assess user satisfaction with the intervention or product being tested. However, only a combination of both quantitative and qualitative data allows a full picture of user perspective. Objective: The purpose of this study was to quantitatively and qualitatively assess patient and therapist perspectives of a VR intervention based on the series of 9 exergames designed to explore hemineglected space. Specifically, we wanted to evaluate (1) perceived-user friendliness of the exergames, (2) attitude towards using the exergames, and (3) intention to use the exergames in the future. Methods: A total of 19 participants (7 patients, 12 therapists) evaluated the exergames they had used 5 times a week during 3 weeks. The Technology Acceptance Model (TAM) questionnaire was filled out after the intervention. Based on those responses, we conducted focus group interviews (with therapists) and individual interviews (with patients). To analyze the TAM questionnaires, we used descriptive statistics. We adopted content and comparative analysis to analyze the interviews and drew illustration maps to analyze the focus group interviews. Results: The therapists took a more critical stance with a mean TAM questionnaire total score of 48.6 (SD 4.5) compared to the patients who had a mean total score of 56.1 (SD 12.3). The perceived user-friendliness score was 5.6 (SD 1.4) for patients and 4.9 (SD 1.4) for therapists. The attitude towards using the exergames was rated 4.8 (SD 1.9) by patients and 3.6 (SD 1.4) by therapists, respectively. The intention to use the exergames in the future was rated 3.9 (SD 2.1) by patients and 3.7 (SD 1.8) by therapists. We gained information on how to improve the exergames in the interviews. Conclusions: Patients and therapists perceived the exergames as user-friendly; however, using the games further with the actual test version was not perceived as conceivable. The therapists were generally more critical towards future use than the patients. Therefore, involving both users to achieve acceptable and user-friendly versions of game-based rehabilitation for the future is deemed crucial and warranted. Trial Registration: NCT02353962; (Archived by WebCite at

  • REWIRE neglect exergames training station (game: Sequence Builder). Source: Image created by the authors; Copyright: Bernadette Tobler-Ammann; URL:; License: Creative Commons Attribution (CC-BY).

    Exergames Encouraging Exploration of Hemineglected Space in Stroke Patients With Visuospatial Neglect: A Feasibility Study


    Background: Use of exergames can complement conventional therapy and increase the amount and intensity of visuospatial neglect (VSN) training. A series of 9 exergames—games based on therapeutic principles—aimed at improving exploration of the neglected space for patients with VSN symptoms poststroke was developed and tested for its feasibility. Objectives: The goal was to determine the feasibility of the exergames with minimal supervision in terms of (1) implementation of the intervention, including adherence, attrition and safety, and (2) limited efficacy testing, aiming to document possible effects on VSN symptoms in a case series of patients early poststroke. Methods: A total of 7 patients attended the 3-week exergames training program on a daily basis. Adherence of the patients was documented in a training diary. For attrition, the number of participants lost during the intervention was registered. Any adverse events related to the exergames intervention were noted to document safety. Changes in cognitive and spatial exploration skills were measured with the Zürich Maxi Mental Status Inventory and the Neglect Test. Additionally, we developed an Eye Tracker Neglect Test (ETNT) using an infrared camera to detect and measure neglect symptoms pre- and postintervention. Results: The median was 14 out of 15 (93%) attended sessions, indicating that the adherence to the exergames training sessions was high. There were no adverse events and no drop-outs during the exergame intervention. The individual cognitive and spatial exploration skills slightly improved postintervention (P=.06 to P=.98) and continued improving at follow-up (P=.04 to P=.92) in 5 out of 7 (71%) patients. Calibration of the ETNT was rather error prone. The ETNT showed a trend for a slight median group improvement from 15 to 16 total located targets (+6%). Conclusions: The high adherence rate and absence of adverse events showed that these exergames were feasible and safe for the participants. The results of the amount of exergames use is promising for future applications and warrants further investigations—for example, in the home setting of patients to augment training frequency and intensity. The preliminary results indicate the potential of these exergames to cause improvements in cognitive and spatial exploration skills over the course of training for stroke patients with VSN symptoms. Thus, these exergames are proposed as a motivating training tool to complement usual care. The ETNT showed to be a promising assessment for quantifying spatial exploration skills. However, further adaptations are needed, especially regarding calibration issues, before its use can be justified in a larger study sample.

  • Rehabilitation Gaming System used at Home. Source: Image created by the authors; Copyright: SPECS; URL:; License: Creative Commons Attribution (CC-BY).

    Domiciliary VR-Based Therapy for Functional Recovery and Cortical Reorganization: Randomized Controlled Trial in Participants at the Chronic Stage Post Stroke


    Background: Most stroke survivors continue to experience motor impairments even after hospital discharge. Virtual reality-based techniques have shown potential for rehabilitative training of these motor impairments. Here we assess the impact of at-home VR-based motor training on functional motor recovery, corticospinal excitability and cortical reorganization. Objective: The aim of this study was to identify the effects of home-based VR-based motor rehabilitation on (1) cortical reorganization, (2) corticospinal tract, and (3) functional recovery after stroke in comparison to home-based occupational therapy. Methods: We conducted a parallel-group, controlled trial to compare the effectiveness of domiciliary VR-based therapy with occupational therapy in inducing motor recovery of the upper extremities. A total of 35 participants with chronic stroke underwent 3 weeks of home-based treatment. A group of subjects was trained using a VR-based system for motor rehabilitation, while the control group followed a conventional therapy. Motor function was evaluated at baseline, after the intervention, and at 12-weeks follow-up. In a subgroup of subjects, we used Navigated Brain Stimulation (NBS) procedures to measure the effect of the interventions on corticospinal excitability and cortical reorganization. Results: Results from the system’s recordings and clinical evaluation showed significantly greater functional recovery for the experimental group when compared with the control group (1.53, SD 2.4 in Chedoke Arm and Hand Activity Inventory). However, functional improvements did not reach clinical significance. After the therapy, physiological measures obtained from a subgroup of subjects revealed an increased corticospinal excitability for distal muscles driven by the pathological hemisphere, that is, abductor pollicis brevis. We also observed a displacement of the centroid of the cortical map for each tested muscle in the damaged hemisphere, which strongly correlated with improvements in clinical scales. Conclusions: These findings suggest that, in chronic stages, remote delivery of customized VR-based motor training promotes functional gains that are accompanied by neuroplastic changes. Trial Registration: International Standard Randomized Controlled Trial Number NCT02699398 (Archived by at

  • Older adult using a serious game on a tablet. Source: The Authors; Copyright: Rakel Berenbaum; URL:; License: Creative Commons Attribution (CC-BY).

    Designing Serious Computer Games for People With Moderate and Advanced Dementia: Interdisciplinary Theory-Driven Pilot Study


    Background: The field of serious games for people with dementia (PwD) is mostly driven by game-design principals typically applied to games created by and for younger individuals. Little has been done developing serious games to help PwD maintain cognition and to support functionality. Objectives: We aimed to create a theory-based serious game for PwD, with input from a multi-disciplinary team familiar with aging, dementia, and gaming theory, as well as direct input from end users (the iterative process). Targeting enhanced self-efficacy in daily activities, the goal was to generate a game that is acceptable, accessible and engaging for PwD. Methods: The theory-driven game development was based on the following learning theories: learning in context, errorless learning, building on capacities, and acknowledging biological changes—all with the aim to boost self-efficacy. The iterative participatory process was used for game screen development with input of 34 PwD and 14 healthy community dwelling older adults, aged over 65 years. Development of game screens was informed by the bio-psychological aging related disabilities (ie, motor, visual, and perception) as well as remaining neuropsychological capacities (ie, implicit memory) of PwD. At the conclusion of the iterative development process, a prototype game with 39 screens was used for a pilot study with 24 PwD and 14 healthy community dwelling older adults. The game was played twice weekly for 10 weeks. Results: Quantitative analysis showed that the average speed of successful screen completion was significantly longer for PwD compared with healthy older adults. Both PwD and controls showed an equivalent linear increase in the speed for task completion with practice by the third session (P<.02). Most important, the rate of improved processing speed with practice was not statistically different between PwD and controls. This may imply that some form of learning occurred for PwD at a nonsignificantly different rate than for controls. Qualitative results indicate that PwD found the game engaging and fun. Healthy older adults found the game too easy. Increase in self-reported self-efficacy was documented with PwD only. Conclusions: Our study demonstrated that PwD’s speed improved with practice at the same rate as healthy older adults. This implies that when tasks are designed to match PwD’s abilities, learning ensues. In addition, this pilot study of a serious game, designed for PwD, was accessible, acceptable, and enjoyable for end users. Games designed based on learning theories and input of end users and a multi-disciplinary team familiar with dementia and aging may have the potential of maintaining capacity and improving functionality of PwD. A larger longer study is needed to confirm our findings and evaluate the use of these games in assessing cognitive status and functionality.

  • Source: Image created by the authors; Copyright: The authors; URL:; License: Creative Commons Attribution (CC-BY).

    Rehabilitation-Oriented Serious Game Development and Evaluation Guidelines for Musculoskeletal Disorders


    Background: The progress in information and communication technology (ICT) led to the development of a new rehabilitation technique called “serious game for functional rehabilitation.” Previous works have shown that serious games can be used for general health and specific disease management. However, there is still lack of consensus on development and evaluation guidelines. It is important to note that the game performance depends on the designed scenario. Objective: The objective of this work was to develop specific game scenarios and evaluate them with a panel of musculoskeletal patients to propose game development and evaluation guidelines. Methods: A two-stage workflow was proposed using determinant framework. The development guideline includes the selection of three-dimensional (3D) computer graphics technologies and tools, the modeling of physical aspects, the design of rehabilitation scenarios, and the implementation of the proposed scenarios. The evaluation guideline consists of the definition of evaluation metrics, the execution of the evaluation campaign, the analysis of user results and feedbacks, and the improvement of the designed game. Results: The case study for musculoskeletal disorders on the healthy control and patient groups showed the usefulness of these guidelines and associated games. All participants enjoyed the 2 developed games (football and object manipulation), and found them challenging and amusing. In particular, some healthy subjects increased their score when enhancing the level of difficulty. Furthermore, there were no risks and accidents associated with the execution of these games. Conclusions: It is expected that with the proven effectiveness of the proposed guidelines and associated games, this new rehabilitation game may be translated into clinical routine practice for the benefit of patients with musculoskeletal disorders.

  • Source: Image created by the authors; Copyright: The authors; URL:; License: Creative Commons Attribution (CC-BY).

    Gamification in Stress Management Apps: A Critical App Review


    Background: In today’s society, stress is more and more often a cause of disease. This makes stress management an important target of behavior change programs. Gamification has been suggested as one way to support health behavior change. However, it remains unclear to which extend available gamification techniques are integrated in stress management apps, and if their occurrence is linked to the use of elements from behavior change theory. Objective: The aim of this study was to investigate the use of gamification techniques in stress management apps and the cooccurrence of these techniques with evidence-based stress management methods and behavior change techniques. Methods: A total of 62 stress management apps from the Google Play Store were reviewed on their inclusion of 17 gamification techniques, 15 stress management methods, and 26 behavior change techniques. For this purpose, an extended taxonomy of gamification techniques was constructed and applied by 2 trained, independent raters. Results: Interrater-reliability was high, with agreement coefficient (AC)=.97. Results show an average of 0.5 gamification techniques for the tested apps and reveal no correlations between the use of gamification techniques and behavior change techniques (r=.17, P=.20), or stress management methods (r=.14, P=.26). Conclusions: This leads to the conclusion that designers of stress management apps do not use gamification techniques to influence the user’s behaviors and reactions. Moreover, app designers do not exploit the potential of combining gamification techniques with behavior change theory.

  • Serious game evaluation test. Source: The authors; Copyright: The authors; URL:; License: Creative Commons Attribution (CC-BY).

    Medical Student Evaluation With a Serious Game Compared to Multiple Choice Questions Assessment


    Background: The gold standard for evaluating medical students’ knowledge is by multiple choice question (MCQs) tests: an objective and effective means of restituting book-based knowledge. However, concerns have been raised regarding their effectiveness to evaluate global medical skills. Furthermore, MCQs of unequal difficulty can generate frustration and may also lead to a sizable proportion of close results with low score variability. Serious games (SG) have recently been introduced to better evaluate students’ medical skills. Objectives: The study aimed to compare MCQs with SG for medical student evaluation. Methods: We designed a cross-over randomized study including volunteer medical students from two medical schools in Paris (France) from January to September 2016. The students were randomized into two groups and evaluated either by the SG first and then the MCQs, or vice-versa, for a cardiology clinical case. The primary endpoint was score variability evaluated by variance comparison. Secondary endpoints were differences in and correlation between the MCQ and SG results, and student satisfaction. Results: A total of 68 medical students were included. The score variability was significantly higher in the SG group (σ2 =265.4) than the MCQs group (σ2=140.2; P=.009). The mean score was significantly lower for the SG than the MCQs at 66.1 (SD 16.3) and 75.7 (SD 11.8) points out of 100, respectively (P<.001). No correlation was found between the two test results (R2=0.04, P=.58). The self-reported satisfaction was significantly higher for SG (P<.001). Conclusions: Our study suggests that SGs are more effective in terms of score variability than MCQs. In addition, they are associated with a higher student satisfaction rate. SGs could represent a new evaluation modality for medical students.

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    Date Submitted: Dec 8, 2017

    Open Peer Review Period: Dec 9, 2017 - Feb 3, 2018

    Background: Prenatal counseling at the limits of viability involves sensitive interactions between neonatal providers and families. Empathetic discussions are currently learned through practice in tim...

    Background: Prenatal counseling at the limits of viability involves sensitive interactions between neonatal providers and families. Empathetic discussions are currently learned through practice in times of high stress. Decision aids may help improve provider communication but have not been universally adopted. Virtual standardized patients are increasingly recognized as a modality for education, but prenatal counseling simulations have not been described. To be valuable as a tool, a virtual patient would need to accurately portray emotions and elicit a realistic response from the provider. Objective: To determine if neonatal providers can accurately identify a standardized virtual prenatal patient’s emotional states, and examine the frequency of empathic responses to statements made by the patient. Methods: A panel of Neonatologists, Simulation specialists, and Ethicists developed a dialogue and identified empathic responses. VANESSA, a screen-based simulation of a woman at 23 weeks gestation, was capable of displaying anger, fear, sadness, and happiness through animations. 24 neonatal providers, including a subgroup with an ethics-interest, were asked to identify VANESSA’s emotions 28 times, respond to statements, and answer open ended questions. The emotions were displayed: without dialogue, with text dialogue, and with audio dialogue. Participants completed a post-encounter survey describing demographics and experience. Data was reported using descriptive statistics. Qualitative data from open ended questions e.g. “What would you do?” was examined using thematic analysis. Results: Half of our participants had over 10 years of clinical experience (Table 1). Most participants reported using medical research (n=18, 78.3%) and mortality calculators (n=17, 73.9%). Only the ethics interested subgroup (n=10, 41.6%), listed counseling literature (n=7, 70.0%). Of 672 attempts, participants accurately identified VANESSA’s emotions (n=523, 77.8%) of the time, and most (n=14, 61.11%) reported that they were confident in identifying these emotions (Fig 1). The ethics interest group were more likely to choose empathic responses (p= 0.002) (Fig 2). Participants rated VANESSA as easy to use (n=22, 91.20%), and reported that she had realistic dialogue (n=15, 65.22%). Conclusions: This pilot study shows that a prenatal counseling simulation is feasible and can yield useful data on prenatal counseling communication. Our participants showed a high rate of emotion recognition and empathy in their responses.

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    Date Submitted: Dec 7, 2017

    Open Peer Review Period: Dec 8, 2017 - Feb 2, 2018

    Background: Cigarette smoking is the leading preventable cause of death in the United States, causing an estimated 438,000 deaths each year. Researchers have developed many efficacious smoking-cessati...

    Background: Cigarette smoking is the leading preventable cause of death in the United States, causing an estimated 438,000 deaths each year. Researchers have developed many efficacious smoking-cessation interventions, yet ample room remains for improvement upon not only their efficacy, but also their effectiveness. One of the most effective smoking cessation interventions is contingency management (CM). Objective: There are two barriers to CM, which involves delivering monetary incentives for objective evidence of health behavior, including the cost of incentives and sustainability of treatment outcomes. The goal of the present study was to evaluate the feasibility of a videogame-based smartphone application, BreathFree, to replace monetary incentives used in CM with videogame-based incentives. Methods: Twenty-one smokers participated in this study. Participants were given an overview of the goals of the BreathFree game and were trained to submit a carbon monoxide (CO) sample via an Android tablet. After playing several levels of the game participants were told that they could continue and play one extra level, or they could stop and complete an outcome survey, receive payment, and be dismissed. Results: When asked with a multiple choice question whether the game was fun, 52% said "Yes," 29%" said "Maybe, it has the potential to be fun," and 19% said "No." Fifty-eight percent of participants, given the option to play an extra level of the game, chose to do so, and 86% signed up to be notified when the full version of the game was released. Conclusions: This was the first study to evaluate a smartphone-delivered, videogame-based CM application for smoking cessation. The prototype of BreathFree was highly endorsed on multiple dimensions from a group of treatment-seeking smokers. More than half of participants decided to play the extra level, which meant they delayed smoking their next cigarette, as well as getting paid, by at least a few minutes. These results are promising and we are now fully developing the game to test in the context of a clinical trial. Clinical Trial: Not Applicable

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    Date Submitted: Dec 4, 2017

    Open Peer Review Period: Dec 4, 2017 - Jan 29, 2018

    Background: Video and hobby gaming are immensely popular among adults, but associations between gaming and health have primarily been studied in children and adolescents. Furthermore, most research fo...

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    Date Submitted: Nov 29, 2017

    Open Peer Review Period: Nov 30, 2017 - Jan 25, 2018

    Background: Extant evidence suggests that the proportion of adolescents suffering from anxiety disorders (AD) has increased by up to 70% since the mid-1980s, with experience of anxiety at this stage a...

    Background: Extant evidence suggests that the proportion of adolescents suffering from anxiety disorders (AD) has increased by up to 70% since the mid-1980s, with experience of anxiety at this stage associated with significant negative short- and long-term life outcomes. Existing therapeutic interventions (e.g.: CBT, ABM) have proven to have clinically measurable benefits in reducing anxiety, but their efficacy is often compromised by social and practical barriers. The growing discrepancy between demand for, and access to, clinical interventions for anxiety has led to the development of a range of electronic and mobile health interventions. One such protocol is therapeutic games, which aim to provide clinical frameworks in dynamic, adaptable and personalisable virtual environments. While some evidence exists to suggest therapeutic games are associated with reductions in subjective anxiety and observed stress reactivity, there is currently, to our knowledge, no systematic review of the adherence to, and effectiveness of, therapeutic games for adolescent anxiety. Objective: The aim of this review was to establish the effectiveness of therapeutic games in making clinically measurable reductions in AD symptoms in adolescent samples. Methods: A systematic search of existing academic literature published between 1990 and July 2017 was conducted using the databases JMIR, JSTOR, PsycARTICLES, PsycINFO, ScienceDIRECT and Scopus. Records linked to empirical papers on therapeutic games for anxiety using adolescent samples were evaluated. Results: A total of 5 studies (total number of participants N=410) met the inclusion criteria and 3 gamified anxiety interventions for adolescents were identified. Papers included a mixture of randomised-controlled trials, quasi-experimental studies and usability studies comprising of quantitative and qualitative measures, with varying degrees of mixed-methods. Extant evidence shows potential for therapeutic games to create clinically measurable reductions in symptoms of anxiety in adolescent samples, though findings are complicated in some cases by low sample size, and in other cases by research design and methodological complications, including anxiety reductions in control groups caused by control-game selection. Conclusions: While research into this field appears to be extremely limited, as demonstrated by the small number of articles meeting the inclusion criteria for this review, early findings suggest that therapeutic games have potential in helping to engage adolescents with anxiety and lead to clinically measurable reductions in symptoms. Considerations for future research are discussed. Clinical Trial: N/A

  • Serious Games to Assess Mild Cognitive Impairment: ‘The game is the assessment’

    Date Submitted: Nov 9, 2017

    Open Peer Review Period: Nov 11, 2017 - Jan 6, 2018

    Background: Background: Early recognition of mild cognitive impairment (MCI) and subtle changes to cognitive abilities that precede an MCI diagnosis has the potential to improve the efficacy of thera...

    Background: Background: Early recognition of mild cognitive impairment (MCI) and subtle changes to cognitive abilities that precede an MCI diagnosis has the potential to improve the efficacy of therapeutic treatment programs. Objective: Objective: The work addresses mobile games’ potential as empirical assessment tools for cognitive processes within the domains of attention, recognition, recall, and memory applied to game strategy. Methods: Methods: Two games have been developed with this objective. WarCAT is based on a familiar card game, War, and “Lock Picking” is a search for an optimal score, akin to finding the combination that opens a lock. Results: Both games provide players with immediate feedback but engage different algorithms and heuristics to solve the respective problems at hand. Conclusions: Conclusions: By collecting player data on large scales to allow for baseline establishment of cognitive abilities across demographic (age) profiles, longitudinal performance of individuals and of groups can be established, and from there, the potential exists to employ machine learning methods to detect subtle changes in an individual’s cognitive processes over time. Clinical Trial: n/a

  • Serious games in the context of people with cognitive disabilities: a case study

    Date Submitted: Oct 27, 2017

    Open Peer Review Period: Oct 28, 2017 - Dec 23, 2017

    Background: While traditional video games provide amusement, with the advent of serious games (SG), it has raised the potential and the results that can be achieved from the games, these artifacts, wh...

    Background: While traditional video games provide amusement, with the advent of serious games (SG), it has raised the potential and the results that can be achieved from the games, these artifacts, whose main differentials are the fact that they are naturally playful and motivators. While in the 1990s, the games aimed only at entertainment, nowadays teaching and learning combine with entertainment and become the main goals to be achieved through the SG. A strong example of SG application is for motivation and help in the formal or special teaching-learning process acting as a pedagogical tool. In this sense, the following question arises: What are the characteristics and interface resources considered adequate to compose the interface of a serious game that have educational objectives directed to people with Williams-Beuren Syndrome? Here's the motivation guide for this article. Objective: Elementary mathematics education for people with Williams Syndrome Methods: An exploratory and descriptive study,using qualitative and quantitative approaches. Results: The results portfolio obtained from the WBS user experience assessment presents the confidence rectangle within the "desirable" quadrant. This is what a project program is, since scientifically this is one of the biggest difficulties reported by unlock authors, it is not possible to teach content and maintain playfulness. Conclusions: The prototype of the game here called SoundMath, was intended to meet a demand for learning elementary arithmetic for people with WBS, from a playful and immersive process. Through the results of the evaluations carried out, this work provides relevant information that can encourage the development of this game, as well as help companies in the educational segment, and contribute to the improvement of the quality of the applications targeted to this type of public. Other important point to be highlighted from this work is with regard to the social aspect that this work encompasses, because it is the development of a solution applied to a daily problem of this public. But we did not just develop; we decided to go beyond and document the entire process of engineering and gamification, based on data obtained throughout this study of design and design of a serious educational game prototype that contained in its layout the ideal characteristics to mediate a teaching-learning process from its use, as well as document and outline a methodological process that may serve as the basis for further studies. Thus, we believe that the results and reflections raised from this study may, in the future, broaden the knowledge about the design of serious games for people with cognitive disabilities. The prototype of the game here called SoundMath, was intended to meet a demand for learning elementary arithmetic for people with WBS, from a playful and immersive process. Through the results of the evaluations carried out, this work provides relevant information that can encourage the development of this game, as well as help companies in the educational segment, and contribute to the improvement of the quality of the applications targeted to this type of public. Other important point to be highlighted from this work is with regard to the social aspect that this work encompasses, because it is the development of a solution applied to a daily problem of this public.