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  Serious Games for Health and Medicine

  Oct 15, 2019

  A Game to Deal With Alcohol Abuse (Jib): Development and Game Experience Evaluation

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  • Darlinton Barbosa Feres Carvalho  
  • Daniel Bueno Domingueti  
  • Sandro Martins De Almeida Santos  
  • Diego Roberto Colombo Dias  

  Abstract:

  Background: Alcohol abuse is the primary cause of (public) health problems in most parts of the world. However, it is undeniable that alcohol consumption is a practice that is widely accepted socially in many places, even being protected by law as a cultural and historical heritage. The issue of alcohol abuse is complex and urgent, and consequently, it is necessary to create innovative approaches such as the proposal explored in this study. Objective: This study aimed to explore the development and evaluation of a serious game for smartphones to present a novel approach to address the issue of alcohol abuse. Methods: A serious game was developed to instill the consequences of alcohol abuse into the player through experimentation in the game. In the game, the consequences of alcohol use are demonstrated by increasing the game speed that gives an illusion of fun but also leads to a premature death. The evaluation employed an assessment based on the Alcohol Use Disorders Identification Test (AUDIT) and the Game Experience Questionnaire (GEQ). The participants belonged to the university student’s house. Results: The game development process has been presented, including its mechanics and gameplay. The game has the style of action and adventure games in which the player controls an indigenous avatar that can deflect or attack opponents coming his or her way. The game evaluation comprised an assessment based on 23 participants, aged 20 to 29 years. According to the AUDIT assessment, 18 participants reported having a low or nonexistent degree of alcohol dependence and 5 declared average dependence. Regarding their habit of playing games on smartphones, 9 participants declared they have this habit of playing (H), and among the 14 that did not have this habit of playing (NH), 3 participants declared not having a smartphone at all. The GEQ core assessment showed a higher positive affect among the participants with a habit of playing games, scoring 2.80 (H) on a scale of 4.0 versus 1.61 (NH), and higher tension as an opposite relationship of 0.81 (NH) versus 0.37 (H). The overall GEQ evaluation showed that the game presents a more positive than negative affect on all users, besides showing the other desirable characteristics of serious games. Conclusions: We present a new way of dealing with the issue of alcohol abuse through a game designed for smartphones. It promotes an overall positive user experience, having a greater impact on users accustomed to games. The proposed approach has its niche, though it is still a minority in the evaluated population. Further research should explore new game features, such as new styles, to make the game more attractive to a wider audience, in addition to performing an in-depth study on the effects of playing it.

  • JMIR Serious Games 2019;7(4):e11151

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  Usability of Games and Gamification

  Sep 30, 2019

  Usability, Acceptability, Feasibility, and Effectiveness of a Gamified Mobile Health Intervention (Triumf) for Pediatric Patients: Qualitative Study

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  Authors List:

  • Riin Tark  
  • Mait Metelitsa  
  • Kirsti Akkermann  
  • Kadri Saks  
  • Sirje Mikkel  
  • Kadri Haljas  

  Abstract:

  Background: Mental disorders are notably prevalent in children with chronic illnesses, whereas a lack of access to psychological support might lead to potential mental health problems or disruptions in treatment. Digitally delivered psychological interventions have shown promising results as a supportive treatment measure for improving health outcomes during chronic illness. Objective: This study aimed to evaluate the usability, acceptability, and feasibility of providing psychological and treatment support in a clinical setting via a mobile game environment. In addition, the study aimed to evaluate the preliminary effectiveness of the mobile health game. Methods: Patients aged 7 to 14 years with less than a year from their diagnosis were eligible to participate in the study. In total, 15 patients were invited to participate by their doctor. A total of 9 patients (age range: 7-12 years; mean age 9.1 years) completed the 60-day-long study in which the Triumf mobile health game was delivered as a digital intervention. In an engaging game environment, patients were offered psychological and treatment support, cognitive challenges, and disease-specific information. The fully digital intervention was followed by a qualitative interview conducted by a trained psychologist. The results of the interview were analyzed in conjunction with patient specific in-game qualitative data. Ethical approval was obtained to conduct the study. Results: Patients positively perceived the game, resulting in high usability and acceptability evaluations. Participants unanimously described the game as easy to use and engaging in terms of gamified activities, while also providing beneficial and trustworthy information. Furthermore, the overall positive evaluation was emphasized by an observed tendency to carry on gaming post study culmination (67%, 10/15). Psychological support and mini games were the most often used components of the game, simultaneously the participants also highlighted the education module as one of the most preferred. On average, the patients sought and received psychological support or education on 66.6 occasions during the 60-day intervention. Participants spent the most time collecting items from the city environment (on average 15.6 days, SD 8.1), indicative of exploratory behavior, based on the quantitative in-game collected data. During the intervention period, we observed a statistically significant decrease in general health problems (P=.003) and saw a trend toward a decrease in depression and anxiety symptoms. Conclusions: This study demonstrated that a game environment could be a promising medium for delivering comprehensive supportive care to pediatric patients with cancer alongside standard treatment, with potential application across a variety of chronic conditions. Importantly, the results indicate that the study protocol was feasible with modifications to randomized controlled trials, and the game could be considered applicable in a clinical context. By giving an empirical evaluation of delivering psychological support via the game environment, our work stands to inform future mobile health interventions.

  • JMIR Serious Games 2019;7(3):e13776

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  Games for Medical Education and Training

  Sep 26, 2019

  Impact of Using a 3D Visual Metaphor Serious Game to Teach History-Taking Content to Medical Students: Longitudinal Mixed Methods Pilot Study

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  Authors List:

  • Hussain Alyami  
  • Mohammed Alawami  
  • Mataroria Lyndon  
  • Mohsen Alyami  
  • Christin Coomarasamy  
  • Marcus Henning  
  • Andrew Hill  
  • Frederick Sundram  

  Abstract:

  Background: History taking is a key component of clinical practice; however, this skill is often poorly performed by students and doctors. Objective: The study aimed to determine whether Metaphoria, a 3D serious game (SG), is superior to another electronic medium (PDF text file) in learning the history-taking content of a single organ system (cardiac). Methods: In 2015, a longitudinal mixed methods (quantitative and qualitative) pilot study was conducted over multiple sampling time points (10 weeks) on a group of undergraduate medical students at The University of Auckland Medical School, New Zealand. Assessors involved in the study were blinded to group allocation. From an initial sample of 83, a total of 46 medical students were recruited. Participants were assigned to either a PDF group (n=19) or a game group (n=27). In total, 1 participant left the PDF group after allocation was revealed and was excluded. A total of 24 students in the game group and 14 students in the PDF group completed follow-up 7 weeks later. Using an iterative design process for over a year, with input from a variety of clinical disciplines, a cardiac history-taking game and PDF file were designed and informed by Cognitive Load Theory. Each group completed its intervention in 40 min. A total of 3 levels of Kirkpatrick training evaluation model were examined using validated questionnaires: affective (perception and satisfaction), cognitive (knowledge gains and cognitive load), and behavioral attitudes (Objective Structured Clinical Exam) as well as qualitative assessment. A priori hypotheses were formulated before data collection. Results: Compared with baseline, both groups showed significant improvement in knowledge and self-efficacy longitudinally (P<.001). Apart from the game group having a statistically significant difference in terms of satisfaction (P<.001), there were no significant differences between groups in knowledge gain, self-efficacy, cognitive load, ease of use, acceptability, or objective structured clinical examination scores. However, qualitative findings indicated that the game was more engaging and enjoyable, and it served as a visual aid compared with the PDF file. Conclusions: Students favored learning through utilization of an SG with regard to cardiac history taking. This may be relevant to other areas of medicine, and this highlights the importance of innovative methods of teaching the next generation of medical students.

  • JMIR Serious Games 2019;7(3):e13748

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  Exergames, Active Games and...

  Aug 28, 2019

  Effects of Full Body Exergaming in Virtual Reality on Cardiovascular and Muscular Parameters: Cross-Sectional Experiment

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  Authors List:

  • Boris Feodoroff  
  • Ippokratis Konstantinidis  
  • Ingo Froböse  

  Abstract:

  Background: In recent years, many studies have associated sedentary behavior in front of screens with health problems in infants, children, and adolescents. Yet options for exergaming—playing video games that require rigorous physical exercise—seem to fall short of the physical activity levels recommended by the World Health Organization. Objective: The purpose of this study was to investigate the effect of a fully immersive virtual reality (VR)-based training system on cardiovascular and muscular parameters of young adults. Methods: A cross-sectional experiment design was used to analyze muscle activity (surface electromyography), heart rate, perceived exertion (RPE), cybersickness symptoms, perceived workload, and physical activity enjoyment (PACES) in 33 participants performing two 5-minute flights on a new training device. Results: Participants’ performance of the planking position required to play the game resulted in moderate aerobic intensity (108 [SD 18.69] bpm). Due to the mainly isometric contraction of the dorsal muscle chain (with a mean activation between 20.6% [SD 10.57] and 26.7% [SD 17.39] maximum voluntary isometric contraction), participants described the exercise as a moderate to vigorous activity (RPE 14.6 [SD 1.82]). The majority reported that they enjoyed the exercise (PACES 3.74 [SD 0.16]). However, six participants had to drop out because of cybersickness symptoms and two because of muscle pain due to prior injuries. Conclusions: Our findings suggest that fully immersive VR training systems can contribute to muscle-strengthening activities for healthy users. However, the dropout rate highlights the need for technological improvements in both software and hardware. In prevention and therapy, movement quality is a fundamental part of providing effective resistance training that benefits health. Exergaming on a regular basis has the potential to develop strong muscles and a healthy back. It is essential that future VR-based training systems take into account the recommendations of sport and exercise science.

  • JMIR Serious Games 2019;7(3):e12324

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  Serious Games for Education

  Aug 27, 2019

  An Epiduroscopy Simulator Based on a Serious Game for Spatial Cognitive Training (EpiduroSIM): User-Centered Design Approach

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  Authors List:

  • Junho Ko  
  • Jong Joo Lee  
  • Seong-Wook Jang  
  • Yeomin Yun  
  • Sungchul Kang  
  • Dong Ah Shin  
  • Yoon Sang Kim  

  Abstract:

  Background: Performing high-level surgeries with endoscopy is challenging, and hence, an efficient surgical training method or system is required. Serious game–based simulators can provide a trainee-centered educational environment unlike traditional teacher-centered education environments since serious games provide a high level of interaction (feedback that induces learning). Methods: EpiduroSIM was designed based on a serious game. For spatial cognitive training, the virtual environment of EpiduroSIM was modeled based on a cognitive map. Results: EpiduroSIM was developed considering user accessibility to provide various functions. The experiment for the validation of EpiduroSIM focused on psychological fidelity and repetitive training effects. The experiments were conducted by dividing 16 specialists into 2 groups of 8 surgeons. The group was divided into beginner and expert based on their epiduroscopy experience. The psychological fidelity of EpiduroSIM was confirmed through the training results of the expert group rather than the beginner group. In addition, the repetitive training effect of EpiduroSIM was confirmed by improving the training results in the beginner group. Conclusions: EpiduroSIM may be useful for training beginner surgeons in epiduroscopy.

  • JMIR Serious Games 2019;7(3):e12678

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  Serious Games for Health and Medicine

  Aug 8, 2019

  Development and Evaluation of a Virtual Research Environment to Improve Quality of Care in Overcrowded Emergency Departments: Observational Study

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  Authors List:

  • Charles-Henri Houze-Cerfon  
  • Christine Vaissié  
  • Laurent Gout  
  • Bruno Bastiani  
  • Sandrine Charpentier  
  • Dominique Lauque  

  Abstract:

  Background: Despite a wide range of literature on emergency department (ED) overcrowding, scientific knowledge on emergency physicians’ cognitive processes coping with overcrowding is limited. Objective: This study aimed to develop and evaluate a virtual research environment that will allow us to study the effect of physicians’ strategies and behaviors on quality of care in the context of ED overcrowding. Methods: A simulation-based observational study was conducted over two stages: the development of a simulation model and its evaluation. A research environment in emergency medicine combining virtual reality and simulated patients was designed and developed. Afterwards, 12 emergency physicians took part in simulation scenarios and had to manage 13 patients during a 2-hour period. The study outcome was the authenticity of the environment through realism, consistency, and mastering. The realism was the resemblance perceived by the participants between virtual and real ED. The consistency of the scenario and the participants’ mastering of the environment was expected for 90% (12/13) of the participants. Results: The virtual ED was considered realistic with no significant difference from the real world with respect to facilities and resources, except for the length of time of procedures that was perceived to be shorter. A total of 100% (13/13) of participants deemed that patient information, decision making, and managing patient flow were similar to real clinical practice. The virtual environment was well-mastered by all participants over the course of the scenarios. Conclusions: The new simulation tool, Virtual Research Environment in Emergency Medicine, has been successfully designed and developed. It has been assessed as perfectly authentic by emergency physicians compared with real EDs and thus offers another way to study human factors, quality of care, and patient safety in the context of ED overcrowding.

  • JMIR Serious Games 2019;7(3):e13993

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  Exergames, Active Games and...

  Jul 31, 2019

  Exergaming Improves Executive Functions in Patients With Metabolic Syndrome: Randomized Controlled Trial

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  Authors List:

  • Shanshan Wu  
  • Eun-Ah Jo  
  • Hongqing Ji  
  • Kyung-Hee Kim  
  • Jung-Jun Park  
  • Bo Hyun Kim  
  • Kyoung Im Cho  

  Abstract:

  Background: Recent studies indicate that participation in exercise-related games can improve executive function, attention processing, and visuospatial skills. Objective: The aim of this study was to investigate whether exercise via exergaming (EXG) can improve executive function in patients with metabolic syndrome (MetS). Methods: A total of 22 MetS patients were recruited and randomly assigned to an EXG group or a treadmill exercise (TE) group. The reaction time (RT) and electrophysiological signals from the frontal (Fz), central (Cz), and parietal (Pz) cortices were collected during a Stroop task after 12 weeks of exercise. Results: During the Stroop congruence (facilitation) judgment task, both the EXG and TE groups showed significantly faster RT after 12 weeks of exercise training. For N200 amplitude, the EXG group demonstrated significantly increased electrophysiological signals from the Fz and Cz cortices. These changes were significantly larger in the EXG group than in the TE group. Separately, for the P300 amplitude, the EXG groups presented significantly increased electrophysiological signals from the Fz, Cz, and Pz cortices, whereas the TE group showed significantly increased electrophysiological signals from the Cz and Pz cortices only. During the Stroop incongruence (interference) judgment task, both the EXG and TE groups showed significantly faster RT. For P300 amplitude, the EXG group had significantly increased electrophysiological signals from the Fz and Cz cortices only, whereas the TE group had significantly increased electrophysiological signals from the Fz, Cz, and Pz cortices. Conclusions: EXG improves executive function in patients with MetS as much as normal aerobic exercise does. In particular, a unique benefit of EXG beyond increased aerobic capacity is the improved selective attention among cognitive functions. Thus, EXG could be recommended to someone who needs to improve their brain responses of concentration and judgment as well as physical fitness. Trial Registration: ClinicalTrials.gov NCT04015583; https://clinicaltrials.gov/ct2/show/NCT04015583

  • JMIR Serious Games 2019;7(3):e13575

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  Exergames, Active Games and...

  Jul 31, 2019

  Factors Associated with Sustained Exergaming: Longitudinal Investigation

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  Authors List:

  • Erin Kathleen O'Loughlin  
  • Tracie A Barnett  
  • Jennifer J McGrath  
  • Mia Consalvo  
  • Lisa Kakinami  

  Abstract:

  Background: Exergaming is technology-driven physical activity (PA) which, unlike traditional video game play, requires that participants be physically active to play the game. Exergaming may have potential to increase PA and decrease sedentary behavior in youth, but little is known about sustained exergaming. Objective: The objectives of this study were to describe the frequency, correlates, and predictors of sustained exergaming. Methods: Data were available in AdoQuest (2005-11), a longitudinal investigation of 1843 grade 5 students in Montréal, Canada. This analysis used data from grade 9 (2008-09) and 11 (2010-11). Participants at Time 1 (T1; mean age 14 years, SD 0.8 ) who reported past-week exergaming (n=186, 19.1% of AdoQuest sample) completed mailed self-report questionnaires at Time 2 (T2; mean age 16 years, SD 0.8). Independent sociodemographic, psychological, and behavioral correlates (from T2)/predictors (from T1 or earlier) were identified using multivariable logistic regression. Results: Of 186 exergamers at T1, 81 (44%) reported exergaming at T2. Being female and having higher introjected regulation (ie, a type of PA motivation indicative of internalizing PA as a behavior) were independent correlates. None of the predictors investigated were associated with sustained exergaming. Conclusions: Almost half of grade 9 exergamers sustained exergaming for 2 years. Exergaming may be a viable approach to help adolescents engage in and sustain PA during adolescence. Sex and PA motivation may be important in the sustainability of exergaming.

  • JMIR Serious Games 2019;7(3):e13335

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  Questionnaires and Instruments...

  Jul 23, 2019

  A Brief Measure of Interpersonal Interaction for 2-Player Serious Games: Questionnaire Validation

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  Authors List:

  • Maja Gorsic  
  • Joshua D Clapp  
  • Ali Darzi  
  • Domen Novak  

  Abstract:

  Background: Competitive and cooperative serious games have become increasingly popular in areas such as rehabilitation and education and have several potential advantages over single-player games. However, they are not suitable for everyone, and the user experience in competitive and cooperative serious games depends on many factors. One important factor is the verbal interaction between players, but the effect of this factor has not been extensively studied because of the lack of a validated measurement tool. Objective: This paper aimed to validate a brief questionnaire that measures the verbal interaction between 2 players of a serious game. The questionnaire consists of 8 questions pertaining to the amount of conversation, its valence (positive or negative emotion), and its game relatedness. Methods: The questionnaire was validated with 30 pairs of participants who played a competitive serious game for 10 min while being recorded with cameras. The questionnaire was filled out by both participants, an in-person observer, and 2 members of our research group who watched the videos. Results from these raters were used to develop questionnaire instructions, and the finalized questionnaire was given to 2 additional raters who were trained on 5 videos and then rated the other 25 videos independently. Results: The questionnaire’s interrater reliability is excellent for the amount of conversation and its game relatedness (intraclass correlation coefficients [ICCs] above 0.9). Interrater reliability is fair to good for conversation valence (ICCs between 0.4 and 0.7). We believe that the lower interrater reliability for valence is primarily because of a limited spread of valence values in our sample. Furthermore, questionnaire ratings were significantly correlated with players’ personality characteristics (eg, amount of conversation was correlated with extraversion) and pressure/tension experienced in the competitive game. Conclusions: The validated questionnaire has the potential to be a useful tool for studying user experience in competitive and cooperative serious games. Furthermore, it could be adapted for other applications such as entertainment games. However, it has only been validated with unimpaired university students in a 2-player competitive serious game and should next be validated with different target populations (eg, stroke survivors) and different game designs (eg, cooperative games).

  • JMIR Serious Games 2019;7(3):e12788

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  Exergames, Active Games and...

  Jul 22, 2019

  Effects of Social Interaction Mechanics in Pervasive Games on the Physical Activity Levels of Older Adults: Quasi-Experimental Study

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  Authors List:

  • Luciano Henrique De Oliveira Santos  
  • Kazuya Okamoto  
  • Silvana Schwerz Funghetto  
  • Adriana Schüler Cavalli  
  • Shusuke Hiragi  
  • Goshiro Yamamoto  
  • Osamu Sugiyama  
  • Carla Denise Castanho  
  • Tomoki Aoyama  
  • Tomohiro Kuroda  

  Abstract:

  Background: The novel genre of pervasive games, which aim to create more fun and engaging experiences by promoting deeper immersion, could be a powerful strategy to stimulate physical activity among older adults. To use these games more effectively, it is necessary to understand how different design elements affect player behavior. Objective: The aim was to vary a specific design element of pervasive games for older adults, namely social interaction, to test the effect on levels of physical activity. Methods: Over 4 weeks, two variations of the same pervasive game were compared: social interaction for the test group and no social interaction for the control group. In both versions, players had to walk to physical locations and collect virtual cards, but the social interaction version allowed people to collaborate to obtain more cards. Weekly step counts were used to evaluate the effect on each group, and the number of places visited was used as an indicator of play activity. Results: A total of 32 participants were recruited (no social interaction=15, social interaction=17); 18 remained until the end of the study (no social interaction=7, social interaction=11). Step counts during the first week were used as the baseline (no social interaction: mean 17,099.4, SE 3906.5; social interaction: mean 17,981.9, SE 2171.1). For the following weeks, changes to individual baseline were as follows for no social interaction (absolute/proportional): 383.8 (SE 563.8)/1.1% (SE 4.3%), 435.9 (SE 574.5)/2.2% (SE 4.6%), and −106.1 (SE 979.9)/−2.6% (SE 8.1%) for weeks 2, 3, and 4, respectively. For social interaction they were 3841.9 (SE 1425.4)/21.7% (SE 5.1%), 2270.6 (SE 947.1)/16.5% (SE 4.4%), and 2443.4 (SE 982.6)/17.9% (SE 4.7%) for weeks 2, 3, and 4, respectively. Analysis of group effect was significant (absolute change: η2=.19, P=.01; proportional change: η2=.27, P=.009). Correlation between the proportional change and the play activity was significant (r=.34, 95% CI 0.08 to 0.56), whereas for absolute change it was not. Conclusions: Social interaction design elements of the pervasive game may have some positive effects on the promotion of physical activity, although other factors might also have influenced this effect. Trial Registration: Japan Medical Association Clinical Trial Registration Number JMA-IIA00314; https://dbcentre3.jmacct.med.or.jp/JMACTR/App/JMACTRS06/JMACTRS06.aspx?seqno=7274 (Archived by WebCite at http://www.webcitation.org/761a6MVAy)

  • JMIR Serious Games 2019;7(3):e13962

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  Theoretical Foundations and...

  Jul 16, 2019

  Diagnostic Markers of User Experience, Play, and Learning for Digital Serious Games: A Conceptual Framework Study

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  Authors List:

  • Jun Wen Tan  
  • Nabil Zary  

  Abstract:

  Background: Serious games for medical education have seen a resurgence in recent years, partly due to the growth of the video game industry and the ability of such games to support learning achievements. However, there is little consensus on what the serious and game components in a serious game are composed of. As a result, electronic learning (e-learning) and medical simulation modules are sometimes mislabeled as serious games. We hypothesize that one of the main reasons is the difficulty for a medical educator to systematically and accurately evaluate key aspects of serious games. Objective: This study aimed to identify markers that can evaluate serious games and distinguish between serious games, entertainment games, and e-learning. Methods: Jabareen’s eight-phase framework-building procedure was used to identify the core markers of a serious game. The procedure was modified slightly to elicit “diagnostic criteria” as opposed to its original purpose of a conceptual framework. Following the identification of purported markers, the newly developed markers were tested on a series of freely available health care serious games—Dr. Game Surgeon Trouble, Staying Alive, and Touch Surgery—and the results were compared to the published test validity for each game. Results: Diagnostic criteria for serious games were created, comprising the clusters of User Experience (UX), Play, and Learning. Each cluster was formed from six base markers, a minimum of four of which were required for a cluster to be considered present. These criteria were tested on the three games, and Dr. Game Surgeon Trouble and Staying Alive fit the criteria to be considered a serious game. Touch Surgery did not meet the criteria, but fit the definition of an e-learning module. Conclusions: The diagnostic criteria appear to accurately distinguish between serious games and mediums commonly misidentified as serious games, such as e-learning modules. However, the diagnostic criteria do not determine if a serious game will be efficacious; they only determine if it is a serious game. Future research should include a much larger sample of games designed specifically for health care purposes.

  • JMIR Serious Games 2019;7(3):e14620

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  Exergames, Active Games and...

  Jun 18, 2019

  Effects of the FIT Game on Physical Activity in Sixth Graders: A Pilot Reversal Design Intervention Study

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  Authors List:

  • Damon Joyner  
  • Heidi Wengreen  
  • Sheryl Aguilar  
  • Gregory Madden  

  Abstract:

  Background: The FIT Game is a low-cost intervention that increases fruit and vegetable consumption in elementary school children. For this study, the FIT Game was adapted into an intervention designed to increase children’s physical activity at school. Objective: We aimed to evaluate if the FIT Game could increase children’s physical activity relative to their baseline levels. Methods: A total of 29 participants were recruited from a sixth-grade classroom. An ABAB reversal design was used. Participants wore an accelerometer while at school during pre/postintervention baseline (A) and intervention (B) phases. During the FIT Game intervention, daily physical activity goals encouraged the class to increase their median daily step count above the 60th percentile of the previous 10 days. When daily goals were met, game-based accomplishments were realized. Results: Children met their activity goals 80% of the time during the intervention phases. Physical activity at school increased from a median of 3331 steps per day during the baseline to 4102 steps during the FIT Game phases (P<.001, Friedman test). Conclusions: Preliminary evidence showed that playing the FIT Game could positively influence children’s physical activity at school.

  • JMIR Serious Games 2019;7(2):e13051

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