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Journal Description

JMIR Serious Games (JSG, ISSN 2291-9279; Impact Factor: 3.351) is a multidisciplinary journal devoted to computer/web/virtual reality/mobile applications that incorporate elements of gaming, gamification or novel hardware platforms such as virtual reality headsets or Microsoft Kinect to solve serious problems such as health behavior change, physical exercise promotion (exergaming), medical rehabilitation, diagnosis and treatment of psychological/psychiatric disorders, medical education, health 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.

The journal is indexed in PubMed, PubMed Central, DOAJ, and SCIE/Web of Science, and JCR (Journal Citation Reports) where it received an official impact factor by Clarivate. In June 2019, JSG received an impact factor of 3.351, ranking JSG at the top of all gaming-related academic journals, ahead of (for example) more established competitor journals such as the Games for Health Journal. 

 

Recent Articles:

  • Source: depositphotos; Copyright: depositphotos; URL: https://depositphotos.com/stock-photos/kids-running-elementary-school-st100.html?qview=219743054; License: Licensed by the authors.
    Exergames, Active Games and...

    Jun 18, 2019

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

    Authors List:

    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.

  • Using VR to promote physical activity in adolescents and trying to carry over the effects to the real world. Source: Pexels; Copyright: Sebastian Voortman; URL: https://www.pexels.com/photo/girl-wearing-vr-box-driving-bicycle-during-golden-hour-166055/; License: Licensed by the authors.
    Exergames, Active Games and...

    Jun 17, 2019

    Younger Adolescents’ Perceptions of Physical Activity, Exergaming, and Virtual Reality: Qualitative Intervention Study

    Authors List:

    Abstract:

    Background: Novel strategies to promote physical activity (PA) in adolescence are required. The vEngage study aims to test whether a virtual reality (VR) exergaming intervention can engage younger adolescents (aged 13 to 15 years) with PA. Objective: This study aimed to gather adolescents’ views of using VR to encourage PA and identify the key features they would like to see in a VR exergaming intervention via interviews. Methods: Participants were recruited through 2 schools in London, United Kingdom. Semistructured interviews were conducted with adolescents about their views on PA and what might work to increase PA, technology, knowledge and experience of VR, and desired features in a VR exergaming intervention. Data were analyzed using Framework Analysis. Results: A total of 31 participants aged between 13 and 15 years (58% female, 62% from nonwhite ethnicities) participated in this interview study. The vast majority had no awareness of government PA recommendations but felt they should be more thoroughly informed. All participants were positive about the use of VR in PA promotion. Rewards, increasing challenges, and a social or multiplayer aspect were identified by participants as crucial aspects to include in a VR exercise game. Barriers were related to cost of high-end systems. Being able to exercise at home was very appealing. VR exergaming was viewed as a way to overcome multiple perceived social and cultural barriers to PA, particularly for girls. Conclusions: Key elements that should be incorporated into a VR game for health intervention were identified and described. These also included the use of rewards, novelty and enjoyment in immersive game play, multiplayer options, and real-world elements, as well as continual updates and new challenge levels. The use of VR to promote PA in adolescents is promising, but some barriers were raised.

  • CliniPup (montage). Source: The Authors / Shutterstock Inc; Copyright: The Authors; URL: https://games.jmir.org/2019/2/e12431; License: Creative Commons Attribution (CC-BY).
    Serious Games for Health and Medicine

    Jun 11, 2019

    A Web-Based Serious Game for Health to Reduce Perioperative Anxiety and Pain in Children (CliniPup): Pilot Randomized Controlled Trial

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    Abstract:

    Background: As pediatric ambulatory surgeries are rising and existing methods to reduce perioperative anxiety and pain are lacking in this population, a serious game for health (SGH), CliniPup, was developed to address this unmet need. CliniPup was generated using the SERES framework for serious game development. Objective: The goal of the research was to clinically evaluate CliniPup as an adjunct therapy to existing pharmacological interventions aimed at reducing perioperative anxiety and pain in children undergoing ambulatory surgery. Methods: CliniPup was evaluated in a prospective randomized controlled pilot trial in 20 children aged 6 to 10 years who underwent elective surgery and their parents. Study participants were randomly assigned to the test (n=12) or control group (n=8). Children in the test group played CliniPup 2 days prior to surgery, and children in the control group received standard of care. On the day of surgery, pediatric anxiety was measured with the modified Yale Preoperative Anxiety Scale and parental anxiety was assessed with the State-Trait Anxiety Inventory. Pediatric postoperative pain was assessed by the Wong-Baker Faces Pain Rating Scale. Child and parent user experience and satisfaction were also evaluated in the test group using structured questionnaires. Results: Despite the small sample, preoperative anxiety scores were significantly lower (P=.01) in children who played CliniPup prior to surgery compared to controls. Parental preoperative anxiety scores were also lower in the test group (P=.10) but did not reach significance. No significant differences were observed in postoperative pain scores between groups (P=.54). The evaluation of user experience and satisfaction revealed that both children and parents were satisfied with CliniPup and would recommend the game to peers. Conclusions: Results of the pilot trial introduce CliniPup as a potentially effective and attractive adjunct therapy to reduce preoperative anxiety in children undergoing ambulatory surgery with a trend toward positive impact on parental preoperative anxiety. These results support the use of the SERES framework to generate an evidence-based SGH that results in positive health outcomes for patients. Based on these preliminary findings, we propose a research agenda to further develop and investigate this tool. Trial Registration: ClinicalTrials.gov NCT03874442; https://clinicaltrials.gov/ct2/show/NCT03874442 (Archived by WebCite at http://www.webcitation.org/78KZab8qc)

  • CliniPup (montage). Source: The Authors / Placeit; Copyright: JMIR Publications; URL: https://games.jmir.org/2019/2/e12429; License: Creative Commons Attribution (CC-BY).
    Formative Evaluation and Development...

    Jun 10, 2019

    Development of CliniPup, a Serious Game Aimed at Reducing Perioperative Anxiety and Pain in Children: Mixed Methods Study

    Authors List:

    Abstract:

    Background: An increasing number of children undergo ambulatory surgery each year, and a significant proportion experience substantial preoperative anxiety and postoperative pain. The management of perioperative anxiety and pain remains challenging in children and is inadequate, which negatively impacts the physical, psychosocial, and economic outcomes. Existing nonpharmacological interventions are costly, time consuming, vary in availability, and lack benefits. Therefore, there is a need for an evidence-based, accessible, nonpharmacological intervention as an adjunct to existing pharmacological alternatives to reduce perioperative anxiety and pain in children undergoing ambulatory surgery. Technology-enabled interventions have been proposed as a method to address the unmet need in this setting. In particular, serious games hold a unique potential to change health beliefs and behaviors in children. Objective: The objective of this research was to describe the rationale, scientific evidence, design aspects, and features of CliniPup, a serious game aimed at reducing perioperative anxiety and pain in children undergoing ambulatory surgery. Methods: The SERES Framework for serious game development was used to create the serious game, CliniPup. In particular, we used a mixed methods approach that consisted of a structured literature review supplemented with ethnographic research, such as expert interviews and a time-motion exercise. The resulting scientific evidence base was leveraged to ensure that the resulting serious game was relevant, realistic, and theory driven. A participatory design approach was applied, wherein clinical experts qualitatively reviewed several versions of the serious game, and an iterative creative process was used to integrate the applicable feedback. Results: CliniPup, a serious game, was developed to incorporate a scientific evidence base from a structured literature review, realistic content collected during ethnographic research such as expert interviews, explicit pedagogical objectives from scientific literature, and game mechanics and user interface design that address key aspects of the evidence. Conclusions: This report details the systematic development of CliniPup, a serious game aimed at reducing perioperative anxiety and pain in children undergoing ambulatory surgery. Clinical experts validated CliniPup’s underlying scientific evidence base and design foundations, suggesting that it was well designed for preliminary evaluation in the target population. An evaluation plan is proposed and briefly described.

  • Source: Pexels; Copyright: Tim Gouw; URL: https://www.pexels.com/photo/man-in-white-shirt-using-macbook-pro-52608/; License: Licensed by JMIR.
    Theoretical Foundations and...

    Jun 6, 2019

    Affective Game Planning for Health Applications: Quantitative Extension of Gerontoludic Design Based on the Appraisal Theory of Stress and Coping

    Authors List:

    Abstract:

    User retention is the first challenge in introducing any information and communication technologies (ICT) for health applications, particularly for seniors who are increasingly targeted as beneficiaries of such technologies. Interaction with digital technologies may be too stressful to older adults to guarantee their adoption in their routine selfcare. The second challenge, which also relates to adoption, is to supply empirical evidence that support the expectations of their beneficial outcomes. To address the first challenge, persuasive technologies such as serious games (SGs) are increasingly promoted as ludic approaches to deliver assistive care to older adults. However, there are no standards yet to assess the efficacy of different genres of games across populations, or compare and contrast variations in health outcomes arising from user interface design and user experience. For the past 3 decades, research has focused either on qualitative assessment of the appeal of digital games for seniors (by game designers) or on the quantitative evaluation of their clinical efficacy (by clinical researchers). The consensus is that interindividual differences play a key role in whether games can be useful or not for different individuals. Our challenge is to design SGs that retain their users long enough to sustain beneficial transfer effects. We propose to add a neuropsychological experimental framework (based on the appraisal theory of stress and coping) to a Gerontoludic design framework (that emphasizes designing positive and meaningful gaming experience over benefit-centric ones) in order to capture data to guide SG game development. Affective Game Planning for Health Applications (AGPHA) adds a model-driven mixed-methods experimental stage to a user-centered mechanics-dynamics-aesthetics game-design cycle. This intersectoral framework is inspired by latest trends in the fields of neuroimaging and neuroinformatics that grapple with similar challenges related to the psychobiological context of an individual's behaviors. AGPHA aims to bring users, designers, clinicians, and researchers together to generate a common data repository that consists of 4 components to define, design, evaluate, and document SGs. By unifying efforts under a standard approach, we will accelerate innovations in persuasive and efficacious ICTs for the aging population.

  • Source: Flickr / Placeit; Copyright: JMIR Publications; URL: https://games.jmir.org/2019/2/e14342; License: Creative Commons Attribution (CC-BY).
    Serious Games for Education

    May 29, 2019

    A Badge Design Framework for a Gamified Learning Environment: Cases Analysis and Literature Review for Badge Design

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    Abstract:

    Background: In the past, the educational badge was an extrinsic means of rewarding the motivation to learn. Based on continued research, however, the badge began to be recognized as a scale to measure the learner’s knowledge and skill and an important means of helping learners to gradually build intrinsic motivation by using certain extrinsic motivators. As the badge’s value has grown, the importance of its design has garnered attention. Objective: The objective of this research was to establish a badge design framework that can be used in a gamified learning environment. Methods: Data were collected from previous studies on badge design, 943 badge cases were extracted from 11 online and offline gamification in education contents, and their patterns and features were analyzed. Results: Based on the analysis of results from previous studies and 943 collected badge cases, our study suggests three conditions for badge design. Through the literature review and collected badge cases, our study designed a badge design framework. First, it is necessary to distinguish whether the type of learning activity required for earning badges is physical or conceptual. Second, it is necessary to distinguish whether the scale of an activity required for earning badges requires individual learning or interaction-induced learning. Third, it is important to review whether the time and effort invested in earning badges is simple, repetitive, and short-term or continuous and long-term. Based on these three conditions, collected badge cases were analyzed. To verify self-developed badge types, we conducted a chi-square test on the collected cases and confirmed that there was a significant difference for each of the eight badge types (Pearson chi-square 1117.7, P<.001). Conclusions: Through its literature review on previous studies, this study demonstrated the badge’s educational effectiveness. The badge design framework suggested in our study is expected to resolve some of the difficulties experienced during the badge design process in a gamified learning environment, encourage efficient badge design, and maximize learning effect.

  • Recovery Warrior. Source: Image created by the Authors; Copyright: The Authors; URL: http://games.jmir.org/2019/2/e11716/; License: Creative Commons Attribution (CC-BY).
    Serious Games for Health and Medicine

    May 23, 2019

    A Motion-Activated Video Game for Prevention of Substance Use Disorder Relapse in Youth: Pilot Randomized Controlled Trial

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    Abstract:

    Background: Body motion-activated video games are a promising strategy for promoting engagement in and adherence to addiction treatment among youth. Objective: This pilot randomized trial (N=80) investigated the feasibility of a body motion–activated video game prototype, Recovery Warrior 2.0, targeting relapse prevention in the context of a community inpatient care program for youth. Methods: Participants aged 15-25 years were recruited from an inpatient drug treatment program and randomized to receive treatment as usual (control) or game play with treatment as usual (intervention). Assessments were conducted at baseline, prior to discharge, and at 4 and 8 weeks postdischarge. Results: The provision of the game play intervention was found to be feasible in the inpatient setting. On an average, participants in the intervention group played for 36.6 minutes and on 3.6 different days. Participants in the intervention group mostly agreed that they would use the refusal skills taught by the game. Participants in the intervention group reported attending more outpatient counseling sessions than those in the control group (10.8 versus 4.8), but the difference was not significant (P=.32). The game had no effect on drug use at 4 or 8 weeks postdischarge, with the exception of a benefit reported at the 4-week follow-up among participants receiving treatment for marijuana addiction (P=.04). Conclusions: Preliminary evidence indicates that a motion-activated video game for addiction recovery appears to be feasible and acceptable for youth within the context of inpatient treatment, but not outpatient treatment. With further development, such games hold promise as a tool for the treatment of youth substance use disorder. Trial Registration: ClinicalTrials.gov NCT03957798; https://clinicaltrials.gov/show/NCT03957798 (Archived by WebCite at http://www.webcitation.org/78XU6ENB4)

  • Source: The Authors / Placeit; Copyright: JMIR Publications; URL: http://games.jmir.org/2019/2/e13620/; License: Creative Commons Attribution (CC-BY).
    Games for Cognitive Assessment

    May 9, 2019

    Search and Match Task: Development of a Taskified Match-3 Puzzle Game to Assess and Practice Visual Search

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    Background: Visual search declines with aging, dementia, and brain injury and is linked to limitations in everyday activities. Recent studies suggest that visual search can be improved with practice using computerized visual search tasks and puzzle video games. For practical use, it is important that visual search ability can be assessed and practiced in a controlled and adaptive way. However, commercial puzzle video games make it hard to control task difficulty, and there are little means to collect performance data. Objective: The aim of this study was to develop and initially validate the search and match task (SMT) that combines an enjoyable tile-matching match-3 puzzle video game with features of the visual search paradigm (taskified game). The SMT was designed as a single-target visual search task that allows control over task difficulty variables and collection of performance data. Methods: The SMT is played on a grid-based (width × height) puzzle board, filled with different types of colored polygons. A wide range of difficulty levels was generated by combinations of 3 task variables over a range from 4 to 8 including height and width of the puzzle board (set size) and the numbers of tile types (distractor heterogeneity). For each difficulty level, large numbers of playable trials were pregenerated using Python. Each trial consists of 4 consecutive puzzle boards, where the goal of the task is to find a target tile configuration (search) on the puzzle board and swap 2 adjacent tiles to create a line of 3 identical tiles (match). For each puzzle board, there is exactly 1 possible match (single target search). In a user study with 28 young adults (aged 18 to 31 years), 13 older (aged 64 to 79 years) and 11 oldest (aged 86 to 98 years) adults played the long (young and older adults) or short version (oldest adults) of the difficulty levels of the SMT. Participants rated their perception and the usability of the task and completed neuropsychological tests that measure cognitive domains engaged by the puzzle game. Results: Results from the user study indicate that the target search time is associated with set size, distractor heterogeneity, and age. Results further indicate that search performance is associated with general cognitive ability, selective and divided attention, visual search, and visuospatial and pattern recognition ability. Conclusions: Overall, this study shows that an everyday puzzle game–based task can be experimentally controlled, is enjoyable and user-friendly, and permits data collection to assess visual search and cognitive abilities. Further research is needed to evaluate the potential of the SMT game to assess and practice visual search ability in an enjoyable and adaptive way. A PsychoPy version of the SMT is freely available for researchers.

  • Source: The Authors / Placeit; Copyright: The Authors; URL: http://games.jmir.org/2019/2/e13242; License: Creative Commons Attribution (CC-BY).
    Serious Games for Health and Medicine

    May 8, 2019

    An Interactive Mobile App Game to Address Aggression (RegnaTales): Pilot Quantitative Study

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    Abstract:

    Background: The rapid advancement in media technology has radically changed the way we learn and interact with one another. Games, with their engaging and interactive approach, hold promise in the delivery of knowledge and building of skills. This has potential in child and adolescent mental health work, where the lack of insight and motivation for therapy are major barriers to treatment. However, research on the use of serious games in mental health interventions for children and adolescents is still in its infancy. Objective: This study adds to the research on serious games in mental health interventions through the development and evaluation of RegnaTales, a series of 6 mobile apps designed to help children and adolescents manage anger. We examined the usability and playability of RegnaTales, as well as children’s aggression levels before and after the game play. Methods: A total of 72 children aged between 6 and 12 years were recruited for the study. Thirty-five participants had a clinical diagnosis of disruptive behavior disorders (DBD), whereas 37 were typically developing (TD) children. Each child played 1 of the 6 RegnaTales apps for approximately 50 min before completing the Playability and Usability Questionnaire. The Reactive-Proactive Aggression Questionnaire was completed before and after the game play. Results: The overall results showed high levels of enjoyment and playability. TD children and children with DBD had similar experienced fun and perceived playability scores on all 6 mobile apps. All 6 mobile apps garnered comparable experienced fun and perceived playability scores. Furthermore, 42% (5/12) to 67% (8/12) of the children indicated that they would like to play the games again. Importantly, children felt that they acquired skills in anger management, were motivated to use them in their daily lives, and felt confident that the skills would help them better manage their anger. Children reported significantly lower reactive aggression after playing the mobile apps Rage Raver (P=.001), Abaddon (P=.008), and RegnaTools (P=.03). These apps focused on the psychoeducation of the link between thoughts and emotions, as well as equipping the participants with various emotion regulation strategies such as relaxation and cognitive restructuring. Conclusions: This study presents evidence to support RegnaTales as a feasible serious game. The preliminary findings associated with reduction in reactive aggression, coupled with future research to further establish its efficacy, could warrant RegnaTales as a potential intervention for anger issues among clinical and community populations.

  • Mobile phone with the Tumaini app open. Source: The Authors / PlaceIt; Copyright: JMIR Publications; URL: http://games.jmir.org/2019/2/e13037/; License: Creative Commons Attribution (CC-BY).
    Theoretical Foundations and...

    May 8, 2019

    Interactive Narrative in a Mobile Health Behavioral Intervention (Tumaini): Theoretical Grounding and Structure of a Smartphone Game to Prevent HIV Among...

    Authors List:

    Abstract:

    The increasing availability of smartphones, including in low-income countries, offers an unprecedented opportunity to reach individuals with innovative health promotion interventions. Electronic games delivered via smartphone offer promising avenues for sexual health promotion and HIV prevention, especially for young people. By giving players real agency in a virtual and safe environment, well-designed games can provide a level of experiential learning unparalleled by many other behavioral interventions. The design of effective games for health relies on multidisciplinary insight and expertise. However, relatively few studies discuss the theoretical understanding underlying their intervention. Making explicit the theoretical grounding of a game-based intervention allows articulation of assumptions and strategies, anticipation of outcomes, and evaluation of impacts (including intermediate effects), thereby increasing understanding of pathways to change, with a view to contributing to the development of more effective games. It also helps strengthen the credibility and improve the accountability of games for health. We present the multidisciplinary theoretical framework—integrating intervention design, mediators, and behavioral outcomes—and the structure of an HIV prevention game for young African adolescents that has shown promise in a randomized pilot study in Western Kenya. The central component of Tumaini (hope for the future in Kiswahili) is an interactive role-playing narrative in which the player makes choices for characters that determine how their paths unfold. In addition, a series of mini-games reinforce skills, and the “My Story” component links the game world to the player’s own life and goals, and a reward system motivates continued play. With its “choose-your-own-adventure” format, Tumaini is intended to be replayed so that players can experience the consequences resulting from different choices made in the role-playing narrative. Grounded in theories of narrative and applied communication and in social behavioral theories, especially Social Cognitive Theory, Tumaini is designed to help young adolescents acquire the information, skills, and motivation they need to avoid and reduce sexual risks. We close by situating Tumaini within discussion of the theory and practice of using interactive narrative in health promotion, with a view to furthering theoretical elaboration.

  • Source: Image created by the Authors; Copyright: The Authors; URL: http://games.jmir.org/2019/2/e12130/; License: Creative Commons Attribution (CC-BY).
    Viewpoints and Personal Experiences...

    May 7, 2019

    Do-It-Yourself Gamified Cognitive Training: Viewpoint

    Authors List:

    Abstract:

    Cognitive decline is an important nonmotor symptom in Parkinson disease (PD). Unfortunately, very few treatment options are available. Recent research pointed to small positive effects of nonpharmacological cognitive training in PD. Most of these trainings are performed under supervision and solely computerized versions of (traditional) paper-pencil cognitive training programs, lacking rewarding gamification stimulants that could help to promote adherence. By describing 3 different self-invented ways of cognitive gaming in patients with PD, we aimed to raise awareness for the potential of gamified cognitive training in PD patients. In addition, we hoped to inspire the readers with our case descriptions, highlighting the importance of both personalization and cocreation in the development of games for health. In this viewpoint, we have presented 3 PD patients with different ages, with different disease stages, and from various backgrounds, who all used self-invented cognitive training, including elements of personalization and gamification. To indicate generalization into a larger PD population, the recruitment results from a recent cognitive game trial are added. The presented cases show similarities in terms of awareness of their cognitive decline and the ways this process could potentially be counteracted, by looking for tools to train their cognition. On the basis of the response of the recruitment procedure, there seems to be interest in gamified cognitive training in a larger PD population too. Gamification may add to traditional therapies in terms of personalization and adherence. Positive results have already been found with gamified trainings in other populations, and the cases described here suggest that PD is also an attractive area to develop and test gamified cognitive trainings. However, no results of gamified cognitive trainings in PD have been published to date. This suggests an unmet need in this area and may justify the development of gamified cognitive training and its evaluation, for which our considerations can be used.

  • Source: Shutterstock Inc; Copyright: wavebreakmedia; URL: https://www.shutterstock.com/nl/image-photo/little-sick-girl-using-digital-tablet-186128498?src=Wy2jhsY8FuSabvLtoMapjA-1-2; License: Licensed by the authors.
    Serious Games for Health and Medicine

    May 2, 2019

    Developing Theory-Driven, Evidence-Based Serious Games for Health: Framework Based on Research Community Insights

    Authors List:

    Abstract:

    Background: The idea of using serious games to effectuate better outcomes in health care has gained significant traction among a growing community of researchers, developers, and health care professionals. Many now recognize the importance of creating evidence-based games that are purposefully designed to address physical and mental health challenges faced by end users. To date, no regulatory resources have been established to guide the development of serious games for health (SGH). Developers must therefore look elsewhere for guidance. Although a more robust level of evidence exists in the research literature, it is neither structured nor is there any clear consensus. Developers currently use a variety of approaches and methodologies. The establishment of a well-defined framework that represents the consensus views of the SGH research community would help developers improve the efficiency of internal development processes, as well as chances of success. A consensus framework would also enhance the credibility of SGH and help provide quality evidence of their effectiveness. Objective: This research aimed to (1) identify and evaluate the requirements, recommendations, and guidelines proposed by the SGH community in the research literature, and; (2) develop a consensus framework to guide developers, designers, researchers, and health care professionals in the development of evidence-based SGH. Methods: A critical review of the literature was performed in October to November 2018. A 3-step search strategy and a predefined set of inclusion criteria were used to identify relevant articles in PubMed, ScienceDirect, Institute of Electrical and Electronics Engineers Xplore, CiteSeerX, and Google Scholar. A supplemental search of publications from regulatory authorities was conducted to capture their specific requirements. Three researchers independently evaluated the identified articles. The evidence was coded and categorized for analysis. Results: This review identified 5 categories of high-level requirements and 20 low-level requirements suggested by the SGH community. These advocate a methodological approach that is multidisciplinary, iterative, and participatory. On the basis of the requirements identified, we propose a framework for developing theory-driven, evidence-based SGH. It comprises 5 stages that are informed by various stakeholders. It focuses on building strong scientific and design foundations that guide the creative and technical development. It includes quantitative trials to evaluate whether the SGH achieve the intended outcomes, as well as efforts to disseminate trial findings and follow-up monitoring after the SGH are rolled out for use. Conclusions: This review resulted in the formulation of a framework for developing theory-driven, evidence-based SGH that represents many of the requirements set out by SGH stakeholders in the literature. It covers all aspects of the development process (scientific, technological, and design) and is transparently described in sufficient detail to allow SGH stakeholders to implement it in a wide variety of projects, irrespective of discipline, health care segments, or focus.

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  • Using 360-video as a research stimulus in digital health studies: Lessons learned

    Date Submitted: Jul 10, 2019

    Open Peer Review Period: Jul 15, 2019 - Sep 9, 2019

    Due to the accessibility of 360-video cameras to record content and the technology to view the videos via mobile and other devices, the use of 360-video to place people in different contexts and conve...

    Due to the accessibility of 360-video cameras to record content and the technology to view the videos via mobile and other devices, the use of 360-video to place people in different contexts and convey health-related information is becoming easier. 360-videos have the potential to enhance health-related attitudes and behaviors, and they are being used increasingly in health marketing. We describe the challenges and lessons learned in designing and implementing a 360-video as part of an online experiment focused on inducing empathy among clinicians for patient experience. Given the rapid change in digital technology, future research can use these learnings to design and implement 360-video studies more quickly.

  • Learning to read by Learning to Write – An Evaluation of a Serious Game to Foster Business Process Model Comprehension

    Date Submitted: Jul 5, 2019

    Open Peer Review Period: Jul 9, 2019 - Sep 3, 2019

    Background: The management and required comprehension of business process models is of utmost importance for almost any enterprise. To foster the comprehension of such models, this paper incorporates...

    Background: The management and required comprehension of business process models is of utmost importance for almost any enterprise. To foster the comprehension of such models, this paper incorporates the idea of a serious game called “Tales of Knightly Process”. Objective: In order to investigate whether the serious game has a positive immediate and follow-up impact on process model comprehension, two studies with n = 81 and n = 64 and participants each were conducted. Methods: Within two studies (four weeks between Study I and Study II), participants were divided into a game and control group (i.e., Study I), as well as follow-up game and follow-up control group. In both studies, participants had to answer 10 comprehension questions on 5 different process models. Note that, in Study I, players of the game group played the serious game before they answered the comprehension questions. Results: Inferential statistics (ANOVA) revealed, regarding Study I, that participants from the game group showed a better immediate performance measure compared to control group participants (P < .001). In addition, Hedges g of .77 indicated a medium to large effect size. Regarding Study II, follow-up game group participants showed a better performance measure compared to participants from the follow-up control group (P = .002), here, a Hedges g of .82 implied a large effect size. Finally, in both studies, analyses indicated that complex process models are more difficult to comprehend (Study I: P < .001; Study II: P < .001) Conclusions: Essentially, participants who played the serious game in Study I showed a better performance in the comprehension of process models in both studies. Hence, we conclude that this serious game can foster process model comprehension significantly.

  • Physical activity, gaming and virtual reality: the views of parents of adolescents

    Date Submitted: Jun 3, 2019

    Open Peer Review Period: Jun 6, 2019 - Aug 1, 2019

    Background: Virtual reality (VR) exergaming may be a promising avenue to engage adolescents with physical activity (PA). Since parental support is a consistent determinant of adolescent PA, it is cruc...

    Background: Virtual reality (VR) exergaming may be a promising avenue to engage adolescents with physical activity (PA). Since parental support is a consistent determinant of adolescent PA, it is crucial to gather the views of parents of adolescents about this type of intervention. Objective: The aim of this study was to interview parents of adolescents (13-17 year olds) about PA, gaming and VR. Methods: Semi-structured interviews were conducted with 18 parents of adolescents aged 13-17 years. Data was synthesized using framework analysis. Results: Parents believed encouraging PA in adolescents was important (particularly for mental health benefits) and most thought their child was not active enough. Parents reported their adolescents gamed regularly, with perceptions of gaming mostly negative due to violent content of the games and a potential for addiction. However, parents were permissive of gaming mainly because they wanted children to have autonomy of choice in leisure time and because they used screens frequently and did not want to appear hypocritical. Parents discussed an inability to relate to gaming due to ‘generational differences’ but an exception was exergaming, which they had played with their children in the past (e.g. Wii Fit). They commented that adolescents are ‘tough consumers’ who would only engage with high-end graphics and high game quality. Specific recommendations for promoting a VR exergaming intervention were provided, but ultimately parents strongly supported harnessing gaming for any positive purpose. Conclusions: The current study suggests promise for a VR exergaming intervention, but this must be framed in a way that it addresses parental concerns, particularly around addiction, violence and safety, without actively involving them participating. While parents would rather their children performed ‘real world’ PA, they believed the key to engaging them was through technology. Overall, there was the perception that harnessing gaming and sedentary screen-time for a positive purpose would be strongly supported.

  • Escape Rooms as a method of clinical evaluation in Nursing Students: A quasi-experimental study

    Date Submitted: May 20, 2019

    Open Peer Review Period: May 23, 2019 - Jul 18, 2019

    Background: Gamification has been shown to be a positive learning tool for its use among nursing students, but there are currently no studies available about its possible implementation in the evaluat...

    Background: Gamification has been shown to be a positive learning tool for its use among nursing students, but there are currently no studies available about its possible implementation in the evaluation of nursing students’ clinical skills. Objective: The aim of this study was to understand the gameful experience and satisfaction of nursing students in the evaluation of their clinical skills using an escape room, as opposed to the traditional method of objective structured clinical evaluation. Methods: A quasi-experimental study was carried out on 237 nursing students divided randomly into a control group (n=120) and an experimental group (n=117). The participants completed a questionnaire about their knowledge and then the experimental group also filled out a questionnaire about their game experience and their satisfaction with the game. Results: The finding showed higher than average scores in all the dimensions of the Gameful Experience Scale, except in the dimension of negative effects. Regarding satisfaction, the highest scores were found in the dimensions of activity duration (3.51±0.66); the organisers’ attentiveness to students (3.60±0.61) and applicability of content to their training (3.50±0.58). As for the final evaluation, statistically significant differences were found between both groups (U=759.500; Z=-11.878; p<0.05), and the experimental group had a final average score of 9.59±0.36, while the control group’s was 7.46±1.36. Conclusions: Escape rooms are a useful tool used for evaluation of nursing students as opposed to objective structured clinical evaluation.

  • Leaderboard Design Principles to Improve Motivation in a Gamified Learning Environment: Cases Analysis and Literature Review for Leaderboard Design

    Date Submitted: May 19, 2019

    Open Peer Review Period: May 22, 2019 - Jul 17, 2019

    Background: Gamification in education enhances learners’ motivation, problem-solving and decision making abilities, and social skills such as communication. Numerous on-going studies are examining t...

    Background: Gamification in education enhances learners’ motivation, problem-solving and decision making abilities, and social skills such as communication. Numerous on-going studies are examining the application of gamification design methodology and game mechanics to a learning environment. Leaderboards are a type of game mechanic that assist learners in goal setting and unleash motivation for learning. Objective: This study suggests principles for leaderboard design to assist learners in efficient goal setting, improve learning motivation, and promote learning in gamified learning environments. Methods: This study analyze previous studies on leaderboards that focus on their educational effectiveness and influence on social interactions and apply our findings to leaderboard design principles. Results: This study determined four leaderboard design objectives from previous studies. Based on these objectives, we developed three leaderboard design principles. First, macro leaderboards and micro leaderboards should be designed and used together. Second, all the elements used to measure learners’ achievements in an educational environment should be incorporated into the micro leaderboard. Third, leaderboards should be designed and considered for application in contexts other than the learning environment. This study further analyzes best practices considering the three leaderboard design principles. Conclusions: This study helps to resolve the problems associated with leaderboard design for the application of gamification in educational environments. In classrooms, teachers use existing gamification services. However, this study advocates applying the leaderboard design principles suggested in this research.

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