https://games.jmir.org/issue/feedJMIR Serious Games2022-10-03T10:15:03-04:00JMIR Publicationseditor@jmir.orgOpen Journal Systems This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published JMIR Serious Games, is properly cited. The complete bibliographic information, a link to the original publication on https://games.jmir.org/, as well as this copyright and license information must be included. Serious games for health and social change https://games.jmir.org/2024/1/e49550/ Comparing Walking-Related Everyday Life Tasks of Children with Gait Disorders in a Virtual Reality Setup With a Physical Setup: Cross-Sectional Noninferiority Study2024-03-18T10:30:04-04:00Sophia RhielAndrina KläyUrs KellerHubertus J A van HedelCorinne Ammann-Reiffer<strong>Background:</strong> A frequent rehabilitation goal for children with gait disorders is to practice daily-life walking activities. Unfortunately, these are often difficult to practice in a conventional therapeutic setting. Virtual reality (VR) with head-mounted displays (HMDs) could be a promising approach in neurorehabilitation to train such activities in a safe environment. First, however, we must know whether obstacles in VR are indeed mastered as obstacles. <strong>Objective:</strong> This study aimed to provide information on whether VR is feasible and motivating to induce and practice movements needed to master real obstacles in children and adolescents with gait disorders. Furthermore, this project aims to evaluate which kinds of everyday walking activities are appropriate to be practiced in VR. <strong>Methods:</strong> In this cross-sectional study, participants stepped over a bar, crossed a gap, balanced over a beam, and circumvented stationary obstructions arranged in a course under real physical and virtual conditions wearing a VR HMD. We recorded the respective primary outcomes (step height, step length, step width, and minimal shoulder-obstacle distance) with motion capture. We then calculated the mean differences and 95% CI of the spatiotemporal parameters between the VR and physical setup and later compared them using noninferiority analysis with margins defined a priori by a clinical expert panel. Additionally, the participants responded to a standardized questionnaire while the therapists observed and evaluated their movement performance. <strong>Results:</strong> We recruited 20 participants (mean age 12.0, range 6.6-17.8 years) with various diagnoses affecting their walking ability. At 3.77 (95% CI 1.28 to 6.26) cm, the mean difference in step height of the leading foot in the overstepping task did not exceed the predefined margin of –2 cm, thus signifying noninferiority of the VR condition compared to mastering the physical obstacles. The same was true for step length (–1.75, 95% CI –4.91 to 1.41 cm; margin –10 cm), step width (1.05, 95% CI 0.20 to –1.90 cm; margin 3 cm), and the minimal shoulder-obstacle distance (0.25, 95% CI –0.85 to 0.35 cm; margin –2 cm) in the other tasks. Only the trailing foot in the overstepping task yielded inconclusive results. <strong>Conclusions:</strong> Children with gait disorders perform everyday walking tasks like overstepping, crossing, balancing, or circumventing similarly in physical and VR environments, suggesting that VR could be a feasible therapeutic tool to practice everyday walking tasks. 2024-03-18T10:30:04-04:00 https://games.jmir.org/2024/1/e48545/ An Escape Game on University Students’ Mental Health During the COVID-19 Pandemic: Cocreation Study2024-03-18T10:15:03-04:00David LabrosseClara ViéHana HajjamClément TisseronDimitri ThellierIlaria Montagni<strong>Background:</strong> The COVID-19 pandemic has had a severe impact on students’ mental health. Interventions are needed to promote their psychological well-being and prevent mental illnesses in the aftermath of this unprecedented situation. Digital escape games can be an effective tool to support students’ mental health. A cocreation approach can improve the acceptability of these interventions by involving different stakeholders (eg, end users, game designers, and health professionals) to obtain audience-specific games. <strong>Objective:</strong> This study aims to describe the process of testing and optimizing the game “EscapeCovid” on students’ mental health, to serve as a model for the cocreation of future similar interventions. <strong>Methods:</strong> The PRODUCES (Problem, Objective, Design, End Users, Cocreators, Evaluation, Scalability) framework was used. Cocreation steps (test and optimization) were detailed for replicability. A total of 45 students tested a pilot version of the game, with 10 undergoing a semistructured interview. Meetings with a group of stakeholders and brainwriting were organized to optimize the game. <strong>Results:</strong> We produced a new version of the game incorporating the suggestions provided by student testers and following the stakeholders’ guidelines. Improvements were made to both the content and the form of the new version of the pilot game. The storyline, including the protagonist and the scenes, was adapted to the student population. <strong>Conclusions:</strong> Our results suggested that cocreation can contribute to the design of more widely accepted interventions aimed at promoting mental health and preventing psychological disorders. Results also suggest that an end user–centered approach can facilitate intervention tailoring. When conceiving a health-related escape game for students, we recommend using the cocreation approach to enhance players’ experience, thus positively influencing their learning process and overall well-being. 2024-03-18T10:15:03-04:00 https://games.jmir.org/2024/1/e49218/ Using a Virtual Reality Tool to Provide Primary Prevention Training in the Construction Field Following a Periodic Medical Visit: Cross-Sectional Study2024-03-15T10:45:04-04:00Sylvain ChamotIsabelle MahieuMarion DelzardLéa LeroyGwen MarhicMaxime Gignon<strong>Background:</strong> The construction field is highly concerned with the risk of work-related accidents, and training employees is difficult due to their small numbers in most companies. <strong>Objective:</strong> This study aimed to study the impact of a virtual reality (VR) training tool following a periodic occupational health medical visit on the feeling of personal effectiveness in preventing occupational risks related to co-activity on a construction site. <strong>Methods:</strong> We conducted a cross-sectional study with employees who had a periodic medical visit between April 1, 2022, and October 13, 2022, in a French occupational health service specializing in the construction field (Services Médicaux Interentreprises Bâtiment Travaux Publics [SMIBTP]). The employees were divided into 2 groups according to the training received: a medical visit alone or coupled with a session with a VR tool. We compared the scores for a “feeling of self-efficacy in occupational risk prevention” using the Fisher exact test. <strong>Results:</strong> Of the 588 employees included, 210 had a medical visit alone, and 378 had a medical visit coupled with VR training. Training with the VR tool was associated with an increased “feeling of self-efficacy in occupational risk prevention.” The employees who benefited from the training reported a willingness to apply the advice given on prevention to a greater extent than those who did not, and they believed that risks on the worksite could be reduced using this tool. <strong>Conclusions:</strong> Using VR training as a complement to periodic medical visits in an occupational health service improves the feeling of personal effectiveness in occupational risk prevention at the end of the training. If this trend is confirmed over a longer period of time, it could be an easily accessible prevention lever for employees in the future. 2024-03-15T10:45:04-04:00 https://games.jmir.org/2024/1/e51310/ Smartphone-Based Virtual and Augmented Reality Implicit Association Training (VARIAT) for Reducing Implicit Biases Toward Patients Among Health Care Providers: App Development and Pilot Testing2024-03-07T17:15:28-05:00Jiabin ShenAlex J ClintonJeffrey PenkaMegan E GregoryLindsey SovaSheryl PfeilJeremy PattersonTensing MaaBackground: Implicit bias is as prevalent among healthcare professionals as among the wider population and is significantly associated with lower healthcare quality. Objective: The study goal was to develop and evaluate the preliminary efficacy of an innovative mobile application, Virtual and Augmented Reality-based Implicit Association Training (VARIAT), to reduce implicit biases among Medicaid providers. Methods: An interdisciplinary team developed two interactive case-based training modules for Medicaid providers focused on implicit bias towards lower socioeconomic status (SES) and Sexual Orientation & Gender Identity (SOGI), respectively. The simulations combine experiential learning, facilitated debriefing, and game-based educational strategies. A total of 18 Medicaid providers participated in this pilot study. Outcomes were measured on three domains: training reactions, affective knowledge, and skill-based knowledge related to implicit biases in SES/SOGI. Results: Participants reported high relevance of training to their job for both the SES module (M= 4.75, SD = 0.45) and SOGI module (M = 4.67, SD = 0.50). Significant improvement in skill-based knowledge for minimizing health disparities for LGBTQ+ patients was found post-training (d= 0.72). Participants reported that they expected the training to help improve their relationship and avoid undesirable events with patients. Conclusions: This study developed an innovative smartphone-based implicit bias training program for Medicaid providers and conducted a pilot evaluation on the user experience and preliminary efficacy. Preliminary evidence showed positive satisfaction and preliminary efficacy of the intervention. 2024-03-07T17:15:28-05:00 https://games.jmir.org/2024/1/e34535/ A Smartphone-Gamified Virtual Reality Exposure Therapy Augmented With Biofeedback for Ailurophobia: Development and Evaluation Study2024-03-06T10:00:05-05:00Ali KhaleghiAbbas NarimaniZahra AghaeiAnahita Khorrami BanarakiPeyman Hassani-Abharian<strong>Background:</strong> To the best of our knowledge, no specialized research has been conducted to address ailurophobia (fear of cats) in Iran or globally. This has driven our project, along with the prevalence of ailurophobia and the absence of a gamified virtual reality exposure therapy (VRET) that incorporates affordable and easily accessible biofeedback (BF) tools. We hypothesize that a gamified VRET augmented with BF will yield more positive effects than a similar device lacking BF. <strong>Objective:</strong> This study primarily focuses on the development and preliminary evaluation of a smartphone-gamified VRET integrated with BF, targeting animal phobia, with a specific case study on ailurophobia. The secondary objectives are using affordable and readily available BF found in devices such as smart bands and smartwatches and creating a mobile virtual reality gamified app to improve patients’ adherence to treatments while simultaneously enhancing the app’s accessibility, scalability, and outreach. <strong>Methods:</strong> Evaluations encompassed 3 methods. First, we identified the tool’s potential positive effects on phobia interventions, exploring 4 effects: intrinsic motivation, simulation of fearful situations, management of stressful circumstances without therapists’ presence and mitigation of catastrophic thoughts, and preliminary effects on ailurophobia treatment. Participants were divided into BF and non-BF groups. Second, we gathered user preferences and opinions about the treatment. Third, we conducted heuristic evaluations using 44 heuristics from existing system usability scales assessing user interfaces, virtual reality platforms, and video games’ playability. To interpret the data, mean scores; ANOVA, single factor; and ANOVA, 2-factor with replication were used. A total of 29 individuals were identified, of which 10 met the eligibility criteria or were accessible. <strong>Results:</strong> The smartphone-gamified VRET augmented with BF exhibited better results on the identified effects compared with the non-BF version and contributed to normalizing encounters with cats. Moreover, 41 of the 44 heuristics achieved a percentage above 62%, indicating its potential as a therapeutic product and its ability to enhance patient adherence to treatments. Patient preferences on the treatment and its strengths and weaknesses were provided for further improvement. <strong>Conclusions:</strong> The tool has the potential to evolve into a comprehensive solution by incorporating various types of cats and their behaviors, simulating environments in which they are commonly found, and enhancing its appeal through an increased sense of adventure without inducing unrealistic fears. By adapting fear elements, the game can be tailored to treat various animal phobias. Phobia-focused games should avoid action and combat scenarios to prevent reinforcement of fear responses. After rigorous evaluation, further exploration is required to provide remote use beyond clinical settings. 2024-03-06T10:00:05-05:00 https://games.jmir.org/2024/1/e47257/ Digital Gamification Tools to Enhance Vaccine Uptake: Scoping Review2024-02-29T10:15:04-05:00Hina HakimS Michelle DriedgerDominique GagnonJulien ChevrierGeneviève RochEve DubéHolly O Witteman<strong>Background:</strong> Gamification has been used successfully to promote various desired health behaviors. Previous studies have used gamification to achieve desired health behaviors or facilitate their learning about health. <strong>Objective:</strong> In this scoping review, we aimed to describe digital gamified tools that have been implemented or evaluated across various populations to encourage vaccination, as well as any reported effects of identified tools. <strong>Methods:</strong> We searched Medline, Embase, CINAHL, the Web of Science Core Collection, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Academic Search Premier, PsycInfo, Global Health, and ERIC for peer-reviewed papers describing digital gamified tools with or without evaluations. We also conducted web searches with Google to identify digital gamified tools lacking associated publications. We consulted 12 experts in the field of gamification and health behavior to identify any papers or tools we might have missed. We extracted data about the target population of the tools, the interventions themselves (eg, type of digital gamified tool platform, type of disease/vaccine, type and design of study), and any effects of evaluated tools, and we synthesized data narratively. <strong>Results:</strong> Of 1402 records, we included 28 (2%) peer-reviewed papers and 10 digital gamified tools lacking associated publications. The experts added 1 digital gamified tool that met the inclusion criteria. Our final data set therefore included 28 peer-reviewed papers and 11 digital gamified tools. Of the 28 peer-reviewed papers, 7 (25%) explained the development of the tool, 16 (57%) described evaluation, and 2 (7%) reported both development and evaluation of the tool. The 28 peer-reviewed papers reported on 25 different tools. Of these 25 digital gamified tools, 11 (44%) were web-based tools, 8 (32%) mobile (native mobile or mobile-enabled web) apps, and 6 (24%) virtual reality tools. Overall, tools that were evaluated showed increases in knowledge and intentions to receive vaccines, mixed effects on attitudes, and positive effects on beliefs. We did not observe discernible advantages of one type of digital gamified tool (web based, mobile, virtual reality) over the others. However, a few studies were randomized controlled trials, and publication bias may have led to such positive effects having a higher likelihood of appearing in the peer-reviewed literature. <strong>Conclusions:</strong> Digital gamified tools appear to have potential for improving vaccine uptake by fostering positive beliefs and increasing vaccine-related knowledge and intentions. Encouraging comparative studies of different features or different types of digital gamified tools could advance the field by identifying features or types of tools that yield more positive effects across populations and contexts. Further work in this area should seek to inform the implementation of gamification for vaccine acceptance and promote effective health communication, thus yielding meaningful health and social impacts. 2024-02-29T10:15:04-05:00 https://games.jmir.org/2024/1/e39587/ Assessing the Importance of Content Versus Design for Successful Crowdfunding of Health Education Games: Online Survey Study2024-02-27T15:25:46-05:00Hong HuangHan YuWanwan LiBackground: Health education games make health-related tasks enjoyable and interactive, thereby encouraging user participation. Entrepreneurs and health educators can leverage online crowdfunding platforms, like Kickstarter, to transform their innovative ideas into funded projects. Objective: This research focuses on health education game initiatives on Kickstarter. Through an online user survey, it aims to understand user perceptions and evaluate the significance of eight distinct components that may influence the success of such crowdfunding initiatives. Methods: Seventy-five participants evaluated games using eight dimensions: Game Rules, Learning Objectives, Narrative, Content Organization and User Friendliness, Engagement, Interactivity, Skill Building, and Assessment & Feedback. The survey data was analyzed using descriptive statistical analysis, exploratory factor analysis, the Wilcoxon-Mann-Whitney Test, and multivariate analysis. Results: Exploratory data analysis shows that, among the eight dimensions, Skill Building, Content Organization, and Interactivity are the top-ranking dimensions most closely associated with entrepreneurial game development. The eight dimensions can be grouped into three categories from exploratory factor analysis: content-related, instruction-related, and game design. Further statistical analysis confirmed the correlation between these dimensions with the success of crowdfunding health education games. Conclusions: This empirical analysis identifies critical factors for game proposal design that can increase the likelihood of securing crowdfunding support. 2024-02-27T15:25:46-05:00 https://games.jmir.org/2024/1/e45546/ A Serious Game (“Fight With Virus”) for Preventing COVID-19 Health Rumors: Development and Experimental Study2024-02-26T10:00:04-05:00Shuo XiongLong ZuoQiwei ChenZhang ZeliangMohd Nor Akmal Khalid<strong>Background:</strong> Health rumors arbitrarily spread in mainstream social media on the internet. Health rumors emerged in China during the outbreak of COVID-19 in early 2020. Many midelders/elders (age over 40 years) who lived in Wuhan believed these rumors. <strong>Objective:</strong> This study focused on designing a serious game as an experimental program to prevent and control health rumors. The focus of the study was explicitly on the context of the social networking service for midelders/elders. <strong>Methods:</strong> This research involved 2 major parts: adopting the Transmission Control Protocol model for games and then, based on the model, designing a game named “Fight With Virus” as an experimental platform and developing a cognitive questionnaire with a 5-point Likert scale. The relevant variables for this experimental study were defined, and 10 hypotheses were proposed and tested with an empirical study. In total, 200 participants were selected for the experiments. By collecting relevant data in the experiments, we conducted statistical observations and comparative analysis to test whether the experimental hypotheses could be proved. <strong>Results:</strong> We noted that compared to traditional media, serious games are more capable of inspiring interest in research participants toward their understanding of the knowledge and learning of health commonsense. In judging and recognizing the COVID-19 health rumor, the test group that used game education had a stronger ability regarding identification of the rumor and a higher accuracy rate of identification. Results showed that the more educated midelders/elders are, the more effective they are at using serious games. <strong>Conclusions:</strong> Compared to traditional media, serious games can effectively improve midelders’/elders’ cognitive abilities while they face a health rumor. The gameplay effect is related to the individual’s age and educational background, while income and gender have no impact. 2024-02-26T10:00:04-05:00 https://games.jmir.org/2024/1/e50282/ Immersive Virtual Reality–Based Methods for Assessing Executive Functioning: Systematic Review2024-02-26T09:45:23-05:00Rebecca KirkhamLars KooijmanLucy AlbertellaDan MylesMurat YücelKristian Rotaru<strong>Background:</strong> Neuropsychological assessments traditionally include tests of executive functioning (EF) because of its critical role in daily activities and link to mental disorders. Established traditional EF assessments, although robust, lack ecological validity and are limited to single cognitive processes. These methods, which are suitable for clinical populations, are less informative regarding EF in healthy individuals. With these limitations in mind, immersive virtual reality (VR)–based assessments of EF have garnered interest because of their potential to increase test sensitivity, ecological validity, and neuropsychological assessment accessibility. <strong>Objective:</strong> This systematic review aims to explore the literature on immersive VR assessments of EF focusing on (1) EF components being assessed, (2) how these assessments are validated, and (3) strategies for monitoring potential adverse (cybersickness) and beneficial (immersion) effects. <strong>Methods:</strong> EBSCOhost, Scopus, and Web of Science were searched in July 2022 using keywords that reflected the main themes of VR, neuropsychological tests, and EF. Articles had to be peer-reviewed manuscripts written in English and published after 2013 that detailed empirical, clinical, or proof-of-concept studies in which a virtual environment using a head-mounted display was used to assess EF in an adult population. A tabular synthesis method was used in which validation details from each study, including comparative assessments and scores, were systematically organized in a table. The results were summed and qualitatively analyzed to provide a comprehensive overview of the findings. <strong>Results:</strong> The search retrieved 555 unique articles, of which 19 (3.4%) met the inclusion criteria. The reviewed studies encompassed EF and associated higher-order cognitive functions such as inhibitory control, cognitive flexibility, working memory, planning, and attention. VR assessments commonly underwent validation against gold-standard traditional tasks. However, discrepancies were observed, with some studies lacking reported a priori planned correlations, omitting detailed descriptions of the EF constructs evaluated using the VR paradigms, and frequently reporting incomplete results. Notably, only 4 of the 19 (21%) studies evaluated cybersickness, and 5 of the 19 (26%) studies included user experience assessments. <strong>Conclusions:</strong> Although it acknowledges the potential of VR paradigms for assessing EF, the evidence has limitations. The methodological and psychometric properties of the included studies were inconsistently addressed, raising concerns about their validity and reliability. Infrequent monitoring of adverse effects such as cybersickness and considerable variability in sample sizes may limit interpretation and hinder psychometric evaluation. Several recommendations are proposed to improve the theory and practice of immersive VR assessments of EF. Future studies should explore the integration of biosensors with VR systems and the capabilities of VR in the context of spatial navigation assessments. Despite considerable promise, the systematic and validated implementation of VR assessments is essential for ensuring their practical utility in real-world applications. 2024-02-26T09:45:23-05:00 https://games.jmir.org/2024/1/e53072/ Exploring the Use of a Learning-Based Exergame to Enhance Physical Literacy, Soft Skills, and Academic Learning in School-Age Children: Pilot Interventional Study2024-02-23T10:00:05-05:00Aurelie GoncalvesFlorence LespiauGaëtan BrietEugénie Vaillant-CoindardAngèle PalermoElsa DecobertNathan Allegret-BourdonElodie Charbonnier<strong>Background:</strong> There is ample evidence that most children do not perform enough physical activity (PA). To address this major public health problem, the French government implemented 30 minutes of daily PA (DPA) at schools but did not provide any supplemental resources or concrete guidance. Considering both children’s interest in video games and the need for teachers to complete their curriculum, the use of a learning-based exergame that combines PA and learning appears particularly relevant. <strong>Objective:</strong> The first objective of this study was to evaluate the feasibility of implementing 30 minutes of DPA through exergaming among school-age children. The second objective was to examine the effects of an exergaming program on physical literacy, academic learning, and soft skills (motivation, self-efficacy, and concentration). <strong>Methods:</strong> This interventional study had a pre-post design and used the Play LÜ exergame platform. The study included 79 children with a mean age of 8.9 (SD 1.2) years from grade 2 (7 years old) to grade 5 (11 years old). Play LÜ requires players to throw balls against a wall to reach a target or to activate an object and provides an interactive game area for educational activities linked to specific learning themes. After a 4-session familiarization phase during which the teachers chose to prioritize mathematics learning in 30-minute DPA sessions, students took part in DPA sessions over a period of 3 weeks with Play LÜ and a motor skills circuit behind the LÜ setup to keep them continuously active. All sessions were carried out by PA specialists. Each session started with a warm-up using the Grööve application, continued with main activities promoting mathematics learning adapted to each grade level, and ended with a 3-minute meditation for returning to a calm and serene state using the Gaïa application. Before (T0) and after (T1) the program, students completed a self-evaluation booklet to assess their levels of physical literacy, academic performance, and soft skills. <strong>Results:</strong> The implementation of this exergaming program was welcomed by the school’s administration, teaching staff, and parents. After the program, we observed increased scores for physical literacy (difference +2.6, percentage change +3.6%; <i>W</i>=933.0; <i>P</i>=.002; <i>r</i><sub>rb</sub>=−0.39, 95% CI −0.58 to −0.16) and motivation in mathematics (+0.7, +9.8%; <i>W</i>=381.5; <i>P</i>=.005; <i>r</i><sub>rb</sub>=−0.44, 95% CI −0.66 to −0.16). In addition, it is important to note that some measures progressed differently across learning levels and age groups. <strong>Conclusions:</strong> The study results indicate positive impacts of learning-based exergaming on physical literacy and motivation in mathematics among school-age children. 2024-02-23T10:00:05-05:00