%0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e66167 %T Digital Ergonomics of NavegApp, a Novel Serious Game for Spatial Cognition Assessment: Content Validity and Usability Study %A Sanchez-Escudero,Juan Pablo %A Aguillon,David %A Valencia,Stella %A Garcia-Barrera,Mauricio A %A Aguirre-Acevedo,Daniel Camilo %A Trujillo,Natalia %+ Group of Epidemiology, Universidad de Antioquia, Calle 70 No. 52-21, Medellín, Colombia, 57 6042198332, juanp.sanchez@udea.edu.co %K serious games %K spatial cognition %K digital neuropsychology %K Alzheimer disease %K content validity %K usability %D 2025 %7 2.4.2025 %9 Original Paper %J JMIR Serious Games %G English %X Background: Alzheimer disease (AD) is the leading cause of dementia worldwide. With aging populations and limited access to effective treatments, there is an urgent need for innovative markers to support timely preventive interventions. Emerging evidence highlights spatial cognition (SC) as a valuable source of cognitive markers for AD. This study presents NavegApp, a serious game (SG) designed to assess 3 key components of SC, which show potential as cognitive markers for the early detection of AD. Objective: This study aimed to determine the content validity and usability perception of NavegApp across multiple groups of interest. Methods: A multistep process integrating methodologies from software engineering, psychometrics, and health measurement was implemented to validate the software. Our approach was structured into 3 stages, guided by the software life cycle for health and the Consensus-Based Standards for the Selection of Health Status Measurement Instruments (COSMIN) recommendations for evaluating the psychometric quality of health instruments. To assess content validity, a panel of 8 experts evaluated the relevance and representativeness of tasks included in the app. In addition, 212 participants, categorized into 5 groups based on their clinical status and risk level for AD, were recruited to evaluate the app’s digital ergonomics and usability at various stages of development. Complementary analyses were performed to identify group differences and to explore the association between task difficulty and user agreeableness. Results: NavegApp was validated as a highly usable tool by both experts and users. The expert panel confirmed that the tasks included in the game were representative (Aiken V=0.96-1.00) and relevant (Aiken V=0.96-1.00) for measuring SC components. Both experts and nonexperts rated NavegApp’s digital ergonomics positively, with minimal differences between groups (rrb 0.08-0.29). Differences in usability perceptions were observed among participants with sporadic mild cognitive impairment compared to cognitively healthy individuals (rrb 0.26-0.29). A moderate association was also identified between task difficulty and user agreeableness (Cramér V=0.37, 95% CI 0.28-0.54). Conclusions: NavegApp is a valid and user-friendly SG designed for SC assessment, developed by integrating software engineering and psychometric evaluation methodologies. While the results are promising, further studies are warranted to evaluate its diagnostic accuracy and construct validity. This work outlines a comprehensive framework for SG development in cognitive assessment, emphasizing the importance of incorporating psychometric validity measures from the outset of the design process. %M 40173437 %R 10.2196/66167 %U https://games.jmir.org/2025/1/e66167 %U https://doi.org/10.2196/66167 %U http://www.ncbi.nlm.nih.gov/pubmed/40173437 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e65498 %T Feasibility and Usability of an Artificial Intelligence—Powered Gamification Intervention for Enhancing Physical Activity Among College Students: Quasi-Experimental Study %A Gao,Yanan %A Zhang,Jinxi %A He,Zhonghui %A Zhou,Zhixiong %K physical activity %K gamification %K artificial intelligence %K digital health %K digital intervention %K feasibility study %D 2025 %7 24.3.2025 %9 %J JMIR Serious Games %G English %X Background: Physical activity (PA) is vital for physical and mental health, but many college students fail to meet recommended levels. Artificial intelligence (AI)-powered gamification interventions through mobile app have the potential to improve PA levels among Chinese college students. Objective: This study aimed to assess the feasibility and usability of an AI-powered gamification intervention. Methods: A quasi-experimental study spanning 2 months was conducted on a sample of college students aged 18 to 25 years old from 18 universities in Beijing. PA data were recorded using the ShouTi Fitness app, and participant engagement was evaluated through surveys. User satisfaction was gauged through the System Usability Scale, while the intervention’s feasibility was assessed through Spearman rank correlation analysis, Mann-Whitney tests, and additional descriptive analyses. Results: As of July 2023, we enrolled 456 college students. In total, 18,073 PA sessions were recorded, with men completing 8068 sessions and women completing 10,055 sessions. The average PA intensity was 7 metabolic equivalent of energy (MET)s per session. Most participants preferred afternoon sessions and favored short-duration sessions, with men averaging 66 seconds per session and women 42 seconds. The System Usability Scale score for the intervention based on app is 65.2. Users responded positively to the integration of AI and gamification elements, including personalized recommendations, action recognition, smart grouping, dynamic management, collaborative, and competition. Specifically, 341 users (75%) found the AI features very interesting, 365 (80%) were motivated by the gamification elements, 364 (80%) reported that the intervention supported their fitness goals, and 365 (80%) considered the intervention reliable. A significant positive correlation was observed between the duration of individual PA and intervention duration for men (ρ=0.510, P<.001), although the correlation was weaker for women (ρ=0.258, P=.046). However, the frequency of PA declined after 35 days. Conclusions: This study provides pioneering evidence of the feasibility and usability of the AI-powered gamification intervention. While adherence was successfully demonstrated, further studies or interventions are needed to directly assess the impact on PA levels and focus on optimizing long-term adherence strategies and evaluating health outcomes. %R 10.2196/65498 %U https://games.jmir.org/2025/1/e65498 %U https://doi.org/10.2196/65498 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e57802 %T Gamified mHealth System for Evaluating Upper Limb Motor Performance in Children: Cross-Sectional Feasibility Study %A Mia,Md Raihan %A Ahamed,Sheikh Iqbal %A Nemanich,Samuel %+ Department of Occupational Therapy, Marquette University, 1700 West Wells St, Milwaukee, WI, 53233, United States, 1 4142883243, sam.nemanich@marquette.edu %K mobile health %K mHealth %K digital health %K mobile apps %K smartphones %K iPad %K gamification %K serious games %K digital interventions %K digital technology %K spatiotemporal %K upper limb movement %K motor performance %K motor skills %K pediatrics %K toddler %K children %K youth %D 2025 %7 28.2.2025 %9 Original Paper %J JMIR Serious Games %G English %X Background: Approximately 17% of children in the United States have been diagnosed with a developmental or neurological disorder that affects upper limb (UL) movements needed for completing activities of daily living. Gold-standard laboratory assessments of the UL are objective and precise but may not be portable, while clinical assessments can be time-intensive. We developed MoEvGame, a mobile health (mHealth) gamification software system for the iPad, as a potential advanced technology to assess UL motor functions. Objective: This feasibility study examines whether MoEvGame can assess children’s whole-limb movement, fine motor skills, manual dexterity, and bimanual coordination. The specific aims were to (1) design and develop novel mHealth gamified software tools to examine theory-driven features of UL movement, (2) analyze spatiotemporal game data with new algorithms and statistical techniques to quantify movement performance as a parameter of speed, accuracy, and precision, and (3) validate assessment methods with healthy participants from schools. Methods: Elementary school children (N=31, median 9.0, IQR 4.0-14.0 years old) participated by playing 5 games. The game tasks were focused on key features of skilled motor control: (1) whole limb reaching, (2) fine motor control and manual dexterity, and (3) bilateral coordination. Spatiotemporal game data were transferred and stored in a cloud-based data management server for further processing and analysis. We applied change point detection (ie, the pruned exact linear time method), signal processing techniques, and other algorithms to calculate movement speed and accuracy from spatiotemporal parameters. Different statistical methods (ie, Pearson correlation, mean, standard deviation, P value, 95% confidence interval) were used to compare speed-accuracy tradeoffs and evaluate the relationship between age and motor performance. Results: A negative correlation was identified between speed and accuracy in the whole limb movement (r=–0.30 to –0.42). Significant relationships between age and upper limb performance were found: older participants exhibited lower errors with faster completion times compared to younger participants. Significant differences in bimanual coordination were found related to phase synchronization (in-phase congruent [mean 28.85, SD 18.97] vs antiphase congruent [mean 112.64, SD 25.82] and in-phase mirrored [mean 23.78, SD 16.07] vs antiphase mirrored [mean 121.39, SD 28.19]). Moreover, the average speed (revolutions per second) and travel distance (m) of the in-phase mode were significantly higher than those of the antiphase coordination. Conclusions: Results of this feasibility study show that spatiotemporal data captured from the mHealth app can quantify motor performance. Moving beyond traditional assessments, MoEvGame incorporates gamification into ubiquitous and accessible technology as a fast, flexible, and objective tool for UL motor assessment. %M 40053722 %R 10.2196/57802 %U https://games.jmir.org/2025/1/e57802 %U https://doi.org/10.2196/57802 %U http://www.ncbi.nlm.nih.gov/pubmed/40053722 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e56269 %T A Serious Game to Study Reduced Field of View in Keyhole Surgery: Development and Experimental Study %A Whitley,Phoebe %A Creasey,Connor %A Clarkson,Matthew J %A Thompson,Stephen %+ Advanced Research Computing, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 2076792000, s.thompson@ucl.ac.uk %K keyhole surgery %K laparoscopic surgery %K serious games %K image mosaicking %K field of view %K javascript %K html %K opensource %D 2025 %7 11.2.2025 %9 Original Paper %J JMIR Serious Games %G English %X Background: During keyhole surgery, the surgeon is required to perform highly demanding tasks while only being able to see part of the patient’s anatomy. This limited field of view is widely cited as a key limitation of the procedure, and many computational methods have been proposed to overcome it. However, the precise effects of a limited field of view on task performance remain unknown due to the lack of tools to study these effects effectively. Objective: This paper describes our work on developing a serious game with 2 objectives: (1) to create an engaging game that communicates some of the challenges of keyhole surgery, and (2) to test the effect of a limited field of view on task performance. The development of a serious game that can be played by a wide range of participants will enable us to gather quantitative data on the effects of the reduced field of view on task performance. These data can inform the future development of technologies to help surgeons reduce the impact of a limited field of view on clinical outcomes for patients. The game is open source and may be adapted and used by other researchers to study related problems. Methods: We implemented an open-source serious game in JavaScript, inspired by the surgical task of selectively cauterizing blood vessels during twin-to-twin transfusion surgery. During the game, the player is required to identify and cut the correct blood vessel under different fields of view and varying levels of vascular complexity. We conducted a quantitative analysis of task performance time under different conditions and a formative analysis of the game using participant questionnaires. Results: We recruited 25 players to test the game and recorded their task performance time, accuracy, and qualitative metrics. Reducing the field of view resulted in participants taking significantly longer (P<.001) to perform otherwise identical tasks (mean 6.4 seconds, 95% CI 5.0-7.8 seconds vs mean 13.6 seconds, 95% CI 10.3-16.9 seconds). Participants found the game engaging and agreed that it enhanced their understanding of the limited field of view during keyhole surgery. Conclusions: We recruited 25 players to test the game and recorded their task performance time, accuracy, and qualitative metrics. Reducing the field of view resulted in participants taking statistically significantly longer (16.4 vs 9.8 seconds; P=.05) to perform otherwise identical tasks. Participants found the game engaging and agreed that it enhanced their understanding of the limited field of view during keyhole surgery. %M 39933172 %R 10.2196/56269 %U https://games.jmir.org/2025/1/e56269 %U https://doi.org/10.2196/56269 %U http://www.ncbi.nlm.nih.gov/pubmed/39933172 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e53045 %T Tongue Muscle Training App for Middle-Aged and Older Adults Incorporating Flow-Based Gameplay: Design and Feasibility Pilot Study %A Su,Kuan-Chu %A Wu,Ko-Chiu %A Chou,Kuei-Ru %A Huang,Chia-Hsu %K exergame %K mobile app %K flow %K self-care %K feasibility %K older adults %K dysphagia %K tongue exercises %D 2025 %7 9.1.2025 %9 %J JMIR Serious Games %G English %X Background: Complications due to dysphagia are increasingly prevalent among older adults; however, the tediousness and complexity of conventional tongue rehabilitation treatments affect their willingness to rehabilitate. It is unclear whether integrating gameplay into a tongue training app is a feasible approach to rehabilitation. Objective: Tongue training has been proven helpful for dysphagia treatment. Following the development of a tongue training app, a feasibility trial aimed to identify physiological and psychological factors that affect user and flow experience and explored whether training specialized muscles could produce a flow experience for optimal immersion. We aimed to provide a useful tool for medical rehabilitation so that older adults could retain tongue muscle flexibility. Methods: After consulting professional nurses, we developed a mobile gaming app for middle-aged and older adults to train their tongue muscles. This pilot study used an image recognition system to detect the tongue movements of 32 healthy middle-aged and older adults (7 males, 21.9%; 25 females, 78.1%) during 3 game training tasks, each requiring different reaction speeds. Their physiological and psychological signals, as well as the results of the Flow State Scale 2 (FSS2) questionnaire, were used for correlation analysis regarding relevant flow experiences to establish and evaluate the feasibility of our method. Results: Through exploratory factor analyses, a 2-factor (operation and immersion) structure was confirmed to have an adequate model fit (χ²36=448.478; P<.001; Kaiser-Meyer-Olkin=0.757) and internal consistency reliability (Cronbach α=0.802). The slow, medium, and fast levels all significantly affected the FSS2 score for operation (P=.001), the National Aeronautics and Space Administration Task Load Index (P<.001), and flow distance (P<.001). K-means clustering revealed that participants could be further categorized into 3 groups. Through the analysis of changes in the participants’ physiological and psychological signals for each given task, Pearson correlation indicated that changes were primarily related to flow distance. For the 12 indicators measured in this study, the low, medium, and high operation groups showed significance in 58% (7/12), 50% (6/12), and 25% (3/12) of the indicators, respectively. Similarly, the low, medium, and high immersion groups had changes in 50% (6/12), 33% (4/12), and 17% (2/12) of indicators, respectively. Conclusions: Our research supports the further development of a gaming app to aid older adults with tongue muscle training and measure flow using physiological and psychological signals to enhance training accuracy and feasibility. Next, we aim to conduct a randomized pilot trial, improve app functions, offer alternative rehabilitation options, and encourage long-term participation. Future goals include enhancing long-term efficacy, diversifying training modes, and adding a multiuser interactive option for an added challenge. %R 10.2196/53045 %U https://games.jmir.org/2025/1/e53045 %U https://doi.org/10.2196/53045 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e57030 %T User Experience of a Semi-Immersive Musical Serious Game to Stimulate Cognitive Functions in Hospitalized Older Patients: Questionnaire Study %A Samson,Laurent %A Carcreff,Lena %A Noublanche,Frédéric %A Noublanche,Sophie %A Vermersch-Leiber,Hélène %A Annweiler,Cédric %K virtual reality %K geriatrics %K reminiscence %K episodic memory %K serious game %K neurocognitive disorders %K older adults %K user experience %D 2025 %7 6.1.2025 %9 %J JMIR Serious Games %G English %X Background: Reminiscence therapy through music is a psychosocial intervention with benefits for older patients with neurocognitive disorders. Therapies using virtual or augmented reality are efficient in ecologically assessing, and eventually training, episodic memory in older populations. We designed a semi-immersive musical game called “A Life in Songs,” which invites patients to immerse themselves in a past era through visuals and songs from that time period. The game aspires to become a playful, easy-to-use, and complete tool for the assessment, rehabilitation, and prevention of neurocognitive decline associated with aging. Objective: This study aimed to assess the user experience (UX) associated with the newly designed serious game. Methods: After one or several sessions of the game guided by the therapist, patients of the geriatric wards were asked to answer questions selected from 2 widely known UX scales (AttrakDiff and meCUE [modular evaluation of the components of user experience]) with the therapist’s help. The internal consistency of the UX dimensions was assessed through Cronbach α to verify the validity of the dimensions. The level of engagement of the patient throughout the experimental session was also assessed following an internally developed scale, which included 5 levels (interactive, constructive, active, passive, and disengaged behaviors). UX mean scores were computed and presented graphically. Verbal feedbacks were reported to support the quantitative results. Results: Overall, 60 inpatients with a mean age of 84.2 (SD 5.5) years, the majority of whom were women (41/60, 68%), were included. Their score on the Mini-Mental State Examination (MMSE) ranged between 12 and 29. A majority of patients (27/56, 48%) had no major neurocognitive disorder (MNCD), 22/56 (39%) had mild MNCD, and 7/56 (13%) had moderate MNCD. The results revealed very positive UX with mean values beyond the neutral values for every UX dimension of both scales. The overall mean (SD) judgment was rated 3.92 (SD 0.87) (on a scale of −5 to 5). Internal consistency was acceptable to good for the emotional dimensions of the meCUE. Questionable to unacceptable consistency was found for the other UX dimensions. Participants were mostly active (23/60, 38%) and constructive (21/60, 35%). Conclusions: These findings demonstrated a very good appreciation of the game by geriatric inpatients. Participants’ and health care professionals’ verbal comments strongly aligned with the quantitative results. The poor internal consistency in the UX dimensions reflected the high heterogeneity among the included patients. Further studies are needed to evaluate the potential benefits of clinical factors such as neurocognitive functions, mood, depression, or quality of life. %R 10.2196/57030 %U https://games.jmir.org/2025/1/e57030 %U https://doi.org/10.2196/57030 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e49847 %T Perceptions of Patients With Stroke Regarding an Immersive Virtual Reality–Based Exercise System for Upper Limb Rehabilitation: Questionnaire and Interview Study %A Chen,Jiayin %A Or,Calvin Kalun %A Li,Zhixian %A Yeung,Eric Hiu Kwong %A Chen,Tianrong %+ Department of Data and Systems Engineering, University of Hong Kong, Room 8-7, Haking Wong Building, The University of Hong Kong, Pokfulam Road, Hong Kong, China (Hong Kong), 852 39172587, klor@hku.hk %K virtual reality %K stroke %K perception %K rehabilitation %K questionnaire %K interview %D 2025 %7 1.1.2025 %9 Original Paper %J JMIR Serious Games %G English %X Background: With substantial resources allocated to develop virtual reality (VR)–based rehabilitation exercise programs for poststroke motor rehabilitation, it is important to understand how patients with stroke perceive these technology-driven approaches, as their perceptions can determine acceptance and adherence. Objective: This study aimed to examine the perceptions of patients with stroke regarding an immersive VR-based exercise system developed to deliver shoulder, elbow, forearm, wrist, and reaching exercises. Methods: A questionnaire was used to assess the perceptions of 21 inpatients who had experienced stroke (mean time from stroke onset: 37.2, SD 25.9 days; Brunnstrom stage of stroke recovery for the arm: 3-5) regarding the perceived usefulness of, ease of use of, attitude toward, intrinsic motivation for, and intention to use the exercise system. The measurement items were rated on a 7-point Likert scale ranging from 1 (very strongly disagree) to 7 (very strongly agree), with higher values indicating more positive perceptions. Descriptive statistics were used to summarize the responses. Moreover, we conducted semistructured interviews that were audio recorded, transcribed, and subjected to content analysis to identify thematic patterns. Results: The questionnaire results revealed that the patients’ perceptions of the exercise system were positive (mean ratings >6). The content analysis revealed 6 positive themes from 73 statements about the exercise system: ease of use, usefulness, enjoyment, motivation, accessibility, and game design. Conversely, 15 statements reflected negative perceptions, which were clustered into 3 themes: difficulty in handling VR devices, uncomfortable experiences when using VR devices, and monotony. Conclusions: Integrating VR technology into poststroke functional exercises holds significant promise based on patient interests. However, patient preferences and adaptability must be considered to promote the technology’s success. VR-guided exercises should be user-friendly, health-promoting, engaging, and well-designed. Furthermore, addressing challenges, such as bulkiness, motion sickness, discomfort, and exercise monotony, is crucial for the widespread adoption and diffusion of this technology. %M 39742513 %R 10.2196/49847 %U https://games.jmir.org/2025/1/e49847 %U https://doi.org/10.2196/49847 %U http://www.ncbi.nlm.nih.gov/pubmed/39742513 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e58452 %T Game-Based Promotion of Assertiveness to Mitigate the Effects of Bullying in High School Students: Development and Evaluation Study %A Lepe-Salazar,Francisco %A Mejía-Romero,Fernando %A Benicio-Rodríguez,Dámaso %A Hernández-Reyes,Aylin %A Nakajima,Tatsuo %A Salgado-Torres,Sarita %+ Ludolab, Nigromante 89, Centro, Colima, 28030, Mexico, 52 3121100163, flepe@ludolab.org %K serious games %K bullying %K assertiveness %K multiple composite scenarios %K scenario %K cognitive behavioral therapy %K gaming %K design %K development %K bully %K assertive %K feasibility %D 2024 %7 24.12.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: For years, Mexico has reported the highest global incidence of school bullying, with approximately 19% of students going through some form of hostile peer interactions. Despite numerous interventions, these harmful conducts remain deeply entrenched in educational environments. Objective: To address this issue, we developed Bernstein, a serious game that promotes assertiveness—an essential protective factor that reduces the negative effects of bullying. Methods: Bernstein was designed using multiple composite scenarios, a methodology grounded in cognitive behavioral therapy. To evaluate the game’s effectiveness, we conducted an exploratory trial using the Rathus Assertiveness Schedule to assess assertiveness levels before and after the intervention. Participants were high school students who met the inclusion criteria of being open to playing a serious game (with no prior gaming experience required) and having access to a computer with internet connectivity for remote participation. A total of 100 students (65 boys and 35 girls) enrolled in the intervention; however, only 46 participants in the treatment group and 46 in the control group completed the study, resulting in a dropout rate of 8% (8/100). A paired 1-tailed t test was used to compare pre- and postintervention scores within each group, and a one-way ANOVA was conducted to compare the average score improvements between the 2 groups. Results: The treatment group showed a pretest mean Rathus Assertiveness Schedule score of –2.78 (SD 25.93) and a posttest mean of 1.69 (SD 29.48), with a paired 1-tailed t test yielding a P value of .01. The control group had a pretest mean of 2.07 (SD 25.69) and a posttest mean of –2.39 (SD 32.98), with a paired 1-tailed t test yielding a P value of .04. The one-way ANOVA (between groups) yielded a P value of .006, indicating a statistically significant difference, favoring Bernstein over the alternative protocol. Participant feedback highlighted the game’s engaging narrative and character design, although usability issues, such as navigation challenges, were noted as areas for improvement. Conclusions: The results suggest that Bernstein is a promising tool for promoting assertiveness in high school students, providing a potential strategy for addressing bullying-related issues. The study underscores the value of integrating Bernstein into educational programs, offering students a safe and interactive environment to develop resilience. As an exploratory trial, this study faced limitations affecting the generalizability of findings, including the remote format’s impact on facilitator guidance and a relatively small sample size. Further trials with larger, more diverse groups are recommended to validate these early results and enhance Bernstein’s scalability as part of a comprehensive antibullying strategy. %M 39718822 %R 10.2196/58452 %U https://games.jmir.org/2024/1/e58452 %U https://doi.org/10.2196/58452 %U http://www.ncbi.nlm.nih.gov/pubmed/39718822 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e60155 %T The Effect of the Mediterranean Diet–Integrated Gamified Home-Based Cognitive-Nutritional (GAHOCON) Training Programme for Older People With Cognitive Frailty: Pilot Randomized Controlled Trial %A Kwan,Rick Yiu Cho %A Law,Queenie Pui Sze %A Tsang,Jenny Tsun Yee %A Lam,Siu Hin %A Wang,Kam To %A Sin,Olive Shuk Kan %A Cheung,Daphne Sze Ki %+ School of Nursing, Tung Wah College, Ma Kam Chan Memorial Building, 31 Wylie Road, Homantin, Hong Kong SAR, China (Hong Kong), 852 34686813, rickkwan@twc.edu.hk %K cognitive frailty %K gamification %K health education %K Mediterranean diet %K home based %K cognitive training %K older adults %K geriatric %K elderly %K cognitive training %K cognitive function %K health education %K intervention %K nutritional education %K cognitive impairment %K dementia %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Cognitive frailty is known to be associated with both nutrition and cognitive training. However, effective treatments that engage older adults with cognitive frailty in both the Mediterranean diet and cognitive training are lacking. Objective: This study aims to examine the feasibility and preliminary effects of Gamified Home-Based Cognitive-Nutritional (GAHOCON) on older adults with cognitive frailty, focusing on Mediterranean diet knowledge, adherence to the Mediterranean diet, cognitive function, physical frailty, grip strength, walking speed, memory, and body composition. Methods: This study applied a 2-center, assessor-blinded, 2-parallel-group, noninferiority, randomized controlled trial design. Eligible participants were community-dwelling adults aged 60 years or older, living with cognitive frailty, and exhibiting poor adherence to the Mediterranean diet. Participants were randomly assigned to the intervention or control group in a 1:1 ratio. In the intervention group, participants received 4 weeks of center-based training (health education) followed by 8 weeks of home-based training (GAHOCON). In the control group, participants received only the 4 weeks of center-based training and 8 weeks of self-revision of health educational materials at home. During the intervention period, time spent by the participants and the levels of difficulty completed by them weekly on GAHOCON were measured as markers of feasibility. The outcomes included Mediterranean diet knowledge, adherence to the Mediterranean diet, cognitive function, physical frailty, grip strength, walking speed, memory, and body composition. Data were collected at baseline (T0) and 1 week postintervention (T1). The Wilcoxon signed rank test was used to examine within-group effects for the outcome variables in each group separately. Results: A total of 25 participants were recruited, with 13 allocated to the intervention group and 12 to the control group. The median cumulative minutes spent on GAHOCON training increased from 117 to 926 minutes. The median level of difficulty completed for game 1 increased from level 14 to level 20, while for game 2, it increased from level 2 to level 24. After the completion of the interventions, Mediterranean diet knowledge was retained in the intervention group but significantly decreased in the control group (r=–0.606, P=.04). Significant improvements were observed in the intervention group in Mediterranean diet adherence (r=–0.728, P=.009), cognitive function (r=–0.752, P=.007), physical frailty (r=–0.668, P=.02), and walking speed (r=–0.587, P=.03), but no such improvements were seen in the control group. Conclusions: GAHOCON is feasible in engaging older adults with cognitive frailty to regularly participate in the intervention. Preliminary evidence suggests that it can retain Mediterranean diet knowledge following nutritional education, improve adherence to the Mediterranean diet, and enhance global cognitive function, physical frailty, and walking speed. However, the difficulty of the later levels of game 1 may be too high. Future studies should adjust the difficulty level of game 1. Additionally, trials with larger sample sizes and longer follow-up periods are needed to confirm its effects. Trial Registration: ClinicalTrials.gov NCT05207930; https://clinicaltrials.gov/ct2/show/NCT05207930 %M 39671585 %R 10.2196/60155 %U https://rehab.jmir.org/2024/1/e60155 %U https://doi.org/10.2196/60155 %U http://www.ncbi.nlm.nih.gov/pubmed/39671585 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47754 %T Effectiveness of Game-Based Training of Selective Voluntary Motor Control in Children With Upper Motor Neuron Lesions: Randomized Multiple Baseline Design Study %A Fahr,Annina %A Kläy,Andrina %A Coka,Larissa S %A van Hedel,Hubertus J A %+ Swiss Children's Rehab, University Children's Hospital Zurich, Mühlebergstrasse 104, Affoltern am Albis, 8910, Switzerland, 41 44 762 52 91, hubertus.vanhedel@kispi.uzh.ch %K neurorehabilitation %K single-case design %K interactive computer play %K cerebral palsy %K surface electromyography %K motor control %K mirror movements %K involuntary movements %D 2024 %7 18.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Selective voluntary motor control (SVMC) is the ability to control joint movements independently. Impairments in SVMC can affect functional activities, but only a few interventions directly target SVMC. Therefore, we developed a game-based intervention for children with upper motor neuron lesions to improve SVMC. The intervention trained selective activation of a muscle or joint movement while providing immediate feedback about involuntarily occurring muscle activations or movements in another joint. The intervention was provided in a playful manner with a custom-made game environment and a technology-based interface to capture muscle activation or joint movements. Objective: This study aimed to investigate the effectiveness of this game-based intervention and explore treatment response–related factors in children with impaired SVMC undergoing inpatient neurorehabilitation. Methods: We conducted a single-case research study with a randomized, nonconcurrent, multiple baseline design. The study consisted of a random-length baseline phase where no SVMC-specific intervention was provided and an intervention phase with additional SVMC training. Concurrently in both phases, children attended their individual multimodal rehabilitation program at our clinic, Swiss Children’s Rehab. During the intervention phase, participants completed ten 45-minute sessions with our game-based SVMC training. SVMC was measured repeatedly throughout both phases and at the 3-month follow-up with a short custom-made assessment. Results: Eighteen children with reduced SVMC from upper motor neuron lesions participated in the study. The mean age of the children was 12.7 (SD 2.9) years, and they mostly had spastic cerebral palsy. A linear mixed-effects model revealed a significant trend (P<.001) for improved SVMC already in the baseline phase. This trend did not change significantly (P=.15) when the game-based SVMC training was introduced in the intervention phase, suggesting no additional improvements due to the SVMC training. Although we could not find an overall treatment effect, we could explain 89.4% of the total random variation of the treatment effect by patient and therapy characteristics. Children with spasticity in the trained movement (20.1%), and those who trained the more affected side (23.5%) benefited most from the intervention. At the 3-month follow-up, SVMC had deteriorated compared to the end of the intervention but was still better than at the beginning of the study. Conclusions: The regular concomitant rehabilitation program already yielded improvements in SVMC, while the game-based SVMC training showed no additional effects. Although the intervention did not show a group effect, we could identify patient and therapy characteristics that determine who is likely to profit from the intervention. Trial Registration: German Clinical Trials Register DRKS00025184; https://tinyurl.com/msnkek9b %M 39556826 %R 10.2196/47754 %U https://formative.jmir.org/2024/1/e47754 %U https://doi.org/10.2196/47754 %U http://www.ncbi.nlm.nih.gov/pubmed/39556826 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e13723 %T Developing Game-Based Design for eHealth in Practice: 4-Phase Game Design Process %A de Vette,Frederiek %A Ruiz-Rodriguez,Aurora %A Tabak,Monique %A Oude Nijeweme-d'Hollosy,Wendy %A Hermens,Hermie %A Vollenbroek-Hutten,Miriam %+ Biomechanical Engineering Group, Faculty of Engineering Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 53 489 5798, a.ruizrodriguez@utwente.nl %K game based %K gamification %K game %K eHealth %K telemedicine %K development %K design %K engagement %K game preferences %K older adults %K self-management %K prototyping %K evaluations %K creative %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Games are increasingly used in eHealth as a strategy for user engagement. There is an enormous diversity of end users and objectives targeted by eHealth. Hence, identifying game content that drives and sustains engagement is challenging. More openness in the game design process and motivational strategies could aid researchers and designers of future game-based apps. Objective: This study aims to provide insights into our approach to develop game-based eHealth in practice with a case study (Personalised ICT Supported Services for Independent Living and Active Ageing [PERSSILAA]). PERSSILAA is a self-management platform that aims to counter frailty by offering training modules to older adults in the domains of healthy nutrition and physical and cognitive training to maintain a healthy lifestyle. We elaborate on the entire game design process and show the motivational strategies applied. Methods: We introduce four game design phases in the process toward game-based eHealth: (1) end-user research, (2) conceptualization, (3) creative design, and (4) refinement (ie, prototyping and evaluations). Results: First, 168 participants participated in end-user research, resulting in an overview of their preferences for game content and a set of game design recommendations. We found that conventional games popular among older adults do not necessarily translate well into engaging concepts for eHealth. Recommendations include focusing game concepts on thinking, problem-solving, variation, discovery, and achievement and using high-quality aesthetics. Second, stakeholder sessions with development partners resulted in strategies for long-term engagement using indicators of user performance on the platform’s training modules. These performance indicators, for example, completed training sessions or exercises, form the basis for game progression. Third, results from prior phases were used in creative design to create the game “Stranded!” The user plays a person who is shipwrecked who must gather parts for a life raft by completing in-game objectives. Finally, iterative prototyping resulted in the final prototype of the game-based app. A total of 35 older adults participated using simulated training modules. End users scored appreciation (74/100), ease of use (73/100), expected effectivity and motivation (62/100), fun and pleasantness of using the app (75/100), and intended future use (66/100), which implies that the app is ready for use by a larger population. Conclusions: The study resulted in a game-based app for which the entire game design process within eHealth was transparently documented and where engagement strategies were based on extensive user research. Our user evaluations indicate that the strategies for long-term engagement led to game content that was perceived as engaging by older adults. As a next step, research is needed on the user experience and actual engagement with the game to support the self-management of older adults, followed by clinical studies on its added value. %M 39514861 %R 10.2196/13723 %U https://formative.jmir.org/2024/1/e13723 %U https://doi.org/10.2196/13723 %U http://www.ncbi.nlm.nih.gov/pubmed/39514861 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e59141 %T Home-Based, Low-Intensity, Gamification-Based, Interactive Physical-Cognitive Training for Older Adults Using the ADDIE Model: Design, Development, and Evaluation of User Experience %A Kamnardsiri,Teerawat %A Kumfu,Sirintip %A Munkhetvit,Peeraya %A Boripuntakul,Sirinun %A Sungkarat,Somporn %K exergame %K physical-cognitive training %K computer-based interventions %K gamification %K older adults %K instructional design model %K low-intensity %D 2024 %7 29.10.2024 %9 %J JMIR Serious Games %G English %X Background: Declines in physical and cognitive function are natural biological processes, leading to an increased risk of falls. Promising evidence suggests that combined physical-cognitive exercise has beneficial effects in improving both physical and cognitive health. Although moderate-to-high exercise intensity is commonly recommended, it might be impractical for older adults facing physical limitations or contraindications. Thus, low-intensity exercise is a viable option. The main barriers to engaging in exercise in older adults include transportation, time, motivation, and enjoyment. To overcome these challenges, a home-based, gamification-based training system may provide an effective approach to enhance exercise adherence. Objective: This study aimed to develop and evaluate the usability of a low-intensity, gamification-based, interactive physical-cognitive exercise for older adults in a home-based setting. Methods: The prototype of a game-based physical-cognitive exercise was created following the ADDIE model (analysis, design, development, implementation, and evaluation) and assessed for user experience in older adults. A total of 15 older adults engaged in the game-based physical-cognitive exercise at home for 60 minutes per day, 3 days per week, for 4 weeks. The usability of the game-based training system was evaluated using the system usability scale (SUS) after completion of a 4-week training program. As for satisfaction, the 8-item Physical Activity Enjoyment Scale (PACES) questionnaire was used to assess participants’ enjoyment level after 1 week and 4 weeks of training. Descriptive statistics were used to illustrate the SUS score. A Wilcoxon signed-rank test was used to compare the PACES scores between the first week and the end of the 4-week period, with significance set at P<.05. Results: As for experts’ consensus, the game-based training consisted of 3 games: Ocean Diver, Road Runner, and Moving and Memorizing. The games had 3 levels of difficulty: beginner, intermediate, and advanced. A computer vision–based system was selected as the delivery platform for a home setting. The total SUS score for all participants was mean 87.22 (SD 5.76), indicating the user’s perception of the usability of a system ranging from good to excellent. At the end of the 4-week training, the total PACES score was significantly greater than the first week, suggesting an improvement in enjoyment (first week: mean 44.93, SD 3.99 vs fourth week: mean 50.53, SD 4.70; P=.001). Conclusions: The prototype of low-intensity, gamification-based, interactive physical-cognitive training was designed and developed using the ADDIE model, which included both experts and end users in the process. The findings showed that the exergame prototype was a usable and practical approach for a home-based setting, enhancing older adults’ enjoyment and motivation. Further research is warranted to determine the effectiveness of such gamification-based training in promoting physical and cognitive functions. %R 10.2196/59141 %U https://games.jmir.org/2024/1/e59141 %U https://doi.org/10.2196/59141 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e52563 %T Examining the Feasibility, Acceptability, and Preliminary Efficacy of an Immersive Virtual Reality–Assisted Lower Limb Strength Training for Knee Osteoarthritis: Mixed Methods Pilot Randomized Controlled Trial %A Lo,Hermione Hin Man %A Ng,Marques %A Fong,Pak Yiu Hugo %A Lai,Harmony Hoi Ki %A Wang,Bo %A Wong,Samuel Yeung-shan %A Sit,Regina Wing Shan %K virtual reality %K VR %K immersive %K knee %K joint %K arthritis %K arthritic %K osteoarthritis %K knee osteoarthritis %K gerontology %K geriatric %K older adult %K elder %K elderly %K older person %K older people %K aging %K pain %K function %K acceptability %K user experience %K RCT %K randomized %K controlled trial %K limb %K strength %K muscle %K muscular %K physiotherapy %D 2024 %7 27.9.2024 %9 %J JMIR Serious Games %G English %X Background: Knee osteoarthritis prevalently causes significant pain, activity limitations, psychological distress, and reduced quality of life. Despite lower limb strength training being a core treatment for knee osteoarthritis, adherence remains a challenge, prompting the exploration of virtual reality (VR) to improve exercise compliance. Recent research suggests the potential of VR in providing enhanced pain management and functional outcomes for knee osteoarthritis, necessitating further exploration of immersive VR technology. Objective: We aimed to study the feasibility, acceptability, and preliminary efficacy of an immersive VR-assisted lower limb strength training for knee osteoarthritis (VRiKnee). Methods: A convergent, parallel, mixed methods study was conducted in 30 participants with knee osteoarthritis. After 1:1 randomization, the VRiKnee group (n=15) was assigned to perform repetitive concentric quadriceps and isometric vastus medialis oblique exercise in an immersive environment using a head-mounted display for 12 weeks. The control group (n=15) completed the same exercises without VRiKnee. VRiKnee participants were interviewed at week 12 to study VRiKnee acceptability and user experience. Quantitative data included feasibility outcomes such as recruitment, dropout, and exercise adherence rates, and effectiveness outcomes such as the numeric rating scale, the Western Ontario and McMaster Universities Osteoarthritis Index (100 points) pain and function subscales, and objective physical activity measured by metabolic equivalents of task using an ActivPAL accelerometer. Qualitative data were analyzed by thematic analysis, followed by integration with quantitative data using joint displays. Results: The recruitment rate was 100% (N=30), with enrollment of 30 participants in 7.57 weeks. The median age was 63.5 (IQR 61.8‐66.3) years, with 76% (n=23) being female. The response rates were 80% and 93% for the VRiKnee and control groups. Dropout rates were 13% for VRiKnee and 7% for the control group. Median exercise adherence was 77% (IQR 37-104%) for VRiKnee and 62% (IQR 40-166%) for the control group, respectively, with adherence reduction over this study’s period and no significant intergroup differences (P=.82). No statistically significant differences were observed in primary and secondary outcomes, though positive trends were observed in pain and stiffness. Cybersickness was reported by 5 (33%) participants in the VRiKnee group. In the qualitative analysis, 4 themes, 11 subthemes, and 16 quotes were generated, identifying facilitators and barriers with practical suggestions to enhance the usability of VRiKnee. Conclusions: VRiKnee demonstrated feasibility, acceptability, and potential efficacy in managing knee osteoarthritis. Future trials of larger sample sizes and better VR designs will confirm its role in clinical practice. Trial Registration: Chinese Clinical Trial Registry CHiCTR2100046313; https://www.chictr.org.cn/showprojEN.html?proj=125404 %R 10.2196/52563 %U https://games.jmir.org/2024/1/e52563 %U https://doi.org/10.2196/52563 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e54082 %T Acceptability of a Serious Game About Proton Radiotherapy Designed for Children Aged 5 to 14 Years and Its Potential Impact on Perceived Anxiety: Feasibility and Randomized Controlled Pilot Trial %A Cederved,Catarina %A Ljungman,Gustaf %A Back,Jon %A Ångström-Brännström,Charlotte %A Engvall,Gunn %K anxiety %K feasibility %K acceptability %K pediatric oncology %K psychological preparation %K proton radiotherapy %K serious game %K games %K cancer %D 2024 %7 23.9.2024 %9 %J JMIR Serious Games %G English %X Background: Children who are going to undergo radiotherapy have displayed fear and anxiety. Therefore, a web-based serious game was developed as a psychological preparation to investigate if it could affect anxiety levels. In an earlier stage, children with experience of radiotherapy had been part of the developmental process. Objective: The study aimed to investigate the feasibility in terms of reach, usability, and acceptability of a serious game about proton radiotherapy and to pilot that it did not increase anxiety levels in children aged 5 to 14 years undergoing radiotherapy. Methods: The design was a randomized controlled pilot trial with predefined feasibility criteria. In total, 28 children were assessed for eligibility, and 23 met the inclusion criteria. They were consecutively randomized into 1 of 2 study arms. One child was excluded after randomization. If randomized into arm 1, the children received the intervention before treatment started. Children in arm 2 were treated as controls. Questionnaires with fixed answers were used to assess anxiety levels (an adapted version of the State-Trait Anxiety Inventory for Children) and experiences of gameplay (an adapted version of Player Experience of Need Satisfaction [PENS]). The children were asked to answer questionnaires at 5 different measurement occasions during their radiotherapy treatment. Results: In arm 1, age ranged from 5 to 13 (mean 8.4, SD 2.4) years. In arm 2, age ranged from 5 to 11 (mean 7.6, SD 2.3) years. The sample consisted of 15 girls and 7 boys. The feasibility criterion that the children should play the game for 20 minutes or more was not met. Mean playtime for children in arm 1 was 32.1 (SD 23.8) minutes, where 18 children had played for at least 15 minutes. The criterion that 70% (n=16) or more of the participants should return all of the questionnaires was not met; however, more than 73% (n=16) returned the PENS questionnaires. The State-Trait Anxiety Inventory for Children was returned by 73% (n=16) on day 0, 77% (n=17) on day 1, 82% (n=18) on day 3, 82% (n=18) on day 6, and 86% (n=19) on day 15. Conclusions: All feasibility criteria set for the study were not met, suggesting that adaptions need to be made if a future study is to be undertaken. Further, the analysis revealed that there was no indication that playing increased the children’s self-reported anxiety. The PENS questionnaire adapted for children showed promising results regarding player satisfaction when using the serious game. When studying children with severe conditions and young age, 5 measurement occasions seemed to be too many. Measuring both player satisfaction or experience and knowledge transfer would be preferable in future studies. Trial Registration: ClinicalTrials.gov NCT04728555; https://clinicaltrials.gov/study/NCT04728555 %R 10.2196/54082 %U https://games.jmir.org/2024/1/e54082 %U https://doi.org/10.2196/54082 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55613 %T Digital Gamification Tool (Let’s Control Flu) to Increase Vaccination Coverage Rates: Proposal for Algorithm Development %A Lopes,Henrique %A Baptista-Leite,Ricardo %A Hermenegildo,Catarina %A Atun,Rifat %+ NOVA Center for Global Health, NOVA Information Management School, Universidade Nova de Lisboa, Campus de Campolide, Lisbon, 1070-312, Portugal, 351 962499020, hlopes@novaims.unl.pt %K influenza %K gamification %K public health policies %K vaccination coverage rates %K health promotion %D 2024 %7 10.9.2024 %9 Proposal %J JMIR Res Protoc %G English %X Background: Influenza represents a critical public health challenge, disproportionately affecting at-risk populations, including older adults and those with chronic conditions, often compounded by socioeconomic factors. Innovative strategies, such as gamification, are essential for augmenting risk communication and community engagement efforts to address this threat. Objective: This study aims to introduce the “Let’s Control Flu” (LCF) tool, a gamified, interactive platform aimed at simulating the impact of various public health policies (PHPs) on influenza vaccination coverage rates and health outcomes. The tool aligns with the World Health Organization’s goal of achieving a 75% influenza vaccination rate by 2030, facilitating strategic decision-making to enhance vaccination uptake. Methods: The LCF tool integrates a selection of 13 PHPs from an initial set proposed in another study, targeting specific population groups to evaluate 7 key health outcomes. A prioritization mechanism accounts for societal resistance and the synergistic effects of PHPs, projecting the potential policy impacts from 2022 to 2031. This methodology enables users to assess how PHPs could influence public health strategies within distinct target groups. Results: The LCF project began in February 2021 and is scheduled to end in December 2024. The model creation phase and its application to the pilot country, Sweden, took place between May 2021 and May 2023, with subsequent application to other European countries. The pilot phase demonstrated the tool’s potential, indicating a promising increase in the national influenza vaccination coverage rate, with uniform improvements across all targeted demographic groups. These initial findings highlight the tool’s capacity to model the effects of PHPs on improving vaccination rates and mitigating the health impact of influenza. Conclusions: By incorporating gamification into the analysis of PHPs, the LCF tool offers an innovative and accessible approach to supporting health decision makers and patient advocacy groups. It enhances the comprehension of policy impacts, promoting more effective influenza prevention and control strategies. This paper underscores the critical need for adaptable and engaging tools in PHP planning and implementation. International Registered Report Identifier (IRRID): RR1-10.2196/55613 %M 39255031 %R 10.2196/55613 %U https://www.researchprotocols.org/2024/1/e55613 %U https://doi.org/10.2196/55613 %U http://www.ncbi.nlm.nih.gov/pubmed/39255031 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e54193 %T A Virtual Reality Serious Game for the Rehabilitation of Hand and Finger Function: Iterative Development and Suitability Study %A Bressler,Michael %A Merk,Joachim %A Gohlke,Tanja %A Kayali,Fares %A Daigeler,Adrien %A Kolbenschlag,Jonas %A Prahm,Cosima %+ BG Klinik Tuebingen, Clinic for Hand, Plastic, Reconstructive and Burn Surgery, University of Tuebingen, Schnarrenbergstrasse 95, Tuebingen, 72076, Germany, 49 650 4432134, michael.bressler.hprv@gmail.com %K video games %K virtual reality %K exercise therapy %K physical therapy %K hand rehabilitation %K finger rehabilitation %D 2024 %7 27.8.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Restoring hand and finger function after a traumatic hand injury necessitates a regimen of consistent and conscientious exercise. However, motivation frequently wanes due to unchallenging repetitive tasks or discomfort, causing exercises to be performed carelessly or avoided completely. Introducing gamification to these repetitive tasks can make them more appealing to patients, ultimately increasing their motivation to exercise consistently. Objective: This study aims to iteratively develop a serious virtual reality game for hand and finger rehabilitation within an appealing and engaging digital environment, encouraging patient motivation for at least 2 weeks of continuous therapy. Methods: The development process comprised 3 distinct stages, each of which was subject to evaluation. Initially, a prototype was created to encompass the game’s core functionalities, which was assessed by 18 healthy participants and 7 patients with impaired hand function. Subsequently, version 1 of the game was developed and evaluated with 20 patients who were divided into an investigation group and a control group. On the basis of these findings, version 2 was developed and evaluated with 20 patients who were divided into an investigation group and a control group. Motivation was assessed using the Intrinsic Motivation Inventory (IMI), while the application’s quality was rated using the Mobile Application Rating Scale and the System Usability Scale. User feedback was gathered using semistructured interviews. Results: The prototype evaluation confirmed the acceptance and feasibility of the game design. Version 1 significantly increased motivation in 2 IMI subscales, effort (P<.001) and usefulness (P=.02). In version 2, a significant increase in daily performed exercises was achieved (P=.008) compared to version 1, with significantly higher motivation in the IMI subscale effort (P=.02). High Mobile Application Rating Scale scores were obtained for both versions 1 and 2, with version 2 scoring 86.9 on the System Usability Scale, indicating excellent acceptability. User feedback provided by the semistructured interviews was instrumental in the iterative development regarding improvements and the expansion of the playable content. Conclusions: This study presented a virtual reality serious game designed for hand and finger rehabilitation. The game was well received and provided an environment that effectively motivated the users. The iterative development process incorporated user feedback, confirming the game’s ease of use and feasibility even for patients with severely limited hand function. %M 39190432 %R 10.2196/54193 %U https://games.jmir.org/2024/1/e54193 %U https://doi.org/10.2196/54193 %U http://www.ncbi.nlm.nih.gov/pubmed/39190432 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e54684 %T Feasibility and Acceptability of a Mobile Game to Support Smoking Cessation: Repeated Measures Study %A Goodwin,Shelby %A Nastasi,Jessica A %A Newman,Schyler T %A Rapoza,Darion %A Raiff,Bethany R %+ Department of Psychology, College of Science and Mathematics, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, United States, 1 856 256 4500 ext 53782, raiff@rowan.edu %K mHealth %K mobile health %K smoking cessation %K video game intervention %K mobile phone %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Approximately half of smokers attempt to quit, but 90% of these attempts fail. Video game–based interventions have the potential to address common barriers to evidence-based smoking cessation treatment, including high cost, lack of health care access, and low engagement. Objective: The purpose of this study was to evaluate the feasibility and acceptability of a video game–based smoking cessation intervention called Inspired and its impact on the 7-day smoking point prevalence at the 30-day follow-up. Methods: US adults (n=48) were recruited via the web to use Inspired on their smartphones for 7 weeks. The object of the game was to defend a healing tree against attackers. Levels of the game were unlocked twice daily when participants self-reported the number of cigarettes they smoked since the previous entry. Completion of the levels awarded players in-game currency, which could strengthen in-game abilities. Participants received additional in-game rewards to aid gameplay by submitting either smoking self-reports only or self-reports indicating abstinence, determined through random assignment. In addition, participants completed a web-based survey at intake, week 4, week 7, and the 30-day follow-up. Results: Of the 48 participants, who had an average age of 39.8 (SD 10.7) years, 27 (56%) were female, 4 (8%) Hispanic, 37 (77%) White, and 27 (56%) employed; 26 (54%) earned .11 in all cases). After the intervention, the experimental group performed the desired behavior as often as the 2 control groups (P≥.17 in all cases). Conclusions: Our findings suggest that optimized gamification can be used to make digital behavior change interventions more effective. Trial Registration: Open Science Framework (OSF) H7JN8; https://osf.io/h7jn8 %M 38517466 %R 10.2196/43078 %U https://games.jmir.org/2024/1/e43078 %U https://doi.org/10.2196/43078 %U http://www.ncbi.nlm.nih.gov/pubmed/38517466 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e48545 %T An Escape Game on University Students’ Mental Health During the COVID-19 Pandemic: Cocreation Study %A Labrosse,David %A Vié,Clara %A Hajjam,Hana %A Tisseron,Clément %A Thellier,Dimitri %A Montagni,Ilaria %+ University of Bordeaux, Inserm, Bordeaux Population Health Research Center U1219, 146 rue Léo Saignat, Bordeaux, 33000, France, 33 06 42 19 33 63, ilaria.montagni@u-bordeaux.fr %K students %K game %K mental health %K COVID-19 %K cocreation %K university student %K promote %K psychological well-being %K effective tool %K tool %K acceptability %K testing %K questionnaire %K learning %K motivation %K user centered %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusions: 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. %M 38498033 %R 10.2196/48545 %U https://games.jmir.org/2024/1/e48545 %U https://doi.org/10.2196/48545 %U http://www.ncbi.nlm.nih.gov/pubmed/38498033 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48080 %T Improving Behavioral-Based Safety Training in Using Verbal Commands Through a Theory-Driven and Feedback-Based Nonimmersive Virtual Reality Game: Development and Usability Study %A Atagbuzia,Chukwudiebube %A Ng,Ean H %A Natarajan,Ganapathy %+ Oregon State University, 204 Rogers Hall, Oregon State University, Corvallis, OR, 97331, United States, 1 15417370570, ean.ng@oregonstate.edu %K behavioral safety training %K SERES framework %K Reflection, Engagement, Choice, Information, Play, Exposition framework %K gamification %K gestalt laws of perception %D 2024 %7 12.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The construction, chemical, aviation, medical, and health care industries have used serious games for safety training. To our knowledge, serious games have not been developed focusing on behavioral change to improve safety through the use of verbal commands and instilling players with heightened awareness of their spatial proximity to other people in their surroundings. Objective: We aimed to develop a theory-driven serious game for improving safety behavior using verbal commands and validate the implementation of the theoretical frameworks used for game development. The game developed, KitchenSpeak, was a first-person character (FPC) game where users respond to in-game prompts to use loud verbal commands when they are approaching another employee’s blind spot. Methods: In addition to using the SERES framework in guiding the general game design and development, and the Reflection, Engagement, Choice, Information, Play, Exposition (RECIPE) framework to inform the design of the game mechanics, we also applied gestalt laws of perception for graphic design to guide the design of the game’s user interface. We conducted 2 evaluative tests (alpha and beta) to collect end user and stakeholder feedback on the implementation of the theoretical frameworks, as well as to collect relevant information for full-scale implementation and a future validation study. Results: The alpha and beta tests had 8 and 40 participants, respectively. The alpha test results revealed that the theoretical frameworks were adequately applied; however, suggestions were also made to modify and improve the game. The beta test results suggested further improvements for the game design and found no differences in the perception of ease of play between participants with and without previous FPC gaming experience (P=.47; Kruskal-Wallis). Results suggested that the game met its design and theoretical requirements, and it would be easily playable by all players regardless of their previous experience in FPC games. Conclusions: A theory-driven and evidence-based FPC game titled KitchenSpeak was developed to teach the use of kitchen-speak terms in commercial kitchens. Evaluative tests were conducted to validate the implementation of the theoretical frameworks. Our main contributions are creating and validating game-based training to improve behavioral-based safety in the workplace and the incorporation of gestalt laws of perception for graphic design in the game’s user interface. %M 38470470 %R 10.2196/48080 %U https://formative.jmir.org/2024/1/e48080 %U https://doi.org/10.2196/48080 %U http://www.ncbi.nlm.nih.gov/pubmed/38470470 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e46697 %T A Novel Casual Video Game With Simple Mental Health and Well-Being Concepts (Match Emoji): Mixed Methods Feasibility Study %A Pine,Russell %A Mbinta,James %A Te Morenga,Lisa %A Fleming,Theresa %+ School of Health, Victoria University of Wellington, Kelburn Parade, Kelburn, Wellington, 6012, New Zealand, 64 4 472 1000, russell.pine@vuw.ac.nz %K adolescent %K anxiety %K casual video games %K digital mental health interventions %K gaming %K mental health %K micro interventions %K serious game %K teenage %K video game %K youth %D 2024 %7 12.2.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Adolescence is a crucial phase for early intervention and prevention of mental health problems. Casual video games are popular and have promise as a novel mechanism for reaching young people, but this potential has seldom been explored. Objective: This study aimed to explore the acceptability, feasibility, and possible indicators of therapeutic changes after playing a purpose-built novel casual video game (Match Emoji) with simple mental health and well-being content among young adolescents. Methods: We conducted a single-arm, nonrandomized trial of Match Emoji with 12- to 14-year-old school students (N=45; 26 [57%] New Zealand European, 12 [26%] Māori; 7 [15%] Asian or Pacific; 27 [60%] boys, 3 [6%] non-binary). Participants were invited to play Match Emoji for 15 minutes, 2-3 times a week over 2 weeks (a total of 60 minutes). Acceptability was assessed through the frequency and duration of use (analytics analyzed at the end of the 2-week intervention period and at weeks 4 and 6) and through participant reports. The Child and Adolescent Mindfulness Measure (CAMM), General Help-Seeking Questionnaire (GHSQ), Flourishing Scale (FS), and Revised Children’s Anxiety and Depression Scale (RCADS) were assessed at baseline and week 2 to indicate possible effects. Focus groups were held in week 4. Results: Most participants (n=39, 87%) used Match Emoji for at least 60 minutes over the 2-week intervention, with 80% (36/45) continuing to play the game after the intervention period. Mean change (from baseline to 2 weeks) on each measure was 1.38 (95% CI –0.03 to 2.79; P=.06) for CAMM; 0.8 (95% CI –2.71 to 4.31; P=.64) for GHSQ; –1.09 (95% CI –2.83 to 0.66; P=.21) for FS; and –3.42 (95% CI –6.84 to –0.001; P=0.49) for RCADS. Focus group feedback suggested that Match Emoji was enjoyable and helpful. Conclusions: The casual video game with mental health content appeared to be acceptable and provided a promising indication of possible therapeutic effects. This approach is worthy of further investigation. International Registered Report Identifier (IRRID): RR2-10.2196/31588 %M 38345848 %R 10.2196/46697 %U https://games.jmir.org/2024/1/e46697 %U https://doi.org/10.2196/46697 %U http://www.ncbi.nlm.nih.gov/pubmed/38345848 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51812 %T Assessing the Impact of a Serious Game (MedSMARxT: Adventures in PharmaCity) in Improving Opioid Safety Awareness Among Adolescents and Parents: Quantitative Study %A Abraham,Olufunmilola %A McCarthy,Tyler James %A Zaborek,Jen %+ Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Room 2515 Rennebohm Hall, 777 Highland Avenue, Madison, WI, 53705, United States, 1 608 263 4498, olufunmilola.abraham@wisc.edu %K adolescent %K opioid %K medication safety %K serious games %K gamification %K health behavior %D 2023 %7 7.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The opioid crisis continues to worsen across the United States, affecting people of all demographics. Few evidence-based interventions exist for educating families, particularly those with adolescents, about opioid prescription safety. Serious games have demonstrated impacts in improving medication-related outcomes for various health conditions. The characterizing goal of this serious game is to improve opioid safety knowledge and awareness among adolescents and their families. Objective: This study evaluated the impact of a serious game, MedSMARxT: Adventures in PharmaCity, designed to foster opioid safety awareness among adolescents and their parents. Methods: A national sample of parents and their adolescent children was recruited through Qualtrics research panels, social media, listservs, and snowball sampling. Eligible participants were adolescents aged between 12 and 18 years and their parents. Study participants were required to reside in the United States; speak, read, and understand English; and have access to a computer with a webcam. Parent-child dyads completed pregame and postgame surveys and participated in gameplay for up to 30 minutes. Primary outcome scales have been previously evaluated by the study team. Results: A total of 60 adolescent participants and 68 parent participants met full attention criteria for inclusion in this study. Statistical analysis confirmed that both adolescents’ and parents’ concept scores improved from baseline regarding opioid safety self-efficacy (adolescent: mean 0.35, SD 0.60; P<.001; parent: mean 0.28, SD 0.42; P<.001), perceived knowledge (adolescent: mean 1.08, SD 1.04; P<.001; parent: mean 0.56, SD 0.55; P<.001), behavioral intent (adolescent: mean 0.26, SD 0.39; P<.001; parent: mean 0.25, SD 0.32; P<.001), safe storage (adolescent: mean 0.12, SD 0.27; P<.001; parent: mean 0.03, SD 0.11; P=.03), disposal knowledge (adolescent: mean 0.10, SD 0.27; P=.006; parent: mean 0.07, SD 0.16; P<.001), and knowledge about misuse behavior (adolescent: mean 0.05, SD 0.14; P=.002; parent: mean 0.04, SD 0.10; P<.001). Participant groups, stratified by who completed and who did not complete gameplay, improved their knowledge and awareness, with no significant differences between subgroups. Conclusions: The use of this serious game to improve opioid prescription safety practices among parents and adolescents was supported by the study findings. MedSMARxT: Adventures in PharmaCity is an intervention with the capability of teaching parents and adolescents about safe opioid prescription practices. Further studies and game refinement are needed to demonstrate the effectiveness of a game-based intervention in clinical settings and community pharmacies. %M 38060287 %R 10.2196/51812 %U https://formative.jmir.org/2023/1/e51812 %U https://doi.org/10.2196/51812 %U http://www.ncbi.nlm.nih.gov/pubmed/38060287 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e46242 %T The Multidomain Metaverse Cancer Care Digital Platform: Development and Usability Study %A Kim,Sunghak %A Jung,Timothy %A Sohn,Dae Kyung %A Chae,Yoon %A Kim,Young Ae %A Kang,Seung Hyun %A Park,Yujin %A Chang,Yoon Jung %+ Division of Cancer Control and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408, Republic of Korea, 82 10 8729 5835, eunice.ncc@gmail.com %K metaverse %K virtual reality %K cancer education %K cancer care %K digital health %K cancer treatment %K patient care %K cross-sectional survey %K digital health intervention %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: As cancer treatment methods have diversified and the importance of self-management, which lowers the dependence rate on direct hospital visits, has increased, effective cancer care education and management for health professionals and patients have become necessary. The metaverse is in the spotlight as a means of digital health that allows users to engage in cancer care education and management beyond physical constraints. However, it is difficult to find a multipurpose medical metaverse that can not only be used in the field but also complements current cancer care. Objective: This study aimed to develop an integrated metaverse cancer care platform, Dr. Meta, and examine its usability. Methods: We conducted a multicenter, cross-sectional survey between November and December 2021. A descriptive analysis was performed to examine users’ experiences with Dr. Meta. In addition, a supplementary open-ended question was used to ask users for their suggestions and improvements regarding the platform. Results: Responses from 70 Korean participants (male: n=19, 27% and female: n=51, 73%) were analyzed. More than half (n=37, 54%) of the participants were satisfied with Dr. Meta; they responded that it was an interesting and immersive platform (n=50, 72%). Less than half perceived no discomfort when using Dr. Meta (n=34, 49%) and no difficulty in wearing and operating the device (n=30, 43%). Furthermore, more than half (n=50, 72%) of the participants reported that Dr. Meta would help provide non–face-to-face and noncontact services. More than half also wanted to continue using this platform in the future (n=41, 59%) and recommended it to others (n=42, 60%). Conclusions: We developed a multidomain metaverse cancer care platform that can support both health professionals and patients in non–face-to-face cancer care. The platform was uniquely disseminated and implemented in multiple regional hospitals and showed the potential to perform successful cancer care. %M 38032697 %R 10.2196/46242 %U https://games.jmir.org/2023/1/e46242 %U https://doi.org/10.2196/46242 %U http://www.ncbi.nlm.nih.gov/pubmed/38032697 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e44708 %T Case-Based Serious Gaming for Complication Management in Colorectal and Pancreatic Surgery: Prospective Observational Study %A Schwarzkopf,Sophie-Caroline %A Distler,Marius %A Welsch,Thilo %A Krause-Jüttler,Grit %A Weitz,Jürgen %A Kolbinger,Fiona R %+ Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstrasse 74, Dresden, 01307, Germany, 49 351 458 ext 19624, fiona.kolbinger@uniklinikum-dresden.de %K Serious game %K surgical education %K clinical reasoning %K medical education %K postoperative complications %K educational games %K computer-based learning %K colorectal surgery %K decision-making %K pancreatic surgery %D 2023 %7 9.11.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: The potential risk and subsequent impact of serious complications after pancreatic and colorectal surgery can be significantly reduced through early recognition, correct assessment, and timely initiation of appropriate therapy. Serious gaming (SG) is an innovative teaching method that combines play with knowledge acquisition, increased concentration, and quick decision-making and could therefore be used for clinically oriented education. Objective: This study aims to develop a case-based SG platform for complication management in pancreatic and colorectal surgery, validate the application by comparing game courses of various professional groups in the health care sector, and test the acceptance of the developed platform in the context of clinical education by measuring levels of usability and applicability within the framework of a validity and usefulness analysis. Methods: In this observational trial, a novel SG for management of postoperative complications was developed and prospectively validated in a cohort of 131 human caregivers with varying experience in abdominal surgery. A total of 6 realistic patient cases were implemented, representing common complications after pancreatic and colorectal surgery. Cases were developed and illustrated using anonymized images, data, and histories of postoperative patients. In the prospective section of this study, following a brief case presentation, participants were asked to triage the virtual patient, make an initial suspected diagnosis, and design a 3-step management plan, throughout which the results of selected diagnostic and therapeutic actions were presented. Participants’ proposed case management was compared to ideal case management according to clinical guidelines. Usability, applicability, validity, and acceptance of the application were assessed using the Trier Teaching Evaluation Inventory as part of a noncomparative analysis. In addition, a comparative analysis of conventional teaching and learning formats was carried out. Results: A total of 131 cases were answered. Physicians selected more appropriate therapeutic measures than nonphysicians. In the Trier Teaching Evaluation Inventory, design, structure, relevance, timeliness, and interest promotion were predominantly rated positively. Most participants perceived the application to be superior to conventional lecture-based formats (training courses, lectures, and seminars) in terms of problem-solving skills (102/131, 77.9%), self-reflection (102/131, 77.9%), and usability and applicability (104/131, 79.4%). Conclusions: Case-based SG has educational potential for complication management in surgery and could thereby contribute to improvements in postoperative patient care. %M 37943588 %R 10.2196/44708 %U https://games.jmir.org/2023/1/e44708 %U https://doi.org/10.2196/44708 %U http://www.ncbi.nlm.nih.gov/pubmed/37943588 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e46602 %T Developing a Game (Inner Dragon) Within a Leading Smartphone App for Smoking Cessation: Design and Feasibility Evaluation Study %A White,Justin S %A Salem,Marie K %A Toussaert,Séverine %A Westmaas,J Lee %A Raiff,Bethany R %A Crane,David %A Warrender,Edward %A Lyles,Courtney %A Abroms,Lorien %A Thrul,Johannes %+ Philip R Lee Institute for Health Policy Studies, University of California, 490 Illinois Street, Box 0936, San Francisco, CA, 94158, United States, 1 415 476 8045, Justin.White@ucsf.edu %K smoking cessation %K mobile app %K games for health %K gamification %K software design %K feasibility %K mobile phone %D 2023 %7 11.8.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: Several stand-alone smartphone apps have used serious games to provide an engaging approach to quitting smoking. So far, the uptake of these games has been modest, and the evidence base for their efficacy in promoting smoking cessation is still evolving. The feasibility of integrating a game into a popular smoking cessation app is unclear. Objective: The aim of this paper was to describe the design and iterative development of the Inner Dragon game within Smoke Free, a smartphone app with proven efficacy, and the results of a single-arm feasibility trial as part of a broad program that seeks to assess the effectiveness of the gamified app for smoking cessation. Methods: In phase 1, the study team undertook a multistep process to design and develop the game, including web-based focus group discussions with end users (n=15). In phase 2, a single-arm study of Smoke Free users who were trying to quit (n=30) was conducted to assess the feasibility and acceptability of the integrated game and to establish the feasibility of the planned procedures for a randomized pilot trial. Results: Phase 1 led to the final design of Inner Dragon, informed by principles from psychology and behavioral economics and incorporating several game mechanics designed to increase user engagement and retention. Inner Dragon users maintain an evolving pet dragon that serves as a virtual avatar for the users’ progress in quitting. The phase-2 study established the feasibility of the study methods. The mean number of app sessions completed per user was 13.8 (SD 13.1; median 8; range 1-46), with a mean duration per session of 5.8 (median 1.1; range 0-81.1) minutes. Overall, three-fourths (18/24, 75%) of the participants entered the Inner Dragon game at least once and had a mean of 2.4 (SD 2.4) sessions of game use. The use of Inner Dragon was positively associated with the total number of app sessions (correlation 0.57). The mean satisfaction score of participants who provided ratings (11/24, 46%) was 4.2 (SD 0.6) on a 5-point scale; however, satisfaction ratings for Inner Dragon were only completed by 13% (3/24) of the participants. Conclusions: Findings supported further development and evaluation of Inner Dragon as a beneficial feature of Smoke Free. The next step of this study is to conduct a randomized pilot trial to determine whether the gamified version of the app increases user engagement over a standard version of the app. %M 37566442 %R 10.2196/46602 %U https://games.jmir.org/2023/1/e46602 %U https://doi.org/10.2196/46602 %U http://www.ncbi.nlm.nih.gov/pubmed/37566442 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41173 %T Effectiveness of an Individualized Exergame-Based Motor-Cognitive Training Concept Targeted to Improve Cognitive Functioning in Older Adults With Mild Neurocognitive Disorder: Study Protocol for a Randomized Controlled Trial %A Manser,Patrick %A Michels,Lars %A Schmidt,André %A Barinka,Filip %A de Bruin,Eling D %+ Motor Control and Learning Group – Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Leopold-Ruzicka-Weg 4, Zurich, 8093, Switzerland, 41 79 519 96 46, patrick.manser@hest.ethz.ch %K cognition %K cognitive impairment %K effectiveness %K exercise %K exergame %K neuroplasticity %K neurosciences %K technology %K training %D 2023 %7 6.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Simultaneous motor-cognitive training is considered promising for preventing the decline in cognitive functioning in older adults with mild neurocognitive disorder (mNCD) and can be highly motivating when applied in the form of exergaming. The literature points to opportunities for improvement in the application of exergames in individuals with mNCD by developing novel exergames and exergame-based training concepts that are specifically tailored to patients with mNCD and ensuring the implementation of effective training components. Objective: This study systematically explores the effectiveness of a newly developed exergame-based motor-cognitive training concept (called “Brain-IT”) targeted to improve cognitive functioning in older adults with mNCD. Methods: A 2-arm, parallel-group, single-blinded randomized controlled trial with a 1:1 allocation ratio (ie, intervention: control), including 34 to 40 older adults with mNCD will be conducted between May 2022 and December 2023. The control group will proceed with the usual care provided by the (memory) clinics where the patients are recruited. The intervention group will perform a 12-week training intervention according to the “Brain-IT” training concept, in addition to usual care. Global cognitive functioning will be assessed as the primary outcome. As secondary outcomes, domain-specific cognitive functioning, brain structure and function, spatiotemporal parameters of gait, instrumental activities of daily living, psychosocial factors, and resting cardiac vagal modulation will be assessed. Pre- and postintervention measurements will take place within 2 weeks before starting and after completing the intervention. A 2-way analysis of covariance or the Quade nonparametric analysis of covariance will be computed for all primary and secondary outcomes, with the premeasurement value as a covariate for the predicting group factor and the postmeasurement value as the outcome variable. To determine whether the effects are substantive, partial eta-squared (η2p) effect sizes will be calculated for all primary and secondary outcomes. Results: Upon the initial submission of this study protocol, 13 patients were contacted by the study team. Four patients were included in the study, 2 were excluded because they were not eligible, and 7 were being informed about the study in detail. Of the 4 included patients, 2 already completed all premeasurements and were in week 2 of the intervention period. Data collection is expected to be completed by December 2023. A manuscript of the results will be submitted for publication in a peer-reviewed open-access journal in 2024. Conclusions: This study contributes to the evidence base in the highly relevant area of preventing disability because of cognitive impairment, which has been declared a public health priority by the World Health Organization. Trial Registration: ClinicalTrials.gov NCT05387057; https://clinicaltrials.gov/ct2/show/NCT05387057 International Registered Report Identifier (IRRID): DERR1-10.2196/41173 %M 36745483 %R 10.2196/41173 %U https://www.researchprotocols.org/2023/1/e41173 %U https://doi.org/10.2196/41173 %U http://www.ncbi.nlm.nih.gov/pubmed/36745483 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 4 %P e38133 %T Applying Gamification Principles and Therapeutic Movement Sequences to Design an Interactive Physical Activity Game: Development Study %A Kim,Hyungsook %A O'Sullivan,David Michael %A Chung,Seong Hee %+ Division of Sport Science, Pusan National University, 2, Busandaehak-ro 63beon-gil, Geumjeong-gu, Pusan, 46241, Republic of Korea, 82 1076845811, davidosullivan@pusan.ac.kr %K home workout %K mobile assistant %K movement %K physical activity %K depression %D 2022 %7 16.12.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Depression is a severe illness that has accelerated with the spread of COVID-19 and associated lockdowns. As a result, reported physical activity has substantially decreased, further increasing depressive symptoms. Objective: This study aims to explain the use of gamification principles to develop content for an interactive physical activity game for depression based on clinically proven depression diagnostic criteria. Methods: We discuss related work in this field, the game design framework, the users’ depression severity, how we customize the contents accordingly, the gradual progression of the game to match exercise principles, and user flow optimization. Results: We provide a brief description of each of the games developed, including instructions on how to play and design aspects for flow, audio, and visual feedback methods. Exergames (interactive physical activity–based games) stimulate certain physical fitness factors such as improving reaction time, endurance, cardiovascular fitness, and flexibility. In addition, the game difficulty progresses based on various factors, such as the user’s performance for successful completion, reaction time, movement speed, and stimulated larger joint range of motions. Cognitive aspects are included, as the user has to memorize particular movement sequences. Conclusions: Mental health issues are linked to behavior and movement; therefore, future physical activity–based interactive games may provide excellent stimulation for inducing user flow, while physical activity can help train various physical fitness factors linked to depression. %M 36525298 %R 10.2196/38133 %U https://games.jmir.org/2022/4/e38133 %U https://doi.org/10.2196/38133 %U http://www.ncbi.nlm.nih.gov/pubmed/36525298 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e40603 %T A Telemedicine Platform for Aphasia: Protocol for a Development and Usability Study %A Nunes,Monara %A Teles,Ariel Soares %A Farias,Daniel %A Diniz,Claudia %A Bastos,Victor Hugo %A Teixeira,Silmar %+ Federal University of Piauí, Avenue Osório Batista, number1106, Alto do balanço neighborhood., Regeneração, 64490000, Brazil, 55 86999420054, monarakgn@gmail.com %K aphasia %K serious games %K deep learning %K telemedicine %K diagnosis %K treatment %K language %K machine learning %K rehabilitation %K smart platform %D 2022 %7 24.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Aphasia is a central disorder of comprehension and expression of language that cannot be attributed to a peripheral sensory deficit or a peripheral motor disorder. The diagnosis and treatment of aphasia are complex. Interventions that facilitate this process can lead to an increase in the number of assisted patients and greater precision in the therapeutic choice by the health professional. Objective: This paper describes a protocol for a study that aims to implement a computer-based solution (ie, a telemedicine platform) that uses deep learning to classify vocal data from participants with aphasia and to develop serious games to treat aphasia. Additionally, this study aims to evaluate the usability and user experience of the proposed solution. Methods: Our interactive and smart platform will be developed to provide an alternative option for professionals and their patients with aphasia. We will design 2 serious games for aphasia rehabilitation and a deep learning–driven computational solution to aid diagnosis. A pilot evaluation of usability and user experience will reveal user satisfaction with platform features. Results: Data collection began in June 2022 and is currently ongoing. Results of system development as well as usability should be published by mid-2023. Conclusions: This research will contribute to the treatment and diagnosis of aphasia by developing a telemedicine platform based on a co-design process. Therefore, this research will provide an alternative method for health care to patients with aphasia. Additionally, it will guide further studies with the same purpose. International Registered Report Identifier (IRRID): PRR1-10.2196/40603 %M 36422881 %R 10.2196/40603 %U https://www.researchprotocols.org/2022/11/e40603 %U https://doi.org/10.2196/40603 %U http://www.ncbi.nlm.nih.gov/pubmed/36422881 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e37079 %T Development of a Therapeutic Video Game With the MDA Framework to Decrease Anxiety in Preschool-Aged Children With Acute Lymphoblastic Leukemia: Mixed Methods Approach %A Yang,Dai-Jie %A Lu,Meng-Yao %A Chen,Chi-Wen %A Liu,Pei-Ching %A Hou,I-Ching %+ College of Nursing, National Yang Ming Chiao Tung University, Number 155, Section 2, Linong Street, Beitou District, Taipei City, 11221, Taiwan, 886 28267000 ext 67315, evidta@gmail.com %K acute lymphoblastic leukemia %K therapeutic video games %K childhood cancer %K preschoolers %K anxiety %D 2022 %7 22.8.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Preschool-aged children with acute lymphoblastic leukemia (ALL) receive long-term treatment according to the Taiwan Pediatric Oncology Group (TPOG)–ALL 2013 protocol. Severe anxiety and noncompliance ahead of frequent invasive therapies leads to an increase in health care costs. Previous studies have shown that therapeutic video games (TVGs) can decrease the anxiety experienced by children who are ill. To our knowledge, no existing TVG has been designed specifically for preschool-aged children with ALL in Taiwan. Objective: The purpose of this study was to develop a TVG using the popular Mechanics, Dynamics, and Aesthetics (MDA) framework for game design and to investigate the effect of this TVG on the reduction of therapy-related anxiety among preschool-aged children with ALL. Methods: This study used a mixed methods approach over three phases: (1) develop a TVG using the MDA framework, (2) test the reliability of the TVG among three certified children’s art therapists, and (3) evaluate the reduction of therapy-related anxiety among participants after using the TVG for 6 weeks, using a two-group, stratified randomized controlled trial at a medical center in northern Taiwan. Eligible preschool-aged children with ALL were randomly assigned 1:1 into an experimental group or a control group. The two groups of subjects received the same usual care, and only the experimental group had access to and used the TVG. The children’s anxiety responses were reported by their family caregivers using the face rating scale (FRS). Descriptive analyses, the Fisher exact test, the Pearson chi-square test, and the Mann-Whitney U test were used to statistically analyze the variables. Results: Six mechanics rules supported the dynamics of the TVG using four main features—character, nursery, tasks, and market—in order to complete all of the therapy-related anxiety reduction scenarios and to achieve eight aesthetics goals. The results of reliability test showed that participants found the TVG to be useful and trustworthy for preschool-aged children with ALL (Cronbach α=.98). A total of 15 participants were enrolled and randomly allocated to the experimental group (n=7) or the control group (n=8). The average number of TVG log-ins was 37.9 (SD 15.30, range 14-62) in the experimental group. The demographic data showed homogeneity across the two groups regarding age (3 to 5 years), sex (male), risk classification (standard risk), and treatment status (continuation therapy). The mean FRS score was 6.16 (SD 3.31) for the experimental group as compared to 7.45 (SD 2.71) for the control group (P=.04), which represented a significant difference between the groups at the 6-week follow-up. Conclusions: This research provides evidence that using a TVG can decrease anxiety in preschool-aged children with ALL in Taiwan. The TVG could be used to support clinical professionals before they perform invasive therapies. However, it is recommended to increase the statistical power for inference. Trial Registration: ClinicalTrials.gov NCT04199637; https://www.clinicaltrials.gov/ct2/show/NCT04199637 %M 35994340 %R 10.2196/37079 %U https://games.jmir.org/2022/3/e37079 %U https://doi.org/10.2196/37079 %U http://www.ncbi.nlm.nih.gov/pubmed/35994340 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e39186 %T Breathing as an Input Modality in a Gameful Breathing Training App (Breeze 2): Development and Evaluation Study %A Lukic,Yanick Xavier %A Teepe,Gisbert Wilhelm %A Fleisch,Elgar %A Kowatsch,Tobias %+ Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Weinbergstrasse 56/58, Zurich, , Switzerland, 41 446328638, ylukic@ethz.ch %K breathing training %K serious game %K biofeedback %K digital health %K mobile health %K mHealth %K mobile phone %K machine learning %K deep learning %K transfer learning %K neural networks %D 2022 %7 16.8.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Slow-paced breathing training can have positive effects on physiological and psychological well-being. Unfortunately, use statistics indicate that adherence to breathing training apps is low. Recent work suggests that gameful breathing training may help overcome this challenge. Objective: This study aimed to introduce and evaluate the gameful breathing training app Breeze 2 and its novel real-time breathing detection algorithm that enables the interactive components of the app. Methods: We developed the breathing detection algorithm by using deep transfer learning to detect inhalation, exhalation, and nonbreathing sounds (including silence). An additional heuristic prolongs detected exhalations to stabilize the algorithm’s predictions. We evaluated Breeze 2 with 30 participants (women: n=14, 47%; age: mean 29.77, SD 7.33 years). Participants performed breathing training with Breeze 2 in 2 sessions with and without headphones. They answered questions regarding user engagement (User Engagement Scale Short Form [UES-SF]), perceived effectiveness (PE), perceived relaxation effectiveness, and perceived breathing detection accuracy. We used Wilcoxon signed-rank tests to compare the UES-SF, PE, and perceived relaxation effectiveness scores with neutral scores. Furthermore, we correlated perceived breathing detection accuracy with actual multi-class balanced accuracy to determine whether participants could perceive the actual breathing detection performance. We also conducted a repeated-measure ANOVA to investigate breathing detection differences in balanced accuracy with and without the heuristic and when classifying data captured from headphones and smartphone microphones. The analysis controlled for potential between-subject effects of the participants’ sex. Results: Our results show scores that were significantly higher than neutral scores for the UES-SF (W=459; P<.001), PE (W=465; P<.001), and perceived relaxation effectiveness (W=358; P<.001). Perceived breathing detection accuracy correlated significantly with the actual multi-class balanced accuracy (r=0.51; P<.001). Furthermore, we found that the heuristic significantly improved the breathing detection balanced accuracy (F1,25=6.23; P=.02) and that detection performed better on data captured from smartphone microphones than than on data from headphones (F1,25=17.61; P<.001). We did not observe any significant between-subject effects of sex. Breathing detection without the heuristic reached a multi-class balanced accuracy of 74% on the collected audio recordings. Conclusions: Most participants (28/30, 93%) perceived Breeze 2 as engaging and effective. Furthermore, breathing detection worked well for most participants, as indicated by the perceived detection accuracy and actual detection accuracy. In future work, we aim to use the collected breathing sounds to improve breathing detection with regard to its stability and performance. We also plan to use Breeze 2 as an intervention tool in various studies targeting the prevention and management of noncommunicable diseases. %M 35972793 %R 10.2196/39186 %U https://games.jmir.org/2022/3/e39186 %U https://doi.org/10.2196/39186 %U http://www.ncbi.nlm.nih.gov/pubmed/35972793 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e36936 %T A Biofeedback-Based Mobile App With Serious Games for Young Adults With Anxiety in the United Arab Emirates: Development and Usability Study %A Almeqbaali,Mariam %A Ouhbi,Sofia %A Serhani,Mohamed Adel %A Amiri,Leena %A Jan,Reem K %A Zaki,Nazar %A Sharaf,Ayman %A Al Helali,Abdulla %A Almheiri,Eisa %+ Department of Information Systems and Security, College of Information Technology, United Arab Emirates University, Sheik Khalifa Bin Zayed St, Al Ain, Abu Dhabi, United Arab Emirates, 971 3 7135572, serhanim@uaeu.ac.ae %K connected mental health %K mental health %K anxiety %K digital game %K biofeedback %K app %K serious game %K gaming %K gamification %K young adult %K user-centered design %K stress %K stress relief %K user-centred design %K youth %K user feedback %K user experience %K usability %K user need %K development %K mHealth %K mobile health %D 2022 %7 2.8.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Following the outbreak of COVID-19, several studies have reported that young adults encountered a rise in anxiety symptoms, which could negatively affect their quality of life. Promising evidence suggests that mobile apps with biofeedback, serious games, breathing exercises, and positive messaging, among other features, are useful for anxiety self-management and treatment. Objective: This study aimed to develop and evaluate the usability of a biofeedback-based app with serious games for young adults with anxiety in the United Arab Emirates (UAE). Methods: This study consists of two phases: Phase I describes the design and development of the app, while Phase II presents the results of a usability evaluation by experts. To elicit the app’s requirements during Phase I, we conducted (1) a survey to investigate preferences of young adults in the UAE for mobile games for stress relief; (2) an analysis of serious games for anxiety; and (3) interviews with mental health professionals and young adults in the UAE. In Phase II, five experts tested the usability of the developed app using a set of Nielsen’s usability heuristics. Results: A fully functional biofeedback-based app with serious games was co-designed with mental health professionals. The app included 4 games (ie, a biofeedback game, card game, arcade game, and memory game), 2 relaxation techniques (ie, a breathing exercise and yoga videos), and 2 additional features (ie, positive messaging and a mood tracking calendar). The results of Phase II showed that the developed app is efficient, simple, and easy to use. Overall, the app design scored an average of 4 out of 5. Conclusions: The elicitation techniques used in Phase I resulted in the development of an easy-to-use app for the self-management of anxiety. Further research is required to determine the app’s usability and effectiveness in the target population. %M 35916692 %R 10.2196/36936 %U https://games.jmir.org/2022/3/e36936 %U https://doi.org/10.2196/36936 %U http://www.ncbi.nlm.nih.gov/pubmed/35916692 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e33412 %T HelperFriend, a Serious Game for Promoting Healthy Lifestyle Behaviors in Children: Design and Pilot Study %A Espinosa-Curiel,Ismael Edrein %A Pozas-Bogarin,Edgar Efrén %A Hernández-Arvizu,Maryleidi %A Navarro-Jiménez,Maria Elena %A Delgado-Pérez,Edwin Emeth %A Martínez-Miranda,Juan %A Pérez-Espinosa,Humberto %+ Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica Tepic, Andador 10, entre calles 3 y 4, Ciudad del Conocimiento, Tepic, Nayarit, 63173, Mexico, 52 3111295930 ext 28607, ecuriel@cicese.mx %K serious game %K children %K education and behavior change %K healthy lifestyle behaviors %K physical activity %K healthy eating %K socioemotional wellness %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: The use of health games is a promising strategy for educating and promoting healthy lifestyle behaviors among children. Objective: We aimed to describe the design and development of a serious game, called HelperFriend, and evaluate its feasibility, acceptability, and preliminary effects in children in a pilot study. HelperFriend is a vicarious experiential video game designed to promote 3 lifestyle behaviors among young children: physical activity, healthy eating, and socioemotional wellness. Methods: Participants aged 8 to 11 years were recruited from an elementary school and randomized to receive a healthy lifestyle behavior educational talk (control) or play six 30-minute sessions with HelperFriend (intervention). Assessments were conducted at baseline (T0) and after the intervention (ie, 4 weeks) (T1). The primary outcome was gain in knowledge. The secondary outcomes were intention to conduct healthy behaviors, dietary intake, and player satisfaction. Results: Knowledge scores of intervention group participants increased from T0 to T1 for physical activity (t14=2.01, P=.03), healthy eating (t14=3.14, P=.003), and socioemotional wellness (t14=2.75, P=.008). In addition, from T0 to T1, the intervention group improved their intention to perform physical activity (t14=2.82, P=.006), healthy eating (t14=3.44, P=.002), and socioemotional wellness (t14=2.65, P=.009); and there was a reduction in their intake of 13 unhealthy foods. HelperFriend was well received by intervention group. Conclusions: HelperFriend appears to be feasible and acceptable for young children. In addition, this game seems to be a viable tool to help improve the knowledge, the intention to conduct healthy behaviors, and the dietary intake of children; however, a well-powered randomized controlled trial is needed to prove the efficacy of HelperFriend. %M 35522474 %R 10.2196/33412 %U https://games.jmir.org/2022/2/e33412 %U https://doi.org/10.2196/33412 %U http://www.ncbi.nlm.nih.gov/pubmed/35522474 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e34781 %T Augmented Reality-Based Surgery on the Human Cadaver Using a New Generation of Optical Head-Mounted Displays: Development and Feasibility Study %A Puladi,Behrus %A Ooms,Mark %A Bellgardt,Martin %A Cesov,Mark %A Lipprandt,Myriam %A Raith,Stefan %A Peters,Florian %A Möhlhenrich,Stephan Christian %A Prescher,Andreas %A Hölzle,Frank %A Kuhlen,Torsten Wolfgang %A Modabber,Ali %+ Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany, 49 241 80 88231, bpuladi@ukaachen.de %K digital health in surgery %K surgical technique %K surgical training %K computer-assisted surgery %K optical see-through head-mounted display %K HoloLens %K surgical navigation %K medical regulation %K open-source %K AR %K augmented reality %K surgery %K surgeon %K cadaver %K serious game %K head-mounted display %D 2022 %7 25.4.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Although nearly one-third of the world’s disease burden requires surgical care, only a small proportion of digital health applications are directly used in the surgical field. In the coming decades, the application of augmented reality (AR) with a new generation of optical-see-through head-mounted displays (OST-HMDs) like the HoloLens (Microsoft Corp) has the potential to bring digital health into the surgical field. However, for the application to be performed on a living person, proof of performance must first be provided due to regulatory requirements. In this regard, cadaver studies could provide initial evidence. Objective: The goal of the research was to develop an open-source system for AR-based surgery on human cadavers using freely available technologies. Methods: We tested our system using an easy-to-understand scenario in which fractured zygomatic arches of the face had to be repositioned with visual and auditory feedback to the investigators using a HoloLens. Results were verified with postoperative imaging and assessed in a blinded fashion by 2 investigators. The developed system and scenario were qualitatively evaluated by consensus interview and individual questionnaires. Results: The development and implementation of our system was feasible and could be realized in the course of a cadaver study. The AR system was found helpful by the investigators for spatial perception in addition to the combination of visual as well as auditory feedback. The surgical end point could be determined metrically as well as by assessment. Conclusions: The development and application of an AR-based surgical system using freely available technologies to perform OST-HMD–guided surgical procedures in cadavers is feasible. Cadaver studies are suitable for OST-HMD–guided interventions to measure a surgical end point and provide an initial data foundation for future clinical trials. The availability of free systems for researchers could be helpful for a possible translation process from digital health to AR-based surgery using OST-HMDs in the operating theater via cadaver studies. %M 35468090 %R 10.2196/34781 %U https://games.jmir.org/2022/2/e34781 %U https://doi.org/10.2196/34781 %U http://www.ncbi.nlm.nih.gov/pubmed/35468090 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e30949 %T Identifying Video Game Preferences Among Adults Interested in Quitting Smoking Cigarettes: Survey Study %A Upton,Caitlyn R %A Nastasi,Jessica A %A Raiff,Bethany R %+ Department of Psychology, College of Science and Mathematics, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, United States, 1 (856) 256 4500 ext 5, raiff@rowan.edu %K genres %K popular games %K smoking cessation %K video games %K smartphone %K mobile phone %D 2022 %7 24.3.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Smoking is the most prevalent cause of morbidity and mortality in the United States. Although most individuals who smoke express a desire to quit smoking, only a small percentage are successful. Serious games have become popular in health sectors as a potential avenue for delivering a scalable treatment that is both accessible and engaging for the smoking population. Several smoking cessation games have already been developed, but these games feature a broad range of gameplay elements and are not necessarily based on existing video game preferences in the general or smoking population. Objective: To better inform treatment development, this study aims to evaluate video game genre preferences among treatment-seeking individuals who smoke (N=473). Methods: Participants responded to a screening survey to enroll in a larger, serious game intervention for smoking cessation. During this screening survey, participants were asked to disclose their favorite video games, which resulted in 277 unique game titles. These titles were coded for genre categories based on publisher listings and game features. The genres were then analyzed for the frequency of reporting overall and across age groups. Results: Action, Role-Playing, and Action-Adventure were the most reported genres among adults aged ≤34 years; Action, Action-Adventure, and Logic were the most reported genres among adults aged 35-44 years; and Logic and Action were the most reported genres among adults aged ≥45 years. Conclusions: These data indicate that treatment-seeking individuals who smoke have different game preferences across age groups, and the data provide novel information to inform the development of future serious games targeting the smoking population that are tailored to the preferences of their age group. Trial Registration: ClinicalTrials.gov NCT03929003; https://clinicaltrials.gov/ct2/show/NCT03929003 %M 35323116 %R 10.2196/30949 %U https://games.jmir.org/2022/1/e30949 %U https://doi.org/10.2196/30949 %U http://www.ncbi.nlm.nih.gov/pubmed/35323116 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e34698 %T Feasibility, Enjoyment, and Language Comprehension Impact of a Tablet- and GameFlow-Based Story-Listening Game for Kindergarteners: Methodological and Mixed Methods Study %A Vanden Bempt,Femke %A Economou,Maria %A Dehairs,Ward %A Vandermosten,Maaike %A Wouters,Jan %A Ghesquière,Pol %A Vanderauwera,Jolijn %+ Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leopold Vanderkelenstraat 32/3765, Leuven, 3000, Belgium, 32 16376202, femke.vandenbempt@kuleuven.be %K serious gaming %K language comprehension %K enjoyment %K feasibility %K GameFlow %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Enjoyment plays a key role in the success and feasibility of serious gaming interventions. Unenjoyable games will not be played, and in the case of serious gaming, learning will not occur. Therefore, a so-called GameFlow model has been developed, which intends to guide (serious) game developers in the process of creating and evaluating enjoyment in digital (serious) games. Regarding language learning, a variety of serious games targeting specific language components exist in the market, albeit often without available assessments of enjoyment or feasibility. Objective: This study evaluates the enjoyment and feasibility of a tablet-based, serious story-listening game for kindergarteners, developed based on the principles of the GameFlow model. This study also preliminarily explores the possibility of using the game to foster language comprehension. Methods: Within the framework of a broader preventive reading intervention, 91 kindergarteners aged 5 years with a cognitive risk for dyslexia were asked to play the story game for 12 weeks, 6 days per week, either combined with a tablet-based phonics intervention or control games. The story game involved listening to and rating stories and responding to content-related questions. Game enjoyment was assessed through postintervention questionnaires, a GameFlow-based evaluation, and in-game story rating data. Feasibility was determined based on in-game general question response accuracy (QRA), reflecting the difficulty level, attrition rate, and final game exposure and training duration. Moreover, to investigate whether game enjoyment and difficulty influenced feasibility, final game exposure and training duration were predicted based on the in-game initial story ratings and initial QRA. Possible growth in language comprehension was explored by analyzing in-game QRA as a function of the game phase and baseline language skills. Results: Eventually, data from 82 participants were analyzed. The questionnaire and in-game data suggested an overall enjoyable game experience. However, the GameFlow-based evaluation implied room for game design improvement. The general QRA confirmed a well-adapted level of difficulty for the target sample. Moreover, despite the overall attrition rate of 39% (32/82), 90% (74/82) of the participants still completed 80% of the game, albeit with a large variation in training days. Higher initial QRA significantly increased game exposure (β=.35; P<.001), and lower initial story ratings significantly slackened the training duration (β=−0.16; P=.003). In-game QRA was positively predicted by game phase (β=1.44; P=.004), baseline listening comprehension (β=1.56; P=.002), and vocabulary (β=.16; P=.01), with larger QRA growth over game phases in children with lower baseline listening comprehension skills (β=−0.08; P=.04). Conclusions: Generally, the story game seemed enjoyable and feasible. However, the GameFlow model evaluation and predictive relationships imply room for further game design improvements. Furthermore, our results cautiously suggest the potential of the game to foster language comprehension; however, future randomized controlled trials should further elucidate the impact on language comprehension. %M 35319480 %R 10.2196/34698 %U https://games.jmir.org/2022/1/e34698 %U https://doi.org/10.2196/34698 %U http://www.ncbi.nlm.nih.gov/pubmed/35319480 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e32027 %T A Virtual Reality Game Suite for Graded Rehabilitation in Patients With Low Back Pain and a High Fear of Movement: Within-Subject Comparative Study %A Peebles,Alexander T %A van der Veen,Susanne %A Stamenkovic,Alexander %A France,Christopher R %A Pidcoe,Peter E %A Thomas,James S %+ Department of Physical Therapy, Virginia Commonwealth University, 900 E. Leigh St, 4th Floor, Richmond, VA, 23298, United States, 1 740 541 6324, jthomas32@vcu.edu %K virtual reality %K reaching %K intervention %K rehabilitation %K exergaming %K biomechanics %K serious games %K gamification %K movement %K physiotherapy %K lumbar %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Complex movement pathologies that are biopsychosocial in nature (eg, back pain) require a multidimensional approach for effective treatment. Virtual reality is a promising tool for rehabilitation, where therapeutic interventions can be gamified to promote and train specific movement behaviors while increasing enjoyment, engagement, and retention. We have previously created virtual reality–based tools to assess and promote lumbar excursion during reaching and functional gameplay tasks by manipulating the position of static and dynamic contact targets. Based on the framework of graded exposure rehabilitation, we have created a new virtual reality therapy aimed to alter movement speed while retaining the movement-promoting features of our other developments. Objective: This study aims to compare lumbar flexion excursion and velocity across our previous and newly developed virtual reality tools in a healthy control cohort. Methods: A total of 31 healthy participants (16 males, 15 females) took part in 3 gamified virtual reality therapies (ie, Reachality, Fishality, and Dodgeality), while whole-body 3D kinematics were collected at 100 Hz using a 14-camera motion capture system. Lumbar excursion, lumbar flexion velocity, and actual target impact location in the anterior and vertical direction were compared across each virtual reality task and between the 4 anthropometrically defined intended target impact locations using separate 2-way repeated measures analysis of variance models. Results: There was an interaction between game and impact height for each outcome (all P<.001). Post-hoc simple effects models revealed that lumbar excursion was reduced during Reachality and Fishality relative to that during Dodgeality for the 2 higher impact heights but was greater during Reachality than during Fishality and Dodgeality for the lowest impact height. Peak lumbar flexion velocity was greater during Dodgeality than during Fishality and Reachality across heights. Actual target impact locations during Dodgeality and Fishality were lower relative to those during Reachality at higher intended impact locations but higher at lower intended impact locations. Finally, actual target impact location was further in the anterior direction for Reachality compared to that for Fishality and for Fishality relative to that for Dodgeality. Conclusions: Lumbar flexion velocity was reduced during Fishality relative to that during Dodgeality and resembled velocity demands more similar to those for a self-paced reaching task (ie, Reachality). Additionally, lumbar motion and target impact location during Fishality were more similar to those during Reachality than to those during Dodgeality, which suggests that this new virtual reality game is an effective tool for shaping movement. These findings are encouraging for future research aimed at developing an individualized and graded virtual reality intervention for patients with low back pain and a high fear of movement. %M 35319471 %R 10.2196/32027 %U https://games.jmir.org/2022/1/e32027 %U https://doi.org/10.2196/32027 %U http://www.ncbi.nlm.nih.gov/pubmed/35319471 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e31638 %T A Reusable Multiplayer Game for Promoting Active School Transport: Development Study %A Laine,Teemu H %A Duong,Nhi %A Lindvall,Helena %A Oyelere,Solomon Sunday %A Rutberg,Stina %A Lindqvist,Anna-Karin %+ Department of Digital Media, Ajou University, Sanhak Hall 618, 206 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea, 82 312191851, teemu@ubilife.net %K gamification %K active school transport %K physical activity %K formative evaluation %K architecture %K mobile phone %K web browser %D 2022 %7 14.3.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Most children and adolescents in Sweden do not meet the recommended daily physical activity levels of the World Health Organization. Active school transport (AST) and gamification are potential methods for increasing children’s daily physical activity. We previously developed a game named Tic-Tac-Training for promoting active transport at workplaces; however, the game has not been applied to AST. Objective: The objectives of this study are to investigate how Tic-Tac-Training functions to promote AST among schoolchildren in northern Sweden, improve the game to be more suitable for schoolchildren, and construct a road map for future development based on children’s ideas. Methods: First, we developed Tic-Tac-Training using the Scrum agile software development method. Second, we conducted a questionnaire-based formative evaluation of the game with schoolchildren (n=16; 9/16, 56% male; 6/16, 38% female; and 1/16, 6% other aged 11-12 years) in Luleå, Sweden. Third, we conducted focus group interviews with 33 children (13/33, 39% male and 20/33, 61% female aged 12-13 years) to gather ideas for gamifying AST. We mapped the interview results to the Octalysis gamification framework and established a road map for future development. Results: The formative evaluation revealed several issues, including a lack of interesting game features, lack of support for continuous engagement, disliked competitive features, and lack of incentives for discourse and participation. New features such as rewards, collectibles, and levels were implemented based on the results. The focus group interviews revealed additional ideas for gamifying AST, such as using avatars, in-game currency and trading, and context-sensitive tasks. Conclusions: The results have several potential impacts on how reusable, gamified AST interventions can be developed and what kind of gamification elements schoolchildren in northern Sweden wish to see. These results can interest game researchers and teachers who wish to apply gamification in school contexts. Finally, we aim to continue developing the game based on the road map. %M 35285815 %R 10.2196/31638 %U https://games.jmir.org/2022/1/e31638 %U https://doi.org/10.2196/31638 %U http://www.ncbi.nlm.nih.gov/pubmed/35285815 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e31570 %T A Serious Puzzle Game to Enhance Adherence to Antirheumatic Drugs in Patients With Rheumatoid Arthritis: Systematic Development Using Intervention Mapping %A Pouls,Bart PH %A Bekker,Charlotte L %A van Dulmen,Sandra %A Vriezekolk,Johanna E %A van den Bemt,Bart JF %+ Department of Rheumatology Research, Sint Maartenskliniek, Hengstdal 3, Nijmegen, 6574NA, Netherlands, 31 612502678, b.pouls@maartenskliniek.nl %K medication adherence %K serious game %K eHealth %K rheumatoid arthritis %K intervention mapping %K intervention development %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Patients’ implicit attitudes toward medication need and concerns may influence their adherence. Targeting these implicit attitudes by combining game-entertainment with medication-related triggers might improve medication adherence in patients with rheumatoid arthritis (RA). Objective: The aim of this study was to describe the systematic development of a serious game to enhance adherence to antirheumatic drugs by using intervention mapping. Methods: A serious game was developed using the intervention mapping framework guided by a multidisciplinary expert group, which proceeded along 6 steps: (1) exploring the problem by assessing the relationship between medication adherence and implicit attitudes, (2) defining change objectives, (3) selecting evidence-based behavior change techniques that focused on adjusting implicit attitudes, (4) designing the intervention, (5) guaranteeing implementation by focusing on intrinsic motivation, and (6) planning a scientific evaluation. Results: Based on the problem assessment and guided by the Dual-Attitude Model, implicit negative and illness-related attitudes of patients with RA were defined as the main target for the intervention. Consequently, the change objective was “after the intervention, participants have a more positive attitude toward antirheumatic drugs.” Attention bias modification, evaluative conditioning, and goal priming were the techniques chosen to implicitly target medication needs. These techniques were redesigned into medication-related triggers and built in the serious puzzle game. Thirty-seven patients with RA tested the game at several stages. Intrinsic motivation was led by the self-determination theory and addressed the 3 needs, that is, competence, autonomy, and relatedness. The intervention will be evaluated in a randomized clinical trial that assesses the effect of playing the serious game on antirheumatic drug adherence. Conclusions: We systematically developed a serious game app to enhance adherence to antirheumatic drugs among patients with RA by using the intervention mapping framework. This paper could serve as a guideline for other health care providers when developing similar interventions. %M 35179510 %R 10.2196/31570 %U https://games.jmir.org/2022/1/e31570 %U https://doi.org/10.2196/31570 %U http://www.ncbi.nlm.nih.gov/pubmed/35179510 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e29179 %T Effects of Game Mode in Multiplayer Video Games on Intergenerational Social Interaction: Randomized Field Study %A Zahn,Carmen %A Leisner,David %A Niederhauser,Mario %A Roos,Anna-Lena %A Iseli,Tabea %A Soldati,Marco %+ School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Riggenbachstrasse 16, Olten, CH-4600, Switzerland, 41 (0)629572473, carmen.zahn@fhnw.ch %K video games %K computer games %K older adults %K game mode %K serious game %K social interaction %K video analysis methods %D 2022 %7 16.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Maintaining social relationships is a basic human need and particularly essential in old age, including when living in a retirement home. Multiplayer video games can promote positive social interactions among players from different generations while playing. Yet, such facilitation of positive social interactions depends on specific game design. To systematically investigate the effects of game design on social interaction between seniors and their coplayers, the game Myosotis FoodPlanet was developed in this study, and the impacts of 3 different game modes on social interaction were compared in a controlled field trial. Objective: This study aims to compare the effects of 3 different game modes (competitive, cooperative, and creative) on social interactions (verbal and nonverbal communication) between seniors and their younger coplayers. Methods: This study was conducted in a Swiss retirement home as a controlled field trial. Participants were residents of the retirement home (N=10; mean age 84.8 years, SD 5.9 years) and played in pairs with their caregivers. Each pair played 3 game modes in random order. This resulted in 30 game sequences of 20 minutes each. A within-subject design was applied with game mode as the within-factor and social interaction as the outcome variable. To assess the quality of social interaction, 30 video-recorded game sequences were analyzed based on an event sampling method. Results: Analysis of variance for repeated measurements revealed significant effects: there was significantly more verbal communication in the creative mode than in the cooperative mode (P=.04) with a strong effect size (Cohen f=0.611). An examination of verbal communication revealed more game-related communication in the creative mode than in the cooperative mode (P=.01) and the competitive mode (P=.09) with marginally significant effects and strong effect sizes (Cohen f=0.841). In addition, significantly more biography-related communication occurred in the creative mode than in the cooperative mode (P=.03), with a strong effect size (r=0.707). Regarding nonverbal communication (eg, laughing together), analysis of variance for repeated measurements showed significant differences among the game modes (P=.02) with a strong effect size (Cohen f=0.758). Results showed that there was significantly more laughing together in the competitive mode (competitive>cooperative>creative). Conclusions: The results show that game mode can be an important factor for shaping the social interactions of players playing together. Compared with other modes, creative game modes can increase verbal communication. In contrast, competitive modes may stimulate more laughing together. This has important implications for game design and the use of computer games to promote social interaction between seniors and their coplayers in practice. %M 35171097 %R 10.2196/29179 %U https://formative.jmir.org/2022/2/e29179 %U https://doi.org/10.2196/29179 %U http://www.ncbi.nlm.nih.gov/pubmed/35171097 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e32243 %T Using Virtual Reality to Induce and Assess Objective Correlates of Nicotine Craving: Paradigm Development Study %A Liu,Weichen %A Andrade,Gianna %A Schulze,Jurgen %A Doran,Neal %A Courtney,Kelly E %+ Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, United States, 1 858 534 5157, kecourtney@health.ucsd.edu %K nicotine %K craving %K cue-exposure %K virtual reality %K attentional bias %K pupillometry %K development %K smoking %K addiction %K eye-tracking %D 2022 %7 15.2.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Craving is a clinically important phenotype for the development and maintenance of nicotine addiction. Virtual reality (VR) paradigms are successful in eliciting cue-induced subjective craving and may even elicit stronger craving than traditional picture-cue methods. However, few studies have leveraged the advances of this technology to improve the assessment of craving. Objective: This report details the development of a novel, translatable VR paradigm designed to both elicit nicotine craving and assess multiple eye-related characteristics as potential objective correlates of craving. Methods: A VR paradigm was developed, which includes three Active scenes with nicotine and tobacco product (NTP) cues present, and three Neutral scenes devoid of NTP cues. A pilot sample (N=31) of NTP users underwent the paradigm and completed subjective measures of nicotine craving, sense of presence in the VR paradigm, and VR-related sickness. Eye-gaze fixation time (“attentional bias”) and pupil diameter toward Active versus Neutral cues, as well as spontaneous blink rate during the Active and Neutral scenes, were recorded. Results: The NTP Cue VR paradigm was found to elicit a moderate sense of presence (mean Igroup Presence Questionnaire score 60.05, SD 9.66) and low VR-related sickness (mean Virtual Reality Sickness Questionnaire score 16.25, SD 13.94). Scene-specific effects on attentional bias and pupil diameter were observed, with two of the three Active scenes eliciting greater NTP versus control cue attentional bias and pupil diameter (Cohen d=0.30-0.92). The spontaneous blink rate metrics did not differ across Active and Neutral scenes. Conclusions: This report outlines the development of the NTP Cue VR paradigm. Our results support the potential of this paradigm as an effective laboratory-based cue-exposure task and provide early evidence of the utility of attentional bias and pupillometry, as measured during VR, as useful markers for nicotine addiction. %M 35166685 %R 10.2196/32243 %U https://games.jmir.org/2022/1/e32243 %U https://doi.org/10.2196/32243 %U http://www.ncbi.nlm.nih.gov/pubmed/35166685 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e32400 %T Evaluation of an AIDS Educational Mobile Game (AIDS Fighter · Health Defense) for Young Students to Improve AIDS-Related Knowledge, Stigma, and Attitude Linked to High-Risk Behaviors in China: Randomized Controlled Trial %A Tang,Jian %A Zheng,Yu %A Zhang,Daiying %A Yu,Xingli %A Ren,Jianlan %A Li,Mei %A Luo,Yue %A Tian,Min %A Chen,Yanhua %+ Department of Nursing, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Jiangyang District, Luzhou, 646000, China, 86 18982765016, chen_yanhua25@163.com %K young students %K AIDS education %K educational game %K game-based intervention %K serious games %K public health %K HIV %K AIDS epidemic %K stigma %K health defense %K health knowledge %K digital health %K digital health intervention %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: The AIDS epidemic among young students is serious, and effective preventive interventions are urgently needed. Game-based intervention has become an innovative way to change healthy behaviors, and we have developed an AIDS educational game called AIDS Fighter · Health Defense. Objective: In this study, we tested the effect of AIDS Fighter · Health Defense on young students in improving AIDS-related knowledge, stigma, and attitude related to high-risk behaviors in Southwest China. Methods: A randomized controlled trial was conducted from September 14 to 27, 2020. In total, 96 students from 2 classes in a middle school were selected by stratified cluster sampling in Luzhou City, Southwest China. The students were randomly divided into the intervention group (n=50, 52%) and the control group (n=46, 48%). The intervention group played the AIDS educational game AIDS Fighter · Health Defense; the control group learned AIDS-related knowledge through independent learning on the QQ chat group. An AIDS-related knowledge questionnaire, a stigma scale, and an attitude questionnaire on AIDS-related high-risk behaviors were used to measure the effect of the AIDS educational game via face-to-face interviews. The user experience of the game was assessed using the Educational Game User Experience Evaluation Scale. The difference was statistically significant at P≤.05. Results: After the intervention, the AIDS knowledge awareness rate (X̅ [SD], %) of the intervention and control groups were 70.09 (SD 11.58) and 57.49 (SD 16.58), with t=4.282 and P<.001. The stigma scores of the 2 groups were 2.44 (SD 0.57) and 2.48 (SD 0.47), with t=0.373 and P=0.71. The positive rate (X̅ [SD], %) of attitudes of high-risk AIDS behaviors of the 2 groups were 82.00 (SD 23.44) and 79.62 (SD 17.94), with t=0.555 and P=0.58. The mean percentage of the game evaluation was 54.73% as excellent, 31.45% as good, 13.09% as medium, and 0.73% as poor. Conclusions: AIDS Fighter · Health Defense could increase AIDS-related knowledge among young students, but the effect of the game in reducing AIDS-related stigma and improving the attitudes of high-risk AIDS behaviors was not seen. Long-term effects and large-scale studies are needed to assess the efficacy of game-based intervention. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000038230; https://trialsearch.who.int/Trial2.aspx?TrialID=ChiCTR2000038230 %M 34870603 %R 10.2196/32400 %U https://games.jmir.org/2022/1/e32400 %U https://doi.org/10.2196/32400 %U http://www.ncbi.nlm.nih.gov/pubmed/34870603 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e31471 %T Developing a Health Game to Prepare Preschool Children for Anesthesia: Formative Study Using a Child-Centered Approach %A Ingadottir,Brynja %A Laitonen,Elina %A Stefansdottir,Adalheidur %A Sigurdardottir,Anna Olafia %A Brynjolfsdottir,Berglind %A Parisod,Heidi %A Nyman,Johanna %A Gunnarsdottir,Karitas %A Jónsdóttir,Katrín %A Salanterä,Sanna %A Pakarinen,Anni %+ Faculty of Nursing, School of Health Sciences, University of Iceland, Eiriksgata 34, Reykjavik, 101, Iceland, 354 8651817, brynjain@hi.is %K anesthesia %K child-centred design %K children %K digital health %K educational games %K health games %K hospital %K patient education %K serious games %K surgery %K user-centred design %K video games %D 2022 %7 20.1.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Every year, millions of children undergo medical procedures that require anesthesia. Fear and anxiety are common among young children undergoing such procedures and can interfere with the child’s recovery and well-being. Relaxation, distraction, and education are methods that can be used to prepare children and help them cope with fear and anxiety, and serious games may be a suitable medium for these purposes. User-centered design emphasizes the involvement of end users during the development and testing of products, but involving young, preschool children may be challenging. Objective: One objective of this study was to describe the development and usability of a computer-based educational health game intended for preschool children to prepare them for upcoming anesthesia. A further objective was to describe the lessons learned from using a child-centered approach with the young target group. Methods: A formative mixed methods child (user)-centered study design was used to develop and test the usability of the game. Preschool children (4-6 years old) informed the game design through playful workshops (n=26), and usability testing was conducted through game-playing and interviews (n=16). Data were collected in Iceland and Finland with video-recorded direct observation and interviews, as well as children’s drawings, and analyzed with content analysis and descriptive statistics. Results: The children shared their knowledge and ideas about hospitals, different emotions, and their preferences concerning game elements. Testing revealed the high usability of the game and provided important information that was used to modify the game before publishing and that will be used in its further development. Conclusions: Preschool children can inform game design through playful workshops about health-related subjects that they are not necessarily familiar with but that are relevant for them. The game’s usability was improved with the participation of the target group, and the game is now ready for clinical testing. %M 35049507 %R 10.2196/31471 %U https://games.jmir.org/2022/1/e31471 %U https://doi.org/10.2196/31471 %U http://www.ncbi.nlm.nih.gov/pubmed/35049507 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e33282 %T An Exploratory Digital Board Game Approach to the Review and Reinforcement of Complex Medical Subjects Like Anatomical Education: Cross-sectional and Mixed Methods Study %A Tan,Jun Wen %A Ng,Kian Bee %A Mogali,Sreenivasulu Reddy %+ Lee Kong Chian School of Medicine, Nanyang Technological University, Office of Medical Education, Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore, 65 65923114, sreenivasulu.reddy@ntu.edu.sg %K serious games %K board games %K anatomy %K flow %D 2022 %7 10.1.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Serious games have the potential to resolve educational problems faced by medical students, such as insufficient rehearsal due to boredom and lack of motivation. However, serious games’ relatively novel concepts in science and many genres of games that are common in recreation remain underresearched in the literature. Board games are one such genre that, despite their potential, affordability, and flexibility, are rarely designed for medical students, and little is known about student perceptions of them and their compatibility with rehearsal. Objective: In this cross-sectional study, we sought to elicit, via an exploratory mixed methods approach, student perceptions of a digital serious board game specifically designed for the gamified rehearsal of complex medical subjects, with the chosen topic of anatomy. Methods: A digital serious board game, based on self-determination theory (SDT), was first designed and developed to facilitate the rehearsal of anatomy information. Students were then voluntarily recruited to partake in the intervention and were randomly split into three teams of 2 players per game session, after which they were administered the Flow Short Scale (FSS), which is a 13-item measure where items were rated on a 7-point Likert scale ranging from 1 (“not at all”) to 7 (“very much”). Students then participated in a focus group discussion to elicit their perceptions of the game. Findings from the FSS were subject to descriptive analysis, and the focus group discussion was subject to inductive thematic analysis. Results: A total of 12 undergraduate, second-year medical students from the Lee Kong Chian School of Medicine in Singapore participated in the study. FSS results indicated a moderate level of overall flow (mean score 4.94, SD 1.07) via the subdomains of fluency (mean score 4.77, SD 1.13) and absorption (mean score 5.21, SD 1.1). Students perceived the game as fun, enjoyable, engaging, and appropriate as a rehearsal tool that alleviated the monotony of traditional methods of rehearsal. Conclusions: Our digital board game–based rehearsal tool, when based on SDT, appeared to be suitable for gamified rehearsal in a fun and enjoyable environment due to its facilitation of intrinsic motivation in its players. %M 35006080 %R 10.2196/33282 %U https://games.jmir.org/2022/1/e33282 %U https://doi.org/10.2196/33282 %U http://www.ncbi.nlm.nih.gov/pubmed/35006080 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e33144 %T Contribution of the co.LAB Framework to the Collaborative Design of Serious Games: Mixed Methods Validation Study %A Jaccard,Dominique %A Suppan,Laurent %A Bielser,Félicia %+ Media Engineering Institute, HES-SO University of Applied Sciences and Arts Western Switzerland, Av. Sports 20, Yverdon, 1400, Switzerland, 41 245577556, dominique.jaccard@heig-vd.ch %K serious game %K educational game %K education %K simulation game %K gaming %K design %K framework %K methodology %K mixed method %K validation %D 2021 %7 24.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Multidisciplinary collaboration is essential to the successful development of serious games, albeit difficult to achieve. In a previous study, the co.LAB serious game design framework was created to support collaboration within serious game multidisciplinary design teams. Its use has not yet been validated in a real usage context. Objective: The objective of this study was to perform a first assessment of the impact of the co.LAB framework on collaboration within multidisciplinary teams during serious game design and development. Methods: A mixed methods study was conducted, based on 2 serious game design projects in which the co.LAB framework was used. The first phase was qualitative and carried out using a general inductive approach. To this end, all members of the first serious game project team who used the co.LAB framework were invited to take part in a focus group session (n=6). In a second phase, results inferred from qualitative data were used to define a quantitative instrument (questionnaire) that was designed according to the Checklist for Reporting Results of Internet E-Surveys. Members of both project teams (n=11) were then asked to answer the questionnaire. Quantitative results were reported as median (Q1, Q3), and appropriate nonparametric tests were used to assess between-group differences. Finally, results gathered through the qualitative and quantitative phases were integrated. Results: In both phases, the participation rate was 100% (6/6 and 11/11). Verbatim transcripts were classified into 4 high level themes: (1) influence on collaborative dimensions; (2) impact on project course, monitoring, and efficiency; (3) qualitative perceptions of the framework; and (4) influence of team composition on the use of the framework. The web-based questionnaire was then developed according to the 7 dimensions of collaboration by Burkhardt et al. In both projects, the co.LAB framework had a positive impact on most dimensions of collaboration during the multidisciplinary design and development of serious games. When all collaborative dimensions were aggregated, the overall impact of the framework was rated on a scale from –42 to 42 (very negative to very positive). The overall median score was 23 (Q1, Q3: 20, 27), with no significant difference between groups (P=.58). Most respondents also believed that all serious game design teams should include a member possessing significant expertise in serious game design to guide the development process. Conclusions: The co.LAB framework had a positive impact on collaboration within serious game design and development teams. However, expert guidance seems necessary to maximize development efficiency. Whether such guidance can be provided by means of a collaborative web platform remains to be determined. %M 34822336 %R 10.2196/33144 %U https://games.jmir.org/2021/4/e33144 %U https://doi.org/10.2196/33144 %U http://www.ncbi.nlm.nih.gov/pubmed/34822336 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e27848 %T An Interactive Physical-Cognitive Game-Based Training System Using Kinect for Older Adults: Development and Usability Study %A Kamnardsiri,Teerawat %A Phirom,Kochaphan %A Boripuntakul,Sirinun %A Sungkarat,Somporn %+ Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, 9th Floor, Faculty of Associated Medical Sciences, 110 Intawaroros Rd, Sripoom, Chiang Mai, 50200, Thailand, 66 53936042, somporn.sungkarat@cmu.ac.th %K digital game %K interactive game-based training %K physical-cognitive training %K exergaming %K Kinect sensors %K older adults %K falls %K PACES %K user-centered design %K game-based exercise %D 2021 %7 27.10.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Declines in physical and cognitive functions are recognized as important risk factors for falls in older adults. Promising evidence suggests that interactive game-based systems that allow simultaneous physical and cognitive exercise are a potential approach to enhance exercise adherence and reduce fall risk in older adults. However, a limited number of studies have reported the development of a combined physical-cognitive game-based training system for fall risk reduction in older adults. Objective: The aim of this study is to develop and evaluate the usability of an interactive physical-cognitive game-based training system (game-based exercise) for older adults. Methods: In the development phase (Part I), a game-based exercise prototype was created by integrating knowledge and a literature review as well as brainstorming with experts on effective fall prevention exercise for older adults. The output was a game-based exercise prototype that covers crucial physical and cognitive components related to falls. In the usability testing (Part II), 5 games (ie, Fruits Hunter, Where Am I?, Whack a Mole, Sky Falls, and Crossing Poison River) with three difficulty levels (ie, beginner, intermediate, and advanced levels) were tested in 5 older adults (mean age 70.40 years, SD 5.41 years). After completing the games, participants rated their enjoyment level while engaging with the games using the Physical Activity Enjoyment Scale (PACES) and commented on the games. Descriptive statistics were used to describe the participants’ characteristics and PACES scores. Results: The results showed that the average PACES score was 123 out of 126 points overall and between 6.66 and 7.00 for each item, indicating a high level of enjoyment. Positive feedback, such as praise for the well-designed interactions and user-friendly interfaces, was also provided. Conclusions: These findings suggest that it is promising to implement an interactive, physical-cognitive game-based exercise in older adults. The effectiveness of a game-based exercise program for fall risk reduction has yet to be determined. %M 34704953 %R 10.2196/27848 %U https://games.jmir.org/2021/4/e27848 %U https://doi.org/10.2196/27848 %U http://www.ncbi.nlm.nih.gov/pubmed/34704953 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e27036 %T Immersion Experiences in a Tablet-Based Markerless Augmented Reality Working Memory Game: Randomized Controlled Trial and User Experience Study %A Zhang,Bo %A Robb,Nigel %+ Department of Education Information Technology, Faculty of Education, East China Normal University, No 3663, North Zhongshan Road, Putuo District, Shanghai, 200062, China, 86 13505194318, bzhang@ed.ecnu.edu.cn %K augmented reality %K markerless augmented reality %K immersion experience %K cognitive training games %K working memory %K markerless augmented reality n-back game %D 2021 %7 12.10.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: In recent years, augmented reality (AR), especially markerless augmented reality (MAR), has been used more prevalently to create training games in an attempt to improve humans' cognitive functions. This has been driven by studies claiming that MAR provides users with more immersive experiences that are situated in the real world. Currently, no studies have scientifically investigated the immersion experience of users in a MAR cognitive training game. Moreover, there is an observed lack of instruments on measuring immersion in MAR cognitive training games. Objective: This study, using two existing immersion questionnaires, investigates students’ immersion experiences in a novel MAR n-back game. Methods: The n-back task is a continuous performance task that taps working memory (WM) capacity. We compared two versions of n-back training. One was presented in a traditional 2D format, while the second version used MAR. There were 2 experiments conducted in this study that coordinated with 2 types of immersion questionnaires: the modified Immersive Experiences Questionnaire (IEQ) and the Augmented Reality Immersion (ARI) questionnaire. Two groups of students from two universities in China joined the study, with 60 participants for the first experiment (a randomized controlled experiment) and 51 participants for the second. Results: Both groups of students experienced immersion in the MAR n-back game. However, the MAR n-back training group did not experience stronger immersion than the traditional (2D) n-back control group in the first experiment. The results of the second experiment showed that males felt deeply involved with the AR environment, which resulted in obtaining higher levels of immersion than females in the MAR n-back game. Conclusions: Both groups of students experienced immersion in the MAR n-back game. Moreover, both the modified IEQ and ARI have the potential to be used as instruments to measure immersion in MAR game settings. Trial Registration: UMIN Clinical Trials Registry UMIN000045314; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000051725 %M 34636738 %R 10.2196/27036 %U https://games.jmir.org/2021/4/e27036 %U https://doi.org/10.2196/27036 %U http://www.ncbi.nlm.nih.gov/pubmed/34636738 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28037 %T Acceptability Evaluation of the Use of Virtual Reality Games in Smoking-Prevention Education for High School Students: Prospective Observational Study %A Guo,Jong-Long %A Hsu,Hsiao-Pei %A Lai,Tzu-Ming %A Lin,Mei-Ling %A Chung,Chih-Ming %A Huang,Chiu-Mieh %+ Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, 886 2 28267362, cmhuang2021@nycu.edu.tw %K behavioral intention %K ARCS motivation model %K persuasiveness %K smoking prevention %K educational games %D 2021 %7 28.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Alternative forms of cigarettes, such as electronic cigarettes (e-cigarettes), are becoming increasingly common among adolescents. Many high schools now provide smoking-prevention education in an attempt to minimize the potential negative health effects and illness burdens e-cigarettes may induce in adolescents. However, it is often difficult to motivate young students to engage with traditional education regarding the harmful effects of tobacco; thus, the development of alternative approaches may be required. Objective: In this study, we aimed to conduct an acceptability evaluation of educational virtual reality games designed to support smoking-prevention measures. We based the acceptability evaluation on the following two experience types: game-playing and content-learning experiences. The paths by which these experience types affect the intention to abstain from smoking were also examined. Methods: We applied a prospective observational study design. We developed educational games based on three-dimensional virtual reality technology, in which participants operated joysticks to complete challenge tasks. To increase the possibility of the games fostering motivation to abstain from smoking, the ARCS motivational model (comprising attention, relevance, confidence, and satisfaction) was used as a framework during the games’ design. We measured the participants’ game-playing experiences by inquiring about the strength of the ARCS elements; content-learning experiences were measured using overall knowledge improvement and the perceived persuasiveness of the content. A total of 130 students participated in the program. Study hypotheses for this evaluation were derived from a literature review. We used partial least squares structural equation modeling to examine the proposed hypotheses. Results: Based on the responses of the students to questionnaire items concerning attention, relevance, confidence, and satisfaction in the context of the games, most students agreed or strongly agreed that the educational games were motivational, and that their game-playing experiences were positive. Regarding content-learning experiences, there was a significant improvement in knowledge (t129=25.67, P<.001), and most students perceived themselves as being persuaded to abstain from smoking. Attention, relevance, and satisfaction significantly influenced perceived persuasiveness (t=3.19, P<.001; t=4.28, P<.001; and t=3.49, P<.001, respectively); however, confidence did not (t=0.42, P=.67). Perceived persuasiveness, relevance, and satisfaction significantly influenced the intention to abstain from smoking (t=3.57, P<.001). In addition to directly affecting the intention to abstain from smoking, indirect effects were observed from both relevance and satisfaction to intention via perceived persuasiveness (t=2.87, P=.004 and t=2.11, P=.04, respectively). However, intention was not significantly influenced by knowledge improvement. Conclusions: Our findings revealed that the educational games were positively accepted by the participating students. This indicates that the integration of the ARCS framework and persuasive strategies is applicable for smoking-prevention education. We recommend that the games be included as teaching materials for smoking-prevention education. %M 34581679 %R 10.2196/28037 %U https://www.jmir.org/2021/9/e28037 %U https://doi.org/10.2196/28037 %U http://www.ncbi.nlm.nih.gov/pubmed/34581679 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28796 %T A Computer-Based Interactive Narrative and a Serious Game for Children With Asthma: Development and Content Validity Analysis %A Sarasmita,Made Ary %A Larasanty,Luh Putu Febryana %A Kuo,Li-Na %A Cheng,Kuei-Ju %A Chen,Hsiang-Yin %+ Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Health and Science Building, 7th Floor, 250 Wuxing Street, Taipei, 110, Taiwan, 886 02 2736 1661 ext 6175, shawn@tmu.edu.tw %K asthma %K computer %K children %K interactive narrative %K serious game %K digital education %K mobile phone %D 2021 %7 13.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Nonadherence to medications, failure to prevent exposure to asthma triggers, lack of knowledge about using medications, and fixed mindsets contribute to poor asthma control in children. Digital learning could provide a new strategy for improving health-related outcomes in children with asthma. Objective: The aim of this study is to develop and design a digital educational program, titled Module of Inhaler and Asthma Triggers for Children (MIRACLE), for Indonesian children with asthma. The program comprises an interactive narrative and a serious game. It was proposed to increase the understanding of asthma self-management, instruct on proper inhaler techniques, improve asthma control, and promote a growth mindset for children with asthma. Methods: Two phases of research were conducted to develop the program. In the first phase, a literature search and two rounds of the Delphi technique were conducted to obtain agreement from an expert panel regarding elements of asthma self-management and the design of interactive narratives and a serious game. The expert panel item statements were evaluated using the content validity index (CVI). In the second phase, the SERES framework, Norma Engaging Multimedia Design, and Psychological Theory of Growth Mindset were applied to create a storyline, learn objectives, and game challenges. Results: In the first phase, 40 experts were invited to participate in Delphi round 1. Forty responses were collected to generate 38 item statements that consisted of part 1, elements of asthma self-management (25 items), and part 2, design of an interactive narrative and a serious game (13 items); 38 experts were involved in Delphi round 2. In total, 24 statements in part 1 and 13 items in part 2 had item-CVI values >0.80. The average CVI was 0.9, which was considered acceptable. Four narrative plots and five game sessions were developed during the second phase. Challenges with the scenario, scoring, and feedback on asthma difficulties were designed to promote a growth mindset for learners. Conclusions: We developed a culture-specific, computer-based asthma program containing an interactive narrative and a serious game to deliver asthma self-management and promote a growth mindset among Indonesian children. %M 34515641 %R 10.2196/28796 %U https://www.jmir.org/2021/9/e28796 %U https://doi.org/10.2196/28796 %U http://www.ncbi.nlm.nih.gov/pubmed/34515641 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30390 %T Conceptual Ambiguity Surrounding Gamification and Serious Games in Health Care: Literature Review and Development of Game-Based Intervention Reporting Guidelines (GAMING) %A Warsinsky,Simon %A Schmidt-Kraepelin,Manuel %A Rank,Sascha %A Thiebes,Scott %A Sunyaev,Ali %+ Department of Economics and Management, Karlsruhe Institute of Technology, Kaiserstr. 89, Karlsruhe, 76133, Germany, 49 72160846037, sunyaev@kit.edu %K game-based interventions %K gamification %K serious games %K literature review %K reporting guidelines %K conceptual ambiguity %D 2021 %7 10.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In health care, the use of game-based interventions to increase motivation, engagement, and overall sustainability of health behaviors is steadily becoming more common. The most prevalent types of game-based interventions in health care research are gamification and serious games. Various researchers have discussed substantial conceptual differences between these 2 concepts, supported by empirical studies showing differences in the effects on specific health behaviors. However, researchers also frequently report cases in which terms related to these 2 concepts are used ambiguously or even interchangeably. It remains unclear to what extent existing health care research explicitly distinguishes between gamification and serious games and whether it draws on existing conceptual considerations to do so. Objective: This study aims to address this lack of knowledge by capturing the current state of conceptualizations of gamification and serious games in health care research. Furthermore, we aim to provide tools for researchers to disambiguate the reporting of game-based interventions. Methods: We used a 2-step research approach. First, we conducted a systematic literature review of 206 studies, published in the Journal of Medical Internet Research and its sister journals, containing terms related to gamification, serious games, or both. We analyzed their conceptualizations of gamification and serious games, as well as the distinctions between the two concepts. Second, based on the literature review findings, we developed a set of guidelines for researchers reporting on game-based interventions and evaluated them with a group of 9 experts from the field. Results: Our results show that less than half of the concept mentions are accompanied by an explicit definition. To distinguish between the 2 concepts, we identified four common approaches: implicit distinction, synonymous use of terms, serious games as a type of gamified system, and distinction based on the full game dimension. Our Game-Based Intervention Reporting Guidelines (GAMING) consist of 25 items grouped into four topics: conceptual focus, contribution, mindfulness about related concepts, and individual concept definitions. Conclusions: Conceptualizations of gamification and serious games in health care literature are strongly heterogeneous, leading to conceptual ambiguity. Following the GAMING can support authors in rigorous reporting on study results of game-based interventions. %M 34505840 %R 10.2196/30390 %U https://www.jmir.org/2021/9/e30390 %U https://doi.org/10.2196/30390 %U http://www.ncbi.nlm.nih.gov/pubmed/34505840 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 3 %P e26062 %T A Therapeutic Game for Sexually Abused Children and Adolescents (Vil Du?!): Exploratory Mixed Methods Evaluation %A Endendijk,Joyce Johanna %A Tichelaar,Henny %A Deen,Menno %A Deković,Maja %+ Child and Adolescent Studies, Utrecht University, Heidelberglaan 1, Utrecht, 3548 CS, Netherlands, 31 30 253 4896, j.j.endendijk@uu.nl %K child sexual abuse %K psychotherapy %K serious games %K evaluation %K working elements %K acceptability %D 2021 %7 3.8.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Talking about experiences of sexual abuse in therapy is difficult for children and adolescents. Possible reasons for this difficulty are a lack of vocabulary to describe the situation or feelings of shame, fear, and self-blame associated with sexual abuse. The serious game Vil Du?! was developed to help children open up about their sexual abuse experiences. Vil Du?! is a nonverbal communication game that resembles a dress-up game in which children can show the therapist what happened to them. Objective: This exploratory evaluation study examines which working elements of the game could be identified in therapy with victims of sexual abuse (aim 1). In addition, this study examines how therapists evaluate the acceptability of the game (aim 2). Methods: The therapists completed 23 web-based surveys on the use of Vil Du?! In addition, semistructured interviews were conducted with 10 therapists. The data were analyzed in NVivo following previously reported stepwise guidelines. Results: Regarding aim 1, therapists mentioned various working elements of Vil Du?!; for instance, Vil Du?! puts the child in control of the situation. In addition, Vil Du?! reduces barriers to disclosure because there is no need to talk or have eye contact with the therapist. Regarding aim 2, Vil Du?! was generally evaluated more positively than negatively by the therapists. For instance, therapists indicated that using Vil Du?! is time efficient and might make the treatment process less confronting and difficult for the client. According to therapists, most clients indeed experienced less tension and more positive (or neutral) emotions than negative emotions when using Vil Du?! Conclusions: The most important working elements of Vil Du?!, according to therapists, are that it enables children to regain control over their sexual abuse experiences and reduces barriers to disclosing sexual abuse experiences. The more positive evaluation of Vil Du?! indicates the acceptability of the game for therapists as well as their clients. %M 34342592 %R 10.2196/26062 %U https://games.jmir.org/2021/3/e26062 %U https://doi.org/10.2196/26062 %U http://www.ncbi.nlm.nih.gov/pubmed/34342592 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e23835 %T A Virtual Reality–Based App to Educate Health Care Professionals and Medical Students About Inflammatory Arthritis: Feasibility Study %A Klemm,Philipp %A Kleyer,Arnd %A Tascilar,Koray %A Schuster,Louis %A Meinderink,Timo %A Steiger,Florian %A Lange,Uwe %A Müller-Ladner,Ulf %A Knitza,Johannes %A Sewerin,Philipp %A Mucke,Johanna %A Pfeil,Alexander %A Schett,Georg %A Hartmann,Fabian %A Hueber,Axel J %A Simon,David %+ Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Ulmenweg 18, Erlangen, 91054, Germany, 49 091318543253, david.simon@uk-erlangen.de %K feasibility %K virtual reality %K inflammatory arthritis %K psoriatic arthritis %K rheumatoid arthritis %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Inflammatory arthritides (IA) such as rheumatoid arthritis or psoriatic arthritis are disorders that can be difficult to comprehend for health professionals and students in terms of the heterogeneity of clinical symptoms and pathologies. New didactic approaches using innovative technologies such as virtual reality (VR) apps could be helpful to demonstrate disease manifestations as well as joint pathologies in a more comprehensive manner. However, the potential of using a VR education concept in IA has not yet been evaluated. Objective: We evaluated the feasibility of a VR app to educate health care professionals and medical students about IA. Methods: We developed a VR app using data from IA patients as well as 2D and 3D-visualized pathological joints from X-ray and computed tomography–generated images. This VR app (Rheumality) allows the user to interact with representative arthritic joint and bone pathologies of patients with IA. In a consensus meeting, an online questionnaire was designed to collect basic demographic data (age, sex); profession of the participants; and their feedback on the general impression, knowledge gain, and potential areas of application of the VR app. The VR app was subsequently tested and evaluated by health care professionals (physicians, researchers, and other professionals) and medical students at predefined events (two annual rheumatology conferences and academic teaching seminars at two sites in Germany). To explore associations between categorical variables, the χ2 or Fisher test was used as appropriate. Two-sided P values ≤.05 were regarded as significant. Results: A total of 125 individuals participated in this study. Among them, 56% of the participants identified as female, 43% identified as male, and 1% identified as nonbinary; 59% of the participants were 18-30 years of age, 18% were 31-40 years old, 10% were 41-50 years old, 8% were 51-60 years old, and 5% were 61-70 years old. The participants (N=125) rated the VR app as excellent, with a mean rating of 9.0 (SD 1.2) out of 10, and many participants would recommend use of the app, with a mean recommendation score of 3.2 (SD 1.1) out of 4. A large majority (120/125, 96.0%) stated that the presentation of pathological bone formation improves understanding of the disease. We did not find any association between participant characteristics and evaluation of the VR experience or recommendation scores. Conclusions: The data show that IA-targeting innovative teaching approaches based on VR technology are feasible. %M 33973858 %R 10.2196/23835 %U https://games.jmir.org/2021/2/e23835 %U https://doi.org/10.2196/23835 %U http://www.ncbi.nlm.nih.gov/pubmed/33973858 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e14746 %T Leaderboard Design Principles to Enhance Learning and Motivation in a Gamified Educational Environment: Development Study %A Park,Sungjin %A Kim,Sangkyun %+ Department of Industrial Engineering, Kangwon National University, 417, Engineering Building, Kangwon Deahak Gil 1, Chuncheon, KS007, Republic of Korea, 82 033 250 6287, saviour@kangwon.ac.kr %K leaderboard design %K gamification %K learning motivation %K affordance %D 2021 %7 20.4.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Gamification in education enhances learners’ motivation, problem-solving abilities, decision-making abilities, and social skills such as communication. Numerous ongoing 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 the motivation for learning. Objective: The aim of this study was to develop leaderboard design principles to assist learners in efficient goal setting, improve learning motivation, and promote learning in gamified learning environments. Methods: This study implemented 2 different strategies. First, we analyzed previous research on leaderboards that focus on educational efficacy and influence on social interactions. Second, we collected and analyzed data related to cases of leaderboards being used in educational and sport environments. Results: This study determined 4 leaderboard design objectives from previous studies. Based on these objectives, we developed 3 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 learning environments. This study further analyzes best practices considering the 3 leaderboard design principles. Conclusions: This study contributes toward resolving problems associated with leaderboard design for the application of gamification in educational environments. Based upon our results, we strongly suggest that when teachers consider applying gamification in classrooms, the leaderboard design principles suggested in this research should be incorporated. %M 33877049 %R 10.2196/14746 %U https://games.jmir.org/2021/2/e14746 %U https://doi.org/10.2196/14746 %U http://www.ncbi.nlm.nih.gov/pubmed/33877049 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 1 %P e19765 %T The Development of an Escape Room–Based Serious Game to Trigger Social Interaction and Communication Between High-Functioning Children With Autism and Their Peers: Iterative Design Approach %A Terlouw,Gijs %A Kuipers,Derek %A van 't Veer,Job %A Prins,Jelle T %A Pierie,Jean Pierre E N %+ NHL Stenden University of Applied Sciences, Rengerslaan 10, Leeuwarden, Netherlands, 31 0628317457, gijs.terlouw@nhlstenden.com %K serious game %K autism %K design research %K boundary object %D 2021 %7 23.3.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Children with autism spectrum disorder (ASD) have social deficits that affect social interactions, communication, and relationships with peers. Many existing interventions focus mainly on improving social skills in clinical settings. In addition to the direct instruction–based programs, activity-based programs could be of added value, especially to bridge the relational gap between children with ASD and their peers. Objective: The aim of this study is to describe an iterative design process for the development of an escape room–based serious game as a boundary object. The purpose of the serious game is to facilitate direct communication between high-functioning children with ASD and their peers, for the development of social skills on the one hand and strengthening relationships with peers through a fun and engaging activity on the other hand. Methods: This study is structured around the Design Research Framework to develop an escape room through an iterative-incremental process. With a pool of 37 children, including 23 children diagnosed with ASD (5 girls) and 14 children (7 girls) attending special primary education for other additional needs, 4 testing sessions around different prototypes were conducted. The beta prototype was subsequently reviewed by experts (n=12). During the design research process, we examined in small steps whether the developed prototypes are feasible and whether they have the potential to achieve the formulated goals of different stakeholders. Results: By testing various prototypes, several insights were found and used to improve the design. Insights were gained in finding a fitting and appealing theme for the children, composing the content, and addressing different constraints in applying the goals from the children’s and therapeutic perspectives. Eventually, a multiplayer virtual escape room, AScapeD, was developed. Three children can play the serious game in the same room on tablets. The first test shows that the game enacts equal cooperation and communication among the children. Conclusions: This paper presents an iterative design process for AScapeD. AScapeD enacts equal cooperation and communication in a playful way between children with ASD and their peers. The conceptual structure of an escape room contributes to the natural emergence of communication and cooperation. The iterative design process has been beneficial for finding a constructive game structure to address all formulated goals, and it contributed to the design of a serious game as a boundary object that mediates the various objectives of different stakeholders. We present 5 lessons learned from the design process. The developed prototype is feasible and has the potential to achieve the goals of the serious game. %M 33755023 %R 10.2196/19765 %U https://games.jmir.org/2021/1/e19765 %U https://doi.org/10.2196/19765 %U http://www.ncbi.nlm.nih.gov/pubmed/33755023 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e18815 %T Design of a Game-Based Training Environment to Enhance Health Care Professionals’ E–Mental Health Skills: Protocol for a User Requirements Analysis %A Bierbooms,Joyce J P A %A Sluis-Thiescheffer,Wouter R J W %A Feijt,Milou A %A IJsselsteijn,Wijnand A %A Bongers,Inge M B %+ Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO box 90153, Tilburg, 5000 LE, Netherlands, 31 630642496, J.J.P.A.Bierbooms@tilburguniversity.edu %K mental health %K skill development %K eHealth %K games %K user-centered design %D 2021 %7 17.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: E–mental health (EMH) offers various possibilities for mental health care delivery, with many studies demonstrating its clinical efficacy. However, the uptake of EMH technologies by mental health care professionals remains to be low. One of the reasons for this is the lack of knowledge and skills in using these technologies. Skill enhancement by means of serious gaming has been shown to be effective in other areas but has not yet been applied to the development of EMH skills of mental health care professionals. Objective: The aim of this paper is to describe a study protocol for the user requirements analysis for the design of a game-based training environment for mental health care professionals to enhance their skills in EMH. Methods: The user requirements are formulated using three complementary outputs: personas (lively descriptions of potential users), scenarios (situations that require EMH skills), and prerequisites (required technical and organizational conditions). We collected the data using a questionnaire, co-design sessions, and interviews. The questionnaire was used to determine mental health care professionals’ characteristics, attitudes, and skill levels regarding EMH and was distributed among mental health care professionals in the Netherlands. This led to a number of recognizable subuser groups as the basis for personas. Co-design sessions with mental health care professionals resulted in further specification of the personas and an identification of different user scenarios for the game-based training environment. Interviews with mental health care professionals helped to determine the preferences of mental health care professionals regarding training in EMH and the technical and organizational conditions required for the prospective game-based training environment to be used in practice. This combination of requirement elicitation methods allows for a good representation of the target population in terms of both a broad view of user needs (through the large N questionnaire) and an in-depth understanding of specific design requirements (through interviews and co-design). Results: The questionnaire was filled by 432 respondents; three co-design sessions with mental health care professionals and 17 interviews were conducted. The data have been analyzed, and a full paper on the results is expected to be submitted in the first half of 2021. Conclusions: To develop an environment that can effectively support professionals’ EMH skill development, it is important to offer training possibilities that address the specific needs of mental health care professionals. The approach described in this protocol incorporates elements that enable the design of a playful training environment that is user driven and flexible and considers the technical and organizational prerequisites that influence its implementation in practice. It describes a protocol that is replicable and provides a methodology for user requirements analyses in other projects and health care areas. International Registered Report Identifier (IRRID): RR1-10.2196/18815 %M 33595453 %R 10.2196/18815 %U http://www.researchprotocols.org/2021/2/e18815/ %U https://doi.org/10.2196/18815 %U http://www.ncbi.nlm.nih.gov/pubmed/33595453 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e18161 %T A Virtual Reality Exergame to Engage Adolescents in Physical Activity: Mixed Methods Study Describing the Formative Intervention Development Process %A Farič,Nuša %A Smith,Lee %A Hon,Adrian %A Potts,Henry W W %A Newby,Katie %A Steptoe,Andrew %A Fisher,Abi %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 207 7679 4466 ext 419, nusa.faric.11@ucl.ac.uk %K adolescent %K adult %K exercise %K leisure activities %K obesity %K sports %K video games %K mobile phone %K virtual reality %K motivation %D 2021 %7 4.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Early adolescence (13-17 years) is a critical developmental stage for physical activity promotion. Virtual reality (VR) exergaming is a promising intervention strategy to engage adolescents in physical activity. Objective: The vEngage project aims to develop a physical activity intervention for adolescents using VR exergaming. Here, we describe the formative intervention development work and process of academic-industry collaboration. Methods: The formative development was guided by the Medical Research Council framework and included recruiting an adolescent user group to provide iterative feedback, a literature review, a quantitative survey of adolescents, qualitative interviews with adolescents and parents, inductive thematic analysis of public reviews of VR exergames, a quantitative survey and qualitative interviews with users of the augmented reality running app Zombies, Run!, and building and testing a prototype with our adolescent user group. Results: VR exergaming was appealing to adolescents and acceptable to parents. We identified behavior change techniques that users would engage with and features that should be incorporated into a VR exergame, including realistic body movements, accurate graphics, stepped levels of gameplay difficulty, new challenges, in-game rewards, multiplayer options, and the potential to link with real-world aspects such as physical activity trackers. We also identified some potential barriers to use, such as cost, perceived discomfort of VR headsets, and motion sickness concerns. A prototype game was developed and user-tested with generally positive feedback. Conclusions: This is the first attempt to develop a VR exergame designed to engage adolescents in physical activity that has been developed within a public health intervention development framework. Our formative work suggests that this is a very promising avenue. The benefit of the design process was the collaborative parallel work between academics and game designers and the involvement of the target population in the game (intervention) design from the outset. Developing the game within an intervention framework allowed us to consider factors, such as parental support, that would be important for future implementation. This study also serves as a call to action for potential collaborators who may wish to join this endeavor for future phases and an example of how academic-industry collaboration can be successful and beneficial. %M 33538697 %R 10.2196/18161 %U http://www.jmir.org/2021/2/e18161/ %U https://doi.org/10.2196/18161 %U http://www.ncbi.nlm.nih.gov/pubmed/33538697 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 1 %P e25052 %T Validation of a Portable Game Controller to Assess Peak Expiratory Flow Against Conventional Spirometry in Children: Cross-sectional Study %A Chelabi,Khadidja %A Balli,Fabio %A Bransi,Myriam %A Gervais,Yannick %A Marthe,Clement %A Tse,Sze Man %+ Division of Respiratory Medicine, Department of Pediatrics, Sainte-Justine University Hospital Center, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada, 1 (514) 345 4931 ext 5409, sze.man.tse@umontreal.ca %K asthma %K pediatrics %K serious game %K peak expiratory flow %K pulmonary function test, adherence, self-management %D 2021 %7 29.1.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: International asthma guidelines recommend the monitoring of peak expiratory flow (PEF) as part of asthma self-management in children and adolescents who poorly perceive airflow obstruction, those with a history of severe exacerbations, or those who have difficulty controlling asthma. Measured with a peak flow meter, PEF represents a person’s maximum speed of expiration and helps individuals to follow their disease evolution and, ultimately, to prevent asthma exacerbations. However, patient adherence to regular peak flow meter use is poor, particularly in pediatric populations. To address this, we developed an interactive tablet-based game with a portable game controller that can transduce a signal from the user’s breath to generate a PEF value. Objective: The purpose of this study was to evaluate the concordance between PEF values obtained with the game controller and various measures derived from conventional pulmonary function tests (ie, spirometry) and to synthesize the participants’ feedback. Methods: In this cross-sectional multicenter study, 158 children (aged 8-15 years old) with a diagnosis or suspicion of asthma performed spirometry and played the game in one of two hospital university centers. We evaluated the correlation between PEF measured by both the game controller and spirometry, forced expiratory volume at 1 second (FEV1), and forced expiratory flow at 25%-75% of pulmonary volume (FEF25-75), using Spearman correlation. A Bland-Altman plot was generated for comparison of PEF measured by the game controller against PEF measured by spirometry. A post-game user feedback questionnaire was administered and analyzed. Results: The participants had a mean age of 10.9 (SD 2.5) years, 44% (71/158) were female, and 88% (139/158) were White. On average, the pulmonary function of the participants was normal, including FEV1, PEF, and FEV1/forced vital capacity (FVC). The PEF measured by the game controller was reproducible in 96.2% (152/158) of participants according to standardized criteria. The PEF measured by the game controller presented a good correlation with PEF measured by spirometry (r=0.83, P<.001), with FEV1 (r=0.74, P<.001), and with FEF25-75 (r=0.65, P<.001). The PEF measured by the game controller presented an expected mean bias of –36.4 L/min as compared to PEF measured by spirometry. The participants’ feedback was strongly positive, with 78.3% (123/157) reporting they would use the game if they had it at home. Conclusions: The game controller we developed is an interactive tool appreciated by children with asthma, and the PEF values measured by the game controller are reproducible, with a good correlation to values measured by conventional spirometry. Future studies are necessary to evaluate the clinical impact this novel tool might have on asthma management and its potential use in an out-of-hospital setting. %M 33512326 %R 10.2196/25052 %U http://games.jmir.org/2021/1/e25052/ %U https://doi.org/10.2196/25052 %U http://www.ncbi.nlm.nih.gov/pubmed/33512326 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 1 %P e22494 %T Managing Game-Related Conflict With Parents of Young Adults With Internet Gaming Disorder: Development and Feasibility Study of a Virtual Reality App %A Shin,Yu-Bin %A Kim,Jae-Jin %A Kim,Hyunji %A Kim,Soo-Jeong %A Eom,Hyojung %A Jung,Young Hoon %A Kim,Eunjoo %+ Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonju-ro 211, Gangnam-gu, Seoul, 06273, Republic of Korea, 82 2 2019 3340, ejkim96@yuhs.ac %K internet gaming disorder %K family conflict %K coping behavior %K virtual reality %D 2021 %7 18.1.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Individuals with internet gaming disorder (IGD) report facing family conflicts repeatedly because of their excessive internet gaming. With recent advancements in virtual reality (VR) technology, VR therapy has emerged as a promising method for the management of various psychiatric disorders, including IGD. Given that several risk and protective factors for young people with addiction can be influenced by their interpersonal context, the potential utility of VR-based apps for managing family conflicts needs to be examined with reference to IGD management. However, few studies have evaluated potential treatment modules related to interpersonal conflict management, such as emotion regulation and taking the perspective of others. Objective: This preliminary study aims to examine the potential use of a VR-based app in the management of game-related conflicts with parents of young adults with IGD and matched controls. Methods: In total, 50 young male adults (24 with IGD and 26 controls) were recruited to participate in the study. We developed a virtual room where game-related family conflicts arise. Using this room, participants completed 2 VR tasks that required them to express anger and then implement coping skills (ie, risk/benefit assessment of stopping a game and taking parents’ perspective) to deal with negative emotions in interpersonal conflict situations and to decrease one’s gaming behavior. Results: The results showed that immersion in our VR app tended to provoke negative emotions in individuals with IGD. In addition, after a risk/benefit assessment of stopping a game, the response of stopping a game immediately increased significantly in the IGD group, suggesting that patients’ gaming behavior could be changed using our VR program. Furthermore, in individuals with IGD, longer gaming hours were associated with a lower level of perceived usefulness of the coping skills training. Conclusions: The findings of this study indicate that our VR app may be useful for implementing more desirable behaviors and managing gaming-related family conflicts in individuals with IGD. Our VR app may offer an alternative for individuals with IGD to learn how a vicious cycle of conflicts is developed and to easily and safely assess their dysfunctional thoughts behind the conflicts (ie, perceived unreasonable risks of stopping a game and thoughts acting as a barrier to taking the perspective of others). %M 33459603 %R 10.2196/22494 %U http://games.jmir.org/2021/1/e22494/ %U https://doi.org/10.2196/22494 %U http://www.ncbi.nlm.nih.gov/pubmed/33459603 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 3 %P e17979 %T Serious Game on a Smartphone for Adolescents Undergoing Hemodialysis: Development and Evaluation %A Santana,Cristina Célia De Almeida Pereira %A Freitas,Ana Tereza Vaz De Souza %A Oliveira Barreto,Gilson %A Sousa De Avelar,Igor %A Mazaro-Costa,Renata %A Bueno,Gina Nolêto %A Ribeiro,Diuly Caroline %A Damasceno Silva,Gabriela %A Naghettini,Alessandra Vitorino %+ Hospital das Clínicas, Postgraduate Program Teaching in Health, Goias Federal University, Primeira Avenida, S/nº, Setor Universitário, Goiânia, 74605-020, Brazil, 55 62991507049, ccaps44@gmail.com %K adolescent %K hemodialysis %K serious game %K operability %D 2020 %7 14.9.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Adolescents with chronic kidney disease have a hard time adhering to hemodialysis as a therapy, indicating a need to establish new alternatives for motivation and adherence to treatment. Objective: The objective of this study was to develop and evaluate a serious game to stimulate and motivate adolescents undergoing hemodialysis. Methods: We describe the technological production followed by a qualitative analysis. We invited 8 adolescents undergoing hemodialysis in the city Goiânia, located in the midwest of Brazil, to participate. The final convenience sample included 7 (87.5% of the target population) adolescents. The process was conducted in 3 phases: creation of a serious game, evaluation of its use, and observation of its motivating effect on behavioral modification with a focus on acquiring the necessary competence for self-care. Results: An app (Bim) in the modality of a serious game was developed to be used during hemodialysis; the player was encouraged to take care of a character with daily actions during his or her treatment. The game was made available to adolescents aged 10-14 years. Mobile devices were offered during the hemodialysis treatment for a period of 30-40 minutes, 3 times a week for 60 days. The usage definitions of the game were freely chosen by the participants. The qualitative evaluation of the use of the Bim app showed that it encompasses scenarios and activities that enable the exercise of daily actions for the treatment of patients. The behavioral evaluation showed that the Bim app worked as a motivating stimulus for behavioral adherence to hemodialysis requirements. Conclusions: The easy-to-access app interface showed good operability for its users. The description of the character and proposed activities contributed to motivation and ability to cope with hemodialysis care. %M 32924950 %R 10.2196/17979 %U http://games.jmir.org/2020/3/e17979/ %U https://doi.org/10.2196/17979 %U http://www.ncbi.nlm.nih.gov/pubmed/32924950 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 3 %P e16655 %T A Serious Game on the First-Aid Procedure in Choking Scenarios: Design and Evaluation Study %A Boada,Imma %A Rodriguez Benitez,Antonio %A Thió-Henestrosa,Santiago %A Soler,Josep %+ Graphics and Imaging Laboratory, Escola Politècnica Superior, Edifici Politècnica IV, C/ de la Universitat de Girona, 6, Campus Montilivi, 17003 Girona, Spain, 34 618334786, imma.boada@udg.edu %K choking %K prevention %K first-aid procedure %K first-aid education %D 2020 %7 19.8.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Choking is one of the causes of unintentional injury death. Gaining the knowledge of the first-aid procedure that has to be applied in case of choking can increase the chances of survival of persons with choking. Serious games can be a good channel for educating people about choking scenarios and the actions to be taken to save the persons with choking. Objective: The objective of this study is to present and evaluate the effectiveness of a serious game designed to prevent choking and to promote the first-aid procedure that needs to be applied in case of choking. Methods: In this study, we present a serious game as a set of minigames that reproduces the main steps of the protocol for the first-aid performed in choking. In the proposed game, the player acquires the role of a helper who has to save the person in a choking emergency by applying the main steps of the protocol. Time and score restrictions are imposed to pass each minigame. To test this game, we performed a pilot study with 48 high school students. Different tests were performed to assess the students’ preferences and their knowledge on choking before and after playing the proposed game. The obtained results were analyzed using Mann-Whitney U test when a grade variable was involved and by using Fisher exact test when 2 categorical variables were involved. Results: The findings of our study showed that the players enjoyed the game. No statistical differences were detected when considering the gender of the player, their preferences for video games, or their previous experience in choking emergencies. By comparing the knowledge of these students before and after playing the game, we found that all the indicators of the knowledge about how to act in case of a choking emergency were improved through this serious game. Conclusions: The findings of our study show that the proposed game is a good strategy for promoting and teaching first-aid procedures in choking emergencies to nonexperts in this field. %M 32812882 %R 10.2196/16655 %U http://games.jmir.org/2020/3/e16655/ %U https://doi.org/10.2196/16655 %U http://www.ncbi.nlm.nih.gov/pubmed/32812882 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e13170 %T Toward Gamified Pain Management Apps: Mobile Application Rating Scale–Based Quality Assessment of Pain-Mentor’s First Prototype Through an Expert Study %A Hoffmann,Alexandra %A Faust-Christmann,Corinna A %A Zolynski,Gregor %A Bleser,Gabriele %+ Junior Research Group wearHEALTH, Department of Computer Science, Technische Universität Kaiserslautern, Gottlieb-Daimler-Straße 48, Kaiserslautern, 67663, Germany, 49 631 205 3456, hoffmann@cs.uni-kl.de %K mHealth %K chronic pain %K stress management %K pain management %K health app %K gamification %K health professional %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of health apps to support the treatment of chronic pain is gaining importance. Most available pain management apps are still lacking in content quality and quantity as their developers neither involve health experts to ensure target group suitability nor use gamification to engage and motivate the user. To close this gap, we aimed to develop a gamified pain management app, Pain-Mentor. Objective: To determine whether medical professionals would approve of Pain-Mentor’s concept and content, this study aimed to evaluate the quality of the app’s first prototype with experts from the field of chronic pain management and to discover necessary improvements. Methods: A total of 11 health professionals with a background in chronic pain treatment and 2 mobile health experts participated in this study. Each expert first received a detailed presentation of the app. Afterward, they tested Pain-Mentor and then rated its quality using the mobile application rating scale (MARS) in a semistructured interview. Results: The experts found the app to be of excellent general (mean 4.54, SD 0.55) and subjective quality (mean 4.57, SD 0.43). The app-specific section was rated as good (mean 4.38, SD 0.75). Overall, the experts approved of the app’s content, namely, pain and stress management techniques, behavior change techniques, and gamification. They believed that the use of gamification in Pain-Mentor positively influences the patients’ motivation and engagement and thus has the potential to promote the learning of pain management techniques. Moreover, applying the MARS in a semistructured interview provided in-depth insight into the ratings and concrete suggestions for improvement. Conclusions: The experts rated Pain-Mentor to be of excellent quality. It can be concluded that experts perceived the use of gamification in this pain management app in a positive manner. This showed that combining pain management with gamification did not negatively affect the app’s integrity. This study was therefore a promising first step in the development of Pain-Mentor. %M 32452803 %R 10.2196/13170 %U http://formative.jmir.org/2020/5/e13170/ %U https://doi.org/10.2196/13170 %U http://www.ncbi.nlm.nih.gov/pubmed/32452803 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 1 %P e16254 %T Engaging African American Youth in the Development of a Serious Mobile Game for Sexual Health Education: Mixed Methods Study %A Patchen,Loral %A Ellis,Lindsey %A Ma,Tony Xuyen %A Ott,Corilyn %A Chang,Katie H K %A Araya,Brook %A Atreyapurapu,Sravanthi %A Alyusuf,Amal %A Gaines Lanzi,Robin %+ MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, United States, 1 2028777128, loral.patchen@medstar.net %K sexual health %K sex education %K African Americans %K youth %K adolescents %K video games %K games, experimental %K community-based participatory research %K user-centered design %D 2020 %7 31.1.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Although teen pregnancy rates decreased dramatically in the United States over the past decade, the rates of sexually transmitted infections (STIs) among adolescents and young adults increased. STI rates disproportionately affect African American youth and young adults. Innovative, accessible, and culturally relevant sexual health interventions are urgently needed. Objective: This study aimed to identify the optimal modality for a game-based sexual health intervention; develop the educational, entertainment, and technological aspects of the serious game; and demonstrate its usability and acceptance by the target population. Methods: This project was grounded in formative data collection with community-based participatory research principles and practices combined with a user-centered design and development approach. Sexually Active Adolescent–Focused Education (SAAFE) was developed using input and feedback from African American youths aged 15 to 21 years who participated in a youth advisory board and focus group discussions to inform the co-design and cocreation of the serious game. The process was highly iterative with multiple sessions for user input following design changes. It proceeded in 3 stages. Social cognitive theory and problem-solving theory were leveraged to provide evidence-based, trauma-informed education through a serious game. Usability testing assessed the quality of user experience with the prototype. Results: Across all 3 stages, a total of 86 self-identified African American males and females aged 15 to 21 years from the District of Columbia and Birmingham, Alabama, participated. Participants requested a dating simulation game. They wanted SAAFE to be customizable, realistic, entertaining, educational, modern, and experiential, linking consequences to their gameplay decisions. Usability testing resulted in an initial System Usability Survey score of 77.7, placing the game in the 82nd percentile and above average for usability. Conclusions: Initial results suggest that the SAAFE prototype is a promising intervention to engage African American youth in sexual health education using a role-playing game. If proven efficacious, the game has the potential to meet the need for sex education, counterbalance unhealthy portrayals of sex in popular media, and respond to the disparities in the STI epidemic. %M 32012041 %R 10.2196/16254 %U http://games.jmir.org/2020/1/e16254/ %U https://doi.org/10.2196/16254 %U http://www.ncbi.nlm.nih.gov/pubmed/32012041 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 1 %P e11786 %T Development of Serious Games (Equit’Game) to Address Health and Environmental Inequalities: Protocol for an App-Delivered Program to Perform a Territorial Diagnosis %A Kihal Talantikite,Wahida %A Renou,Damien %A Magdelaine,Arnold %A Harang,William %A Zmirou-Navier,Denis %A Deguen,Severine %+ School of Public Health, Av du Pr Leon Bernard, Rennes, 35000, France, 33 299022805, Severine.Deguen@ehesp.fr %K serious game %K territorial diagnosis tool %K health inequality %K environmental inequalities %K Equit'Game %D 2020 %7 7.1.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Territorial diagnosis is a prerequisite for local actions concerning public health and for the reduction of social, environmental, and health-related inequalities. To orient local programs or initiatives targeting health inequalities, policymakers need a simulation of territorial diagnosis tools. Yet, very few platforms have been developed for the purpose of guiding public authorities as they seek to reduce these social inequalities. Objective: This study aimed to describe the design and methods of the development process of a territorial diagnosis tool based on a serious game named Equit’Game that puts learners at the heart of the territorial diagnosis process, asking them to review the current state of health, environmental state, and socioeconomic state of their territory. Methods: The realistic situations employed in our serious game should encourage players, in a fun and playful manner, to (1) appropriate the data of their own territory, (2) apply their methodological knowledge in a practical way, (3) reflect on the most pertinent statistical or spatial tools for their situation, and (4) ultimately, to acquire new knowledge and skills in the use of territorial diagnosis tools with a spatial dynamic. Equit’Game was deployed over the course of a week’s training and structured into 4 levels: level 1, Dataminer (identifying relevant information to respond to the question); level 2, Analyst (selecting the appropriate method of analysis); level 3, Atlas (mapping the data); and level 4, Cluster (extraction of statistical and spatial information). Equit’Game has also been designed as a sort of virtual campus, creating a fun learning environment in which each door represents a level. Users can access Equit’Game via a platform compatible with tablets, PCs, and mobile phones. Results: In the first step, we tested our application interface designed especially for adults among a panel of local health professionals. The following are some of the most relevant points: font size and colors used, voice accompaniment in texts and messages guiding the user, clear and easy interfaces, and the change between successive game levels. In the second step, we used our application, Equit’Game, with postgraduate students from the School of Public Health (École des hautes études en santé publique). At the end of the game session, we conducted a satisfaction survey, including several items covering both the application interface and the execution of the game. Conclusions: Equit’Game was developed to help learners with the techniques of territorial diagnosis, with the aim of creating an innovative tool for public health capable of conveying educational messages and providing a structure for training. International Registered Report Identifier (IRRID): PRR1-10.2196/11786 %M 31909726 %R 10.2196/11786 %U https://www.researchprotocols.org/2020/1/e11786 %U https://doi.org/10.2196/11786 %U http://www.ncbi.nlm.nih.gov/pubmed/31909726 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 4 %P e13695 %T Development of a Mobile Game to Influence Behavior Determinants of HIV Service Uptake Among Key Populations in the Philippines: User-Centered Design Process %A Hemingway,Charlotte %A Baja,Emmanuel S %A Dalmacion,Godafreda V %A Medina,Paul Mark B %A Guevara,Ernest Genesis %A Sy,Tyrone Reden %A Dacombe,Russell %A Dormann,Claire %A Taegtmeyer,Miriam %+ Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L35QA, United Kingdom, 44 7942118311, charlotte.hemingway@lstmed.ac.uk %K HIV %K video games %K health communication %K persuasive communication %K games %K experimental %K user-centered design %D 2019 %7 20.12.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: Opportunities in digital distribution place mobile games as a promising platform for games for health. However, designing a game that can compete in the saturated mobile games market and deliver persuasive health messages can feel like an insurmountable challenge. Although user-centered design is widely advocated, factors such as the user’s subject domain expertise, budget constraints, and poor data collection methods can restrict the benefits of user involvement. Objective: This study aimed to develop a playable and acceptable game for health, targeted at young key populations in the Philippines. Methods: Authors identified a range of user-centered design methods to be used in tandem from published literature. The resulting design process involved a phased approach, with 40 primary and secondary users engaged during the initial ideation and prototype testing stages. Selected methods included participatory design workshops, playtests, playability heuristics, and focus group discussions. Subject domain experts were allocated roles in the development team. Data were analyzed using a framework approach. Conceptual frameworks in health intervention acceptability and game design guided the analysis. In-game events were captured through the Unity Analytics service to monitor uptake and game use over a 12-month period. Results: Early user involvement revealed a strong desire for online multiplayer gameplay, yet most reported that access to this type of game was restricted because of technical and economic constraints. A role-playing game (RPG) with combat elements was identified as a very appealing gameplay style. Findings guided us to a game that could be played offline and that blended RPG elements, such as narrative and turn-based combat, with match-3 puzzles. Although the game received a positive response during playtests, gameplay was at times perceived as repetitive and predicted to only appeal to casual gamers. Knowledge transfer was predominantly achieved through interpretation of the game’s narrative, highlighting this as an important design element. Uptake of the game was positive; between December 1, 2017, and December 1, 2018, 3325 unique device installs were reported globally. Game metrics provided evidence of adoption by young key populations in the Philippines. Game uptake and use were substantially higher in regions where direct engagement with target users took place. Conclusions: User-centered design activities supported the identification of important contextual requirements. Multiple data collection methods enabled triangulation of findings to mediate the inherent biases of the different techniques. Game acceptance is dependent on the ability of the development team to implement design solutions that address the needs and desires of target users. If target users are expected to develop design solutions, they must have adequate expertise and a significant role within the development team. Facilitating meaningful partnerships between health professionals, the games industry, and end users will support the games for health industry as it matures. %M 31859673 %R 10.2196/13695 %U http://games.jmir.org/2019/4/e13695/ %U https://doi.org/10.2196/13695 %U http://www.ncbi.nlm.nih.gov/pubmed/31859673 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 3 %P e13776 %T Usability, Acceptability, Feasibility, and Effectiveness of a Gamified Mobile Health Intervention (Triumf) for Pediatric Patients: Qualitative Study %A Tark,Riin %A Metelitsa,Mait %A Akkermann,Kirsti %A Saks,Kadri %A Mikkel,Sirje %A Haljas,Kadri %+ Triumf Research OU, Kannikese 33-1, Tartu, 50408, Estonia, 372 5078577, tarkriin@gmail.com %K psychological stress %K coping skills %K psychological feedback %K mobile app %K mHealth %K mental health %K chronic illness %K cancer %K pediatrics %D 2019 %7 30.9.2019 %9 Original Paper %J JMIR Serious Games %G English %X 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. %M 31573904 %R 10.2196/13776 %U https://games.jmir.org/2019/3/e13776 %U https://doi.org/10.2196/13776 %U http://www.ncbi.nlm.nih.gov/pubmed/31573904 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 2 %P e11960 %T Younger Adolescents’ Perceptions of Physical Activity, Exergaming, and Virtual Reality: Qualitative Intervention Development Study %A Faric,Nuša %A Yorke,Eleanor %A Varnes,Laura %A Newby,Katie %A Potts,Henry WW %A Smith,Lee %A Hon,Adrian %A Steptoe,Andrew %A Fisher,Abigail %+ Department of Behavioural Science & Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 02067694466 ext 41914, nfaric@gmail.com %K exercise %K obesity %K video games %K adolescent %K adolescence %K sports %K health %K leisure activities %K virtual reality %D 2019 %7 17.06.2019 %9 Original Paper %J JMIR Serious Games %G English %X 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. %M 31210135 %R 10.2196/11960 %U http://games.jmir.org/2019/2/e11960/ %U https://doi.org/10.2196/11960 %U http://www.ncbi.nlm.nih.gov/pubmed/31210135 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 2 %P e12429 %T Development of CliniPup, a Serious Game Aimed at Reducing Perioperative Anxiety and Pain in Children: Mixed Methods Study %A Verschueren,Sarah %A van Aalst,June %A Bangels,Anne-Marie %A Toelen,Jaan %A Allegaert,Karel %A Buffel,Connor %A Vander Stichele,Geert %+ MindBytes BVBA, Schoondreef 7, Merksplas,, Belgium, 32 476753516, sarah.verschueren@hotmail.com %K serious games for health %K behavior change %K perioperative pain %K perioperative anxiety %K pediatric %K ambulatory surgery %D 2019 %7 1.6.2019 %9 Original Paper %J JMIR Serious Games %G English %X 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. %M 31199333 %R 10.2196/12429 %U http://games.jmir.org/2019/2/e12429/ %U https://doi.org/10.2196/12429 %U http://www.ncbi.nlm.nih.gov/pubmed/31199333 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 2 %P e11909 %T Acceptability of a Plasticity-Focused Serious Game Intervention for Posttraumatic Stress Disorder: User Requirements Analysis %A Jones,Matthew %A Denisova,Alena %A Mitchell,Stephen %A Owen,Tom %+ Health Services Research, Medical School, Swansea University, ILS 2, Swansea University Medical School, Singleton Park Campus, Swansea,, United Kingdom, 44 01792513409, m.b.jones@swansea.ac.uk %K PTSD %K mobile applications %K neuronal plasticity %K cognitive behavioral therapy %D 2019 %7 16.04.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: Trauma-focused cognitive behavioral therapy (TF-CBT) is a first-line treatment for posttraumatic stress disorder (PTSD). Despite a solid evidence base, TF-CBT response and attrition rates vary considerably. Plasticity-focused interventions, including the use of serious games, have the potential to improve TF-CBT response and treatment retention. Objective: The aim of this study was to assess the acceptability of a mobile phone–delivered plasticity-focused serious game to improve response to TF-CBT for PTSD, and carry out a user requirements analysis should the development of a prototype be warranted. Methods: We conducted 2 one-to-one interviews (n=2), one focus group involving service users who had received a diagnosis of PTSD (n=3) and one focus group involving psychological trauma service clinicians (n=4). Results: We found that the concept of a plasticity-focused mobile phone intervention for PTSD is acceptable to patients and clinicians. Service users and clinicians both believed that the usage should be guided by a therapist, and both contributed useful inputs regarding the audiovisual aspects of the proposed serious game. It was accepted that the game would not be suitable for all patients and that clinicians would need to appropriately prescribe the usage of the game. Conclusions: The findings highlight the acceptability of the proposed serious game and clarify the user requirements for such an intervention. It is the intention of the authors to carry out a user experience evaluation using a prototype serious game in a clinical population. %M 30990461 %R 10.2196/11909 %U http://games.jmir.org/2019/2/e11909/ %U https://doi.org/10.2196/11909 %U http://www.ncbi.nlm.nih.gov/pubmed/30990461 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 4 %P e10519 %T A Mobile App Delivering a Gamified Battery of Cognitive Tests Designed for Repeated Play (OU Brainwave): App Design and Cohort Study %A Thirkettle,Martin %A Lewis,Jennifer %A Langdridge,Darren %A Pike,Graham %+ Centre for Behavioural Science & Applied Psychology, Sheffield Hallam University, Heart of the Campus Building, 42 Collegiate Crescent, Sheffield, S10 2BQ, United Kingdom, 44 01142256718, m.thirkettle@shu.ac.uk %K cognitive psychology %K gamification %K mobile app %K Morningness-Eveningness %K mobile phone %D 2018 %7 30.10.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Mobile phone and tablet apps are an increasingly common platform for collecting data. A key challenge for researchers has been participant “buy-in” and attrition for designs requiring repeated testing. Objective: The objective of this study was to develop and assess the utility of 1-2 minute versions of both classic and novel cognitive tasks using a user-focused and user-driven mobile phone and tablet app designed to encourage repeated play. Methods: A large sample of app users (N=13,979 at first data collection) participated in multiple, self-paced sessions of classic working memory (N-back), spatial cognition (mental rotation), sustained attentional focus (persistent vigilance task), and split attention (multiple object tracking) tasks, along with the implementation of a comparatively novel action-learning task. The “OU Brainwave” app was designed to measure time-of-day variation in cognitive performance and did not offer any training program or promise any cognitive enhancement. To record participants’ chronotype, a full Morningness-Eveningness questionnaire was also included, which measures whether a person's circadian rhythm produces peak alertness in the morning, in the evening, or in between. Data were collected during an 18-month period. While the app prompted re-engagement at set intervals, participants were free to complete each task as many times as they wished. Results: We found a significant relationship between morningness and age (r=.298, n=12,755, P<.001), with no effect of gender (t13,539=−1.036, P=.30). We report good task adherence, with ~4000 participants repeatedly playing each game >4 times each—our minimum engagement level for analysis. Repeated plays of these games allowed us to replicate commonly reported gender effects in gamified spatial cognition (F1,4216=154.861, P<.001, η2ρ=.035), split attention (F1,4185=11.047, P=.001, η2ρ=.003), and sustained attentional focus (F1,4238=15.993, P<.001, η2ρ=.004) tasks. We also report evidence of a small gender effect in an action-learning task (F1,3988=90.59, P<.001, η2ρ=.022). Finally, we found a strong negative effect of self-reported age on performance, when controlling for number of plays, in sustained attentional focus (n=1596, F6,1595=30.23, P<.001, η2=.102), working memory (n=1627, F6,1626=19.78, P<.001, η2=.068), spatial cognition (n=1640, F6,1639=23.74, P<.001, η2=.080), and split attention tasks (n=1616, F6,1615=2.48, P=.02, η2=.009). Conclusions: Using extremely short testing periods and permitting participants to decide their level of engagement—both in terms of which gamified task they played and how many sessions they completed—we were able to collect a substantial and valid dataset. We suggest that the success of OU Brainwave should inform future research oriented apps—particularly in issues of balancing participant engagement with data fidelity. %M 30377140 %R 10.2196/10519 %U http://games.jmir.org/2018/4/e10519/ %U https://doi.org/10.2196/10519 %U http://www.ncbi.nlm.nih.gov/pubmed/30377140 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 1 %P e4 %T Development of an Exergame to Deliver a Sustained Dose of High-Intensity Training: Formative Pilot Randomized Trial %A McBain,Thomas %A Weston,Matthew %A Crawshaw,Paul %A Haighton,Catherine %A Spears,Iain %+ Academy of Sport and Physical Activity, Sheffield Hallam University, Collegiate Hall, Collegiate Crescent, Sheffield, S102BP, United Kingdom, 44 1142255805, t.mcbain@shu.ac.uk %K high-intensity interval training %K video games %K heart rate %K boxing %K metabolic syndrome %D 2018 %7 27.03.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Sport science can play a critical role in reducing health inequalities. The inverse relationship between life expectancy, cardiorespiratory fitness, and socioeconomic status could be addressed by performing high-intensity training (HIT), delivered in a class salient and accessible approach. Commercially available exergames have shown encouraging compliance rates but are primarily designed for entertainment purposes rather than focusing on health-related outcomes. A serious game tailored toward delivering an exercise stimulus, while reducing the aversive protocols associated with HIT, could be beneficial to engage and improve health outcomes in socially deprived males. Objective: The aims of this study were to develop an exergame capable of delivering HIT and evaluate the effect on selected health outcomes in men recruited in regions of socioeconomic deprivation. Methods: We conducted an exploratory trial in our target population, and participants were allocated to intervention (n=14) or control groups (n=10) by third-party minimization. The intervention was a 6-week training program consisting of three sessions of exergaming per week. The sessions involved a structured warm-up, then brief intermittent repetitions in the form of boxing rounds (10 s, 20 s, and 30 s) against their peers with a work/rest ratio of 0.25. Results: Retention to the intervention was 87.5% (21/24). Over the duration of the intervention, session attendance was 67.5% (170/252); repetition mean and peak heart rates (% of maximal) and session ratings of perceived exertion (AU, arbitrary units) were 86.3 (5.4%), 89.9 (6.1%), and 7.5 (2.2 AU), respectively. The effect of the intervention, when compared with the control, was a likely small beneficial improvement in predicted maximum oxygen consumption (VO2 max, 3.0; 90% confidence limits ±2.6%). Effects on body mass, waist circumference, and blood pressure were either trivial or unclear. Conclusions: Over the 6-week intervention, the exergame delivered a consistent and sustained dose of HIT, with some beneficial effects on aerobic fitness in the target population. Trial Registration: ClinicalTrials.gov NCT03477773; https://clinicaltrials.gov/ct2/show/NCT03477773 (Archived by WebCite at http://www.webcitation.org/6yDLgVs35) %M 29588271 %R 10.2196/games.7758 %U http://games.jmir.org/2018/1/e4/ %U https://doi.org/10.2196/games.7758 %U http://www.ncbi.nlm.nih.gov/pubmed/29588271 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e51 %T More Stamina, a Gamified mHealth Solution for Persons with Multiple Sclerosis: Research Through Design %A Giunti,Guido %A Mylonopoulou,Vasiliki %A Rivera Romero,Octavio %+ Salumedia Tecnologias, Avda. Republica Argentina nº 24, Edificio Torre de los Remedios 5ª planta modulo A, Sevilla, 41011, Spain, 34 717702622, drguidogiunti@gmail.com %K multiple sclerosis %K telemedicine %K fatigue %K mobile applications %K video games %K qualitative research %K exercise %K chronic disease %K user-computer interface %K software design %D 2018 %7 02.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Multiple sclerosis (MS) is one of the world’s most common neurologic disorders. Fatigue is one of most common symptoms that persons with MS experience, having significant impact on their quality of life and limiting their activity levels. Self-management strategies are used to support them in the care of their health. Mobile health (mHealth) solutions are a way to offer persons with chronic conditions tools to successfully manage their symptoms and problems. Gamification is a current trend among mHealth apps used to create engaging user experiences and is suggested to be effective for behavioral change. To be effective, mHealth solutions need to be designed to specifically meet the intended audience needs. User-centered design (UCD) is a design philosophy that proposes placing end users’ needs and characteristics in the center of design and development, involving users early in the different phases of the software life cycle. There is a current gap in mHealth apps for persons with MS, which presents an interesting area to explore. Objective: The purpose of this study was to describe the design and evaluation process of a gamified mHealth solution for behavioral change in persons with MS using UCD. Methods: Building on previous work of our team where we identified needs, barriers, and facilitators for mHealth apps for persons with MS, we followed UCD to design and evaluate a mobile app prototype aimed to help persons with MS self-manage their fatigue. Design decisions were evidence-driven and guided by behavioral change models (BCM). Usability was assessed through inspection methods using Nielsen’s heuristic evaluation. Results: The mHealth solution More Stamina was designed. It is a task organization tool designed to help persons with MS manage their energy to minimize the impact of fatigue in their day-to-day life. The tool acts as a to-do list where users can input tasks in a simple manner and assign Stamina Credits, a representation of perceived effort, to the task to help energy management and energy profiling. The app also features personalization and positive feedback. The design process gave way to relevant lessons to the design of a gamified behavioral change mHealth app such as the importance of metaphors in concept design, negotiate requirements with the BCM constructs, and tailoring of gamified experiences among others. Several usability problems were discovered during heuristic evaluation and guided the iterative design of our solution. Conclusions: In this paper, we designed an app targeted for helping persons with MS in their fatigue management needs. We illustrate how UCD can help in designing mHealth apps and the benefits and challenges that designers might face when using this approach. This paper provides insight into the design process of gamified behavioral change mHealth apps and the negotiation process implied in it. %M 29500159 %R 10.2196/mhealth.9437 %U http://mhealth.jmir.org/2018/3/e51/ %U https://doi.org/10.2196/mhealth.9437 %U http://www.ncbi.nlm.nih.gov/pubmed/29500159 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 8 %P e161 %T Engaging Adolescents to Inform the Development of a Mobile Gaming App to Incentivize Physical Activity %A Pope,Lizzy %A Garnett,Bernice %A Dibble,Marguerite %+ University of Vermont, 533 Waterman Building, 85 South Prospect St, Burlington, VT, 05405, United States, 1 802 656 2187, bgarnett@uvm.edu %K adolescents %K qualitative research %K mHealth %K physical activity %D 2017 %7 29.08.2017 %9 Short Paper %J JMIR Res Protoc %G English %X Background: Involving youth in the development of a mobile game designed to increase physical activity may increase relevancy and adoption. Objective: To share the development process used to create a gaming app aimed at incentivizing physical activity in high school students. Methods: Five focus groups were conducted with high school students (N=50) to understand gaming behaviors. A subset of students from the focus groups chose to complete a Web-based survey (N=10). Four different versions of gaming artwork and concept design based on student input were pilot tested (N=35), and group consensus building determined the direction of the game. The 4 game versions differed in their artwork style and gaming concept with some requiring competition versus cooperation, or being more individual versus team based. Group consensus building meant that all artwork and game concept options were displayed at the front of a classroom. Students could then vote for their top artwork and concept choices by putting stickers on the top 1 or 2 artwork and concept options that they liked best. Once all votes were cast, investigators discussed the voting results with students, and brainstormed ways to incorporate popular aspects of the 3 “losing” artwork and game concepts into the winning ideas. Results: Focus group transcripts were analyzed for common themes. Artwork and gaming concept-voting data was tallied at the time of voting to share with students in real time. Focus groups and survey results revealed important themes for a successful gaming app: (1) competition, (2) balanced in-game rewards, (3) accessibility, and (4) aesthetic features. Consensus voting indicated the popularity of a collaborative competitive content design (35/66, 53%) and playful art (27/71, 38%). Conclusions: To ensure saliency and effectiveness of game-based physical activity interventions, youth need to be included in design and implementation. Furthermore, the unique preferences and social constructs of high school students need to be considered during intervention development. %M 28851676 %R 10.2196/resprot.8113 %U http://www.researchprotocols.org/2017/8/e161/ %U https://doi.org/10.2196/resprot.8113 %U http://www.ncbi.nlm.nih.gov/pubmed/28851676 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 3 %P e16 %T Designing Serious Computer Games for People With Moderate and Advanced Dementia: Interdisciplinary Theory-Driven Pilot Study %A Tziraki,Chariklia %A Berenbaum,Rakel %A Gross,Daniel %A Abikhzer,Judith %A Ben-David,Boaz M %+ Communication, Aging and Neuropsychology Lab (CANlab), Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, PO Box 167, Herzliya, 4610101, Israel, 972 9 960 2429, boaz.ben.david@idc.ac.il %K serious games %K dementia %K functionality %K learning in context %K speed of processing %D 2017 %7 31.07.2017 %9 Original Paper %J JMIR Serious Games %G English %X Background: The field of serious games for people with dementia (PwD) is mostly driven by game-design principals typically applied to games created by and for younger individuals. Little has been done developing serious games to help PwD maintain cognition and to support functionality. Objectives: We aimed to create a theory-based serious game for PwD, with input from a multi-disciplinary team familiar with aging, dementia, and gaming theory, as well as direct input from end users (the iterative process). Targeting enhanced self-efficacy in daily activities, the goal was to generate a game that is acceptable, accessible and engaging for PwD. Methods: The theory-driven game development was based on the following learning theories: learning in context, errorless learning, building on capacities, and acknowledging biological changes—all with the aim to boost self-efficacy. The iterative participatory process was used for game screen development with input of 34 PwD and 14 healthy community dwelling older adults, aged over 65 years. Development of game screens was informed by the bio-psychological aging related disabilities (ie, motor, visual, and perception) as well as remaining neuropsychological capacities (ie, implicit memory) of PwD. At the conclusion of the iterative development process, a prototype game with 39 screens was used for a pilot study with 24 PwD and 14 healthy community dwelling older adults. The game was played twice weekly for 10 weeks. Results: Quantitative analysis showed that the average speed of successful screen completion was significantly longer for PwD compared with healthy older adults. Both PwD and controls showed an equivalent linear increase in the speed for task completion with practice by the third session (P<.02). Most important, the rate of improved processing speed with practice was not statistically different between PwD and controls. This may imply that some form of learning occurred for PwD at a nonsignificantly different rate than for controls. Qualitative results indicate that PwD found the game engaging and fun. Healthy older adults found the game too easy. Increase in self-reported self-efficacy was documented with PwD only. Conclusions: Our study demonstrated that PwD’s speed improved with practice at the same rate as healthy older adults. This implies that when tasks are designed to match PwD’s abilities, learning ensues. In addition, this pilot study of a serious game, designed for PwD, was accessible, acceptable, and enjoyable for end users. Games designed based on learning theories and input of end users and a multi-disciplinary team familiar with dementia and aging may have the potential of maintaining capacity and improving functionality of PwD. A larger longer study is needed to confirm our findings and evaluate the use of these games in assessing cognitive status and functionality. %M 28760730 %R 10.2196/games.6514 %U http://games.jmir.org/2017/3/e16/ %U https://doi.org/10.2196/games.6514 %U http://www.ncbi.nlm.nih.gov/pubmed/28760730 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 2 %N 2 %P e17 %T The Value of Children's Voices for a Video Game Development in the Context of Type 1 Diabetes: Focus Group Study %A Sparapani,Valéria de Cássia %A Fels,Sidney %A Nascimento,Lucila Castanheira %+ Ribeirao Preto College of Nursing, World Health Organization Collaborating Centre for Nursing Research Development, Department of Maternal-Infant and Public Health Nursing, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto,, Brazil, 55 16 3315 3435, valsparapani@hotmail.com %K type 1 diabetes mellitus %K video games %K qualitative research %K pediatric nursing %K serious games %K self-management %D 2017 %7 19.07.2017 %9 Original Paper %J JMIR Diabetes %G English %X Background: Children with type 1 diabetes mellitus (T1DM) face daily challenges performing self-care tasks, controlling symptoms, and dealing with psychosocial issues. The use of video games to improve health is a successful support for persons with chronic diseases, promoting adequate self-management through simulations of real life. Involving future users in the development of games is essential to generating innovative, creative, and effective programs. Objective: Our goal is to identify what children with T1DM need to know about their disease and their self-care tasks as well as their preferences in video games. Methods: Children with T1DM provided input about their learning needs, self-care tasks, and preferences in video games. Three categories were identified through qualitative content analysis: dealing with emotions and knowledge, practical skills and awareness, and game preferences. Results: Children expressed concerns about the difficulties of self-care, lack of knowledge about diabetes, and lack of awareness about the consequences of behaviors related to self-care, which contribute to inappropriate behaviors and significantly impact self-management of their disease. They expressed enthusiasm for a video game for children with diabetes that considered their needs and preferences. Conclusions: Findings support the potential benefits when children’s input is considered in game design. Consideration of customer needs and preferences is a powerful resource in the development of video games with enhanced learning experience. %M 30291061 %R 10.2196/diabetes.7652 %U http://diabetes.jmir.org/2017/2/e17/ %U https://doi.org/10.2196/diabetes.7652 %U http://www.ncbi.nlm.nih.gov/pubmed/30291061 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 3 %P e14 %T Rehabilitation-Oriented Serious Game Development and Evaluation Guidelines for Musculoskeletal Disorders %A Idriss,Mohamad %A Tannous,Halim %A Istrate,Dan %A Perrochon,Anaick %A Salle,Jean-Yves %A Ho Ba Tho,Marie-Christine %A Dao,Tien-Tuan %+ Sorbonne University, Université de technologie de Compiègne, CNRS, UMR 7338 Biomechanics and Bioengineering, Centre de recherche Royallieu, Compiègne, CS 60 319, France, 33 0344234334, tien-tuan.dao@utc.fr %K rehabilitation exercise %K virtual rehabilitation %K rehabilitation %K user computer interface %K musculoskeletal diseases %D 2017 %7 04.07.2017 %9 Original Paper %J JMIR Serious Games %G English %X Background: The progress in information and communication technology (ICT) led to the development of a new rehabilitation technique called “serious game for functional rehabilitation.” Previous works have shown that serious games can be used for general health and specific disease management. However, there is still lack of consensus on development and evaluation guidelines. It is important to note that the game performance depends on the designed scenario. Objective: The objective of this work was to develop specific game scenarios and evaluate them with a panel of musculoskeletal patients to propose game development and evaluation guidelines. Methods: A two-stage workflow was proposed using determinant framework. The development guideline includes the selection of three-dimensional (3D) computer graphics technologies and tools, the modeling of physical aspects, the design of rehabilitation scenarios, and the implementation of the proposed scenarios. The evaluation guideline consists of the definition of evaluation metrics, the execution of the evaluation campaign, the analysis of user results and feedbacks, and the improvement of the designed game. Results: The case study for musculoskeletal disorders on the healthy control and patient groups showed the usefulness of these guidelines and associated games. All participants enjoyed the 2 developed games (football and object manipulation), and found them challenging and amusing. In particular, some healthy subjects increased their score when enhancing the level of difficulty. Furthermore, there were no risks and accidents associated with the execution of these games. Conclusions: It is expected that with the proven effectiveness of the proposed guidelines and associated games, this new rehabilitation game may be translated into clinical routine practice for the benefit of patients with musculoskeletal disorders. %M 28676468 %R 10.2196/games.7284 %U http://games.jmir.org/2017/3/e14/ %U https://doi.org/10.2196/games.7284 %U http://www.ncbi.nlm.nih.gov/pubmed/28676468 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 2 %P e10 %T Development, Usability, and Efficacy of a Serious Game to Help Patients Learn About Pain Management After Surgery: An Evaluation Study %A Ingadottir,Brynja %A Blondal,Katrin %A Thue,David %A Zoega,Sigridur %A Thylen,Ingela %A Jaarsma,Tiny %+ Landspitali - the National University Hospital of Iceland, Surgical Services, 13A Hringbraut, Reykjavik, 101, Iceland, 354 8245884, brynjain@landspitali.is %K evaluation studies %K knowledge %K pain management %K patient education %K self care %K surgical procedures, operative %K video games %D 2017 %7 10.05.2017 %9 Original Paper %J JMIR Serious Games %G English %X Background: Postoperative pain is a persistent problem after surgery and can delay recovery and develop into chronic pain. Better patient education has been proposed to improve pain management of patients. Serious games have not been previously developed to help patients to learn how to manage their postoperative pain. Objective: The aim of this study was to describe the development of a computer-based game for surgical patients to learn about postoperative pain management and to evaluate the usability, user experience, and efficacy of the game. Methods: A computer game was developed by an interdisciplinary team following a structured approach. The usability, user experience, and efficacy of the game were evaluated using self-reported questionnaires (AttrakDiff2, Postoperative Pain Management Game Survey, Patient Knowledge About Postoperative Pain Management questionnaire), semi-structured interviews, and direct observation in one session with 20 participants recruited from the general public via Facebook (mean age 48 [SD 14]; 11 women). Adjusted Barriers Questionnaire II and 3 questions on health literacy were used to collect background information. Results: Theories of self-care and adult learning, evidence for the educational needs of patients about pain management, and principles of gamification were used to develop the computer game. Ease of use and usefulness received a median score between 2.00 (IQR 1.00) and 5.00 (IQR 2.00) (possible scores 0-5; IQR, interquartile range), and ease of use was further confirmed by observation. Participants expressed satisfaction with this novel method of learning, despite some technological challenges. The attributes of the game, measured with AttrakDiff2, received a median score above 0 in all dimensions; highest for attraction (median 1.43, IQR 0.93) followed by pragmatic quality (median 1.31, IQR 1.04), hedonic quality interaction (median 1.00, IQR 1.04), and hedonic quality stimulation (median 0.57, IQR 0.68). Knowledge of pain medication and pain management strategies improved after playing the game (P=.001). Conclusions: A computer game can be an efficient method of learning about pain management; it has the potential to improve knowledge and is appreciated by users. To assess the game’s usability and efficacy in the context of preparation for surgery, an evaluation with a larger sample, including surgical patients and older people, is required. %M 28490419 %R 10.2196/games.6894 %U http://games.jmir.org/2017/2/e10/ %U https://doi.org/10.2196/games.6894 %U http://www.ncbi.nlm.nih.gov/pubmed/28490419 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 2 %P e23 %T For You and Your Baby (4YYB): Adapting the Centers for Disease Control and Prevention’s Text4Baby Program for Saudi Arabia %A Bahanshal,Soha %A Coughlin,Steven %A Liu,Benyuan %+ Department of Computer Science, University of Massachusetts Lowell, 1 University Ave, Lowell, MA,, United States, 1 781 654 7200, bahasoha@gmail.com %K Saudi Arabia %K telemedicine %K text messaging %K health knowledge, attitudes, practice %K pregnant women %D 2017 %7 28.02.2017 %9 Viewpoint %J JMIR Res Protoc %G English %X Background: Poor birth outcomes in the Kingdom of Saudi Arabia (KSA) have been found to be partially due to missed prenatal appointments as well as lack of knowledge of healthy pregnancy behaviors. Objective: The objectives are to summarize birth outcomes and the antenatal care system in KSA, summarize research related to the US Text4Baby mobile health program, and outline the development of an Arabic version of the Text4baby app, For You and Your Baby (4YYB). Methods: First, birth outcomes, health care access, and smartphone usage among Saudi Arabian women are reviewed. Next, the current evidence behind Text4Baby is described. Finally, a plan to develop and test 4YYB is proposed. In the plan, studies will need to be conducted to determine the effectiveness of 4YYB in educating pregnant Saudi women on healthy knowledge and behaviors. This will create an evidence base behind 4YYB before it is launched as a full-scale public health effort in KSA. Results: The KSA offers public medical services but remaining challenges include poor birth outcomes and health care access barriers. An estimated 73% to 84% of Saudi women of child-bearing age use smartphone social media apps. A total of 13 published articles on Text4Baby were identified and reviewed. Due to design limitations, the studies provide only limited evidence about the effectiveness of the program in increasing healthy pregnancy knowledge and behaviors. To be useful for Saudi women, the educational messages in 4YYB will need to be translated from English to Arabic and tailored for cultural norms. Conclusions: Developing the 4YYB Arabic-language app for use by pregnant Saudi Arabian women based on Text4Baby is a viable approach, but a rigorous study design is needed to determine its effectiveness in improving healthy pregnancy knowledge and behaviors. %M 28246065 %R 10.2196/resprot.5818 %U http://www.researchprotocols.org/2017/2/e23/ %U https://doi.org/10.2196/resprot.5818 %U http://www.ncbi.nlm.nih.gov/pubmed/28246065 %0 Journal Article %@ 2291-9279 %I JMIR Publications Inc. %V 4 %N 1 %P e6 %T Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men %A LeGrand,Sara %A Muessig,Kathryn Elizabeth %A McNulty,Tobias %A Soni,Karina %A Knudtson,Kelly %A Lemann,Alex %A Nwoko,Nkechinyere %A Hightow-Weidman,Lisa B %+ Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, 310 Trent Drive, Room 305, Durham, NC, 27710, United States, 1 9194380448, sara.legrand@duke.edu %K mobile applications %K video games %K serious games %K HIV %K medication adherence %K health knowledge, attitudes, practice %K youth %K men who have sex with men %D 2016 %7 13.05.2016 %9 Original Paper %J JMIR Serious Games %G English %X Background: In the United States, the human immunodeficiency virus (HIV) disproportionately affects young men who have sex with men (YMSM). For HIV-positive individuals, adherence to antiretroviral therapy (ART) is critical for achieving optimal health outcomes and reducing secondary transmission of HIV. However, YMSM often struggle with ART adherence. Novel mobile phone apps that incorporate game-based mechanics and social networking elements represent a promising intervention approach for improving ART adherence among YMSM. Objective: This study used a multiphase, iterative development process to create an ART adherence app for YMSM. Methods: The three-phase development process included: (1) theory-based concept development jointly by public health researchers and the technology team, (2) assessment of the target population’s ART adherence needs and app preferences and development and testing of a clickable app prototype, and (3) development and usability testing of the final app prototype. Results: The initial theory-based app concept developed in Phase One included medication reminders, daily ART adherence tracking and visualization, ART educational modules, limited virtual interactions with other app users, and gamification elements. In Phase Two, adherence needs, including those related to information, motivation, and behavioral skills, were identified. Participants expressed preferences for an ART adherence app that was informational, interactive, social, and customizable. Based on the findings from Phase Two, additional gaming features were added in Phase Three, including an interactive battle, superhero app theme, and app storyline. Other features were modified to increase interactivity and customization options and integrate the game theme. During usability testing of the final prototype, participants were able to understand and navigate the app successfully and rated the app favorably. Conclusions: An iterative development process was critical for the development of an ART adherence game app that was viewed as highly acceptable, relevant, and useful by YMSM. %M 27178752 %R 10.2196/games.5687 %U http://games.jmir.org/2016/1/e6/ %U https://doi.org/10.2196/games.5687 %U http://www.ncbi.nlm.nih.gov/pubmed/27178752 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e6 %T Digital Gaming for Improving the Functioning of People With Traumatic Brain Injury: Protocol of a Feasibility Study %A Välimäki,Maritta %A Korkeila,Jyrki %A Kauppi,Kaisa %A Kaakinen,Johanna K %A Holm,Suvi %A Vahlo,Jukka %A Tenovuo,Olli %A Hämäläinen,Heikki %A Sarajuuri,Jaana %A Rantanen,Pekka %A Orenius,Tage %A Koponen,Aki %+ Faculty of Medicine, Department of Nursing Science, Lemminkäisenkatu 1, University of Turku, 20014, Finland, 358 23338495, mava@utu.fi %K digital games %K brain injury %K cognitive rehabilitation %D 2016 %7 09.02.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Traumatic brain injury (TBI) is a critical public health problem. The recovery process for people with TBI is typically slow and dependent on complex and intensive assisted rehabilitation programs. Objective: To evaluate the effects and feasibility of digital games for cognitive functioning and general well-being among people with traumatic brain injury. Methods: This is a single-site feasibility study conducted in Finland, which uses a pragmatic, randomized controlled trial with three arms, and will recruit patients from the Turku University Hospital, Division of Clinical Neurosciences in Finland. Participants must meet the following inclusion criteria: (1) a Finnish speaking adult, aged 18-65 years; (2) diagnosed with a traumatic brain injury (diagnostic criteria ICD-10, S06.X, T90.5) in the University Hospital; (3) access to a TV, a computer, and the Internet at home; (4) not an active digital gamer (5 hours or less a week); (5) willing to participate in the study. Participants must have been discharged from the neurologic treatment period for traumatic brain injury for over 12 months before the commencement of the trial, and they may not have actively participated in cognitive rehabilitation during the 3 months prior to the trial. Written informed consent will be mandatory for acceptance into the trial. Exclusion criteria are as follows: (1) sensory, cognitive, or physical impairment (eg, severe cognitive impairment); (2) a deficiency restricting the use of computers or computer game control system unaided (eg, impairment in vision, severe astigmatism, hemiplegia, disorder in visuospatial perception, dysfunction of the central vestibular system); (3) apathy identified in previous neuropsychological evaluations; (4) diagnosed severe mental disorders (eg, schizophrenia or severe depressive disorders to be identified in medical records as the secondary diagnosis). Results: The preparatory phase for the study is fulfilled. Recruitment started in June 2015 and finished November 2015. Results will be reported in 2016. Conclusions: The specific outcomes such as primary outcome measures were selected because they are widely used psychological tests and thought to be sensitive to changes in the cognitive functions related to TBI. Trial Registration: Clinicaltrials.gov NCT02425527; https://clinicaltrials.gov/ct2/show/NCT02425527 (Archived by WebCite at http://www.webcitation.org/6esKI1uDH) %M 26860741 %R 10.2196/resprot.4841 %U http://www.researchprotocols.org/2016/1/e6/ %U https://doi.org/10.2196/resprot.4841 %U http://www.ncbi.nlm.nih.gov/pubmed/26860741 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 3 %P e114 %T Using Video Games to Enhance Motivation States in Online Education: Protocol for a Team-Based Digital Game %A Janssen,Anna %A Shaw,Tim %A Goodyear,Peter %+ Sydney Medical School, University of Sydney, Level 2, Charles Perkins Centre D17, University of Sydney, Sydney, 2006, Australia, 61 02 9036 9406, anna.janssen@sydney.edu.au %K digital games %K medical education %K online learning %D 2015 %7 28.09.2015 %9 Protocol %J JMIR Res Protoc %G English %X Background: Video and computer games for education have been of interest to researchers for several decades. Over the last half decade, researchers in the health sector have also begun exploring the value of this medium. However, there are still many gaps in the literature regarding the effective use of video and computer games in medical education, particularly in relation to how learners interact with the platform, and how the games can be used to enhance collaboration. Objective: The objective of the study is to evaluate a team-based digital game as an educational tool for engaging learners and supporting knowledge consolidation in postgraduate medical education. Methods: A mixed methodology will be used in order to establish efficacy and level of motivation provided by a team-based digital game. Second-year medical students will be recruited as participants to complete 3 matches of the game at spaced intervals, in 2 evenly distributed teams. Prior to playing the game, participants will complete an Internet survey to establish baseline data. After playing the game, participants will voluntarily complete a semistructured interview to establish motivation and player engagement. Additionally, metrics collected from the game platform will be analyzed to determine efficacy. Results: The research is in the preliminary stages, but thus far a total of 54 participants have been recruited into the study. Additionally, a content development group has been convened to develop appropriate content for the platform. Conclusions: Video and computer games have been demonstrated to have value for educational purposes. Significantly less research has addressed how the medium can be effectively utilized in the health sector. Preliminary data from this study would suggest there is an interest in games for learning in the medical student body. As such, it is beneficial to undertake further research into how these games teach and engage learners in order to evaluate their role in tertiary and postgraduate medical education in the future. %M 26416522 %R 10.2196/resprot.4016 %U http://www.researchprotocols.org/2002/3/e114/ %U https://doi.org/10.2196/resprot.4016 %U http://www.ncbi.nlm.nih.gov/pubmed/26416522