%0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e54075 %T Identifying Key Principles and Commonalities in Digital Serious Game Design Frameworks: Scoping Review %A Maxim,Raluca Ionela %A Arnedo-Moreno,Joan %+ , Universitat Oberta de Catalunya, Rambla del Poblenou, 154-156, Sant Martí, Barcelona, 08018, Spain, 34 724346819, rmaxim@uoc.edu %K entertainment game design frameworks %K serious game design frameworks %K design principles %K empathic design thinking %K artificial intelligence %D 2025 %7 5.3.2025 %9 Review %J JMIR Serious Games %G English %X Background: Digital serious games (DSGs), designed for purposes beyond entertainment and consumed via electronic devices, have garnered attention for their potential to enhance learning and promote behavior change. Their effectiveness depends on the quality of their design. Frameworks for DSG design can guide the creation of engaging games tailored to objectives such as education, health, and social impact. Objective: This study aims to review, analyze, and synthesize the literature on digital entertainment game design frameworks and DSG design frameworks (DSGDFWs). The focus is on conceptual frameworks offering high-level guidance for the game creation process rather than component-specific tools. We explore how these frameworks can be applied to create impactful serious games in fields such as health care and education. Key goals include identifying design principles, commonalities, dependencies, gaps, and opportunities in the literature. Suggestions for future research include empathic design thinking, artificial intelligence integration, and iterative improvements. The findings culminate in a synthesized 4-phase design process, offering generic guidelines for designers and developers to create effective serious games that benefit society. Methods: A 2-phase methodology was used: a scoping literature review and cluster analysis. A targeted search across 7 databases (ACM, Scopus, Springer, IEEE, Elsevier, JMIR Publications, and SAGE) was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Studies included academic or industry papers evaluating digital game design frameworks. Cluster analysis was applied to categorize the data, revealing trends and correlations among frameworks. Results: Of 987 papers initially identified, 25 (2.5%) met the inclusion criteria, with an additional 22 identified through snowballing, resulting in 47 papers. These papers presented 47 frameworks, including 16 (34%) digital entertainment game design frameworks and 31 (66%) DSGDFWs. Thematic analysis grouped frameworks into categories, identifying patterns and relationships between design elements. Commonalities, dependencies, and gaps were analyzed, highlighting opportunities for empathic design thinking and artificial intelligence applications. Key considerations in DSG design were identified and presented in a 4-phase design baseline with the outcome of a list of design guidelines that might, according to the literature, be applied to an end-to-end process of designing and building future innovative solutions. Conclusions: The main benefits of using DSGDFWs seem to be related to enhancing the effectiveness of serious games in achieving their intended objectives, such as learning, behavior change, and social impact. Limitations primarily seem to be related to constraints associated with the specific contexts in which the serious games are developed and used. Approaches in the future should be aimed at refining and adapting existing frameworks to different contexts and purposes, as well as exploring new frameworks that incorporate emerging technologies and design principles. %M 40053743 %R 10.2196/54075 %U https://games.jmir.org/2025/1/e54075 %U https://doi.org/10.2196/54075 %U http://www.ncbi.nlm.nih.gov/pubmed/40053743 %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 e57304 %T The Mediating Role of Problematic Use of Loot Boxes Between Internet Gaming Disorder and Online Gambling Disorder: Cross-Sectional Analytical Study %A González-Cabrera,Joaquín %A Caba-Machado,Vanessa %A Díaz-López,Adoración %A Jiménez-Murcia,Susana %A Mestre-Bach,Gemma %A Machimbarrena,Juan M %K loot boxes %K loot box %K gaming %K gambling %K problematic %K video games %K game %K games %K addict %K addiction %K addictions %K addictive %K internet %K virtual object %K virtual objects %K gamification %K IGD %K OGD %K monetize %K monetization %K reward %K rewards %K incentive %K incentives %K internet gaming disorder %K online gambling disorder %D 2024 %7 20.9.2024 %9 %J JMIR Serious Games %G English %X Background: The video game industry has introduced a new form of monetization through microtransactions. A controversial example has been the so-called “loot boxes” (LBs) as virtual objects, which are randomized and bought with legal money. In recent years, LBs have come to connect 2 distinct problem behaviors, namely internet gaming disorder (IGD) and online gambling disorder (OGD). Many association studies have been conducted on the 3 constructs, but few have delved into the relationship of problematic use of LBs (PU-LB) with IGD and OGD. Objective: This study aims to explore the mediating role of the PU-LB between IGD and OGD. Methods: This cross-sectional and analytical study used incidental sampling in 24 Spanish schools. The final sample consisted of 542 participants (male: n=523, 96.5%; age: range 11‐30 y) who played video games, bought LBs, and had gambled online in the last 12 months. Participants then completed the Spanish versions of the Internet Gaming Disorder Scale–Short Form, Online Gambling Disorder Questionnaire, and PU-LB scale. Results: IGD scores were found to be significantly associated with both PU-LB (r=0.473, P<.001) and OGD (r=0.209, P<.001). Moreover, PU-LB was significantly associated with OGD (r=0.351, P<.001). The structural equation model results indicated that IGD had no significant direct effect on OGD (P=.903). However, the indirect effect of IGD on OGD through PU-LB was significant (P<.001). Therefore, PU-LB fully mediated the relationship between IGD and OGD. Furthermore, these results were found in the subsamples of both minors (<18 y) and young adults (≥18 y). Conclusions: It is suggested that there is a mediation effect of problematic LB use between internet gambling and online gambling problems in both minors and young adults. This has potential practical implications by providing more evidence on how LBs have become a hinge feature between 2 clinically relevant and independent issues. In this regard, adequate industry self-regulation is needed, and effective legislation for the protection of minors is necessary. %R 10.2196/57304 %U https://games.jmir.org/2024/1/e57304 %U https://doi.org/10.2196/57304 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e60771 %T Exploring the Impact of a Persuasive Serious Video Game (Farmily) on Promoting Home Gardening Among Novices: Design and Randomized Controlled Trial %A García de Alba-Chávez,Carlos Alberto %A Espinosa-Curiel,Ismael Edrein %A Michel-Nava,Rosa María %+ Unidad de Transferencia Tecnológica Tepic, Centro de Investigación Científica y de Educación Superior de Ensenada, Andador 10, entre Calles 3 y 4, Ciudad del Conocimiento, Tepic, Nayarit, 63173, Mexico, 52 3111295930 ext 28607, ecuriel@cicese.edu.mx %K serious video game %K persuasive game %K home gardening %K knowledge %K attitude %K self-efficacy %K intention %D 2024 %7 8.8.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Home gardens worldwide provide sustenance, economic support, and access to fresh produce and promote household well-being, health, self-sufficiency, and food security. However, they face significant challenges worldwide and necessitate innovative promotion approaches. Serious video games have proven effective in promoting agricultural knowledge. However, more research is needed on the persuasive potential of agriculture games to influence players’ thoughts, attitudes, and behaviors. This provides an opportunity to examine the impact of persuasive games on promoting home gardening among novices. Objective: This study aims to describe the design and development of Farmily, a persuasive video game promoting home gardening among novices. In addition, it evaluated the effectiveness of Farmily and compared its impact with that of a traditional home gardening workshop. Furthermore, the study explored how game enjoyment relates to the game’s outcomes. Methods: A randomized controlled trial with 50 novice gardening participants aged 20 to 50 years was carried out. Participants were randomly assigned to a control group (1.5-hour workshop) or an experimental group (1.5-hour Farmily session). Pre- and postintervention assessments were conducted. We evaluated Farmily’s impact on knowledge, attitudes, perceived self-efficacy, and intentions regarding initiating home gardens. In addition, we investigated the user enjoyment and its relationship with the game’s effect outcomes. Results: The experimental group significantly improved their knowledge (t24=4.26; P<.001), attitude (z24=2.98; P=.003), self-efficacy (t24=2.6; P=.02), and intention to initiate home gardens (z24=4.15; P<.001). The experimental group showed similar effectiveness in knowledge transfer (t24=–1.71; P=.09) and a more significant impact on attitude (z24=2.73; P=.006), self-efficacy (t24=2.21; P=.03), and intention to start a home garden (t24=–5.33; P<.001) than the control group. Farmily was well received by the intervention group, generating high enjoyment. Furthermore, user enjoyment substantially correlated with user attitudes (r23=0.72; P<.001) and self-efficacy (r23=0.67; P<.001), yet no discernible association was observed among user enjoyment, knowledge (r23=0.26; P=.20), and intention (r23=0.06; P=.77). Conclusions: Evidence indicates that Farmily appears to be a viable tool for promoting home gardening among novices in the short term. Farmily demonstrated similar effects in knowledge improvement to those of a traditional workshop and had a more significant impact on the other variables. In addition, we found that the player’s gaming experience positively relates to the player’s attitudes and self-efficacy. A well-powered randomized controlled trial with more diverse samples and extended follow-up periods will be conducted to establish the long-term efficacy of Farmily and gain a deeper understanding of the influence of enjoyment on game outcomes. %M 39116437 %R 10.2196/60771 %U https://games.jmir.org/2024/1/e60771 %U https://doi.org/10.2196/60771 %U http://www.ncbi.nlm.nih.gov/pubmed/39116437 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50063 %T The Application of a Serious Game Framework to Design and Develop an Exergame for Patients With Heart Failure %A Berglund,Aseel %A Jaarsma,Tiny %A Orädd,Helena %A Fallström,Johan %A Strömberg,Anna %A Klompstra,Leonie %A Berglund,Erik %+ Department of Computer and Information Science, Linköping University, Linköping, Sweden, 46 732703862, aseel.berglund@liu.se %K mobile health apps %K physical activity %K exergames %K player-centered design %K heart failure %K human-computer interaction %K mobile phone %D 2024 %7 7.8.2024 %9 Viewpoint %J JMIR Form Res %G English %X Reducing inactivity in patients with chronic disease is vital since it can decrease the risk of disease progression and mortality. Exergames are an innovative approach to becoming more physically active and positively affecting physical health outcomes. Serious games are designed for purposes beyond entertainment and exergames are serious games for physical activity. However, current commercial exergames might not optimally meet the needs of patients with special needs. Developing tailored exergames is challenging and requires an appropriate process. The primary goal of this viewpoint is to describe significant lessons learned from designing and developing an exergame for patients with chronic heart failure using the player-centered, iterative, interdisciplinary, and integrated (P-III) framework for serious games. Four of the framework’s pillars were used in the design and development of a mobile exergame: player-centered design, iterative development of the game, interdisciplinary teamwork, and integration of play and serious content. The mobile exergame was developed iteratively in 7 iterations by an interdisciplinary team involving users and stakeholders in all iterations. Stakeholders played various roles during the development process, making the team stay focused on the needs of the patients and creating an exergame that catered to these needs. Evaluations were conducted during each iteration by both the team and users or patients according to the player-centered design pillar. Since the exergame was created for a smartphone, the assessments were conducted both on the development computer and on the intended platforms. This required continuous deployment of the exergame to the platforms and smartphones that support augmented reality. Our findings show that the serious game P-III framework needs to be modified in order to be used for the design and development of exergames. In this viewpoint, we propose an updated version of the P-III framework for exergame development including (1) a separate and thorough design of the physical activity and physical interaction, and (2) early and continuous deployment of the exergame on the intended platform to enable evaluations and everyday life testing. %M 39110976 %R 10.2196/50063 %U https://formative.jmir.org/2024/1/e50063 %U https://doi.org/10.2196/50063 %U http://www.ncbi.nlm.nih.gov/pubmed/39110976 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e48099 %T Enhancing Serious Game Design: Expert-Reviewed, Stakeholder-Centered Framework %A Bunt,Lance %A Greeff,Japie %A Taylor,Estelle %+ Unit for Data Science and Computing, North-West University, 1174 Hendrick Van Eck Boulevard, Vanderbijlpark, 1900, South Africa, 27 720880188, Lance.Bunt@nwu.ac.za %K serious games %K stakeholder theory %K enterprise architecture %K serious game development %K design framework %D 2024 %7 31.5.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Traditional serious game design methods often overlook stakeholder needs. This study integrates stakeholder theory and enterprise architecture (EA), along with the Architecture Development Method, to propose a novel framework for serious game design. Crafted to aid practitioners, researchers, and specialists in leveraging resources more effectively, the framework is validated through a design science research methodology. Expert reviews have further refined its features, making it a robust tool for enhancing serious game design and implementation. Objective: This paper introduces a framework for designing serious games, covering stakeholder analysis, requirements gathering, and design implementation planning. It highlights the importance of expert review in validating and refining the framework, ensuring its effectiveness and reliability for use in serious game design. Through critical assessment by experts, the framework is optimized for practical application by practitioners, researchers, and specialists in the field, ensuring its utility in enhancing serious game development. The next step will be to validate the framework empirically by applying it to a serious game development project. Methods: We developed and validated a conceptual framework for serious game design by synthesizing stakeholder theory and EA through literature review, concept mapping, and theory development by way of a design science research approach. The framework is iteratively refined and validated via expert review, drawing on insights from professionals experienced in serious games, stakeholder theory, and EA. This method ensures the framework’s practical relevance and effectiveness in addressing real-world design challenges. Results: An expert review by 29 serious game practitioners validated the framework’s success in stakeholder management, confirming its stakeholder-centered effectiveness. Although the experts praised its structured approach, they suggested clearer guidance for game design elements. In addition, the experts, while acknowledging the framework’s complexity, saw its depth as valuable for efficient management. The consensus calls for a refined balance between detailed functionality and user-friendly design, with the framework’s impact on stakeholder capabilities revealing a spectrum of professional needs. Conclusions: This paper presents a framework for creating effective and organizationally aligned serious games. Evaluated across execution, practical, and EA levels, it is logical but varies in ease of understanding, with experts calling for more accessibility at the EA level. It enhances stakeholder efficiency and management but is criticized for rigidity and a need for flexibility. Recommendations include streamlining the framework, enhancing clarity, reducing administrative tasks, and incorporating clear guidelines on technology use, motivational elements, and operational tools. This aims to help stakeholders produce more targeted and adaptable game designs. The next iteration will be developed after application to a project and team feedback. %M 38820585 %R 10.2196/48099 %U https://games.jmir.org/2024/1/e48099 %U https://doi.org/10.2196/48099 %U http://www.ncbi.nlm.nih.gov/pubmed/38820585 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e43078 %T Gamification of Behavior Change: Mathematical Principle and Proof-of-Concept Study %A Lieder,Falk %A Chen,Pin-Zhen %A Prentice,Mike %A Amo,Victoria %A Tošić,Mateo %+ Department of Psychology, University of California, Los Angeles, 502 Portola Plaza, Los Angeles, Los Angeles, CA, 90095, United States, 1 424 259 5300, falk.lieder@psych.ucla.edu %K gamification %K points %K feedback %K behavior change %K habit formation %K chatbot %K digital interventions %K mobile phone %K artificial intelligence %D 2024 %7 22.3.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Many people want to build good habits to become healthier, live longer, or become happier but struggle to change their behavior. Gamification can make behavior change easier by awarding points for the desired behavior and deducting points for its omission. Objective: In this study, we introduced a principled mathematical method for determining how many points should be awarded or deducted for the enactment or omission of the desired behavior, depending on when and how often the person has succeeded versus failed to enact it in the past. We called this approach optimized gamification of behavior change. Methods: As a proof of concept, we designed a chatbot that applies our optimized gamification method to help people build healthy water-drinking habits. We evaluated the effectiveness of this gamified intervention in a 40-day field experiment with 1 experimental group (n=43) that used the chatbot with optimized gamification and 2 active control groups for which the chatbot’s optimized gamification feature was disabled. For the first control group (n=48), all other features were available, including verbal feedback. The second control group (n=51) received no feedback or reminders. We measured the strength of all participants’ water-drinking habits before, during, and after the intervention using the Self-Report Habit Index and by asking participants on how many days of the previous week they enacted the desired habit. In addition, all participants provided daily reports on whether they enacted their water-drinking intention that day. Results: A Poisson regression analysis revealed that, during the intervention, users who received feedback based on optimized gamification enacted the desired behavior more often (mean 14.71, SD 6.57 times) than the active (mean 11.64, SD 6.38 times; P<.001; incidence rate ratio=0.80, 95% CI 0.71-0.91) or passive (mean 11.64, SD 5.43 times; P=.001; incidence rate ratio=0.78, 95% CI 0.69-0.89) control groups. The Self-Report Habit Index score significantly increased in all conditions (P<.001 in all cases) but did not differ between the experimental and control conditions (P>.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 e42733 %T A Serious Game to Train Rhythmic Abilities in Children With Dyslexia: Feasibility and Usability Study %A Vonthron,Francois %A Yuen,Antoine %A Pellerin,Hugues %A Cohen,David %A Grossard,Charline %+ Poppins, 73 rue Leon Bourgeois, Palaiseau, 91120, France, 33 669515961, francois.vonthron@gmail.com %K serious game %K rhythm %K dyslexia %K musical abilities %K design framework %K reading skills %K children %K digital health intervention %K attention-deficit/hyperactivity disorder %K ADHD %K child development %K mobile phone %D 2024 %7 11.1.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Rhythm perception and production are related to phonological awareness and reading performance, and rhythmic deficits have been reported in dyslexia. In addition, rhythm-based interventions can improve cognitive function, and there is consistent evidence suggesting that they are an efficient tool for training reading skills in dyslexia. Objective: This paper describes a rhythmic training protocol for children with dyslexia provided through a serious game (SG) called Mila-Learn and the methodology used to test its usability. Methods: We computed Mila-Learn, an SG that makes training remotely accessible and consistently reproducible and follows an educative agenda using Unity (Unity Technologies). The SG’s development was informed by 2 studies conducted during the French COVID-19 lockdowns. Study 1 was a feasibility study evaluating the autonomous use of Mila-Learn with 2500 children with reading deficits. Data were analyzed from a subsample of 525 children who spontaneously played at least 15 (median 42) games. Study 2, following the same real-life setting as study 1, evaluated the usability of an enhanced version of Mila-Learn over 6 months in a sample of 3337 children. The analysis was carried out in 98 children with available diagnoses. Results: Benefiting from study 1 feedback, we improved Mila-Learn to enhance motivation and learning by adding specific features, including customization, storylines, humor, and increasing difficulty. Linear mixed models showed that performance improved over time. The scores were better for older children (P<.001), children with attention-deficit/hyperactivity disorder (P<.001), and children with dyslexia (P<.001). Performance improved significantly faster in children with attention-deficit/hyperactivity disorder (β=.06; t3754=3.91; P<.001) and slower in children with dyslexia (β=−.06; t3816=–5.08; P<.001). Conclusions: Given these encouraging results, future work will focus on the clinical evaluation of Mila-Learn through a large double-blind randomized controlled trial comparing Mila-Learn and a placebo game. %M 37830510 %R 10.2196/42733 %U https://games.jmir.org/2024/1/e42733 %U https://doi.org/10.2196/42733 %U http://www.ncbi.nlm.nih.gov/pubmed/37830510 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39838 %T Improving Adherence to Physical Therapy in the Development of Serious Games: Conceptual Framework Design Study %A Ambros-Antemate,Jorge Fernando %A Beristain-Colorado,María del Pilar %A Vargas-Treviño,Marciano %A Gutiérrez-Gutiérrez,Jaime %A Hernández-Cruz,Pedro Antonio %A Gallegos-Velasco,Itandehui Belem %A Moreno-Rodríguez,Adriana %+ Facultad de Medicina y Cirugía, Universidad Autónoma “Benito Juárez” de Oaxaca, Ex Hacienda de Aguilera S/N, Calz. San Felipe del Agua, Oaxaca de Juárez, 68000, Mexico, 52 9515153058, pberistain.cat@uabjo.mx %K conceptual framework %K serious game %K Flow Theory %K adherence %K gamification %K physical rehabilitation %D 2023 %7 10.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Insufficient levels of treatment adherence can have adverse effects on the outcomes of physical rehabilitation. To address this issue, alternative approaches to traditional therapies, such as serious games, have been designed to enhance adherence. Nevertheless, there remain gaps in the development of serious games concerning the effective implementation of motivation, engagement, and the enhancement of treatment adherence. Objective: This study aims to design a conceptual framework for the development of serious games that incorporate essential adherence factors to enhance patient compliance with physical rehabilitation programs. Methods: We formulated a conceptual framework using iterative techniques inspired by a conceptual framework analysis. Initially, we conducted a comprehensive literature review, concentrating on the critical adherence factors in physical rehabilitation. Subsequently, we identified, categorized, integrated, and synthesized the concepts derived from the literature review to construct the conceptual framework. Results: The framework resembles a road map, comprising 3 distinct phases. In the initial phase, the patient’s characteristics are identified through an initial exploration. The second phase involves the development of a serious game, with a focus on enhancing treatment adherence by integrating the key adherence factors identified. The third phase revolves around the evaluation of the serious game. These phases are underpinned by 2 overarching themes, namely, a user-centered design and the GameFlow model. Conclusions: The conceptual framework offers a detailed, step-by-step guide for creating serious games that incorporate essential adherence factors, thereby contributing to improved adherence in the physical rehabilitation process. To establish its validity, further evaluations of this framework across various physical rehabilitation programs and user groups are necessary. %M 37948110 %R 10.2196/39838 %U https://formative.jmir.org/2023/1/e39838 %U https://doi.org/10.2196/39838 %U http://www.ncbi.nlm.nih.gov/pubmed/37948110 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e42173 %T The Development of Game-Based Digital Mental Health Interventions: Bridging the Paradigms of Health Care and Entertainment %A Lukka,Lauri %A Palva,J Matias %+ Department of Neuroscience and Biomedical Engineering, Aalto University, Rakentajanaukio 2, Espoo, 02150, Finland, 358 440375666, lauri.lukka@aalto.fi %K digital mental health interventions %K development frameworks %K gamification %K game-based interventions %K intervention development %K mental health %K paradigms %K serious games %D 2023 %7 4.9.2023 %9 Viewpoint %J JMIR Serious Games %G English %X Game elements are increasingly used to improve user engagement in digital mental health interventions, and specific game mechanics may yield therapeutic effects per se and thereby contribute to digital mental health intervention efficacy. However, only a few commercial game–based interventions are available. We suggest that the key challenge in their development reflects the tension between the 2 underlying paradigms, health care and entertainment, which have disparate goals and processes in digital development. We describe 3 approaches currently used to negotiate the 2 paradigms: the gamification of health care software, designing serious games, and purpose shifting existing entertainment games. We advanced an integrative framework to focus attention on 4 key themes in intervention development: target audience, engagement, mechanisms of action, and health-related effectiveness. On each theme, we show how the 2 paradigms contrast and can complement each other. Finally, we consider the 4 interdependent themes through the new product development phases from concept to production. Our viewpoint provides an integrative synthesis that facilitates the research, design, and development of game-based digital mental health interventions. %M 37665624 %R 10.2196/42173 %U https://games.jmir.org/2023/1/e42173 %U https://doi.org/10.2196/42173 %U http://www.ncbi.nlm.nih.gov/pubmed/37665624 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e45436 %T Gamification and Soft Skills Assessment in the Development of a Serious Game: Design and Feasibility Pilot Study %A Altomari,Luca %A Altomari,Natalia %A Iazzolino,Gianpaolo %+ Department of Mechanical, Energy and Management Engineering, University of Calabria, Ponte Pietro Bucci, Rende, 87036, Italy, 39 3932671847, luca.altomari@gmail.com %K gamification %K soft skills %K recruitment %K serious games %K assessment %K process mining %K work-life skills %D 2023 %7 26.7.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: The advent of new technologies has had a profound impact on the labor market, transforming the way we work and interact with each other. With the rise of digital tools and platforms, gamification has emerged as a powerful technique for enhancing productivity and engagement in various fields, including human resource management. In particular, gamification has been found to be effective in developing and assessing soft skills, which play a critical role in determining the success of individuals, teams, and organizations. Objective: We present a serious game that identifies the most sought-after skills in the job market and offers feedback, and we provide a set of guidelines for the creation of serious games. Methods: We present the serious game Among the Office Criticality (AOC). The AOC game structure involves a set of sequence analysis techniques, which is known as process mining. Results: The pilot study findings indicate that the game is both engaging and beneficial to subjects, suggesting that the results align with current theoretical perspectives. Furthermore, the study suggests that the obtained data can be extended to the broader population. Conclusions: This study illustrates a serious game structured according to the needs of the labor market and developed to put the user at the center, using evaluation techniques consistent with the literature, with the aim of constituting an interdisciplinary approach suitable for adequately assessing users and creating value for them. %M 37494078 %R 10.2196/45436 %U https://games.jmir.org/2023/1/e45436 %U https://doi.org/10.2196/45436 %U http://www.ncbi.nlm.nih.gov/pubmed/37494078 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e40054 %T A Software Engineering Framework for Reusable Design of Personalized Serious Games for Health: Development Study %A Carlier,Stéphanie %A Naessens,Vince %A De Backere,Femke %A De Turck,Filip %+ Internet Technology and Data Science Lab, Faculty of Engineering and Architecture, Ghent University, Technologiepark-Zwijnaarde 126, Ghent, 9052, Belgium, 32 9 331 49 38, stephanie.carlier@ugent.be %K serious game %K health care %K personalization %K domain knowledge %K framework %K eHealth %K cocreation %D 2023 %7 6.3.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: The use of serious games in health care is on the rise, as these games motivate treatment adherence, reduce treatment costs, and educate patients and families. However, current serious games fail to offer personalized interventions, ignoring the need to abandon the one-size-fits-all approach. Moreover, these games, with a primary objective other than pure entertainment, are costly and complex to develop and require the constant involvement of a multidisciplinary team. No standardized approach exists on how serious games can be personalized, as existing literature focuses on specific use cases and scenarios. The serious game development domain fails to consider any transfer of domain knowledge, which means this labor-intensive process must be repeated for each serious game. Objective: We proposed a software engineering framework that aims to streamline the multidisciplinary design process of personalized serious games in health care and facilitates the reuse of domain knowledge and personalization algorithms. By focusing on the transfer of knowledge to new serious games by reusing components and personalization algorithms, the comparison and evaluation of different personalization strategies can be simplified and expedited. In doing so, the first steps are taken in advancing the state of the art of knowledge regarding personalized serious games in health care. Methods: The proposed framework aimed to answer 3 questions that need to be asked when designing personalized serious games: Why is the game personalized? What parameters can be used for personalization? and How is the personalization achieved? The 3 involved stakeholders, namely, the domain expert, the (game) developer, and the software engineer, were each assigned a question and then assigned responsibilities regarding the design of the personalized serious game. The (game) developer was responsible for all the game-related components; the domain expert was in charge of the modeling of the domain knowledge using simple or complex concepts (eg, ontologies); and the software engineer managed the personalization algorithms or models integrated into the system. The framework acted as an intermediate step between game conceptualization and implementation; it was illustrated by developing and evaluating a proof of concept. Results: The proof of concept, a serious game for shoulder rehabilitation, was evaluated using simulations of heart rate and game scores to assess how personalization was achieved and whether the framework responded as expected. The simulations indicated the value of both real-time and offline personalization. The proof of concept illustrated how the interaction between different components worked and how the framework was used to simplify the design process. Conclusions: The proposed framework for personalized serious games in health care identifies the responsibilities of the involved stakeholders in the design process, using 3 key questions for personalization. The framework focuses on the transferability of knowledge and reusability of personalization algorithms to simplify the design process of personalized serious games. %M 36877554 %R 10.2196/40054 %U https://games.jmir.org/2023/1/e40054 %U https://doi.org/10.2196/40054 %U http://www.ncbi.nlm.nih.gov/pubmed/36877554 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 4 %P e40119 %T Impact of Personalized Avatars and Motion Synchrony on Embodiment and Users’ Subjective Experience: Empirical Study %A Jung,Myeongul %A Sim,Sangyong %A Kim,Jejoong %A Kim,Kwanguk %+ Department of Computer Science, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea, 82 222202319, kenny@hanyang.ac.kr %K embodiment %K virtual reality %K virtual avatar %K personalization %K personalized %K body motion %K presence %K simulator sickness %K simulator %K simulation %K avatar %K motion %K body ownership %K self location %K agency %K experience %K virtual world %K immersive %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Embodiment through a virtual avatar is a key element for people to feel that they are in the virtual world. Objective: This study aimed to elucidate the interaction between 2 methods of eliciting embodiment through a virtual avatar: motion synchronization and appearance similarity between a human and avatar, to understand embodiment (agency, body ownership, and self-location) and subjective experience (presence, simulator sickness, and emotion) in virtual reality. Methods: Using a full-body motion capture system, 24 participants experienced their virtual avatars with a 3D-scanned face and size-matched body from a first-person perspective. This study used a 2 (motion; sync and async) × 2 (appearance; personalized and generic) within-subject design. Results: The results indicated that agency and body ownership increased when motion and appearance were matched, whereas self-location, presence, and emotion were affected by motion only. Interestingly, if the avatar’s appearance was similar to the participants (personalized avatar), they formed an agency toward the avatar’s motion that was not performed by themselves. Conclusions: Our findings would be applicable in the field of behavioral therapy, rehabilitation, and entertainment applications, by eliciting higher agency with a personalized avatar. %M 36346658 %R 10.2196/40119 %U https://games.jmir.org/2022/4/e40119 %U https://doi.org/10.2196/40119 %U http://www.ncbi.nlm.nih.gov/pubmed/36346658 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e35907 %T Points and the Delivery of Gameful Experiences in a Gamified Environment: Framework Development and Case Analysis %A Park,Sungjin %A Kim,Sangkyun %+ Graduate School of Business, Kyung Hee University, 506, Orbis Hall, 24, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea, 82 02 961 0448, saviour@khu.ac.kr %K point %K design framework %K gamification %K gameful experience %K pointsification %K overjustification effect %D 2022 %7 29.9.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Points represent one of the most widely used game mechanics in gamification. They have been used as a means to provide feedback to users. They visually show user performance and are used along with other game mechanics to produce synergy effects. However, using points without analyzing the application environment and targets adversely affects users. Objective: This study aims to identify the problems that users encounter when points are applied improperly, to solve problems based on an analysis of previous studies and actual point use cases, and to develop a point design framework to deliver gameful experiences. Methods: Three problems were identified by analyzing previous studies. The first problem is points that only accumulate. The second is points that emphasize a user’s difference from other people. The third pertains to the reward distribution problem that occurs when points are used as rewards. Results: We developed a framework by deriving 3 criteria for applying points. The first criterion is based on the passive acquisition approach and the active use approach. The second criterion is used to classify points as “high/low” and “many/few” types. The third criterion is the classification of personal reward points and group reward points based on segmentation of the reward criteria. We developed 8 types of points based on the derived point design framework. Conclusions: We expect that some of the problems that users experience when using points can be solved. Furthermore, we expect that some of the problems that arise when points are used as rewards, such as pointsification and the overjustification effect, can be solved. By solving such problems, we suggest a direction that enables a gameful experience for point users and improves the core value delivery through gameful experiences. We also suggest a gameful experience delivery method in the context of the ongoing COVID-19 pandemic. %M 36173674 %R 10.2196/35907 %U https://games.jmir.org/2022/3/e35907 %U https://doi.org/10.2196/35907 %U http://www.ncbi.nlm.nih.gov/pubmed/36173674 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e32095 %T Migration of an Escape Room–Style Educational Game to an Online Environment: Design Thinking Methodology %A Videnovik,Maja %A Vold,Tone %A Dimova,Georgina %A Kiønig,Linda Vibeke %A Trajkovik,Vladimir %+ Department of Business Administration and Organizational Studies, Inland Norway University of Applied Sciences, Postbox 400, Elverum, 2418, Norway, 47 97064109, tone.vold@inn.no %K digital games %K escape room %K computational thinking %K gamification %K students’ engagement %K interactive learning environments %K serious games %K digital health %K education %K student education %K learning outcomes %K digital learning %K digital education %K educational games %D 2022 %7 26.9.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: The COVID-19 pandemic outbreak has led to a sudden change in education, closing schools and shifting to online teaching, which has become an enormous challenge for teachers and students. Implementing adequate online pedagogical approaches and integrating different digital tools in the teaching process have become a priority in educational systems. Finding a way to keep students' interest and persistence in learning is an important issue that online education is facing. One possible way to establish engaging and interactive learning environments, using the energy and enthusiasm of students for educational purposes, is the use of game-based learning activities and gamification of different parts of the educational process. Objective: This paper presents a use case of migrating an escape room–style educational game to an online environment by using the design thinking methodology. We wanted to show that the design thinking methodology is useful to create engaging and motivating online games that provide educational value. Methods: Starting from students’ perspective, we created a simple digital escape room–style game where students got an opportunity to self-assess their knowledge in computer science at their own pace. Students tested this prototype game, and their opinions about the game were collected through an online survey. The test's goal was to evaluate the students' perceptions about the implemented digital escape room–style educational game and gather information about whether it could achieve students' engagement in learning computer science during online teaching. Results: In total, 117 students from sixth and seventh grades completed the survey regarding the achieved student engagement. Despite the differences in students’ answers about game complexity and puzzle difficulty, most students liked the activity (mean 4.75, SD 0.67, on a scale from 1 to 5). They enjoyed the game, and they would like to participate in this kind of activity again (mean 4.74, SD 0.68). All (n=117, 100%) students found the digital escape room–style educational game interesting for playing and learning. Conclusions: The results confirmed that digital escape room–style games could be used as an educational tool to engage students in the learning process and achieve learning outcomes. Furthermore, the design thinking methodology proved to be a useful tool in the process of adding novel educational value to the digital escape room–style game. %M 36155979 %R 10.2196/32095 %U https://games.jmir.org/2022/3/e32095 %U https://doi.org/10.2196/32095 %U http://www.ncbi.nlm.nih.gov/pubmed/36155979 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e21376 %T Designing a Serious Game (Above Water) for Stigma Reduction Surrounding Mental Health: Semistructured Interview Study With Expert Participants %A Wehbe,Rina R %A Whaley,Colin %A Eskandari,Yasaman %A Suarez,Ally %A Nacke,Lennart E %A Hammer,Jessica %A Lank,Edward %+ Human Computer Interaction for Social Good (HCI4GOOD), Faculty of Computer Science, Dalhousie University, 6299 South Street, Halifax, NS, B3H4R2, Canada, 1 902 494 2211, rina.wehbe@dal.ca %K human–computer interaction %K games for change %K games for mental health %K sensitive topics %K game design %K empirical analysis %K expert participants %D 2022 %7 19.5.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Although in many contexts unsuccessful games targeting learning, social interaction, or behavioral change have few downsides, when covering a sensitive domain such as mental health (MH), care must be taken to avoid harm and stigmatization of people who live with MH conditions. As a result, evaluation of the game to identify benefits and risks is crucial in understanding the game’s success; however, assessment of these apps is often compared with the nongame control condition, resulting in findings specifically regarding entertainment value and user preferences. Research exploring the design process, integrating field experts, and guidelines for designing a successful serious game for sensitive topics is limited. Objective: The aim of this study is to understand which elements of game design can guide a designer when designing a game for sensitive topics. Methods: To carefully probe the design space of serious games for MH, we present Above Water (AbW), a game targeting the reduction of stigma surrounding MH, now in its second iteration. The game, AbW, serves as a consistent research probe to solicit expert feedback. Experts were recruited from a range of topic domains related to MH and wellness, game design, and user experience. Results: By using this deployment as a research probe, this study demonstrates how to synthesize gained insights from multiple expert perspectives and create actionable guidelines for successful design of serious games targeting sensitive topics. Conclusions: Our work contributes to a better understanding of how to design specialized games to address sensitive topics. We present a set of guidelines for designing games for sensitive subjects, and for each guideline, we present an example of how to apply the finding to the sample game (AbW). Furthermore, we demonstrate the generalizability to other sensitive topics by providing an additional example of a game that could be designed with the presented guidelines. %M 35588056 %R 10.2196/21376 %U https://games.jmir.org/2022/2/e21376 %U https://doi.org/10.2196/21376 %U http://www.ncbi.nlm.nih.gov/pubmed/35588056 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e30464 %T Identifying Player Types to Tailor Game-Based Learning Design to Learners: Cross-sectional Survey using Q Methodology %A Van Gaalen,A E J %A Schönrock-Adema,J %A Renken,R J %A Jaarsma,A D C %A Georgiadis,J R %+ Anatomy & Medical Physiology Section, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University Groningen, Antonius Deusinglaan 1, Groningen, 9713AV, Netherlands, 31 648527717, j.r.georgiadis@umcg.nl %K gamification %K serious games %K game-based learning %K medical education %K computers %K new technology %K focus group %K play %K qualitative %K player types %K taxonomy %K theory %K framework %D 2022 %7 4.4.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Game-based learning appears to be a promising instructional method because of its engaging properties and positive effects on motivation and learning. There are numerous options to design game-based learning; however, there is little data-informed knowledge to guide the choice of the most effective game-based learning design for a given educational context. The effectiveness of game-based learning appears to be dependent on the degree to which players like the game. Hence, individual differences in game preferences should be taken into account when selecting a specific game-based learning design. Objective: We aimed to identify patterns in students’ perceptions of play and games—player types and their most important characteristics. Methods: We used Q methodology to identify patterns in opinions on game preferences. We recruited undergraduate medical and dental students to participate in our study and asked participants to sort and rank 49 statements on game preferences. These statements were derived from a prior focus group study and literature on game preferences. We used by-person factor analysis and varimax rotation to identify common viewpoints. Both factors and participants’ comments were used to interpret and describe patterns in game preferences. Results: From participants’ (n=102) responses, we identified 5 distinct patterns in game preferences: the social achiever, the explorer, the socializer, the competitor, and the troll. These patterns revolved around 2 salient themes: sociability and achievement. The 5 patterns differed regarding cheating, playing alone, story-telling, and the complexity of winning. Conclusions: The patterns were clearly interpretable, distinct, and showed that medical and dental students ranged widely in how they perceive play. Such patterns may suggest that it is important to take students’ game preferences into account when designing game-based learning and demonstrate that not every game-based learning-strategy fits all students. To the best of our knowledge, this study is the first to use a scientifically sound approach to identify player types. This can help future researchers and educators select effective game-based learning game elements purposefully and in a student-centered way. %M 35377333 %R 10.2196/30464 %U https://games.jmir.org/2022/2/e30464 %U https://doi.org/10.2196/30464 %U http://www.ncbi.nlm.nih.gov/pubmed/35377333 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e28982 %T Serious Game for Change in Behavioral Intention Toward Lifestyle-Related Diseases: Experimental Study With Structural Equation Modeling Using the Theory of Planned Behavior %A Egashira,Mahiro %A Son,Daisuke %A Ema,Arisa %+ Department of Community-Based Family Medicine, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, 683-8503, Japan, 81 859 38 6661, sondtky@gmail.com %K lifestyle-related disease %K mechanism of behavior change %K serious game %K theory of planned behavior %D 2022 %7 21.2.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Health activities should be tailored to individual lifestyles and values. To raise awareness of health behaviors, various practices related to health education, such as interactive activities among individuals with different backgrounds, have been developed. Moreover, serious games have been used as a tool for facilitating communication. However, there have been few investigations that are based on the framework of the theory of planned behavior on the mechanisms of health-related behavioral intention change from playing serious games. Objective: We aimed to investigate the mechanisms of behavioral intention change among various age groups after an intervention using a serious game to increase awareness of lifestyle-related diseases. Methods: Adults, undergraduates, and high school students played a serious game, called Negotiation Battle, and answered a questionnaire—Gaming Event Assessment Form for Lifestyle-related Diseases—before, immediately after, and 2-4 weeks after the game. The questionnaire was composed of 16 items based on the theory of planned behavior. We used structural equation modeling to compare responses from the 3 groups. Results: For all 3 age groups (adults: mean 43.4 years, range 23-67 years; undergraduates: mean 20.9 years, range 19-34 years; high school students: mean 17.9 years, 17-18 years), perceived behavior control was the key factor of behavioral intention change. Immediately after the game, causal relationships between perceived behavioral control and behavioral intention were enhanced or maintained for all groups—adults (before: path coefficient 1.030, P<.001; after: path coefficient 2.045, P=.01), undergraduates (before: path coefficient 0.568, P=.004; after: path coefficient 0.737, P=.001), and high school students (before: path coefficient 14.543, P=.97; after: path coefficient 0.791, P<.001). Analysis of free descriptions after intervention suggested that experiencing dilemma is related to learning and behavioral intention. Conclusions: The study revealed that the serious game changed the behavioral intention of adolescents and adults regarding lifestyle-related diseases, and changes in perceived behavioral control mediated the alteration mechanism. %M 35188465 %R 10.2196/28982 %U https://games.jmir.org/2022/1/e28982 %U https://doi.org/10.2196/28982 %U http://www.ncbi.nlm.nih.gov/pubmed/35188465 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e28896 %T Team Building Through Team Video Games: Randomized Controlled Trial %A Keith,Mark J %A Dean,Douglas L %A Gaskin,James %A Anderson,Greg %+ Information Systems Department, Marriott School of Business, Brigham Young University, Campus Dr, Provo, UT, 84602, United States, 1 801 674 5159, mark.keith@gmail.com %K team video gaming %K team building %K flow %K team cohesion %K video games %K gamification %K team %K teamwork %K cohesion %K theory %K framework %K performance %D 2021 %7 14.12.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Organizations of all types require the use of teams. Poor team member engagement costs billions of US dollars annually. Objective: This study aimed to explain how team building can be accomplished with team video gaming based on a team cohesion model enhanced by team flow theory. Methods: In this controlled experiment, teams were randomly assigned to a team video gaming treatment or a control treatment. Team productivity was measured during both pretreatment and posttreatment team tasks. After the pretest, teams who were involved in the team video gaming treatment competed against other teams by playing the Halo or Rock Band video game for 45 minutes. After the pretest, teams in the control treatment worked alone for 45 minutes. Then, all teams completed the posttest team activity. This same experimental protocol was conducted on 2 different team tasks. Results: For both tasks, teams in the team video gaming treatment increased their productivity significantly more (F1=8.760, P=.004) on the posttest task than teams in the control treatment. Our flow-based theoretical model explained team performance improvement more than twice as well (R2=40.6%) than prior related research (R2=18.5%). Conclusions: The focused immersion caused by team video gaming increased team performance while the enjoyment component of flow decreased team performance on the posttest. Both flow and team cohesion contributed to team performance, with flow contributing more than cohesion. Team video gaming did not increase team cohesion, so team video gaming effects are independent of cohesion. Team video gaming is a valid practical method for developing and improving newly formed teams. %M 34904954 %R 10.2196/28896 %U https://games.jmir.org/2021/4/e28896 %U https://doi.org/10.2196/28896 %U http://www.ncbi.nlm.nih.gov/pubmed/34904954 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e29964 %T Using the Behaviour Change Wheel Program Planning Model to Design Games for Health: Development Study %A Robertson,Michael C %A Baranowski,Tom %A Thompson,Debbe %A Basen-Engquist,Karen M %A Swartz,Maria Chang %A Lyons,Elizabeth J %+ Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch at Galveston, 301 University Blvd, Galveston, TX, 77555, United States, 1 409 772 2578, ellyons@utmb.edu %K physical activity %K video games %K eHealth %K intervention %K behavior and behavior mechanisms %K psychological theory %K serious games %K gamification %K older women %K older adults %K behavior change %K behavioral interventions %K mobile phone %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Games for health are a promising approach to health promotion. Their success depends on achieving both experiential (game) and instrumental (health) objectives. There is little to guide game for health (G4H) designers in integrating the science of behavior change with the art of game design. Objective: The aim of this study is to extend the Behaviour Change Wheel program planning model to develop Challenges for Healthy Aging: Leveraging Limits for Engaging Networked Game-Based Exercise (CHALLENGE), a G4H centered on increasing physical activity in insufficiently active older women. Methods: We present and apply the G4H Mechanics, Experiences, and Change (MECHA) process, which supplements the Behaviour Change Wheel program planning model. The additional steps are centered on identifying target G4H player experiences and corresponding game mechanics to help game designers integrate design elements and G4H objectives into behavioral interventions. Results: We identified a target behavior of increasing moderate-intensity walking among insufficiently active older women and key psychosocial determinants of this behavior from self-determination theory (eg, autonomy). We used MECHA to map these constructs to intervention functions (eg, persuasion) and G4H target player experiences (eg, captivation). Next, we identified behavior change techniques (eg, framing or reframing) and specific game mechanics (eg, transforming) to help realize intervention functions and elicit targeted player experiences. Conclusions: MECHA can help researchers map specific linkages between distal intervention objectives and more proximal game design mechanics in games for health. This can facilitate G4H program planning, evaluation, and clearer scientific communication. %M 34870604 %R 10.2196/29964 %U https://games.jmir.org/2021/4/e29964 %U https://doi.org/10.2196/29964 %U http://www.ncbi.nlm.nih.gov/pubmed/34870604 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e32721 %T Virtual Reality in Health Care: Bibliometric Analysis %A Pawassar,Christian Matthias %A Tiberius,Victor %+ Faculty of Economics and Social Sciences, University of Potsdam, August-Bebel-Str 89, Potsdam, 14482, Germany, 49 3319773593, tiberius@uni-potsdam.de %K virtual reality %K healthcare %K bibliometric analysis %K literature review %K citation analysis %K VR %K usability %K review %K health care %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Research into the application of virtual reality technology in the health care sector has rapidly increased, resulting in a large body of research that is difficult to keep up with. Objective: We will provide an overview of the annual publication numbers in this field and the most productive and influential countries, journals, and authors, as well as the most used, most co-occurring, and most recent keywords. Methods: Based on a data set of 356 publications and 20,363 citations derived from Web of Science, we conducted a bibliometric analysis using BibExcel, HistCite, and VOSviewer. Results: The strongest growth in publications occurred in 2020, accounting for 29.49% of all publications so far. The most productive countries are the United States, the United Kingdom, and Spain; the most influential countries are the United States, Canada, and the United Kingdom. The most productive journals are the Journal of Medical Internet Research (JMIR), JMIR Serious Games, and the Games for Health Journal; the most influential journals are Patient Education and Counselling, Medical Education, and Quality of Life Research. The most productive authors are Riva, del Piccolo, and Schwebel; the most influential authors are Finset, del Piccolo, and Eide. The most frequently occurring keywords other than “virtual” and “reality” are “training,” “trial,” and “patients.” The most relevant research themes are communication, education, and novel treatments; the most recent research trends are fitness and exergames. Conclusions: The analysis shows that the field has left its infant state and its specialization is advancing, with a clear focus on patient usability. %M 34855606 %R 10.2196/32721 %U https://games.jmir.org/2021/4/e32721 %U https://doi.org/10.2196/32721 %U http://www.ncbi.nlm.nih.gov/pubmed/34855606 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e27953 %T Game Design in Mental Health Care: Case Study–Based Framework for Integrating Game Design Into Therapeutic Content %A Siriaraya,Panote %A Visch,Valentijn %A Boffo,Marilisa %A Spijkerman,Renske %A Wiers,Reinout %A Korrelboom,Kees %A Hendriks,Vincent %A Salemink,Elske %A van Dooren,Marierose %A Bas,Michael %A Goossens,Richard %+ Faculty of Industrial Design Engineering, Delft University of Technology, Mekelweg 5, Delft, 2628 CD, Netherlands, 31 152789111, spanote@gmail.com %K design models %K gamification %K case studies %K mental health %K eHealth %D 2021 %7 1.12.2021 %9 Viewpoint %J JMIR Serious Games %G English %X While there has been increasing interest in the use of gamification in mental health care, there is a lack of design knowledge on how elements from games could be integrated into existing therapeutic treatment activities in a manner that is balanced and effective. To help address this issue, we propose a design process framework to support the development of mental health gamification. Based on the concept of experienced game versus therapy worlds, we highlight 4 different therapeutic components that could be gamified to increase user engagement. By means of a Dual-Loop model, designers can balance the therapeutic and game design components and design the core elements of a mental health care gamification. To support the proposed framework, 4 cases of game design in mental health care (eg, therapeutic protocols for addiction, anxiety, and low self-esteem) are presented. %M 34855611 %R 10.2196/27953 %U https://games.jmir.org/2021/4/e27953 %U https://doi.org/10.2196/27953 %U http://www.ncbi.nlm.nih.gov/pubmed/34855611 %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 e25831 %T Software Engineering Frameworks Used for Serious Games Development in Physical Rehabilitation: Systematic Review %A Ambros-Antemate,Jorge Fernando %A Beristain-Colorado,María Del Pilar %A Vargas-Treviño,Marciano %A Gutiérrez-Gutiérrez,Jaime %A Hernández-Cruz,Pedro Antonio %A Gallegos-Velasco,Itandehui Belem %A Moreno-Rodríguez,Adriana %+ Doctorado en Biociencias, Facultad de Medicina y Cirugía, Universidad Autónoma “Benito Juárez” de Oaxaca, Ex Hacienda de Aguilera S/N, Calz. San Felipe del Agua, Oaxaca de Juárez, 68120, Mexico, 52 9511332346, jambros.cat@uabjo.mx %K serious game %K physical rehabilitation %K framework %K methodology %D 2021 %7 11.11.2021 %9 Review %J JMIR Serious Games %G English %X Background: Serious games are a support in the rehabilitation process for treating people with physical disabilities. However, many of these serious games are not adapted to the patient’s needs because they are not developed with a software engineering framework with a set of activities, actions, and tasks that must be executed when creating a software product. Better serious games for rehabilitation will be developed if the patient and therapist requirements are identified, the development is planned, and system improvements and feedback are involved. The goal is that the serious game must offer a more attractive environment, while maintaining patient interest in the rehabilitation process. Objective: This paper submits the results of a systematic review of serious games in physical rehabilitation identifying the benefits of using a software engineering framework. Methods: A systematic research was conducted using PubMed, PEDro (Physiotherapy Evidence Database), IEEE Xplore, ScienceDirect, ACM Digital Library, Mary Ann Liebert, Taylor & Francis Online, Wiley Online Library, and Springer databases. The initial search resulted in 701 papers. After assessing the results according to the inclusion criteria, 83 papers were selected for this study. Results: From the 83 papers reviewed, 8 used a software engineering framework for its development. Most of them focused their efforts on 1 or more aspects, such as data acquisition and processing, game levels, motivation, therapist supervision. Conclusions: This systematic review proves that most of the serious games do not use a software engineering framework for their development. As a result, development systems overlook several aspects and do not have a standardized process, eventually omitting important implementation aspects, which impact the patient’s recovery time. %M 34762052 %R 10.2196/25831 %U https://games.jmir.org/2021/4/e25831 %U https://doi.org/10.2196/25831 %U http://www.ncbi.nlm.nih.gov/pubmed/34762052 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e26810 %T Impulsivity, Self-control, Interpersonal Influences, and Maladaptive Cognitions as Factors of Internet Gaming Disorder Among Adolescents in China: Cross-sectional Mediation Study %A Yu,Yanqiu %A Mo,Phoenix Kit-Han %A Zhang,Jianxin %A Li,Jibin %A Lau,Joseph Tak-Fai %+ Center for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Ngan Shing St, Sha Tin, Hong Kong, Hong Kong, 852 2252 8713, jlau@cuhk.edu.hk %K cognition %K adolescent health %K health risk behaviors %K internet %K self-control %K China %D 2021 %7 27.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Gaming disorder, including internet gaming disorder (IGD), was recently defined by the World Health Organization as a mental disease in the 11th Revision of the International Classification of Diseases (ICD-11). Thus, reducing IGD is warranted. Maladaptive cognitions related to internet gaming (MCIG) have been associated with IGD, while impulsivity, self-control, parental influences, and peer influences are key risk factors of IGD. Previous literature suggests that MCIG is associated with the aforementioned 4 risk factors and IGD, and may thus mediate between these risk factors and IGD. These potential mediations, if significant, imply that modification of MCIG may possibly alleviate these risk factors’ harmful impacts on increasing IGD. These mediation hypotheses were tested in this study for the first time. Objective: This study tested the mediation effects of MCIG between intrapersonal factors (impulsivity and self-control) and IGD, and between interpersonal factors (parental influences and peer influences) and IGD among adolescents in China. Methods: An anonymous, cross-sectional, and self-administered survey was conducted among secondary school students in classroom settings in Guangzhou and Chengdu, China. All grade 7 to 9 students (7 to 9 years of formal education) of 7 secondary schools were invited to join the study, and 3087 completed the survey. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) checklist was used to assess IGD. MCIG was assessed by using the Chinese version of the Revised Internet Gaming Cognition Scale. Impulsivity, self-control, and parental or peer influences were measured by using the motor subscale of the Barratt Impulsiveness Scale, the Brief Self-Control Scale, and the modified interpersonal influence scale, respectively. Structural equation modeling was conducted to examine the mediation effects of MCIG between these risk factors and IGD. Results: The prevalence of IGD was 13.57% (418/3081) and 17.67% (366/2071) among all participants and adolescent internet gamers, respectively. The 3 types of MCIG (perceived rewards of internet gaming, perceived urges for playing internet games, and perceived unwillingness to stop playing without completion of gaming tasks) were positively associated with IGD. Impulsivity, self-control, parental influences, and peer influences were all significantly associated with the 3 types of MCIG and IGD. The 3 types of MCIG partially mediated the associations between the studied factors and IGD (effect size of 30.0% to 37.8%). Conclusions: Impulsivity, self-control, and interpersonal influences had both direct and indirect effects via MCIG on IGD. Modifications of the 3 types of MCIG can potentially reduce the harmful impacts of impulsivity and interpersonal influences on IGD and enhance the protective effect of self-control against IGD. Future longitudinal studies are warranted. %M 34704960 %R 10.2196/26810 %U https://www.jmir.org/2021/10/e26810 %U https://doi.org/10.2196/26810 %U http://www.ncbi.nlm.nih.gov/pubmed/34704960 %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 %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e24546 %T The Impact of Gamification-Induced Users' Feelings on the Continued Use of mHealth Apps: A Structural Equation Model With the Self-Determination Theory Approach %A Wang,Tong %A Fan,Lingye %A Zheng,Xu %A Wang,Wei %A Liang,Jun %A An,Kai %A Ju,Mei %A Lei,Jianbo %+ Institute of Medical Technology, Health Science Center, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, China, 86 82805901, jblei@hsc.pku.edu.cn %K mHealth app %K continued use %K continuance intention %K gamification %K self-determination theory (SDT) %K expectation confirmation model of information system continuance (ECM-ISC) %K PLS-SEM %D 2021 %7 12.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Continued use of mHealth apps can achieve better effects in health management. Gamification is an important factor in promoting users’ intention to continue using mHealth apps. Past research has rarely explored the factors underlying the continued use of mobile health (mHealth) apps and gamification’s impact mechanism or path on continued use. Objective: This study aimed to explore the factors influencing mHealth app users’ intention to continue using mHealth apps and the impact mechanism and path of users’ feelings induced by gamification on continued mHealth app use. Methods: First, based on the expectation confirmation model of information system continuance, we built a theoretical model for continued use of mHealth apps based on users’ feelings toward gamification. We used self-determination theory to analyze gamification’s impact on user perceptions and set the resulting feelings (competence, autonomy, and relatedness) as constructs in the model. Second, we used the survey method to validate the research model, and we used partial least squares to analyze the data. Results: A total of 2988 responses were collected from mHealth app users, and 307 responses were included in the structural equation model after passing the acceptance criteria. The intrinsic motivation for using mHealth apps is significantly affected by autonomy (β=.312; P<.001), competence (β=.346; P<.001), and relatedness (β=.165; P=.004) induced by gamification. The intrinsic motivation for using mHealth apps has a significant impact on satisfaction (β=.311, P<.001) and continuance intention (β=.142; P=.045); furthermore, satisfaction impacts continuance intention significantly (β=.415; P<.001). Confirmation has a significant impact on perceived usefulness (β=.859; P<.001) and satisfaction (β=.391; P<.001), and perceived usefulness has a significant impact on satisfaction (β=.269; P<.001) and continuance intention (β=.273; P=.001). The mediating effect analysis showed that in the impact path of the intrinsic motivation for using the mHealth apps on continuance intention, satisfaction plays a partial mediating role (β=.129; P<.001), with a variance accounted for of 0.466. Conclusions: This study explored the impact path of users’ feelings induced by gamification on the intention of continued mHealth app use. We confirmed that perceived usefulness, confirmation, and satisfaction in the classical continued use theory for nonmedical information systems positively affect continuance intention. We also found that the path and mechanism of users' feelings regarding autonomy, competence, and relatedness generated during interactions with different gamification elements promote the continued use of mHealth apps. %M 34387550 %R 10.2196/24546 %U https://www.jmir.org/2021/8/e24546 %U https://doi.org/10.2196/24546 %U http://www.ncbi.nlm.nih.gov/pubmed/34387550 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 3 %P e25793 %T Association of Extensive Video Gaming and Cognitive Function Changes in Brain-Imaging Studies of Pro Gamers and Individuals With Gaming Disorder: Systematic Literature Review %A Choi,Eunhye %A Shin,Suk-Ho %A Ryu,Jeh-Kwang %A Jung,Kyu-In %A Hyun,Yerin %A Kim,Jiyea %A Park,Min-Hyeon %+ Department of Psychiatry, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea, 82 2 2030 2720, neominnie00@daum.net %K brain imaging %K cognitive function %K gaming disorder %K pro gamers %K video games %K cognition %K brain %K games %K gaming %D 2021 %7 9.7.2021 %9 Review %J JMIR Serious Games %G English %X Background: The World Health Organization announced the inclusion of gaming disorder (GD) in the International Classification of Diseases, 11th Revision, despite some concerns. However, video gaming has been associated with the enhancement of cognitive function. Moreover, despite comparable extensive video gaming, pro gamers have not shown any of the negative symptoms that individuals with GD have reported. It is important to understand the association between extensive video gaming and alterations in brain regions more objectively. Objective: This study aimed to systematically explore the association between extensive video gaming and changes in cognitive function by focusing on pro gamers and individuals with GD. Methods: Studies about pro gamers and individuals with GD were searched for in the PubMed and Web of Science databases using relevant search terms, for example, “pro-gamers” and “(Internet) gaming disorder.” While studies for pro gamers were searched for without date restrictions, only studies published since 2013 about individuals with GD were included in search results. Article selection was conducted by following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: By following the PRISMA guidelines, 1903 records with unique titles were identified. Through the screening process of titles and abstracts, 86 full-text articles were accessed to determine their eligibility. A total of 18 studies were included in this systematic review. Among the included 18 studies, six studies included pro gamers as participants, one study included both pro gamers and individuals with GD, and 11 studies included individuals with GD. Pro gamers showed structural and functional alterations in brain regions (eg, the left cingulate cortex, the insula subregions, and the prefrontal regions). Cognitive function (eg, attention and sensorimotor function) and cognitive control improved in pro gamers. Individuals with GD showed structural and functional alterations in brain regions (eg, the striatum, the orbitofrontal cortex, and the amygdala) that were associated with impaired cognitive control and higher levels of craving video game playing. They also showed increased cortical thickness in the middle temporal cortex, which indicated the acquisition of better skills. Moreover, it was suggested that various factors (eg, gaming expertise, duration or severity of GD, and level of self-control) seemed to modulate the association of extensive video game playing with changes in cognitive function. Conclusions: Although a limited number of studies were identified that included pro gamers and/or individuals who reported showing symptoms of GD for more than 1 year, this review contributed to the objective understanding of the association between extensive video game playing and changes in cognitive function. Conducting studies with a longitudinal design or with various comparison groups in the future would be helpful in deepening the understanding of this association. %M 34255648 %R 10.2196/25793 %U https://games.jmir.org/2021/3/e25793 %U https://doi.org/10.2196/25793 %U http://www.ncbi.nlm.nih.gov/pubmed/34255648 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 3 %P e28674 %T The co.LAB Generic Framework for Collaborative Design of Serious Games: Development Study %A Jaccard,Dominique %A Suppan,Laurent %A Sanchez,Eric %A Huguenin,Audrey %A Laurent,Maxence %+ Media Engineering Institute, University of Applied Sciences Western Switzerland, Av. Sports 20, Yverdon, 1400, Switzerland, 41 244592638, dominique.jaccard@heig-vd.ch %K serious game %K educational game %K simulation game %K design %K design framework %K methodology %K collaborative design %K collaborative web platform %D 2021 %7 2.7.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Serious games are increasingly used at all levels of education. However, research shows that serious games do not always fulfill all the targeted pedagogical objectives. Designing efficient and engaging serious games is a difficult and multidisciplinary process that requires a collaborative approach. Many design frameworks have been described, most of which are dedicated to the development of specific types of serious games and take the collaborative dimension into account only to a limited extent. Objective: Our aim was to create a generic serious game design framework that could be adapted to all kinds of serious games and implemented in a collaborative web platform. Methods: We combined the results of a literature review with our experience in serious game design and development to determine the basic building blocks of a collaborative design framework. We then organized these building blocks into categories and determined the features that a generic design framework should include. Finally, based on the paradigm of complex systems and systemic modelling, we created the co.LAB generic design framework and specifications to allow its implementation in a collaborative web platform. Results: Based on a total of 10 existing design methodologies or frameworks, 23 building blocks were identified and represent the foundation of the co.LAB framework. These blocks were organized into 5 categories: “context and objectives,” “game design,” “mechanics,” “learning design,” and “assessment.” The arrangement by categories provides a structure that can be visualized in multiple and complementary ways. The classical view links game and learning design while other views offer project, systemic, and process visualizations. For the implementation of the co.LAB framework in a web platform, we propose to convert the building blocks into “cards.” Each card would constitute a collaborative working space for the design of the corresponding block. To make the framework adaptive, cards could be added, adapted, or removed according to the kind of serious game intended. Enhancing the visualization of relationships between cards should support a systemic implementation of the framework. Conclusions: By offering a structured view of the fundamental design elements required to create serious games, the co.LAB framework can facilitate the design and development of such games by virtue of a collaborative, adaptive, and systemic approach. The different visualizations of the building blocks should allow for a shared understanding and a consistent approach throughout the design and development process. The implementation of the co.LAB framework in a collaborative web platform should now be performed and its actual usability and effectiveness tested. %M 34255655 %R 10.2196/28674 %U https://games.jmir.org/2021/3/e28674 %U https://doi.org/10.2196/28674 %U http://www.ncbi.nlm.nih.gov/pubmed/34255655 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e25854 %T Standardizing the Development of Serious Games for Physical Rehabilitation: Conceptual Framework Proposal %A Beristain-Colorado,María Del Pilar %A Ambros-Antemate,Jorge Fernando %A Vargas-Treviño,Marciano %A Gutiérrez-Gutiérrez,Jaime %A Moreno-Rodriguez,Adriana %A Hernández-Cruz,Pedro Antonio %A Gallegos-Velasco,Itandehui Belem %A Torres-Rosas,Rafael %+ Doctorado en Biociencias, Facultad de Medicina y Cirugía, Universidad Autónoma “Benito Juárez” de Oaxaca, Ex Hacienda de Aguilera S/N, Calz. San Felipe del Agua., Oaxaca de Juárez, 68120, Mexico, 52 9511332346, pberistain.cat@uabjo.mx %K serious game %K physical rehabilitation %K framework %K software engineering %K gamification %D 2021 %7 24.6.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Serious games have been used as supportive therapy for traditional rehabilitation. However, most are designed without a systematic process to guide their development from the phases of requirement identification, planning, design, construction, and evaluation, which reflect the lack of adaptation of rehabilitation requirements and thus the patient’s needs. Objective: The aim of this study was to propose a conceptual framework with standardized elements for the development of information systems by using a flexible and an adaptable process centered on the patient’s needs and focused on the creation of serious games for physical rehabilitation. Methods: The conceptual framework is based on 3 fundamental concepts: (1) user-centered design, which is an iterative design process focused on users and their needs at each phase of the process, (2) generic structural activities of software engineering, which guides the independent development process regardless of the complexity or size of the problem, and (3) gamification elements, which allow the transformation of obstacles into positive and fun reinforcements, thereby encouraging patients in their rehabilitation process. Results: We propose a conceptual framework to guide the development of serious games through a systematic process by using an iterative and incremental process applying the phases of context identification, user requirements, planning, design, construction of the interaction devices and video game, and evaluation. Conclusions: This proposed framework will provide developers of serious games a systematic process with standardized elements for the development of flexible and adaptable software with a high level of patient commitment, which will effectively contribute to their rehabilitation process. %M 34185003 %R 10.2196/25854 %U https://games.jmir.org/2021/2/e25854/ %U https://doi.org/10.2196/25854 %U http://www.ncbi.nlm.nih.gov/pubmed/34185003 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e23130 %T A Prediction Model for Detecting Developmental Disabilities in Preschool-Age Children Through Digital Biomarker-Driven Deep Learning in Serious Games: Development Study %A Kim,Ho Heon %A An,Jae Il %A Park,Yu Rang %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2228 2493, yurangpark@yuhs.ac %K developmental delay %K diagnosis prediction %K deep learning %K serious games %K digital health %K digital phenotyping %K digital biomarkers %D 2021 %7 4.6.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Early detection of developmental disabilities in children is essential because early intervention can improve the prognosis of children. Meanwhile, a growing body of evidence has indicated a relationship between developmental disability and motor skill, and thus, motor skill is considered in the early diagnosis of developmental disability. However, there are challenges to assessing motor skill in the diagnosis of developmental disorder, such as a lack of specialists and time constraints, and thus it is commonly conducted through informal questions or surveys to parents. Objective: This study sought to evaluate the possibility of using drag-and-drop data as a digital biomarker and to develop a classification model based on drag-and-drop data with which to classify children with developmental disabilities. Methods: We collected drag-and-drop data from children with typical development and developmental disabilities from May 1, 2018, to May 1, 2020, via a mobile application (DoBrain). We used touch coordinates and extracted kinetic variables from these coordinates. A deep learning algorithm was developed to predict potential development disabilities in children. For interpretability of the model results, we identified which coordinates contributed to the classification results by applying gradient-weighted class activation mapping. Results: Of the 370 children in the study, 223 had typical development, and 147 had developmental disabilities. In all games, the number of changes in the acceleration sign based on the direction of progress both in the x- and y-axes showed significant differences between the 2 groups (P<.001; effect size >0.5). The deep learning convolutional neural network model showed that drag-and-drop data can help diagnose developmental disabilities, with an area under the receiving operating characteristics curve of 0.817. A gradient class activation map, which can interpret the results of a deep learning model, was visualized with the game results for specific children. Conclusions: Through the results of the deep learning model, we confirmed that drag-and-drop data can be a new digital biomarker for the diagnosis of developmental disabilities. %M 34085944 %R 10.2196/23130 %U https://games.jmir.org/2021/2/e23130 %U https://doi.org/10.2196/23130 %U http://www.ncbi.nlm.nih.gov/pubmed/34085944 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e24449 %T Mobile Game Design Guide to Improve Gaming Experience for the Middle-Aged and Older Adult Population: User-Centered Design Approach %A Lee,Seyeon %A Oh,Hyunyoung %A Shi,Chung-Kon %A Doh,Young Yim %+ Graduate School of Culture Technology, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea, 82 42 350 2994, yydoh@kaist.ac.kr %K mobile games %K older adults %K middle-aged adults %K design guideline %K gaming experience %D 2021 %7 20.5.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: The number of older adult gamers who play mobile games is growing worldwide. Earlier studies have reported that digital games provide cognitive, physical, and socioemotional benefits for older adults. However, current mobile games that understand older adults’ gameplay experience and reflect their needs are very scarce. Furthermore, studies that have analyzed older adults’ game experience in a holistic manner are rare. Objective: The purpose of this study was to suggest mobile game design guidelines for adults older than 50 years from a holistic gaming experience perspective. Adopting a human-centric approach, this study analyzes middle-aged and older adults’ gameplay experience and suggests practical design guides to increase accessibility and satisfaction. Methods: We organized a living laboratory project called the “Intergenerational Play Workshop.” In this workshop, 40 middle-aged and older adults (mean age 66.75 years, age range 50-85 years) played commercial mobile games of various genres with young adult partners for 1 month (8 sessions). Using a convergent parallel mixed-method design, we conducted a qualitative analysis of dialogue, game diaries, and behavioral observations during the workshop and a quantitative analysis of the satisfaction level of the game elements for the mobile games that they played. Results: This project was active from April 2019 to December 2021, and the data were collected at the workshops from July 1 to August 28, 2019. Based on the identified themes of positive and negative experiences from the qualitative data, we proposed 45 design guides under 3 categories: (1) cognitive and physical elements, (2) psychological and socioemotional elements, and (3) consumption contextual elements. Our empirical research could reaffirm the proposals from previous studies and provide new guidelines for improving the game design. In addition, we demonstrate how existing commercial games can be evaluated quantitatively by using the satisfaction level of each game’s elements and overall satisfaction level. Conclusions: The final guidelines were presented to game designers to easily find related information and enhance the overall understanding of the game experience of middle-aged and older adults. %M 34014175 %R 10.2196/24449 %U https://games.jmir.org/2021/2/e24449 %U https://doi.org/10.2196/24449 %U http://www.ncbi.nlm.nih.gov/pubmed/34014175 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e21900 %T A Gamification Framework for Cognitive Assessment and Cognitive Training: Qualitative Study %A Khaleghi,Ali %A Aghaei,Zahra %A Mahdavi,Mohammad Amin %+ Department of Computer Engineering, Imam Khomeini International University, Norouzian Boulevard, Qazvin, Iran, 98 9121003006, ali.khaleghi.ir@gmail.com %K cognitive tasks %K boredom %K motivation %K gamification %K game elements %K framework %K process %K gamification design %K cognitive training %K cognitive assessment %D 2021 %7 18.5.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Cognitive tasks designed to measure or train cognition are often repetitive and presented in a monotonous manner, features that lead to participant boredom and disengagement. In this situation, participants do not put forth their best effort to do these tasks well. As a result, neuropsychologists cannot draw accurate conclusions about the data collected, and intervention effects are reduced. It is assumed that greater engagement and motivation will manifest as improved data quality. Gamification, the use of game elements in nongame settings, has been heralded as a potential mechanism for increasing participant engagement in cognitive tasks. Some studies have reported a positive effect of gamification on participant performance, although most studies have shown mixed results. One reason for these contrasting findings is that most studies have applied poor and heterogeneous design techniques to gamify cognitive tasks. Therefore, an appropriate gamification design framework is needed in these tasks. Objective: This study aimed to propose a framework to guide the design of gamification in cognitive tasks. Methods: We employed a design science research (DSR) approach to provide a framework for gamifying cognitive assessments and training by synthesizing current gamification design frameworks and gamification works in cognitive assessment and training, as well as incorporating field experiences. The prototypes of the framework were iteratively evaluated with 17 relevant experts. Results: We proposed a framework consisting of 7 phases: (1) preparation; (2) knowing users; (3) exploring existing tools for assessing or training a targeted cognitive context and determining the suitability of game-up and mapping techniques; (4) ideation; (5) prototyping using the Objects, Mechanics, Dynamics, Emotions (OMDE) design guideline; (6) development; and (7) disseminating and monitoring. Conclusions: We found that (1) an intermediate design framework is needed to gamify cognitive tasks, which means that game elements should be selected by considering current cognitive assessment or training context characteristics since game elements may impose an irrelevant cognitive load that, in turn, can jeopardize data quality; (2) in addition to developing a new gamified cognitive task from scratch, 2 gamification techniques are widely used (first, adding game elements to an existing cognitive task and second, mapping an existing game to a cognitive function or impairment to assess or train it); and (3) further research is required to investigate the interplay of cognitive processes and game mechanics. %M 33819164 %R 10.2196/21900 %U https://games.jmir.org/2021/2/e21900 %U https://doi.org/10.2196/21900 %U http://www.ncbi.nlm.nih.gov/pubmed/33819164 %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 %@ 2368-7959 %I JMIR Publications %V 8 %N 3 %P e21115 %T The Moderating Role of Coping Mechanisms and Being an e-Sport Player Between Psychiatric Symptoms and Gaming Disorder: Online Survey %A Bányai,Fanni %A Zsila,Ágnes %A Kökönyei,Gyöngyi %A Griffiths,Mark D %A Demetrovics,Zsolt %A Király,Orsolya %+ Centre of Excellence in Responsible Gaming, University of Gibraltar, Europa Point Campus, Europa Point, Gibraltar, GX111AA, Gibraltar, 36 30 976 1097, zsolt.demetrovics@unigib.edu.gi %K gaming disorder %K esports %K professional gaming %K video games %K coping skills %K psychiatric symptoms %K psychiatry %K mental health %K gaming %D 2021 %7 23.3.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The emerging popularity of playing video games (gaming) as a hobby and as a professional sport raises awareness about both the benefits and possible downsides of the activity. Although a healthy and passionate hobby for most, a minority of gamers experience addiction-like symptoms and are considered to have gaming disorder (GD). GD has previously been found to be related to aversive conditions, such as depression or anxiety, as well as putatively maladaptive coping strategies. Objective: The aim of this study is twofold: to explore the moderating effect of different coping strategies and type of video game usage (professional [e-sport] or recreational) on the relationship between psychiatric symptoms and GD. Methods: A sample of 3476 gamers (n=3133, 90.13% males; mean age 23.20, SD 6.48 years) was recruited via the website and social networking site of the most popular gaming magazine in Hungary (GameStar). Results: The main effect of psychiatric symptoms was moderate to large in all models, whereas the moderation effects were significant (P<.001) for 4 out of 8 coping strategies (ie, self-blame/self-distraction, denial, emotional/social support, and active coping). However, the explained variance of the models only increased negligibly (from 0.3% to 0.5%) owing to the moderation effect. The direction of the moderations was as expected (ie, putatively maladaptive strategies were associated with more GD symptoms when the level of psychiatric symptoms was high, while putatively adaptive strategies were associated with less). Furthermore, no considerable moderation effect of the player type (recreational vs professional players) was found on the association between psychiatric symptoms and GD (β=.04; P=.02; 0.1% change in the explained variance). Conclusions: Future studies should be designed to better understand coping-related mechanisms in the context of video gaming and GD. %M 33755024 %R 10.2196/21115 %U https://mental.jmir.org/2021/3/e21115 %U https://doi.org/10.2196/21115 %U http://www.ncbi.nlm.nih.gov/pubmed/33755024 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e20537 %T Defining Digital Game-Based Learning for Science, Technology, Engineering, and Mathematics: A New Perspective on Design and Developmental Research %A Ishak,Shahrul Affendi %A Din,Rosseni %A Hasran,Umi Azmah %+ Science, Technology, Engineering, and Mathematics Enculturation Research Centre, Faculty of Education, Universiti Kebangsaan Malaysia, 43600 UKM, Bangi, 43600, Malaysia, 60 166656420, rosseni@ukm.edu.my %K digital game-based learning %K STEM digital game %K game development model %K game design %K design and developmental research %D 2021 %7 19.2.2021 %9 Viewpoint %J J Med Internet Res %G English %X In the modern age, digital games are widely used as informal media for Science, Technology, Engineering, and Mathematics (STEM) education and medical therapy for game-based learning. Digital games provide learners with a graphical system of interaction that enhances scientific concepts within an enjoyable environment. The vastly increasing number of digital games produced in the market affects the quality of STEM digital games while requiring multidisciplinary expertise. This paper proposes a framework for STEM digital game-based learning encompassing input-process-output stages. Several studies from the early 2000s onward were reviewed to discuss and present a new perspective on a framework for the design and development of digital games, particularly for STEM. This proposed framework consists of digital game development as input, experience as a process, and constructs as output. This simple and precise framework will generate a universal product for various types of learners. It can thus be used as a guideline for game designers, developers, and experts to develop STEM digital games and achieve better learning outcomes. %M 33605885 %R 10.2196/20537 %U http://www.jmir.org/2021/2/e20537/ %U https://doi.org/10.2196/20537 %U http://www.ncbi.nlm.nih.gov/pubmed/33605885 %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 %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e19280 %T Archetypes of Gamification: Analysis of mHealth Apps %A Schmidt-Kraepelin,Manuel %A Toussaint,Philipp A %A Thiebes,Scott %A Hamari,Juho %A Sunyaev,Ali %+ Department of Economics and Management, Karlsruhe Institute of Technology, Kaiserstraße 89, Karlsruhe, D-76133, Germany, 49 72160846037, sunyaev@kit.edu %K mHealth %K smartphones %K mobile phones %K gamification %K quantified-self %K exergames, persuasive technology %D 2020 %7 19.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nowadays, numerous health-related mobile apps implement gamification in an attempt to draw on the motivational potential of video games and thereby increase user engagement or foster certain health behaviors. However, research on effective gamification is still in its infancy and researchers increasingly recognize methodological shortcomings of existing studies. What we actually know about the phenomenon today stems from fragmented pieces of knowledge, and a variety of different perspectives. Existing research primarily draws on conceptual knowledge that is gained from research prototypes, and isolated from industry best practices. We still lack knowledge on how gamification has been successfully designed and implemented within the industry and whether certain gamification approaches have shown to be particularly suitable for certain health behaviors. Objective: We address this lack of knowledge concerning best practices in the design and implementation of gamification for health-related mobile apps by identifying archetypes of gamification approaches that have emerged in pertinent health-related mobile apps and analyzing to what extent those gamification approaches are influenced by the underlying desired health-related outcomes. Methods: A 3-step research approach is employed. As a first step, a database of 143 pertinent gamified health-related mobile apps from the Apple App Store and Google Play Store is set up. Second, the gamification approach of each app within the database is classified based on an established taxonomy for gamification in health-related apps. Finally, a 2-step cluster analysis is conducted in order to identify archetypes of the most dominant gamification approaches in pertinent gamified health-related mobile apps. Results: Eight archetypes of gamification emerged from the analysis of health-related mobile apps: (1) competition and collaboration, (2) pursuing self-set goals without rewards, (3) episodical compliance tracking, (4) inherent gamification for external goals, (5) internal rewards for self-set goals, (6) continuous assistance through positive reinforcement, (7) positive and negative reinforcement without rewards, and (8) progressive gamification for health professionals. The results indicate a close relationship between the identified archetypes and the actual health behavior that is being targeted. Conclusions: By unveiling salient best practices and discussing their relationship to targeted health behaviors, this study contributes to a more profound understanding of gamification in mobile health. The results can serve as a foundation for future research that advances the knowledge on how gamification may positively influence health behavior change and guide practitioners in the design and development of highly motivating and effective health-related mobile health apps. %M 33074155 %R 10.2196/19280 %U https://mhealth.jmir.org/2020/10/e19280 %U https://doi.org/10.2196/19280 %U http://www.ncbi.nlm.nih.gov/pubmed/33074155 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e14958 %T An Integrative Model for the Effectiveness of Biofeedback Interventions for Anxiety Regulation: Viewpoint %A Weerdmeester,Joanneke %A van Rooij,Marieke MJW %A Engels,Rutger CME %A Granic,Isabela %+ Behavioural Science Institute, Radboud University, Montessorilaan 3, Nijmegen, 6525 HR, Netherlands, 31 243612076, j.weerdmeester@psych.ru.nl %K biofeedback %K neurofeedback %K anxiety %K appraisal %K mechanisms %K mental health %K eHealth %K video games %K wearable technology %K review %K mobile phone %D 2020 %7 23.7.2020 %9 Viewpoint %J J Med Internet Res %G English %X Biofeedback has shown to be a promising tool for the treatment of anxiety; however, several theoretical as well as practical limitations have prevented widespread adaptation until now. With current technological advances and the increasing interest in the use of self-monitoring technology to improve mental health, we argue that this is an ideal time to launch a new wave of biofeedback training. In this viewpoint paper, we reflect on the current state of biofeedback training, including the more traditional techniques and mechanisms that have been thought to explain the effectiveness of biofeedback such as the integration of operant learning and meditation techniques, and the changes in interoceptive awareness and physiology. Subsequently, we propose an integrative model that includes a set of cognitive appraisals as potential determinants of adaptive trajectories within biofeedback training such as growth mindset, self-efficacy, locus of control, and threat-challenge appraisals. Finally, we present a set of detailed guidelines based on the integration of our model with the mechanics and mechanisms offered by emerging interactive technology to encourage a new phase of research and implementation using biofeedback. There is a great deal of promise for future biofeedback interventions that harness the power of wearables and video games, and that adopt a user-centered approach to help people regulate their anxiety in a way that feels engaging, personal, and meaningful. %M 32706654 %R 10.2196/14958 %U https://www.jmir.org/2020/7/e14958 %U https://doi.org/10.2196/14958 %U http://www.ncbi.nlm.nih.gov/pubmed/32706654 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 3 %P e14620 %T Diagnostic Markers of User Experience, Play, and Learning for Digital Serious Games: A Conceptual Framework Study %A Tan,Jun Wen %A Zary,Nabil %+ Games for Health Innovations Centre, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore,, Singapore, 65 96945179, junwen.tan2@gmail.com %K serious games %K diagnostic criteria %K medical education %D 2019 %7 16.07.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: Serious games for medical education have seen a resurgence in recent years, partly due to the growth of the video game industry and the ability of such games to support learning achievements. However, there is little consensus on what the serious and game components in a serious game are composed of. As a result, electronic learning (e-learning) and medical simulation modules are sometimes mislabeled as serious games. We hypothesize that one of the main reasons is the difficulty for a medical educator to systematically and accurately evaluate key aspects of serious games. Objective: This study aimed to identify markers that can evaluate serious games and distinguish between serious games, entertainment games, and e-learning. Methods: Jabareen’s eight-phase framework-building procedure was used to identify the core markers of a serious game. The procedure was modified slightly to elicit “diagnostic criteria” as opposed to its original purpose of a conceptual framework. Following the identification of purported markers, the newly developed markers were tested on a series of freely available health care serious games—Dr. Game Surgeon Trouble, Staying Alive, and Touch Surgery—and the results were compared to the published test validity for each game. Results: Diagnostic criteria for serious games were created, comprising the clusters of User Experience (UX), Play, and Learning. Each cluster was formed from six base markers, a minimum of four of which were required for a cluster to be considered present. These criteria were tested on the three games, and Dr. Game Surgeon Trouble and Staying Alive fit the criteria to be considered a serious game. Touch Surgery did not meet the criteria, but fit the definition of an e-learning module. Conclusions: The diagnostic criteria appear to accurately distinguish between serious games and mediums commonly misidentified as serious games, such as e-learning modules. However, the diagnostic criteria do not determine if a serious game will be efficacious; they only determine if it is a serious game. Future research should include a much larger sample of games designed specifically for health care purposes. %M 31313660 %R 10.2196/14620 %U http://games.jmir.org/2019/3/e14620/ %U https://doi.org/10.2196/14620 %U http://www.ncbi.nlm.nih.gov/pubmed/31313660 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 2 %P e13303 %T Affective Game Planning for Health Applications: Quantitative Extension of Gerontoludic Design Based on the Appraisal Theory of Stress and Coping %A Khalili-Mahani,Najmeh %A De Schutter,Bob %+ PERFORM Centre, Concordia University, PC 2 207, 7200 Sherbrooke O, Montreal, QC, H4B 1R6, Canada, 1 514 848 2424 ext 5370, najmeh.khalili-mahani@concordia.ca %K games %K user acceptance of health care %K psychology %K informatics %K aging %K adaptation %K rehabilitation %D 2019 %7 06.06.2019 %9 Viewpoint %J JMIR Serious Games %G English %X User retention is the first challenge in introducing any information and communication technologies (ICT) for health applications, particularly for seniors who are increasingly targeted as beneficiaries of such technologies. Interaction with digital technologies may be too stressful to older adults to guarantee their adoption in their routine selfcare. The second challenge, which also relates to adoption, is to supply empirical evidence that support the expectations of their beneficial outcomes. To address the first challenge, persuasive technologies such as serious games (SGs) are increasingly promoted as ludic approaches to deliver assistive care to older adults. However, there are no standards yet to assess the efficacy of different genres of games across populations, or compare and contrast variations in health outcomes arising from user interface design and user experience. For the past 3 decades, research has focused either on qualitative assessment of the appeal of digital games for seniors (by game designers) or on the quantitative evaluation of their clinical efficacy (by clinical researchers). The consensus is that interindividual differences play a key role in whether games can be useful or not for different individuals. Our challenge is to design SGs that retain their users long enough to sustain beneficial transfer effects. We propose to add a neuropsychological experimental framework (based on the appraisal theory of stress and coping) to a Gerontoludic design framework (that emphasizes designing positive and meaningful gaming experience over benefit-centric ones) in order to capture data to guide SG game development. Affective Game Planning for Health Applications (AGPHA) adds a model-driven mixed-methods experimental stage to a user-centered mechanics-dynamics-aesthetics game-design cycle. This intersectoral framework is inspired by latest trends in the fields of neuroimaging and neuroinformatics that grapple with similar challenges related to the psychobiological context of an individual's behaviors. AGPHA aims to bring users, designers, clinicians, and researchers together to generate a common data repository that consists of 4 components to define, design, evaluate, and document SGs. By unifying efforts under a standard approach, we will accelerate innovations in persuasive and efficacious ICTs for the aging population. %M 31172966 %R 10.2196/13303 %U http://games.jmir.org/2019/2/e13303/ %U https://doi.org/10.2196/13303 %U http://www.ncbi.nlm.nih.gov/pubmed/31172966 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 2 %P e13037 %T Interactive Narrative in a Mobile Health Behavioral Intervention (Tumaini): Theoretical Grounding and Structure of a Smartphone Game to Prevent HIV Among Young Africans %A Winskell,Kate %A Sabben,Gaëlle %A Obong'o,Christopher %+ Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 4047275286, swinske@emory.edu %K mHealth %K serious games %K games for health %K narrative %K HIV %K adolescence %K sub-Saharan Africa %K behavioral theory %K narrative theory %D 2019 %7 08.05.2019 %9 Viewpoint %J JMIR Serious Games %G English %X The increasing availability of smartphones, including in low-income countries, offers an unprecedented opportunity to reach individuals with innovative health promotion interventions. Electronic games delivered via smartphone offer promising avenues for sexual health promotion and HIV prevention, especially for young people. By giving players real agency in a virtual and safe environment, well-designed games can provide a level of experiential learning unparalleled by many other behavioral interventions. The design of effective games for health relies on multidisciplinary insight and expertise. However, relatively few studies discuss the theoretical understanding underlying their intervention. Making explicit the theoretical grounding of a game-based intervention allows articulation of assumptions and strategies, anticipation of outcomes, and evaluation of impacts (including intermediate effects), thereby increasing understanding of pathways to change, with a view to contributing to the development of more effective games. It also helps strengthen the credibility and improve the accountability of games for health. We present the multidisciplinary theoretical framework—integrating intervention design, mediators, and behavioral outcomes—and the structure of an HIV prevention game for young African adolescents that has shown promise in a randomized pilot study in Western Kenya. The central component of Tumaini (hope for the future in Kiswahili) is an interactive role-playing narrative in which the player makes choices for characters that determine how their paths unfold. In addition, a series of mini-games reinforce skills, and the “My Story” component links the game world to the player’s own life and goals, and a reward system motivates continued play. With its “choose-your-own-adventure” format, Tumaini is intended to be replayed so that players can experience the consequences resulting from different choices made in the role-playing narrative. Grounded in theories of narrative and applied communication and in social behavioral theories, especially Social Cognitive Theory, Tumaini is designed to help young adolescents acquire the information, skills, and motivation they need to avoid and reduce sexual risks. We close by situating Tumaini within discussion of the theory and practice of using interactive narrative in health promotion, with a view to furthering theoretical elaboration. %M 31066692 %R 10.2196/13037 %U http://games.jmir.org/2019/2/e13037/ %U https://doi.org/10.2196/13037 %U http://www.ncbi.nlm.nih.gov/pubmed/31066692